HRT to Treat Adrenal Burnout & Low T - Advice?

Pharma / TRT Testosterone Replacement
1

Hello y’all,

I am a 30 year old male, living in Belgium, who has had a long workout history (around 10 years), including the occasional anabolic cycle. What exactly caused it is not clear, but I have been dealing with burn out syndrom (adrenal fatigue) and lowish test/thyroid related problems for about a small year now.

I had passed several endocrinologists, none of which were up to any good (surprise!!).
As I have been at home, unable to work for 6 months already now, I wanted to take matters into my own hands and I decided to visit Dr. Hertoghe, an insanely expensive but wellknown hormone doctor in Brussels.

Currently my main symptoms are:

  • Severe fatigue, unable to work, unable to workout, hardly able to manage household.
  • Very little libido
  • Brain Fog/ Trouble concentrating
  • Ringing Ears
  • Memory problems
  • Poor selfesteem
  • Mild depression, no joy of life
  • No energy to work out

I would be glad if some of you experts :slight_smile: would like to comment on the treatment I have only just started.
I will post the major blood work (and urine testing), especially the exceeding values (Exclamation marks), from my first visit (two days ago) to Dr. Hertoghe:
BLOOD:

  • Insulin: 6 mg/dl (3 -22)
  • Glucose: 90 mg/dl (60 - 110)
  • IGF Binding Protein 3: 5,85 mg/L (2,96 - 4,96) !!
  • Somatomedine-C (IGF1): 262 ng/ml (190 - 490)
  • Creatinine: 0,85 mg/dl (0.70 - 1.30)
  • Vit. D: 34,7 ng/ml (30 - 60)
  • Cholesterol LDL: 134 mg/dl (0 - 114) !!!
  • Cholesterol HDL: 44 mg/dl (40 - 109) !
  • CRP: High sensitive (inflammation): 0,84 mg/L (0 - 0,55) !!
  • Ratio AA/EPA fats: 17,31 (5.0 - 10)
  • Free T3: 4,09 pg/ml (2.1 - 4.2)
  • Free T4: 1,67 ng/dl (0,7 - 1,8)
  • TSH: 0,49 (0,3 - 4,5)
  • Pregnenolone: 3.51 ng/ml (3,90 - 13,50) !!
  • Progesterone: 0,54 µg/L (0 - 1)
  • Transcortine: 57mg/L (20 - 50) !!
  • SHBG: 19 pmol/ml (20 - 55) !!! (Worried about this value and TRT)
  • Oestron 59 pg/ml (10 - 60) !
  • Oestradiol: 47 ng/L (<30) !!!
  • FSH: 4,9 IE/L (2 - 15)
  • Free Cortisol: 4,3 ng/ml (10-30) !!!
  • Cortisol 11,6 µg/dl (7 - 25)
  • DHEA-S: 199µg/dl (200 - 610) !!
  • Testosterone: 5071 pg/ml (3000 - 10000)
  • Free Testosterone: 225 pg/ml (50 - 280)
  • Percentage of bound Testosterone 95,6 (4,4 % free) !!!

URINE TESTING:

  • Creatinine 3,05g/24u (1,0 - 2,2) !!!
  • Jodium 50 µg/L (??)
  • Jodium per 24h: 140 µg/24h (170 - 280)
  • Natrium per 24h: 352,8 mmol/24h (100 - 220) !!!
  • Calcium per 24h: 11,48 mmol/24h (3,50 - 7) !!!
  • Magnesium per 24h: 5,88 mmol/24h (2,46 - 4,92) !!
  • Fosfor per 24h: 51,24 mmol/24h (12,9 - 25,8) !!!
  • T3: 0,37µg/L
  • T3 per 24h: 1590 pmol/24h (800 - 2500)
  • Cortisol 24h: 16,8 µg/24h (10 - 100) !!
  • T4: 0,52 µg/L
  • T4 per 24h: 1870 pmol/24h (550 - 3160)
  • Melatonine (6-sulfatoxy) per 24h: 10,30 µg/24h (15,60 - 58,1) !!!
  • Aldosterone per 24h 6,7 µg/24h (5.0 - 20)
  • Nickel: 2,7 µg/g creat (<2) !!
  • IgE 11,4 kE/L (20 - 100) !!!
  • Candida Albicans 116,3 mg/L (<80 = negative)
  • PSA 1,01 µg/L (0.1 - 1.8)

That’s about it! Dr. Hertoghe got me started (only just now) on the following therapy:

  • ERFA Thyroid (T4/T3): Increasing from 15mg/day to 90mg/day
  • Hydrocortisone 20mg : 1,5 pill/day
  • DHEA 35mg: 1 cap/day
  • Pregnenolone 50mg: 2 caps/day
  • Testogel 10% (100mg/g): 1,5g = 150mg/day (Alternatively 250mg Test E/10days)
  • A’Dex 1mg : 2 x 0,5 pill/week
  • Melatonine 0,2mg: 0,25 to 0,50 pill/day
  • Omnitrope Growth Hormone (pen with clics): 1 click/day for 10 days, 2 click/day for 10 days, then 3 clicks/day permanently
  • Vit. B Stress Complex
  • Folic Acid 10mg: 1 capsule/day
  • Vit. B12: 1 pill/day
  • Vit. D: 2 x 1 ampoule weekly
  • Borage Oil 1000mg: 5 caps/day
  • Omega 3: 1cap/day
  • Anti Oxidant (Selenium + Zink): 1 cap/day
  • Copper 2mg: 1 cap/day
  • Vitamine A: 2 teaspoons/day
  • Zinc Citrate 22,5mg: 2 caps/day
  • Glutamine 500mg: 4 caps/day
  • off course dietary measures

Well now, that’s about it, now some questions:

  • What’s your general opinion on the therapy he is giving me?
  • I have been (slowly) recovering from (very) low shbg (9!). It has now gotten to 19 in half a year. According to Dr. Hertoghe the Erfa T3 will significantly increase SHBG to maintain Testosterone positive effects, yet still I remain afraid that the low shbg values will diminish the TRT efficacy.
  • I have only started on Erfa and Melatonine yesterday and already experienced some sides:
  • Very nervous feeling, unable to relax
  • Restless Legs at night, unable to sleep
    What’s your opinion on this? Is my body adapting to the medicin or is this abnormal?
  • Dr. Hertoghe prescribed A’Dex, but I still have some Aroxifen around (Tamoxifen 20mg + Aromasin 20mg). Will this do the trick or should I really stick to the A’dex? If it does do the trick, at what dosage?

That’s it for now. I would be majorly greatful if anyone would be willing to spend a few minutes to look at my situation as I no longer trust one doctor’s opinion and like to selfhandle my health issues. I will later on share my experiences with other users also.

Thanks,
K.

2

Actually you want lower SHBG! T+SHBG is not bio-available.

Read the stickies! This is the best thing for now.
-advice for new guys
-thyroid basics
–too bad that we do not have prior temperature data
–provide current temperatures
–provide history of iodized salt use and iodine in vitamins

SERMs do not decrease estrogens, so you do not need those.

We often see [always see?] that those with thyroid problems cannot absorb transdermal T. So start preparing and rad the protocol for injections sticky.

Google Wilson’s book on “adrenal fatigue” -read it.

Note that TRT with un[der] treated thyroid or adrenal problems can not work well as the increased/restored metabolic rates with youthful T levels cannot be managed with the other weaknesses.

3

Thanks for your reply.
I know about thyroid basics already, have been reading a lot. :slight_smile:

Waking temperatures (under armpit):
Prior temperature data (when feeling well): Around 36,8 °C (98,2 °F)
Temperature before treatment: Around 35,6 °C (96,1 °F)
Current Temperature (two days on treatment 15mg ERFA (T4/T3)): 35,9°C (96,6 °F)
History of iodized salt and iodine vitamins: None
Current use of iodized salt : Started
Current use of iodin vitamins: None yet. Which ones are suggested?
I have injections also, but I was thinking because of the low shbg, better to use transdermal daily, as the low shbg will hypermetabolize injectable T and thus break it down too quickly.
I have started two days ago and have never felt this depressed, anxious… Don’t know what’s going on…

Thanks.

4

T bound to SHBG is not bio-available and the liver clears that up. As far as I am concerned, T+SHBG is a metabolite. Your logic seems flawed. Low SHBG can be a symptom of a problem and may not be so much of a problem in itself. SHBG can be indicating insulin resistance, elevated levels of insulin. Also some association with anabolic steroid use. Do some research. You will find that there are indications that low SHBG is associated with low iodine and thyroid issues. Iodine replenishment may resolve this.

SHBG does not transport T, it eliminates it. SHBG+T is tightly bound. SHBG will transport estrogens.

Please measure oral temperatures. If above 98.6 thyroid dose may be too high. There also may be some transient effects when introducing thyroid meds.

So we can assume that you were iodine deficient and that was part of your history. The question is: Are you treating simple iodine deficiency with meds when iodine should be replenished? As you replenish iodine you may need to reduce the meds, monitor oral temperature.

What is your total cholesterol?

You can find vitamins that will have 150mcg iodine. But you need large doses at this point.

Is your thyroid enlarged, asymmetric or lumpy?

Again, there is the expectation that you will not absorb transdermal T. How effective thyroid meds are at resolving that is unknown.

5

[quote]KSman wrote:
T bound to SHBG is not bio-available and the liver clears that up. As far as I am concerned, T+SHBG is a metabolite.
=> Newest research has found that the role of T bound to shbg is much more important than previously thought. Bound T delivers T to receptors in the tissues, whereas excessive bio-available T (mine is 4% !!) converts it mostly to DHT and estrogen, rendering it quite useless or even harmful!

Your logic seems flawed. Low SHBG can be a symptom of a problem and may not be so much of a problem in itself. SHBG can be indicating insulin resistance, elevated levels of insulin. Also some association with anabolic steroid use. Do some research. You will find that there are indications that low SHBG is associated with low iodine and thyroid issues. Iodine replenishment may resolve this.
=> I don’t think my logic is flawed. I have been tested for insulin intolerance (ITT) in a wellknown hospital. Except for my adrenal fatigue (low cortisol output) no insulin-glucose related issues came up. Indeed low thyroid activity can also cause SHBG excretion from the liver being impaired, which is probably my issue(although I have high blood thyroid hormone values). I guess in my case (although currently untested) a high reverse T3 is blocking the receptors and thus rendering the T3 unable to do it’s job. Although not spoken off by my doc, I might start replenishing the iodine insuffiency soon and regulating ERFA (thyroid med) downhill.

SHBG does not transport T, it eliminates it. SHBG+T is tightly bound.
=> Indeed, highest binding affinity with T. But isn’t it excessively unbound T that is excreted in stead of the bound T which may deliver it’s effects to tissue receptors?

SHBG will transport estrogens.
=> True, diminishing estrogen should lower shbg. But as I clearly have Estrogen Dominance, I ask myself the question where my shbg will drop if I go on a’dex for example…

Please measure oral temperatures. If above 98.6 thyroid dose may be too high. There also may be some transient effects when introducing thyroid meds.
=> Oral always slightly higher. May I ask what you mean by “transient” effects?

So we can assume that you were iodine deficient and that was part of your history. The question is: Are you treating simple iodine deficiency with meds when iodine should be replenished? As you replenish iodine you may need to reduce the meds, monitor oral temperature.
=> Will do so. Don’t know why the doc didn’t mention my low iodine…

What is your total cholesterol?
=> 191 mg/dl (Ref. 120 - 200)

You can find vitamins that will have 150mcg iodine. But you need large doses at this point.
=> What dosage would be recommended to replenish?

Is your thyroid enlarged, asymmetric or lumpy?
=> According to the clinical exam by Dr. Hertoghe slightly enlarged.

Again, there is the expectation that you will not absorb transdermal T. How effective thyroid meds are at resolving that is unknown.
=> I always have the choice to go for injections (Androtardyl - Test E. ) instead if no effect. I am only afraid that I would have to inject quite frequently due to low shbg causing hypermetabolisation, super fast clearance.

Thanks a lot. /[quote]

Thanks KSman.
I am quite well informed

6

“Bound T delivers T to receptors in the tissues” that is dead wrong and a common error from extrapolating the action of E+SHBT to testosterone. Yes, there is logic in the explanations, but the assumption is wrong. This notion is very wide spread and repeated.

Note:
TT=T+SHBG, T+albumin, FT
bio-AVAILABLE T = T+albumin, FT
bio-AVAILABLE T != T+SHBG ; T+SHBG is not bio-available

No more of this please!

Transient effects: When a change creates a stronger response that fades out to a steady state lower response.

Docs do not ask about iodine…

Cannot replenish with 150mcg, see the thyroid basics sticky.

Low iodine status increases TSH and longer elevated TSH enlarges the thyroid. So this is consistent.

With transdermal, one does not know how much is getting delivered. With injections, delivery is 100%. If you inject and FT levels are low, then you have a clearance problem. If TT is low from low SHBG, that makes sense and if FT is OK or Bio-T is OK, TRT should be effective. Bio-T might be the better lab work for you. If serum albumin is good, then albumin+T will be good and that is what does most of the heavy lifting. With low T, albumin can be lower, perhaps 3.7, but TRT will improve albumin as part of the anabolic response.

7

[quote]KSman wrote:
“Bound T delivers T to receptors in the tissues” that is dead wrong and a common error from extrapolating the action of E+SHBT to testosterone. Yes, there is logic in the explanations, but the assumption is wrong. This notion is very wide spread and repeated.
=> So actually the action of SHBG is being overestimated by many? Then why is it that so many with low shbg values do bad on TRT? Is there another explanation? High E2 in need of AI’s?

Note:
TT=T+SHBG, T+albumin, FT
bio-AVAILABLE T = T+albumin, FT
bio-AVAILABLE T != T+SHBG ; T+SHBG is not bio-available

No more of this please!

Transient effects: When a change creates a stronger response that fades out to a steady state lower response. => Agreed, but by being put on thyroid meds (erfa) with my already high FT3 and FT4 values, I expect nothing but hyper symptoms, correct?

Docs do not ask about iodine… => Actually he did in the first visit, but didn’t mention the low result in the second visit.

Cannot replenish with 150mcg, see the thyroid basics sticky. => Can not? I will read the sticky.

Low iodine status increases TSH and longer elevated TSH enlarges the thyroid. So this is consistent.
=> My thyroid is slightly enlarged, palpable at swallowing.

With transdermal, one does not know how much is getting delivered. With injections, delivery is 100%. If you inject and FT levels are low, then you have a clearance problem. If TT is low from low SHBG, that makes sense and if FT is OK or Bio-T is OK, TRT should be effective. Bio-T might be the better lab work for you. If serum albumin is good, then albumin+T will be good and that is what does most of the heavy lifting. With low T, albumin can be lower, perhaps 3.7, but TRT will improve albumin as part of the anabolic response.
=> My FT is high, actually too high (4,2%!), ideal would be 2% I believe. Yet I have no energy, no libido, bad mood, … . Will give the gels a shot anyhow combined with small dose A’dex.

=> I understand you fully refute James (Meso-RX forum) who claims that the SHBG is the core issue in badly working TRT?
=> So, having read and said all this, what would be your final advise?

Thanks a lot, appreciate it.
[/quote]

8

With low SHBG you may not be able to obtain high normal TT. But look at FT or bio-T lab results.

The most realistic concern with SHBG should be with what the cause is and dealing with that.

Many guys want lower SHBG to increase FT. As men age, SHBG increases making T issues worse. Body builders saturate SHBG with DHT type synthetic steroids which have a higher binding preference for SHBG, allowing more T to be FT.

I have to admit that I do not know what the problems might be with low SHBG other than indicating other pathologies as a symptom.

Do not worry about %FT, be concerned with absolute FT and you would want that to be high normal youthful level, not age adjusted. [When I turned 60, my hormone ranges changed.]

Note that SHBT+T cannot -->E2. FT will -->E2 and albumin+T most likely gives up T for aromatization. If your FT is the same as a guy who has normal SHBG and SHGB+T in TT, your T–>E2 rates might be the same.

SHBG is made in the liver, typically in response to estrogen levels as we are a deviation of the female blueprint and have the same basic mechanisms. So the key is the liver and I expect that the pathologies that lead to low SHBG are from the effects of the pathology on the liver. Your E2 is high and stresses the consideration that a pathology is at work. We often see cases here where there are multiple health issues, not a simple age related decline in T. I was lucky, my TRT was very uncomplicated and text book. After my near death hospital accident in 2010, that is no longer the case.

9

I don’t see your cortisol in the lab test but your IGF-1 is high and high IGF is indicative to adrenal fatigue. My IGF is high too and I thought I had some hard disease like cancer but then searching on forums I found that adrenal fatigue lead to high IGF and high GH or HGH.

I wish I could see your thyroid numbers and your testosterone numbers when you didn’t start your HRT. Some people don’t need TRT or thyroid medications just treating the adrenal fatigue can help both numbers

10

BG & OP

  • IGF Binding Protein 3: 5,85 mg/L (2,96 - 4,96) !!
  • Somatomedine-C (IGF1): 262 ng/ml (190 - 490)

IGF-1 is very mid range. NOT HIGH
IGF-BP is high.

Both of these are indicative of overall GH levels and have longer half lives. Direct GH measurement is not very useful.

Normal IGF-1 and high IGF-BP is creating an ambiguous situation. Note that both are made in the liver in response to GH. So we would like to see if liver markers are normal.

Cortisol levels are lowish. Look again. If blood pressure is a bit high, test homocysteine which is specific to inflammatory processes in the arteries [endothelial dysfunction].

I strongly disagree with rhGH medication!

HIGH CRP suggests inflammation or infection. This can contribute to adrenal fatigue.

  • Transcortine: 57mg/L (20 - 50) !!
  • Free Cortisol: 4,3 ng/ml (10-30) !!!
  • Cortisol 11,6 µg/dl (7 - 25) TIME OF DAY is needed
  • Cortisol 24h: 16,8 µg/24h (10 - 100) !!

I do not understand how the following leads to thyroid medication:

  • Free T3: 4,09 pg/ml (2.1 - 4.2) HIGH normal
  • Free T4: 1,67 ng/dl (0,7 - 1,8) mid high normal
  • TSH: 0,49 (0,3 - 4,5) LOW

If treating adrenal fatigue and [not measured] rT3, then one would use T3 and not any T4 medication as more T4 will lead to more T4–>rT3 in that situation.

It would have been good to have temperature measurements as per thyroid basics sticky to see if despite the higher fT3, fT4 levels there was a sign of functional hypothyroidism.

For adrenal fatigue, the issues are difficult and involve life style changes. All I can do is recommend that one get this book and read it: http://www.amazon.com/Adrenal-Fatigue-Century-Stress-Syndrome/dp/1890572152

Urine tests suggest significant dehydration, making interpretation difficult for me and the labels are hard to understand.

Note that all of these also speak to adrenal insufficiency

  • Pregnenolone: 3.51 ng/ml (3,90 - 13,50) !!
  • Progesterone: 0,54 µg/L (0 - 1)
  • Transcortine: 57mg/L (20 - 50) !!
  • Free Cortisol: 4,3 ng/ml (10-30) !!!
  • Cortisol 11,6 µg/dl (7 - 25)
  • DHEA-S: 199µg/dl (200 - 610) !!

Pregnenolone is not made in the adrenals, but throughout the body in the mitochondria. However, a significant amount is made in the testes and when T is low, pregnenolone is low. When on TRT and not using hCG, pregnenolone levels are lower again.

TRT without hCG will decrease pregnenolone and make things worse! So I disagree with that as well.

To support cortisol production, one can apply small amounts of progesterone or pregnenolone oral or cream.

11

[quote]KSman wrote:
With low SHBG you may not be able to obtain high normal TT. But look at FT or bio-T lab results.

The most realistic concern with SHBG should be with what the cause is and dealing with that.

Many guys want lower SHBG to increase FT. As men age, SHBG increases making T issues worse. Body builders saturate SHBG with DHT type synthetic steroids which have a higher binding preference for SHBG, allowing more T to be FT.

I have to admit that I do not know what the problems might be with low SHBG other than indicating other pathologies as a symptom.

Do not worry about %FT, be concerned with absolute FT and you would want that to be high normal youthful level, not age adjusted. [When I turned 60, my hormone ranges changed.]

Note that SHBT+T cannot -->E2. FT will -->E2 and albumin+T most likely gives up T for aromatization. If your FT is the same as a guy who has normal SHBG and SHGB+T in TT, your T–>E2 rates might be the same.

SHBG is made in the liver, typically in response to estrogen levels as we are a deviation of the female blueprint and have the same basic mechanisms. So the key is the liver and I expect that the pathologies that lead to low SHBG are from the effects of the pathology on the liver. Your E2 is high and stresses the consideration that a pathology is at work. We often see cases here where there are multiple health issues, not a simple age related decline in T. I was lucky, my TRT was very uncomplicated and text book. After my near death hospital accident in 2010, that is no longer the case.[/quote]

=> The pathology possibly being (severe) adrenal fatigue with my cortisol labs showing low? Or any other clues?

12

[quote]KSman wrote:
BG & OP

  • IGF Binding Protein 3: 5,85 mg/L (2,96 - 4,96) !!
  • Somatomedine-C (IGF1): 262 ng/ml (190 - 490)
    IGF-1 is very mid range. NOT HIGH
    IGF-BP is high.
    Both of these are indicative of overall GH levels and have longer half lives. Direct GH measurement is not very useful.
    => Exactly! I was having my doubts about what BG was saying aswell…
    I have been given Somatropine HGH (pharmaceutical brand) to optimize HGH. According to the hormone doc this is the med that should be relieving most of my fatigue related symptoms in pretty short term.

Normal IGF-1 and high IGF-BP is creating an ambiguous situation. Note that both are made in the liver in response to GH. So we would like to see if liver markers are normal.
=> Which liver markers are needed? I have Gamma GT value, that is the only liver value under “liver tests”. Gamma GT: 19 U/L (Ref. 8 - 61), will this do?
My lipid profile however shows way too little Omega fats and way too many bad fasts. I am currently correcting this through paleo diet (only fresh foods, much red flesh, unbaked, all steamed to temperature)

Cortisol levels are lowish. Look again. If blood pressure is a bit high, test homocysteine which is specific to inflammatory processes in the arteries [endothelial dysfunction].
I strongly disagree with rhGH medication!
=> rHGH? Why would anyone want that, except for acromegaly maybe…
=> Homocysteine value is normal: Homocysteine: 6,2µmol/L (Ref. <8 = optimal)

HIGH CRP suggests inflammation or infection. This can contribute to adrenal fatigue.

  • Transcortine: 57mg/L (20 - 50) !!
  • Free Cortisol: 4,3 ng/ml (10-30) !!!
  • Cortisol 11,6 Ã?µg/dl (7 - 25) TIME OF DAY is needed
  • Cortisol 24h: 16,8 Ã?µg/24h (10 - 100) !!
    => My CRP was only slightly elevated. Possibly caused by the slight candida or mere a cold?

I do not understand how the following leads to thyroid medication:

  • Free T3: 4,09 pg/ml (2.1 - 4.2) HIGH normal
  • Free T4: 1,67 ng/dl (0,7 - 1,8) mid high normal
  • TSH: 0,49 (0,3 - 4,5) LOW
    => Indeed, this was my big question mark too. I do have VERY low body temperature around 96,50 upon waking, but it did rise on the thyroid meds (Erfa) pretty fast, thus indicating a sluggish thyroid. But then again I was feeling like hell on Erfa T4/T3 (depressed, anxious, fast heart rate, high BP), I quit the meds today and feel (a little) better already, but body temp went back down. Possibly Iodine deficiency causing this?

If treating adrenal fatigue and [not measured] rT3, then one would use T3 and not any T4 medication as more T4 will lead to more T4–>rT3 in that situation.
=> Yes, I know, which is why I was having doubts about Erfa T4/T3 aswell. Cytomel T3 would be a better choice in this case I believe.

It would have been good to have temperature measurements as per thyroid basics sticky to see if despite the higher fT3, fT4 levels there was a sign of functional hypothyroidism.
=> Above.

For adrenal fatigue, the issues are difficult and involve life style changes. All I can do is recommend that one get this book and read it: http://www.amazon.com/Adrenal-Fatigue-Century-Stress-Syndrome/dp/1890572152
=> I am currently reading Wilson’s book and trying to assemble an appropriate therapy on my own, regardless of doctors opinions.

Urine tests suggest significant dehydration, making interpretation difficult for me and the labels are hard to understand.
=> I did use to drink way too little. Sometimes all I drank was two cups of coffee a day and alcohol in the evening … Nasty habits. My body didn’t seem to be signaling thirst adequately. I am now drinking 2L of purified water a day (at least).

Note that all of these also speak to adrenal insufficiency

  • Pregnenolone: 3.51 ng/ml (3,90 - 13,50) !!
  • Progesterone: 0,54 Ã?µg/L (0 - 1)
  • Transcortine: 57mg/L (20 - 50) !!
  • Free Cortisol: 4,3 ng/ml (10-30) !!!
  • Cortisol 11,6 Ã?µg/dl (7 - 25)
  • DHEA-S: 199Ã?µg/dl (200 - 610) !!
    => Indeed, I am currently starting to supplement DHEA (35mg/day), Cortisol (Hydro) 30mg/day spread, Pregnenolone 50mg/day. Now 6th day of supplementing.

Pregnenolone is not made in the adrenals, but throughout the body in the mitochondria. However, a significant amount is made in the testes and when T is low, pregnenolone is low. When on TRT and not using hCG, pregnenolone levels are lower again.
TRT without hCG will decrease pregnenolone and make things worse! So I disagree with that as well.
=> Should I even consider TRT at all at this point? Should I not try to correct the underlying problems first and start TRT only after (if necessary)?

To support cortisol production, one can apply small amounts of progesterone or pregnenolone oral or cream.[/quote]
=> Doing that.

KSMan, first of all, I want to thank you for all the valuable information you provide me with. Your knowledge seems to go much further than the knowledge of the average endocrinologist. :slight_smile:
I will put my answers inside your message to make things easier to read. I wanted to put my full blood/urine exam in annex, but it’s in dutch and might be hard for you to understand.

Regards.

13

I am not sure what is going on with your thyroid.

This does not make sense:

  • Free T3: 4,09 pg/ml (2.1 - 4.2)
  • Free T4: 1,67 ng/dl (0,7 - 1,8)
  • TSH: 0,49 (0,3 - 4,5)

And why prescribe thyroid meds for this? Ask your doc what he is thinking.
Are the above figures correct?
Is your thyroid enlarged, asymmetric or lumpy? Many from long term iodine deficiency?

I think that you should be addressing your lack of iodine intake.

So that is an other issue. And if you have adrenal fatigue, you should be testing for rT3. If rT3 needs to come down, meds should be T3 only, enough to suppress TSH and T4 to reduce T4–>rT3.
Knowing body temperatures before thyroid meds would have been very useful.

Healthy fats: need essential fatty acids - fish oil caps, nuts, flax seed meal

See if you can find that book.

Lower homocysteine is better.
rhGH is HGH

When you restore youthful levels of TRT or GH, you are increasing/restoring your metabolic rate. If thyroid function is weak and/or adrenals are weak, you end up doing poorly or crashing because the other system(s) cannot keep up with the restored metabolic demands.

I don’t think that you should be looking at long term GH! Try to get your body working right on the other issues. Your IGF-1 was reasonable and should get better when you get the other issues under control.

CRP can be up from many different things.

Typical basic liver markers are AST/ALT.

If TRT makes you feel better, great. I think that the cortisol should allow things to go proceed. The only question mark is rT3.

Sorry if the above is a bit scattered, I was looking for your comments above and responding as found.

14

[quote]KSman wrote:
I am not sure what is going on with your thyroid.

This does not make sense:

  • Free T3: 4,09 pg/ml (2.1 - 4.2)
  • Free T4: 1,67 ng/dl (0,7 - 1,8)
  • TSH: 0,49 (0,3 - 4,5)

And why prescribe thyroid meds for this? Ask your doc what he is thinking.
Are the above figures correct?
Is your thyroid enlarged, asymmetric or lumpy? Many from long term iodine deficiency?

I think that you should be addressing your lack of iodine intake.

So that is an other issue. And if you have adrenal fatigue, you should be testing for rT3. If rT3 needs to come down, meds should be T3 only, enough to suppress TSH and T4 to reduce T4–>rT3.
Knowing body temperatures before thyroid meds would have been very useful.

Healthy fats: need essential fatty acids - fish oil caps, nuts, flax seed meal

See if you can find that book.

Lower homocysteine is better.
rhGH is HGH

When you restore youthful levels of TRT or GH, you are increasing/restoring your metabolic rate. If thyroid function is weak and/or adrenals are weak, you end up doing poorly or crashing because the other system(s) cannot keep up with the restored metabolic demands.

I don’t think that you should be looking at long term GH! Try to get your body working right on the other issues. Your IGF-1 was reasonable and should get better when you get the other issues under control.

CRP can be up from many different things.

Typical basic liver markers are AST/ALT.

If TRT makes you feel better, great. I think that the cortisol should allow things to go proceed. The only question mark is rT3.

Sorry if the above is a bit scattered, I was looking for your comments above and responding as found.[/quote]

Yes, the thyroid figures are correct.
Doc put me on thyroid meds probably to treat my low body temp.
Body temp at waking (before starting meds!) = 96,40 F
Thyroid is slightly enlarged, palpable at swallowing.
Can you recommend an Iodin brand that can be bought online?
Will be testing for RT3 soon.
I am on Fish Oil caps 6/day (Omega 3)
I am already reading the book.
My liver tests (4 months ago):
ALT (GPT): 55 U/L (Ref. <45) !!
AST (GOT): 24 U/L (Ref. <35)
Other liver values were all medium range.

15

Finally some body temperatures.

What we know, free thyroid hormones are well above mid range and temperatures were low. The hormones say that you do not have hyperthyroidism and that is correct. However, low body temperature indicates a functional state of hyperthyroidism. The only thing that in my understanding is rT3. So the thyroid med is then wrong, should be T3 only.

But why would TSH be that low? I am thinking of a possibility where perhaps there is some degree of hypothyroidism from thyroid secreting thyroid nodules that are independent of TSH control. That keeps hormones up, rT3 keeps temperatures down and the rT3 also coaxes the hypothalamus to still order some TSH as rT3 is clouding its ability to see the fT3 and fT4 in the blood.

Need:

  • fT3 treatment
  • thyroid ultrasound and if lumps are found, a needle biopsy
    There is a radioactive iodine tagging diagnostic that can be called for and it needs the thyroid to take up the iodine isotope from the blood stream. If you take iodine supplements, then iodine uptake will be muted and the procedure can be ineffective. So you might want to hold off on the iodine for now.

Liver is getting a bit interesting. Suggest that you continue to monitor.

So you need to get the ball rolling in the right direction.

When its time for iodine replenishment, google iodoral.

Enlarged thyroid:

If one is iodine deficient for a long time, elevated TSH enlarges the thyroid gland. Nodules can form and some can be thyroid hormone productive not not needing TSH for permission any more [out of control]. As these create hormones in greater amounts, TSH levels drop and can go to zero. From there on one has hypothyroidism. Have seen this close up and attended the needle biopsy. So that does not make be much of an expert, but that is how I see it. Some nodules can become cancerous, hence the need to do the needle biopsy to know. It is seeing all of this happen to someone I know closely that made me into an iodine nut case :slight_smile: In your case, I think that this is what is going on and rT3 is causing TSH to be higher than it would otherwise be.

I am not trying to be alarmist. Now you can get this explored. This is the first time I have seen this situation.

16

[quote]KSman wrote:
Finally some body temperatures.

What we know, free thyroid hormones are well above mid range and temperatures were low. The hormones say that you do not have hyperthyroidism and that is correct. However, low body temperature indicates a functional state of hyperthyroidism. The only thing that in my understanding is rT3. So the thyroid med is then wrong, should be T3 only.

But why would TSH be that low? I am thinking of a possibility where perhaps there is some degree of hypothyroidism from thyroid secreting thyroid nodules that are independent of TSH control. That keeps hormones up, rT3 keeps temperatures down and the rT3 also coaxes the hypothalamus to still order some TSH as rT3 is clouding its ability to see the fT3 and fT4 in the blood.

Need:

  • fT3 treatment
  • thyroid ultrasound and if lumps are found, a needle biopsy
    There is a radioactive iodine tagging diagnostic that can be called for and it needs the thyroid to take up the iodine isotope from the blood stream. If you take iodine supplements, then iodine uptake will be muted and the procedure can be ineffective. So you might want to hold off on the iodine for now.

Liver is getting a bit interesting. Suggest that you continue to monitor.

So you need to get the ball rolling in the right direction.

When its time for iodine replenishment, google iodoral.

Enlarged thyroid:

If one is iodine deficient for a long time, elevated TSH enlarges the thyroid gland. Nodules can form and some can be thyroid hormone productive not not needing TSH for permission any more [out of control]. As these create hormones in greater amounts, TSH levels drop and can go to zero. From there on one has hypothyroidism. Have seen this close up and attended the needle biopsy. So that does not make be much of an expert, but that is how I see it. Some nodules can become cancerous, hence the need to do the needle biopsy to know. It is seeing all of this happen to someone I know closely that made me into an iodine nut case :slight_smile: In your case, I think that this is what is going on and rT3 is causing TSH to be higher than it would otherwise be.

I am not trying to be alarmist. Now you can get this explored. This is the first time I have seen this situation. [/quote]

Thanks KsMan, I will be going to visit a team of doctors (internal diseases, physiology, psychology combined). I will be sure to mention.
What I did mention is when I take my temperature in my ass, it is always much higher, actually quite perfect, 37°C. Also at my GP’s office, he uses a fast thermometer (to the forehead) to scan temperature, which is also normal (36,7° C). Maybe the (slow) digital thermometers are unreliable?

17

Need oral temp. When at doc’s office you are talking and that cannot be useful.

Oral should be OK after a while not talking, eating, working etc.

18

[quote]KSman wrote:
Need oral temp. When at doc’s office you are talking and that cannot be useful.

Oral should be OK after a while not talking, eating, working etc.[/quote]

Okay. I ordered a new thermometer (infrared forehead scanning), they seem pretty accurate.

So mate, a few more questions:
I intend to follow Dr. Wilson’s protocol to restore my adrenal glands to proper function including his supplement quartet, I hear nothing but good reviews about these supplements, but I am in doubt about treating candida / iodine shortage simultaneously while on the protocol. I might have (had doubtful blood result IgG) some candida overgrowth.

Will I even be needing antifungals if I would use iodine to kill of the yeast? Will this require specific anti candida diet or will it suffice to follow Dr. Wilson’s paleo style diet, running along the iodine? I have also heard of restoring the glands FIRST, and starting iodine treatment only after.

Thanks.

19

I do not know if iodine will reduce candida. But there is a lot of traffic on the subject. candidia iodine - Google Search

And a high quality probiotic may be useful. The yeast infection looks like it could be one of the inflammatory illnesses that Wilson indicates as a cause or contributor to adrenal fatigue. And having this problem in your gut will have similar aspects to a continuous food allergy or sensitivity.

The question might be would iodine deficiency contribute to this problem or make ones immune system less able to avoid this?

Other trace elements such as zinc might be useful.

20

KSMan, you are very… very mistaken.

You misunderstand the phrase “tightly bound.” Studies show that SHBG retains its binding with testosterone for less than one hour.

The idea that SHBG “stealz ur tee” is so utterly moronic that I can’t be bothered to argue. SHBG prolongs the action of testosterone in the body and protects testosterone from early excretion or metabolization.

If you were correct, that the binding of testosterone to SHBG was irreversible, then you are asserting that the male body eradicates 98% of the testosterone that it creates, leaving only 2% to perform its function. This assertion reaches a mystifyingly and headache-inducing level of stupid that I just… I don’t know what to say.

[For the sake of accuracy, only ~60% of T is strongly bound, while ~%2 remains free and the remainder is weakly bound, which (according to studies) preserves it for an average of 18 minutes.]

freemanbe,

The reality is that SHBG’s primary role is to transport testosterone. You will see this assertion within the first paragraph that you read about SHBG within any modern book on male endocrinology. It mediates the free to bound ratio of multiple hormones, has its own signaling pathways through SHBG-R, is sometimes absolutely required to signal the androgen receptors in certain tissues (yes, SHBG-T completes a signaling pathway) and most importantly – SHBG is the primary buffer (just like a testosterone ester) that prolongs the action of testosterone in the body, temporarily protecting it from metabolization and excretion, which is necessary due to the pulsatile nature of testosterone release.

SHBG does not steal, remove, eat, destroy, metabolize, or block testosterone. It protects it. It releases T back to the free form over time and/or through diffusion within certain target tissues. End of discussion.

Greetings from the other other board you mentioned. :wink: