T Nation

Implications of High DHEA-S? Also, rT3 Labs Came In

I just got some more labs done and the results are below. My regimen is 12mg Test E every day (84 mg/wk) and 250iu hcg EOD. I still feel horrible. No energy, insomnia, dampened mood (always bored), no sex drive, and problems with erectile quality.

Total Testosterone 420 ng/dL (240 - 950 ng/dL)
SHBG 10 nmol/L (15 - 80 nmol/L) LOW
Albumin 4.8 g/dL (3.5 - 5.0 g/dL)
Calculated Free Testosterone 204 pg/mL (90 - 300 pg/mL)
DHEA-S 542.5 ug/dL (211 - 492 ug/dL) HIGH
TSH 1.59 mcU/mL (0.30 - 4.00 mcU/mL)
fT4 1.30 ng/dL (0.9 - 1.7 ng/dL)
fT3 414 pg/dL (230 - 420 pg/dL)
rT3 296 pg/mL (160 - 353 pg/mL)

rT3 labs came in and I’m in the upper range of normal, which seems to be ok seeing as my fT3 is also in the upper range of normal, so they basically cancel each other out, right? Or does that suggest an adrenal function problem?

My main concerns at this moment are with my SHBG and my DHEA-S. I continue to have symptoms and the lab ranges point to these two values. Are they somehow related to one another? Is high DHEA-S a big problem and if so, what does it indicate? Can’t find much on the web. Is there any way to naturally lower DHEA-S?

@KSman and anyone else willing to contribute, any help on the matter would be greatly appreciated. I’m still pulling hair here.

Thank you

Highish rt3 BLOCKS ft3. Are you chronically stressed or dealing with any injuries? Thats what typically raises rt3. Elevated rt3 could be why you feel down; it makes it as if your ft3 were low. Wouldn’t worry about high dhea that much. Are you supplementing with it?

No e2 labs?

I am not supplementing with it, no. I’ve read that high DHEA-S is bad too though, and could lower SHBG. I’m not sure where I read that and how reliable it is, though.

Regarding rT3, I was at the upper third of the lab ranges and with ft3, I was at the tip top. I don’t really see it as much of an issue. No injuries or stress to speak of. I’m not as worried about the rT3 itself, more of the implications - adrenal problems, which can also be indicated by my DHEA-S level, if I’m not mistaken.

  • only if body temperatures are as suggested
    Lab ranges are what is found in the general population, which also includes some individuals who have higher rT3 levels and adverse effects from that. The people in the stats are not screened for perfect health and metabolism.

Have no idea how to lower DHEA-S

Why are you not testing FT directly and E2?

Low SHBG is lowering TT by lowering T+SHBG

Can you increase T dose to get FT higher and have more FT–>E2 to increase SHBG? - assuming E2 is low…

Is AM cortisol OK? - looking for some other adrenal related issues that may exist.

rT3 is indicative of stressed adrenals. What is your stress like? See thyroid basics sticky.
TSH is elevated, suggesting that rT3 is blocking what fT3 that the hypothalamus can see.

Report body temperatures!

Temperatures and overall body heat have been ok. Haven’t tested in a while, but after IR, I’ve felt ok temperature-wise. I can start reporting again though, if it would help.

Mid day body temp 97.9, but it’s somewhat cold in my house at the moment.

The lab does not offer direct FT testing for whatever dumb reason. I got E2 tested, but the results still haven’t come in.

What you’re saying about increasing FT to get E2 higher makes sense, but adding more T will only lower SHBG further, I assume.

I know Dr. Crissler has said something about low SHBG also somehow affecting the body’s sensitivity to E2.

Only had one AM cortisol test and it was as follows:
Cortisol Lvl 15.2 ug/dL (5.0-25.0 ug/dL)

Seems ok to me; should it be higher? What exactly does a high DHEA-S level mean? Is my DHEA-S trying to balance out a high cortisol level or something?

My stress isn’t so bad, really. I stress about my condition, which could be making it worse, but I live a pretty low stress life otherwise.

Does the rT3 value scare you that much? It’s only just above the halfway point.

That is well above mid-range=176.5!

There is no known control loop for DHEA, but something in the adrenals may be not right. Your cortisol is a good number. Down near 10 is worrisome.

See https://en.wikipedia.org/wiki/Steroid_hormone


The mid-point is actually 256.5, but I’m still above mid-range, yes.

I suppose that, coupled with my DHEA, is indicative of an adrenal problem. My fT3 being so high may be my thyroid’s way of balancing rT3 out - does that sound correct? And with an fT3 value that high, my SHBG should also be higher. Something isn’t right here.

So KSman, how do the adrenals play a part in the (over)conversion of T4 into rT3?

Not really understood by me. It is probably a reaction to starvation stress that lowers your metabolism. Probably an adverse thing, but if it helps you survive a famine, you get to pass on those genetics. Darwin is smiling. Over training does the same thing as well as other stresses. In some cases, clearly a genetic mal-adaption or design error.

When rT3 is elevated and fT3 is elevated, the feedback mechanism is trying to balance things out as you suggest.

I do not connect SHBG with thyroid hormones. But when low thyroid function leads to low LH/FSH and T, E2 is then lower and SHBG is less too. But that is all rater indirect.

So stress may be a factor for you an stress can take many forms.

When rT3 is there, if you increase T4, T4–>rT3 increases too. So treatment has some wrinkles. My rT3 was presumed a problem because T3+T4 meds had no effect on me. So got switched to time release T3 only and that works. Feeding T4 to a rT3 situation can be ineffective and make things worse. I know what my stressor was, was situational and non-medical.

Interesting. I’ve never been deprived of food though, via diet or any other means. I highly doubt I’ve ever overtrained, if I do work out, it’s usually very light as my body can’t handle hard work at the moment. Just lucky I guess.

I’m not sure if thyroid issues are to blame for my symptoms, my temperatures have actually been ok for the most part, hovering around the 97.6-97.8 area most mornings.

My initial blood tests indicated low testosterone (~200), but treatment with the hormone has yet to show any effect whatsoever. I’m getting a CT scan to determine if an adrenal nodule is to blame for my high DHEA-S level, hoping that they find something.

In the mean time, I’m thinking of just giving in and admitting that this may be depression coupled with low T. There doesn’t seem to be anything else I can do.

Estradiol came back at 40 pg/ml on a high sensitivity test. Too high. Thank god, that can very easily explain my symptoms. What do you think, @KSman? quarter tablet every couple days?