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Lab Help? Complex - Doctor Not Sure How to Interpret

Hello all,

Yes, another SSRI post (sigh)

  • Male
  • 5’10
  • 160 lbs (~10-15% BF)
  • History of use of many psychiatric drugs (SSRIs, tricyclic antidepressants, MAOIs). No hair loss drugs or acne drugs. No current drugs - psychiatric or recreational.
  • Appear in decent physical shape with the exception of some stubborn midsection weight gain
  • Eat very well (mostly meat, fruits, and vegetables).
  • Workout lightly (much less due to busy schedule and gym closure due to covid)

Symptoms: numbed emotions, dead libido, weak erections, lack of brain/dick response, etc.

I’d appreciate any insights that can be provided with regard to my lab work. I’ve been dealing with a variety of health issues for a few years as a result of psychiatric drug use (including sexual problems). Before ultimately deciding that T was probably the correct path for me, I tried to maximize my health through lifestyle choices (diet, exercise, sleep, reduced stress) to no avail.

My body has become extremely sensitive to outside chemicals ever since using so many psychiatric drugs, to the point where even nasal decongestants or tylenol may significantly worsen my baseline physical and emotional symptoms for months or even permanently (yes - it sounds silly, but sadly it’s true).

I had planned to start long-term TRT treatment to try to reverse all these sexual difficulties that derived from my psychiatric drug use. Per my reading here, I thought it would be a good idea to get one final extensive baseline bloodwork panel prior to starting, just so that I would have numbers (HCT, RBC, etc.) to compare to once on the hormone.

I’ve had a lot of bloodwork taken over the last couple years, and most of the time it has been relatively consistent (with the exceptions of times where my symptoms significantly worsen after trying a drug or supplement – symptoms which are sometimes reflected in my bloodwork by numbers such as very low free T (outside range).

Anyway, I thought I reached a point of stability where I thought treatment was a good idea to begin. These are my baseline bloods:

Oddities to observe:

  • TSH jumped very high for no reason. Previously, it was about 1.2 (I’ve read 1 is optimal). I’ve noticed I’ve been very fatigued lately and have had cool body temperatures, so it makes sense that my thyroid is not functioning optimally. However, what is odd is that fT3 and fT4 appear to be normal. T3 should bind to receptors and shut off TSH production, correct? I use iodized salt and get selenium through brazil nuts.

  • Alkaline Phosphatase is high. This is associated with some serious health problems,. which is somewhat concerning; however, it is only just outside the range and could be variation due to a number of factors (more testing to come for this one).

  • Total and free T - about average of what I’ve seen across the last two years
    SHBG - about average of what I’ve seen across the last two years

  • LH - in range but at the very top of the range (8.2). This number has typically been much lower (2-5) BUT with the same T and free T levels, leading me to think I may be beginning to have some testicular failure (primary hypogonadism) if my pituitary is working this hard. I recognize the pulsatile nature of LH, but this seems exceptionally high. Furthermore, my testicles do not appear healthy. They appeared to have shrunk further after having an adverse drug reaction.

  • Cortisol, ACTH, and pregnenolone - Appear at least slightly elevated most of the time (across many tests). DHEA is often elevated too. I take supplements to lower this, such as PS, magnesium, ashwagandha, vitamin C, and try to eat a diet higher in sodium.

As of right now, it appears I have slight adrenal issues, a thyroid that suddenly went AWOL, a very delicate (and possibly failing) endocrine system, and a scary alkaline phosphatase number.

I feel like complete garbage and I’m quite directionless. My doctor is unsure how to proceed. Is testosterone the correct path forward? Should the thyroid be corrected first? How should the adrenals be approached?

Any advice would be greatly appreciated. Thank you.

Yeah I would get the thyroid situation taken care of and then move on from there. You may just be hypothyroid and things will start to fall in line.

Hey, thanks for the reply.

That’s my thinking as well. I believe the adrenals are probably overcompensating for the lack of thyroid.

What doesn’t make sense is why my fT3 is actually higher on this test than a previous thyroid lab test several months ago, yet TSH went way up. The two should be inversely correlated, if I understand the system correctly.

Perhaps rT3 is way too high? This number has been on the higher end (17-19) with a range of [9-23] on previous tests. I have not received rT3 for this lab yet. Still pending…

I can’t think of too many other reasons I’d end up with such numbers. Also, why the sudden increase in TSH? That’s a huge jump in just several months

In any case, I’ve been experiencing extreme fatigue lately and need to get this resolved ASAP. It is extremely difficult to work.

I would not dx anything with thyroid based off of one lab. Esp since your free t3 is fine.

I would retake tsh and free t3 and free t4.

Lh being top of the range. I would retake that too.

I would def not start trt. Your total t is great and free t is mid range even with your higher shbg.

You need to keep investigating.

Also you an cortisol looks high . Did you take this within 1 hour of getting up?
Cortisol and pregnenolone both high may indicate adrenal issues??

Maybe see an endocrinologist as part of you investigation

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A properly functioning HPTA would see LH increase if SHBG were to become abnormally high, in this case I would have a look at the liver since it produces SHBG.

I have seen countless times people try to circumvent a medical problem by going on TRT, sometimes it works, but other times you find yourself right back where you started.

TRT will decrease the SHBG, but you need to find out what is going on before considering TRT.