Lab Results - Need Interpretation

If cortisol is getting near 10 I consider that a problem. Adrenal fatigue has different phases and low cortisol is sort of an end game. Quite a complex thing overall and can’t do simple generalizations. That is why I direct folks to read Wilson’s book.

We have one guy here who had an unpleasant outcome with IR. He got quite vocal about anyone doing IR. I can’t see a heart risk that could be any different from someone restoring normal thyroid function with Rx thyroid meds. And I can’t see that been an issue unless one was very fragile already.

My criteria for adrenal fatigue is rT3 centric. If fT3 is adequate and body temperatures are low, I suspect that rT3 is the problem. Then one can test rT3 or assume that is the problem. There are places that guys here are from where that labwork is not available. There are other things that can reduce mitochondrial metabolic rates, such as low CoQ10, often induced by statin drugs.

So I started the IR protocol yesterday. Fortunately for me, I’m not feeling any of the detox symptoms (yet). I’m now on day 2 of 50mg iodoral supplements and have taken 100mg total.

My basal body temperature is still low, at around 96.5 degrees. Do you know of a typical timeline for detox symptoms? Like when I’ll start to feel poorly from the bromine leaving the body?

If there is any bromine problem at all… Do not know timeline, but the chemistry should be rapid.

Fair enough. Pretty doubtful that I had any sort of problem with bromine toxicity, as I’m not experiencing any of the detox symptoms. Unfortunately, I don’t think that iodine is helping my condition, as my temperatures have remained low.

This is actually interesting because as you’ve mentioned, low T is the symptom at my age, not the cause. Maybe the underlying condition lies in thyroid function. I wonder if any doctor will prescribe me anything with TSH at 1.49 though.

Unrelated question, @KSman, you recommend hcg dosed at 250iu EOD, but I’ve been doing it at 125 ED to keep E2 levels at a more stable level. Is there any difference there, really?

@KSman I haven’t felt any better, haven’t felt any worse, so I’m going to stop with the iodine supplementation. I can say one thing though, I still feel terrible. No energy, zero libido, etc. Probably going to have to go the Rx route with thyroid meds. I’ve heard good things about NDT products (as opposed to synthetic), what do you think I should tell my doctor?

That is, if I’m not completely screwed, seeing as I’m still “in range.”

If you eliminate iodine deficiency as a cause, you should test fT3, fT4 to see what the problem is. At this point, your TSH numbers will be inflated by the iodine.

Hey @KSman, something interesting to note: when taking my temperature this morning (96.7), I decided to retest immediately afterward just for the sake of accuracy. I got about 97.5. Tested again and got nearly the same values. Is there any reason why this discrepancy would exist?

I used a digital thermometer, one that takes about 30 seconds to give a reading, if that makes a difference.

And one more thing (unrelated), what is the purpose of progesterone in men? From what I understand, it can play a part in mitigating estrogen dominance.

Sometimes the thermometer is funny. I would take the two dominating values from 3 different tests and assume that’s your temp. See what happens tomorrow.

The thermometer could be cold as well, thus cooling your mouth and reducing the temp reading. Drinking water and eating food also affects readings.

Fever thermometers are often trashy and are not very good for the fine differences we are concerned with.

See this: steroid hormone wiki - Google Search

and https://upload.wikimedia.org/wikipedia/commons/thumb/1/13/Steroidogenesis.svg/1024px-Steroidogenesis.svg.png

Note progesterone → cortisol

In women, E2 levels are high and progesterone balances E2. When progesterone levels are low and there is estrogen dominance, women get PMS, ovarian cysts, fibroids, tender breasts and more. In males, testosterone balances E2. DHEA may be acting like this too, but not well understood. Women start to loose progesterone levels in their 30’s, similar to DHEA decline in males and females.

Females make progesterone in ovaries and adrenals. In males its in adrenals only.

Update on labs:

TT = 582 ng/dL (240-950)
SHBG = 8 nmol/L (10-80) <—L
Albumin = 4.6 g/dL (3.5-5)
FT = 313 pg/mL (90-300) <—H
prolactin = 5.8 ng/mL (2.6-13.1)
hematocrit = 46.3% (<50%)
cortisol = 15.2 ug/dL (5-25) - 8:10 AM
ALT = 32 unit/L (0-52)
AST = 20 unit/L (0-39)
TSH = 0.84 mcU/mL (0.3-4)
fT4 = 1.21 ng/dL (0.9-1.7)

E2, fT3, rT3, DHEA-S, and IGF-1 all to come (tested today)

Some other labs:

Iron = 119 ug/dL (40-160)
Total Iron Binding Capacity = 332 ug/dL (230-430)
% Saturation = 35.8% (14-50%)
Ferritin = 322 ng/mL (20-300) <—H

My BBT has consistently been measuring 97.8 with a new, more accurate thermometer. My TSH and fT4 both look pretty good, awaiting fT3 results.

So far, I still feel like garbage. No energy, weak erections, weak morning erections, no libido. I have all of the classic symptoms of low T, but my numbers look good (especially free T). I can only PRAY that my E2 comes back elevated to explain this.

To me, everything else looks good besides the IGF-1, DHEA-S, and E2 (will update when the results come in).

Is there any reason to be concerned with:
High FT
Low SHBG
High ferritin

I’m really at my wit’s end here. I’m about ready to throw in the towel if E2 comes back normal. Should I seek psychiatric help? It certainly doesn’t feel like something mental, especially seeing as how my erections (even those in the morning) are weak.

Oh and I’m constantly suffering from dry, tired eyes. Not sure if that has anything to do with it, but it almost feels like it’s contributing to my fatigue etc.

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New results came in:

DHEA-S = 513.0 ug/dL (211-492)
fT3 = 407 pg/dL (230-420)
E2 = 13 pg/mL (27 - 52)

Well, low E2 would explain why I’m feeling so poorly. This makes no sense. Why is my E2 so low? I’m not using an AI and my free testosterone is through the roof. Test inaccuracies, possibly?

Any cause for concern on the DHEA-S and fT3 labs?

this is the type of thermometer KSman recommended to me. I leave it in for 10 minutes. It’s accurate and easy to read. You have to shake it down pretty hard to get the stuff to settle before you take your temp…Its cheap, I like it.

http://www.amazon.com/gp/product/B0006GBEKS/ref=s9_wsim_gw_g194_i1_r?ie=UTF8&fpl=fresh&pf_rd_m=ATVPDKIKX0DER&pf_rd_s=desktop-5&pf_rd_r=0XJMXDZCKET9302C8NFY&pf_rd_t=36701&pf_rd_p=cca70e28-a3b0-4f0d-b847-0ae9cb54558a&pf_rd_i=desktop

that’s the one I prefer to use out of the two I have.

Temps are fine nowadays. I wonder if it’s because I’m now testosterone dominant and before the estradiol was inhibiting thyroid function. Interesting to consider. @KSman or whomever else, any thoughts on how I should proceed? My free T is really high and estradiol really low. My doc wants to lower my dose of T and see if that can bring E2 up a bit (how, I don’t know…).

I’ve stopped supplementing with vitamin D and am hoping that helps a bit. Still feeling very foggy, fatigued, and have a very, very low libido.

Should I take a free E2 instead of total? Will that make any difference?

How does that notion hold up to the levels of estrogen that women have?

With fT3=407 and midrange=325, you should have strong body temperatures. Is high fT3 suggesting some problems with rT3?

You were going to report rT3 lab work.

You need more T, not less? Case is complicated by low SHBG that is creating lower TT numbers. T+SHBG–>E2 does not happen. FT/Bio_t drives T–>E2

How is body weight/fat?
Waist size?
fasting cholesterol?
fasting glucose?
A1C?

Higher unbound T lowers SHBG. Lower E2 lowers E2. You might be in a trap where lower SHBG increases FT. Hypothyroidism lowers SHBG.

I need more T? Wouldn’t that just drive my FT higher and SHBG lower? I’m already above range on FT. I’ve been considering shooting EOD though, to see what happens. I’ll try and get the rT3 next doc visit.

Body fat is ok, not great, but I’m certainly not obese. No gyno, but I feel like I have sensitive nipples, which is strange considering my E2 is so low.
Waist size ~32/34
Haven’t taken fasting cholesterol.
I had a cup of coffee that morning with sugar and glucose was 105 (lab range <100).
Have not yet taken A1C.

Pretty sure I’m not hypothyroid, the iodine may have actually helped with that.

More T will increase E2. SHBG is a balance of FT and E2.
Bottom line would be if you feel better.

DHEA: Adrenal hormones DHEA, progesterone do not have a control loop. But may influenced by cortisol production activities that do have a control loop with the hypothalamus and pituitary.

I’ve done some reading and the general consensus is that guys with low SHBG almost universally feel like garbage even when on TRT. I’m going to keep my hopes up and try everything under the sun, daily dosing, whatever.

So, bear with me on this one here: is it possible that my E2 is actually high? Because my FT is high, Can it be assumed that my Free E2 is also high? Total E2 may just be measuring minimal E2 bound by SHBG and the rest is floating around freely causing me to feel poorly?

Interesting idea. I do not understand the issue with low SHBG.

One could experiment with AI doses to see if they can find a fE2 that feels OK, whatever the labs show.

It is my understanding that E[123]+SHBG is not tightly bound. So then the distinction if bound or free is then less of an issue.

From what I understand, SHBG has a higher affinity for T than it does for E, so I’m not sure on what an optimal E / SHBG ratio would be for the T / E / SHBG. All I know now is that my free T is above range, so one can assume that there is an over-conversion of T to E2, yet the labs don’t show that.

Do you know if there is any other function of SHBG in the body on the cellular level? The basic idea at the moment is that it is sort of a “bank vault” that binds to T (and to a lesser extent E) and helps regulate the release of T into the body.

If this were true, might a more effective treatment method for me be the pellets?

And might a SERM be an appropriate treatment option in this case? I feel as though the estrogenic properties of a SERM may artificially stimulate the production of SHBG. I’d like to shy away from Clomid because of the side effects (estrogen/vision -related), but what about nolvadex? Are there any estrogen-related sides from nolvadex in the brain?

Also, by the way, my IGF-1 result came in:

IGF1 LC MS 198 ng/mL 66 - 346 ng/mL
IGF1 Z SCORE 0.25 NEG 2.0 - +2.0

Not sure what any of this means, but it seems to be mid-range. Just FYI