Greetings from Finland
I’m a long time lurker here and have read the stickies over and over again through the years and searched this forum and countless others in a quest to find a reason and help for my symptoms.
Backround: 33 old male, 83 kg (183 lbs), 178 cm (5 ft 10), bodyfat below 20 %, have been lifting for 10 years and have gone through many bulk and cut cycles in an attempt to gain better body composition, so essentially yo yo dieting. No steroids ever.
Symptoms: Gyno since puberty around 11 – 12 years old (had surgery 2015), fatigue especially in the mornings, trouble focusing, “brain fog”, insomnia, depression, anxiety, almost absent libido in recent years, trouble keeping an erection. Less than optimal results from weight training → mostly novice lifts after years of training even with an experienced coach. On a side note I have always had somewhat bad hyposmia, can only smell and recognize strong smells like garlic and gasoline. Normal puberty apart from gyno so I guess no Kallmans. Still the low LH makes me wonder…
Meds and diagnoses: Have taken escitalopram for around 2 years 2014-2016 (helped my anxiety, killed my remaining libido), had a sleep study done in 2015 and got diagnosed with mild obstructive sleep apnea that is treated with a mouth piece that was shown in control study to remove the apnea → no noticeable effect on symptoms. Have taken many sleep meds for chronic insomnia, these have helped and I don’t have to take them every day, only when I can’t get to sleep. I try to take them only when needed. The ones I currently use are zolpidem, mirtazapine and doxepin all in very low doses.
Have had my testosterone levels checked many times because of the gyno and the other symptoms. My TT has varied from low normal to pretty good, how ever LH is always low and SHBG relatively high so free T has been borderline low on every occasion but never below the threshold. Have been told by several GPs this can’t be the source of my symptoms. Recently a functional doc diagnosed me with low t3 hypothyroidism, how ever I was eating keto at the time and was well within the range (labs below) so I was very skeptical of his diagnosis. I intend to take a new t3 blood test after consuming high carbs for a month or so.
Morning temps always around 36 C or 96,8 F. I use Iodised salt and take kelp as a supplement. Fingers are usually cold, have been eating more carbs and this seems to help some.
Chronic constipation. Have had it all my life and I take psyllium husks and magnesium oxide (1 g) every day to keep my bowels functioning. My cholesterol levels are always somewhat low and lately I have been contemplating that maybe these supplements are causing some absorption issues.
Bloodwork (all morning fasted samples):
13 Dec 2017:
TT 19.5 nmol/l (8 – 29)
fT 271 pmol/l (155 – 800)
SHBG 44 nmol/l (15 – 95)
LH 1.08 IU/l (1.5 – 9.3)
FSH 5,9 IU/l (1.4 – 18.1)
11 Nov 2017
CRP 0.5 mg/l (<3)
GT 18 U/l (<60)
ALAT 22 U/l (<50)
TSH 1.97 mU/l (0.4 – 4.0)
T4 free 17.2 pmol/l (10 – 21)
T3 free 4.1 pmol/l (3.5 – 6.5)
Cortisol 309 nmol/l (133 – 530)
DHEAS 11.67 umol/l (4.34 – 12.19)
B12 541 pmol/l (180 – 700)
Hcyst 7 (<10)
Chol 3.9 mmol/l (<5)
HDL 1.2 mmol/l (>1)
LDL 2.4 mmol/l (<3)
Trigly 0.8 (< 1.7)
Uraat 247
Ferritin 122 ug/l (20-250)
Fe 26 umol/l (9-34)
Transf 2.4 g/l (2.0-3.6)
Prealb 0.28 g/l (0.2-0.4)
D-1,25 127 pmol/l (48 – 190)
TFer – Ky 41 % (17 -52)
5 Oct 2017
TT 12.5 nmol/l (8 – 29)
fT 176 pmol/l (155 – 800)
SHBG 43 nmol/l (15 – 95)
E2 0.11 nmol/l (<0.15 for males)
LH 1.39 IU/l (1.5 – 9.3)
21 Mar 2013
TT 17,0 nmol/l (10 - 38)
LH 1,2 IU/l (2,5 - 7)
12 Jul 2013
TT 13,1 nmol/l (8,4-28,7)
fT 19,7 pmol/l (13,3 - 118,7)
3 Dec 2013 (no range given)
TT 20,3 nmol/l
fT 283 pmol/l
LH 2,4 U/l
FSH 6,0 U/l
SHBG 44 nmol/l
What I’ve gathered from all of this is I have borderline low free t due to high SHBG and always very low LH which would make me secondary. I have spend thousands of euros already out of pocket and am very frustrated with the medical community. So far I have not seen an endo since there’s only one in town in the private sector and he isn’t specialized in hypogonadism and I’m afraid it would be once again waste of money. We have a very good public healthcare system if you are clearly sick but with my current levels there is no hope for getting treatment as stated by many GPs already. Any advice would be much appreciated gentlemen. Am I missing something here or is this all in my head? Cheers.