T Nation

My Situation - Log/Advice Needed


#1

What's up guys.

I'm in a rather unique situation. I likely have several conditions affecting me and I've been on a ~2 year journey trying to figure out how to fix them. It's obvious (to me) that one of them is a testosterone problem, with the other one(s) being a bit more complicated. I'm dealing with moderate/severe cognitive issues likely mixed with mild hypogonadism issues (fatigue/mood/motivation). The cognitive issues are my primary concern and other avenue's of addressing them have fallen short. While T deficiency may or may not be fully or even partially responsible for my primary concerns I'm beginning to think it's almost fully responsible for my secondary concerns.

If you'd like to see my inquiries/methods/details to/for treating my cognitive issues you can find them here:

Pre-Front Cortex & Dopamine Theory: http://bit.ly/1AevFjs
Lyme Disease Theory: http://bit.ly/1x9EwhM

I'm thinking Lyme disease or Toxoplasmosis Gondii may be responsible primarily for the cognitive issues and the blend of T problems with it may be causing my overall situation. So onto my T concerns!

-------------------------------------------------------------\

Alright, I've had a strong feeling I have had T problems for quite some time, my whole life really. Some of my anecdotal indicators:

26 year old male. 6'1" 170 lbs.

  • Very late puberty (~14)
  • Glandular Gynecomastia (Caused me severe emotional stress when I was younger)
  • Slim to no facial hair
  • Poor sleep quality. (Always 5 hours solid, then continual wake/sleep cycles until rise. Always wake up feeling very tired. Very hard to get myself out of bed.)
  • Seemingly OK sex drive, not too strong not too weak. Possible that my psychological drive is just as strong.
  • Erections seem OK as well, could be better. Never late to rise though!
  • Orgasms definitely weak. Very low volume/velocity, very unsatisfying. (lol.. sorry!)
  • Mild fatigue (from sleep? chicken/egg?)
  • DEFINITE word recall problems (from this or other conditions I don't know)

So about 1.5 years ago I went into my doctors to get this checked out, mostly motivated from my cognitive issues (again check http://bit.ly/1AevFjs to see what those are, it's complicated). I go get a blood test. The best part about this was having my doctor say that I will in fact be disappointed with my results and when I come back and am I can then pick up the antidepressants that he can hardly contain himself from writing for me right on the spot. I'll never forget that. Anyways, I wasn't disappointed with my results, they were exactly what I had suspected.

My complete lab can be located here: http://imgur.com/a/seSIH but basically the relevant stuff is:

Free Testosterone @ 8.9 ------- UNITS: pg/mL ----- Reference Range: (9.3-26.5)
Total Testosterone @ 399 ------- UNITS: ng/dL ------ Reference Range: (348-1197)
TSH @ 1.19 --------------------- UNITS: UIU/ML ----- Reference Range: (0.34 - 5.60)

I have a TT of a 90 year old man and a FT of a 50 year old man. My TSH appears to be fine but I'm definitely not ruling out adrenal fatigue (rT3). I've yet to be able to test my body temperature (just learned about that tonight) but will be doing that ASAP.

I didn't take action after getting my results because I just couldn't fathom that my severe problems could stem from T problems, but I'm starting to get desperate after running out of options and I'm beginning to take any problem area very seriously.

So I've yet to understand where the exact problem could be in the Adrenals/Thyroid/Testes chain but I wanted to get the ball rolling and see what you guys think about it. Do you think this could be causing my primary symptoms or is it likely just exacerbating it?

I suppose I already know this is a problem but I feel it'd be foolish to go into my doctors office unsure of myself as I don't trust their judgment or understanding of this kind of stuff at all.

------------------------------------------------------------\ ADDITIONAL INFORMATION

Supplement Stack:
- Lion's Mane - 2g 2/day (4g total)
- Reishi - 2g 2/day (4g total)
- Ashwagandha - 500mg KSM-66
- Bacopa - 600mg 60%
- ALCAR - 2g
- Fish Oil - 1g EPA
- Pregnenolone - 25mg (still need to play with dosing)
- Vitamin D3 - 4k IU
- Cebria (Cerebrolysin peptide derivative)

-age = 25
-height = 6'0
-waist = 32
-weight = 170

-describe body and facial hair = Body hair is light/normal. Legs seem normal (hairy even), no chest hair. Facial hair is extremely patchy and peach fuzzy. At 22 it was basically bare but from 23-25 that small amount developed. My father said he could grow a mustache at 19.

-describe where you carry fat and how changed = My body fat is pretty naturally low, with the only amount I have being on my hips (by/on Iliac Crest) and abdomen. Both are minimal.

-health conditions, symptoms [history]
Physically very healthy, only conditions as mentioned above.

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
Effexor - 6 months
Mirtazapine - 6 months
Zoloft - 3 months?
Vyvanse - 2 weeks max
Welbutrin - 2 months?

All problems were WELL underway by many years before I touched an SSRI. Only used them out of PURE desperation, I've never considered myself depressed in any way. I was desperate for anything at all in the beginning of my realization this was physiological and let doctors talk me into that shit.

-lab results with ranges = Above

-describe diet [some create substantial damage with starvation diets]
Ages 22 and below were a pretty poor standard American diet. Junk food all the time, processed crap, mild pop intake, always lots of water though. During my workout days (2008-2009) I drank LARGE quantities of whole milk and crammed the calories good or bad)

@ 23 I started learning about real nutrition and now I eat healthier than probably 99% of America. Quality fats/proteins. Coconut oil. Organic as much as possible. Minimal processed carbs. High protein when possible. Lots of water. Kale shakes.

-describe training [some ruin there hormones by over training]
None atm. 2008-2010 heavy weight training. Gained ~50 lbs in a year. Lost it slowly over ~2 years due to my situation. Used to be my passion, now stresses me out just thinking about it. I'll get back to it some day!

-testes ache, ever, with a fever?
Not that I can recall.

-how have morning wood and nocturnal erections changed
Morning wood a lot on my initial wake ups (see sleep disturbances above) but none on my final wake up usually.

Hope that about covers it!

Thanks guys!


KSman is Here
KSman is Here
KSman is Here
#2

You need to find out why T is low. Low-T is the symptom, not the cause. The cause may be creating your other issues, beyond the effects of low T.

Please read the advice for new guys sticky. <<<<<<!!!
Be open minded to all of the issues there and don’t have low-T Tunnel Vision.

You are vitamin D deficient, get 5,000iu Vit-D3 oil based tiny gel caps.

You have low cholesterol, eat red meat, eggs and whole milk.

Labs required:
TT
FT
E2
LH/FSH
prolacin


#3

[quote]KSman wrote:
You need to find out why T is low. Low-T is the symptom, not the cause. The cause may be creating your other issues, beyond the effects of low T.

Please read the advice for new guys sticky. <<<<<<!!!
Be open minded to all of the issues there and don’t have low-T Tunnel Vision.

You are vitamin D deficient, get 5,000iu Vit-D3 oil based tiny gel caps.

You have low cholesterol, eat red meat, eggs and whole milk.

Labs required:
TT
FT
E2
LH/FSH
prolacin
[/quote]

Right-o

I’ve been on D3 for about 7 months now @ 4k UI/day and have been eating at LEAST 2 eggs a day since then as well.

I have a doctors appointment on Monday so I’ll be seeing if I can get those tests run and I’ll report back with the results when they come in.

Thanks!


#4

ping ksman is here thread


#5

I’ve yet to get my tests run since my new insurance wont kick in until September, but does anyone have any other thoughts on my situation? Can anyone relate? Has anyone dealt with cognition issues that were resolved by exogenous T?

I’m struggling with impatience a bit lol, just trying to get some discussion going.

Thanks guys!


#6

Alright so I got the results from my E2, FSH/LH, and Prolactin lab work (Quest):

CPT
83002 – FSH – 3.0 – (1.6-8.0 mIU/mL )
83001 – LH – 4.0 – (1.5-9.3 mIU/mL )
84146 – PROLACTIN – 9.1 – (2.0-18.0 ng/mL )
82670 – ESTRADIOL – 25 – (< OR = 39 pg/mL )

They all appear to be in normal range. I haven’t found much information on what the optimal numbers are within “normal” range but there they are.

As a reminder, here are my tests from over a year ago that prompted these additional labs:

Free Testosterone @ 8.9 ------- UNITS: pg/mL ----- Reference Range: (9.3-26.5)
Total Testosterone @ 399 ------- UNITS: ng/dL ------ Reference Range: (348-1197)
TSH @ 1.19 --------------------- UNITS: UIU/ML ----- Reference Range: (0.34 - 5.60)

Along with these results I’ve also been taking my temperature regularly and it’s consistently low, but sporadic.

I can wake up with between 96.8 - 97.3 (I never break 97.3 in the morning) and vary wildly throughout the day, sometimes hitting 98.6 and other times never breaking 98. Then before bed it dips down like in the mornings. I began taking Lugol’s Iodine just in case, though from what I understand if my TSH levels are fine (which they appear to have been at least a year ago) then Iodine probably isn’t a problem, but I wanted to try it for several reasons. This is pretty wishy washy tracking so for the next while I’m going to be taking daily readings and charting it, and will post the results here when it appears conclusive.

I’ve began reading “Adrenal Fatigue: The 21st Century Stress Syndrome” as well as reading on Dr. Rind’s literature (drrind.com - STTM suggested reading on adrenal fatigue) and believe I very much fit the case for adrenal fatigue. I’ll feel a bit more absolute once my temperature is charted through the next couple weeks as wild variance in temperature appears to be very indicative of adrenal fatigue.

That’s basically my current theory; rT3 elevation due to adrenal fatigue leading to hypothyroidism. Though how exactly this may cause low T I have no clue, I haven’t dug that far in yet, but I plan to. Better understanding my recent lab results will definitely fill in some gaps.

Thoughts?

Thanks


#7

You have a good grasp of the role of rT3.

TSH might not be telling the whole story. I have more faith in body temperatures as a guide to whats going on.

Your LH/FSH are sort of consistent with your old T lab data. Prolactin is not a factor. E2 is elevated relative to your T, making you estrogen dominant to a degree. Might be worth trying 0.5mg anastrozole per week to see how you respond and feel.


#8

[quote]KSman wrote:
You have a good grasp of the role of rT3.

TSH might not be telling the whole story. I have more faith in body temperatures as a guide to whats going on.

Your LH/FSH are sort of consistent with your old T lab data. Prolactin is not a factor. E2 is elevated relative to your T, making you estrogen dominant to a degree. Might be worth trying 0.5mg anastrozole per week to see how you respond and feel.[/quote]

Excellent, thanks for the response.

Should I even bother with thyroid labs before attempting to treat my adrenals first? It seems pretty clear based on my temperatures that I’m hypothyroid; with my I.R. not doing anything (5 days in no change in temps or feelings-good or bad(bromine etc)) and my matchup with adrenal fatigue symptoms indicate that it’s probably an rT3 problem (if I’m understanding it correctly).

And also do you think that hypothyroid is causing my low T or is that something independent of it; IE would it be balanced if my E2 wasn’t hogging all my T resources? And if so, why is that happening?

so,

Perhaps if it’s all the same I might just get a 24 hour cortisol with an fT3/rT3 lab if my insurance covers it. Otherwise I’ll just start the adrenal treatment and see if I can talk to an endo about anastrazole.

Last thing, I experimented with topical hydrocortisone cream (about a quarter sized dollop) and absolutely noticed increased energy/well-being. Temperature unaffected though. The cream is 1% so I have no clue really how much HC I was getting. I don’t plan to continue doing that, was just curious.


#9

There is no simple fix for adrenal fatigue. So this will take time.

I don’t recall a case here where IR did not work because of rT3. Interesting.

24 hour cortisol or 4 sample salivary cortisol?


#10

THYROGLOBULIN ANTIBODIES <1 < or = 1 IU/mL CB
THYROID PEROXIDASE ANTIBODIES 1 <9 IU/mL CB

T4, FREE 1.2 0.8-1.8 ng/dL BH
TSH 2.16 0.40-4.50 mIU/L BH
T3, FREE 3.6 2.3-4.2 pg/mL BH
CORTISOL, TOTAL 13.0 mcg/dL CB ****Did not request, doctor threw in for some reason
Reference Range: For 8 a.m.(7-9 a.m.) Specimen: 4.0-22.0
Reference Range: For 4 p.m.(3-5 p.m.) Specimen: 3.0-17.0

  • Please interpret above results accordingly *

T3 REVERSE, LC/MS/MS 17 ng/dL EZ

Pretty un-freakin-believable. Just my luck that I’ve felt like absolute crap all day long for 7 years and have temperatures dipping into the low 96’s and my detailed in depth thyroid labs all turn out NORMAL. That’s just great.

I really can’t believe this at the moment. I need something to explain why I feel like I do.

I didn’t get my iron checked but my doctor at this point probably thinks anything that comes out of my mouth is probably a joke, I’m embarrassed to even ask for it.

My 4 sample cortisol wont be in for a few days, but with my rT3/fT3 ratio being >20 (21.2 if I did the math right) I’m not expecting much.

I’m really struggling guys, is there anything here that I’m not seeing?


#11

Alright, results are in (4 Sample Salivary Cortisol Test):

let it be known that I work 2nd shift so my sleep schedule is way different than the norm. I was unable to find any articles on this so I took it upon myself to measure upon my own personal waking and 2 times during they day, and then before my own personal bed time. I don’t know if this ruins or tarnishes the results but i’m sure my circadian rhythm is way off.

  • 1:30 PM (Awaken) - 0.59 mcg/dL
  • 7:00 PM - .05 mcg/dL (error??? that’s extremely low)
  • 11:16 PM - .26 mcg/dL
  • 3:20 AM (Bed) - .20 mc/dL

Here are the ranges provided by Quest:

Reference Range:
8-10 AM: 0.04-0.56
4-6 PM: < OR = 0.15
10-11 PM: < OR = 0.09

So, upon rising I’m slightly high. My second reading is extremely low, not sure what to think about that (how much room for error is there in saliva testing?). And then my next two are absolutely too high.

From what I’ve read this is indicative of the beginning stages of adrenal fatigue (too high cortisol due to chronic stress), which honestly confuses me a bit because my symptoms time frame is way off from that idea. My problems started like 7 years ago and peaked around 5 years ago.

Since these results took so long to come in I got ancy and ordered and have been taking the following for adrenal fatigue:

  • Collagen Types 1&2 - 6g/day
  • Pregnenolone - 25mg/day
  • Milk Thistle - 150mg/day
  • Licorice Root (Non DGL) - 1-2g/day

Haven’t noticed it helping any, but I do have dessicated adrenal on the way. And I don’t know if I mentioned it or not before but Hydrocortisone cream does have a moderately positive effect on me.

Thoughts?


#12

The possibility that the second cortisol reading is wrong has some merit.

TSH up
fT4 marginal low-centered
fT3 somewhat high
rT3=17 is high? can you find the lab ranges?
low body temperatures

Your fT3 is more than enough to normally support body temperatures and metabolic rate.
I have to conclude that rT3 is a problem.

So your labs say that you have enough fT3 to be health. But it is not getting into your cells because rT3 is jambing the fT3 receptors in the cell walls. So you have hypothyroid symptoms because all of your cells do not have enough rT3 getting into the cells to affect/maintain proper levels of cellular metabolism. fT3 regulates mitochondrial metabolism and the mitochondria create the universal fuel that powers your cells.

mitochondria burn fats/lipids in your blood stream, so lower activity can contribute to adverse blood lipid profiles as well as lower pregnenolone levels because mitochondria also produce that.

This touches on cell wall permeability. Your cell walls need to have essential fatty acids. Do you take fish oil, eat nuts or flax seed oil/meal?
You also should be taking a high potency B-complex multi-vit with trace elements and iodine. Look for boron, selenium, chromium etc
Vitamin D 5000iu would also be helpful. I realize that you are taking some of these.

So the above does not address your low T. I think that thyroid and adrenal fatigue should be a primary focus.


#13

Alright I’ve found a new doctor that actually is willing to listen and to help and he right away suggested TRT.

But before we jump on that bandwagon I’m thinking of treating the thyroid first with Armour, maybe give that a couple weeks and see how I feel and if not I might just jump straight into the T.

If I do end up going to T route what would you suggest as far as dosing? He mentioned the creams are the best (obviously not) but they’re too expensive so the vials are the way to go. He started off with saying once every 2 weeks then eventually once every month. Didn’t follow the logic. He is very open to suggestion though and admitted splitting the dose is probably the best to prevent peaks & valleys. He hadn’t heard of hCg or an A.I. but I’m hoping he’ll be open to it or else I won’t even bother with him.

So what would you think as far as dosage on all 3 of those things?

Thank you very much,

AE


#14

[quote]AlmostEasy wrote:
Alright I’ve found a new doctor that actually is willing to listen and to help and he right away suggested TRT.

But before we jump on that bandwagon I’m thinking of treating the thyroid first with Armour, maybe give that a couple weeks and see how I feel and if not I might just jump straight into the T.

If I do end up going to T route what would you suggest as far as dosing? He mentioned the creams are the best (obviously not) but they’re too expensive so the vials are the way to go. He started off with saying once every 2 weeks then eventually once every month. Didn’t follow the logic. He is very open to suggestion though and admitted splitting the dose is probably the best to prevent peaks & valleys. He hadn’t heard of hCg or an A.I. but I’m hoping he’ll be open to it or else I won’t even bother with him.

So what would you think as far as dosage on all 3 of those things?

Thank you very much,

AE[/quote]

Interested to see how this prevails, going for my follow up wednesday with endocrine but my syptoms are the same and my thought process has been the same in such that…
Thyroid/adrenal fatigue is my main issue and its causing my low test, only think im worried about is my endorcrine doc has TRT tunnel vission and its the only thing shes mentioning… Ill know more when i see my full bloods wednesday which might say why shes keen on TRT, but im only 22 and I can get and maintain an erection so I want to consider a Clomid/HCT restart before TRT… Im sure my balls havnt given up completely!


#15

Just follow suggested protocol in the protocol for injections sticky and know the stuff in the advice for new guys sticky.