T Nation

Rebalancing HPA Axis and T Levels

Age: 22
Height: 5 ft 10 in
Weight: 130
Fat: Used to not have fat on belly but have some now

My story/stressors:

I had taken the drug MDMA (1st time) 5 months ago and had a bad comedown which lasted 1 week but I recovered completely. Every week I would also drink like 5-6 drinks. Then mid May I got really dehydrated and that is when my symptoms started. Even after drinking plenty of water/gatorade I felt very fatigued/out of it. I expected this to go away after 1 day but it kept continuing. I could not concentrate on anything (both socially and work-wise) and became extremely anxious,felt depressed, had low motivation, lower libido (which i just attributed to anxiety). I am also very sensitive to the heat and get hot flashes. I got scared my one time MDMA use might be related but that seemed absurd since I recovered from that but yet nobody was giving me answers.

I even tried out antidepressants b/c GP said this is standard anxiety for like 9 weeks which were not much help. Now things have gotten better but I still experience occasional anxiety and still have low motivation/fatigue/low libido/brain fog/hot flashes/belly fat/noise sensitivity/irritability. Morning wood happens less often too. Only recently (last month) I finally got answers from a psychiatrist that my HPA axis was thrown off balance by all these events in succession. And only recently (2 weeks ago) did I bother to get my T levels checked and they were on the lower end of the range which also supported the HPA axis theory…

I was relieved to find out my problem was physical and not psychological but I still am wondering what to do from here and if TRT would make for a quicker recovery since I am still experiencing symptoms. Following are some test results:

TSH: 1.6 (0.40-4.50 mIU/L)
Cholesterol: 115 (125-200) Low but GP said this is really good


Vitamin D3: 35 ng/mL (30-100)
TSH: 0.89 (0.40-4.50 mIU/L) Dropped but fluctuations are normal says dr.
Free T4: 2.1 (1.0-2.4 ng/dL)
Total T4: 10.3 (4.8-10.4 mcg/dL)
Free T3: 297 (210-440 pg/dL)
Total T3: 125 (76-181 ng/dL)

Docs say Thyroid is normal even though my T4 was on the higher end of the range but to retest again in a few weeks.

WBC count: 8.1 (3.8-10.8 Thousand/uL)
RBC count: 5.61 (4.20-5.80 million/uL)
Vitamin B12: 609 (200-1100 pg/mL)
Folates, Serum: 14.5 (>5.4 ng/mL)

September: (9 AM tests)

Copper, Serum: 77 (72-166 ug/dL)
Zinc, Serum: 62 (56-134 ug/dL)

TSH: 1.71 (0.40-4.50 mIU/L) Looks like it went back up…
Free T4: 1.6 (0.8-1.8 ng/dL) Still on the higher end and ref range changed…
Total T3: 131 (76-181 ng/dL)

Other thyroid labs were not done this time and Dr says ok thyroid is def normal.

LH: 3.6 (1.7-8.6 mIU/mL)
FSH: 1.1 (1.5-12.4 mIU/mL) LOW
Ferritin: 38 (30-400 ng/mL) To me this seemed like it was on the low end but dr said its good.

Cortisol, Serum: 11 (3-20 ug/dL) Seemed low for AM test but dr said normal
Prolactin: 11 ng/mL (no range)
Total Testosterone: 359 ng/dL (348- 1197 ng/dL)
Bioavailable T: 225 ng/dL (62.6%)
Free Testosterone: 86 pg/mL (no range given)

What should be my plan of action once I see an endo? I also read the thyroid sticky–should I get thyroid stuff done again with reverse T3 this time?

Cholesterol: 115 (125-200) Low but GP said this is really good

Your doc got sold the lie that the cholesterol drug reps have spun. Your cholesterol is to low. Cholesterol is the base for making your vitamin D, cortisol, pregnenolone, progesterone, testosterone, estrogens and others.

You need to eat cholesterol rich foods. Cholesterol levels below 160 are associated with increased all cause mortality.

Take 5000iu vit-D3 per day, tiny oil based caps. Take 25,000 for the first 5 days.


  • read the thyroid basics sticky
  • evaluate your long term use of iodized salt
  • check your waking and mid-afternoon oral body temperatures <<<<<<<<<<<<<<<<<<<<<<<<<<<
  • fT3 and fT3 should be near mid range or a bit higher, your fT3 is lower that that, fT3 is the most important lab

Ferritin should be higher.

  • do you eat iron rich foods?
  • do you have digestive problems or food sensitivities?

Cortisol is border line low. Done at 8AM?
Do your energy levels follow a pattern during the day?

Prolactin is good a lower number.

Need ranges for bio-T and FT

Your LH/FSH are low. Your HPTA is shut down. Suggest:

  • 10mg nolvadex per day, please not clomid, not high dose please
  • after 3-4 weeks you may feel better
  • test LH/FSH, TT, FT, E2
  • if LH/FSH still low, HPTA is broken, start TRT
  • otherwise if LH/FSH and TT, FT look like a good end point, you can try a restart. But better to stay on the serm longer to allow the testes to resume form and function.
  • if E2 above 22pg/ml, you may need anastrozole
  • when time to attempt restart, slowly taper off of the nolvadex over 3 weeks and stay on anastrozole during this and cruise on that
  • eval labs and how you feel again.
  • if good, you are OK, otherwise contemplate staying on low dose nolvadex or 250iu hCG SC EOD

read the advice for new guys sticky to pick up other things that you need to know, will clarify the above

Thanks for the reply. I forgot to mention the supplements I am currently taking. I don’t have any digestive issues and low cholesterol is something I have had for years since I was young.

Vitamin D–4000 IU/day
Magnesium Citrate-- 2 tsp Natural Calm/day
B Complex
Vitamin B12-- 1000 mcg methylcobalmin/day
Zinc Glycinate 22 mg (~150% DV) (only twice a week)
1000 mg EPA fish oil

I just started taking oral temperature today when I woke up at 8 AM and it was low at 96.7 F so if there is a pattern this week I guess there could be some iodine issue. Additionally, my Saliva Cortisol 24 hr results came in all low/below range so I am wondering if I have adrenal fatigue causing low T and what to do about it since I have heard you need to treat adrenals first, then thyroid, then testosterone. I also notice I do have the most energy at night and feel very tired in the afternoons.

Morning(6-8 AM) – 10.0 (13.0-24.0 nM/L)
Noon (12-1 PM)-- 2.7 (5.0-8.0 nM/L)
Afternoon (4-5 PM)-- 2.2 (4.0-7.0 nM/L)
Night (10 PM-12 AM)-- 0.8 (1.0-3.0 nM/L)

Total–15.7 (23.0-42.0 nM/L)

Are you going to read Wilson’s book?

  • evaluate your long term use of iodized salt
    A: I guess there could be some iodine issue

Can you tell me more about your iodine sources? Any in your vitamins and how long have you have taken?

No iodine in any of the supplements I take but the salt that is in my food at home is iodized and pretty much everything I eat has salt in it. However, until recently I was not eating that much to begin with.

I just got a hold of Wilson’s book on kindle and skimmed it quickly. Seems like a long journey to recovery but hopefully it won’t be that bad as I don’t have any of the respiratory or getting sick easily symptoms (I haven’t gotten sick in ages) He did mention hydrocortisone though as a fast (but bad long term) method and I am thinking hopefully I can eventually find a doctor that understands this stuff and prescribe some low dose of that since I am desperate for relief. Otherwise I did go get some Aswandgha but haven’t tried it yet.

It just feels terrible not being myself/not able to concentrate or socialize like I used to. Something that scares me is my horrible memory and how I cannot seem to remember stuff or even remember how it felt to be normal. Even if I do remember events from last year or further back its very foggy and doesn’t feel like I really did it. I just tell myself its normal to feel like that given this hormonal imbalance. Hopefully it resolves itself once the hormones come into balance and I will be able to remember past events as if none of this ever happened.

Also got a bunch more blood tests done today that included thyroid with RT3,E2, and more.

Cortisol is produced in the adrenal glands from progesterone. Some guys get benefits from small amounts of progesterone cream.

Get DHEA-S tested. If low, that is another measure of adrenal insufficiency.

I had that tested too in this one massive blood test I did–took like 10 vials lol. Got some of the results already including DHEA-S.

Iron, Total: 108 (50-195 mcg/dL)
TIBC: 392 (250-425 mcg/dL)
%Transferrin Saturation: 28% (15-60%)

According to STTM website it looks like my iron needs some work.

DHEA-S: 398 (24-537 mcg/dL) I think this is fine too
Cortisol, Serum (8 AM): 9.8 (4.0-22.0 mcg/dL) on the lower end, confirms saliva and previous serum cortisol test

Estradiol(E2): 30 (<= 39 pg/mL) More than optimal but seems ok/don’t think this is causing issues.

Just got the rest of all my massive blood test results. Endo prescribed Clomid 50 mg 3x week unfortunately not Nolvadex and he was reluctant to even prescribe this medication. Also did nothing to address Cortisol problem and was like oh saliva cortisol means nothing and since I passed ACTH test the adrenals are normal which kind of irritated me and so I did not get any hydrocortisone.

Also found out I have low pregnenolone and read on multiple sites that this can cause cognitive issues,depression,anxiety. Endo just said DHEA-S is normal so therefore its not a concern but I;m sure hes wrong as it is very very low. Should I start supplementing that? Also my testosterone randomly went up to the 400s without much change in LH/FSH but this was done at Quest and not Labcorp like before…

FSH: 0.8 (1.6-8.0 mIU/mL)
LH: 3.8 (1.5-9.3 mIU/mL)
Total Testosterone: 463 (250-1100 ng/dL)
Free Testosterone: 118 (35-155 pg/mL)

Pregnenolone: <5 (13-208 ng/dL)
Progesterone: <0.1 (</= 0.3 ng/mL)
DHEA: 398 (24-537 ng/dL)
Cortisol AM: 9.8 (4-22 mcg/dL)

TSH: 1.93 (0.40-4.50 mIU/mL)
Free T4: 1.3 (0.8-1.8 ng/dL)
Free T3: 282 (210-440 pg/dL)
Reverse T3: 15 (8-25 ng/dL)

My ratio of FT3/RT3 is around 19 so barely less than 20.

I passed ACTH test

  • that indicates that the adrenals can produce cortisol if thee is enough ATCH. But your ATCH levels can still be low leading to low cortisol. Your doctor does not understand the issues. If your cortisol is low, it is low. Its not because your adrenals cannot respond to ATCH. If ATCH is low, that points to the pituitary. You don’t want to be near the bottom of the range because people there are dragging there asses.

FSH=0.8 is low. That is a good indicator of your LH status, better than the LH lab value itself. This points to the pituitary.

FT4 is good. fT3 is lowish. There might be an iron connection there.

rT3 is mid range. Might still be some effects of that.

What do your body temperatures look like now?

  • RBC was good
  • hematocrit HTC?
  • TSH is indicating that the thyroid is not able to product hormones as easily as it should.
  • was there sea salt in the house for for a while earlier?

I have seen serum iron make wild swings, so I don’t quite trust that.

When males have low iron, if diet includes red meat and other ample sources of iron, one can suspect GI blood loss.

So your FT was quite good. Why when TT was mid range? Because you had a short term surge of LH that caused a wave of T production and that leads to FT. After a while more will combine with SHBG and FT will drop.

FT can vary a lot for:

  • natural guys [not non TRT]
  • or guys on TRT using transdermal T products

For guys injecting T EOD or twice a week, FT levels can be quite steady and a lab result is really indicative of what is going on.

DHEA is good. The production of DHEA does not have a known pituitary control loop. So this does not offset a pituitary insufficiency suspicion.

That may be too much clomid. Watch for estrogen sides.

My ACTH levels also came out normal at 39 (range:6-50 pg/mL) so they suspected nothing wrong with adrenals at the primary and secondary level. But they nobody has bothered to explain why these levels are low in the first place. I am starting to think this is actually related to my low cholesterol and not some adrenal fatigue thing.

Are there any other tests the endocrinologist should be doing? Most are very reluctant to give any hydrocortisone and just say my serum cortisol is normal or that saliva tests are a waste of money.

My sodium and potassium levels are all good and I don’t have any of the low blood pressure symptoms nor do I easily get sick–haven’t gotten sick in months actually which makes me doubt adrenal fatigue.

Sodium: 140 (135-146)
Potassium: 4.3 (3.5-5.3)
Hematocrit: 45.3 (38.5-50%)

I have never used sea salt either and my body temperatures in the morning are around 97.7–more accurate now since I left the thermometer in my mouth for a full 5 minutes. I have also started taking iron supplements since my diet does not include red meat. My worst symptom is feeling completely blank and major concentration issues which lead to more anxiety.

Only started the Clomid yesterday though so it has not had time to take effect. Also got a cholesterol supplement which has 250 mg cholesterol equivalent to 1 egg which i take 4 times a day.

I will probably be on Clomid for 4-6 weeks. How often do I need to monitor my E2?

Doctors think the only problem is the low FSH and everything else is normal. But I feel like there is some cortisol issue going on that is not being diagnosed since ACTH and ACTH test came out normal. Will supplementing with low dose 10 mg pregnenolone help?

So after about 4 weeks on Clomid my new levels are:

Cortisol: 24.6
E2: 52 (used quest sensitive 4021x)
TT: 1140
FT: 340

I was feeling better in the 3rd week almost back to my normal self but then my mood and everything suddenly crashed. I assume it is due to the estradiol? What should I do about that? Also somehow my AM cortisol levels went higher too.

Maybe I missed it but, are you taking an AI? You should be taking an AI if you are using a SERM for a restart. Clomid is notarious for estrogen sides in some guys. I am not familiar with the quest lab numbers but, if you are not on an AI you need to get on one ASAP as some of your test is aromitazing into E (especially with as much as you are currently producing). You should probably be on anastrazole.

Can you describe your diet? You should be taking a good fish oil, like Flameout.

Currently I am not taking an AI and now I have basically stopped the Clomid. Last dose of 25 mg was 4 days ago. It made me feel low the next day so I will not be taking it anymore. Diet consists of stuff like pasta, chicken, fish, rice, green beans, pancakes for breakfast. Body temps seem to be fine around 98. Levels now

Cortisol, Serum: 18 (3-20 ug/dL)
Total Testosterone: 1051 ng/dL
Free Testosterone: 282.7 pg/mL
Estradiol: 57 pg/mL (</= 39 pg/mL)

So my cortisol levels have recovered. I still have the high E2 though. This test was done before that last dose. But now that I stopped, can I expect my body to decrease the E2 on its own to 20-30 and keep the T level around 700-800 or so?

So I also felt good in my 3rd week on Clomid 50 mg 3x a week but then 4th week things went down and decreased the dose to 25 mg 2x a week (starting 5th week) then felt better but not as good as the 3rd week. Now again in the 8th week I am just feeling depressed again this week for no reason. Even last week things were better. Make sure to check cortisol levels also since strangely Clomid somehow affects that too.

I get morning erections on some days and on some days I don’t. I have trouble staying asleep the whole night. I will be getting another test done tomorrow to see what the heck happened in these last 2 weeks and to see if the E2 is coming down naturally without an AI. If it doesn’t I am not sure what to do. Last 2 tests it seems like the T level decreased but E2 slightly increased.

Your E2 is out of whack. You need an AI, and/or get off the Clomid you probably didn’t need in the first place. You’re levels weren’t terrible. Getting your shitty cholesterol numbers up would have been step number 1 for me.

Sorting out the cortisol issues would also have been higher on the list than a SERM. I used licorice root, astragalus, ashwaganda and huperizine A after reading the following article. An adaptogen and licorice root are probably worth a shot on their own.

If T levels were still low you could have then tried a test booster to see if increased levels made you feel any better. Alphamale worked for me years ago. There are probably some others now that would work well.

I’ve been off of Clomid for 3 weeks now and I had tapered it to 12.5 mg before stopping. These are my lab results from 3 weeks ago.
It looks like my Total T decreased significantly while my Free T still stayed pretty high. My E2 is still somewhat high. Dr told me its going to be a 4-6 more weeks for my body to adjust getting off this medication and if I don’t feel back to normal naturally then we will look for other options.My libido is still not what it used to be. My symptoms are better from when I started but not gone. I experience mood shifts from being anxious to feeling low throughout the week. I think this all has to do with the Zuclomiphine part of the medication needing to exit my system since its estrogenic.

Cortisol, Serum: 12.7 ug/dL (3-22 ug/dL)
Total Testosterone: 587 ng/dL (250-1100 ng/dL)
Free Testosterone: 180 pg/mL (35.0-155.0 pg/mL)
Estradiol: 39 pg/mL (</= 39 pg/mL)

Cortisol decreased again but I think the T and E2 issue is playing more of a role. My Total T/E2 ratio is still horrible. Why is my Free T high but Total T mid range? Is it right for me to just wait this out for 4-6 weeks and then re-evaluate?

I know the cholesterol also might be playing some role so I have been taking Sonic Cholesterol supplements 4x daily to raise it. I’m simultaneously trying to attack everything at the same time since I need to get better quickly as a student. I also take the adaptogen Ashwagandha twice daily and 1 g of Vitamin C for adrenals.

Some interesting coupling of LH/FSH and cortisol.

“10 mg pregnenolone” Pregnenolone absorption is very poor, might need 100mg an a oral to get anything done.

Really seems like anastrozole would be useful and may increase T levels.

While on clomid with high E2, that was probably a result of too much clomid and high LH driving T–>E2 inside the testes where anastrozole would not have been effective.

You need smaller doses of a SERM and try Nolvadex next time.