Strange Hormone Issue?

Pharma / TRT Testosterone Replacement
1

Hey guys, I was wondering if I could get some insight on my issue:
I’ve been feeling fatigued and weak for some time. I got my blood tested and my testosterone was below normal for my age. My vitamin D levels were also low. I started taking t cream from a compounding pharmacy. I don’t feel as weak and depressed as before. But during the day I still feel pretty bad. For example, if I stand for too long I feel like dropping dead. I actually have to go lie down 3-4 times throughout the day just to make it through.

However, at night like around 6 or 7 PM my energy levels change. I don’t feel depressed and I have energy. In fact, at night I can lift weights, and strangely enough my strength has increased. I’m 34 and I’m started to get bigger than when I was 22. I find this really odd. Anyway, is there any illness that causes low hormones during the day but normal hormones at night? It sounds like a stupid question I guess, but why the heck do I feel normal at night but horrible during the day?

2

have you ever been a night shift worker?

3

Yup. About 8 or so years ago. I would start at 7PM and work until 7AM. The shift was a breeze. As soon as I would get home I would go to sleep without a problem. Then my wife started complaining that she was married to a vampire. So I got a regular 40 hour work week from 8AM to 6PM. That was a COMPLETE disaster. My productivity crashed. I felt asleep most of the day. In fact, for the next 8 years of working in the day time my performance has pretty much had highs and lows. Mostly I spend the day fighting sleepiness and fatigue.

I have two kids now so I can’t go back to vampire mode. But do you think that my hormone levels are low during the day because my body wants to be sleeping?

4

It sounds like a classic case of adrenal fatigue to me based on the details you gave us. Have you had your cortisol levels checked recently?

I would get really tired around mid-afternoon and then get my “second wind” around 7:00, then stay up late. Working out was a nightmare. It took only a couple of sets for me to get really dizzy and feeling sick to where I had to cut my workouts short. It could be a reason for your low T levels. Do some research on adrenal fatigue/insufficiency. Here is a pretty good introductory article…

It could be a lot of things… you should get an entire male hormone panel done.

5

Thanks for the response. I live in Ft. Lauderdale and there’s a pretty good doc here that is more into a holistic approach. Or so I thiught. He tested my blood and as far as I know only looked at the T levels and the vitamin D as well. Cortisol was never mentioned. To be fair he’s not an endocrinologist. But I guess I could still ask him for an entire hormone panel next time I go.

I’ve been taking compounded T cream for a month now, and still feel fairly cruddy. I can’t imagine going through life like this.

6

Second vote for adrenal fatigue/cortisol imbalance. Get your adrenals checked.

7

I think you guys may be right. For the past three years I’ve been feeling very nervous and anxious. It’s been like a huge feeling of insecurity. I’ve been jumpy. If someone gets near me, or what I think is too near, I feel an adrenaline like response. I feel like either attacking the person or getting away from them. It’s been so bad that it feels as if something is sitting on my chest.

Three days ago something odd happened. My wife had some prednisone in the cabinet. I’ve had this hacking cough for weeks now and asked her if it would help. She said it would. So I took it. Within an hour I felt “normal”. I felt myold confidence back and didn’t feel jumpy or nervous at all. I was able to go the entire day without having to lie down from the fatigue. What do you guys make of that?

When I go see the doc do I ask for another blood test, and ask to check cortisol levels, or is that in a urine test? I don’t know what to ask the guy, but I want to feel human again.

8

cipher,
you found your answer. Prednisone being a corticosteroid gave your body a boost. The same kind of boost as if your adrenals kicked back in. There is an ACTH test which will tell if your adrenals are working at all, but here is the hitch: if you respond “normally” to the test, your doctor may say there is no problem…
If you can get your doctor to give you an AM and PM cortisol test, you very well may find your numbers are very low and something needs to be done. If your doctor is hip, he will prescribe “Cortef”,(mild hydrocortisone) to take the load off your adrenals. If your doctor won’t help you with a script, PM me for non-prescription advice.

Good luck.

9

Thanks! This is exactly why I came to this forum. When it comes to endocrinology, nutrition, etc. I trust more what the folks say in here than any physician!

10

Suggest a 4 sample saliva cortisol test. Take on a normal stressful day, not on a weekend.

Test Thyroid levels: TSH, fT3, fT4

What were your pre TRT LH and FSH levels?

Test DHEA-S

Get and retain copies of all of your lab work.

Prednisone is dangerous and should be used only for isolate events. It is catabolic, muscle and bone loss!

What is your iodine intake? Iodized salt? Do you eat a lot of seafood? If your thyroid levels are low, you may not be absorbing T very well.

Low vit-D and you live there… not getting much sun exposure? Is your skin color dark? That reduces ones vit-D response to the sun.

Post lab numbers, units and ranges.

You need serum E2 lab results.

You need hCG injections to preserve your testes.

Age=34
Weight
Waste size

11

Holy crow! Those are a lot of levels to check! Maybe I should see an endo. My doc will look at me as if I’m from Mars I’ve I start asking for all those tests. From what I know all he’s ever checked were vitamin D levels, and T levels. I did start eating better and have been taking a lot of vitamin C, omega 3, CLAs, and vitamin B. I feel better but I still don’t feel 100%. On some days I feel okay UNTIL I take the test cream. Then I feel run down.

12

Almost forgot these…

Age = 34
Weight = 196
Waist = 34-35

13

I’m glad I just ran across this. I’ve had an issue for several years and finally got to an endocrinologist that will be running an ACTH test on Friday for me. My ACTH level was 5.7 and he said normal was 7.2-63. I’ll be reading that article noted above for sure.

14

So the real issue here is how do you treat adrenal “fatigue”/insufficiency/whatever. Adrenal fatigue is considered to be BS by most doctors. The problem is that (theoretically) taking hydrocortisone (synthetic cortisol) would only further suppress your natural production of cortisol. This could be dangerous. You cannot live without cortisol. Furthermore, prolonged elevation of corticosteroid levels can have its own myriad of unintended side effects.

I am a member of another forum where a few people with “adrenal fatigue” have really gotten screwed up by using hydrocortisone. Look up cushing syndrome and see what could happen if you take too much cortisol.

Is the best thing to find out what is causing the cortisol problem and then treat that, with hydrocortisone being a last ditch option? I think so. That is my humble opinion.

I would ONLY rely on an ACTH stim test to reach final conclusions about the status of adrenal gland activity. Doing otherwise could be VERY VERY counterproductive. The validity of saliva cortisol tests is often questioned.

I am not a doctor by any means, but I do know that you need to be careful with the adrenal glands. You can live without testsoterone (albeit a shitty existence), but you will run into big time problems with low or high cortisol levels. That being said, if you do indeed have a problem, you should investigate it, but use the stim test!

15

I agree. I’m more concerned about why I have this problem. I’ve gained 40 lbs in 2 years and have exercised by lifting weights and cardio and eating between 1600-2200 depending on what a doctor, trainer, dietician tells me and nothing works. It took me four months to get into the endocrinologist. I have to trust that this doctor knows how to treat me but I’m really not thrilled about taking a steriod type drug.

I have terrible water retension issues and even with an RX still have swollen almost pregnant looking ankles and such.(I’m a woman)
I really don’t want to just take a medicine to help symptons I want to be better.
I’m just frustrated about working so hard and never seeing any results.

16

I agree with the above about working hard, and seeing very little results. I was busting my butt in the gym, but I wasn’t getting any bigger at all. I have to have some kind of adrenal condition based on what I wrote above. But I also had my T levels tested and they are seriously below normal. I just turned 35 last week. I’ve been feeling cruddy for 8 years now. So my condition must have started then. I had been playing with a psychiatrist because everyone told me I was clinically depressed. That got me nowhere. I don’t have insurance right now so I can’t see anyone. Very irritating. So I have hypogonadism AND an adrenal condition? Or is one causing the other? No one knows.

17

Hypogonadism can burn out your adrenal glands. At least that’s what I’ve heard. There’s a study out there in mice that shows how low estrogen levels (which is a secondary consequence of low T) shortens the telomeres in your adrenal gland DNA. This prematurely ages the adrenal glands (in mice).

But yes it is pretty much a chicken or the egg situation. Are you treating the low T? If so, how? The symptoms of adrenal problems and low T overlap a lot. Trust me, I know this from experience.

18

That’s what’s frustrating me. Around the age of 27 or 28 I started feeling really rundown. I exercised and ate a good diet, but I felt dead. I went to see the doc and he gave me psych meds. That didn’t change anything. I was told I was unmotivated and needed a life goal, blah, blah, blah. I started med school at 30. It had been a lifelong dream. That was impossible. I didn’t have the energy or the drive to study, and I failed a class by 4 points. I got suspended and never went back since as more time went by I felt more sluggish, tired, and depressed. I went from job to job after that. I felt super insecure and nervous all the time because I didn’t know what was happening. I beat myself up quite a bit. I was a loser. I didn’t care. I needed to pick myself up by the bootstraps, etc. Then last year I was no longer able to get out of bed. I was too tired.

Of course, family came by and helped with the whole you don’t care about anyone. Get up! Loser! Blah, blah, blah again. So I tried that. The result was that I would heavy breath as if I just jogged mile. Then I would get dizzy and fatigued and end up on the floor to rest. I went to the doctor, and he said that maybe we should test hormones. So we did and these were the results:

Vitamin D3 = 31
Vitamin D2 = <4
TSH, 3rd Generation = 0.75
T4, Free 0.8
T3, Free = 321
DHT = 17L
T Total = 78L
T Free = 17.3L
T Bioavailable = 35.6L
Estradiol = 20

Around this same time I started getting so fatigued about three to four times a day that I would have to lie down for at least ten minutes. I was at Wal-Mart, and the fatigue hit me so hard I had to sit down in the grocery aisle. I told my wife to just leave me on the floor. The doc gave me T gel. I immediately felt better! I was alive! I couldn’t believe it! Then after a week all the good feelings went away. The fatigue wasn’t as bad, but I felt nauseous and tired. I took prednisone one day for my inflamed joints and got that wonderful feeling back! But that went away as well.

Where I am now…I have no job, and no insurance. I take what’s left of my T cream from a compounding pharmacy, (I can’t afford a doc visit, blood test, and refill of the cream right now) but still, from around 11Am to 3PM I feel dead tired. I even have to lie down and sometimes I fall asleep. If I take prednisone I have energy throughout the day. But I was told that if I do have a cortisol issue taking pred could kill me because my body would stop making cortisol. So I stopped that.

From what I’ve read there’s more to T replacement than just taking T. I know that. But at this time I’m unemployed, with no insurance, and I’m supporting a wife, a daughter, and a newborn on 1100 a month from unemployment. I don’t qualify for Medicaid because I make too much money. (???)

So, what it comes down to is either meds or pay bills, buy food, and pay for rent. I work in computers (Linux and Windows servers) but can’t find a job. Even if I did I’m so fatigued and my thinking is so “muddy” at times that I might end up losing the job. So…I need to see a doctor to get well in order to feel normal and work. In order to see a doc and buy meds I need a job. So I feel trapped and VERY angry at times. :frowning:

What I’m going to have to do is to find any job right now. Take stimulants to get through the job for the next three months. Get insurance. See a doctor and get my issues straightened out, and then get a better job.

I’m thinking that since I’ve had this T issue for years now, without knowing it, that I probably burned my adrenals out and now cortisol is messed up. I’m eating right, taking lots of vitamin c, and exercising. Hopefully I should feel a little better, right? Man, I hope so.

19

Wow, you really seem like you have had it rough. I’m tired but not like you state. Although I certainly don’t want it to get that way!
My plan is to take the test tomorrow and get a copy of all my results. Then do a ton of research and also see what the doctor says next. This is the most progress I have made in two years with a doctor so the fact that they even found something that was not “normal” made me happy. I know crazy but I wanted to have validation that all the physical and mental signs I was experiencing were not just in my head.
I’ll be praying for you and your situation and I’ll visit back here after I get my test results if you are interested.

20

Please use the edit button and add lab ranges to your post above.

Are you getting sun exposure? Your body can make vit-D3, 10,000iu per day.

Find some DHEA on a vitamin shelf and take 50iu per day and see if that is helpful.

Your E2 looks reasonable, but with T so low, that makes you estrogen dominant. You do not appear to have HPTA inhibition from E2 levels.

Your afternoon fatigue could be adrenal fatigue. If you feel better with DHEA during those times of the day, your body may be making more cortisol with restored DHEA levels.