T Nation

T Up 65% in a Month. LH Doubled. How?

Been lurking for a few weeks and have learned a tremendous amount. KSMan, ctastrophe et al are more knowledgeable and empathetic than any of the doctors I’ve seen lately. A hell of a lot cheaper, too

A little background: I’m 36 and have dealt with fatigue and sleep problems for most of my adult life. 15 years ago I was diagnosed with Narcolepsy. Since then I have relied primarily upon stimulants (adderall, ritalin, etc.) and caffeine to stay awake. I’ve tried tons of different meds – Xyrem, Provigil, Wellbutrin, to name a few – and they were either ineffective or the side effects intolerable.

Recently, I began looking into alternative sources of energy. (Being perpetually zonked on stimulants tends to lose its appeal after a decade or so.) So I decided to get my testosterone checked. Here are my labs (all testing done at LabCorp):

Test #1: 8/21/12, 9:51 am, non-fasting

Testosterone, serum 461 ng/dL (348-1197)
Free Testosterone (Direct) 8.1 pg/mL (8.7-25.1)

Concerned by the low-ish levels, I sought out the aid of an Endocrinologist, who had me re-tested:

Test #2: 9/4/12, 8:45 am, non-fasting

Testosterone, serum 584
Free Testosterone (Direct) 11.3
LH 2.3 mIU/mL (1.7-8.6)
FSH 2.9 mIU/mL (1.5-12.4)
Prolactin 15.1 ng/mL (4.0-15.2)
TSH 1.24 uIU/mL (0.45-4.5)
Free T4 (Direct) .87 ng/dL (.82-1.77)

Perhaps not surprisingly, the Endocrinologist concluded there was nothing wrong and decided to take no action. Subsequent research in the T-Nation forums convinced me to get my Estradiol and SHBG levels checked, which I did, along with the other essentials, two weeks later:

Test #3: 9/20/12, 9:20 am, fasting

Testosterone, serum 767
Free Testosterone 12.1
LH 4.9
FSH 4.1
Estradiol (Roche ECLIA Methodology) 24.7 pg/mL (7.6-42.6)
SHBG 49.4 nmol/L (16.5-55.9)

Needless to say, I was pretty surprised by the latest numbers.

When I took the first test, I had been off Adderall for over a month – my first extended stimulant break in half a decade – and had been almost completely sedentary during that period. Shortly after the first test, I went back on Adderall.

After the second test, I started taking 4000 IU of D3 daily. I also got a couple of B12 shots, which I’d never tried before. Other than that, my basic lifestyle (diet, exercise) remained the same.

I am encouraged by the improvement, but also a bit perplexed. Any theories on why my levels jumped so quickly? Could it really be attributed to the Adderall, D3, and/or B12? What about the fact that I was fasting before the third test?

Any advice on where to go from here? My energy has improved a bit but I’m still plagued by apathy, brain fog, and low libido. I am grateful for any input. Thanks

Endo said nothing about your prolactin ?

Nope. Endo has been pretty worthless. From what I’ve read in these forums, that’s not entirely unusual :slight_smile:

You are at the top of the range, it should have made him at least interested.
Check this article out http://www.sharedjourney.com/malediagnosis/prolactin.html
With your test rising, and E2 at a decent level, I’d bet your prolactin level is
giving you the fatigue and brain fog.

I don’t think fasting before a T test would have an impact. D3 and B12 probably helped… and T levels tend to be highest in the morning. But a 200 point jump in a couple of weeks is quite a bit.

Prolactin won’t help as stated above. Also I’m curious why your SHBG levels are so high. If those came down it would improve the free T levels.

Thanks for the Prolactin link, PKNY. Looks like I’ll have to look into finding a doc who’s willing to treat borderline-high levels.

I was curious about the SHBG levels too. But from what I’ve read (not a whole lot, admittedly), it sounds like a pretty tricky thing to treat.

[quote]Cygnus X-1 wrote:
Thanks for the Prolactin link, PKNY. Looks like I’ll have to look into finding a doc who’s willing to treat borderline-high levels.

I was curious about the SHBG levels too. But from what I’ve read (not a whole lot, admittedly), it sounds like a pretty tricky thing to treat.
[/quote]

As best I can tell somethings make SHBG go up, some things make SHBG go down, but these are almost always secondary to other treatment goals (raising T on TRT or lower E2) and there isn’t a really direct way of adjusting it without throwing your original treatment goals out the window.

I’d love for someone to tell me otherwise as I’m low now.

From what I’ve read, Winstrol and a few other steroids are often used to bring SHBG down, but I’d prefer to try something a little less drastic first. Am looking into doctors but it’s hard to tell over the internet if a practitioner is “open-minded” (but credible) or a complete charlatan. And trial-and-error with physicians can be a costly process.

My testosterone roller-coaster ride continues. Latest labs:

10/11/12, 8:30 am, Quest Diagnostics

TT: 384 (250-1100)
Free T: 74.5 pg/mL (35.0 - 155.0)
FSH: 3.4
LH: 3.9
Prolactin: 8.1

Cortisol: 8.6 mcg/dL (4.0 - 22.0)
Glucose: 86

Total Cholesterol: 145
HDL: 51

I’m going to go ahead and assume the 767 from last month was an anomaly. If anyone can recommend a decent doc in the L.A. area, feel free to PM me. Otherwise I’ll be calling around to compounding pharmacies tomorrow…

You need to get cholesterol increased, all of your ‘steroid’ hormones are made from that.

Take a high potency fish oil product. And try a lot of it. Your brain needs to get rewired and your brain needs essential fatty acids as an essential building material.

Cortisol is way too low, that can make you drag your butt. You may have adrenal fatigue. Search that term here and “rT3”.

LA docs can have a cash flow entitlement attitude.

You may be a bit estrogen dominant, might have some progress with 1/2 mg anastrozole per week.

Thanks KSMan. I will head straight to the pub and load up on fish & chips. Take care of the cholesterol and fatty acids in on fell swoop! As a backup, I’m looking into picking up a bottle of Flameout. Will that do the trick?

I will go ahead and get RT3 tested, hopefully by the end of the week.

Not sure how best to move forward on the Cortisol issue. I imagine docs will be a bit reticent to prescribe me Cortizone pills.

Can one be “estrogen dominant” even if their Estradiol level is normal? Mine seemed okay (24.7) when I last got it tested.

Thanks again for the input! Much appreciated.

I’ve had moderate success raising my cortisol. Check out my serm restart thread.

When T levels are low, E2 levels that seem low still make the T:E2 ratio unfavourable.

Thanks dhickey/KSMan. I checked out the serm restart thread, dhickey, and it looks like we have some similar issues, so I will be watching your progress intently.

I finally found a good doctor. She’s extremely knowledgeable and yet very open-minded as well. She knows more about sleep disorders than most of the sleep docs I’ve seen. (Unfortunately, she’s also a two-and-a-half hour commute away. Sigh.) We met on Wednesday for over an hour and covered EVERYTHING – testosterone, thyroid etc. – and the impression I get is that she is open to trying pretty much anything.

She pointed out that all of my sleep studies have shown an abnormal number of Periodic Limb Movements (as seen in Restless Legs Syndrome), and that research has found the vast majority of PLMD/RLS sufferers to be iron deficient. The deficiency is in the cerebrospinal fluid (CSF) and NOT the blood, so labs can appear normal. (http://www.ncbi.nlm.nih.gov/pubmed/15743333) My Hemoglobin is a little low but my other iron values (ferritin etc.) are in the reference range, albeit on the low end, usually.

Incidentally, I looked up info on iron after our appointment and there’s some evidence that iron deficiency can play a role in low cortisol.

She proposed starting me on Iron supplements first, then Magnesium (my level’s on the low end of the ref range), then, if necessary, testosterone and/or thyroid meds (my Free T4 was 0.5 last time it was checked). I was kind of impatient to start feeling better NOW, so she agreed to give me a 200mg shot of Depo-Testosterone (Cypionate) to evaluate its effects, then start on the Iron in a week or so.

So far it’s been a little over 36 hours since the injection, and I can’t say I’ve noticed much, save for an improved outlook and sense of optimism. But I’m inclined to attribute that to finding a doctor who gives a damn. (It is remarkable what a difference it makes, on a purely psychological level, to see a doctor who cares – or appears to, at least.) Energy level is more or less the same, but I feel more “vigorous,” for lack of a better word. Read into that what you will.

Iron is stored in the body and levels will build. One can have too much.

Calcium and magnesium are needed in large amounts. Need continuous amounts. Ca metabolism needs cobalt, copper and vit-D3. Most should be taking 4-6,000 units per day. You are there already.

200mg injection will spike E2 and when the T is gone, you still have E2. You should get on the protocol and tell doc what you want to start with.