T Nation

Time to Take Action


#1

Hey everyone. I've been lurking for the last few months and trying to learn as much as possible. I was desperate enough from a multitude of long-term symptoms that I wasted who knows how much on bullshit supplements, doctors of all types, as well as countless hours reading and searching for info, and years of my life feeling like dogshit.

I came across this place and, after having checked out just about everything else, started to think maybe I had a hormone problem. I found a local doctor who seems attentive and motivated, and he sent me off for my labs, and so here I am with "My Thread". I haven't begun any supplements or regimens of any kind, so I'm a blank slate.

I won't bother recounting my symptoms. Suffice to say, like many of you, my symptoms can best be described as "all of them" and "severe", but having been an athlete, a veteran, and growing up in a difficult home environment, some of us are fortunate enough never have been poisoned with the entitled idea that anyone gives a shit how you feel. In other words, despite suffering from constant exhaustion, anxiety, etc, I have put one foot in front of the other and held shit together.

Seems to be the story for a lot of guys, which is probably why most people don't take these issues seriously. Anyway, enough of that. I did my numbers and as far as I can tell they're not good. Doc is concerned as well:

Sex: M
Age: 34
Body: 5'11" 180, 15% BF or so

(Quest did the test)

Test name: My numbers (ref range)
TSH: 2.04 (0.4-4.5 mIU/L)
T4, FREE: 1.0 (0.8-1.8 ng/dL)
T3, FREE: 2.9 (2.3-4.2 pg/mL)
T3 REVERSE, LC/MS/MS: 17 (8-25 ng/dL)

Thyroglobulin Panel
-Thyro antibodies: <1 (< or = 1IU/mL)
-Thyroglobulin: 17.2 (2.8-40.9 ng/mL)

IGF I, LC/MS: 191 (53-331 ng/mL)
Z Score (Male): .6 (-2.0-2.0 SD)

Dihydrotestosterone, LC/MS/MS: 40 (16-79 ng/dL)

Pregnenolone, LC/MS/MS: 34 (13-208 ng/dL)
DHEA Sulfate: 190 (106-464 mcg/dL)
Progesterone: <0.5 (<1.4 ng/mL)
Prolactin: 9.2 (2.0-18.0 ng/mL)
Estradiol: 21 (< or = 39 pg/mL)

PSA, Total: 0.3 (< or = 4.0 ng/mL)

Total Test: 512 (250-1100 ng/dL)
Free Test: 39.9 (L) (46-224 pg/mL)
Bioavail Test: 83.8 (L) (110-575 ng/dL)
SHBG: 61 (H) (10-50 nmol/L)
Albumin, Serum: 4.6 (3.6-5.1 g/dL)

1,25 (OH)2 Vits
Vit D total: 45 (18-72 pg/mL)
Vit D3 1,25 (OH)2: 45 (n/a)
Vit D2 1,25 (OH)2: <8 (n/a)

Vit D, 25-OH, Total: 41 (30-100 ng/mL)
Vit D3 25-OH: 41 (n/a)
Vit D2 25-OH: <4 (n/a)

Doc doesn't seem to have an idea where the low T numbers are from yet. Job and commute require that I'm on my ass a lot of the day, but I make myself get in a good workout at least four days a week, focusing on squats, deadlifts, etc. I eat plenty of cholesterol in meat, eggs, etc, and eat well otherwise (I drink a giant kale shake wit other vegetables and nuts and coconut oil every morning). From sports and the military I've had several severe concussions, and I was concerned about it since I have been reading it can affect hormone production, but doc says that this kind of deficiency would be accompanied by elevated Prolactin. Main issues are fatigue (which i push through, if barely), anxiety and depression (which I manage, if barely), very low sex drive and function (which I, perhaps unconsciously, found a way around by getting a conservative religious girlfriend), and, worst of all for my line of work (my day job is for the DoD, but I devote a lot of time to my long-form history podcast), the mental fog, memory gaps, and inability to focus is debilitating.

Since I'm only 34, doc wants to try a few things before going straight to TRT. On Monday, I'm going in to get:

Clomid - (don't remember dosage)
Anastrozole - 1 mg p/week

Pregnenolone - 60 mg
7 Keto DHEA - 100 mg

A Vitamin D supp

Then we'll reassess and check my bloodwork in a month to see how I respond. I'm not sure what kind of results to expect at the end of that month, or what would merit a change.

Current medications:
-Excedrin or Ibuprofin for headaches 2-3 times a week
-Imitrex for migraines 1-2 times per month (severe migraines and headaches used to -occur 4-6 days a week, but I've managed to control them via lifestyle)
-Provigil 3-4 days a week for fatigue (try to avoid taking it regularly, but I've got a long commute and often I can't stay awake)

-Very rarely drink (once a month I'll have a beer or two)
-Don't smoke
-No hormones or steroids in the past
-No drugs except mushrooms, mescaline, DMT, but it's been 3-4 years since I've done any of that

Well that about covers it for now. If you're still reading to this point, i do appreciate it. I'll do my part and keep a log of my daily experiences, sleep habits, food intake, medications, and bloodwork in order to hopefully learn my responses and add a grain of sand to the body of knowledge being developed here.

If anyone sees anything that jumps out or has any advice, like I said, I'm a blank slate. Thanks again.


High SHBG - Should I Worry?
#2

[quote]El Chaos wrote:
Hey everyone. I’ve been lurking for the last few months and trying to learn as much as possible. I was desperate enough from a multitude of long-term symptoms that I wasted who knows how much on bullshit supplements, doctors of all types, as well as countless hours reading and searching for info, and years of my life feeling like dogshit.

I came across this place and, after having checked out just about everything else, started to think maybe I had a hormone problem. I found a local doctor who seems attentive and motivated, and he sent me off for my labs, and so here I am with “My Thread”. I haven’t begun any supplements or regimens of any kind, so I’m a blank slate.

I won’t bother recounting my symptoms. Suffice to say, like many of you, my symptoms can best be described as “all of them” and “severe”, but having been an athlete, a veteran, and growing up in a difficult home environment, some of us are fortunate enough never have been poisoned with the entitled idea that anyone gives a shit how you feel. In other words, despite suffering from constant exhaustion, anxiety, etc, I have put one foot in front of the other and held shit together.

Seems to be the story for a lot of guys, which is probably why most people don’t take these issues seriously. Anyway, enough of that. I did my numbers and as far as I can tell they’re not good. Doc is concerned as well:

Sex: M
Age: 34
Body: 5’11" 180, 15% BF or so

(Quest did the test)

Test name: My numbers (ref range)
TSH: 2.04 (0.4-4.5 mIU/L)
T4, FREE: 1.0 (0.8-1.8 ng/dL)
T3, FREE: 2.9 (2.3-4.2 pg/mL)
T3 REVERSE, LC/MS/MS: 17 (8-25 ng/dL)

Thyroglobulin Panel
-Thyro antibodies: <1 (< or = 1IU/mL)
-Thyroglobulin: 17.2 (2.8-40.9 ng/mL)

IGF I, LC/MS: 191 (53-331 ng/mL)
Z Score (Male): .6 (-2.0-2.0 SD)

Dihydrotestosterone, LC/MS/MS: 40 (16-79 ng/dL)

Pregnenolone, LC/MS/MS: 34 (13-208 ng/dL)
DHEA Sulfate: 190 (106-464 mcg/dL)
Progesterone: <0.5 (<1.4 ng/mL)
Prolactin: 9.2 (2.0-18.0 ng/mL)
Estradiol: 21 (< or = 39 pg/mL)

PSA, Total: 0.3 (< or = 4.0 ng/mL)

Total Test: 512 (250-1100 ng/dL)
Free Test: 39.9 (L) (46-224 pg/mL)
Bioavail Test: 83.8 (L) (110-575 ng/dL)
SHBG: 61 (H) (10-50 nmol/L)
Albumin, Serum: 4.6 (3.6-5.1 g/dL)

1,25 (OH)2 Vits
Vit D total: 45 (18-72 pg/mL)
Vit D3 1,25 (OH)2: 45 (n/a)
Vit D2 1,25 (OH)2: <8 (n/a)

Vit D, 25-OH, Total: 41 (30-100 ng/mL)
Vit D3 25-OH: 41 (n/a)
Vit D2 25-OH: <4 (n/a)

Doc doesn’t seem to have an idea where the low T numbers are from yet. Job and commute require that I’m on my ass a lot of the day, but I make myself get in a good workout at least four days a week, focusing on squats, deadlifts, etc. I eat plenty of cholesterol in meat, eggs, etc, and eat well otherwise (I drink a giant kale shake wit other vegetables and nuts and coconut oil every morning). From sports and the military I’ve had several severe concussions, and I was concerned about it since I have been reading it can affect hormone production, but doc says that this kind of deficiency would be accompanied by elevated Prolactin. Main issues are fatigue (which i push through, if barely), anxiety and depression (which I manage, if barely), very low sex drive and function (which I, perhaps unconsciously, found a way around by getting a conservative religious girlfriend), and, worst of all for my line of work (my day job is for the DoD, but I devote a lot of time to my long-form history podcast), the mental fog, memory gaps, and inability to focus is debilitating.

Since I’m only 34, doc wants to try a few things before going straight to TRT. On Monday, I’m going in to get:

Clomid - (don’t remember dosage)
Anastrozole - 1 mg p/week

Pregnenolone - 60 mg
7 Keto DHEA - 100 mg

A Vitamin D supp

Then we’ll reassess and check my bloodwork in a month to see how I respond. I’m not sure what kind of results to expect at the end of that month, or what would merit a change.

Current medications:
-Excedrin or Ibuprofin for headaches 2-3 times a week
-Imitrex for migraines 1-2 times per month (severe migraines and headaches used to -occur 4-6 days a week, but I’ve managed to control them via lifestyle)
-Provigil 3-4 days a week for fatigue (try to avoid taking it regularly, but I’ve got a long commute and often I can’t stay awake)

-Very rarely drink (once a month I’ll have a beer or two)
-Don’t smoke
-No hormones or steroids in the past
-No drugs except mushrooms, mescaline, DMT, but it’s been 3-4 years since I’ve done any of that

Well that about covers it for now. If you’re still reading to this point, i do appreciate it. I’ll do my part and keep a log of my daily experiences, sleep habits, food intake, medications, and bloodwork in order to hopefully learn my responses and add a grain of sand to the body of knowledge being developed here.

If anyone sees anything that jumps out or has any advice, like I said, I’m a blank slate. Thanks again.[/quote]

SHBG is high which I believe is why your free t and bio avail t is low even though your total t seems normal.

rt3 is in range but could probably be lower and will block t3 at receptors.

No cortisol test? Usually one for morning, aftenoon, evening and late evening is best.

TSH should be closer to 1.0. Log your waking body temperatures immediately when waking before drinking etc for a few days. You should be 97.4 or higher. Also make sure you can reach 98.6 by afternoon. Do you use an iodine supplement? Use iodized salt throughout life? Could be iodine deficient affecting your thyroid. Make sure you take selenium with iodine.

Your docs response is thoughtful, although keto 7 dhea will not metabolize into dhea or dhea sulfate unless I’m mistaken.

Hopefully someone with a bit more knowledge can chime in as well.

Also read all the stickies in the trt section. Learn as much as you can and good luck.


#3

Thanks for the response. I’ll start logging my waking body temp tomorrow. I go in to see my doc again this week and I’ll schedule a set of cortisol tests as well.

I began taking an iodine supplement after reading the thread here about it a month or two ago. I have typically always been hot when everyone else around me (male and female) are cold, and I am most comfortable with my air conditioner at about 64 or lower. I frequently wake up at night sweating through the sheets despite it being cold as balls in my apartment.

Supplements I take are:
Iodine
ZMA
B-complex w/L-5-methylfolate (I’m a homozygous MTHFR)
That’s usually about it… Maybe some valerian or melatonin when I can’t sleep…

I’m keeping a detailed log and I’ll update weekly:

Wake time
Waking temp
Waking feeling (good/neutral/shitty)
Breakfast
10 am feeling
Saytime temp
Workout
Daytime food
2 pm feeling
Evening food
Nighttime feeling
Supplements
Bedtime

Not that anyone wants all that information, but I’ll try to make myself useful by isolating variables and discerning trends.


#4

Oh, also… I can’t be sure that this is related cortisol levels until I measure, but I wake up every morning with jaw and neck pain from clenching my jaw so tightly all night. Struggle with it during the day as well, despite having no more than a cup of coffee of caffeine most of the time. In addition to the tight jaw upon waking, I often have an elevated heart rate (not always - typical waking heart rate is around 55 - but a couple times a week I’ll wake up with a clenched jaw and a heart rate of 80-90 bpm for no reason I can track).


#5

Depression could be behind a lot of your symptoms, including: fatigue, lack of motivation, loss of libido, and sexual dysfunction.

You don’t mention you’re taking any medications for it, but some can really kill the last two. I speak from bitter, personal experience. :slight_smile:

Have you looked into working with a psychologist and see if you can manage the depression better? That’s where I’d start (or have started in my case), and see if that helps resolve some of the problems.

What I did find interesting about your case is that your total testosterone, SHBG and albumin are in the same ballpark as mine, but your free testosterone level is way lower. Yours was measured, whereas mine was calculated. I wonder where the discrepancy crept in.


#6

AM cortisol, at 8AM please
fasting cholesterol [could be too low, undermining pregnenolone, DHEA etc
fasting glucose
CBC
hematocrit
AST/ALT

You can try 25mg DHEA

pituitary can be mechanically damaged, nothing to do with a prolactin secreting pituitary adinoma

you are a bit estrogen dominant relative to your FT level
1mg anastrozole per week will crash E2 and make you feel worse, try 0.5mg in EOD divided doses, which might also be too much
dissolve anastrozole in vodka, 1mg/ml and dispense by the drop, count drops per ml and to the math

Have you been getting selenium in your vitamins long-term?
essential for thyroid

TSH: 2.04 (0.4-4.5 mIU/L)
T4, FREE: 1.0 (0.8-1.8 ng/dL)
T3, FREE: 2.9 (2.3-4.2 pg/mL)
T3 REVERSE, LC/MS/MS: 17 (8-25 ng/dL)

TSH should be nearer to 1.0
fT4 should be near 1.3, you are low
fT3 should be near 3.25, you are low
Please post your body temperatures
What was your long-term history of use of iodized salt?
Thyroid sore, enlarged, lumpy or asymmetrical?

Muscle cramps or muscles tend to want to lock up? That would be a magnesium deficiency.

E2 drives SHBG up. More FT or bio-T tends to drive SHBG down.


#7

Wow, thanks… I’ll get those levels ASAP.

Was at doc today and received a prescription completely out of whack from that. He prescribed:

100mg 7 Keto DHEA
60mg pregnenolone
1mg/week anastrozole
100mg clomid (50mg twice a day)

I had already taken my week’s 1mg of anastrozole before seeing your post, but if I feel shitty this week I’ll suck it up and start doing it by the drop next week.

My vitamins don’t have selenium, but I eat a couple brazil nuts 2-3 times a week just for the selenium. Is that sufficient? (I’m in the process of scheduling a SpectraCell test, so I’ll try to get all my nutrient levels soon.)

My personal use of iodized salt was zero, except for the salt they put in a Chipotle burrito or my local shawarma. I saw the iodine thread about a month ago, though, and I’ve been taking a bit of sea kelp daily since then. I haven’t noticed any physical soreness or misshapenness with my thyroid.

Magnesium is one that I’ve been pretty good about supplementing with for the last few years. Don’t know my levels, but I don’t have problems with cramps.

I’ll start tracking my temperature, and post it once I have a sample size that might be meaningful for you.

Oh, also, I’m not sure if I posted this up there, but I have a double-mutation MTHFR, as well as genetically-determined shitty ability to absorb B12 and B6 through the intestine. I just found that out about two months ago, and so I’ve just recently started taking the right kind of folate and sublingual and/or injection B vitamins.

So, I’ll come with more data next post, but I guess the questions at this point are:

  1. Should I cut back the DHEA from 100mg to 25mg?
  2. Are the 15 or so Brazil nuts a week enough selenium? (I should say that there is probably some more in my diet that I’m not tracking… every morning I down a 32 oz smoothie with some combination of kale, broccoli, spinach, beet, ginger, carrots, berries, pineapple, pumpkin seeds, almonds, chia seeds, and flax seeds… most of it stays constant except for the fruit, which I switch out to keep it interesting.)
  3. How do you feel about the 100mg clomid?
  4. Do you own this site? If so, I’ll just buy some shit to throw a bit of cash your way. Otherwise, where is your blog and fucking Donate button? The importance and quality of this information and the work you put in for people is too goddamn good to just be charity.

#8

[quote]Graemsay wrote:
Depression could be behind a lot of your symptoms, including: fatigue, lack of motivation, loss of libido, and sexual dysfunction.
[/quote]

Could be, I suppose. I’m a partially service-disabled vet (diagnosis PTSD), and my overall psychology and physical health took a nosedive after a physically and emotionally traumatizing event in 2004. Still, my childhood was one of those American horror stories they make movies about, and I came out of it pretty resilient, I think. I get the run-of-the-mill 1950s American male depression and anxiety, where you grit your teeth and don’t want to be around people, but it’s never been anything I didn’t feel like I had under full control. Whether or not it’s true, I’ve always handled anxiety and depression by telling myself that it’s usually physical in origin, and that whatever environmental causes my overactive neocortex starts grabbing onto to explain it are just stories I’m telling myself. You feel great one day, the next day you feel depressed and it’s not like anything in your life changed from one day to the next, so I just look at it like a storm coming through and drenching me. I just close the windows and wait it out, and usually a good night’s sleep and decent breakfast does more for my depression than talking through my first-world problems (not to denigrate what anyone else goes through… this is just a helpful way for me to approach things).

Several years ago, a doctor put me on a few different anti-depressants in succession in an attempt to help with migraines. Holy shit was that horrible. Nothing emotional, no suicidal thoughts or more depression or anything. I just felt sick and terrible. Paxil was the worst, holy shit the absolute worst. That was several years ago, though, and only for a few months. None of that since then.


#9

Hmm… Walking temp is 96.9…pretty low. I will keep checking each morning to make it’s not an anomaly.


#10

Please see this: https://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/hpta_restart_for_trt_guys_with_application_to_gear_and_pct


#11

Hmm… felt very depressed the last two days. Is that normal?

Not a big deal, as I’m good at just treating it like a cold or a headache and just letting it be without letting it metastasize into negative thoughts, but it does suck.

This is my sixth day of Clomid (haven’t had a chance to get in to talk to my doc about Nova) and six days since I took 1 mg of Anastrozole (hadn’t seen note about spreading it out yet). Also, 8th day of 100 mg 7 Keto DHEA and 60 mg pregnenolone.


#12

[quote]El Chaos wrote:
Hmm… felt very depressed the last two days. Is that normal?

Not a big deal, as I’m good at just treating it like a cold or a headache and just letting it be without letting it metastasize into negative thoughts, but it does suck.

This is my sixth day of Clomid (haven’t had a chance to get in to talk to my doc about Nova) and six days since I took 1 mg of Anastrozole (hadn’t seen note about spreading it out yet). Also, 8th day of 100 mg 7 Keto DHEA and 60 mg pregnenolone.[/quote]

It’s more than likely the Clomid or your e2 went too low. Clomid makes some feel depressed and horrible. If your e2 gets too low, that can also make you feel depressed and horrible. It’s not the keto dhea or preg.