T Nation

Trying to Find the Source of the Problem

Age: 31 (in June)
Height: 5’10"
Weight: 200
Waist: 34
Body/Facial Hair: Little hair on chest and not hairy/No real thick hair. My facial hair is kinda patchy and is only really thick on chin.
Describe fat: My arms and legs are pretty lean, I mainly carry my fat on belly and love handles.

Health cond/history: in 2010 I was hospitalized for being in a car wreck that knocked me silly (bad concussion) and found out via an MRI that I had nodules on my Thyroid. I went to a Endocrinologist for awhile and he would just get the nodules measured to make sure they weren’t growing and told me they were small and nothing to worry about at that point. He had me do blood work and I don’t think he tested my Testosterone, just my thyroid hormones and at the time I was a idiot and just listened to him and he said everything was OK. I quit going due to the fact I felt like nothing was being accomplished and it was getting costly… Fast forward to Jan 2016 I had been feeling unmotivated, sluggish, brain fog and sex drive wasn’t what it was a few years ago. So I decided to go to get my own blood work through private MD labs (Female hormone panel) to check my Test. Well it came back around 360mg/dL with my E being less than 5pg/ml. I recently found me a Dr who proscribes TRT by contacting compounding pharmacies. I went to the appointment and basically told her Im feeling no energy or drive and wanted my testosterone checked along with thyroid. She did the test and of course my Test was low again and the only thing she did to check my thyroid was check my TSH.

RXs: just Test-C 100ml per week (haven’t injected yet)
Diet: has been terrible for past three months, but before that I tracked macros and ate a decent amount of fat and was eating at maintenance and tried to eat a lot of healthy fats and protein, more of a bodybuilder diet.
training: been off and on for about two months, before that it was weights 4x a week (m,t,t,f) defiantly was not overtraining.
testes do not ache
morning wood: sometimes, but not that often and nighttime erections seem to get them for afew days then none for awhile.

first lab results (got tested on my own)
Ill post the others when I get home tonight and get access to the labs my Dr took.

Date: 1-7-16
Testosterone, Serum 366 Range 348-1197 ng/dL
Estradiol <5.0 Low Range 7.6-42.6 pg/mL
hematocrit 45.0 Range 37.5-51.0%
FSH 4.2 Range 1.5-12.4 mIU/mL
LH 5.0 Range 1.7-8.6 mIU/mL
WBC 6.4 Range 3.4-10.8 x10E6/uL

That was my first set of blood work I got on my own. I just got blood work done through the Dr and it didn’t include a full thyroid panel or prolactin or cortisol. I will post results from recnt blood work later.

I have ordered new blood work for Monday, on my own through private MD Labs. I plan on getting the Thyroid Panel along with AM cortisol since they weren’t included in my Dr.'s office blood work. Is there anything else I should include in my blood work for Monday? I want to figure out what is causing my low testosterone before I jump on the lifelong commitment of the needle at the age of 30.

I have also been checking my temps for the past few days and upon waking it is 97.2 on average and three hours later 97.6 and later in the day it gets up to 98.6.

I just want to know if this is something I can fix on my own by doing IR or is it my pituitary gland from my concussion? After reading these forums I am confident I will be able to get the help I’m looking for here. Thanks

Heres my current lab work from my Dr:

Testosterone 323 (348-1197 ng/dL)
Free Test (direct) 9.8 (8.7-25.1 pg/mL)
Cholesterol, total 222 (100-199 mg/dL)
LDL/HDL Ratio 2.4 (0.0-3.6 ratio units)
LDL 147 (0-99 mg/dL)
Triglycerides 70 (0-149 mg/dL)
HDL 61 (>39 mg/dL)
TSH 1.130 (0.450-4.500 uIU/mL)
DHEA-Sulfate 349.9 (138.5-475.2 ug/dL)
Hemoglobin A1c 5.2 (4.8-5.6%)
Estradiol <5.0 (7.6-42.6 pg/mL)L
WBC 6.6 (3.4-10.8x10E3/uL)
RBC 4.98 (4.14-5.80x10E6/uL)
Hemoglobin 15.6 (12.6-17.7 g/dL)
Hematocrit 45.0 (37.5-51.0%)

Please let me know what other blood work I need to order . Thanks

Your body temps are indicating a problem.

Have you read the thyroid basics explained thread?

What is your history of using iodized salt?
Outer eyebrows sparse?
Dry skin?
Feel cold easily?

Nodules can be from high TSH caused by low iodine. The nodules can start to produce thyroid hormones and then TSH lower and can get very low in hyperthyroidism.

Car wreck may have damaged your pituitary gland. Best eval fo that is a MRI.

fasting glucose
fasting cholesterol

I’m going tomorrow to get my Thyroid Hormone bloodwork along with cortisol and I added prolactin as well.

I do not use a lot of salt on anything.
My outer eyebrows are defiantly not thick but not bald.
I do have dry-ish skin but I wouldn’t say its super dry or flaky.
As for feeling cold I think I do and mostly my hands and feet.
I also have noticed lately that my fingernails have been becoming jagged and getting chips in them.
I woke up today at 7AM and temp was 96.5 then checked three hours later with a temp of 97.4 and just checked it again at 5:30PM and it is currently 98.6

Definite iodine deficiency and low thyroid function.

Do labs at 8AM.

Have you read the thyroid basics explained thread?

Yeah I read that thread, that’s why I got the thyroid panel… For some reason it didn’t include t3… Here are the results:

TSH 1.280 (0.450-4.500uIU/mL)
T4,Free(Direct) 1.24 (0.82-1.77ng/dL)
Triiodothyronine,Free,serum 2.7 (2.0-4.4pg/mL)
Cortisol AM 11.1 (6.2-19.4 ug/dL)
Prolactin 42.8 (4.0-15.2ng/mL)

Ok why is prolactin so high? What’s that mean? I gave the iodine ordered for IR… Do you believe that’s tbe source of my low test?

TSH is not bad.
fT4 is nearly midrange
fT3 is well below midrange
AM cortisol is marginal good, but time of day dependent

prolactin is a serious issue. Ask for a MRI to screen for a pituitary adinoma. Maybe a confirming prolactin lab first, without any sex or orgasms for a few days prior, and hugging babies and puppies can also increase prolactin.

prolactin is HPTA repressive, lowers T, but there can be many/multiple causes.
condition can be managed well with 0.5mg/week dostinex/cabergoline
Have you lost any width of peripheral vision? Should be almost 180 degrees.

Body temps are low, fT3 seems to be the cause.

I don’t think I’ve lost any peripheral vision… Should I still do the IR protocol? And can this be fixed without TRT? I do have a 1 year old baby.

even with the prolactin being high do you think I also have ID? Also if the cause of low T is from ID would IR help T levels get back to normal, or would you have to go on TRT still?

Hello there i am 31 years of age and have been fit my whole life when i reached 28 i started declining in a big way until i turned thirty no doctor would see me that specializes in trt which i thought was the rout of my problems. At 30 i went for a full blood screen through a company called Andrologix in Florida and of course my levels were very low. Ever since i have been on trt i take 1/2 ml twice a week Hcg twice a week and anastrazol i feel like new. I recently also added ephedrine pill with b12 and caffeine which also helps me pump through my circuit training. The thing i really liked about them is that they cared for my well being and not just my money cause after screening many companys that do this most were in it for the dollar.

I would not assume any connection between prolactin levels and ID.
I have seen some cases where treating hypothyroidism allowed T to recover, but many cases where that did not happen.

The key point is that fT3 is what really makes things happen in your body and that is well below midrange.
You should see what can resolve by dealing with your iodine status then see whats left that is thyroid related. Dealing with prolactin is a separate path.

I’m almost done with week 2 of IR protocol. My morning temps upon waking are usually around 97.4 and my daytime temps are getting up to over 98.6… Should I still worry about the lower morning temps? Would I possibly need to get on t3?
One other question is once thyroid hormone is back in order and body temps are optimal, does that increase metabolism and help fat burning abilities?

Thyroid function, by controlling your metabolic rate has a big influence on fat burning/storage balance.

98.6 during the day means things are working reasonably well. Would be better if AM temperatures were better. Doing thyroid meds in this case is difficult call to make. One can always try meds and see if your quality of life increases. You do want to avoid meds if possible.

If you are getting to 98.6F, one can argue that rT3 cannot be a problem.

What time of day were your thyroid labs done? - looking for the temperature implications. Perhaps fT3 is OK in the afternoon.

A [prolactin secreting] adinoma can press on the optic nerves if bigger and that can show up as reduced peripheral vision. Could holding a baby take prolactin that high? Definitely out of my knowledge base.

Do you feel any change with IR on metal clarity or energy?

Ok now today my temps are not getting there I’ve been up since 8am and it’s currently 2:20pm and my body temp is 97.8… I have no idea where to go from here… I’ll test again at about 5pm and see if it goes up any.
I have a dr appt and I’m going to bring up the high prolactin. Is there anything else I need to bring up or ask about? Basically all my dr knows as of now is I have low t

My Dr appt is this Wednesday and I have been checking my temps with a exergen forehead scanner… I have a cheap CVS digital oral thermometer that Ive been using at work… with it I’m getting higher temps. I dunno what to do from here.

Fever thermometers are often not good enough for what we are concerned with.

Ok… the Dr did another test for prolactin levels and it was high again… I am being referred to an endo. I hope I can figure out the source of this problem and get my test levels up naturally.

I’ve been researching a little and I no believe I have Cushings Syndrome brought on by a pituitary tumor.

I do not have ALL of the symptoms.

I do have fatty deposit around my upper back (buffalo hump) and around neck area of my face. The buffalo hump is not an extreme one, but is defiantly noticeable. I thought it was from bad posture until reading about Cushings.

I also have fat around my mid section and lower body fat on both my arms and legs.

I’m obviously not positive that’s what I have, because I have looked at the symptom list and I don’t have all of the symptoms. Possibly I have a “minor” case of Cushings?

Here are the listed symptoms on WebMD:

Your case might be different than someone else’s, but when the disease is full-blown, common symptoms are:
•Rounded, rosy face ( my face feels rounded and not lean as it used to be… figured was just chubby)
• Weight gain, especially upper body (Yes around mid section not extreme)
•A fat pad in the upper back or base of the neck (yes on upper back)
•Thin arms and legs (yes)
• Acne (Not much)
•Being very tired (yes sometimes)
•Weak muscles, especially when using your shoulders and hip muscles (not much)
• High blood pressure (been getting high readings at last few Dr visit)
•High blood sugar levels (Not sure)
• Depression and anxiety (Nope)
• Osteoporosis (No)
• Kidney stones (No)
• Sleep problems (Yes, but have small children who don’t allow good sleep)
•Extra hair growth on your body and face (No)
•Low sex drive and problems having an erection ( my Sex drive not what it was, but get erctions when I need to. Im just not in the mood as often)

I will defiantly mention all this to the Endo when I go to my Appointment.

I hope this is not what it is, because I read that you have to have surgery to have the tumor removed for cushings. I don’t have much sick time at work due to being a newer employee and they advise to take 3-4 weeks minimum off of work after the surgery.

If this I what it is, I haven’t gained a lot of fat or lost a lot of muscle despite my poor eating habits and lack of gym going in the past year. I still look like I lift with a shirt on, but the chub shows when I don’t have a shirt on.

This is just so frustrating. I just want this fixed and back to normal. I know this is a long road ahead of me BUT I want this problem fixed YESTERDAY!

But your Cortisol AM 11.1 (6.2-19.4 ug/dL) contradicts that.

Would it make a difference what time the blood was drawn? Looking at the results, it shows the blood was drawn at 10:50AM. My appointment was earlier but the labcorp I went to was horrible and running way behind that day.