T Nation

What Am I Missing? Low T, Fibro, Thyroid? Docs No Help


#1

Last year, I was 39 and coming off of a broken ankle and after several months I topped my weight at 304 lbs (at 6’2"). Closing in on my 40th birthday and having issues sleeping at night, I decided to make a change. On 4/1/2015, I quit caffeine completely (1-3 sodas/day), I started working out (weights/cardio) and eating cleaner (limiting breads, noodles, dairy and red meat).

A couple months later, I dropped a few pounds but a few symptoms started. I’m a side sleeper and I would wake up very sore, especially my the outside of my deltoids. I also started having bathroom issues. I would normally have a bowel movement 2-3 times a day and was having them 5-6 times a day. I also suddenly had some vision / brain fog / vertigo issues. I noticed an increase in fatigue but thought it was from working out and not having caffeine anymore.

Then during a routine dermatologist apt in mid September, she discovered I had a swollen lymph node at the base of my neck near my collarbone. Needless to say I started to freak the hell out, thinking I had something majorly wrong with me. I thought all my symptoms together ment something bad. I was referred to an ENT who ordered a CT scan of my neck and by the time I went back in to have my scan read, he preformed a physical examination saying my Lymph node was already normalized, CT was clear and it was probably just an infection and that was normal. Unfortunately, I was unable to recover from my mental slide and I had a period of high anxiety that started mid Oct/2015. This is VERY uncommon for me, as I am usually described as mild manner, even tempered and I would not consider myself as stressed. Looking back, I wonder if the anxiety was a symptom since it was so unlike me? I finally worked my way out mentally in March 2016 but the high Cortisol wrecked me (I think). Fatigue and digestive issues were very bad during these times.

I had a bad chiropractor visit on 3/9 that left me with muscle spasms and a sore neck. My Dr. ordered a MRI of my head and neck to rule out MS and other similar disorders. All clear. My Dr suggested that I may have fibromalgia but he ordered a Testosterone test which came back low. He’s referred me to a uralogist for a vasectomy and low T consult. Apt is scheduled in July.

Over the last 2-3 months, I’ve also noticed increased sexual issues with keeping erections, noticed some testicle and member shrinkage, erections not as hard and lower desire.

I stopped working out in January but lately I’ve been trying to get back into it. Energy levels are starting to improve a little. I bottomed out at 273lbs in March but I’m back up to 282lbs. I went over a year without caffeine but now will occasionally (once in a few weeks) have a soda.

I got glasses in February for the first time but feel like my prescription has changed and my eyes have gotten better. Feel like this was sudden but hey I am 40 now I guess.

So I’m thinking I had boarder-line T levels, working out took me to the low side. Anxiety and high cortisol really pushed it down? At one point, I thought I had Lyme disease since the symptoms are similar. Thyroid issues run in my family with two Aunts and my grandma.

Thoughts? Am I off? What did I miss? What do I ask for at the Urologist in a few weeks?

Symptoms:

  • Frequent BMs, Drs tell me “take fiber”, which I have started (hemorrhoids too, I think) Worried about colon / rectal cancer.
  • Fatigue (I’m not waking up feeling refreshed)
  • Muscle soreness and joint pain (very stiff if I’m in the car for 45min or at my desk)
  • Brain fog / clarity / focus
  • Vision issues
  • Decrease sense of smell or taste
  • Start of sexual issues

Testosterone:
01/25/2013: Serum 396 Free 10.7
02/09/2016: Serum 322 ng/dl (348-1197 ng/dl normal)
02/09/2016: Free 7.2 pg/ml 6.8-21.5 normal

Thyroid:
12/10/2012: TSH 2.34 (.45-4.5 normal)
3/11/2016: TSHR 1.36 (.32-5.0 Normal) TSH w Reflex Free T4

Prolactin:
3/11/2016: 4.6 (1.6-18.8)

Urinalysis- 2/09/2016:
Color/Clarity Yellow,clear
Leuk neg
Nitrite neg
Urobili norm
Protein neg
pH 6
Blood neg
Sp. Gr. 1.005
Ketone neg
Bili neg
Glucose norm

Blood Work - 2/09/2016:
Glucose, Serum 101 H 65-99 (mg/dL)
BUN 9 6-24 (mg/dL)
Creatinine, Serum 1.04 0.76-1.27 (mg/dL)
eGFR If NonAfricn Am 89 >59 (mL/min/1.73)
eGFR If Africn Am 103 >59 (mL/min/1.73)
BUN/Creatinine Ratio 9 9-20
Sodium, Serum 142 134-144 (mmol/L)
Potassium, Serum 4.5 3.5-5.2 (mmol/L)
Chloride, Serum 103 97-108 (mmol/L)
Carbon Dioxide, Total 24 18-29 (mmol/L)
Calcium, Serum 10.0 8.7-10.2 (mg/dL)
Protein, Total, Serum 7.1 6.0-8.5 (g/dL)
Albumin, Serum 4.7 3.5-5.5 (g/dL)
Globulin, Total 2.4 1.5-4.5 (g/dL)
A/G Ratio 2.0 1.1-2.5
Bilirubin, Total 0.9 0.0-1.2 (mg/dL)
Alkaline Phosphatase, S 108 39-117 (IU/L)
AST (SGOT) 21 0-40 (IU/L)
ALT (SGPT) 24 0-44 (IU/L)

WBC 6.8 3.4-10.8 (x10E3/uL)
RBC 5.21 4.14-5.80 (x10E6/uL)
Hemoglobin 14.9 12.6-17.7 (g/dL)
Hematocrit 42.9 37.5-51.0 (%)
MCV 82 79-97 (fL)
MCH 28.6 26.6-33.0 (pg)
MCHC 34.7 31.5-35.7 (g/dL)
RDW 13.0 12.3-15.4 (%)
Platelets 256 150-379 (x10E3/uL)
Neutrophils 59 (%)
Lymphs 29 (%)
Monocytes 10 (%)
Eos 2 (%)
Basos 0 (%)
Neutrophils (Absolute) 3.9 1.4-7.0 (x10E3/uL)
Lymphs (Absolute) 2.0 0.7-3.1 (x10E3/uL)
Monocytes(Absolute) 0.7 0.1-0.9 (x10E3/uL)
Eos (Absolute) 0.1 0.0-0.4 (x10E3/uL)
Baso (Absolute) 0.0 0.0-0.2 (x10E3/uL)
Immature Granulocytes 0 (%)
Immature Grans (Abs) 0.0 0.0-0.1 (x10E3/uL)

BP 3/11/2016: 120 over 80
Never smoked
No medications
I take 1000iu of Vit D on average 5 days/week. I was low on a blood test in 2013.
I usually drink 4-5 drinks at a time about twice to three times per month


TRT and Digestion Issues
#2

Are those BMs ugent, pain driven, crampy, gassy, watery? If so, you may need to try pepto bismol. If it fixes anything, you have had some adverse bug in your guts. Take three times in one day and one dose the next morning and see what happens.

Please read these links found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • thyroid basics - check oral body temperatures as suggested - IMPORTANT
  • finding a TRT doc

Do not start any TRT before getting LH/FSH labwork

Labs - you have some now
TT
FT
E2
LH/FSH
prolactin
AM cortisol - at 8AM please
TSH
fT3
fT4 [please not T3, T4]
fasting cholesterol
occult blood test - not blood work, checking for blood in your poop

Pain in shoulders/neck might need a good massage therapist who does deep tissue work and has some sports medicine background.

You have hormone, thyroid, muscular/skeletal and digestive issues. You need to be open minded to the numerous possibilities. Do not get T tunnel vision.

Was ankle fracture unexpected? I am wondering if you have some bone loss.

Please do not forget to check body temperatures.

Low energy can be from digestive issues that may be creating absorption problems, thyroid issues, and low T.

1000iu Vit-D3 probably not enough, many need 5,000-6,000iu

TSH should be near 1.0, the lab ranges are useless and mislead doctors
TSH could be up from not using iodized salt or vitamins that list iodine+selenium


#3

Thank you for your reply. I’ll check out the link and specific tests when I get home from work.
“Are those BMs ugent, pain driven, crampy, gassy, watery?”

No, best I can describe is I used to go 2-3 times a day but now I go 5-6 times a day doing about half what I did before. I have a feeling of incomplete evacuation when Im done, hence the hemorrhoid issues. Stool is soft and fluffy most times. Color is good. I’ve been paying attention for blood (not to say the occult blood test isnt a good idea, just not apparent blood) for months. I’ve read where caffeine can help with constipation so maybe thats my problem. I’m on week two of fiber suppliment oranage drink in the AM.

“Was ankle fracture unexpected? I am wondering if you have some bone loss”. I rolled it in a rut. I thought it was a bad sprain, I waited to long. When I went to Dr. an X ray showed the ligaments from the roll pulled some bone off my shin bones. He said it was too late to immobilize. Took about a year to recover and now I’m mostly pain free except maybe some arthritis before it rains. :smile:

“1000iu Vit-D3 probably not enough, many need 5,000-6,000iu” I do 5,000iu in the winter but back it off to 1000iu in the summer and I do get outside. When it was tested I was just below normal.

"TSH could be up from not using iodized salt or vitamins that list iodine+selenium"
I’m sorry, I put the results from oldest to newest. Here’s the latest:
3/11/2016: TSHR 1.36 (.32-5.0 Normal) TSH w Reflex Free T4

Also, I RARELY add salt to my food. My wife cooks and we use: morton’s sea salt which looking it up may not have any iodine added. I’ll check that when I get home too.

Again, thank you for your reply I’ve been struggling for about 8-9 months now.


#4

Before bed 11pm - 97.7
Wake up 7am - 97.9
Afternoon 4pm - 98.1


#5

Thyroid is not bad. Start getting iodine**+selenium**.
Maybe we can get TSH down. Otherwise, doc thinks that things are perfect.

Please check you wife’s body temperatures. Kids?


#7

Catching up on your previous post:
-age 40
-height 6’2"
-waist: Pants 38", belly closer to 48"
-weight: 280
-body and facial hair: Hair thining very little, all my life I’ve had issues with facial hair being patchy, I’ve noticed outside eyebrows thining, hairy chest/stomach, hairy butt
-describe where you carry fat and how changed. Mainly in belly
-testes ache, ever, with a fever? Ache - Yes, mainly in the last 6 months, perhaps 6-10 times. With fever? Not that I have noticed. However, I do feel like I run warm ocassionally (once every few weeks).
-how have morning wood and nocturnal erections changed. I rarely have them anymore. Maybe 3 times a month.

I checked my wife’s temp, very similar to mine. I have not checked the kids.


#8

The whole family needs iodine. Kids get cold easy?


#9

Kids not usually cold.

We’re switching to iodine with our salt. I’m also going to look at a multi-vitamin that has iodine and selenium.

Going to the Uro on Tuesday (first time visit), not optimistic. Going to ask for the outstanding labs. Feel like hell. Hoping for a fixable break-through soon.


#10

I agree with everything ksman said.

Additionally, it sounds like I have the same shoulder problems you do. Do you sleep on your side with your arm underneath the pillow? If so, this is pushing your shoulder out of whack. Try sleeping on your side without your arm underneath the pillow, or keep your arm straight with your palm facing upward.

I am attempting to sleep on my back, but so far I haven’t been very successful. A heating pad on the shoulder seems to help.


#11

Exactly. I found some relief by hugging an extra pillow instead. I have overall soreness and body aches that are annoying. Also I have lipomas that can be very painful.


#12

Probably not the case, but you ever been tested for Lyme disease? Joint pain and fatigue are very common with this.


#13

Funny you mention that. I actually told my doctor “I basically have all the symptoms of Lyme” but he tested my T instead, which TT was clinically low and FT was low normal. I do golf and we’ve found ticks but I haven’t found any on me or any bulls eye rashes.


#14

I would consider that FT to be clinically low as well though.

All experts seem to think 8 ng/dl FT to be indicative of TD. The author, Dr. Abraham Morgentaler also published a 10 ng/dl as also indicative of TD. This is the highest figure mentioned in literature but being at 6-9.8 seems appropriate to me.


#15

bulls eye occurs in less than 30% of Lyme Disease.


#16

Went to the Uro yesterday… I’m very optimistic.

After explaining my history and reviewed the last T numbers from my PCP, he said the right things like “I want to get a complete profile to see whats going on.” Started to discuss pituitary issues vs hypogonadism, which I completed his sentences from what I’ve learned on this site. He ordered the E2, LH/FSH (with out me asking) and another T check. I’ll post them when I get them back.


#17

@KSman
OK, I finally got a different multi-vitamin.
This one has 150mcg of Iodine and 122.5 mcg of Selenium.
However, I have not been able to have my fT3 or fT4 checked yet.

  1. What is your opinion on the amount of Iodine and Selenium in this one/day multi vitamin?
  2. Is it your opinion that I start this MV immediately or should I have my fT3 and fT4 checked?

Waiting on the results of new TT, FT, E2 and LH/FSH numbers.


#18

150mcg is part of your maintenance intake, assuming that you use iodized salt in kitchen and at the table.

Labs? I tend to not care about what labs values are if there is an iodine deficiency and would rather see labs after iodine issues are addressed. Remember that TSH is high during iodine replenishment and for some time after that. So TSH labs can be skipped or ignored in those cases. Many doctors used to [still probably] think that TSH elevation from taking larger amounts of iodine causes hyperthyroidism, because TSH was there only criteria.


#20

@KSman
Idoine maintenance:
Should I expect side effects during the replenishing phase? One of my daughters friends is sick so I’m not sure if I’m catching a bug but I’m day two on the new multivitamin and feel like a truck just ran me over. Diarrhea, feverish, and freezing. I just took an oral temp with a chain store branded IR thermometer and was getting anywhere from 97.7 to 98.1. Couple hours later its 98.6 to 99.8.

Thyroid issues run in my family. My grandmother had a goiter and had her Thyroid removed. One aunt is Hypo and another is Hyper. Neither of my parents have had a known issue.

!!! I FINALLY GOT TEST RESULTS BACK !!!

ESTRADIOL, ENHANCED Range: 0.0-39.8 Value: 49.5 Out of Range

LH Value: 1.9
Reference Range: FEMALES mIU/mL Follicular phase 1.9-12.5 Midcycle peak 8.7-76.3 Luteal phase 0.5-16.9 Pregnant <0.1-1.5 Postmenopausal 15.9-54.0 Contraceptives 0.7-5.6 MALES 20 - 70 years 1.5-9.3 > 70 years 3.1-34.6 Children <0.1-6.0

PROLACTIN Value: 5.5
Reference Range: Females Nonpregnant: 2.8-29.2 ng/mL Pregnant: 9.7-208.5 ng/mL Postmenopausal: 1.8-20.3 ng/mL <2 years: 3.3-14.7 ng/mL 2-5 years: 1.0-12.8 ng/mL 6-10 years: 1.2-11.4 ng/mL 11-17 years: 1.4-14.3 ng/mL Males: 2.1-17.7 ng/mL

TESTOSTERONE TOTAL Range: 350.0-1100.0 Value:299.0 Out of Range
SHBG Range: 13.0-71.0 Value 47.4
BIOAVAILABLE TESTOSTERONE Range: 131-682 Value 109 Out of Range
PERCENT FREE TESTOSTERONE Range 1.60-2.90 Value 1.56

I pulled the results above from the PT portal. I also noticed there was a prescription noted, although they haven’t contacted me yet about results or prescription.

Prescription:
clomiphene citrate 50 mg tablet take 1 tablet by oral route every other day 50 MG

It’s nice to have a reason why I’ve felt so bad the last few months I’m nervous over this next steps.

Feedback please on these test results and what I expect the Uro is wanting to prescribe to me.

(Also thank you to everyone who has commented and shared your knowledge!)


KSman is Here
#21

Please reduce your dose to 25mg/day. 50mg is higher than usual. Sandbag your doctor and build up a stash in case you have to search for a new doctor. I started on 12.5mg/day and increased to 25mg/day.


#22

Even though it’s 50 every other day?