T Nation

Why am I So Tired?

Basic Info
Age: 26
Height: 5’10"
Waist: 40" (at the largest part of my midsection)
Weight: 240
Body and Facial Hair: average for both, I guess
Where I carry fat: midsection
Supplements: multivitamin, vitamin D3 (6000 IU), fish oil, zinc (50 mg), magnesium (400 mg)
OTC Drugs: Rogaine and Zyrtec
Diet: I eat pretty clean and get plenty of healthy fats and cholesterol
Training: 4x/week powerlifting split (Westside)
Morning Wood: yes if I have to pee (usually the case), otherwise no
Testes Ache?: I get testicular pain on an infrequent basis (not with a fever), but I got this checked out recently and had an ultrasound done and the doctor said there’s no reason to think that it’s anything serious (torsion, cancer, etc.).

Health Conditions, Symptoms, History (Cliff’s notes)
I’m always tired! I’d say it started around 2006 and has been getting worse. I fall asleep in class all the time. I fall asleep pretty much every time I read. When I was working I’d fall asleep there. I’ve even fallen asleep while driving. It doesn’t matter how much sleep I get, I can still fall asleep the next day. About 1.5 years ago I had a sleep study done, and they found that I had mild to moderate sleep apnea. I got a CPAP and I used it regularly, and still do, but it didn’t make a difference in my daytime sleepiness and fatigue! So I went and had a multiple sleep latency test done (MSLT, see Wikipedia for details). It showed that I have idiopathic hypersomnolence, which is a fancy way of saying that I’m always tired and they don’t know why. I don’t have narcolepsy–they can tell that from the brain readings they take.

In order to help me stay awake, I’ve tried energy drinks, caffeine, Ritalin (it was prescribed to me as a stimulant), etc. That stuff helps, but I can still fall asleep! Furthermore, I want to fix the problem and not be dependent on stimulants in order to function normally.

History of Steroid Use
I did one 19 week cycle of testosterone enanthate @ 600 mg/week, along with Arimidex to keep my estrogen in check. I was curious to see if my low-ish test level (372 ng/dL, see lab work in following posts) was to blame for my fatigue. Testosterone didn’t fix the problem, but I do think it helped a little bit. I’m currently in the middle of my PCT and it seems like my sleepiness is worse than ever!

Where do I go from here…
Once I’ve been off for a few months and my system is more or less recovered I’ll go see a doctor and get some blood work done to try to get to the bottom of all this. In the meantime, I need to learn more about what could be wrong with me and come up with a game plan for when I see the doctor. Here are the blood tests I plan to ask for, what else I should add?

Testosterone, Total
Testosterone, Free
SHBG (?)
DHT (?)
LH
FSH
Estradiol
Prolactin

TSH
Free T4
Free T3
Reverse T3

Ferritin
8 a.m. Cortisol

If you have any ideas why I’m so tired, please let me know!

Blood Work 7/27/07

Automated Chemistry Result Flag Reference Interval Units
Glucose 89 ( 70-99 ) mg/dL
Urea Nitrogen 17 ( 9-22 ) mg/dL
Creatinine 1.16 ( 0.80-1.30 ) mg/dL
BUN/Creat Ratio 15 ( 7-25 )
Sodium 140 ( 136-145 ) mmol/L
Potassium 4.0 ( 3.5-5.1 ) mmol/L
Chloride 103 ( 98-107 ) mmol/L
Carbon Dioxide 26 ( 21-32 ) mmol/L
Calcium 8.9 ( 8.2-10.4 ) mg/dL
Uric Acid 5.7 ( 3.5-7.2 ) mg/dL
Cholesterol 155 ( 120-199 ) mg/dL
Triglycerides 84 ( 35-149 ) mg/dL
HDLC 37 L ( 40-60 ) mg/dL
LDL 101 ( 0-129 ) mg/dL
Non-HDLC 118 ( 1-159 ) mg/dL

Endocrinology
“Testosterone, Total” 393 ( 175-781 ) ng/dL
TSH 0.91 ( 0.50-3.50 ) uIU/mL
T4-Free 0.9 ( 0.5-1.6 ) ng/dL

Chol/HDL Ratio 4.2
Protein-Total 7.5 ( 6.4-8.2 ) g/dL
Albumin 4.4 ( 3.4-5.0 ) g/dL
Globulin 3.1 ( 2.6-4.4 ) g/dL
Alkaline Phosphatase 105 ( 50-136 ) U/L
ALT (SGPT) 59 ( 30-65 ) U/L
AST (SGOT) 36 ( 15-37 ) U/L
Bilirubin-Total 0.80 ( 0.00-1.00 ) mg/dL
GFR-NonAfrican American >60 mL/min/1.73m2

Hematology
WBC 6.4 ( 3.5-9.9 ) x(10)3/uL
RBC 5.45 ( 4.50-6.00 ) x(10)6/uL
Hemoglobin 16.4 ( 13.0-17.0 ) g/dL
Hematocrit 48.1 ( 39.0-50.0 ) %
MCV 88.3 ( 80.0-96.0 ) fL
MCH 30.1 ( 27.0-33.0 ) pg
MCHC 34.1 ( 32.0-36.0 ) g/dL
RDW 12.6 ( 11.5-14.5 ) %
Platelets 276 ( 150-400 ) x(10)3/uL
MPV 7.1 L ( 7.4-10.4 ) fL
% Neutrophils 57.1 ( 45.0-74.0 ) %
% Lymphocytes 32.5 ( 15.0-44.0 ) %
% Monocytes 9.2 ( 5.0-10.0 ) %
% Eosinophils 0.7 ( 0.0-6.0 ) %
% Basophils 0.5 ( 0.0-2.0 ) %
% NRBC 0.0 ( 0.0-0.0 ) %
Abs Neutrophils 3.6 ( 1.7-6.4 ) x(10)3/uL
Abs Lymphocytes 2.1 ( 0.4-2.5 ) x(10)3/uL
Abs Monocytes 0.6 ( 0.4-1.3 ) x(10)3/uL
Abs Eosinophils 0.0 ( 0.0-0.3 ) x(10)3/uL
Abs Basophils 0.0 x(10)3/uL
Abs NRBC 0.0 ( 0.0-0.0 ) x(10)3/uL

Blood Work 11/4/10

Test Name Result Abnormal Reference Range
GLUCOSE 102 ( 74-106 mg/dL )
BUN 18.7 ( 9-21 mg/dL )
CREATININE 1.2 ( 0.8-1.3 mg/dL )
SODIUM 140 ( 135-142 mEq/L )
POTASSIUM 4.1 ( 3.5-5.2 mEq/L )
CHLORIDE 105 ( 100-108 mEq/L )
CO2 29 ( 22-29 meq/L )

Hematology
Test Name Result Abnormal Reference Range
WBC 5.4 ( 4.8-10.8 10^3/uL )
RBC 5.68 ( 4.60-6.20 10^6/uL )
HB 16.6 ( 14.0-18.0 g/dL )
HCT 49.2 ( 42.0-52.0% )
MCV 87 ( 82.0-99.0 fL )
MCH 29.2 ( 27.0-31.0 pg )
MCHC 33.8 ( 31.0-36.0 g/dL )
RDW 12 ( 11.6-16.5 )
PLTS 227 ( 140-440 10^3/uL )
MPV 7.3 L ( 7.4-11.0 fL )
NEU% 45.1 ( - % )
NEU# 2.44 L ( 2.8-7.6 10^3/uL )
LYM% 40.4 ( - % )
LYM# 2.18 ( 1.2-4.1 10^3/uL )
MON% 10.8 ( - % )
MON# 0.58 ( 0.10-0.60 10^3/uL )
EOS% 1.4 ( - % )
EOS# 0.08 ( 0.0-0.40 10^3/uL )
BASO% 2.3 ( - % )
BAS# 0.12 ( 0.0-0.2 10^3/uL )
ALY% 2 ( - % )
ALY# 0.11 ( 0.0-0.2 10^3/uL )
LIC% 0.5 ( - % )
LIC# 0.03 ( - 10^3/uL )
PCT 0.165 ( - % )
PDW 10 ( - )

Immunochemistry
Test Name Result Abnormal Reference Range
TSH 1.27 ( 0.50-6.00 uIU/ml )

Blood Work 4/28/11

CBC - CBC
Test Name Result Flag(s) Reference Range
WBC 6.2 ( 4.8-10.8 10^3/uL )
RBC 5.55 ( 4.60-6.20 10^6/uL )
HB 16.6 ( 14.0-18.0 g/dL )
HCT 47.9 ( 42.0-52.0 % )
MCV 86 ( 82.0-99.0 fL )
MCH 29.8 ( 27.0-31.0 pg )
MCHC 34.6 ( 31.0-36.0 g/dL )
RDW 11.6 ( 11.6-16.5 )
PLTS 239 ( 140-440 10^3/ul )
MPV 7.6 ( 7.4-11.0 fL )
NEU% 51.6 ( - % )
NEU# 3.21 ( 2.8-7.6 10^3/ul )
LYM% 36.2 ( - % )
LYM# 2.25 ( 1.2-4.1 10^3/ul )
MON% 8.2 ( - % )
MON# 0.51 ( 0.10-0.60 10^3/ul )
EOS% 2.3 ( - % )
EOS# 0.14 ( 0.0-0.40 10^3/ul )
BASO% 1.7 ( - % )
BAS# 0.11 ( 0.0-0.2 10^3/ul )
ALY% 1.3 ( - % )
ALY# 0.08 ( 0.0-0.2 10^3/ul )
LIC% 0.5 ( - % )
LIC# 0.03 ( - 10^3/ul )
PCT 0.181 ( - % )
PDW 11 ( - )

Chemistry
Test Name Result Flag(s) Reference Range
GLUCOSE 100 ( 74-106 mg/dL )
BUN 19.2 ( 9-21 mg/dL )
CREATININE 1.2 ( 0.8-1.3 mg/dL )
SODIUM 140 ( 135-142 mEq/L )
POTASSIUM 4.4 ( 3.5-5.2 mEq/L )
CHLORIDE 104 ( 100-108 mEq/L )
CO2 29 ( 22-29 meq/L )
TOTAL BILIRUBIN 1 ( 0.1-1.2 mg/dL )
ALT(SGPT) 27 ( 0-45 U/L )
AST(SGOT) 24 ( 0-35 U/L )
ALKALINE PHOSPHATASE 101 ( 53-128 U/L )
GGT 9 ( 0-55 U/L )
TOTAL PROTEIN 7.1 ( 6.4-8.3 g/dL )
ALBUMIN 4.5 ( 3.5-5.2 g/dL )
CALCIUM 9.7 ( 8.6-10.3 mg/dL )
PHOSPHOROUS 3.7 ( 2.7-4.5 mg/dL )
URIC ACID 6.1 ( 3.5-7.2 mg/dL )
CHOLESTEROL TOTAL 135 ( 120-199 mg/dL )
TRIGLYCERIDES 53 ( 40-149 mg/dL )

Immunochemistry
Test Name Result Flag(s) Reference Range
FREE T4 1.22 ( 0.75-1.54 ng/dl )
TSH 1.63 ( 0.50-6.00 uIU/ml )

Urinalysis
Test Name Result Flag(s) Reference Range
Color Yellow ( Yellow-Yellow )
Clarity Clear ( Clear-Sl Cloudy )
Specific Gravity 1.015 ( 1.002-1.030 )
pH 6 ( 5.0-8.0 )
Protein neg ( neg- )
Glucose. neg ( neg-neg )
Bilirubin neg ( neg- )
Ketones neg ( neg-neg )
Blood neg ( neg- )
Nitrate neg ( neg- )
Leukocyte Esterase neg ( neg- )
Epithelial Cells few ( neg-few lpf )
Mucous neg ( neg-few lpf )
WBC’S None Seen ( - #/hpf )

  •                            Normal = 0-3			
    

RBC’S None Seen ( - #/hpf )

  •                            Normal = 0-5~			
    

Bacteria neg ( neg-few hpf )
Casts neg ( neg- #/hpf )
Crystals neg ( neg- hpf )

Blood Work 8/25/11

CBC With Differential/Platelet Result Flag Units Reference Interval
WBC 6.3 x10E3/uL ( 4.0-10.5 )
RBC 5.20 x10E6/uL ( 4.10-5.60 )
Hemoglobin 15.3 g/dL ( 12.5-17.0 )
Hematocrit 45.0 % ( 36.0-50.0 )
MCV 87 fL ( 80-98 )
MCH 29.4 pg ( 27.0-34.0 )
MCHC 34.0 g/dL ( 32.0-36.0 )
RDW 13.3 % ( 11.7-15.0 )
Platelets 205 x10E3/uL ( 140-415 )
Neutrophils 51 % ( 40-74 )
Lymphs 36 % ( 14-46 )
Monocytes 10 % ( 4-13 )
Eos 2 % ( 0-7 )
Basos 1 % ( 0-3 )
Neutrophils (Absolute) 3.3 x10E3/uL ( 1.8-7.8 )
Lymphs (Absolute) 2.2 x10E3/uL ( 0.7-4.5 )
Monocytes (Absolute) 0.6 x10E3/uL ( 0.1-1.0 )
Eos (Absolute) 0.1 x10E3/uL ( 0.0-0.4 )
Baso (Absolute) 0.0 x10E3/uL ( 0.0-0.2 )
Immature Granulocytes 0 % ( 0-2 )
Immature Grans (Abs) 0.0 x10E3/uL ( 0.0-0.1 )

Comp. Metabolic Panel (14)
“Glucose, Serum” 93 mg/dL ( 65-99 )
BUN 16 mg/dL ( 6-20 )
“Creatinine, Serum” 1.07 mg/dL ( 0.76-1.27 )
eGFR If NonAfrican Am 96 mL/min/1.73 ( >59 )
BUN/Creatinine Ratio 15 ( 8-19 )
“Sodium, Serum” 131 L mmol/L ( 135-145 )
“Potassium, Serum” 3.7 mmol/L ( 3.5-5.2 )
“Chloride, Serum” 95 L mmol/L ( 97-108 )
“Carbon Dioxide, Total” 25 mmol/L ( 20-32 )
“Calcium, Serum” 9.4 mg/dL ( 8.7-10.2 )
“Protein, Total, Serum” 6.6 g/dL ( 6.0-8.5 )
“Albumin, Serum” 4.5 g/dL ( 3.5-5.5 )
“Globulin, Total” 2.1 g/dL ( 1.5-4.5 )
A/G Ratio 2.1 ( 1.1-2.5 )
“Bilirubin, Total” 1.1 mg/dL ( 0.0-1.2 )
“Alkaline Phosphatase, S” 83 IU/L ( 25-150 )
AST (SGOT) 25 IU/L ( 0-40 )
ALT (SGPT) 28 IU/L ( 0-55 )

“Testosterone, Serum” 372 ng/dL ( 249-836 )
LH 4.5 mIU/mL ( 1.7-8.6 )
“FSH, Serum” 3.0 mIU/mL ( 1.5-12.4 )
Estradiol 47.9 H pg/mL ( 7.6-42.6 )

E2 definitely looks high on that last test. Could be a contributor to your issue, and suppressing your T levels. But since you didnt feel any better while on your cycle, it is doubtful this is the primary cause.

I notice you haven’t had any cortisol tests done–fatigue could bea sign of low cortisol (hypoadrenia). I would recommend testing that, which it looks like you are already planning to do.

Not a lot more I can offer at this point as everything else looks pretty decent.

Lab work is invalid need more to date which you are getting…

Thanks for the replies, guys!

[quote]VTBalla34 wrote:
E2 definitely looks high on that last test. Could be a contributor to your issue, and suppressing your T levels. But since you didnt feel any better while on your cycle, it is doubtful this is the primary cause.

I notice you haven’t had any cortisol tests done–fatigue could bea sign of low cortisol (hypoadrenia). I would recommend testing that, which it looks like you are already planning to do.

Not a lot more I can offer at this point as everything else looks pretty decent.[/quote]
Yeah, I’m not sure why my E2 was so high. For the sake of brevity I omitted this from my original post, but after that blood work I tried running Aromasin at 12.5 mg/day and 25 mg/day but didn’t notice any significant differences.

I need to learn more about cortisol and hypoadrenia. I’ve seen stopthethyroidmadness.com and James Wilson’s book “Adrenal Fatigue” recommended on here (and I skimmed through it a few months ago). Are there any other resources you’d recommend?

[quote]Hardasnails wrote:
Lab work is invalid need more to date which you are getting…[/quote]
To be honest, I didn’t think any conclusions could be drawn from my previous blood work simply because there were too many important markers missing. Although I must say, I’m not happy about my sub-400 testosterone level on those 2 tests.

I’ll get some new lab work done in 2 or 3 months, and I’ll post it in this thread when I do!

I don’t have any other recommendations other than STTM and Wilson’s book, sorry.