T Nation

Woman's Hormone Questions for KSman


#1

My wife recently started visiting an HRT/Weight loss clinic to have bloodwork done to look into treatment for the following issues:

-Somewhat slowish metabolism, and slow progress in changing body composition from diet and training.
-Lack of skin-suppleness in face with periorbital puffiness and facial bloating.
-Android bodyfat patterning. She stores bodyfat primarily in her stomach region and her hips and legs are extremely lean. This could be genetic due to her having a substantial Andean (South American Indian) admixture.
-Extreme moodiness.

She regularly weight trains (3-4x/week) and tends towards a low calorie diet that is very high in protein. She is around 112 pounds at 5'2". Since I met her two years ago, through proper weight training and diet she has gone from 28% bodyfat to 18% at the same weight. She looks great, and at this point, the only way I feel she could improve is by shifting her bodyfat patterning from an android to a more gynoid distribution.

The clinic did fairly extensive blood work, which I don't have on-hand to post right now, but if needed I can include it in a follow-up post. The doctor determined the following from her round of blood work which was done during the luteal phase of her cycle:
-T4, T3, Total T4, and Total T3 - Low normal.
-Total and Free Testosterone - Low normal.
-Ferritin and Vitamin D - Low normal.
-Progesterone - Extremely low, out of range.
-Estradiol - Was out of range (low) based on the reference ranges for the luteal phase as indicated on her blood work sheet, but the doctor insisted that it was fine and should not be treated.

Based on this first round of blood work the doctor prescribed her:
-Oral Progesterone pills to be taken for two weeks starting at day 18 of her cycle (I think).
-Amour Thyroid.

After beginning this protocol we observed the following:
-Anxiety and bloating when beginning the Progesterone cycle each month. It also has made her cycle rather irregular.
-Increase in metabolism.
-She dropped 1% bodyfat out of nowhere after being stuck at 19% for quite some time.
-Much improved energy, mood, and irritability levels (although this comes back a bit when she begins her Progesterone cycle for the month).
-Improved vaginal lubrication.
-No change in skin quality.
-No change in body fat patterning.

We just had her three month follow-up blood work and she had the following results:
-Ferritin - 18 NG/ML (10-220)
-Estradiol (luteal) - 50 PG/ML (74-212)
-Folic Acid - 12.7 NG/ML (> 5.0)
-Progesterone - 3.8 NG/ML (1.84-30.2)
-Free T4 - .82 NG/DL (.73-1.95)
-Free T3 - 2.7 PG/ML (2.3-4.2)
-TSH - 1.6 UIU/ML (.5-4.7)
-Vitamin B12 - 867 PG/ML (250-1100)
-DHEA Sulfate - 152UG/DL (56-326)
-Testosterone - 44 NG/DL (17-76)
-SHBG - 77NMOL/L - (23-152)
-Calc Free Testosterone - .4NG/DL (.3-1.5)
-Vitamin D 54NG/DL (30-100)

Doctor suggested the following:
-Taking a Vitamin D, Folic Acid, B12, Iron, and DHEA supplement.
-Increasing the progesterone dose. She also suggested my wife take it on a daily basis instead of at just the end of her cycle to help minimize the anxiety and bloating side-effects. She also switched her from an oral to a sublingual.
-Increasing the thyroid dose.
-She also gave us the option of using a testosterone cream to improve libido, mood, and to further improve body composition.
-That her estradiol is fine, and there's no need to supplement estradiol in a pre-menopausal woman.

So to sum things up, the thyroid has subtantially improved metabolism, energy levels, and mood for my wife. The progesterone has improved vaginal lubrication, but not much else. She still has issues with facial bloating and android bodyfat patterning.

What suggestions might you have based on what I have told you? Thanks so much for your time.


KSman is Here
#2

She might have Cushings disease - was this discussed?


#3

[quote]theBeth wrote:
She might have Cushings disease - was this discussed?

http://www.nlm.nih.gov/medlineplus/ency/article/000410.htm[/quote]

I had considered this based on the facial bloating and body fat patterning I mentioned previously. She really doesn’t have any of the other symptoms however (except perhaps the low libido, but what DOESN’T cause low libido in women), so I somewhat ruled it out. The testing for this is offered at the clinic but it’s a bit pricey, and I don’t think any of it would be covered by insurance. It might definitely be something to consider in the future though.


#4

[quote]bulletproof_ wrote:

[quote]theBeth wrote:
She might have Cushings disease - was this discussed?

http://www.nlm.nih.gov/medlineplus/ency/article/000410.htm[/quote]

I had considered this based on the facial bloating and body fat patterning I mentioned previously. She really doesn’t have any of the other symptoms however (except perhaps the low libido, but what DOESN’T cause low libido in women), so I somewhat ruled it out. The testing for this is offered at the clinic but it’s a bit pricey, and I don’t think any of it would be covered by insurance. It might definitely be something to consider in the future though.[/quote]

Just a “spot” cortisol shouldn’t be too expensive. Check it in the morning when cortisol is naturally at it’s highest for at least an idea if she has an issue with it. May not be completely conclusive, but it would let you know if further testing is warranted.


#5

Have you read the thyroid basics sticky?

Iodine deficiency: for BOTH of you

  • have you been using iodized salt continuously for years?
  • do you have cool waking and mid day oral body temperatures?

Note that if thyroid med dose is low, body temps can be low. Body temps can guide thyroid meds dose.
You should not tread low thyroid function that is caused by low iodine will a life time of thyroid meds.

I encourage her to try the testosterone cream. She can apply to forearms but not with kids… apply to thighs. Some on her clitoris may may sex more rewarding for her.

The improved vaginal lubrication suggests improving estrogen levels and the improved thyroid status might be a reason. Progesterone is HPOA repressive and taking all month may not be a great idea as that could reduce ovarian hormones.

Really need your wife’s age for context.

She can try DHEA, many women freely convert some to E2 and T. So that is cheap. Start with 25mg EOD and see if she is OK with that.

Watch for facial hair changes.

Diet needs health fats and fish oil, vitamins and trace elements [with 150mcg iodine].

Estrogen levels for a given women depend on her body’s needs, not lab norms. If she is small breasted, she is a lower E type and vise versa. See where things go with a little T and the DHEA.


#6

[quote]KSman wrote:
Have you read the thyroid basics sticky?

Iodine deficiency: for BOTH of you

  • have you been using iodized salt continuously for years?
  • do you have cool waking and mid day oral body temperatures?

Note that if thyroid med dose is low, body temps can be low. Body temps can guide thyroid meds dose.
You should not tread low thyroid function that is caused by low iodine will a life time of thyroid meds.

[/quote]

We will begin consuming iodized salt more frequently. My wife actually tries to avoid salt because she believes it will cause her to become bloated. We have not regularly tested her waking body temperatures, and have not tested her mid-day temperatures at all.

[quote]
I encourage her to try the testosterone cream. She can apply to forearms but not with kids… apply to thighs. Some on her clitoris may may sex more rewarding for her.

The improved vaginal lubrication suggests improving estrogen levels and the improved thyroid status might be a reason. Progesterone is HPOA repressive and taking all month may not be a great idea as that could reduce ovarian hormones.

Really need your wife’s age for context.

She can try DHEA, many women freely convert some to E2 and T. So that is cheap. Start with 25mg EOD and see if she is OK with that.

Watch for facial hair changes.

Diet needs health fats and fish oil, vitamins and trace elements [with 150mcg iodine].

Estrogen levels for a given women depend on her body’s needs, not lab norms. If she is small breasted, she is a lower E type and vise versa. See where things go with a little T and the DHEA.[/quote]

I should have mentioned that she is 29 years old. She tends to store most of her bodyfat around her abdominal area, not so much on her breasts or hips. We will proceed with the small T dose, DHEA, additional iodine, and continue taking the progesterone during the latter portion of her cycle only.

Or do you not feel that the progesterone is necessary? DHEA could correct the low testosterone and estrogen, but is there anything that could potentially influence progesterone in the same way? The less prescriptions she has to worry about, the better.

Thanks so much for your help.


#7

Why testosterone cream?? Testosterone looks good to me…

Iodine can be dangerous and landed me and my friend in bad spots. I spend the day in emergency with him having heart palpitations and swollen lymph nodes and his throat felt like it was closing up.

50 mg or iodine is a shit load of iodine and 333 times the recommended daily…

Have you considers seeing a homeopathic doctor and testing for heavy metals or yeast.

Don’t mess with the thyroid without testing antibodies. One who may be genetically prone to thyroid conditions such as hashimotos or graves may send the auto immune condition into full swing with high levels of iodine. If considering iodine so it under the care of a qualified thyroid specialist. Ksman is not this…

Good luck to you and your wife sir


#8

[quote]
Estrogen levels for a given women depend on her body’s needs, not lab norms. If she is small breasted, she is a lower E type and vise versa.[/quote]

What exactly did you mean by this? Are you saying that small breasted women are healthy with lower estrogen levels??


#9

KSman,

On an embarrassing note, I gave my wife what I THOUGHT was a 25mg DHEA capsule as per your suggestion. It turns out it was a 50mg capsule and by the next morning, she had bloated up like a beach ball. I would assume this is indicative of large-scale conversion of DHEA to estrogen. She didn’t notice any effects that might be associated with Testosterone. Besides my wife’s wrath, I hope there’s something diagnostically valuable that can come from this incident.

I’m curious though why you suggested 25mg every other day instead of 12.5 daily.


#10

You have to see what dose works for her and her HPTA feedback will level things out a bit. Looks like DHEA may be a viable method of increasing E2 for her. And we discussed how some women need more/less and keep that in mind.