Long time reader of these Boards first time poster. It looks like there is quite a lot of knowledge so hopefully someone may be able to to help me out. I apologise for the length of the post. Many thanks in advance for anyone who responds.
My Bio:
I am 24 yr old male (Australian), athletic, weight train 3 times a week plus cardio (HIIT), I only drink socially and rarely and I have a clean diet. No steroid use.
Over the past 18 months I had noticed that had from severe low libido (sex with gf maybe once every two to three weeks, infrequent morning erections only with a full bladder, no erectile dysfunction though), lack of motivation, muscle weakness, weight gain mainly on the stomach and pec area(I went from 90kgs @12% bodyfat to 100kgs 24% bodyfat in 18 months without any major changes to my diet, lifestyle or workout regime), soreness after non-intense exercise, difficulty sleeping, trouble concentrating (brain fog) and just a general apathy.
My doctor diagnosed me with depression and put me on celapram. I was surprised with this as I do not feel sad, any sense of worthlessness or anxiety ect but I understand depression can manifest itself in many ways. I was on celapram for 12 weeks and returned to the doctor to state that there was no real change other than some added brain fog. He prescribed Pristiq and told to come back in 6 weeks. 6 weeks later I return with no improvement so he suggests I undertake a mental health plan (6 months of Government paid therapy combined with continued medication). Having not seen any improvement I went for a second opinion, which the doctor sent me off for some blood tests.
Labs:
Androgens
Total Testosterone 8.7nmol/L (8.3-29) @11am
(tested twice) 13nmol/L (8.3-29) @8 am
SHBG 11 and 12 nmol/L (11-71)
Prolactin 210 mIU/L (40-450)
Vitamin D 25OH 29 nmol/L (25-50 Mild Deficiency) Now taking Vit D supps 2000UI ED
Serum Chemistry = all levels in middle of range
Haematology = all levels in middle of normal range
Iron Studies
Serum Iron 20umol/L (10-30)
Transferrin 34 umol/L (27-53)
Transferrin Saturation 30% (12-45)
Serum Ferritin 180 ug/L (20-300)
Serum Hormone Profile
FSH 3 IU/L
LH 2.4 IU/L
OEST <100 pmol/L (ref <150)
Prog 1 nmol/L (0.9-3.9)
Serum/Plasma Glucose
Plasma 5.0 nmol/L (3.4-7.7)
Lipid Studies
Cholesterol 4.9 nmol/L (3.5-5.4)
Triglyceride 1.0 nmol/L (0.1-2.0)
I have been referred to a ‘sexual health’ specialist as my second opinion doctor does not think that any endo in my area will be able to help. Any advice would be great.
Just got my results back -
At 8.10am
DHEAS 7nmol (2.2-15)
Cortisol 484 (120-620) AM Ref Interval
TSH 3.8 (0.5 -4.5)
For some reason they did not do fT3 and fT4 because TSH is within the ref range. Any recommendations as to what I should say to the specialist when I see him next Monday?
Those TSH test ranges are now discredited and have been rejected by several endocrinologist groups. You have hypothyroidism. If you go on TRT, I have high doubts that you will be able to absorb transdermal T products.
What is your intake of dietary iodine?
The lab range includes those in the population that have undiagnosed thyroid problems.
Check your body temp immediately when you wake up. A pattern near 97F or below indicates hypothyroidism. Search and read for symptoms and see if any match.
Dietary intake of iodine was probably low. I did not use iodised salt, but did eat quite a lot of dairy and meats, however, I believe in Australia these do not contain as much iodine than in other countries. However, since reading some other posts on here I do use a mutli-vit that does give 150 mg (apparently the RDI). If I was deficient, how long would it take to get iodine levels back to optimum?
The multi vitamin would seem to take deficiency off of the table. No harm in using iodized salt as well.
Depends… see what your waking body temp is. You might not have a problem that when fixed will resolve other issues. Don’t jump at a solution looking for a problem.
Based on that, one might conclude that you are not hypo. However, your TSH=3.8 indicates that your thyroid is needing too much stimulation to get the job done. This situation is consistent with a lack of iodine. You can introduce iodized salt to your diet to address that possibility. You need to watch TSH levels over time.
Watch the size of your thyroid and doc should be palpating it. Watch for lumps and bumps, that can occur sometimes from years of over-stimulation.
With your normal waking temps, at this point I would conclude that your T problems are not driven by hypothyroidism.
Testing fT3, fT4 and TSH in the future will provide a more complete view of things.
Given your age and these results, your pituitary is the problem or you are estrogen repressed. Your estrogen labs are useless. [OEST <100 pmol/L (ref <150) ]
Young men with low LH/FSH should have a brain scan to check for pituitary adinomas. With old guys, an age related drop in pituitary function is normal and scans are not done.
Any blows to the head or whiplash prior to the onset of these problems 18 months ago?
Any reduction in peripheral vision - check both eyes.
Fat pattern suggests elevated E2, in relation to T levels. But low SHBG suggests that absolute E2 is low.
Any major illness 18 months ago?
Any exposure to tropical diseases?
I have seen a thyroid specialist who sent me for further bloodwork and in the mean time gave me thyroid armour (dosing up every week, currently split dose of 120mcg , compounded test cream (5%) and dhea (50mg / day touche) supplementation till my next appointment. Since then my bloodwork has returned (i was not taking meds when the blood was taken)
Bloods were taken 9.30 and fasted state.
TSH 1.8 (.4-3.5) down from my previous tests of 3.8 and 3.3 (why?)
because tsh was not out of range lab did not do ft3 and ft4 as asked - will be asking them to do it
RT3 621 pmol (140-540)
Thyroid Antibodies
anti-thyroglobulin Ab 9 IU/ml (<34)
anti-thyroid peroxidase Ab 2 UI/ml (<12)
Cortisol (AM) 243 nmol (100-535)
Test 16.2 nmol (8-35) which is up from previous tests of 8.9 nmol and 13 nmol
SHBG 15 nmol (15-100)
Calc Free T 483 pmol/l (250-720)
FAI 108 (14-65)
Reverse T3, leptin and insulin are a big worry. I must say I am feeling a little better on the meds. I am wondering whether I should ask for my E2 to be checked as well. Any suggestions? My next appointment in next month.
You will need to get fT3, fT4 to fill in the blanks. rT3=621 pmol (140-540) does indicate a problem, well beyond a suggestion. [You will not want to be taking any T4 or T4+T3 medication, would have to be T3 only.]
Low cortisol can cause high rT3. How do you react to major stress events?
Infections, parasites, stimulants, surgeries, injuries and stress can weaken the adrenals.
If high rT3 is causing a functional hypothyroid state, this probably would show up as lower waking body temps… monitor and record. But you reported a good waking body temp, so nothing to be found with that.
KSman - thanks for your advice. My original temp I posted was (heaven forbid I say it) rectal temp not auxillary. I was unaware of the flucution - thus my auxillary temp was 36 C and low (rectal temp is higher than auxillary temp by ~0.5 C). The doctor I went to tested me on a Thyroflex. I am not sure what everyone’s opinion on it as a diagnostic tool but I have noticed it is in the final stages of FDA approval. The test came back with a diminished reflex and the doc came to the conclusion I was hypothyroid (it was not the only test done), however, the cause of the hypothryoidism was inconclusive until further tests (bloods).
As for adrenals - I am not a ‘stressed’ person, if anything I am a little on the apathetic side. No major injuries and surgeries in the last 7 years. I have had head knocks playing rugby but nothing in the last 3 years.