Low Free Test/Cortisol/Vit D. Chronic Infection?

Nutrition
1

Hello, I’ve come across posts on this site a number of times as I crawl the web for information.

I’m having some trouble and I thought I could get some sound advice here.

I’ve been suffering from some sort of generalized fatigue and daytime sleepiness for the past five years. Physically, my body seems to feel fine. However, mentally, it’s another story. I can sleep a normal 8-9 hours and then feel the urge to be back asleep again before lunch time.

I can have sleep attacks even while doing things I enjoy. My short-term memory is quite abysmal some days. Furthermore, I have sexual difficulties, which consist of awful premature ejaculation as well as general low satisfaction and desire.

I went to several physicians who told me they can’t help me or maybe it’s just all in my head. All in my head, my @$$!!! I finally found a physician willing to help. She ordered some extensive blood tests. Reviewing the tests with me, she told me the following.

  1. I have low cortisol.
  2. I have low free testosterone, but normal total testosterone.
  3. I have low vitamin D. also low Vit B12, but that has since come up.
  4. My cholesterol is a bit on the low side.
  5. My CBC suggests that there could be a chronic viral infection.

She recommended extensive vitamin supplements (mega-doses of Vit B12, D, E, among others), echinacea (to improve immune system), and adrenal glandular (to improve cortisol). She did not mention anything in particular to help with the low free testosterone (which has actually gone down while receiving this treatment)

This recommendation was back in February. Since then, I’ve seen some improvement in my symptoms, but I feel like I still have a long way to go.

For example, I can now make love for about fifteen minutes at a time. My wife is very happy about this; however, I still find the satisfaction and desire to be lacking. The sleep attacks aren’t as frequent as before, but they still happen. The numbers just aren’t moving on the cortisol, free testosterone, and vit D.

Can you guys suggest anything to make results happen faster? I don’t want to second-guess my doctor, but I want to make sure I have all the relevant information and there is a lot of knowledge about testosterone on this forum!

2

Repost with all your lab results including lab “normal” ranges on the T-replacement forum. There are some very knowledgeable guys there who may be able to help you sort things out. If you do not have the numbers, ask you doctor to give you a copy.

3

Also, have you been checked out for narcolepsy? sleep specialist?

4

What does your diet look like, currently? Did you have FSH, LH, Prolactin, E2 tested? What were the values? How about a WBC differential? What was your hematocrit, MCV, and MCHC?

5

Alrighty… I should have known better that to post a question without the relevant lab work. Remember, the primary complaint is fatigue/lack of energy, followed by sexual difficulties. I often don’t have the energy to do the things I want to do. Although my sexual experience is far from optimal, it has greatly improved since starting the supplements I described.

Also, I discovered relief from my chronic low-grade headaches via gluten-free diet November last year. I had hoped this would raise my energy as well, but that doesn’t seem to be the case.

These figures are from a blood draw back in May. The supplements described in my previous post were started in February.

TSH - 3.180 uIU/mL
T4, Free Direct -1.52

CBC
WBC = 3.1 1000/uL LOW
RBC - 4.97 1000000/uL
Hemoglobin - 15.1 g/dL
Hematocrit - 45.5 %
MVC 92 fL
MCH 30.4 pg
MCHC - 33.2 g/dL
RDW - 13.3%
Platelets 207 1000/uL
Neutrophils 47%
Lymphs - 47% HIGH
Monocytes - 4%
Eos 1%
Basos - 1%
Neutrophils 1.5 1000/uL LOW
Lymphs 1.5 10000/uL
Monocytes 0.1 1000/uL
Eos 0 1000/uL
Baso 0 1000/uL

Comp Metabolic Panel (14)
Glucose, Serum - 96 mg/dL HIGH
BUN - 10 mg/dL
Creatinine, Serum 1.12 mg/dL
eGFR - >59
BUN/Creatinine Ratio - 9
Sodium, Serum - 139 mmol/L
Potassium, Serum - 4.6 mmol/L
Chloride, Serum 104 mmol/L
Carbon Dioxide, Total 25 mmol/L
Calcium, Serum 9.1 mg/dL
Protein, Total, Serum - 6.5 g/dL LOW
Albumin, Serum - 4.5 g/dL
Globulin, Total - 2.0 g/dL LOW
A/G Ratio - 2.3
Bilirubin, Total - 1.9 mg/dL HIGH
Alkaline Phosphatase, S - 110 IU/L
AST(SGOT) - 23 IU/L
ALT(SGPT) 20 IU/L

Lipid Panel
Total Cholesterol - 117 mg/dL LOW
Triglycerides - 47 mg/dL
HDL Cholesterol - 48 mg/dL
VLDL Cholesterol Cal 9 mg/dL
LDL Cholesterol Calc - 60 mg/dL

Vitamin B12 - 990 pg/mL HIGH (note - this is after taking B12 several months)
Folate (Folic Acid), Serum - 10.2 ng/mL LOW

Testosterone, Serum 467 ng/dL
Free testosterone(Direct) 7.8 pg/mL LOW

Vitamin D, 25-Hydroxy - 33.2 LOW

Hemoglobin A1c - 5.7% HIGH

DHEA-Sulfate 215.6 ug/dL

Zinc, Plasma or Serum 82 ug/dL

DHEA - 989 High
Note - I tried taking some OTC supplements back in January not really knowing what I was doing. The doctor says that these may have artificially raised my DHEA. In any case, I felt like crap anyways.

Triiodothyronine, Free, Serum - 3.4 pg/mL

Cortisol - AM - 6.7 ug/dL LOW

Also… Body Temperature, measured at home using an under-the-tongue thermometer
usually between 96.5 and 97.5 deg F; sometimes below 96.0 deg F!!!

So, based on that, I’ve been prescribed the supplements described in the previous post. There has definitely been some improvement, but improvement has slowed to a crawl. Perhaps I’m just being impatient, but I understand that testosterone is extremely important and I don’t understand what the doctor is not addressing testosterone directly. In my next blood test (to be done soon), I will have SBHG measured, which I understand has something to do with free testosterone.

Thanks to everyone who has taken the time to think about this. I appreciate any knowledge you can fill me in with.

6

[quote]pin_cushion wrote:
Alrighty… I should have known better that to post a question without the relevant lab work. Remember, the primary complaint is fatigue/lack of energy, followed by sexual difficulties. I often don’t have the energy to do the things I want to do. Although my sexual experience is far from optimal, it has greatly improved since starting the supplements I described.

Also, I discovered relief from my chronic low-grade headaches via gluten-free diet November last year. I had hoped this would raise my energy as well, but that doesn’t seem to be the case.

These figures are from a blood draw back in May. The supplements described in my previous post were started in February.

TSH - 3.180 uIU/mL
T4, Free Direct -1.52

CBC
WBC = 3.1 1000/uL LOW
RBC - 4.97 1000000/uL
Hemoglobin - 15.1 g/dL
Hematocrit - 45.5 %
MVC 92 fL
MCH 30.4 pg
MCHC - 33.2 g/dL
RDW - 13.3%
Platelets 207 1000/uL
Neutrophils 47%
Lymphs - 47% HIGH
Monocytes - 4%
Eos 1%
Basos - 1%
Neutrophils 1.5 1000/uL LOW
Lymphs 1.5 10000/uL
Monocytes 0.1 1000/uL
Eos 0 1000/uL
Baso 0 1000/uL

Comp Metabolic Panel (14)
Glucose, Serum - 96 mg/dL HIGH
BUN - 10 mg/dL
Creatinine, Serum 1.12 mg/dL
eGFR - >59
BUN/Creatinine Ratio - 9
Sodium, Serum - 139 mmol/L
Potassium, Serum - 4.6 mmol/L
Chloride, Serum 104 mmol/L
Carbon Dioxide, Total 25 mmol/L
Calcium, Serum 9.1 mg/dL
Protein, Total, Serum - 6.5 g/dL LOW
Albumin, Serum - 4.5 g/dL
Globulin, Total - 2.0 g/dL LOW
A/G Ratio - 2.3
Bilirubin, Total - 1.9 mg/dL HIGH
Alkaline Phosphatase, S - 110 IU/L
AST(SGOT) - 23 IU/L
ALT(SGPT) 20 IU/L

Lipid Panel
Total Cholesterol - 117 mg/dL LOW
Triglycerides - 47 mg/dL
HDL Cholesterol - 48 mg/dL
VLDL Cholesterol Cal 9 mg/dL
LDL Cholesterol Calc - 60 mg/dL

Vitamin B12 - 990 pg/mL HIGH (note - this is after taking B12 several months)
Folate (Folic Acid), Serum - 10.2 ng/mL LOW

Testosterone, Serum 467 ng/dL
Free testosterone(Direct) 7.8 pg/mL LOW

Vitamin D, 25-Hydroxy - 33.2 LOW

Hemoglobin A1c - 5.7% HIGH

DHEA-Sulfate 215.6 ug/dL

Zinc, Plasma or Serum 82 ug/dL

DHEA - 989 High
Note - I tried taking some OTC supplements back in January not really knowing what I was doing. The doctor says that these may have artificially raised my DHEA. In any case, I felt like crap anyways.

Triiodothyronine, Free, Serum - 3.4 pg/mL

Cortisol - AM - 6.7 ug/dL LOW

Also… Body Temperature, measured at home using an under-the-tongue thermometer
usually between 96.5 and 97.5 deg F; sometimes below 96.0 deg F!!!

So, based on that, I’ve been prescribed the supplements described in the previous post. There has definitely been some improvement, but improvement has slowed to a crawl. Perhaps I’m just being impatient, but I understand that testosterone is extremely important and I don’t understand what the doctor is not addressing testosterone directly. In my next blood test (to be done soon), I will have SBHG measured, which I understand has something to do with free testosterone.

Thanks to everyone who has taken the time to think about this. I appreciate any knowledge you can fill me in with.[/quote]

Did you fast before this test? How is your dietary fat intake, what does a typical days diet look like? It might be a slight case of macrocytic anemia due to folate deficiency coupled with low testosterone. I would recommend going to an endocrinologist or HRT doctor and getting a complete panel done… Ask for FSH, LH, Prolactin, and E2… Just out of curiosity, does anyone in your family have glucose 6 phosphate dehydrogenase deficiency? Long shot, but worth asking.

7

Avalible free testosterone is very important when measuring total amount from what i understand,i know this is is a medical condition here, but two supplements i have started using recently Flameout ( fish oil) gives my body a thermogenic affect, i really feel it in a good way, and ELITEPRO, i fall asleep and pretty much stay asleep, my mind feels refreshed when i wake up much better than any of the ZMA sup. i have taken in the past.

8

Seek out KSMan. He is the one on this forum who will have the best advice.

9

Like the other posts have been saying, you need to fill us in on your daily diet. Also it would help to post what your exercise regime looks like.
For a good absorbable vitamin D supp try cod liver oil, it’s one of the best sources of vitamin A & D you can get.

10

Ah, I forgot to mention fish oil. I have been off and on fish oil. I switched to borage seed oil after reading about it. I should also mention that I tried mega-doses of EHA/DHA recommended by someone on another forum in regards to the sexual issues; it made no difference. I also tried ZMA which didn’t seem to help with anything. I’ve also been checked for sleep disorders; they never found anything. The supplement regimen I am on now plus the gluten-free diet is the only thing that I have found to help at all.

You’ve all encouraged me to post about my diet… Well, the fatigue symptoms really started at about age 20; I’m 27 now. At first, it was a matter of not being able to make it thru the day without a nap. It got worse to where I felt tired all the time and would take naps in my car during my work day. Back around age 20, I was eating mostly the food at college; they had plenty of fruits and vegetables as well as meat and potatoes; I love sweet fruit. I didn’t exercise much back then. I also ate a lot of pizza.

Now, I make it a point to prepare my own meals at home whenever possible. I tend to feel hypoglycemic (because of low cortisol/adrenal fatigue?), so I try to keep something healthful in the fridge that I can munch on. My meals frequently consist of some beef or chicken and rice; plus a serving of green vegetables. I try to avoid processed foods and convenience foods as much as possible; adhering to a strict gluten-free diet is an excellent excuse to avoid 95% of the crap out there! I’m sorry, I’d love to have beer and pizza with you, but it’s not on my diet :wink:

In the past four years or so, I’ve been exercising more seriously. I practice sports that emphasize endurance over sheer power and muscle mass; seeking endurance has been somewhat frustrating. I am an amateur athlete, but in recent times, I’ve been reading up on training and working to increase endurance. As an adult, my weight has never been more than 180 lbs or less than 160 lbs. I am 6’0.

In short, the problem started when I was exercising little and eating crap. Eating better and exercising more doesn’t seem to make that much of a difference by itself.

One more thing I’d like to point out: the sexual issues started before the fatigue issues. I think that stress from worrying about sex might have brought on the fatigue. Have you ever heard about how some men have such bad premature ejaculation that they sometimes can’t even get their clothes off before they ejaculate; and did you think about how awful that would be? I used to be intimately familiar with that problem before starting my current supplement regimen. That was stressful!

11

What is the lab range on the TSH? Current lab range should be .3-3 so your TSH is HIGH. Also don’t see test for FREET3? You will want that tested and you will want the result including lab range. I think Thyroid is involved with that TSH alone. Of course TSH is really a pituitary test so you’ll need the FREET3 (must be free not total).

Have your doc test that right away. Hypothyroid explains most of your symptoms… and low T goes hand in hand with HypO.

12

Triiodothyronine, Free, Serum - 3.4 pg/mL

Triiodothyronine is T3. Source: Patient Education on Blood, Urine, and Other Lab Tests - Testing.com

13

[quote]pin_cushion wrote:
I’ve also been checked for sleep disorders; they never found anything. [/quote]

I don’t see how that possible. I mean, I’m pretty ignorant here, but it’s not like you “feel tired” during the day, you’re falling the hell asleep. Are you capable of sleeping for longer stretches at night, like 10 or 12 hours?

And I’d probably recommend at least modest doses of fish oil (couple pills, whatever) a day, just because it’s good for your heart, even though it probably has little/nothing to do with your main concerns.

14

EasyRhino, I appreciate your forthrightness. I’m sure that if I really pushed for it, I could probably get a diagnosis of narcolepsy. However, my understanding is that patients with narcolepsy have sleep attacks; nap; and then feel better for a while before having another sleep attack. I sleep, awake feeling tired; sleep again; and awake feeling tired again.

In my case, I tend to sleep a lot at night. I said that I sleep 8-9 hours most nights. Usually, I still feel tired in the morning. Even going to bed at 11 or earlier, 95% of the time, it’s my alarm that gets me up at 8 AM and I often hit the snooze button. Regardless of what time I go to bed, I find that I want to sleep until 9-10 AM. Yes, I am capable of sleeping 10-12 hours. According to many sources, this is a sign of low cortisol/adrenal fatigue. When I do feel like taking a nap, I still feel unrefreshed even after taking the nap, in contrast to feeling refreshed for a few hours and then napping again, as described for narcolepsy. Furthermore, this symptom is worst in the morning, and not as bad in the evening. This is also typical of low cortisol/adrenal fatigue.

Source: “Adrenal Fatigue, The 21st Century Stress Syndrome”, by James Wilson

So… I seem to be slowly responding to treatment for low cortisol/adrenal fatigue. If I had a diagnosis for narcolepsy, I believe they would be putting me on prescription stimulants for the rest of my life. I strongly feel that such is not an appropriate treatment for my symptoms.

EasyRhino, if you feel like this could be a sleeping disorder, do you have any recommendations about what to do about it?

15

This could be underlying Hypothyroidism too. Your TSH, and low body temps lead to that.

Do you sometimes feel cold when it doesn’t make sense?

Hair, nails, Skin - Brittle, Dry, Coarse?

16

[quote]pin_cushion wrote:
EasyRhino, if you feel like this could be a sleeping disorder, do you have any recommendations about what to do about it?[/quote]

Sorry, like I mentioned, I don’t know nothing about nothing. I don’t even know what the diagnostic process is for narcolepsy, but I imagined getting rigged with an ECG as you fall asleep and looking for unusual REM cycles or whatever.

I’ve had times where I’ve felt tired, really tired… but they’ve always been solved by sleep. And if that didn’t work, then the answer was generally even more sleep. But I haven’t had any sort of legitimate burned out glands or mono or whatever the really dramatic stuff is.

17

The reference range given on my lab for the TSH is .45 - 4.5. I understand that the range for TSH is controversial. Some say that the test shouldn’t be used as a diagnostic at all. As I mentioned in my previous post, Triiodothyronine, Free, Serum - measured at 3.4 pg/mL, is T3. The reference range is 2.0 - 4.4

18

I see some of you have asked about my thyroid. It seems to be normal on all the labs. The physician pointed out that cortisol is low and that points to adrenal issues.

Dr. Bruce Rind has created a matrix of symptoms to compare and contrast thyroid vs. adrenal symptoms. http://www.drrind.com/therapies/metabolic-symptoms-matrix

Based on his matrix, I definitely lean to the adrenal side.

19

Sorry i missed the FT3 result. You’re right it is okay within range. Honestly I’d prefer to see it in the top 2/3 - 3/4 to be optimized and the TSH and low body temp do make me suspicious… but with those test results you won’t be able to get a doc to tackle this as the main problem.

As far as the cortisol/adrenals I’d want to see if you can get a 4x in one day cortisol test it will be alot more indicitave of how your adrenals are doing.

20

Get a CD4 test, a CD4 percent, or a CD4/CD8 ratio test done if possible.

The root cause seems completely unknown at this point. If it is viral, then likely you have a compromised immune system.

If you have an under active immune response based on the test results, you could try bolstering your overall health and specifically your immune system with various products. A good medicinal mushroom product (I like the ones they sell at mushroom harvest) will significantly increase your immune system. There are also products like colostrum (which might not do a lot of good for increased muscle gains) which has been shown to be antiviral and antimicrobic (due to primarily to IgG, lactofrin, proline-rich polypeptides and others). A company called sovereign laboratories makes an antiviral product called viralox (which is made out of colostrum) that appears to be REALLY COOL if it works like they say it does: www.newlifehealthsolutions.com/new-life-health-solutions/viralox-health-spray.html I won’t plague this board with the product claims though :slight_smile: but hopefully that link survives the mods because the product seems like it could offer you a lot of help.