Possibly Low T or Adrenal Fatigue

Pharma / TRT Testosterone Replacement
1

I have been dealing with some unresolved health issues for around 6 years. I have periods where symptoms are worse and where symptoms aren’t as bad.
26M | 5’11" | 180lbs
Symptoms:

  • Fatigue
  • Low libido
  • Poor exercise performance
  • Inability to focus
  • Headaches
  • Joint pain
  • Anxiety
  • Depression
  • Weight gain (however i recently have been able to lose 20 lbs through careful dieting)
  • High bp (140-150/80-90 w/o meds)
  • Low body temp 96.0-96.5 in AM, 97.5-98.0 in PM
  • Always cold especially hands/feet

Current Medication: Vyvanse 40mg (not cause of high bp) dx’d ADHD 2 years ago. Losartan 50mg for bp (helps some)
Supplements: 5000IU vit d (daily), 90 mcg K2 MK-7, 1200 mg omega-3, 450mg magnesium, 30mg zinc.

Labs, most recent to oldest:
1/2/17

TSH 1.320 (.45-4.5)
Testosterone, Serum 389 (348-1197) doctor was concerned by these levels appointment next week
Magnesium, Serum 2.4 (1.6-2.3)
Vitamin D 29.7 (30.0-100.0)
Lipid Panel Cholesteral, Total 121 (100-199), Triglycerides 50 (0-149), HDL 43 (>39), Vldl 10 (5-40), Ldl 68 (0-99)
Glucose, Serum 106 (65-99)

CBC & Comp. Metabolic Panel all normal

3/23/16 I remember being dehydrated for this lab so results are probably slightly inflated (they had to draw from 2 locations)
Eosinophils 1.7 (0.00-.60)
%Eosinophils 21.8 (.7-7.5)
DHEA-S 913.1 (89.0-457.0)
Vitamin D 16.9 (30.0-100.0)
Testosterone, Serum 464 (241-827)
Testosterone, Free 12.25 (5.00-21.00)
SHBG 20 (10-57)
Albumin 4.4 (3.0-4.6)
FSH 2.0 (1.4-18.1)
LH 2.5 (1.5-9.3)
Prolactin 6.5 (2.1-17.7)
Vitamin B12 407 (211-911)

12/12/15
RBC 4.67 (4.7-5.9)
Hgb 13.7 (14.0-17.1)
HCT 40.8 (41.9-53.1)
Eosinophils .83 (0.00-0.60)
% Eosinophils 14.2 (.7-7.5)
DHEA-S 789.0 (89.0-457.0)
Estradiol 18.9 (ND*-39.8)
Progesterone 1.79 (.28-1.22)
Testosterone, Serum 377 (241-827)
Albumin 4.1 (3.0-4.6)
SHBG 21 (10-57)
Testosterone, Free 9.95 (5.00-21.00)
Cortisol 8.7 (5-25) 8:30AM

11/24/15
Vitamin D 13.1 (30.0-100.0)
T3R 20.5 (9.0-27.0)
FT4 1.21 (.89-1.76)
FT3 3.4 (2.3-4.2)
B-12 562 (211-911)

10/23/15
Celiac Panel Negative
Cortisol 10.5 (5-25) 11AM
TSH 1.054 (.350-5.500)
Thyrobolublin Ab 17 (<60)
TPO <28 (<60)
FT4 1.37 (.89-1.76)
TT4 8.7 (4.5-10.9)
FT3 3.3 (2.3-4.2)
TT3 .97 (.60-1.81)
B-12 406 (211-911)
T3RU 35.5 (24.0-35.0) although high i’m fairly sure this is a useless test

I’ve seen several doctors, I got a new GP last week and saw her. I like her so far, she took the time to listen to my concerns and actually thinks my T levels are a concern ~30 from bottom range. Got new labs done with her which showed same T levels. She also said something about my AM cortisol being a bit low. I along with her are completely confused as to what is causing high DHEA-S levels, especially with low T.

Unsure what DHEA-S levels mean. Its a fairly non specific test, but from what I’ve read high levels >600 warrant additional research.

It seems to me like i might have some sort of secondary hypogonadism, but maybe my levels are actually okay? LH and FSH seem lower then they should be, but are within range.

I’m not sure if my AM cortisol is too low or not. I don’t believe my insurance would pay for a 24 hour saliva, but maybe i can do an online one.

I have symptoms of both low T and hypothyroid, but my thyroid tests come back near perfect every time. T appears to be on the low side. AM temps are consistently low. I am considering IR before doing anything else, maybe that could help.

Trying to figure out how i should proceed. I’m sure my doctor already has an idea on what to do next, but I would like to be able to ask for specific tests if need be. I am going to ask for a full male hormone panel. Total T, Free T, LH, FSH, Estradiol (sensitive). And probably ask for another am cortisol.

2

Please read the stickies found here: About the T Replacement Category - #2 by KSman

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc
  • thyroid basics

You have ample fT3 to support good body temps. Low body temps suggest that rT3 is blocking fT3. Odd that TSH is not higher, unless you are mid-phase with long term iodine deficiency now with nodules.

What has been your history of using iodized salt?
Outer eyebrows sparse?
Feel cold easily? -yes

Your cholesterol is pathologically low. Docs have been brainwashed and probably tell you its great. If you have an extreme low fat diet, that is not good. Total cholesterol <160 is associated with increased all cause mortality.

DHEA-S is high as is progesterone. Both are adrenal hormones that do not have a pituitary control loop. Something that needs to be looked at. rT3 has an adrenal stress connection too.

You need Vit-D25 near 60
How long on Vit-D3 5000iu?

Cortisol seems to waver.

Please list all Rx and OTC meds.
Heart burn?
Digestive issues?
Other med conditions/events?

Glucose 106 was fasting? Metformin 500mg once a day with meals may help.

You should add these to the mix:
Fish oil, nuts, flax seed oil/meal
high potency B-complex multi-vits that list iodine+selenium and other trace elements
CoQ10, ubiquinol form, note the spelling carefully, get 50mg and take 100mg for first week and note if you feel any changes

Have you been exposed to toxins or fumes in the work place?
Water is safe?

Labs:
ACTH at 8AM
AM cortisol at 8AM
AST/ALT
serum uric acid
CoQ10

fT3 give controls mitochondrial production of ATP, the universal currency of cellular energy. CoQ10 enables this activity. This is all part of the body’s temperature control loop and low body temps indicate a problem. As your thyroid labs look quite good, I suspect rT3 and or CoQ10 as the weak point.

see what side effect fit you and consider when you introduced and quite 2 years ago:

Your high BP probably has a lot do do with arterial muscle tone. Your magnesium is not a factor in this case. Suggested supplements may help.

Trails to follow:
DHEA-S, ACTH, Cortisol
Low cholesterol
elevated serum glucose

Glucose could be up in-part from lack of mitochondrial activity.

See what diet changes you can make to increase cholesterol.

3

I don’t use much salt when I cook for myself. I eat out a decent amount since I serve at a restaurant. Not sure if they use iodized salt or not, I’ll look into it.

No

Yes, especially hands and feet. I think I have mild Raynaud’s, my hands get super cold during the winter and then hot/red /w some pain. My hands/feet are cold during warmer seasons but I don’t get the cycling from cold to hot.

Don’t have a diet low in fat. I eat medium fat content cuts of meat, don’t avoid fat.

I was on 25K IU D3 for 3 months daily about a year ago. My levels went up a little after that. I’ve been taking 5000iu for the last 3 weeks.

Losartan 50mg
Vyvanse 40mg
Vit-D3 5000iu
90mcg K2 MK-7
1200mg omega-3
450mg magnesium
30mg zinc

I’ve had some heart burn in the evenings.
Some minor G.I. issues with occasional cramping, I have pain with light pressure across abdominal area. Doctor is aware of this from palpating area.
Anxiety, Depression, ADHD & high bp.

Glucose was fasting, my last fasting glucose was 77 like 6 months ago. I’m sure she will retest on next labs.

I currently take a fish oil supplement. I’ll add some nuts to my diet, I like almonds and cashews. I have taken a B-12 L-5-MTHF supplement in the past I’ll consider re-adding it to my supplements. Will also do some research into CoQ10.

No toxins at work or home that i’m aware of. Water safe.

1/2/17
AST - 18 (0-40)
ALT - 15 (0-44)

How do i get my doctor to order CoQ10 test?

Also every doctor that I’ve seen disregards my complaints about body temps. My temp at doctors offices range from like 97.5-98.0, only once was it below 97 and the nurse took it multiple times to make sure it was accurate. My AM temps are always 96.x-97.0 at most.

4

Seems we’re a bit on the same page! I’ve also been having temp problems, especially in the AM. Do you have any aches in your back and heels at the end of the day? That seems to be common in sufferers of Adrenal fatigue

5

Do not count on getting any iodized salt in restaurants or prepared foods. It is all up to you.

I had one other guy who spilled or hyper metabolized Vit-D3 or Vit-D25 but perhaps Vit-D3–>Vit-25 pathway is flawed.

Have you had any abnormalities in a urine test?

Your low cholesterol remains a problem. A higher fat diet might help in that regard.

Note cholesterol as the starting point:

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With regards with the above implication, your high DHEA presents a contradiction that I do not understand.

Try to take Vit-D3 and other oily supplements with a meal that contains fats, avoiding high fiber foods at that time.

I have seen guys get CoQ10 tested, not very often. Do not know the details of that. Or you could take ubiquinol as I suggested to see if any effects.

Sorry that you have to deal with these problems and having to become your own expert.

6

My current doctor said she wasn’t concerned by my DHEA-S levels, saying she would expect my DHEA-S level to be high as a young male. However my levels are way out of range, and all my reading online suggests adrenal adenoma/cancer should be ruled out at levels >700. That being said steroid-only secreting adenomas/cancers are extremely rare, so its probably not this either.

I went to a Naturopathic Doctor about 1.5 years ago and she said that my DHEA-S levels were probably a result of my body trying to compensate for low test. I’ve also heard this from people online on other boards. But I cannot find a mechanism by which that would make any sense, that is just not how your adrenals work, at least not with current understanding. And it wouldn’t explain low-normal cortisol.

I am really at a loss as to what could be causing high DHEA-S, low-normal cortisol, high progesterone, with low T. I cannot seem to find anyone with similar labs anywhere on the internet.

I’ll just have to wait and see what the next round of tests show.

7

Agree.

Experiment: Take Rx hydrocortisone and see if progesterone, ACTH and DHEA-S go down. Would be an interesting diagnostic.

You are already taking supplements that I would suggest.
High BP probably from muscle tone - do you get any muscle cramps?
Wondering if thyroid affecting arterial muscle tone.
Low body temps takes us back to rT3 and adrenal fatigue.

We do not have AM cortisol at 8AM?
I do not see that we can state that cortisol level is low.

8

Okay so i went back to primary, she wanted to do an A1C before proceeding with anything else. Also got a referral to a urologist.
A1C: 5.7 (4.8-5.6)

The urologist examined my testies and looked at my previous labs T: 389 (348-1197), he said there was nothing wrong with my testosterone production and that my levels were normal. He said my fatigue was from the BP medication and asked me why I had high BP in the first place, unusual for BMI/age. He suggested that I exercise more and get outside more. He then said he would test my T levels again and I got those results.

T: 354 (348-1197)

I got a message from my PCP saying that my blood test for A1C showed pre-diabetes and she wanted to talk with me about it, so I am going in next week.

None of this really makes much sense to me I am a 27 and have a normal BMI, it seems to me like there must be a deeper reason for my High BP, low testosterone and high blood sugars. I am afraid that my doctors are not going to look for anything.

I do not have a family history of high BP or diabetes. I do however have a family history of autoimmune and thyroid disease on my mothers side.

I am also unclear on the link between insulin resistance and testosterone. There is apparently some correlation between the two, but most everything i read about the connection seems to have a BMI component.

On another note, I think its absolutely ridiculous how labs evaluate reference range for non-standard labs (specifically hormones). One does not get a test for lets say testosterone unless they feel it could be causing symptoms, people that are getting blood tests for hormones are not the normal. There are many known factors that affect testosterone levels (sleep, age, BMI, illness), to say that you must be in the lowest 5% of all patients tested seems fairly absurd.

EDIT: I found this, seems to have some information i was looking for.
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2265.2005.02299.x/full

9

If you are pre-diabetes, apple cider vinegar and cinnamon increase insulin sensitivity: