I will try to keep my life story short here and jump straight to the puzzle.
I am 32 years old. Since the last 10 years or so, I have been suffering (on and off) from of all the possible low T symptoms you can find, except loss of height.
My symptoms, mostly extreme brain fog, constant fatigue and non-existent libido - come and go and can last for weeks, months and sometimes years. I am happy in general and never suffered from depression.
I have been examined in every way possible for my symptoms but my non-progressive doctors could not find anything (however they failed to check my free or bioavailable T and SHBG).
My happiness is higher than ever before but my symptoms worse than ever right now. This lead me to check my levels.
Questions:
#1: Let’s say my cortisol wasn’t high, could my lower range of bioavailable T be the culprit of my symptoms even though my total T is high? #2: My endocrinologist says my cortisol isn’t very high and that I shouldn’t worry. Okay so what else can I do? Clearly, this isn’t optimal for a non-stressed, slim person with normal values otherwise. He also thinks my T looks normal and does not want to treat it. #3: I will run another 24h urine cortisol test shortly and bring it to another doctor. What else do you guys suggest in my case?
I’m willing to bet you that your SHBG is binding all your FT, you need SHBG tested. If it’s high large doses of T will decrease SHBG so you can feel the effects of your FT.
You need to get Total Test, Free Test, LH, FSH, SHBG, Estradiol, Prolactin, Plus all thyroid labs. There are more once you are actually on TRT, but you need these to even have a clue what is actually going on. (Are you on TRT?) Test Level looks good, high actually.
Thanks for the input systemlord! SHBG is indeed also on my “to test”-list. Unfortunately, I will have to fly abroad to do it as it’s very hard to find a clinic where I live that can test it. Same goes for E2 Sensitive.
If my FT was to become higher, would my high cortisol make less of a difference? I heard the ratio is what’s important.
I do have results for those, except for SHBG. I could however only upload 1 image to start with.
My total is high yes, but do you consider my BAT high too?
TSH better near 1.0
Thyroid lab ranges are rather useless and “normal” means little.
fT3 should be mid-range or a bit higher, 4.20 is low.
fT3 is the active hormone
fT4 level is OK, T4 is reservoir for T4–>T3 conversion.
Evaluate overall thyroid function via oral body temps as discussed below.
T status appears good - so far.
Thyroid affects metabolic rate of every cell in your body and organ system and brain.
Cortisol is made in the adrenals. Should look at other adrenal related hormones. DHEA for one and you do labs for DHEA-S to eval DHEA. Do not test DHEA directly. If you have a lot of stress, which can be many things, the adrenals can suffer and leads to elevated rT3 that interferes with fT3. Do labs for progesterone with is an adrenal hormone in males and note that progesterone–>cortisol. In the long term, higher cortisol levels can drop from adrenal fatigue. Stress can be financial, relationships, death of loved ones, unemployment, acute or chronic infections/inflammation etc.
Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.
KSman is simply a regular member on this site. Nothing more other than highly active.
I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.
The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.
Very informative stuff KSman. despite reading hundreds of hours, I did not know about the range of TSH and FT3 for example.
I checked my first basal temperature this morning and it showed 36.4 C (92.52 F).
Last week I realized my sea salt did not contain any iodine and decided to add iodized salt to my diet.
Other than that, I currently get beyond the DV for every vitamin and mineral from foods (Lots of vegetables, only good fats, lean meat and 30-40% complex carbs). Additionally, I take extra supplement for Vitamin C, D3, Omega 3, Magnesium, and Ashwaganda.
I now added DHEA-S and progesterone to my “to check”-list.
There is literally zero stress in my life, other than the physical stress I put my body to in the gym. Right now I am taking a long recuperation just in case I am overtrained even from my light workout routine (3-4 times a week).
Diagnostic options: Not a lot here in the Philippines where I currently reside. If it’s hard to find a progressive physician in Europe, it’s even 10x harder here. I basically go to the lab and ask to have things checked out, and take the results to different doctors depending on in which specialty it belongs to.
Yesterday I got another test back, an ECG:
(not sure my cardio twice a week can justify that low )
Questions:
#1. Do you really consider my bioavailable T good? I know it’s not the most horrible one, but good?
#2. Is adding 3-5g of iodized salt to my diet daily enough? Other iodized foods I eat are eggs and vegetables.
Forgot to answer this one, sorry. In the first picture attached, there is an Estradiol III test. They could not offer Sensitive Assay in this country.
Updates:
Added extra iodine supplement just in case, but could not find 12.5mg tabs where I live so will order online. Will have to stick with the micro kelp dosages and iodized salt for now :-/
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