Toronto Doctor that's Helpful?

Pharma / TRT Testosterone Replacement
1

Hi, I’ve been trying to get lab work done for my low testosterone for the past 3 years now. The most lab work I’ve been able to get is total testosterone, free testosterone, and prolactin. The problem is that the doctors I’ve seen are all egotistical and won’t listen to what I have to say. It’s very frustrating when the doctor says that I’m wrong and will only order tests they think are sufficient.

Today, I saw Dr. Laith Mahdi. He had good reviews on Google and opencare.com, but was very arrogant in person. He ordered total testosterone and prolactin along with some basic blood work and told me that my testosterone is fine. This the blood test:

Hematology
WBC 8.2 (4.0 - 11.0) x E9/L
RBC 5.41 (4.50 - 6.00) x E12/L
Hemoglobin 147 (135 - 175) g/L
Hematocrit 0.43 (0.40 - 0.50) L/L
MCV 80.2 (80.0 - 100.0) fL
MCH 27.2 (27.5 - 33.0) pg LOW
MCHC 339 (305 - 360) g/L
Platelets 267 (150-400) x E9/L
RDW 13.2 (11.5 - 14.5) %

Differential
Neutrophils 5.0 (2.0 - 7.5) x E9/L
Lymphocytes 1.8 (1.0 - 3.5) x E9/L
Monocytes 1.2 (0.2 - 1.0) x E9/L HIGH
Eosinophils 0.1 (0.0 - 0.5) x E9/L
Basophils 0.0 (0.0 - 0.2) x E9/L

Biochemical Investigation of Anemias
Vitamin B12 648 (198 - 615) pmol/L HIGH
Ferritin 51 (22 - 322) ug/L

General Chemistry
Glucose Fasting 5.5 (3.6 - 6.0) mmol/L
Hemoglobin A1C/Total Hemoglobin 0.054 <0.060

General Chemistry

Results may not accurately reflect mean blood
glucose in patients with hemoglobin variants,
disorders associated with abnormal erythrocyte
turnover, severe renal and liver disorders.

Sodium 138 (135 - 147) mmol/L
Potassium 4.3 (3.5 - 5.5) mmol/L
Creatinine 85 (62 - 115) umol/L
Glomerular Filtration Rate (eGFR) 99

or = 90 mL/min/1.73 m2
For patients of African descent, the reported
eGFR must be multiplied by a correction factor
of 1.21.

Albumin 51 (35-50) g/L HIGH
Alanine Aminotransferase 12 (12 - 49) U/L

Lipids
Hours After Meal 15 Hours
Triglyceride 1.14 mmol/L
Cholesterol 5.30 mmol/L
HDL Cholesterol 1.39 mmol/L

Non HDL Cholesterol 3.91 mmol/L
Non HDL-Cholesterol is calculated from Total
Cholesterol and HDL-c and is not affected by
the fasting status of the patient.

LDL Cholesterol 3.39 mmol/L
Consider the non HDL-C value as an alternate
lipid target if monitoring treatment in
intermediate or high risk patients.

Cholesterol/HDL Ratio 3.8
Cholesterol/HDL-C is not included in the 2012 CCS
guideline as a lipid initiation or treatment
target but is recognized as an indicator of high
CVD risk at Cholesterol/HDL-C ratio >6.0
Lipid Target Values Lipid Target Values should be based on patient
10 year CVD risk assessment. 2012 revised
treatment goals include:
High or Intermediate CVD risk

Primary LDL-C < or = 2.0 mmol/L OR
Tx target > or = 50% decrease in LDL-C
Alternate Non HDL-C < or = 2.6 mmol/L OR
Tx target ApoB < or = 0.8 g/L

Low CVD risk

Primary > or = 50% decrease in LDL-C
Tx target

Thyroid Function
Thyroid Stimulating Hormone [TSH] 2.27 (0.30 - 4.00) mIU/L

Pituitary Function
Prolactin 15 (2 - 18) ug/L

Reproductive and Gonadal
Testosterone 13.7 (8.4 - 28.8) nmol/L
Total Testosterone levels may not reflect the
biologically-active testosterone when SHBG levels
are abnormal.

Bone Markers
25-Hydroxyvitamin D 147 (75 - 250) nmol/L
Season, race and dietary intake affect 25-Hydroxy
Vitamin D levels. Highest levels are found in
the summer months and lowest levels during the
winter.

I told him that total testosterone is not a good indicator for active testosterone and that bioavailable testosterone is better. He didn’t even know what bioavailable testosterone is. He thought it was the same thing as free testosterone and had to look it up after I kept insisting that they are different things. It even says so on the blood report “Total Testosterone levels may not reflect the biologically-active testosterone when SHBG levels are abnormal.”.

The first time I saw him I told him about my symptoms, low libido, fatigue, poor beard growth, etc, and he was very hesitant to order any hormonal blood tests. He had the audacity to tell me that I’m a controlling person, that I want to order him to do whatever I want and that my symptoms are the result of depression. I fucking hate hearing the depression diagnosis. It’s a catch-all for all my symptoms. A get-free card. It’ s when a doctor doesn’t give a shit and wants you to get out of their face.

I’ve been seeing a psychiatrist and while I have some psychiatric problems, poor concentration, poor motivation, poor energy, etc, it’s at best dysthmia and not full-blown depression. Furthermore, I have tried several antidepressants that have either only partially helped, but with lots of side effects, or made me worse! I now just take Selegiline and occasionally modafinil for focus and energy. I have never had suicidal thoughts or negative feelings/emotions. In fact, I barely have any emotions at all. I’ve told this to all the doctors I’ve seen and they all say “well you haven’t tried enough antidepressants” or “you haven’t tried an SSRI which are the best antidepressants”. An SSRI? Are you kidding me? SSRIs are well known to cause a loss of libido and dampen emotions/motivation. They’re also known for decreasing energy. Why would I take an SSRI if my symptoms are the exact same as the side effects these drugs cause?

These doctors always just order the basics: complete blood count, ferritin, vitamin b12, TSH. When the numbers come back normal, or within range (that’s all they care about), they give up and say there’s nothing wrong with me. I’ve been suffering for so long, but no doctor will actually help me. It’s like I’m just a number to them and not a human, patient #xxxx.

Does anyone know of a doctor that isn’t arrogant? Someone that actually cares about the patient? I need to see a family doctor first because I can’t see an endocrinologist without getting a referral.

2

Have you read these stickies?
advice for new guys

  • we need to know more about you, young ? old ? skinny ? fat ?
    finding a TRT doc
    thyroid basics

Your TSH should be near 1.0, you probably have a thyroid problem. Check and post your body temperatures as per the thyroid sticky.
TSH ranger are stupid.

Have you been using iodized salt for years?
Outer eyebrows sparse?
Get cold easily?
Thyroid looks or feels enlarged, asymmetrical or lumpy?
Low energy?
Depression?
Dry skin?

Meanwhile, you can try Wellbutrin, it does not rewire your brain.

I can suggest a Doc on Avenue road, but not in OHIP and you pay out of pocket. Are you up for that?

Ferritin is a bit low. Do you eat red meat. Iron in cereals or vitamins. Normally adult males should avoid iron-added foods. If your iron intake is good from red meat etc, one can be concerned about iron loss from GI bleeds. Any food allergies or digestive issues? One can get an occult blood test. Hematology looks good, but HTC is a bit low, but that could be from lower T as well.

Labs, you have some how:
TT
FT
E2
TSH
fT3
fT4 [please not T3, T4]
LH/FSH important

please post body temps and respond to all questions

3

Hey KSman, I actually made a thread 2 years ago but it didn’t get anywhere because I couldn’t find a doctor that would be willing to order those labs you mentioned.

http://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/free_testosterone_is_007_of_total_testosterone19_years_old_doctor_says_everything_is_fine

Regarding body temperature, I ordered a digital thermometer from eBay. I’ll post my temps as soon as it arrives.

I have read the stickies. Well, I wasn’t planning on making this my main thread, but this would probably be helpful for if I’m able to get a doctor to run those labs you mentioned.

Also, I should mention that I started weight lifting in December of 2013. I went from about 120 lbs to 158 lbs, but I’m now stuck on this weight because of how low my appetite is. I eat just a cup or 2 of rice and I’m full for 5-6 hours. I’ve had to force down food to get to this weight.

My lifts have also been stuck and I haven’t been able to gain any strength since October of 2014.

Lifts:

-Squat: 3x170 lbs
-Deadlift: 4x245 lbs
-Bench: 3x135 lbs
-Overhead press: 5x95 lbs

-age: 21
-height: 5’9"
-waist: 32 inches
-weight: 158 lbs

Little hair on body. No hair on chest. Triangular pubic hair. Hairy balls. I even have hair ON my penis, all the way up to the circumcision scar.

Facial hair: a little mustache, chin hair and a couple of cheek hairs. Hairs are sparse and all over the place. Facial hair grows extremely slowly that I only need to shave once every month.

Always around my abdomen. I don’t think it’s ever changed.

Dysthmia since 2011. Chronic fatigue and low appetite since I was a little kid. Had moderate dental fluorosis. Also a stressful childhood, parents fought all the time and made my heart race. Gave me lots of anxiety. Grew up poor.

Symptoms:
-Low appetite
-Severe fatigue: sleeping 12 hours and waking up tired. Can barely open eyes after 8-10 hours of sleep
-Dead libido. I can’t remember the last time I had sexual thoughts
-Poor memory
-Poor learning ability
-Poor concentration, focus, attention
-Poor motivation
-Severe anhedonia
-Other symptoms that I can’t remember

Multivitamin every other day
Vitamin D3 5000 IU every week day
Creatine 5000 mg everyday
Selegiline 5 mg every week day
Modafinil as needed

No hair loss or prostate drugs ever taken.

Breakfast:
Kebab sandwich or burger - Usually around 500-600 calories with 40 g protein

Lunch: Chicken and rice or chicken and bread
Dinner: More chicken and rice or bread. Usually I’ll pour olive oil on the chicken and use the bread to soak it up and eat it.

Fruits and vegetables: Banana, watermelon. Vegetables: usually just a mix of a lot of vegetables

Snacks: Greek yogurt

Currently doing 5/3/1 bodybuilding. Official Website | Jim Wendler - Elite Powerlifter & Strength Coach

Swapped out some exercises for easier exercises. I try to not hit failure as I feel extremely drained if I do so.

No, testes are always soft and squishable.

Rarely getting morning wood or nocturnal erections now.

Yes, but lately I haven’t been putting salt on my vegetables. I’ll start doing that.

Somewhat.

No, I get hot too easily.

Feels fine.

All the time. Even when I’m on multiple stimulants.

Not really, no negative thoughts. See the above symptoms list.

Scalp, forehead, nose, and back are always oily. Skin around mouth is always dry and flaky. Skin on hands is dry and flaky.

Tried it in the past and could only tolerate 150 mg XL. Makes my heart race and gives me palpitations. Also high blood pressure. But it did help somewhat. Tried it recently and the benefits this time were a lot weaker, but the side effects were stronger. It also gave me cognitive impairment this time.

I should note that I have tried a list of substances that increase libido but none of them have increased my libido.

How much would it cost to see him? I’m still in school and have no job.

The only red meat I eat is CostCo’s Kirkland sirloin beef burger and I eat it every 3 or 4 days. I don’t eat cereal and my multivitamin has no iron. No food allergies, but I do get diarrhea very easily and for no reason a lot of times. Other times I’ll become constipated, again for no reason it seems. Fiber intake is good. As for bleeding, my nose is always bloody when I blow it. I also bleed from my gums in my sleep, but I brush my teeth everyday and I have no dental problems.

I drink a lot of chocolate milk, 500 ml every time I go to the gym as its easy calories and protein. Could that affect my iron absorption? I know that iron absorption is sensitive to different things, like tea for example inhibits iron absorption. I drink a cup or two of tea almost everyday.

I’ve noticed that supplementing with Iron bisglycinate helps some of my symptoms and allows me to laugh to funny things. I used to take 18 mg, but only for a week and would cycle off it with some herb like Rhodiola. Should I supplement Iron?

One thing that I should note is that I get shortness of breath very easily. Just sitting down I’ll feel the need to take in a deep breath.

4

As Ksman said, Wellbutrin may help without sexual side effects, but it can be very anxiogenic, so it is not for people who have anxiety - Wellbutrin is more for people who can’t get out of bed. Another newer AD that doesn’t have sexual side effects so may be worth a try for you is Vilazodone - in fact a lot of people report increased libido from it.

Even I didn’t get any sexual side effects from Vilazodone and I get them from all the SSRIs and SNRIs and even from Remeron and Buspar. (I had to stop Vilazodone because it gave me rage but I think that is uncommon.)

5

I thought that Wellbutrin could displace Modafinil. Both might be overload.

Can’t suggest a clinic there that is not out-of-pocked [no OHIP].

Thermometer at local drug store might have been cheaper/faster.

Are those cholesterol levels high?low

6

You may have a genetic chromosome problem.
Ask around to see if there is some way to get free testing.

See XYY syndrome - Wikipedia

and XYY syndrome - Wikipedia

You can also have you semen checked under a microscope to see if you are fertile. If not, that motivates looking into the above possibilities.

You could also be chimeric. Two fertilized eggs merge and if one is male and the other female, unusual things can happen. Your pubic hair pattern has triggered this line of speculation.

Or your T levels have never been high enough for normal virilization. There can a lack of DHT or ineffective T or DHT receptors.

In any case, you will need more lab work and a diagnosis can move things forward.

7

[quote]seekonk wrote:
As Ksman said, Wellbutrin may help without sexual side effects, but it can be very anxiogenic, so it is not for people who have anxiety - Wellbutrin is more for people who can’t get out of bed. Another newer AD that doesn’t have sexual side effects so may be worth a try for you is Vilazodone - in fact a lot of people report increased libido from it.

Even I didn’t get any sexual side effects from Vilazodone and I get them from all the SSRIs and SNRIs and even from Remeron and Buspar. (I had to stop Vilazodone because it gave me rage but I think that is uncommon.)[/quote]

It definitely increased anxiety, but it also gave me heart palpitations for no reason. Just sitting down or standing up would result in a fast and pounding heart beat and also a weird feeling in my chest. I also had some chest pain. Yeah, Wellbutrin is activating, but tolerance develops to its activating effect, at least for me. It only helped me get out of bed for the first 2 weeks and then it was back to 12 hours of sleep after that.

Vilazodone is an SSRI with partial-agonism at the 5-HT1A receptor. I’d rather not take an SSRI. Besides, Rhodiola increases serotonin, dopamine, and the 5-HT1A receptor count without having any SSRI-like side effects. Rhodiola only works for about 2 weeks for me before I develop a tolerance. I imagine the same thing would happen if I were to take Vilazodone.

I need something that’s activating, but doesn’t increase anxiety. So far I haven’t found anything that works in the long-term.

[quote]KSman wrote:
I thought that Wellbutrin could displace Modafinil. Both might be overload.

Can’t suggest a clinic there that is not out-of-pocked [no OHIP].

Thermometer at local drug store might have been cheaper/faster.

Are those cholesterol levels high?low

[/quote]

Yeah, Wellbutrin can displace Modafinil, but only for the first 2 weeks for me. I quickly develop a tolerance to its wakefulness promoting effects. Modafinil is only taken when I need to get up after 7-8 hours of sleep. You can’t lead a normal life and sleep 12 hours everyday.

Well, how much does that clinic cost approximately?

The thermometer I bought from eBay was only a $1.00 with free shipping. Yeah, buying it from a drug store would definitely have been faster.

Those cholesterol levels are high. I’ll rewrite them in a different unit of measurement:

  • Hours After Meal 15 Hours
  • Triglyceride 100.97 mg/dl
  • Cholesterol 204.95 mg/dl
  • HDL Cholesterol 53.75 mg/dl
  • LDL Cholesterol 131.09 mg/dl
  • Non HDL Cholesterol 151.20 mg/dl
  • Cholesterol/HDL Ratio 3.8

[quote]KSman wrote:
You may have a genetic chromosome problem.
Ask around to see if there is some way to get free testing.

See XYY syndrome - Wikipedia

and XYY syndrome - Wikipedia

You can also have you semen checked under a microscope to see if you are fertile. If not, that motivates looking into the above possibilities.

You could also be chimeric. Two fertilized eggs merge and if one is male and the other female, unusual things can happen. Your pubic hair pattern has triggered this line of speculation.

Or your T levels have never been high enough for normal virilization. There can a lack of DHT or ineffective T or DHT receptors.

In any case, you will need more lab work and a diagnosis can move things forward. [/quote]

Those chromosome problems also result in a tall height for the one suffering from it, but my height is average. I’m only a little bit taller than my dad, I think he’s 5’8" and I’m 5’9". I used to think I might have klinefelter syndrome, but my LH and FSH were just barely above the lowest end of the reference range. From my previous post in the thread from 2 years ago:

  • Follitropin (FSH): 2 IU/L (2 - 8)
  • Lutropin (LH): 3 IU/L (2 - 6)

Chimeric? What are the symptoms of this?

I think it’s just my t level has never been high enough for normal sexual characteristics to develop. Also, my dad has the same body-type as me, wide hips and narrow shoulders, but he has normal muscle mass.

I forgot to mention something important: my hair has been thinning considerably in the past year or two. On the crown of my head there is a prominent bald spot, but it’s not a circle, it’s a horizontal line from my left ear to my right. There’s also a horizontal bald line on just the left side of my scalp that goes from the back of my scalp to the front.

One more thing, I remember getting a blood test like 2 years ago while I was taking Rhodiola Rosea and my total testosterone came back at 489 ng/dL. I was sleep-deprived when they withdrew my blood. Does this mean anything or was it just an anomaly?

Regarding the chromosome testing, it’s not the problem of getting free testing, but the problem of finding a doctor that’s willing to test for it. I’m gonna ask around and Google for doctors that do TRT in Toronto. Hehe, getting my sperm checked. Considering how the doctors I’ve seen won’t even test for free t3 and t4, let alone estradiol or free testosterone, there’s no chance in hell that’d they would have my sperm checked, especially since I’m young and not planning on having a baby.

Thanks for replying to this thread, btw. I appreciate it.

8

[quote]alphaepislon wrote:

Vilazodone is an SSRI with partial-agonism at the 5-HT1A receptor. I’d rather not take an SSRI. [/quote]

Vilazodone is not an SSRI. It is an SRI, which is not the same thing. For example, cocaine is also an SRI. I am not saying vilazodone is like cocaine, just that SRIs can be very different from SSRIs.

9

Chimeric effects will be very random and can be totally hidden with no problems. Parts if your body would have different DNA. Blood DNA can be different than sperm DNA in a few cases. When you get a sun tan, do you tan evenly all over or some parts of your body are different? That is a hallmark of a Chimeric, but many Chimerics would have skin that is the same everywhere.

Thyroid problems can lead to general hair loss, as opposed to male pattern baldness.

Yes, T levels are low, but DHT is unknown and there can be receptor side issues.

Because your dad has similar body attributes, this does sound inherited and if a genetic mutation, that got passed down, suggesting Y chromosome; and he was fertile.

10

Has anyone tried this clinic: ontariomenshealth.ca

They specialize in treating men’s problems including low testosterone. Anyone tried them before?

11

I can’t go on living like this. I’m seriously feeling hopeless now. A lack of money + doctors that don’t care = I can go fuck myself. I haven’t done anything in the past 4 years. Not even exaggerating, I haven’t done shit. I just sleep for 12 hours, barely eat, just mindlessly browse the internet or play a game to kill the time. I don’t enjoy doing anything. I don’t even have motivation to watch TV or movies.

The drugs Bupropion and Selegiline which used to help now don’t do anything. Testosterone is required for antidepressant drugs to work.

I’ve been going to the gym for the past 1 and half years and my lifts are pathetic. Only a couple of them are in the novice range while the others are still in the untrained range. No matter the weight I feel weak and fatigued. My upper body is like that of an 8 year old, shoulders close together with no sign that puberty happened. Facial hair is patchy and sparse. Hips wide as a female’s. Libido is nonexistent, something that I can only dream of having. Appetite is extremely low and I have to force myself to eat. Testes small and as soft as a rotten grape. Bone pain, fat gain despite barely eating above my caloric maintenance, and hair loss. I feel self-conscious every time I put on some clothes. I have to choose shirts that specifically hide my wide hips. I usually wear a sweater even if its hot outside as it hides my feminine body shape pretty well.

All of these symptoms and my doctors don’t care because my level is within the fucking range. Fuck your range, I’m fucking suffering every single day and you can’t be bothered to help me just because I’m within an arbitrary range? I exhibit almost all the symptoms of low testosterone, but just because I’m within the range you’ll diagnose me with depression and send me on my way. Thanks for providing quality medical care.

Life goals? None. There is no point to life when you can’t enjoy anything, when you don’t have motivation for anything, when everything you do is the result of forcing yourself to do it.

12

Did you ever get the tests that Ksman mentioned, especially the thyroid ones?

I live in Toronto and had trouble finding a doc to get all of the bloodwork I wanted, and finally went to a walkin clinic at College and Spadina and saw Dr.Zaki. Google will help find him.

He knew more about thyroid than any other doctor I have seen (which is to say, he actually understood that TSH is not the only game in town) and based on my symptoms agreed to do a blood test for Free T3 and Free T4. As well, he allowed me to pay out of pocket for other tests I wanted, like estradiol and DHT. He was down to earth and worked with me, not against me. He is no anti-aging specialist, just a good doctor who gets it.

13

Thanks for the suggestion, but I couldn’t visit that doctor as he’s far away and I’m too busy right now with school.

Anyway, I had to go see a doctor because my ears were full of wax so I went to see a doctor and after she flushed out my ears I asked her if she does hormone testing. I almost didn’t ask because I thought she would just say no like all the other brainless doctors I’ve seen.

I told her about my symptoms and she was really nice and wrote down a bunch of tests I wanted to get done including some I didn’t even ask her about, like c-reactive protein which is a flag of inflammation. Here are the results:

  • WBC 6.5 (4.0 - 11.0 x E9/L)

  • RBC 5.37 (4.50 - 6.00 x E12/L)

  • Hemoglobin 147 (135 - 175 g/L)

  • Hematocrit 0.443 (0.400 - 0.500 L/L)

  • MCV 83 (80 - 100 fL)

  • MCH 27.4 (27.5 - 33.0 pg) LOW

  • MCHC 332 (305 - 360 g/L)

  • Platelets 247 (150 - 400 x E9/L)

  • RDW 13.1 (11.5 - 14.5 %)

  • Neutrophils 4.2 (2.0 - 7.5 x E9/L)

  • Lymphocytes 1.5 (1.0 - 3.5 x E9/L)

  • Monocytes 0.7 (0.2 - 1.0 x E9/L)

  • Eosinophils 0.1 (0.0 - 0.5 x E9/L)

  • Basophils 0.0 (0.0 - 0.2 x E9/L)

  • Erythrocyte Sedimentation Rate 4 (2 - 30 mm/hr)

  • Vitamin B12 504 (198 - 615 pmol/L)

  • Ferritin 33 (22 - 322 ug/L)

  • Glucose Fasting 5.0 (3.6 - 6.0 mmol/L)

  • Creatinine 75 (62 - 115 umol/L)

  • Glomerular Filtration Rate (eGFR) >120

  • Thyroid Stimulating Hormone [TSH] 1.62 (0.30 - 4.00 mIU/L)

  • Thyroxine Free [Free T4] 18 (9 - 23 pmol/L)

  • Triiodothyronine Free [Free T3] 6.0 (3.5 - 6.5 pmol/L)

  • Follicle Stimulating Hormone [FSH] 3 (2 - 8 IU/L)

  • Luteinizing Hormone [LH] 4 (2 - 6 IU/L)

  • Prolactin 11 (2 - 18 ug/L)

  • Estradiol 137 (< 150 pmol/L)

  • Dehydroepiandrosterone [DHEA-S] 8.8 (< 15.0 umol/L)

  • Testosterone Free 341 (196-636 pmol/L)

  • Sex Hormone Binding Globulin 32.3 (10.0 - 70.0 nmol/L)

  • C Reactive Protein 3 (< 8 mg/L)

MCH is always low. Is this a concern? I’m frequently out of breath even just sitting down and my heart beats forcefully at random times.

My free T3 is near the top of the reference range and T3 is supposed to help burn fat yet I can’t lose belly fat. Even when I was 115 lbs and my arms were bone thin I still had a ton of belly fat. What does this mean? High cortisol?

Is my estradiol okay? Isn’t the optimal number around 22 pg/mL? Mine is 37 pg/mL.

14
  • Thyroid Stimulating Hormone [TSH] 1.62 (0.30 - 4.00 mIU/L)
  • Thyroxine Free [Free T4] 18 (9 - 23 pmol/L)
  • Triiodothyronine Free [Free T3] 6.0 (3.5 - 6.5 pmol/L)

TSH should be near 1.0, disregard the lab range.
fT4 should be mid-range 16 and 18 is a bit higher and not a red flag
fT3 should be mid-range 5 and 6 is getting more than a little high

I can’t see that you posted waking and mid-afternoon body temperatures
If body temperatures are low, try to get rT3 tested and read the thyroid basics sticky.

Irregular heart beat:
take magnesium supplements, also good for muscle cramps
leafy green veges or vitamin K in a multivit

DHEA seems low for your age.
Wondering if cholesterol is low. Cholesterol is the foundation for your hormones
Also adrenal related:
test AM Cortisol, do at 8AM please!

Yes, E2 is high and it would be good to see if you could get Rx for 0.5mg per week in divided doses.