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Hello everyone!
I’m glad to have found this forum. I hope maybe someone here has some suggestions for me.
I’m male, 30 years old with a long history of low testosterone.
I have been to many different clinics and endocrinologists over the years and told them all my problems and suspicions that something’s wrong but no matter how long my levels were they always told me it’s still normal. My lowest was 8nmol at age 30 and 250ng/dl at age 20.
In fact the one endocrinologist told me even if I had lower T than 250ng/dl I’d still not get anything from him.I suffer from depression (endogenous and exogenous) and anxiety and also some ocd kind of thoughts like excessive worrying and fears. I have been having this since I was a child. I never tried antidepressants cause I was scared of them. However last year I decided to see a psychiatrist.
So far I have tried:
Celexa 20mg/day for 30 days, absolutely no effect at all.
Remeron 30mg/day for 8 weeks, also no effect other than being tired and gaining weight.
Currently I am on Wellbutrin 150mg for 4 weeks and now 300mg since 7 days, also no effect so far.That I don’t react to any antidepressant is very discouraging. But since my depression is also caused by physical sickness and other things which depress me I really don’t know if an AD can do very much for me. If I didn’t have so many sorrows and if I wasn’t sick I’d also be less depressed.
My latest extensive labs were done in August by an endocrinologist (see below). Since my LH and T were lower than ever before the doctor said I have to go on TRT.
He then put me on a 2,5% gel which contains 62mg testosterone. I have been on this gel for 1 month now and my levels are still way too low at 10,2 nmol/l. I also don’t feel better at all. My endo told me to use the double amount now which I’ll do but I worry that once my T goes up my e2 will also go up and I don’t know what he will say then cause I am sure that he’s not using AIs.What I also wonder is if there’s something wrong with my thyroid because TSH is high.
I asked my endocrinologist if the high TSH means anything and he said as long as ft3 and ft4 are high I don’t have to do anything. :confused:If you have any advice or input on my results I’m thankful for all advice I can get.
But I also have to mention that I don’t live in America which means that a lot of fancy
treatments which are widely used over here like hcG, Aromatose Inhibtors and all this
stuff isn’t available. My endocrinologist is totally oldschool. He said I can try gel, or Nebido or injections every 2-3 weeks. I’m afraid that’s all.I even went to the library and got the latest andrology books hoping to find something about Aromatose Inhibitors in TRT but they didn’t even mention it which already says a lot. If they don’t mention it then this means that it’s not used in European TRT treaments and this means that I also won’t find a doctor who uses it.
ps: I have been tested for Klinefelter, which was negative. And a pituitary MRI was also normal. Testicles are also normal on the ultrasound. My suspicion is that I have always had low T because even as teenager I was very weak and didn’t get any facial hair until 20.
cholesterol 160 normal range 100-200 mg/d
HDL 53 normal range: 40-120 mg/dl
LDL 90 normal range: 0-160 mg/dlHBA1c 5 normal range 4-6%
GPT 26 normal range: 0-50 U/l
GOT 31 normal range: 0-50 U/l
fT3 4.2 normal range: 2-5pg/ml
fT4 14,1 normal range: 9-18 pmol/l
TSH 4 normal range:0.5-2.5 uU/mlTPO-antibodies 10 normal range: 0-35 U/ml
eGFR 60 normal range: 60-140 ml/min
CK 91 normal range: 0-190 U/ldhea 3010 normal range: 950-6500 ng/ml
prolactine 11 normal range: 2.5-17 ng/ml
cortisol 121 normal range: 50-250 ng/ml
ACTH 15 normal range: 10-48 pg/ml
IGF-1 274 normal range: 115-360 ng/ml
hgh 0.05 normal range: 0-0.8 ng/mlLH 0.71 normal range: 0.8-7 mU/ml
FSH 2.5 normal range: 0.8-11 mU/ml
estradiol 33 normal range: 0-56 pg/ml
shbg 25 normal range: 13-70 nmol/l
testosterone 1.30 normal range: 3-9 ng/ml
free androgen index 16 normal range 30-110
androstenedion 1.45 normal range: 0.7-3.5 ng/mlGnRh / trh test:
LH (start): 0.71 mU/ml
LH (after 30 minutes) 14,9 mU/mlFSH (start) 2.3 mU/m (normal range: 0.9-11 mU/ml)
FSH (after 30 minutes) 3.93 mU/mprolactine (start) 11 ng/ml
prolactine (after 30 minutes) 67 ng/ml—-
Additional Thyroid tests:
August:
TSH 2.4 uU/ml Norm: 0,3-4,2
FT3 4.3 pg/ml Norm: 2,3-4,2
FT4 1,3 ng/dl Norm: 0,9-1,8October:
TSH 4.1 uU/ml Norm: 0,3-4,2
FT3 3.9 pg/ml Norm: 2-4,3THYROID:
Generally, it is useful to improve thyroid hormone signaling before adding testosterone. It sets the foundation for testosterone replacement in order to minimize adverse effects.
The brain is a separate compartment from the body when it comes to thyroid hormone. The brain can have different levels from the body. Outside of doing a lumbar puncture to help determine brain levels, the TSH actually is a measure of what is in the brain. Free T3, Free T4, Total T3, Total T4, and Reverse T3 indicate what is in the body.
When body levels are high, yet TSH is also high, there may be a problem with either thyroid transport into the brain or thyroid activation by Astrocytes in the brain. The problem then becomes how to improve brain levels so that mental function can improve. When body levels are already high, increasing thyroid hormone further may result in hyperthyroid symptoms in the body such as heart palpitations or arrhythmias. Assessing for and addressing metabolic-nutritional problems which can cause transport or activation problems in the brain for thyroid hormone would be a focus of treatment. If thyroid resistance as a possibility, particularly if a person shows signs of hypothyroidism despite high body levels, then it may be possible to add thyroid hormone to improve function.
TESTOSTERONE:
Using anti-estrogens isn’t often needed when doing testosterone replacement treatment.
When testosterone level is optimized to between 650-900 ng/dL, the testosterone signal will often counteract problems with estrogen if they happen at all. As per Endocrine Society guidelines for testosterone replacement, I would go ahead and treat the hypogonadism. If frank problems with estrogen occur – such as gynecomastia, would it be necessary to add an anti-estrogen. Worrying about this issue excessively would simply mean postponing the benefits of restoring testosterone signaling. Techniques to minimize estrogen signaling with testosterone replacement include using transdermal testosterone – and applying it only to the arms and shoulders, and using smaller and more frequent testosterone injections – such as twice or more a week injections.
If adrenal cortex hormones are low and thyroid hormone is suboptimal, then problems may occur with the addition of testosterone. Testosterone suppresses adrenal cortex signaling and exogenous testosterone can reduce thyroid hormone production. Both actions may exacerbate ongoing problems.
DEPRESSION:
Antidepressants generally work on only a small portion of what causes depression. This is why they usually do not work when used alone.
In my experience, it takes multiple problems in one’s body to cause a mental illness – so many problems that the body/mind is unable to mount a compensatory action to maintain function. In depression, these problems summate so that a primarly pro-inflammatory state occurs. These problems may occur in multiple areas such as the nervous system, immune system, endocrine system, gastrointestinal system, metabolism, and nutrition. It is important to do as complete an assessment as one can in at least these areas to identify the underlying causes of depression. The assessment includes taking a history, doing a physical exam, doing lab tests, etc. Once identified, a treatment may then be developed to address each one.
ANXIETY:
Anxiety generally means the sympathetic nervous system is over-activated. This activates problem solving and threat assessment circuits in the nervous system as well as the immune system and other systems of the body.
The question to answer is why is the sympathetic nervous system activated in the first place. Is there an external threat? Is there a psychological threat. Are there internal problems such as infections, metabolic-nutritional problems, which activate the sympathetic nervous system. The assessment – like in depression – goes over multiple areas of the body/mind to help identify causative factors. In general, there usually are several underlying causes which together overwhelm the body/mind’s ability to compensate and maintain function.
Anxiolytic medications such as benzodiazepines help reduce anxiety but generally do not address the underlying cause. Some of the causes may worsen over time – e.g. hormone status, nutritional status, infection, etc. This can then overwhelm what an anxiolytic medication can do. If the underlying causes are not directly addressed, then multiple medications may be necessary to control symptoms of illness and help improve function.
Dear Dr.Mariano,
thank you very much for your reply.When body levels are high, yet TSH is also high, there may be a problem with either thyroid transport into the brain or thyroid activation by Astrocytes in the brain. The problem then becomes how to improve brain levels so that mental function can improve.
This sounds very technical. My concern is that neither my psychiatrist nor my endocrinologist know about this stuff. I’m in Germany and medicine is very orthodox here. I talked to my endocrinologist over the phone and asked him about the high TSH and he said we will do an ultrasound next time I see him.
I could mention the high TSH to my psychiatrist, but I really don’t know if he will say much about this. I also mentioned to him that I have low Testosterone and he also didn’t say anything about it.
We have labs in Germany which offer all kinds of blood tests, like measuring NTs in the blood for depression and things like that. These tests cost a lot of money and I don’t know if they are worth it. But ordinary doctors don’t do such tests at all. When I went to the psychiatrist who’s in a clinic I also thought that maybe they’d do complicated labs and measure NTs in the blood to find out if there is an imbalance but they didn’t do any labs.When I read that there are so many other things which needed to be examined which my doctors aren’t doing then this makes me feel more hopeless and depressed.
Anxiolytic medications such as benzodiazepines help reduce anxiety but generally do not address the underlying cause. Some of the causes may worsen over time – e.g. hormone status, nutritional status, infection, etc. This can then overwhelm what an anxiolytic medication can do. If the underlying causes are not directly addressed, then multiple medications may be necessary to control symptoms of illness and help improve function.
Again, the same problem as with the thyroid hormones.
When I go to a psychiatrist and tell him that I have anxiety and depression then he prescribes antidepressants and that’s it. I mean I don’t know why I am anxious and depressed. I know that I have always been anxious and pessimistic even when I was young. But now my depression is to a huge part because of my personal situation. I have a long list of personal and familiar issues which cause me to be totally depressed and hopeless.
So far I have taken celexa 20mg for 4 weeks, remeron 30mg for 2 months and wellbutrin at 300mg for 3 weeks. None of them made any difference. I really don’t know if I should try more antidepressants or give up. But giving up on them would make me feel more depressed because all the time I had this small hope that maybe I could find something which would make a difference.I have also heard that depression has something to do with inflammation of the brain and things like that. I think I am for whatever reason prone to depression. That’s a fact. But at the same time I have so many problems that I really can’t imagine that many people could be in my shoes and not also be depressed.
I also have a question about DHT.
I started with a relatively small dose of a 2.5% testosterone gel which delivers 60mg testosterone. After 4 weeks blood was drawn 7 hours after application. The results showed that serum T was still very low at 10nmol/l. But what’s concerning is that my DHT levels were slightly above 1000 and the range goes from 250-1000.
Is this a health risk? My doctor told me to use more gel because my serum T is still way too low. I am now using twice the amount of gel. But now I worry what if my DHT levels are twice as high now at 2000? Would having DHT levels which are twice the normal range be a risk for the prostate or cause hair loss?
I also read that DHT is the hormone which makes you feel good. But I don’t feel good at all. I also don’t notice any changes in body hair. I thought that maybe having high DHT would affect facial hair but so far there’s no difference.If gel doesn’t work I only have injections as option. But in Germany they only offer Nebido or Testoviron 250mg every 2-3 weeks. It’s very rigid here. I don’t know if my doctor would be willing to show me how to inject and to be honest I’m also pretty scared of injecting myself because I read so much about hitting a blood vessel and them causing embolism. I’d be really scared to do this myself. But I could impossibly drive to my doctor every week for an injection.
DEPRESSION:When treating depression, it is useful to find an antidepressant which isn’t causing intolerable side effects. Even if it isn’t causing improvement, I would consider it one component of treatment – the one that addresses a nervous system component of depression.
Once this is established, other medications including thyroid hormone can then be added to “augment” treatment. This is fairly standard technique found in textbooks. Some of these augmenting agents include:
1. Liothyronine (T3, Cytomel) 25-50 mcg a day – this is done even without lab testing
2. Lithium Carbonate 300-900 mg a day
3. Atypical antipsychotics such as Seroquel 50-150 mg, Abilify 5 mg a day
4. Adding another antidepressant that works in a different way – for example combining Citalopram with WellbutrinIt is useful for patients to learn more about their illnesses to arm themselves with information when discussing options with their doctors. This may be much more important in other countries where physicians tend to be conservative or rigid. One thing one can do is to simply get a textbook of psychiatry to learn about the mental illnesses and treatments.
For example, in Germany, one can find such textbooks on Amazon.de http://www.amazon.de/s/ref=nb_sb_noss/278-5316272-0503167?__mk_de_DE=%C5M%C5Z%D5%D1&url=search-alias%3Daps&field-keywords=Lehrbuch+der+Psychiatrie
HIGH DENSITY NUTRITION:Since nutritional deficiencies make up a large component of the underlying causes of mental illnesses such as depression, I generally try to help patients improve in function by achieving high nutritional density in their diets.
A good starting point for learning about high density nutrition is the book “Nourishing Traditions” by Sally Fallon and Mary Enig http://www.amazon.de/Nourishing-Traditions-Challenges-Politically-Dictocrats/dp/0967089735/ref=sr_1_1?ie=UTF8&qid=1353739866&sr=8-1
When patients cannot change their diet adequately to obtain high nutritional density, I will then prescribe nutritional supplements to improve nutritional status.
TESTOSTERONE REPLACEMENT THERAPY:Basic testosterone replacement therapy is simple: add enough exogenous testosterone (via transdermal gels or injections or other means) until the total testosterone is midway in the reference range. This is the general recommendation of the world organization for endocrinology, Endocrine Society, in their treatment guideline.
Until one gets an adequate amount to reach the target, the treatment is not sufficient and inadequate.
If options are limited in one’s country, use whatever option there is to the fullest to achieve the target goal.
Transdermal testosterone will always raise DHT since skin can have a lot of 5-alpha reductase to convert testosterone to DHT. The higher DHT is generally not a health risk. It is a risk for accelerating male pattern hair loss in men who have high scalp 5-alpha reductase production. This is generally genetically determined.
Yes, there are complexities in testosterone replacement therapy. DHT and estrogen levels are considerations. Thierre Hertoghe in Belgium and his partners are one of the most skilled practitioners in this regard in Europe.
But before anything else, an adequate dose still has to be achieved before discussion of the effectiveness of treatment can be done.
Can you say anything more about the use of T3 without even lab testing in order to improve depression?
It seems a rather bold move… what if the person seems to have a perfectly good thyroid function on physical examination?
Here is a good review article:
T3 augmentation in major depressive disorder: safety considerations.
Rosenthal LJ, Goldner WS, O’Reardon JP. Am J Psychiatry. 2011 Oct;168(10):1035-40.
PMID: 21969047http://www.ncbi.nlm.nih.gov/pubmed/21969047
http://ajp.psychiatryonline.org/article.aspx?articleid=178261Excerpts from the article:
Augmentation of antidepressants with T3 is one of the oldest evidence-based treatments for major depressive disorder.
In 1969, Prange et al. conducted a pivotal study (8) demonstrating that administration of liothyronine en- hanced response to tricyclic antidepressants in patients was monitored, but methods available at that time were not sensitive or specific. … Many subsequent studies have confirmed the Prange et al. study’s finding of efficacy, but few have formally assessed the HPT axis during treatment.
Joffe and Singer (4) evaluated T3 versus T4 in a randomized trial and found significant changes after 3 weeks in T3, T4, free T4, TSH, and T3 resin uptake in both groups, but these changes were not positive predictors of response; the main finding was that T3 was more effective than T4 as an augmenter.
Two studies of T3 in combination with SSRIs included baseline and follow-up thyroid testing. In the first, Cooper- Kazaz et al. (21) compared sertraline (50–100 mg) combined with either T3 (25–35 μg) or placebo in an 8-week study and found that the sertraline-T3 combination produced superior response and remission rates. After 8 weeks of T3 supplementation, the mean TSH level fell significantly from 1.70 μIU/ml at baseline to 0.28 μIU/ml in responders, whereas nonresponders had mean pre- and posttreatment levels of 1.88 μIU/ml and 0.76 μIU/ml, respectively; responsiveness to treatment was significantly correlated (p=0.01) with the change in TSH level, suggesting that the therapeutic benefit could have been due to changes in the thyroid axis in this population. In a post hoc analysis, baseline T3 levels in patients who responded to T3 augmentation were significantly lower than in those who did not respond (107.60 ng/dl compared with 137.4 ng/dl, p=0.002).
Recommended Safety Guidelines for T3 Augmentation of Antidepressant Medication include:
1. Obtain baseline TSH, free T4, and free T3 levels prior to augmentation.2. Recheck thyroid indices at 3 months and then every 6 months, or at minimum annually. The goal is for the TSH level to be at least at the lower limit of the normal range (around 0.4 μIU/ml) or below in the absence of hyperthyroid symptoms. Free T3 level can be maintained at the upper limit of the normal range based on the severity of depressive symptoms and response to T3.
3. In the longer term, if the patient has a history of multiple episodes or significant treatment resistance, maintenance on T3 is reasonable as an open-ended treatment option. If there are no symptoms of hyperthyroidism and no known cardiac disease, consider maintenance T3 supplementation even if the TSH level is below the normal reference range, depending on clinical efficacy.
Note that the dose used in studies is 25 mcg of T3. T3 is superior to T4 for treatment of depression.
The goal is a TSH at or below 0.4 uIU/mL – without showing signs of hyperthyroidism.
In patients with depression, it is very common to see suboptimal thyroid signaling – either the TSH is excessively high or body levels are suboptimal. Depression often has strong proinflammatory and nutritional deficiency components. These will impair thyroid signaling. The addition of T3 to restore thyroid signaling is thus a logical intervention.
Dear Dr. Mariano,
thank you very much for your book recommendations. I will try to get the book about nutrition.
I also want to eat healthier but all the different stuff out there confused me. Some recommend paleo where you
mustn’t even eat oats anymore. Such super strict diets would overextend my ability to manage my diet. Or even
stuff which I always thought was proven safe and effective like taking fish oil seems to be controversial. There are doctors who say exactly the opposite for example that fish oil is prone to oxidation in the body because of heat etc. That’s discouraging. I’ve been taking fish oil 2gr/d for years. I can’t say I feel better but I hope that it’s at least healthy.I already have books about psychopharmacology from Stephen Stahl. I also read in those books about treatment options. Stahl has all kinds of “heroic combos” like for example SSRI + stimulant, SSRI + mirtazapin, Effexor + Mirtazapin, Wellbutrin + Effexor etc.
So far I have not tried an augmentation therapy. I am seeing my psychiatrist next week and I cannot tell what he will recommend next. I’m not keen on taking a TCA because from what I read TCAs have more side effects than modern antidepressants. And MAOI are definitely no option. I’d live in panic 24/7 if I was taking a MAOI.What’s so discouraging is simply that nothing has worked for me so far. I mean if wellbutrin alone wasn’t enough and I needed to add a SSRI or something else then should I not at least have felt something from wellbutrin? One reason why my doc suggested wellbutrin was because I told him that I also have some symptoms of ADD. I have a hard time concentrating. My memory is also very selective. Things which I learned for college tests in the past are all forgotten after a while and then it’s basically as if I had never learned it in the first place. I suffer from this. It makes me feel stupid. I mean how can one learn more and become more knowledgeable when one cannot hold on to information? I really don’t think this is normal. There are things which I know I should remember but I still always forget them and it’s like I have to think them through again and again. Back in school I was bad at math and even when I had finally figured something out I also quickly forgot it again.
To be honest I also don’t know what to even expect in my situation. I mean I’m physically in bad shape. I have all kinds of things which depress me like chronic seborrhoic eczema, eye floaters, visual disorders which have gotten much worse in the past few years [visual snow, Blue Field Entoptic Syndrome], lipomatosis, joint pain, cracking of joints for no obvious reason. I have been to neurologists, opthalmologists, neuro-opthalmologists because of my visual disorders. Nobody had an explanation or found something.
I also have stretchy, saggy skin. I had a scar on my cheek which is now 1 inch deeper than it was when I got it 10 years ago.
I asked 2 dermatologists if this is normal and one said it could be EDS the other one said it’s still in the normal range. He told me not to get a gene test because it wouldn’t change anything. I got an ultrasound of the major blood vessels and they were okay. I’m also not hypermobile but it’s still very depressing when you know that so many things are wrong with you.
I have been to so many doctors for joint pain and cracking joints and they couldn’t tell me what it is. I wish they had at least found what’s wrong with me. I only know that things are wrong with me but don’t know what it is. And my parents are also sick and I worry a lot about them, too. I really don’t see how anyone could be in my shoes and not be depressed and hopeless as well. 🙁I am also scared of antipsychotics because my mom has been on antipsychotics (seroquel, abilify) and she now suffers from Tardive Dyskinesia which is terrible to watch. I suffer a lot from this. She’s also not doing better at all. She’s now going from one drug to the other but she’s very depressed and has no interests anymore.
A few more short questions:
2) You said: “When body levels are high, yet TSH is also high, there may be a problem with either thyroid transport into the brain or thyroid activation by Astrocytes in the brain. The problem then becomes how to improve brain levels so that mental function can improve.” Is this something which an ordinary endocrinologist or psychiatrist should know how to deal with? Does it make sense to bring this up or will this fall through their filter?
3) I noticed that the hair on my hairline looks different. It’s shorter than the other hair and the hair also looks thinner. Do you know if Propecia or Rogaine would be an option? I read bad stuff about both of them. Or are there other safe options?
@grif 6763 wrote:
A few more short questions:
2) You said: “When body levels are high, yet TSH is also high, there may be a problem with either thyroid transport into the brain or thyroid activation by Astrocytes in the brain. The problem then becomes how to improve brain levels so that mental function can improve.” Is this something which an ordinary endocrinologist or psychiatrist should know how to deal with? Does it make sense to bring this up or will this fall through their filter?
3) I noticed that the hair on my hairline looks different. It’s shorter than the other hair and the hair also looks thinner. Do you know if Propecia or Rogaine would be an option? I read bad stuff about both of them. Or are there other safe options?
Question 2: This isn’t something an endocrinologist would think about. However, if they use TSH as the primary measure of thyroid function, then adding thyroid hormone to lower TSH is the next logical step if the person has signs of hypothyroidism. In regard to the psychiatrist, the answer is again “no”. But thyroid augmentation with a target TSH of below 0.4 is an established standard treatment for depression, particularly to improve the response to antidepressant treatment.
Question 3: Since depression has a large component consisting of excessive pro-inflammatory cytokine signaling, adding Propecia without first addressing the causes of depression is risky since it prevents the brain from responding adequately to counteract inflammatory signaling. This could lead to negative metabolic changes, impaired functioning, and the possibility of structural damage (e.g. brain cell death).
COMPLEX ILLNESSES:When faced with a complex illness such as depression – which generally has multiple simultaneous underlying causes, it is important to first discover what those underlying causes are then address each one in treatment. This would then maximize the chances of a positive outcome while minimizing the negative effects of treatment.
One way of organizing the causes is to organize them at four levels of organization:
1. STRUCTURAL PATHOPHYSIOLOGY: this includes infections, allergies, obesity, brain injury, gastrointestinal illness, cardiovascular illness, respiratory system illness, autoimmune illnesses, genetic predisposition for illness, etc.
2. SIGNALING PATHOPHYSIOLOGY: this includes excessive or suboptimal levels of various signals – hormones, cytokines, neurotransmitters, etc. Lab testing can be done for most of them.
3. METABOLIC AND NUTRITIONAL PATHOPHYSIOLOGY: this includes the ability to maintain adequate body temperature (thermogenesis), dyslipidemia, blood sugar production, nutritional excesses or deficiencies. Many can be lab tested.
4. PSYCHOSOCIAL AND ENVIRONMENTAL PATHOLOGY.Each system in the body is evaluated in the history, physical, and through lab tests to help determine each of the underlying causes of a mental illness. The causes are organized as above. Then each is address the best that we can with treatment.
Another way to help improve understanding of ones illness is to list every symptom one is experiencing. Once done, they can then be organized in groups that are related – e.g. symptoms related to depression, symptoms related to other health problem.
Often, many illnesses have common underlying causes. For example, diabetes, heart disease, obesity, hypertension, mental illness, fibromyalgia, migraine, etc. have many commonalities. Thus addressing each of the identified underlying causes may not only improve mental function but physical health problems also.
Hello Dr. Mariano,
However, if they use TSH as the primary measure of thyroid function, then adding thyroid hormone to lower TSH is the next logical step if the person has signs of hypothyroidism.
Am I understanding you correctly, that taking thyroid hormones would be advised in my situation? Cause if yes, then I can bring it up to the endocrinologist. He said he wants to do an ultrasound next time I see him but this ultrasound will most likely not show much because I already had an ultrasound in September done by a different endocrinologist. I assume if he had found something he would have mentioned it to me.
ps: In Germany we only have L-Thyroxin. Do you know this? Is this not as good as Armour?
I noticed that many people in the US use Armour but in Germany this doesn’t seem to be used by orthodox doctors.Since depression has a large component consisting of excessive pro-inflammatory cytokine signaling, adding Propecia without first addressing the causes of depression is risky since it prevents the brain from responding adequately to counteract inflammatory signaling. This could lead to negative metabolic changes, impaired functioning, and the possibility of structural damage (e.g. brain cell death).
Wow, that’s shocking. I’m amazed how much you know, which is already depressing again because I simply don’t have a doctor who could do all those things which you mentioned. This makes me feel pretty hopeless. I mean in Germany doctors don’t measure nutrients and vitamins. There are labs which offer all kinds of lab tests where you can measure neurotransmitters in the blood or urine and stuff like that but these tests are very expensive and I don’t even know if they are legitimate. I mean it doesn’t help me to waste a lot of money for questionable labs. Even if I knew for example that I have too little muscarinic acid, then what shall I do about it? Knowing that I lack something only helps when I also know how to fix it. :confused:
this includes excessive or suboptimal levels of various signals – hormones, cytokines, neurotransmitters, etc. Lab testing can be done for most of them.
How can neurotransmitters in the brain be measured? I always thought that’s only possible by taking spinal fluid because of the blood brain barrier. I don’t understand this. I mean if it is possible then why didn’t my doctor do it? He’s in a clinic. They should have all the equipment. This is very discouraging.
I can say so much that I don’t have a brain injury and also no heart diseases. I had a brain MRI recently before I went on TRT. I am not aware of allergies but I’m sure if I got tested for allergies they’d probably find something.
I also had my C-reactive protein measured in the past and it wasn’t elevated.I wish I lived in the US then I had bigger chances of finding someone who can help me find out what’s wrong with me.
It took me 10 years to even find an endocrinologist willing to put me on TRT!! Already at age 20 I went to an endocrinology professor and told him my concerns and I had a T level of 250ng/ml and he insisted that everything’s fine and he even made fun of my concerns and acted like I’m only wanting to get access to anabolics.
Compared to the US the medicine in Germany is medieval when it comes to things such as hormones and nutrition. Doctors don’t take this seriously. I also had issues with a receeding gumline and once asked a dentist if it could be a lack of vitamins and he laughed at me and said that nowadays people don’t lack vitamins.Do you think it would make sense for me to take a multi vitamin or something like that?
I’m also unsure about that because of all the reports saying that vitamins actually increase mortality. If yes, can you recommend any brands or products? But I can’t guarantee that I’m able to get them here.
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