[grif]

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.

[grif]

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]

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.

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