These are some of the results that I posted last year (Dr. Mariano converted a few of them into other units):

PS-T3-FREE: 3.8 pmol/l (2.6 – 5.7)
PS-T4-FREE 12 pmol/l (9 – 24)
PS-TSH 1.22 mU/l (0.35 – 4.70)
PS-ANTI-TPO <3 (0 – 15)

CORTISOL 264 nmol/L = 9.57 ug/dL
TESTOSTERONE 14.9 nmol/L = 429 ng/dL
ESTRADIOL <0,07 pmol/L = < 0.07 pg/mL
PS-FSH 2 ie/l (1 – 12)
PS-LH 2 ie/l (2 – 12)
PS-SHBG 36 nmol/L (13 – 60)
IRON – 19,1 (9,0 – 34,0 umol/l)
FERRITIN – 429 – (20 – 250 ug/l)
TIBC – 58 (49 – 83 umol/l)
TRANSFERRIN SATURATION % = 33%

@marsaday1971 3113 wrote:

Hello there J

To me you dont look as though you have a testosterone problem, but instead a thyroid one.

Have you tried any thyroid hormones. They are easy to buy and relatively harmless to use. All you do is monitor how you react to them, starting on a low dose and building up.

your FT4 is 12 and so is bottom of the range. My FT4 pre thyroid meds was also 12 and recently it has been 12 again. I have just increased the thyroxine as my tank is pretty empty when around the 12 mark. I am pretty active and so my body uses up a fair about of thyroid hormone.

Your FT3 wants to be higher as well. Your tSH isnt too bad, but you should ignore this and focus on the FT3 and 4.

Thats it to me – quite simple and straight forward. You will probably come back and say you have tried thyroid meds and this isnt the answer, if so i cannot help you with the testosterone side of things as i have no experience of that.

ps, my Testosterone level came up from 15 to 18 just by using thyroid meds. I have now gotten even better on them and i assume they testosterone levels has gone up even more.

Hello marsaday,

Thank you for your reply 🙂 You`re the first who have suggested thyroid problems, so I have not considered that until now. I got new lab results today:

PS-T3-FREE: 4.6 pmol/l (2.6 – 5.7)
PS-T4-FREE 14 pmol/l (9 – 24)
PS-TSH 2.73 mU/l (0.35 – 4.70)
PS-ANTI-TPO <3 (0 – 15)

CORTISOL 748 nmol/L = 27.12 ug/dL
TESTOSTERONE 13.6 nmol/L = 391 ng/dL
ESTRADIOL <0,07 pmol/L = < 0.07 pg/mL
PS-FSH 2 ie/l (1 – 12)
PS-LH 6 ie/l (2 – 12)
PS-SHBG 17 nmol/L (13 – 60)
PS-PROLACTIN 145 ie/l (0-580)

Thyroid levels are higher, cortisol is much more elevated, estradiol unchanged, testosterone even lower (but lower SHBG so free testosterone should be higher, LH higher.

@DrMariano 3158 wrote:

Suboptimal thyroid signaling can lead to fatigue.

When ferritin is high, but hemochromocytosis is not present, suboptimal vitamin A signaling may be a suspected problem. Vitamin A is necessary to release iron from the Ferritin storage form for cellular metabolic use. Suboptimal vitamin A can cause iron to be trapped in the ferritin form, causing a person to be deficient in cellular iron – important for metabolism, energy production – despite having high ferritin levels.

Suboptimal vitamin A can also impair thyroid signaling. Suboptimal vitamin A can also impair testosterone production.

Excessive vitamin A can be toxic, even leading to osteoporosis, liver failure, death, etc. Thus, monitoring of vitamin A levels is necessary during treatment. Generally, however, doses up to 15,000 IU a day are relatively safe, per Jonathan Wright, M.D.

Excessive immune system inflammatory cytokine signaling can cause a person to sleep excessively. However, when stress/norepinephrine signaling is excessive, deep sleep cannot be achieved and sleep becomes unrestorative.

The libido circuits in the brain are influenced by many signals including testosterone, dopamine, estrogens, inflammatory cytokines, etc. These are in turn influenced by multiple other signals and metabolic/nutritional factors.

Generally, when cycling occurs – meaning a person’s condition is waxing and waning – I would look for the occurrence of positive feedback circuitry and the effectiveness of their control signals. When poorly controlled, the positive feedback loop worsens the person’s condition.

Hello DrMariano 🙂

Interesting, but overwhelming analysis 🙂

Any comments on my recent bloodwork?

Is it possible that my borderline low testosterone levels could explain all my symptoms?

Would it hurt to start on daily doses of 25 mg with Clomiphene to see if it raises my testosterone levels and elevates my suffering?

How would you recommend me to solve this issue of mine? I wish I could book an appointment with you and fly over, but I don`think I can afford it at the time being.

PS: There is not a definitive cyclical component to my condition. I have simply noticed that it happens that I feel normal, which is what really convinces me that I`m really not well most of the time.

Thank you VERY MUCH in advance,

I truly appreciate it more than you can imagine 🙂

Best regards,

Johannes

@DrMariano 3173 wrote:

Cortisol, when elevated, indicates high stress/norepinephrine signaling. When norepinephrine signaling is high when one is trying to sleep, sleep is not restful. This is because sleep isn’t deep enough when the signal for wakefulness – norepinephrine is present.

It is important to look for infections as a contributing factor resulting in adrenal dysregulation. This includes dental infections. Many people do not maintain dental health well by brushing and flossing well. A sign of periodontal disease (i.e. dental infection) is bleeding gums.

I usually fall asleep very easily. I believe that I sleep fairly deeply as well.

Would not infections be ruled out by a normal CRP test? My dental health is excellent as far as I can tell. I floss and brush 2-3 times per day. No bleeding gums.

I appreciate you writing, Doctor, but I`m not sure how to proceed with my situation.

Would an endocrinologist be my best bet?

And would you advice against starting on a trial with 25 mg Clomiphene per day to see if it can raise my testosterone levels? I want to suggest this to my doctor.

Thanks in advance,

Johannes

@DrMariano 3198 wrote:

I can’t give you any advice since you aren’t a patient.

A problem, often, is that there is not enough data when presented in boards like this.

C-Reactive Protein is not a general measure of inflammation. It would not rule out infections.

If total testosterone is over 400 ng/dL, I doubt an endocrinologist would consider a person as having hypogonadism. An anti-aging doctor or bioidentical hormone specialist may consider evaluation and/or treatment. Such a physician may also be able to evaluate other aspects of health such as nutrition.

In Europe, I like the work of Thierre Hertoghe, MD, in Belgium, a bioidentical hormone specialist. His sister is also a physician who works in a similar direction. Other than them, I don’t know any other physician in Europe who can do a thorough evaluation. There should be some. Thierre, himself, gives courses in bio-identifical hormone replacement therapy to other physicians in Europe.

Although Tamoxifen or Clomiphene can be considered to raise testosterone, the question to ask is what risks does this entail, particularly in long-term treatment (e.g. prostate cancer), what what can be done to reduce such risks.

If total testosterone is over 400 ng/dL, I would first consider improving a person’s nutrition and optimizing functioning in systems before considering testosterone replacement, Tamoxifen or Clomiphene, after a thorough evaluation. Problems in metabolism, nutrition, and other systems can reduce testosterone production.

Thanks doctor! 🙂

I do understand.

I will take notice of Thierre Hertoghe. Someone else has already mentioned him as well actually.

Is there any literature or research that suggests prostate cancer with long-term use of Clomiphene/Tamoxifen?

Are you familiar with the herb Tongkat Ali?

I started using this on Friday and it might be random, but I`ve been feeling better the last days. This night I even woke up with (because of) an erection. That has not happened in years. I have not had morning erections either in a long while.

I`ve read lots of testimonials from reliable sources regarding the efficacy of Tongkat Ali, but not research.

Best regards,

Johannes

@DrMariano 3237 wrote:

The risk of prostate cancer with Tamoxifen or Clomiphene depends on the person and the type of prostate cancer. It’s complicated. A simplified discussion is as follows:

Tamoxifen (which can be applicable to Clomiphene) can block estrogen receptors, yet it also may act as an estrogen – though weakly in the prostate.

Tamoxifen, itself, is used in patients with prostate cancer to help block the excess in estrogen signaling from anti-androgen therapy, that can cause problems such as gynecomastia.

Tamoxifen, itself, can help treat some types of prostate cancer.

However, some prostate cancers may respond to estrogen for growth particularly in combination with available testosterone. Thus, there would be some risk for prostate cancer with Tamoxifen.

Further, Tamoxifen clearly increases the risk for uterine cancer – as seen in breast cancer patients treated with Tamoxifen. Since prostate tissue is developmentally the same as uterine tissue, this is a concern as a risk for prostate cancer.

Thus, Tamoxifen is a double edged sword – it can either help or harm. The long-term risks of treatment are important to consider.

Interesting Doctor. I was not aware.

Can the same conclusions be drawn for Clomiphene (although not the same drug)?

@DrMariano 3198 wrote:

I can’t give you any advice since you aren’t a patient.

I understand and respect that, DrMariano.

Could you however tell me if you think there is reason to believe there is something “wrong” with me based on the bloodwork I posted here?

I really don`t feel that well. I think “weakness” could very well describe how I FEEL much of the time. I am relatively strong though, so it is more of a feeling and ache in my body.

I dread going to the doctor since I`ve met so little understanding in the past, but it`s well over a year now since I visited my family doctor and my life is going by everyday with no improvement.

I would feel more confident if you could say if my bloodwork warranted further investigation and diagnosis.

Thank you VERY much in advance,

Johnny