Hi there,

A few other forums I am on have suggested I post my situation of Dr Mariano’s forums’ and see if anyone here has any good advice or theories on what is going on with me. I’m at my wits end and would appreciate any input.

It started on Christmas day last year; I was drinking heavily and in a good natured play fight with friends which went wrong I ended up dislocating my shoulder. I went to A&E, they put it back in and I was sent home.

I woke up the next day with what I now know to be panic attacks. They were horrendous and having had no history of mental illness or psychological problems I thought I was losing my mind. I went back to work after the Christmas break, still battling the anxiety. I also began to get severe fatigue, fibromyalgia-esque pain in my hands, dry gritty vision / sensitivity to light and difficulty reading as a result on monitors / televisions.

I was unable to cope with work and was signed off by my GP. She also persuaded me to take an SSRI, Citalopram, for the anxiety. I was off work for 3 months and unable to do much of anything other than lie in bed in darkened rooms. I was told at the time I had ‘post-viral fatigue’ by my GP. I decided to discontinue the SSRI after 6 weeks as I believed it to be affecting my libido, which was causing problems with my relationship.

I successfully weaned off it and the anxiety did not return, the rest of my symptoms began to ease and I was soon back in work. The only symptom which remained was my lack of libido, which at the time I attributed to after effects of the SSRI.

Being an avid field hockey player I was desperate to regain my former high level of fitness and began exercising as I used to, at least an hour or two per day of intense running / heavy weight lifting. I had always managed with this in the past, but on top of it I decided, possibly now in my error, to start a pattern of calorie restricted dieting along with intermittent fasting and lots of caffeine to lose the weight I had put on. A typical day for me consisted of up at 6am running 4 miles to work, black coffee all morning and then a small 200kcal lunch before running home at 3pm 4miles and straight into a heavy weight session before having the majority of my food for the day. I realise now how ridiculous this was but it was very successful in the results regard and to be honest I felt better than I ever had done, other than the fact I still had no libido. This continued for a couple of months and in July I asked my GP to check my testosterone levels and they were very low, (4.3 nmol/l )

She prescribed me Testogel and at the time, not knowing what I do now about primary / secondary hypogonadism and the effects of exogenous testosterone on your own production, I took it gladly.

My libido started to come back but to my horror so too did the panic attack / anxiety symptoms, so I discontinued the gel after 2 weeks and got my GP to refer me to an endocrinologist.

Soon after stopping the gel I began to crash badly and the same fatigue / visual symptoms returned. I am now having to work reduced hours and am completely unable to exercise or do any of my hobbies.

Since my initial consultant an endocrinologist in September I have I have had an MRI of my pituitary, an ultrasound of my testes, a GNRH stimulation test, numerous blood tests and an ACTH stimulation test which have all come up normal. Cortisol in my ACTH challenge test actually rose out of range so they are obviously capable.

I trialled a selective estrogen receptor modulator for 2 weeks to see if my testosterone levels would rise. They did rise to 18.3nmol/l but subjectively I felt no better at all. They have since fallen to the value in the below blood test.

My basal temperature is consistently below 96.5 and never gets over 97.5 throughout the day. It is this which has led me to believe my low testosterone may be secondary to adrenal dysfunction of some kind.

A 24 hours cortisol assay showed the following:

Sample1: 17.9 nmol/l (12-22)
Sample2: 5.3 nmol/l (5-9)
Sample3: 3.4nmol/l (3-7)
Sample4: 0.5nmol/l (1-3)

DHEA Mean: 0.87 nmol/l (0.40 – 1.47)
DHEA : Cortisol Ratio: 3.21 (2-6)

The most recent blood results I have are from January and are as as follows:

Free Testosterone .274 nmol/l (0.02 – 0.67NMOL/L)
Albumin 53g/L (35 – 50g/l)
SHBG 30nmol/l (13 – 71)
Total Testosterone 14.3 nmol/l (8.50 – 29.0)
Prolactin 238 miu/L (0-350)
FT4 19.4 pmol/l (8 – 21pmol/l)
FT3 4.8pmol/l (2.50 – 6.50pmol/l)
RT3 0.46 pmol/ml (0.14 – 0.54)
TSH 1.74 mu/L (0.4 – 4.5)
E2 69pmol/l
AM cortisol 533nmol/l
CRP <1mg/l (0-10)
Fasting glucose 4.1nmol/l (3-6)
Ferritin 203 ug/L (30 – 330)
B12 1234 ng/L (211 – 911)
T Peroxidase 4 IU/ML (0-80)
Ab Thyroiglobulin 9 IU/ML (0-80)

Current symptoms:

Pronounced fatigue, waking in the middle of the night with ringing in ears, zero libido, dry / photophobic eyes with floaters present that were not before, low mood, difficulty concentrating.

I am unable to tolerate any carbohydrate in the AM – I can seem to later in the day but if I don’t have a breakfast of just P&F then my energy and eyes are MUCH worse than if I don’t. Currently wearing sunglasses to use a computer screen at work and also to take the glare of the strip lighting.

If I don’t have a small amount of fat before bed + 1 isocort then my morning blood glucose is through the roof and I wake up with more of a jolt in the night.

I am based in the UK and no health care professionals seem to have a clue, they want to slap a label of CFS on me and offer me exercise therapy with trycyclic AD’s – the irony being an aversion to exercise is not exactly something I’ve ever suffered from!

This is what I am currently taking on the advice of a nutritionist who works with athletes who have ‘overtrained’:

Sea salt
Pregnenolone 10mg SL
Vit C 2g
B complex
Isocort
Tyrosine, Alpha GPC and ALC
Fish oils
Liquourice

I would really appreciate your input and advice on my situation – either theories on what is going on with me or other tests I could do.

Thanks