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Hello everyone,
After three years of suffering and trying different natural remedies, I eventually accepted and went on TRT since I had bottom range testosterone levels. First HCG, which doubled my levels on their own, but having no effect from it, I went on Nebido since I had read about people with good bloodwork on HCG, but who experienced no positive benefits.
Unfortunately, Nebido did not help either, even though my blood work shows that testosterone is good. I feel virtually NO improvements. In fact, I have gotten headaches lately as well, so in a sense, I`m worse.
Symptoms: aching sensation in my muscles, fatigue, nausea, heavy feeling in my head, zero energy, brain fog, difficulty concentrating and even writing this, low libido, completely limp penis this morning, zero motivation.
Another observation lately is that I easily gain fat, even though my thyroid looks great. I also often have cold hands and feet, but I always thought it was poor circulation.
I look healthy and have pretty decent strength in the gym, but I feel terrible. There is a cyclical nature to my symptoms as I actually have hours, days or even weeks (prior to TRT) where I feel normal and well. But 90% of the time, I don`t.
The only test I never managed to get done because of stubborn doctors is cortisol in saliva and urine, but I`m getting these along with a full panel on Monday.
Please, any comments on what may be going on here and what I can do? I want my life back, but there is no help to get from any of the doctors I`ve seen here in Norway.
Thank you very much,
Johnny
Latest bloodwork. This was on Nebido and HCG. I have now been on hormone therapy for 4 months, so I don`t think it is a matter of being impatient.
My own comments:
– Elevated insulin?
– Could iron be better? Due to a streak of elevated ferritin (700-800) a few years back, I never looked into my iron levels. I have also donated a lot of blood without supplementing iron. It looks like they could be higher.
– Cortisol elevated over the range. Not sure what one can infer from the cortisol in blood.
– Low SHBG?
– Excellent T3/T4? Looking more like hyperthyroid, in spite of symptoms of hypothyroid? TSH elevated and also anti-TPO.
Insulin 85 (18-173)
Alat 50 (<70)
Albumin 44 (36-48)
ASAT 62 (<45)
CRP 1 (<5)
Ferritin 58 (20-300)
Folat serum 26,6 (>5,7)
Free T4 17,3 (11,0-23,0)
Free T3 6,5 (3,5-6,5)
TSH 2,9 (0,20-4,0)
Anti-TPO 51 (<100)
FSH <1 (<12)
Free testosterone index 17,7 (2,3-9,9)
Hb 15,8 (13,4-17,0)
HDL-cholesterol 1,6 (0,8-2,1)
Hematocrit 0,48 (0,40-0,50)
Iron saturation 19 (15-57)
Iron 14,2 (9,0-34,0)
Iron binding capacity 74 (49-83)
Copper serum 14,4 (12,0-25,0)
Cholesterol 4,1 (2,9-5,1)
Cortisol morning (blood) 841 (250-750)
Creatinine serum 80 (60-105)
LDL-cholesterol 2,3 (1,2-4,3)
LH <1 (<12)
Magnezium serum 0,85 (0,71-0,94)
Prolactin 203 (<700)
PSA 0,5 (<2,6)
Vitamin K 0,2 (0,1-2,2)
Selenium 1,7 (0,6-1,8)
SHBG 13 (8-60)
Zinc serum 15,1 (9,0-17,0) (up from 9,9 on last test, have been supplementing since then)
Total testosterone 24 (8-35)
Vitamin D3 79
Vitamin A 2,8 (>0,7)
Vitamin B12 689 (170-650)
Vitamin D 79 (50-150) (up from last test, but maybe I could supplement some more)
Vitamin E 30 (14-50)
Estradiol 0,10 (<0,18)@Johnny 4639 wrote:
Nebido did not help either, even though my blood work shows that testosterone is good. I feel virtually NO improvements. In fact, I have gotten headaches lately as well, so in a sense, I`m worse.
Symptoms: aching sensation in my muscles, fatigue, nausea, heavy feeling in my head, zero energy, brain fog, difficulty concentrating and even writing this, low libido, completely limp penis this morning, zero motivation.
Another observation lately is that I easily gain fat, even though my thyroid looks great. I also often have cold hands and feet, but I always thought it was poor circulation.
I look healthy and have pretty decent strength in the gym, but I feel terrible. There is a cyclical nature to my symptoms as I actually have hours, days or even weeks (prior to TRT) where I feel normal and well. But 90% of the time, I don`t.
Once Testosterone is in a good range, then any problems that are left have other causes.
A lack of testosterone is often not sufficient to explain all symptoms a person with mental issues has. Generally, when a person develops mental problems, one is dealing with a multisystem problem.
Adding testosterone does not often improve a person’s ability to function if there are more important problems going on.
Since psychosocial issues can influence gene expression, metabolism and nutrition, and nervous system neuroplastic changes, psychosocial interventions involving areas such as exercise, therapy, education, relationships, etc. need also to be considered.
General areas to examine and address physiologically are:
1. Nutrition – optimizing nutrition so that is has high nutrient density – more vitamins and other nutrients per calorie.
2. Immune system issues – including gut issues: big ticket, high reward area to examine and optimize, though finding tools to accomplish this effectively can be difficult.
3. Nervous system issues – what some call “adrenal fatigue” is generally a nervous system phenomenon, a response to excessive stress signaling. Psychiatric treatment consideration is important. Adjusting nutrition and doing hormone treatments alone generally are not enough to help most seriously ill people.
4. Thyroid hormone optimization.
5. Diabetes and prediabetes – complex conditions in and of themselves
6. After everything else is considered, optimizing Testosterone and Estradiol signaling.
7. Last, consider addressing growth hormone deficiency – which usually does not work well if the foundation for its treatment is not established.Note that I prefer fasting insulin to be less than 69.45 pmol/L (10 uIU/mL). A value greater than this is a sensitive indicator for insulin resistance (prediabetes to diabetes). Insulin promotes fat storage and pro-inflammatory signaling, and may reduce testosterone production, among many effects.
Gut issues often mean immune system problems.
Thank you for writing, DrMariano.
1. I think my nutrition is very good. At least so good that it can not be causing any problems of this magnitude. I have tried cutting all grains for long periods of time, but I never cut milk, so that remains to see.
2. Gut issues – This is an angle that I`ve been made aware of by others only very recently, but if I have good digestion and no apparent symptoms in that area, could I still be having a gut issue?
3. Because I tested high for cortisol in morning blood prior to starting TRT, I did not think that low cortisol could be the problem, but I will get saliva and urine tests done. My symptoms does indicate low cortisol output.
4. My thyroid is excellent, is it not? Top range T3/T4? The only issue is the mildly elevated TSH and anti-tpo. Could low cortisol be preventing T3 to get into the cells? Or is there such a thing as T3 resistance or problems with uptake?
7. Growth hormone deficiency. This is a new one to me. I suppose it is a specific test. How is this treated?
I have no reason to suspect any mental issues. If I feel down or anything, it is because my body feels so miserable.
Thank you very much for writing and sharing your thoughts, Mariano. It means more than you can imagine.
@DrMariano 4650 wrote:
Once Testosterone is in a good range, then any problems that are left have other causes.
A lack of testosterone is often not sufficient to explain all symptoms a person with mental issues has. Generally, when a person develops mental problems, one is dealing with a multisystem problem.
Adding testosterone does not often improve a person’s ability to function if there are more important problems going on.
Since psychosocial issues can influence gene expression, metabolism and nutrition, and nervous system neuroplastic changes, psychosocial interventions involving areas such as exercise, therapy, education, relationships, etc. need also to be considered.
General areas to examine and address physiologically are:
1. Nutrition – optimizing nutrition so that is has high nutrient density – more vitamins and other nutrients per calorie.
2. Immune system issues – including gut issues: big ticket, high reward area to examine and optimize, though finding tools to accomplish this effectively can be difficult.
3. Nervous system issues – what some call “adrenal fatigue” is generally a nervous system phenomenon, a response to excessive stress signaling. Psychiatric treatment consideration is important. Adjusting nutrition and doing hormone treatments alone generally are not enough to help most seriously ill people.
4. Thyroid hormone optimization.
5. Diabetes and prediabetes – complex conditions in and of themselves
6. After everything else is considered, optimizing Testosterone and Estradiol signaling.
7. Last, consider addressing growth hormone deficiency – which usually does not work well if the foundation for its treatment is not established.Note that I prefer fasting insulin to be less than 69.45 pmol/L (10 uIU/mL). A value greater than this is a sensitive indicator for insulin resistance (prediabetes to diabetes). Insulin promotes fat storage and pro-inflammatory signaling, and may reduce testosterone production, among many effects.
Gut issues often mean immune system problems.
A relevant piece of information to this puzzle is that I had a physical breakdown 7 years ago because I had severly exhausted my body with work, training, etc and undersleeping for a long time. It was initiated by a nervous breakdown so severe that I was out of business (the gym and work) for a whole year and struggled with a moderate depression and anxiety issues. Those were all cured naturally, but I believe I have had the physical issues all the way back since then, but they were masked and overlooked because of my personal situation up until three years ago.
Does that make a case for adrenal fatigue or some kind of imbalance created by that incident?
@Johnny 4669 wrote:
A relevant piece of information to this puzzle is that I had a physical breakdown 7 years ago because I had severly exhausted my body with work, training, etc and undersleeping for a long time. It was initiated by a nervous breakdown so severe that I was out of business (the gym and work) for a whole year and struggled with a moderate depression and anxiety issues. Those were all cured naturally, but I believe I have had the physical issues all the way back since then, but they were masked and overlooked because of my personal situation up until three years ago.
Does that make a case for adrenal fatigue or some kind of imbalance created by that incident?
I no longer use the term “adrenal fatigue” because it is imprecise, misleading, and inappropriately anthropomorphic. Hypothalamic-pituitary-adrenal axis dysregulation is a better term.
Generally when one has a mental illness, I’m looking at a multisystem problem. It takes a lot to cause depression, anxiety, and “nervous breakdowns”. The mind is built to survive. Mental function is highly protected. It generally takes many simultaneous problems to cause a mental illness.
@Johnny 4668 wrote:
Thank you for writing, DrMariano.
1. I think my nutrition is very good. At least so good that it can not be causing any problems of this magnitude. I have tried cutting all grains for long periods of time, but I never cut milk, so that remains to see.
2. Gut issues – This is an angle that I`ve been made aware of by others only very recently, but if I have good digestion and no apparent symptoms in that area, could I still be having a gut issue?
3. Because I tested high for cortisol in morning blood prior to starting TRT, I did not think that low cortisol could be the problem, but I will get saliva and urine tests done. My symptoms does indicate low cortisol output.
4. My thyroid is excellent, is it not? Top range T3/T4? The only issue is the mildly elevated TSH and anti-tpo. Could low cortisol be preventing T3 to get into the cells? Or is there such a thing as T3 resistance or problems with uptake?
7. Growth hormone deficiency. This is a new one to me. I suppose it is a specific test. How is this treated?
I have no reason to suspect any mental issues. If I feel down or anything, it is because my body feels so miserable
1. Generally, when a person who has problems tells me their nutrition is “good”, I find a lot of problems with their nutrition. I usually recommend reading the book “Nourishing Traditions” by Sally Fallon as a starting point to high density nutrition. Even currently popular Paleolithic Diets are often incomplete since they do not do a Traditional Paleolithic Diet, where everything is eaten of an animal – down to the bone, skin, hair, internal organs, brains (though I don’t recommend eating brain due to the risk of prion infections), etc.
2. The intestines are where most of the immune system cells in the body patrol. Gut issues can still occur even when one does not experience mechanical discomfort since gut issues can manifest as behavioral or systemic problems.
3. I like a resting cortisol morning at least 469-607 nmol/L. If one is at rest (e.g. haven’t exercised the previous day, no acute psychosocial stress), and the morning cortisol is high, I would have to look for a source of stress signaling and pro-inflammatory signaling that may drive it to a higher resting level. Cortisol is a reflection of activity in the other systems.
4. Ideally both brain and body levels of thyroid hormone are optimized. Both brain and body levels can have separate levels of thyroid hormone. TSH gives one an indication of brain level. The blood hormone levels indicate what is in the body. When TSH is higher than should be indicated by body levels, then the brain has problems with inadequate thyroid hormone. For example, it may have problems actively transporting thyroid hormone into the brain. Or the astrocytes in the brain may be metabolically impaired and are unable to adequately convert T4 to active T3. Etc. In either case, the brain will have metabolic problems and will compensate. The compensations, however, can lead to problems in mental function including anxiety and depression.
5. Growth hormone is released from the brain. It travels to the liver where it stimulates the production of IGF-1. IGF-1 does most of the actions of growth hormone. IGF-1 is what is measured to give an idea of how much growth hormone one has. One can also do a 24-hour growth hormone urine measurement. Growth hormone is my last consideration in treatment. If given too early, it can cause significant problems. When everything else is addressed, it may improve a person’s well being and function significantly. Growth hormone and IGF-1 production are determine may multiple other signals including thyroid hormone, testosterone, DHEA, norepinephrine, dopamine, pro-inflammatory cytokinbes, etc. Until problems in these areas are addressed, one doesn’t know how much growth hormone can one natively produce.
Hypothalamic-pituitary-adrenal axis dysregulation it is then. Got it.
Three years back I had high ferritin (700+) and was tested for hemachromatosis, but it came back negative and my ferritin eventually dropped down to normal after phlebotomy. I wonder if this indicates that I had an inflammation in the body. At this point I was at rock bottom and virtually impotent. I slept all day long and fell asleep on parties. I have improved since then, but only relatively speaking. Same symptoms, just not that severe.
Another clue for this puzzle, is that my state is not consistently depressed. In fact, I have hours and even stretch of days, where I feel NORMAL and well. Even great! It`s just that my miserable state is the default state for 80-90% of the time. I also tend to believe that all my issues come from the same source, but I have experienced improved sexual function without improvement of other symptoms and I have also experienced feeling great in my body and mind, but with no increase in sexual function.
Another thing is that I often (not always) feel better the day after drinking considerable amounts of alcohol. It puzzles me.
1. Regarding nutrition, I will not say that it could not be better, I simply refuse to believe that my current diet could explain my symptoms, unless there is an allergy of some kind. Thank you for the book recommendation, I will check it out.
2. Interesting, but further confusing for me I`m afraid.
3. Understand. Do you recommend testing rested cortisol? I am taking new blood work this week, so that would be nice to know. I believe the blood work I`ve taken earlier often have been with working out the prior day.
4. That is interesting. With both high T4/T3, my conversion would be good, yes? I know that you can not make any specific comments, but there are few individuals who have said that I should consider a trial of T3 and see if it improves my symptoms. Is that generally a good or bad idea? From what I can tell, the risk is not severe and the body`s own production of thyroid usually picks up after quitting.
5. Understand. I will get the IGF-1 test done.
Hemochromatosis: one problem is overzealous reduction of iron until one is suboptimal. With an iron deficiency, multiple problems occur which can lead to anxiety and depression, lack of energy, etc. Often, I have to restore optimal iron levels for that person in order to restore function.
Thyroid hormone: for a variety of issues, the brain and body can have two disparate levels – with either the brain or the body having too little causing a problem in that area.
Diet: unless a person is eating a traditional diet – like what people use to eat in the 1800s and early 1900s – which were up to 10 times more nutritious that what we have now, then a person is often nutritionally deficient in some or more nutrients. The fact that a person supplements is a realization that some nutrients are insufficient in the diet. The problem is identifying the others that are also insufficient. That is difficult to achieve since the foods these days may not have as much nutrition as in the old days, given massive farming and nutrient defects occurring in the soil itself. If the diet itself was good enough, then no supplements would be needed.
Dr Mariano,
Are you able to comment on my current iron levels? Could they be higher?
Both because of my own symptoms, high ferritin and what I read about hemachromatosis, I never even considered that I could have low iron until just recently. Mind you, these levels are after donating blood four times and multiple blood draws for blood work over the last years. But they were not that much higher three years ago.
That`s interesting about the brain and body having two disparate levels. No easy answers here, I`m afraid?
Would a T3 trial be stupid?
Thanks in advance,
Johnny
@DrMariano 4717 wrote:
Hemochromatosis: one problem is overzealous reduction of iron until one is suboptimal. With an iron deficiency, multiple problems occur which can lead to anxiety and depression, lack of energy, etc. Often, I have to restore optimal iron levels for that person in order to restore function.
Thyroid hormone: for a variety of issues, the brain and body can have two disparate levels – with either the brain or the body having too little causing a problem in that area.
Diet: unless a person is eating a traditional diet – like what people use to eat in the 1800s and early 1900s – which were up to 10 times more nutritious that what we have now, then a person is often nutritionally deficient in some or more nutrients. The fact that a person supplements is a realization that some nutrients are insufficient in the diet. The problem is identifying the others that are also insufficient. That is difficult to achieve since the foods these days may not have as much nutrition as in the old days, given massive farming and nutrient defects occurring in the soil itself. If the diet itself was good enough, then no supplements would be needed.
Even people with hemochromatosis need appropriate levels of iron to function well.
Old fashion traditional diets would be expected to keep iron levels at the higher end of a reference scale.
Thyroid treatment so long as it is under the care of a physician is frequently done in various forms including T3.
@DrMariano 4729 wrote:
Even people with hemochromatosis need appropriate levels of iron to function well.
Old fashion traditional diets would be expected to keep iron levels at the higher end of a reference scale.
Thyroid treatment so long as it is under the care of a physician is frequently done in various forms including T3.
Well, I just got home from my doctor and he said my iron levels were very well, but I know that he does not know what he`s talking about at all so I don`t trust him. Maybe I should supplement for a while.
Is thyroid treatment done with high levels of T3/T4 similar to mine if the patient still have symptoms of hypothyroid?
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