Please help! Health issues. Working theories: undermethylation, adrenal fatigue, hypogonadism.

[Cappa]

Hello.

23 year old male. Been “in the system” since 14 years old. Here’s a very brief history:

ADs: Paxil, Wellbutrin, Effexor XR, Celexa, Anafranil (one dose)
AAP: Zyprexa, Seroquel (one dose)
Benzos: Ativan, Klonopin
ACs: Lamotrigine

As well as a 5 month course of Accutane at age 16.

Diagnoses (cumulative, I have no current Dx): OCD (this is still and has always been the biggest thing), Bipolar Disorder (previously Major Depression, Dysthymia, Mood Disorder NOS), PTSD (complex type), Generalized Anxiety Disorder.

Had an antidepressant-induced manic episode about 1.5 years ago (Effexor) – started heavily abusing marijuana during this period. By the time I was taken to the ER it felt like my head was going to explode. Been in and out of psych wards since, first with mania, then depression (out now since March of this year). I have only ever had manic reactions to SRI antidepressants (whether SSRI, SNRI, or TCA), never without them. I’m not currently taking any psychotropics but instead have opted for Cognitive Behavioral Therapy, which isn’t helping as much as I’d like (although I have realized some benefits).

I have persistent sexual dysfunction from both Paxil and Celexa (that is, sexual dysfunction that has not gone away after discontinuance of the drugs). This includes trouble with erections (morning wood is an extremely rare event), premature ejaculation and severely lowered libido.

I did a hormone test and it has revealed low T, low LH, low FSH. I only saw the values on an unrelated walk-in and will be going back next month for a more comprehensive visit with my GP. Thyroid (TSH, Free T3, Free T4) appeared okay, but I didn’t have a complete look. He said something of the T like “well it’s still in the normal range, so….” even though it’s on the floor of what is considered normal. Having less testosterone than the average 80 year old man is not okay with me. Typical family doctor crap. I also don’t believe that he’s heard of adrenal fatigue.

Ever since “crashing” off of that antidepressant-induced mixed manic episode, I haven’t felt quite the same. I was under an astronomically enormous amount of stress for several months (OCD + mixed mania made me very very crazy) and I suspect adrenal fatigue (may explain other hormone issues – or that could be its own issue, I’m not sure). I also crave salty foods much of the time and usually put in loads of hot sauce (high sodium) in most things that will take it.

My diet has been very clean for several months now. I don’t drink alcohol or coffee, I do my best not to consume high GI carbs (I suspect hypoglycemia as type II diabetes runs in the family) as when I do I usually begin to feel like crap, sluggish and light-headed, although I feel like this generally so I’m not sure. I’m lean at approximately 150 lbs and 5″9. Even still, I have somewhat of a pear shape (tendency for fat below the waist). I also have a tendency towards abdominal fat (although not as great as it is for below the waist) but this has only ever been an issue when I become less lean. I go to the gym but not as regularly as I would like. My endurance in the gym is terrible and I’m very weak (weight training) with very slow recovery in between sets (especially after the first few) until I eventually “poop out”” and it becomes a struggle to even continue.

It is very very difficult for me to get out of bed in the morning, and although I can usually get in an okay number of hours, I usually sleep rather lightly (unless I’m exhausted) and end up getting up early morning and falling back asleep (and then awake and asleep again a few times – until I lay in bed awake for about an hour and finally get up). My sleep needs improvement and I need to be more disciplined in this area. Especially towards people who I’m more comfortable with, I tend to be outwardly irritable and have a generally hostile disposition, despite my best efforts otherwise. I usually feel lethargic and run down although there are portions of the day where I feel a little better in this regard. As well, the OCD is a very big symptom and completely effects the way I think and filter information.

My thoughts are:

• Undermethylation (if this thing is real – I’m skeptical because I don’t know a whole lot about the science behind it, but I’m open minded).
• Adrenal fatigue.
• Hypogonadism (low testosterone) either caused by adrenal insufficiency or as its own issue. This also appears to be a central (secondary) issue due to low LH, low FSH, although it wasn’t irrevocably low (I believe LH was 1 in a range from 1-10 and FSH was 2 in a range from 1-10, although it could be the other way around).
• Quite possibly iatrogenic artifacts from previous medications (persistent adverse effects, see Post-SSRI Sexual Dysfunction), although this is a more complicated one given the variability and complexity of what was going on at the time. I know I have persistent effects, but I’m not sure how to characterize them (maybe the antidepressants brought out an existing genetic predisposition towards premature ejaculation, maybe they directly or indirectly caused or contributed to some of the above listed issues which has lead to what can be described as persistent symptoms, maybe due to other factors at the time, my brain wasn’t able to recover correctly after the drugs were withdrawn). I had persistent symptoms at age 15 (after getting off of Paxil) and again at 22 (after getting off of Celexa).

Questions:

1. What are your thoughts? How should I proceed?
2. What are the appropriate supplements for undermethylation? I’ve read to avoid B12 and folic acid (in any of their forms), although some people on this site are taking them for this condition? I’ve read that important nutrients are calcium, magnesium, C, B6, methionine, TMG, and have read in other places that A, E and zinc are also beneficial.
3. Does anyone know of a good endocrinologist in the Toronto or the Greater Toronto Area? I want one who understands adrenal fatigue and male health issues, one who won’t ignorantly appeal to the acceptability of being literally on the floor of the dubious “normal” range (for testosterone). Failing which, does anyone know of a reliable, cost-effective way of running my own labs? Who is the best provider for this?

That’s it for now. Thank you in advance.

[Cappa]

I should also mention that even with the irritability, low-level hostility and somewhat fluctuating energy levels, my mood is pretty stable (not so much the anxiety). I became clinically depressed after that manic episode but that all seems to have subsided for some time now.

[Cappa]

Is there anybody out there? 🙁

[Cappa]

I have labs results.

These are the two more recent labs. Another one from earlier this year is to follow in the next post. I’d appreciate any help in interpreting this. I’ve posted on another forum as well and the feedback I got over there was that HRT is probably indicated. I want to know what has caused this.

---

Tested on July 13, 2009:

Testosterone: 8.5 nmol/L (8.0 – 38.0)
Bioavailable Testosterone: 3.8 nM (2.7 – 19.2)
Prolactin: 11 ug/L (male: < 18)
sTSH: 2.58 mIU/L (0.35 – 5.00)
DHEAS: 10.4 umol/L (5.73 – 13.4)

Of note:
ALT: 37 U/L (< 46)
HDL: 1.82 mmol/L (male: >= 1.00)
LDL: 1.16 mmol/L
TC/HDL-C RATIO: 1.8

It gives these ranges under “Risk Categories and Treatment Targets”:

High risk (10-year CAD risk >-20%):
Primary target: LDL-C <2.00 mmol/L
Secondary target: TC/HDL-C <4.0

Moderate risk (10-year CAD risk 10% – 19%):
Treat when: LDL-C >=3.50 mmol/L or TC/HDL-C >=5.0

Low risk (10-year CAD risk <10%):
Treat when: LDL-C >=5.00 mmol/L or TC/HDL-C >=6.0

---

Tested on December 9, 2009:

Testosterone: 16.8 nmol/L (8.0 – 38.0)
Free Testosterone: 20.1 pmol/L (31.0 – 94.0)
LH: 2 IU/L (1 – 9)
FSH: 2 IU/L (1 – 12)
sTSH: 1.79 mIU/L (0.35 – 5.00)
T4 Free: 17 pmol/L (10 – 20)
Free T3: 4.9 pmol/L (2.6 – 5.7)
Estradiol (regular, non-sensitive): 104 pmol/L (adult male: < 161 pmol / L)

I fasted from midnight and blood was drawn at about 12:30 PM, so this doesn’t qualify as AM cortisol, but:

ACTH: 4.0 pmol/L (A.M. Fasting: < 10.0 pmol/L)
Cortisol Fasting: 359 nmol/L (170 – 540)

---

In between the first and second lab, I started going back to the gym (weights and some HIIT) and I started taking some supplements (ZMA, Vitamin D3, B vitamins, EPA/DHA, multi, etc.) I have since discontinued the multi and b-vitamins and added high dose calcium/magnesium.. although I doubt this is relevant.

[Cappa]

The test below was taken when I was in the hospital earlier this year (after being depressed in the aftermath of the Effexor-induced mania). They had just put me on Anafranil (which was discontinued shortly after this due to it also inducing mania). In fact, I think I just took the one dose. I also hadn’t slept well the night before and hadn’t been sleeping well in general (sleep still isn’t great, but better now than before).

---

Tested on February 1, 2009:

Free Testosterone: 35 pmol/L (32 – 92)
TSH: 3.0 mU/L (0.30 – 4.2)

AST: 24 U/L (10 – 34)
ALT: 27 U/L (10 – 44)

---

Currently on order:

Free Testosterone
Testosterone
Bioavailable Testosterone
LH
FSH
SHBG
Sensitive Estradiol
Fasting AM Cortisol
Prolactin
TSH
Free T4
Free T3

[hardasnails1973]

@Cappa 2373 wrote:

The test below was taken when I was in the hospital earlier this year (after being depressed in the aftermath of the Effexor-induced mania). They had just put me on Anafranil (which was discontinued shortly after this due to it also inducing mania). In fact, I think I just took the one dose. I also hadn’t slept well the night before and hadn’t been sleeping well in general (sleep still isn’t great, but better now than before).

---

Tested on February 1, 2009:

Free Testosterone: 35 pmol/L (32 – 92)
TSH: 3.0 mU/L (0.30 – 4.2)

AST: 24 U/L (10 – 34)
ALT: 27 U/L (10 – 44)

---

Currently on order:

Free Testosterone
Testosterone
Bioavailable Testosterone
LH
FSH
SHBG
Sensitive Estradiol
Fasting AM Cortisol
Prolactin
TSH
Free T4
Free T3

i suspect thyroid problems which can lead into methylation issues or vice versa.
I do not see vitamin D levels on your check list.
Untill all the data comes in one can only speculate that its thyroid and adrenals imbalance.
Obviously you over in europe not in the USA so you may seek a health professional over there.

[Cappa]

@hardasnails1973 2380 wrote:

i suspect thyroid problems which can lead into methylation issues or vice versa.
I do not see vitamin D levels on your check list.
Untill all the data comes in one can only speculate that its thyroid and adrenals imbalance.
Obviously you over in europe not in the USA so you may seek a health professional over there.

Hey, thanks. I’m in Canada actually. I initially suspected there might be thyroid problems, but aren’t these values okay? From the December 9 lab posted above:

sTSH: 1.79 mIU/L (0.35 – 5.00)
T4 Free: 17 pmol/L (10 – 20)
Free T3: 4.9 pmol/L (2.6 – 5.7)

Thanks.

[Cappa]

@hardasnails1973 2380 wrote:

i suspect thyroid problems which can lead into methylation issues or vice versa.
I do not see vitamin D levels on your check list.
Untill all the data comes in one can only speculate that its thyroid and adrenals imbalance.
Obviously you over in europe not in the USA so you may seek a health professional over there.

I know. I should get my vitamin D checked. What else should I check, aside from what’s listed above (“on order”)? I’m not knowledgeable enough to know where to go from here (all of this is rather new to me) and my family doctor seems rather clueless on how to deal with any of this (“Well you know, hormones fluctuate. We can do testosterone if you want.”). I live in Toronto. Do you know a good doctor (accessible to me either in Canada or across the border in the U.S.) who might be able to help me with this? Money is right right now, but this might be good to know in case I’m able to find a way to work that out.

What do you think I should do at this point? Thanks.

[Cappa]

@hardasnails1973 2380 wrote:

i suspect thyroid problems which can lead into methylation issues or vice versa.
I do not see vitamin D levels on your check list.
Untill all the data comes in one can only speculate that its thyroid and adrenals imbalance.
Obviously you over in europe not in the USA so you may seek a health professional over there.

I know. I should get my vitamin D checked. What else should I check, aside from what’s listed above (“on order”)? I’m not knowledgeable enough to know where to go from here (all of this is rather new to me) and my family doctor seems rather clueless on how to deal with any of this (“Well you know, hormones fluctuate. We can do testosterone if you want.”). I live in Toronto. Do you know a good doctor (accessible to me either in Canada or across the border in the U.S.) who might be able to help me with this? Money is tight right now, but this might be good to know in case I’m able to find a way to work that out.

What do you think I should do at this point? Thanks.

[Cappa]

*tight, not right.

Anxiety has been pretty bad recently. I should be going for that next blood test within a few weeks, although I don’t have a lot of stuff that I should be testing on the requisition. My primary physician doesn’t know how to deal with this, and the cognitive behavioral therapy that I’m getting right now is only helping a little bit. Not going back on meds after what happened the last time (I don’t want a cocktail, especially due to the complexity of the situation), and I never even got great efficacy from them anyways. I guess I’ll just continue on with this and see what happens.

I’ve been mainly talking to myself in this thread… lol, I must be feeling pretty desperate.

[hardasnails1973]

Cappa,
If you want to explore further into your potential issue I am available for consulting for your health needs and willl try to get you some other areas to look into. I have several people that are from canada that i have been dealing with in past years Chip douglas been one of them and finally after 3 years (if he would had listening to the suggestion then) he would have been on his way to recovery. Now after 3 years he is 80% better and his relationship was probably saved.

Email:
matrixhealthandwellness@gmail.com
contact me for info

[Cappa]

@hardasnails1973 2430 wrote:

Cappa,
If you want to explore further into your potential issue I am available for consulting for your health needs and willl try to get you some other areas to look into. I have several people that are from canada that i have been dealing with in past years Chip douglas been one of them and finally after 3 years (if he would had listening to the suggestion then) he would have been on his way to recovery. Now after 3 years he is 80% better and his relationship was probably saved.

Email:
matrixhealthandwellness@gmail.com
contact me for info

Oh, cool. I’ll send you an email soon. Thanks.

[Author]

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