What to work on - Adrenals - Thyroid - Testosterone ? Warning Long Post

[Haritec]

SUMMARY OF HOW I FEEL

I feel demotivated and tired - no morning wood - but can get erections fairly easily, of good quality and no issues with orgasm. Finding it hard to lose fat or add muscle mass. Sex drive is down.

(NOTE - I recently add transdermal DHEA Friday last week - had my first nocturnal erection in months on Sunday Night - same with Monday and Tuesday. On Wednesday night woke twice with wood and woke Thursday AM with a raging hardon - amazing how good an unexpected erection can make you feel )


MEDICAL RESULTS

Over the past few years - my SHBG has doubled from 29 to 59 (Canadian reference range 10 - 55 nmol/L)

One side note - despite being a very fit 52 yrs old (weight lift 3x weekly, stretch every day, Cardio and low back exercises 3x weekly, 5'08" 158 lbs - do sets of 10 pullups, bench press my weight for reps etc) - I was diagnosed with Heart Failure in September. Ejection fraction 22% based on ultrasound- left ventricle quite enlarged (330 ml volume). I started on Coversyl (ace inhibitor) and Bisoprolol (Beta Blocker) for the heart issues in September. Angiogram on Tuesday and they say my ejection fraction is a lot higher - 38 % - no coronary artery issues - still not good but way better than 22%)

I think weight-lifting has helped increase my IGF-1 - which has almost doubled since 2011 (95 in 2011 - 160 in 2012 ref range 87 -238 )


I just found out I have the Celiac genes - both DQ2 and DQ8 - though I have no signs of celiac disease. I have not had the antibody tests yet - will try to get those done, but have gone on a complete gluten free diet ( checking every product for gluten and trying to only eat complete products ( vegetables, fruits, meat, eggs etc - no processed foods ) .




These are my latest results as of Sept 30 2012




AM Cortisol 474 nmol/L (200 - 690)
Estradiol 20 pmol/L (0 - 160 ) Note I recently starting take a fairly large amount of DIM and eating 3 cups cabbage a day - Estradiol used to be around 110 just two months ago.
FSH 3 IU/L (1 - 18 )
LH 4 IU/L (1 - 9)
Progesterone 1.7 nmol/L (0.0 - 3.0)
Prolactin 6 ug/L ( 0 - 15)
Free T3 3.9 pmol/L (3.4 - 6.5)
Free T4 16.9 pmol/L (10.0 - 25.0)
Total Testosterone 13.7 nmol/L (8.0 - 29.0)
TSH 2.88 mIU/L (0.20 - 6.00)
Albumin 37 g/L (33 - 48)
Sex Hormone Binding Globuline 59 nmol/L(10 - 55) HIGH
Free Testosterone 194 pmol/L (175 - 700) ( down from 255 before I started on ace inhibitor and beta blocker)




So - my concerns are it seems I may have issues on a number of fronts.

AM cortisol ideally would be higher - but it is better than the last time I tested it. Progesterone OK or should be higher - Adrenals support needed ??

FreeT3 should ideally be higher - Thyroid needs a bit of help ? NOTE my wife is all into organic food and that included salt with no iodine - I added Iodized salt and Lugoils solution last week.

SHBG continuing to rise - Free Testosterone dropping. I feel demotivated and tired - no morning wood - but can get erections fairly easily, of good quality and no issues with orgasm. Finding it hard to lose fat or add muscle mass.

Given that my adrenals could be better and that my Triglycerides are so low - I went off my low carb diet and have added regular sweet potatoes and brown rice to my diet. Used to be only carbs came from vegetables as I found this kept my body fat a bit lower.

Basically - I am confused as to where I should focus. I have tried things like Longjack for increasing Testosterone, as well as Tribulus, with no real obvious effects.


SUPPLEMENTS

Currently I am taking ( when I read this list I am embarrassed to be honest at how much shit I take)

Pauling Heart Therapy


INGREDIENT

AMOUNT

% DV



Vitamin A 10,000 IU
B-24 mg
Vitamin B-3 450 mg
Vitamin B-6 50 mg
Vitamin B-9 450 mcg
Vitamin B-12 1,000 mcg
Vitamin C 3,000 mg
Vitamin D-3 2,000 IU
Vitamin E 600 IU
L-Lysine 3000 mg
L- Proline 550 mg
L-Arginine 250 mg
L-Carnitine 300 mg
L-Taurine 1100 mg
Creatine 900 mg
Magnesium 200 mg
Zinc 30 mg
Coenzyme Q10 100 mg
Citrus Bioflavonoids 100 mg



With Glandulars (3x Liver tabs 2x daily, 1x Hypothalmus, 1x Orchic Tissue, 1 x Combined (Thyroid, Adrenal, Pituitary, Hypothalmus) )

D- Aspartic Acid 3 grams in AM ( increase testicles ability to process cholesterol)

Calcium Magnesium Citrate ( 2 x daily) (magnesium apparently reduces binding of testosterone to SHBG)

Glucoronolactone (1/8 TSP 2 x daily) ( Liver support - Glucoronidation)

Betaine (3 grams daily) (Liver Support - Methylation )

N Acetyl Cysteine (Liver Support - Glutathione )

4 Brazil Nuts ( Selenium )

Fish Oil Caplets

A product from Need 2 Build Muscle..com - called HCGenerate (as of Nov 1st) No bloodwork since I started this but no feeling it is doing anything either.

Fadogia Agrestis 1000mg (increase Testosterone )
Fenugreek PE Extracted 50% 1000mg
3,4 Divanillytahydrofuran 500mg ( supposed to bind with SHBG )
Bulgarain Tribulus Terrestris 500mg
Vitamin E 200mg
LJ:100 100mg
zinc 7mg

DIET

Typical day ( now that I am eating more carbs )




3 egg omelet (cheese, peas, onions) cooked in walnut oil with 1/2 cup sweet potato

Peas, cabbage, onions and Roast Beef

20 grams Whey before workout

30 grams whey in milk with 1 banana after workout

Roast Chicken (dark meat) with potatos, gravy, cauliflower and broccoli

4 oz mixed nuts

WORKOUTS

Keep them under an hour or so - all compound lifts - One Day is [ DIPS, Squats, Military Press, DeadLifts ] Other Day is {Pullups, Squats, Bench Press, Rows ] 3 sets of 10 for Dips and Pullups, 5sets of 5 on Lifts

Stretch 30 minutes each morning ( have an SI joint issue I work on mostly)

Alternate days from weights - low back / core fitness (Planks, side planks, reverse Hypers, situps on roman chair, light weight good mornings, ) then cardio (20 minutes at max incline + 5 minutes cooldown at no incline)


Well - that was probably way too much info - sorry. I guess this is really bugging me feeling like this and I want a solution. Have thought a lot about trying Clomid -but don't know if it is best to focus on Testosterone or Thyroid or Adrenals. Sooooo confused.

Any suggestions as to what issues is major and should be focused on first would be welcome. Doctor is willing to put me on TRT -but I am hoping to see if something can be done to improve my natural production first. Based on test results - are adrenals and/or thyroid an issue at all ? Should they be addressed first - or is the real issue here Testosterone deficiency ?

[HRTstudent]

How many days per week do you completely rest physically?

What changed since 2 years ago that made your SHBG double?

Any recent or history of steroids , anabolics, or prohormones?

[Haritec]

I rest completely on Sundays.
My schedule is Stretch Monday - Saturday AM
Weights Mon Wed Fri ( < 1 hr)
Tues Thurs Saturday Low back /core workout ( planks, birddogs, hyperextensions) ~ 30 minutes Treadmill fast walk (~3.5 mph) uphill (12 degrees) 20 minutes

No history of use of steroids anabolic hormones, prohormones etc.

During that two year period I would have been undergoing prorgressive deterioration of cardiac capacity due to developing Cardiomyopathy. Currently left ventricle is enlarged to about 330 ml volume with reduced ejection fraction (38 %). Just found out about this recently when I went to see my doctor as I could not understand why I was apparently fit ( low body fat for a 50+ yr old), strong-ish ( do chinups for sets, benchpress my weight + ) but could not seem to get my cardio endurance up. Being treated with ace inhibitor and beta blocker.

Major increase in SHBG has been over a longer period than 2 yrs
(SHBG Ref Range 10 - 55 nmol/L in Canada)
2005 SHBG 29
March 2011 SHBG 38
March 2012 SHBG 47
October 2012 SHBG 59

Biggest difference in this period of time was probably following a low carb diet - no long periods of calorie restriction as my bodyweight has been pretty much stable ( low of 154 lbs high of about 168 lbs - most of the time around 160 lbs ).
Variation in bodyweight has occured when I have tried to - either trying to lose a bit of body fast or add some muscle mass. Usually when trying to lose some bodyfat eat a lot more salads and less fatty meats - when trying to gain add in more eggs and some more carbs). Used intermittent 24 hr fasts to try and cut bodyfat as well.

My DHEA-S is on the lowish side as well -
(DHEA-S ref range 2.2 - 13 in canada)
2005 5.3
Mar 2011 4.4
Oct 2011 5.4


During this period as well - my Hemoglobin has dropped from 160 to 139 (ref range 137 - 180) and Red blood cell count has dropped from 4.9 to 3.9 (ref range 4.5 - 6 ) I live at high elevation (3500 ft) so would have expected RBC to be higher. This has all been accompanied by a moderate increase in Mean Cell Volume (MCV has gone from a 95 to a high of 104 - ref range 82 to 100 )