Help Interpreting Blood Work

[Nate02]

Hi! I have just added test additions to this post in another thread, but I decided to post it in a new thread as well in hope that more people will respond to it. I have an appointment with a doctor Friday whom may prescribe me testosterone , so I would like to be as knowledgeable as possible on my situation. I do not know for certain what the following tests indicate. It looks like my problems will not be remedied by treating my hypothyroidism. As noted at the bottom of the page, I take 50mcgs of Synthroid and I do not feel relief from my symptoms; and from the results it would appear my T3 levels are okay. Does it appear that I have primary or secondary hypogonadism and does it appear I will need testosterone? What do these tests suggest is the issue? Briefly: since I was 12 years old I experienced a poor quality of life. I have been misdiagnosed for a number of years; and finally, I was able to convince my primary physician to test my testosterone at the age of 20. I have had a series of tests over the past 6 months with various doctors; which are all posted below. I don't have a definite diagnosis yet; but at this point, it is confirmed that something must be done to relieve my symptoms and better my life. If there are any questions in regards to my situation, symptoms, etc. please consult my past posts; they have a more extensive history. If the question is not addressed, please post it here and I would be happy to answer.

Please: any advice would be helpful; I look forward to all your input.
I underlined tests that I felt could cause issue.

Testosterone, Serum: 265 (348-1197)

This was concerning, so another more extensive test followed.

TSH: 2.360 (0.450-4.500)
LH: 4.2 (1.7-8.6)
FSH: 1.1 (1.5-12.4)
Testosterone, Serum: 330 (348-1197)
Prolactin: 8.5 (4.0-15.2)

The next test was issued by an endocrinologist.

Free Testosterone(Direct): 9.4 (9.3-26.5)
Testosterone, Total, Lc/Ms: 253.9 (348-1197)
Lh: 4.1 (1.7-8.6)
FSH: 1.1 (1.5-12.4)

The next test my current endocrinologist ordered because I had been off Prozac for one week and figured why not.

Cortisol: 20.8 (2.3-19.4)
TSH: 4.2: (0.450-4.500)

The first two tests were taken at 11:30 AM and 10:30 AM respectively, and the last two were taken at 8:00 AM.

I had an MRI done, and the results came back clear.

ADDITION:

Thyroid Panel With TSH
TSH: 1.930 (0.450-4.500)
Thyroxine (T4): 9.6 (4.5-12.0)
T3 Uptake: 34 (24-39)
Free Thyroxine Index: 3.3 (1.2-4.9)
Thyroid Antibodies
Thyroid Peroxidase (TPO) Ab: 8 (0-34)
Antithyroglobulin Ab: <20 (0-40)
Luteinizing Hormone (LH): 7.3 (1.7-8.6(
FSH, Serum: 1.3 (1.5-12.4)
Calcitonin, Serum: <2.0 (0.0-8.4)
Reverse T3, Serum: 21.5 (9.2-24.1)
Vitamin D, 25-Hydroxy: 32.6 (30.0-100.0)
Triiodothyronine (T3): 115 (71-180)
Estrogens, Total: 83 (40-115)
Ferritin, Serum: 70 (30-400)
Triiodothyronine, Free, Serum: 3.7 (2.0-4.4)

I do not know if this is important, however, these tests were taken at 8 AM. This could cause for the imbalance in some tests, as I had not eaten. I wonder if these are impacted: Calcitonin, Serum; Ferritin, Serum; and/or Vitamin D, 25-Hydoxy.

It is also important to note, I am currently taking: 50mcgs of Synthroid in the morning, 20mg of Adderall in the morning, and 10mg of Prozac at night. I started taking Synthroid before the last blood work.

[kelkel]

Nate, I'm curious if you have been checked for a varicocele by your doctor?
Elevated Cortisol can suppress test levels
Vit D level is poor. Supplement with D3 immediately
Estrogen level does not appear to be a sensitive assay and higher levels can suppress T as well
LH is poor for your age and FSH is shot for some reason.

Determining whether your primary or secondary is not always cut and dried. You really need to find an astute doc to investigate this further and find the cause. He may consider an HCG stimulation test or even nolva-clomid to see what type of response is obtained.

[Nate02]

Nate, I'm curious if you have been checked for a varicocele by your doctor?
Elevated Cortisol can suppress test levels
Vit D level is poor. Supplement with D3 immediately
Estrogen level does not appear to be a sensitive assay and higher levels can suppress T as well
LH is poor for your age and FSH is shot for some reason.

Determining whether your primary or secondary is not always cut and dried. You really need to find an astute doc to investigate this further and find the cause. He may consider an HCG stimulation test or even nolva-clomid to see what type of response is obtained.

No I have not been checked for a varicocele; I have never even heard that term before your mentioning of it. This latest set of blood work was my own doing. I am not sure if I have told you this, but my I am trying to accelerate the process since I am home till mid-January. If I don't come to a conclusion, fine; but, I would like to. So I asked my family physician for those latest tests. Right now I do not have a doctor that I feel represents my interests, unfortunately. If I do not I will most likely have to wait till my school lets out in summer. I am an athlete and would rather not start testosterone during season.

I have been told that a cortisol level in the 20's is actually of normal range in the morning. I know it is on the higher end, but apparently it should be at that time. It decreases throughout the day as I am sure you know. In addition to this, my research has brought me to the conclusion that my cortisol is not a factor because a link doesn't exist. It would seem that hypothyroidism is connected to adrenal fatigue, and I most certainly do not suffer from that.

My vitamin D is poor, but could that be because I tested early in the morning before I had eaten?

What would you recommend for the estrogen? A better test? It seems to be right in the middle. I didn't think that would be of concern.

Do you have any input concerning my LH and FSH?

I know that this is a sensitive subject with testosterone substitutions, especially with my age; however, I wonder if this could be Occam's Razor, and the I simply have functional pituitary issues shown by my decreased FSH. Could this be the case?

Thank you for your comment.

[Nate02]

Nate, I'm curious if you have been checked for a varicocele by your doctor?

I will say though, after reviewing PubMed's information about Varicoceles it would appear I do not have one. I do not feel any pain in my testicles, they seem to be of equal size, and the veins appear to be normal from the outside. However, a doctor could possibly tell me otherwise; as it would seem this is a difficult test to self-administer without prior knowledge of the subject.

[kelkel]

Your young nate. I don't want to see you take test at all. You need to find the problem. Can you travel to a good doc? Where are you from again? Correct on Cortisol. For estrogen I'd recommend the proper test first and foremost. Your D level is what it is. Supplement D3 now.

LH/FSH. Right now no. You had an MRI to rule out pituitary adenomas yet your LH is still low for your age, IMO. Adrenal issues can impact test levels a bit but the majority of your test comes from your boys down below. You really need to pull out all stops and see a good doc.

[Nate02]

Your young nate. I don't want to see you take test at all. You need to find the problem. Can you travel to a good doc? Where are you from again? Correct on Cortisol. For estrogen I'd recommend the proper test first and foremost. Your D level is what it is. Supplement D3 now.

LH/FSH. Right now no. You had an MRI to rule out pituitary adenomas yet your LH is still low for your age, IMO. Adrenal issues can impact test levels a bit but the majority of your test comes from your boys down below. You really need to pull out all stops and see a good doc.

I would rather not myself, but it looks like that is what it is coming to. I want to find the problem, but like I said it seems like there is none on the surface. Okay, I will definitely begin supplementing Vitamin D. I am very concerned about this. Nobody seems to understand or even has a probable guess as to what is going on with me.

I am willing to travel but to a limit. I live in Maryland. Do you know of anyone who lives near or frankly, anywhere in Maryland. Right now I have an appointment to see Doctor Adrian Dobs at John Hopkins. I am hoping that John Hopkins lives up to their reputation with me. However, my appointment is not until March, and like I said I want to get this done before next semester if possible.

I really have a dilemma here.

The reason why I wonder if it could simply be pituitary problems is when I consult labtestsonline.org, it states that low FSH in men is consistent with pituitary and hypothalamic disorders. This leads to me to think that I might possibly be over-thinking the entire situation.

[kelkel]

Check this out. A4M Doc's should be top of the line:

http://www.a4m.com/directory.html#directory_search_form

[Nate02]

Check this out. A4M Doc's should be top of the line:

http://www.a4m.com/directory.html#directory_search_form

According to this, there is a doctor within possibly ten minutes of me. Not to doubt your recommendations, but honestly I just wonder how good this doctor will be with all that I am dealing with. I have already been through a lot of doctors; and it is really time, resource, and energy consuming to pursue another.

I do have an important question for you though. Being on Synthroid and looking at my thyroid tests, does it look like my hypothyroidism is not causing my issues?

[HRTstudent]

What sort of food do you eat regularly?

Do you play any sports or spend any significant time outside in the sun most days?

On a scale of 1-10 (10 being the worst, 1 being none at all) how bad is your depression?

[Nate02]

What sort of food do you eat regularly?

Do you play any sports or spend any significant time outside in the sun most days?

On a scale of 1-10 (10 being the worst, 1 being none at all) how bad is your depression?

Hi! I eat a very balanced diet and I do play sports. I would go into details, but I do not think that is the problem. I am a very health-conscious person; I have done much research and any issue in my lifestyle I resolved. Natural fixes were my first option. Presently, I am not in the sun a lot; but, my symptoms have persisted through times in which I have been in the sun more. Interesting question: These times it is significantly lower; maybe a 3. In the past though, it has lead me to suicidal thoughts with a 10!

[xtitan1]

Posting this here in response to your PM. I have read through this thread and you really need to see a very knowledgable doctor. Don't cancel the JH appointment but I don't think that's the route that's going to end up working. Do see the doctor we discussed. I would run, not walk, to this guy.

If you haven't started testosterone therapy yet, wait until you get clearance because once you start it you can't do some things like a HCG mono response trial or similar diagnostic methods to determine if the problem is pituitary or something else.

You need to check out the stickies on this forum, especially the recommended blood work sticky because the tests you are getting are not really the right ones. For example, free t4, free t3, estradiol or estradiol ultra sensitive. It's important for you to learn this information because an informed patient has a higher likelihood of success even if he is seeing a great doctor.

Your testosterone is not "borderline" it is low. If your endocrinologist thinks that being slightly out of the lab reference range when you are twenty years old is borderline then he doesn't understand much about testosterone replacement therapy.

Since your t is low, your LH and FSH numbers are under-responsive. A properly functioning HPT axis would see high LH and FSH levels as t drops, causing the testicles to increase production. That is not happening.

A cortisol of 20 is not alarming but morning cortisol draws aren't totally awesome for diagnosing adrenal issues because not everyone has the proper high morning low evening cortisol rhythm that they should have. But at this point I wouldn't harp on it too much unless you are seeing cushingoid features (google "mayo clinic Cushing's syndrome"). I'm not thinking your low t is due to cortisol but I could be wrong.

It is good you got a pituitary MRI but unless it was a 3 tesla machine, was done dynamically, and was read by a radiologist specializing in pituitary tumor recognition, I don't put much weight in it, but that's just me. Unfortunately if all of that sounds really complicated, expensive, hard to justify, and hard to get a doctor to agree to, it is.

You need a real expert to get on this. If you let this go it's going to get worse.

[Nate02]

Posting this here in response to your PM. I have read through this thread and you really need to see a very knowledgable doctor. Don't cancel the JH appointment but I don't think that's the route that's going to end up working. Do see the doctor we discussed. I would run, not walk, to this guy.

If you haven't started testosterone therapy yet, wait until you get clearance because once you start it you can't do some things like a HCG mono response trial or similar diagnostic methods to determine if the problem is pituitary or something else.

You need to check out the stickies on this forum, especially the recommended blood work sticky because the tests you are getting are not really the right ones. For example, free t4, free t3, estradiol or estradiol ultra sensitive. It's important for you to learn this information because an informed patient has a higher likelihood of success even if he is seeing a great doctor.

Your testosterone is not "borderline" it is low. If your endocrinologist thinks that being slightly out of the lab reference range when you are twenty years old is borderline then he doesn't understand much about testosterone replacement therapy.

Since your t is low, your LH and FSH numbers are under-responsive. A properly functioning HPT axis would see high LH and FSH levels as t drops, causing the testicles to increase production. That is not happening.

A cortisol of 20 is not alarming but morning cortisol draws aren't totally awesome for diagnosing adrenal issues because not everyone has the proper high morning low evening cortisol rhythm that they should have. But at this point I wouldn't harp on it too much unless you are seeing cushingoid features (google "mayo clinic Cushing's syndrome"). I'm not thinking your low t is due to cortisol but I could be wrong.

It is good you got a pituitary MRI but unless it was a 3 tesla machine, was done dynamically, and was read by a radiologist specializing in pituitary tumor recognition, I don't put much weight in it, but that's just me. Unfortunately if all of that sounds really complicated, expensive, hard to justify, and hard to get a doctor to agree to, it is.

You need a real expert to get on this. If you let this go it's going to get worse.

Well that is quite frightening . Let me first begin by saying I am on TRT. Androgel 1.62% for about one week. I have read up on some things, but apparently not enough. I will read the stickies. And I will keep in mind that my testosterone is low because I have been in the mindset that it is borderline.

I didn't think much of the cortisol. I realize that it should be higher at 8 AM. I don't think I have symptoms of Cushing's Syndrome, although my symptoms seem to fit under 50% of all known medical diagnoses. It's hard to tell.

I would run, not walk, to this guy.

With this statement are you stressing the urgency of my situation or implying that this is a doctor I should visit?

If I decide to see this doctor, should I stop my Androgel 1.62%? I would like to stay on it as this is the beginning of my semester, but not if it will hurt his diagnosis. It would be preferable if I could stay on it because I am just plain tired of feeling this way. Its been too long. I feel like an old man sometimes and its really upsetting.

[kelkel]

Great response XT! I was hoping you'd chime in here with all you've been through. The doc your referring to is who I think it is, correct? Same one you saw?

[xtitan1]

Great response XT! I was hoping you'd chime in here with all you've been through. The doc your referring to is who I think it is, correct? Same one you saw?

Thanks brutha, yep same doc. I'm like confused as to whether its okay to name drs or not. I certainly don't care but maybe the doctor or the patient would.

[xtitan1]

In no way was I trying to frighten you, but sometimes us guys don't take health problems seriously or with the urgency we wish we had in retrospect and I wanted to make sure you wouldn't fall into that trap.

As for your question, I mean both with an exclamation point! It's urgent that you go see Dr. S and ASAP.

I totally know how you feel bro this sh*t isn't cool.

As far as what to do with the androgel , I would never recommend someone starting or stopping a medication without consulting their doctor. When you go to see Dr. S he will request that you mail him a letter and you should mention that your doctor has already started you on androgel. If he needs you to stop he will tell you and how to do it. Better yet when you call to make the appointment let them know and ask that they ask dr. S directly about that specific issue since you only just started the gel. That may not be the normal protocol but this is a special situation because you only just started and maybe won't need nearly as long of a wait after stopping it before you can test for LH and FSH.

Btw you say you began feeling a poor quality of life at an early age. Had you hit puberty by this point or did that happen after you noticed something was wrong? If you had a testosterone problem that early on you probably would be seeing delayed puberty or less than full development of adult male sex characteristics. It would clue you in as to whether the testosterone is a complication or the root problem.

[Nate02]

Great response XT! I was hoping you'd chime in here with all you've been through. The doc your referring to is who I think it is, correct? Same one you saw?

In no way was I trying to frighten you, but sometimes us guys don't take health problems seriously or with the urgency we wish we had in retrospect and I wanted to make sure you wouldn't fall into that trap.

As for your question, I mean both with an exclamation point! It's urgent that you go see Dr. S and ASAP.

I totally know how you feel bro this sh*t isn't cool.

As far as what to do with the androgel , I would never recommend someone starting or stopping a medication without consulting their doctor. When you go to see Dr. S he will request that you mail him a letter and you should mention that your doctor has already started you on androgel. If he needs you to stop he will tell you and how to do it. Better yet when you call to make the appointment let them know and ask that they ask dr. S directly about that specific issue since you only just started the gel. That may not be the normal protocol but this is a special situation because you only just started and maybe won't need nearly as long of a wait after stopping it before you can test for LH and FSH.

Btw you say you began feeling a poor quality of life at an early age. Had you hit puberty by this point or did that happen after you noticed something was wrong? If you had a testosterone problem that early on you probably would be seeing delayed puberty or less than full development of adult male sex characteristics. It would clue you in as to whether the testosterone is a complication or the root problem.

No, I am just kidding I'm not frightened. I'm glad you told me that actually. I take it seriously I am also just anxious to start. Okay, I think I will give him a class today. I just hope I can continue with this. It just feels good to be on it after so long of feeling this way.

I actually feel like it was just around puberty that I started experiencing this poor quality of life. I don't notice a lack of male characteristics compared to other people but I do in my family. So it may be slight. My family is very "high testosterone ". I notice that I don't have as strong of a facial structure, not as physically strong, less body hair, etc. than my family. This isn't severe though.

Another question: Since Lancaster is about 2 hours and 30 minutes of the way for me, can he do further consultation over the phone?

----------------------------------------------------------------------------------------------------------------------------------------------------------

I just got off the phone with his office. Its Monday morning right now. It really seemed promising until I heard the price. I didn't know that he didn't deal with insurance companies and that is too costly for me. I don't think I can see him right now.

On a side note, the secretary did not tell me to stop Androgel 1.62%, but to just include it in the initial letter.

Xtitan1, you seem to be located around my area. Is there any other doctor you know of in the Maryland/Pennsylvania area that is considered "knowledgeable" by your standards? I have Bluecross/Blueshield. Otherwise, it looks like I am doomed . I haven't had much luck in finding a doctor. Most are similar to the two I am seeing now.

I still plan on visiting John Hopkins in hopes that I have a better experience than you did.

[kelkel]

Understood. Better safe than sorry right!

Happy New Year XT! You've been MIA lately.

[Nate02]

Well something interesting did happen today. I didn't even get a chance to bring up HCG . He had blood work done on my initial visit and one of his tests was free testosterone . I can't remember the units, but he said I tested 53 in a reference range from 35-150. As you can see from my results above, I have only been tested for free testosterone once. So now he wants me to stop Androgel 1.62% so he can test me again because he said one test was wrong. (1) Even if this second test was right a 53 seems low for a 20 year old. (2) I still have bad symptoms! Any thoughts on this?

[HRTstudent]

My thoughts are it might be low, but I don't like the idea of a 20 year old going on TRT without a thorough workup... you have a multi-faceted problem and I just don't see throwing some testosterone at it to be the answer you need. At best, it can make some things better, but that will come with the standard downfalls.

To be blunt, I wouldn't be following the advice of just any regular general practitioner who knows very little about HRT.

I'm not sure what he's going to try to do now that he asked you to stop the gel, but it's better he tell you at 2 weeks than at 6 months. Recovery should not be too bad.

[Nate02]

My thoughts are it might be low, but I don't like the idea of a 20 year old going on TRT without a thorough workup... you have a multi-faceted problem and I just don't see throwing some testosterone at it to be the answer you need. At best, it can make some things better, but that will come with the standard downfalls.

To be blunt, I wouldn't be following the advice of just any regular general practitioner who knows very little about HRT.

I'm not sure what he's going to try to do now that he asked you to stop the gel, but it's better he tell you at 2 weeks than at 6 months. Recovery should not be too bad.

Everyone keeps telling me that! I am going crazy! I am saying this is no way to offend you. Just everyone has been telling me that it is a complicated issue that will not be just solved by TRT, yet they can't or won't give me enough basis for this. They just tell me that I need to see a better-equipped doctor. I wanted to go see Doctor Eugene Shippen but his price is too high for me. I cannot find a doctor that is practical for me to visit up to everyone's standards in my area! I appreciate everyone's help too, but it's just maddening to be a 20 year old trying to pursue hormonal problems.

These aren't just any doctors I am seeing as well, I am from an area in Maryland with great health care, and these are two good endocrinologists.

Again, I am sorry if that came off rude. It was not intended to at all.

[Nate02]

Hello everyone: I am back! I recently took a salivary cortisol test. I suspected I had high cortisol, however, it seems I have low cortisol, i.e. adrenal fatigue. The high cortisol could of at least partially explained my low testosterone , but now it looks like it's back to the beginning for me. Please view my initial post if you haven't to understand my situation.

I really need help. I feel like my body is "breaking down". How could a 20 year old have hypothyroidism, low testosterone , and adrenal fatigue? It doesn't make sense, and I fear for something worse. Please share any knowledge you have of what this could be.

Here are my results:
Morning - 3.8 ng/mL (7.0-10)
Midday - 3.1 ng/mL (3.0-6.0)
Evening - 2.5 ng/mL (2.5-4.0)
Night - 2.2 ng/mL (<1.5)

This seems to be adrenal fatigue to me, however I am not certain with my limited knowledge. Any thoughts?

[HRTstudent]

Hello everyone: I am back! I recently took a salivary cortisol test. I suspected I had high cortisol, however, it seems I have low cortisol, i.e. adrenal fatigue. The high cortisol could of at least partially explained my low testosterone , but now it looks like it's back to the beginning for me. Please view my initial post if you haven't to understand my situation.

I really need help. I feel like my body is "breaking down". How could a 20 year old have hypothyroidism, low testosterone , and adrenal fatigue? It doesn't make sense, and I fear for something worse. Please share any knowledge you have of what this could be.

Here are my results:
Morning - 3.8 ng/mL (7.0-10)
Midday - 3.1 ng/mL (3.0-6.0)
Evening - 2.5 ng/mL (2.5-4.0)
Night - 2.2 ng/mL (<1.5)

This seems to be adrenal fatigue to me, however I am not certain with my limited knowledge. Any thoughts?

Those are really good questions. Questions we probably can't answer - they would require a good doctor trained in interdisciplinary fields that has interviewed you, your history, your hereditary, etc etc.

One thing is for sure, I believe you have a multi-facted problem (especially because of your depression) and you should address the problem as such. The chances, I believe, of you simply picking 1 thing and expecting it to "fix" everything are so small IN MY OPINION.

I would honestly start with eating nutritious, unrefined foods, avoid processed stuff as much as possible. Couple that with regular exercise 3-4 times per week where you get your heart rate up but AVOID overtraining/overstressing your body.

Those are pretty general recommendations, but they would serve you well. We also could afford to learn more about you to help you more specifically.

[Nate02]

Maybe you have lyme, ever bitten by any ticks?

I was tested for lyme disease recently by my Naturopathic doctor. Very good thought, though.

Those are really good questions. Questions we probably can't answer - they would require a good doctor trained in interdisciplinary fields that has interviewed you, your history, your hereditary, etc etc.

One thing is for sure, I believe you have a multi-facted problem (especially because of your depression) and you should address the problem as such. The chances, I believe, of you simply picking 1 thing and expecting it to "fix" everything are so small IN MY OPINION.

I think it is multi-faced too. One thing I can say is I do have very constant, very bad anxiety/stress. This could lead to a lot of my issues I think.

I would honestly start with eating nutritious, unrefined foods, avoid processed stuff as much as possible. Couple that with regular exercise 3-4 times per week where you get your heart rate up but AVOID overtraining/overstressing your body.

That is going to be my first step. Thank you.

Those are pretty general recommendations, but they would serve you well. We also could afford to learn more about you to help you more specifically.

I will provide you with any information you deem necessary. I just don't know what you are looking for!

[Trific]

Maybe you have lyme, ever bitten by any ticks?

[Trific]

Since you said you had a poor quality of life since 12, maybe that has harmed you much like a head trauma does and has screwed up your HPTA axis...maybe it can be corrected and maybe not. Until you can figure something better out, I would support things the best you can, eat well, sleep well, exercise some and try to avoid any mental or physical stress.
Support your hormones, thyroid and adrenals the best you can and I heard pregnenolone is helpful with anxiety.

[Nate02]

Since you said you had a poor quality of life since 12, maybe that has harmed you much like a head trauma does and has screwed up your HPTA axis...maybe it can be corrected and maybe not. Until you can figure something better out, I would support things the best you can, eat well, sleep well, exercise some and try to avoid any mental or physical stress.

I think that may be the case, at least to some degree. It is amazing to think that stress could possibly take a toll of that magnitude on my body. Fascinating, really. I will most certainly try to take care of myself. It is difficult though as I am a college student.

Support your hormones, thyroid and adrenals the best you can and I heard pregnenolone is helpful with anxiety.

The Synthroid has balanced my thyroid. I want to take pregnenolone, but I am nervous about adverse effect from taking a hormone like that.

[Trific]

Nate, this following article is from another chatroom....I thought it might be something you should read:

1) It could be adrenal stress, and this could be made worse with TRT unless you take some very simple and inexpensive precautions. In fact, in some cases, adrenal stress can be the cause of low T in the first place. When you are under stress, your adrenals steal pregnenolone and to a lesser extent DHEA away from other hormonal pathways to make cortisol. That is why excessive exercise and/or stress can decrease T. You need pregnenolone to make DHEA and DHEA to make testosterone .

You may want to consider adding 30 mg of oral pregnenolone and 25 mg of oral DHEA to your supllement schedule. It's best to take these in the evening. If your are really stressed, and really deficient in preg or DHEA, then doubling the dose for a week or so may be helpful but don't go higher than that without supervision and hormonal tests as high DHEA can also drive up E and that can cause other issues.

2) It could be that your are also have some thyroid issues going on. Thryoid problems can mimic low T in many symptoms (ED, low energy, brain fog, inability to lose abdominal fat, etc.). You may want to have a complete thyroid panel done which absolutlely must include free T3 and rT3. Your ratio should be at least 20:1 of T3 to rT3. A lot of docs (especially endos) do not believe in T3 and somehow think that supplementing with T4 will fix the problem. I highly recommend not listening to that advice (if you do indeed have thyroid issues) and supplement with Armour or some other biological product that contains all four of the thyroid hormones.

Do you know your TSH? If it is consistently above 2 or so, it may indicate a problem. So TSH is often the first round of testing. Oh, ignore the "normal ranges", anything consistently about 1.5 to 2 should be further evaluated.

Again, watch out for docs that want to give you synthetic T4, yes it will bring down the TSH but it will not fix an rT3 problem and may make it worse.

[HRTstudent]

Nate, this following article is from another chatroom....I thought it might be something you should read:

1) It could be adrenal stress, and this could be made worse with TRT unless you take some very simple and inexpensive precautions. In fact, in some cases, adrenal stress can be the cause of low T in the first place. When you are under stress, your adrenals steal pregnenolone and to a lesser extent DHEA away from other hormonal pathways to make cortisol. That is why excessive exercise and/or stress can decrease T. You need pregnenolone to make DHEA and DHEA to make testosterone .

You may want to consider adding 30 mg of oral pregnenolone and 25 mg of oral DHEA to your supllement schedule. It's best to take these in the evening. If your are really stressed, and really deficient in preg or DHEA, then doubling the dose for a week or so may be helpful but don't go higher than that without supervision and hormonal tests as high DHEA can also drive up E and that can cause other issues.

2) It could be that your are also have some thyroid issues going on. Thryoid problems can mimic low T in many symptoms (ED, low energy, brain fog, inability to lose abdominal fat, etc.). You may want to have a complete thyroid panel done which absolutlely must include free T3 and rT3. Your ratio should be at least 20:1 of T3 to rT3. A lot of docs (especially endos) do not believe in T3 and somehow think that supplementing with T4 will fix the problem. I highly recommend not listening to that advice (if you do indeed have thyroid issues) and supplement with Armour or some other biological product that contains all four of the thyroid hormones.

Do you know your TSH? If it is consistently above 2 or so, it may indicate a problem. So TSH is often the first round of testing. Oh, ignore the "normal ranges", anything consistently about 1.5 to 2 should be further evaluated.

Again, watch out for docs that want to give you synthetic T4, yes it will bring down the TSH but it will not fix an rT3 problem and may make it worse.

This is good advice in general, although id like to expound upon a couple things....

While the pregnenolone pathway does lead to DHEA and then on to testosterone, it's very unlikely that taking pregnenolone will raise either of these to any substantial degree, if at all. I haven't seen anyone report this, and pregnenolone in excess usually results in more progesterone. It certainly had no effect on my DHEA levels despite different doses over different time periods.

To be sure, blood tests for DHEA are reliable and accurate. Just be sure to check for DHEA-s (sulfate)! Just plain DHEA levels vary widely throughout the day, so clinically, we don't look at that, but rather we look at DHEA-s. Any major lab would offer this test.

Pregnenolone blood tests, on the other hand, are less exact. Some say they are useless, but if you have insurance it's worth investigating IMO.

If you start DHEA make sure you choose a micronized version for its increased absorption. Also, take it with a fatty meal because, as a lipid soluble hormone, this will increase its absorption.

And I totally agree on getting a full thyroid panel done. Be sure to get: Total T4, Total T3, Free T3, Free T4, and TSH. Most docs will simply look at TSH because it's what they are trained to do and what insurance wants them to do. But it doesn't give an adequate picture of the thyroid ESPECIALLY when one suspects there may be an issue with the thyroid.

[Nate02]

Nate, this following article is from another chatroom....I thought it might be something you should read:

1) It could be adrenal stress, and this could be made worse with TRT unless you take some very simple and inexpensive precautions. In fact, in some cases, adrenal stress can be the cause of low T in the first place. When you are under stress, your adrenals steal pregnenolone and to a lesser extent DHEA away from other hormonal pathways to make cortisol. That is why excessive exercise and/or stress can decrease T. You need pregnenolone to make DHEA and DHEA to make testosterone .

Can TRT cause adrenal fatigue? I ask because when I had my cortisol tested prior to TRT it was 21 mg/dL at 8 AM. I have done thorough research, and I have learned that cortisol can be high right before dropping into adrenal fatigue. I doubt that starting TRT could affect my cortisol that much, right? I am just on two pumps of Androgel 1.62% a day aka the starter dose.

You may want to consider adding 30 mg of oral pregnenolone and 25 mg of oral DHEA to your supllement schedule. It's best to take these in the evening. If your are really stressed, and really deficient in preg or DHEA, then doubling the dose for a week or so may be helpful but don't go higher than that without supervision and hormonal tests as high DHEA can also drive up E and that can cause other issues.

I have considered doing that. I did have my DHEA tested with my cortisol and I have normal DHEA. Mid-ranged according to the reference scale.

2) It could be that your are also have some thyroid issues going on. Thryoid problems can mimic low T in many symptoms (ED, low energy, brain fog, inability to lose abdominal fat, etc.). You may want to have a complete thyroid panel done which absolutlely must include free T3 and rT3. Your ratio should be at least 20:1 of T3 to rT3. A lot of docs (especially endos) do not believe in T3 and somehow think that supplementing with T4 will fix the problem. I highly recommend not listening to that advice (if you do indeed have thyroid issues) and supplement with Armour or some other biological product that contains all four of the thyroid hormones.

Do you know your TSH? If it is consistently above 2 or so, it may indicate a problem. So TSH is often the first round of testing. Oh, ignore the "normal ranges", anything consistently about 1.5 to 2 should be further evaluated.

Again, watch out for docs that want to give you synthetic T4, yes it will bring down the TSH but it will not fix an rT3 problem and may make it worse.

I do not have thyroid issues anymore. I take Synthroid and and my thyroid levels fall in the normal range. Please read the initial post.

Pregnenolone is a what most would consider a safe drug. Of course I would absolutely talk to your doctor about it before you start.

But, you said you have axiety and Dr Crisler has touted he benefits of pregnenolone (oral specifically) on helping many of his patients with anxiety. The micronized lipid matrix (MLM) pregnenolone seems to be the most highly acclaimed due to its purported enhanced absorption.

I will most likely take pregnenolone, but right now I only have 50 milligrams and I am not comfortable taking such an amount. I will buy a lesser amount. The effect it has on anxiety is desirable in my situation.

Also, it's very cheap! A 150mg x 60 tablet would last you at least a month (300mg is probably more than most take, although I don't know what Dr Crisler recommends) and it's about 30 USD. If you took 150mg a day, that's only 15 bucks a month, which may be cheaper than taking some Rx anxiolytic with a copay.

That is good news.

This is good advice in general, although id like to expound upon a couple things....

While the pregnenolone pathway does lead to DHEA and then on to testosterone, it's very unlikely that taking pregnenolone will raise either of these to any substantial degree, if at all. I haven't seen anyone report this, and pregnenolone in excess usually results in more progesterone. It certainly had no effect on my DHEA levels despite different doses over different time periods.

Good to know.

To be sure, blood tests for DHEA are reliable and accurate. Just be sure to check for DHEA-s (sulfate)! Just plain DHEA levels vary widely throughout the day, so clinically, we don't look at that, but rather we look at DHEA-s. Any major lab would offer this test.

Please read above.

Pregnenolone blood tests, on the other hand, are less exact. Some say they are useless, but if you have insurance it's worth investigating IMO.

If you start DHEA make sure you choose a micronized version for its increased absorption. Also, take it with a fatty meal because, as a lipid soluble hormone, this will increase its absorption.

I will look into it.

And I totally agree on getting a full thyroid panel done. Be sure to get: Total T4, Total T3, Free T3, Free T4, and TSH. Most docs will simply look at TSH because it's what they are trained to do and what insurance wants them to do. But it doesn't give an adequate picture of the thyroid ESPECIALLY when one suspects there may be an issue with the thyroid.

Please read above.

Thank you both for your response. I am really curious as to find if TRT can cause adrenal fatigue.

[HRTstudent]

Pregnenolone is a what most would consider a safe drug. Of course I would absolutely talk to your doctor about it before you start.

But, you said you have axiety and Dr Crisler has touted he benefits of pregnenolone (oral specifically) on helping many of his patients with anxiety. The micronized lipid matrix (MLM) pregnenolone seems to be the most highly acclaimed due to its purported enhanced absorption.

Also, it's very cheap! A 150mg x 60 tablet would last you at least a month (300mg is probably more than most take, although I don't know what Dr Crisler recommends) and it's about 30 USD. If you took 150mg a day, that's only 15 bucks a month, which may be cheaper than taking some Rx anxiolytic with a copay.