My Endocrine System Issue

[Nate02]

Hi guys: I'm sure a good amount of regulars know me, I've posted regularly for the past few months. I have another thread with a lot of this information in it. But the thread has died. I have more lab work and updates so I thought I would repost.
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Brief Bio/Description: I am a 20 year old college student whom plays tennis in the Spring. I am approximately 5'10" and 191 pounds. I have experienced a low quality of life though, since I was twelve years old.

Symptoms: depression, anxiety, constant fatigue, poor motivation, lesser erections, weight gains that are difficult to lose, and poor gains in muscle despite weight lifting

Essentially, I feel like I am turning into a ghost of myself.

Additions (February):

The fatigue is a major symptom lately. Also brain fog.

Peculiarly, after I worked out recently I had two marks on both my shoulders, similar to scratches. Judging from eye, about 5 inches long. I assumed they were stretch marks. They disappeared the day after. I know that high cortisol can cause stretch marks. Obviously, I have low cortisol, but I understand there are cases in which the cortisol rises before it falls. These were not marks from lifting.

When I used the bathroom, I noticed blood on the toilet paper this morning.

When I cough, I feel a pain in the bottom left of my head. Close to my neck.

I don't know if the last two are relevant.
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Results: Test One- Issued by my Family Doctor

Testosterone, Serum: 265 (348-1197)
"""""
Test Two

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)
"""""
Test Three- 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)
"""""
Test Four- Issued by an Endocrinologist-- I had been off Prozac for one week at this point. This is the only test I was off it.

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

I had an MRI done, and the results came back clear.
"""""
Test Five- Test I requested-- Issued by Family Doctor-- This test was after taking Synthroid 50mcgs

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)[/U]
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)

Additions (February):

Obviously, my Adrenal Glands are struggling. I wonder how my anxiety and stress come into play.

Salivary Cortisol Test
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)
"""""

Recently, it came to my attention that Gluten Intolerance can cause a wide array of hormonal imbalances. I didn't expect anything, however my T-Transglutaminase (Ttg) lgg is high.

Celiac Disease Comprehensive:
T-Transglutaminase (Ttg) lgg: 8 U/mL (0-5 U/mL)
Immunoglobulin A, Qn, Serum: 102 mg/dL (91-414 mg/dL)
T-Transglutaminase (Ttg) Iga: <2 (0-3)
Deamidated Gliadin Abs, Iga: 3 (0-19)
Deamidated Gliadin Abs, Igg: 6 (0-19)
Endomysial Antibody Iga: Negative
"""""

This test was completed with Androgel 1.62%- 2.5 mgs. I just increased to 3.75 mgs.

Testosterone, Serum: 474 ng/dL (348-1197 mg/dL)
Dihydrotestosterone: 65n g/dL ("Normal")
Estradiol: 20.6 pg/mL (7.6-42.6 pg/mL)
Free TestosteroneL 19.3 pg/mL (9.3-26.5 pg/mL)

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, 20mgs of Adderall in the morning, and 10mgs of Prozac at night. I started taking Synthroid before the last blood work.

Revision (February): I have bumped my Synthroid to 75mcgs for no other reason that optimization. I have stopped taking Adderall and Prozac. I know that stimulants can hinder the Adrenal Glands. I felt like the Prozac wasn't worth the hassle at 10mgs. It hindered my sexual performance slightly, and if I wasn't getting much out of it I didn't want to continue. I am taking 3.75mgs of Androgel 1.62%. In addition to these prescription medications, I just began taking Licorice Root and Ashwagandha for stress and my Adrenal Glands, as well as a Rainbow Light's Multivitamin.
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Where I am at Now: My two endocrinologists have diagnosed me with unrelated Hypothyroidism and Hypogonadism caused by poor function of my Thyroid and Pituitary. Both my doctors were sure of their decision so I felt more comfortable, but I am skeptical because it seems unlikely for one my age to suffer from both without an underlying cause.

One week ago I started Androgel 1.62%. I have a doctors appointment tomorrow and I will try to convince my doctor to prescribe HCG.

Revision (February): Now having adrenal fatigue, I am more believing that there is an underlying cause for my endocrine issues. I have an appointment at John Hopkins March 19. I hope that some headway into an accurate diagnosis will be made then.

Lately, I am feeling hopeless of the situation. Any advice is warmly welcomed.
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Questions: Diagnoses: What are your thoughts on my diagnoses? Do you think they are legitimate? I have been told that it is indeed a function problem, but I have also been told that I need to see better doctors.
Thank you for reading.

Nate

[Trific]

Well I'm hoping you can get some good answers at John Hopkins, it sucks to feel like crap all the time.

[HRTstudent]

It looks like you've made a lot of major recent changes.

If you were on prozac and adderall for a long time, I don't doubt that there could be some temporary withdrawal effects. These would most likely contribute to feelings associated with "adrenal fatigue".

Your thyroid numbers are looking pretty good though, much improved. Are you doing anything to improve your iron though? Iron is critical to thyroid function. Remember that thyroid sends the signal, but it needs other pieces of the machinery to actually carry out the work. This is why nutrition is very important.

What about your vitamin D - are you doing anything for that? It's very low.

Obviously your testosterone is low, but now that you're on androgel, that will quickly get into a good range. I'm not sure how many pumps you are on, but I would aim for a total T number in the 600's.

And be sure to get an ultrasensitive estradiol assay, not just the estrogens assay.

Stopping the prozac and amphetamines is probably a good idea (assuming you can function without it) because these certainly can have negative effects on people. They're powerful substances. But I would not stop at simply eliminating bad things; I would make a concerted effort to add good things. Good things include more sunlight, stress reduction techniques, nutritious food like lots more color, being active but not overactive, etc....

[Nate02]

Well I'm hoping you can get some good answers at John Hopkins, it sucks to feel like crap all the time.

Thank you. It is not a good time. I have been feeling this way for years.

It looks like you've made a lot of major recent changes.

If you were on prozac and adderall for a long time, I don't doubt that there could be some temporary withdrawal effects. These would most likely contribute to feelings associated with "adrenal fatigue".

Wow. I didn't know such a small dosage of each could do that. I have been on both the prozac and adderall on and off for years. The adderall less so, I took long periods without taking it. It might be contributing, but I obviously have it as well.

Your thyroid numbers are looking pretty good though, much improved. Are you doing anything to improve your iron though? Iron is critical to thyroid function. Remember that thyroid sends the signal, but it needs other pieces of the machinery to actually carry out the work. This is why nutrition is very important.

Is there a test that I am misinterpreting that measures iron? Although, I am taking a multivitamin. Does that suffice?

What about your vitamin D - are you doing anything for that? It's very low.

Yes, I am aiming for about 5,000 IU of Vitamin D every day.

Obviously your testosterone is low, but now that you're on androgel, that will quickly get into a good range. I'm not sure how many pumps you are on, but I would aim for a total T number in the 600's.

Yes, I am aiming for the 600's range. I am about to post recent test results for that now.

And be sure to get an ultrasensitive estradiol assay, not just the estrogens assay.

I've talked with a few doctors about that. None of them seem to know it.

Stopping the prozac and amphetamines is probably a good idea (assuming you can function without it) because these certainly can have negative effects on people. They're powerful substances. But I would not stop at simply eliminating bad things; I would make a concerted effort to add good things. Good things include more sunlight, stress reduction techniques, nutritious food like lots more color, being active but not overactive, etc....

I am trying. Although, this is a line for me. I want to feel better, yes, but I also have minor OCD. If I work actively to drastically change my lifestyle, I know it will be hard for me to stop. I will focus so much on the changes I have made that I won't actually live. If that makes sense?

....

[Nate02]

Does anyone else have any advice even for a lead to a diagnosis/diagnoses? I feel very panicked here. One thing seems to lead to another and so on. I don't know if these are separate surface issues or caused by a deeper diagnosis. There seems to be no stop to my issues and I just wonder if I am ever going to feel better.

I know that I need to find and see a good doctor (hopefully at John Hopkins), but I honestly feel like people can be just as much help. It's a fresh perspective. If it wasn't for me looking into my own issues, I would be still be taking Prozac and Adderall for depression. I know how it can help. So please, if anyone has anything to input I would be so grateful.

[Nate02]

No doctor has mentioned this to me, but I think Hypopituitarism should be suspect.

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001383/

It says that Hypopituitarism treatment involves hormone therapy for: cortisol, growth hormone, sex hormone, and thyroid hormone. Right now, I have issues with three out of the four. The last I need to check is growth hormone. Why has no doctor suggested this as a cause? It seems to fit quite nicely, assuming that my growth hormone is low.

It is also important to realize that all these are low, but not to an extreme. I don't know if that has any merit in a diagnosis of Hypopituitarism.

Any thoughts?

[Trific]

No doctor has mentioned this to me, but I think Hypopituitarism should be suspect.

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001383/

It says that Hypopituitarism treatment involves hormone therapy for: cortisol, growth hormone, sex hormone, and thyroid hormone. Right now, I have issues with three out of the four. The last I need to check is growth hormone. Why has no doctor suggested this as a cause? It seems to fit quite nicely, assuming that my growth hormone is low.

Any thoughts?

Yes, imo I fully agree and to go further I believe many of the people basically that are on TRT is because of some form of hypopituitarism.

[Nate02]

Yes, imo I fully agree and to go further I believe many of the people basically that are on TRT is because of some form of hypopituitarism.

Thank you for your input. This is hard to believe that no doctor has even suggested this. I see a Naturopathic doctor right now but have seen Endocrinologists before whom have not looked further into this. The endocrinologists only knew I had pituitary and thyroid issues, however, didn't even think to check other hormones. Why is it that since I have started this process I have been my own doctor? Health care in my area is supposedly good too...I don't know about that.

Enough ranting though...

Do you know of any mark or more sure test that indicates hypopituitarism? Or do you just examine the individual hormones? Is there anything past IGF-1 that I should check for?

[Trific]

Thank you for your input. This is hard to believe that no doctor has even suggested this. I see a Naturopathic doctor right now but have seen Endocrinologists before whom have not looked further into this. The endocrinologists only knew I had pituitary and thyroid issues, however, didn't even think to check other hormones. Why is it that since I have started this process I have been my own doctor? Health care in my area is supposedly good too...I don't know about that.

Enough ranting though...

Do you know of any mark or more sure test that indicates hypopituitarism? Or do you just examine the individual hormones? Is there anything past IGF-1 that I should check for?

That's why gdevine and others ask for thyroid labs and wants to backfill some other hormones...I'm not sure what they usually check but I think alot of things should be checked and individually addressed even though it's all interconnected.

[Nate02]

That's why gdevine and others ask for thyroid labs and wants to backfill some other hormones...I'm not sure what they usually check but I think alot of things should be checked and individually addressed even though it's all interconnected.

I see. Does it seem like I might luck out and not need HGH? It seems to be following a pattern though. I hope I already have a lot of those things tested in my initial post. It seems that IGF-1 is important. I suppose then that is my next step.

[Trific]

Alot of the people here would love to take HGH but it's so expensive....if you can swing some of that I'd say go for it!

Yes, I'd check into those things and soon it would be nice to know what your total and free test is doing and probably the sensitive E2 you've been wanting...

[Nate02]

Alot of the people here would love to take HGH but it's so expensive....if you can swing some of that I'd say go for it!

Yes, I'd check into those things and soon it would be nice to know what your total and free test is doing and probably the sensitive E2 you've been wanting...

I'm sure people do want it , but not people with hormone issues with it. Under my circumstances I'd rather do without. I want to stay as natural as I can. If my results come back low though, I am so determined to feel 100% that I will accept it gladly.

I understand it is very expensive. How expensive is it with good insurance?

My levels are posted in my initial post with 2.5 milligrams of Androgel 1.62%. I haven't had it tested now that I have moved up until 3.75 milligrams. I have only been on it for a week or so. Yes, it would be nice to finally have that tested.

Edit: It just occurred to me. I havent had my ACTH tested by a doctor yet...I thought I had. I should probably do that. Will it be skewed now that I am on exogenous testosterone and Synthroid?

[Nate02]

Does anyone now if Adrenal Fatigue can cause low testosterone? Lowish in my range?

[VTX1800]

Does anyone now if Adrenal Fatigue can cause low testosterone? Lowish in my range?

The only 2cents I can give ya is n regards to the adderall. I know where your comming from when you abruptly stop taking it. I was on 90mgs a day and the day after I graduated College I through that shit out the door. I experienced heavy withdraws for about a month. A lot of those are very similar to what your dealing with. I've been off them since August 2010 and I felt like crap ever since. My Test level was at 50 and free at 1.4 when Infinally decided to get checked out. Can't help but wonder if that had something to do with my dismal test levels. I'm sure there's much more to it but It has to effect it.

[Nate02]

The only 2cents I can give ya is n regards to the adderall. I know where your comming from when you abruptly stop taking it. I was on 90mgs a day and the day after I graduated College I through that shit out the door. I experienced heavy withdraws for about a month. A lot of those are very similar to what your dealing with. I've been off them since August 2010 and I felt like crap ever since. My Test level was at 50 and free at 1.4 when Infinally decided to get checked out. Can't help but wonder if that had something to do with my dismal test levels. I'm sure there's much more to it but It has to effect it.

It is not good. But you took 90mgs!!! That is a horrible about. I can't believe you're not dead from withdrawal. I wouldn't be surprised if that caused your low testosterone. Thank you for your input.

[Nate02]

Does anyone know if an Estrogen test will still be accurate if you fast before it? I am taking an HGH test too in which you need to fast. Is this okay?

[Nate02]

I visited the doctor today at John's Hopkins. She seemed to be a very knowledgable doctor and I am comfortable with what she said. For those whom don't know, she is one of the best doctors at John's Hopkins, which says a lot.

She thinks that my results do not indicate a problem hormonally, since they are borderline, and that she would see problems in other areas if it was, as well. She believes the anxiety and my poor sleep quality are responsible for my problems. She also does not believe I have adrenal issues, and that Salivary Cortisol Tests are a bad judge.

Right now she wants me to stop the Androgel and Synthroid, and get my anxiety under-check. I am going to start an anti-anxiety medicine, and get tested again in 4 months for the other hormones. I will most likely undergo a sleep study too.

Any thoughts?

[Quester]

Got an update?
I hope you are doing well. I have a lot of respect for you and your struggle. Progress is not only measured in goals but also in the effort. Best wishes as you work through this.

[Nate02]

Got an update?
I hope you are doing well. I have a lot of respect for you and your struggle. Progress is not only measured in goals but also in the effort. Best wishes as you work through this.

Just what is above. My doctor is wanting me to stop testosterone and thyroid hormones for the time being. She wants to be get my anxiety/stress managed because she thinks that may be the cause of my skewed hormones. Hard to believe, but I do have heavy, constant stress, and she is a very good doctor.

Thank you so much for your kind words. It isn't easy dealing with hormonal problems at 21. And I hope your statement is the case with me. I've been plugging away for months now without much to show for it. Just can't seem to find out what is wrong...

[Trific]

So, you are going to crash off T and Synthroid and take up yoga?

Might work.