Shift work, labs, advice?

[ace2021]

30yo M ER provider in underserved inner city trauma center. Work 18-20 shifts 12hrs each with 4-10 nights interspersed randomly throughout the month. Can’t leave the job for 3 years.



Once upon a time was a nationally ranked athlete 5%bf, big libido, tons of energy. Since starting shift work 1.5yrs ago I’ve had a slow but steady decline in sex drive, energy, mood, ability to shrug things off and just feeling like an observer of my life.



I have stopped working out as much because I can’t recover due to erratic sleep patterns, work hours and stress. No matter when I workout I can’t get enough rest and end up feeling like shit at work which can’t happen because I have to make snap decisions and be mentally crisp. Result is loss of muscle mass and some fat gain - 5’7 165lbs. Been this weight but composition changed.



I eat well - meat and vegetables with low carb. Take vitamin c, multivitamin and zinc when feeling run down. Melatonin sometimes.



TT - 540

FT - 11

SHBG - 50

E2 still pending

LH - 6.4

FSH - 2.8

TSH - 1.7



Kind of at a loss. I’ll be in this job for 3 more years and really don’t want it to screw me up. Even once I leave this stressful environment I’ll still be doing nights monthly. I know I’m young and what not but feel like overriding my already taxed HPA would give me a little more even keel feeling? Been studying TRT, have a lot to learn about sex hormone endocrinology but am really thinking TRT may help.



Anyway, let me know what you all think.

 

[Vince Carter]

Posting labs with the lab ranges and not saying "middle normal" as if that's a lab result are very helpful to us. "Middle normal" means diddly squat.

 

[Blackhawk]

Posting labs with the lab ranges and not saying "middle normal" as if that's a lab result are very helpful to us. "Middle normal" means diddly squat.

Especially regarding thyroid. TSH as a single marker is only worthwhile to interpret as a potential need for more specific testing, and any number above 2.0 is cause for concern.

 

[Systemlord]

The previously accepted reference ranges are no longer valid as a result of both the development of more highly sensitive TSH assays and the appreciation that reference populations previously considered normal were contaminated with individuals with various degrees of thyroid dysfunction that served to increase mean TSH levels for the group. Recent laboratory guidelines from the National Academy of Clinical Biochemistry indicate that more than 95% of normal individuals have TSH levels below 2.5 mU/liter.

The middle of the ranges for TSH are no good, TSH isn't even a thyroid hormone, Free T3 is the most potent thyroid hormone and is the only thyroid hormone that interacts with the T3 receptors and is responsible for metabolism, body temperatures and speeds up every cell in the body.

If your doctor doesn't understand any of this, your doctor will be of little help to you.

Your high SHBG is the reason for low Free T, your testosterone production is quite low and I expect LH to be lower than midrange. Total T is elevated do to high SHBG, therefore decreasing your Free T.

If SHBG was lower, Total T would be lower and Free T higher, which wouldn't change the fact that testosterone would still be low.

 

[ace2021]

Thank you for the responses. Edited original post with lab values

 

[Vince]

Have you ever consider finding a new job. It's an awesome time to find work. My current job I found during 1999, then we also had a awesome hiring boom. I was working two jobs I sent oy three resumes a week and did one interview a week. I knew it was time for me to move up, and I had to do it while we were at full employment. I believe you can do the same thing.

 

[ace2021]

In residency, if I leave my training will essentially end. The nature of the work/training requires nights, however once these 3yrs are over I will drop down to 12 shifts at 10hrs per shift (ideally). Burnout in ER is crazy high and I don’t want to become another statistic. Trying to prevent health decline before I’m 45 and a total mess

 

[Jones]

In residency, if I leave my training will essentially end. The nature of the work/training requires nights, however once these 3yrs are over I will drop down to 12 shifts at 10hrs per shift (ideally). Burnout in ER is crazy high and I don’t want to become another statistic. Trying to prevent health decline before I’m 45 and a total mess

You are essentially on a roller coaster of jet lag for the next 3 years and that's not going to change. Your goal should be to keep an eye on your cortisol and inflammatory markers (hs-CRP, ferritin, fibrinogen, LpPLA2, MPO), adrenal health, thyroid, hormones. Maybe you should start with a baseline 4-spot cortisol saliva test that includes DHEA and see where you are functioning now.

I would keep on hand - adrenal support, cortisol lowering agent (I like cortisol manager by Integrative Therapuutics to help lower cortisol before sleep), use HIIT acutely to boost cortisol when it should be high (when you wake). You'll have to take it day by day and start to listen to your body. You may not have time or energy to exercise but you can still control what you eat, be kind to your body. Sleep is your best friend.

Use a specialty lab such as Boston Heart or Salveo if you have to, sounds like you're a physician so you can make an account or ask them for a free learning panel on yourself Their blood panels are pretty comparable. Salveo lab has a good saliva test and lowest cash option I've found for those not going through insurance.

 

[ace2021]

You are essentially on a roller coaster of jet lag for the next 3 years and that's not going to change. Your goal should be to keep an eye on your cortisol and inflammatory markers (hs-CRP, ferritin, fibrinogen, LpPLA2, MPO), adrenal health, thyroid, hormones. Maybe you should start with a baseline 4-spot cortisol saliva test that includes DHEA and see where you are functioning now.

I would keep on hand - adrenal support, cortisol lowering agent (I like cortisol manager by Integrative Therapuutics to help lower cortisol before sleep), use HIIT acutely to boost cortisol when it should be high (when you wake). You'll have to take it day by day and start to listen to your body. You may not have time or energy to exercise but you can still control what you eat, be kind to your body. Sleep is your best friend.

Use a specialty lab such as Boston Heart or Salveo if you have to, sounds like you're a physician so you can make an account or ask them for a free learning panel on yourself Their blood panels are pretty comparable. Salveo lab has a good saliva test and lowest cash option I've found for those not going through insurance.

Hey thanks a ton man. I appreciate the well thought response. I’ll try hiit for waking up and switching to/from nights!

Will definitely check out these lab companies.

It sounds like I need to find a good functional medicine doc to work with too.