Extreme Fatigue With a Few Clues in Blood Work. What am I Missing?

[obesechess]

Hi Folks,

For the past two months or so I have been suffering from a number of odd symptoms, including extreme fatigue, brain fog, lack of motivation, shortness of breath, difficulty regulating my body temperature (sometimes very hot when cooking in an air-conditioned kitchen, or very cold despite wearing long sleeves on a 60 degree day), brain fog, light-headedness, and more.

I have a hormone panel booked tomorrow as part of my every-six-month checkup with my urologist for hypogonadism treatment, so I may get some answers there. In the meantime, my primary care provider ordered a battery of blood work the other day, all of which I have since been told is "normal." I already have a follow-up booked with a different doctor for a second opinion, but more information can't hurt. There are a few things that look abnormal to me.

36M, 5'9", 175lbs, USA.

Current medications:

Trintellix 10mg/day, Vyvanse 30mg/day, HCG 350iu/wk, Arimidex 0.5mg/wk, Tirzepatide 5mg/wk.

I do not smoke or use recreational drugs, I drink comparatively little (I don't remember the last time I had more than three drinks, total, in one week). I do fairly heavy strength training three times per week and am trying to do more cardiovascular exercise, though the aforementioned symptoms have made this more difficult recently.

There was a very large battery of tests ordered and I don't think it's a productive use of anyone's time if I post everything, so if I say "normal" assume that the value is roughly in the middle of the reference range, though I am happy to post specifics if people have questions about specific numbers. I have bolded the things that I believe warrant more attention given my symptoms and have called out anything that's not quite "normal."

Vitamin D3, B12: Normal
WBC Count, RBC count: Normal.
Hemoglobin: Normal, slightly high (16.9 g/dL, reference range 13.2 - 17.1g/dL)
Hematocrit: High (53.5, reference range 38.5% - 50%)
MCV: almost High (99.8 fL, reference range 80 - 100fL)
MCHC: Low, (31.6 g/dL, reference range 32-26g/dL)
MCH: Normal
RDW: Normal
Platelet Count: Normal
MPV: Normal
Absolute Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils: Normal
Glucose: Normal, slightly high (I was not fasted, 97mg/dL, reference range 65-99mg/dL)
Urea Nitrogen: Normal
BUN: Normal
Creatinine: Normal
EGFR: Normal
Sodium, Potassium, Chloride, CO2, Calcium, Protein: Normal
Albumin: High (5.3, reference range 3.6 - 5.1 g/dL)
Globulin: Normal
Albumin/Globulin Ratio: Normal
Bilirubin: High
Alkaline Phosphatase: Normal
AST: High (41 U/L, reference range 10-40 U/L)
ALT: Very High (125 U/L, reference range 9-46 U/L)
Total Cholesterol: Normal, almost high (192 mg/dL, reference range <200mg/dL)
HDL: Normal
Triglycerides: Normal
LDL: High (121mg/dL, reference range <100mg/dL)
Chol/HDLC Ratio: Normal
Non-HDL Cholesterol: High (141, reference range <130mg/dL)
TSH w/Reflex T4: Normal (0.75mlU/L - reference range 0.40 - 4.5mlU/L)

Re: Liver enzymes, these have fluctuated wildly over the past few years, from as low as 51 g/dL up to 125 this week. I had an ultrasound and MRI done on my liver earlier this year and it looked perfectly healthy. I believe this is from the fact that the majority of the medications I take are metabolized in the liver. I am not worried about them at the moment.

Re: Lipids, I am in the process of losing weight - I have kept 100lbs off for over a decade and with the help of Tirzepatide I am finally losing the last bit of body fat. I thought I had more lean mass than I do (170 with more weight to lose feels bad) but I am trying to get below 20% body fat. But since I'm still a bit chubby, I think this explains the high lipid numbers. The lipid numbers have all steadily decreased as I've lost more weight.

What I am concerned about given my symptoms are the hemoglobin/hematocrit and the thyroid. Those hematocrit/MCHC numbers suggest an iron deficiency to me, though perhaps a mild one, and the Thyroid seems to be one of those tests like testosterone where the reference range gets much lower than most people actually feel healthy on. I also have a history of hypothyroid in the family. Iron deficiency or hypothyroid would explain my symptoms (assuming my blood work tomorrow doesn't tell me that my testosterone has just suddenly crashed through the floor after a decade of remaining stable).

So - with the caveats that I already have a follow-up appointment with a more thorough doctor booked - what does everyone else think? What else should I be looking at?

 

[obesechess]

Well, looks like my urologist's office forgot to order the lab work for my hormones today (which is fine, this was like fifteen minutes out of my day) so I'm going to call them on Monday and ask them if they're willing to order a full thyroid panel and an iron/ferritin screen.

Anyone else have any thoughts? Paging @Nelson Vergel as the resident labs expert. If the doc won't order the above I'll just get 'em from you.

 

[obesechess]

Bumping again. I've asked my urologist to order the above, but just for a laugh yesterday I took an iron supplement (25mg of chelated iron with breakfast). I had horrible gas pains about six hours later and don't think I've ever farted that much in my life, but felt significantly less run down and brain-foggy for the remainder of the day. Definitely suggests to me that iron is worth testing.

 

[SS1LE]

Nothing in your blood work really stands out, but all your meds can have a side effect of fatigue. GLP-1's are actually pretty notorious for fatigue and so are AI's

 

[obesechess]

Nothing in your blood work really stands out, but all your meds can have a side effect of fatigue. GLP-1's are actually pretty notorious for fatigue and so are AI's

Thanks, I should have mentioned the following details -

1. I've been on the same dose of all meds other than the GLPs for at least five years now, so I don't think it's those.
2. I took a month off the GLPs and ate at maintenance during that time to rule out both "GLP Side Effects" and "Fatigue from calories being too low," so I don't think that's the issue either.

 

[SS1LE]

Thanks, I should have mentioned the following details -

1. I've been on the same dose of all meds other than the GLPs for at least five years now, so I don't think it's those.
2. I took a month off the GLPs and ate at maintenance during that time to rule out both "GLP Side Effects" and "Fatigue from calories being too low," so I don't think that's the issue either.

Have you tried just taking regular testosterone, not doing HCG mono with a AI (have you verified E2, I feel like crap with E2 below 30pg)? Also for reference just because you have taken a med for years does not mean side effects will not pop up years down the road, my wife took Wellbutrin for 5 years all of a sudden she started getting rashes until the became more and more....long story short stopped the Wellbutrin they disappeared, she tried Wellbutrin again instant rash. Also GLP-1 causing fatigue are not exactly link to low calorie intake sometimes, GLP -1s are also known to affect neurotransmitters and reward pathways.

 

[obesechess]

Have you tried just taking regular testosterone, not doing HCG mono with a AI (have you verified E2, I feel like crap with E2 below 30pg)? Also for reference just because you have taken a med for years does not mean side effects will not pop up years down the road, my wife took Wellbutrin for 5 years all of a sudden she started getting rashes until the became more and more....long story short stopped the Wellbutrin they disappeared, she tried Wellbutrin again instant rash. Also GLP-1 causing fatigue are not exactly link to low calorie intake sometimes, GLP -1s are also known to affect neurotransmitters and reward pathways.

E2 will be part of the upcoming hormone panel. I have not done regular testosterone as I have generally had good success with HCG mono, though I am aware that eventually I will likely have to make the switch.

Good point on the long-term meds issue, though as I need to take these medications I don't have a good way to rule that out.

Also right, I know it's not JUST due to low calorie intake, I'm just saying that neither stopping GLPs nor eating more solved the problem. If it were a side effect of the GLPs, not taking them for 4-5 weeks likely would have cause a reduction in symptoms, unless I am misunderstanding you.

 

[SS1LE]

E2 will be part of the upcoming hormone panel. I have not done regular testosterone as I have generally had good success with HCG mono, though I am aware that eventually I will likely have to make the switch.

Good point on the long-term meds issue, though as I need to take these medications I don't have a good way to rule that out.

Also right, I know it's not JUST due to low calorie intake, I'm just saying that neither stopping GLPs nor eating more solved the problem. If it were a side effect of the GLPs, not taking them for 4-5 weeks likely would have cause a reduction in symptoms, unless I am misunderstanding you.

Without your hormones it is hard to tell, Just for reference The half life of GLP-1s is very long, it takes 5 half lives for a med to be cleared out of the body, So after 4 weeks the triz is just making it out of your body do to the long half life of 5 days.

 

[Vince]

Hi Folks,

For the past two months or so I have been suffering from a number of odd symptoms, including extreme fatigue, brain fog, lack of motivation, shortness of breath, difficulty regulating my body temperature (sometimes very hot when cooking in an air-conditioned kitchen, or very cold despite wearing long sleeves on a 60 degree day), brain fog, light-headedness, and more.

I have a hormone panel booked tomorrow as part of my every-six-month checkup with my urologist for hypogonadism treatment, so I may get some answers there. In the meantime, my primary care provider ordered a battery of blood work the other day, all of which I have since been told is "normal." I already have a follow-up booked with a different doctor for a second opinion, but more information can't hurt. There are a few things that look abnormal to me.

36M, 5'9", 175lbs, USA.

Current medications:

Trintellix 10mg/day, Vyvanse 30mg/day, HCG 350iu/wk, Arimidex 0.5mg/wk, Tirzepatide 5mg/wk.

I do not smoke or use recreational drugs, I drink comparatively little (I don't remember the last time I had more than three drinks, total, in one week). I do fairly heavy strength training three times per week and am trying to do more cardiovascular exercise, though the aforementioned symptoms have made this more difficult recently.

There was a very large battery of tests ordered and I don't think it's a productive use of anyone's time if I post everything, so if I say "normal" assume that the value is roughly in the middle of the reference range, though I am happy to post specifics if people have questions about specific numbers. I have bolded the things that I believe warrant more attention given my symptoms and have called out anything that's not quite "normal."

Vitamin D3, B12: Normal
WBC Count, RBC count: Normal.
Hemoglobin: Normal, slightly high (16.9 g/dL, reference range 13.2 - 17.1g/dL)
Hematocrit: High (53.5, reference range 38.5% - 50%)
MCV: almost High (99.8 fL, reference range 80 - 100fL)
MCHC: Low, (31.6 g/dL, reference range 32-26g/dL)
MCH: Normal
RDW: Normal
Platelet Count: Normal
MPV: Normal
Absolute Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils: Normal
Glucose: Normal, slightly high (I was not fasted, 97mg/dL, reference range 65-99mg/dL)
Urea Nitrogen: Normal
BUN: Normal
Creatinine: Normal
EGFR: Normal
Sodium, Potassium, Chloride, CO2, Calcium, Protein: Normal
Albumin: High (5.3, reference range 3.6 - 5.1 g/dL)
Globulin: Normal
Albumin/Globulin Ratio: Normal
Bilirubin: High
Alkaline Phosphatase: Normal
AST: High (41 U/L, reference range 10-40 U/L)
ALT: Very High (125 U/L, reference range 9-46 U/L)
Total Cholesterol: Normal, almost high (192 mg/dL, reference range <200mg/dL)
HDL: Normal
Triglycerides: Normal
LDL: High (121mg/dL, reference range <100mg/dL)
Chol/HDLC Ratio: Normal
Non-HDL Cholesterol: High (141, reference range <130mg/dL)
TSH w/Reflex T4: Normal (0.75mlU/L - reference range 0.40 - 4.5mlU/L)

Re: Liver enzymes, these have fluctuated wildly over the past few years, from as low as 51 g/dL up to 125 this week. I had an ultrasound and MRI done on my liver earlier this year and it looked perfectly healthy. I believe this is from the fact that the majority of the medications I take are metabolized in the liver. I am not worried about them at the moment.

Re: Lipids, I am in the process of losing weight - I have kept 100lbs off for over a decade and with the help of Tirzepatide I am finally losing the last bit of body fat. I thought I had more lean mass than I do (170 with more weight to lose feels bad) but I am trying to get below 20% body fat. But since I'm still a bit chubby, I think this explains the high lipid numbers. The lipid numbers have all steadily decreased as I've lost more weight.

What I am concerned about given my symptoms are the hemoglobin/hematocrit and the thyroid. Those hematocrit/MCHC numbers suggest an iron deficiency to me, though perhaps a mild one, and the Thyroid seems to be one of those tests like testosterone where the reference range gets much lower than most people actually feel healthy on. I also have a history of hypothyroid in the family. Iron deficiency or hypothyroid would explain my symptoms (assuming my blood work tomorrow doesn't tell me that my testosterone has just suddenly crashed through the floor after a decade of remaining stable).

So - with the caveats that I already have a follow-up appointment with a more thorough doctor booked - what does everyone else think? What else should I be looking at?

I would considered eating a diet high in non-starchy vegetables. I believe if you did this for 3 months all your issues would disappear.

 

[Gman86]

I would considered eating a diet high in non-starchy vegetables. I believe if you did this for 3 months all your issues would disappear.

Why consume foods that contain endogenous pesticides, exogenous pesticides, antinutrients, plant toxins/ defense chemicals and heavy metals, to improve health, when u can get all the same micronutrients, and many more, in other foods that contain no compounds that cause harm within the body when consumed? Makes no sense to me why someone would purposely consume something that’s actively harming them, to improve their health

 

[Vince]

Why consume foods that contain endogenous pesticides, exogenous pesticides, antinutrients, plant toxins/ defense chemicals and heavy metals, to improve health, when u can get all the same micronutrients, and many more, in other foods that contain no compounds that cause harm within the body when consumed? Makes no sense to me why someone would purposely consume something that’s actively harming them, to improve their health

They're very easy to clean. Just use baking soda. I really shocked that you didn't know that!

To wash vegetables with baking soda, add about one teaspoon of baking soda to a bowl of cold water, enough to cover the produce. Submerge your vegetables and let them soak for 12 to 15 minutes, gently swishing them around or scrubbing them with a brush if they have firm skin. After soaking, rinse the vegetables thoroughly under cold running water to remove any baking soda residue.

 

[Gman86]

They're very easy to clean. Just use baking soda. I really shocked that you didn't know that!

To wash vegetables with baking soda, add about one teaspoon of baking soda to a bowl of cold water, enough to cover the produce. Submerge your vegetables and let them soak for 12 to 15 minutes, gently swishing them around or scrubbing them with a brush if they have firm skin. After soaking, rinse the vegetables thoroughly under cold running water to remove any baking soda residue.

Oh dude, exogenous pesticides are the least of my worries when consuming vegetables. Exogenous pesticides are obv horrible for u, but there’s infinitely more endogenous pesticides that vegetables produce on their own, that u have to worry about equally as much, if not more. There was a study done that showed endogenous plant pesticides increased ur risk of cancer more than exogenous pesticides did. Here’s an excerpt from google, and checkout how many endogenous pesticides are in cabbage alone.

But again, it’s not just endogenous or exogenous pesticides that make vegetables bad for people. It’s a combination of all the different things that I mentioned above. Endogenous pesticides, exogenous pesticides, vegetable/ plant toxins/ defense chemicals, anti nutrients and the heavy metals they contain. Once u learn all the things in vegetables that harm the human body when consumed, u’d literally have to be a crazy person to still think they’re healthy for u. Only time someone should consume vegetables is if the enjoyment they get from eating them, outweighs all the negatives on their health that come from consuming them


“What are endogenous pesticides?
Endogenous pesticides are chemicals that plants naturally produce as part of their defense mechanisms against fungi, insects, and other animal predators. Many plants contain dozens of these natural toxins, and some, like cabbage, produce at least 49 known pesticides”

 

[Vince]

Oh dude, exogenous pesticides are the least of my worries when consuming vegetables. Exogenous pesticides are obv horrible for u, but there’s infinitely more endogenous pesticides that vegetables produce on their own, that u have to worry about equally as much, if not more. There was a study done that showed endogenous plant pesticides increased ur risk of cancer more than exogenous pesticides did. Here’s an excerpt from google, and checkout how many endogenous pesticides are in cabbage alone.

But again, it’s not just endogenous or exogenous pesticides that make vegetables bad for people. It’s a combination of all the different things that I mentioned above. Endogenous pesticides, exogenous pesticides, vegetable/ plant toxins/ defense chemicals, anti nutrients and the heavy metals they contain. Once u learn all the things in vegetables that harm the human body when consumed, u’d literally have to be a crazy person to still think they’re healthy for u. Only time someone should consume vegetables is if the enjoyment they get from eating them, outweighs all the negatives on their health that come from consuming them


“What are endogenous pesticides?
Endogenous pesticides are chemicals that plants naturally produce as part of their defense mechanisms against fungi, insects, and other animal predators. Many plants contain dozens of these natural toxins, and some, like cabbage, produce at least 49 known pesticides”

You should start a thread on this subject (if you haven't already). It would be interesting to see the studies on this.

 

[Gman86]

You should start a thread on this subject (if you haven't already). It would be interesting to see the studies on this.

Not a horrible idea. But I feel like most people here are probably sick of hearing how most of the foods we were told growing up that were healthy, are actually foods that are unhealthy, and we should avoid consuming them on a regular basis, if optimal health is the goal. Sometimes I cant help myself tho, and have to interject anytime I see people saying things about nutrition that simply aren’t true. It’s not easy being ahead of the curve with certain things. People do not like information that goes against what they’ve been taught/ told their entire lives. Especially when that new information seems absolutely insane lol. Like vegetables somehow being bad for them. But I’m just the messenger. I didn’t create the human body or plants, and how they both work lol

 

[Vince]

Not a horrible idea. But I feel like most people here are probably sick of hearing how most of the foods we were told growing up that were healthy, are actually foods that are unhealthy, and we should avoid consuming them on a regular basis, if optimal health is the goal. Sometimes I cant help myself tho, and have to interject anytime I see people saying things about nutrition that simply aren’t true. It’s not easy being ahead of the curve with certain things. People do not like information that goes against what they’ve been taught/ told their entire lives. Especially when that new information seems absolutely insane lol. Like vegetables somehow being bad for them. But I’m just the messenger. I didn’t create the human body or plants, and how they both work lol

Here's something I found.

Yes, plants produce endogenous pesticides to protect themselves from pests, and while these substances aren't inherently "bad" for humans, consuming them in small doses can have beneficial effects on our health through a process called hormesis, according to Scientific American and National Institutes of Health (NIH). However, it's important to remember that the term "natural" doesn't mean "safe," and some plant-derived toxins can be harmful if consumed in high concentrations or in their raw form.