Eric's Lady's Labs - Pointers please

[GettingAnswers]

I know this is a male forum, but I was hoping to maybe get the input of Chris or some others with some good knowledge. We are getting me straightened out and I finally convinced my lady to get a full work up because she has fibro, can't function, can't sleep, can't wake up til noon, etc.

Her thyroid levels were perfect which is surprising but her cortisol, DHEA and sex hormones and they look COMPLETELY EFFED.






I think this is way beyond adding a little salt and adrenal helping herbs to her diet. If anyone has any thoughts please chime in so I can go in fully armed for her followup appointment. Luckily she is now seeing my doctor who is an Internal Medicine Specialist turned anti-aging doctor so he is fully ready to do things normal GP won't do. Thanks in advance

 

[Vettester Chris]

Eric, I know the name "ExcelMale" will obviously appeal men needing support with HRT, labs, wellness, etc., but I want to assure everyone this is a site for ALL! It would actually be great to start getting some additional female participation here, as our knowledge pool is diverse and expanding. Many men on here certainly have spouses that are experiencing similar obstacles with hormonal changes. As this great forum continues to evolve, I would like to help create and develop a female section with Nelson and my team. I just wanted to throw that out there, as there's always a place here for the "Excel Female"!

With your wife, can you provide some basic stats? Is she in a peri or post menopausal phase? If she is still having a steady cycle, does she know what "phase" these labs were taken? Judging by the E2 compared to her progesterone, I'd be guessing that her cycles are not normal anymore, but I need to know her status? What she exhibits is Estrogen Dominance, where in most cases of menopause, you will find the diagnosis to be primary in the ovaries with a reduction of progesterone and testosterone production. Like with men, you can check the gonadotropin levels of LH & FSH, and more times than not with menopausal women you will find these values to be highly elevated. Unlike men, secondary hypogonadism tends to be the culprit in a great deal of cases of men over 35yo, experiencing andropause, the equal counterpart.

If you look at her P/E2 ratio of 9, you can see that E2 is in charge. E2 and Progesterone counterbalance each other, and when progesterone declines there is a myriad of potential risks and sides that start to accompany this; ranging from mood (GABA production), sleep disorders, immune system, anxiety disorders, cardiac risks, and even more importantly, Breast Cancer, which as you know is an epidemic in post menopausal women.

An all too common theme with estrogen dominance is the effect it has with the adrenals. As you have observed, your wife's cortisol is tanked! In most cases you will find this will also negatively effect iron and ferritin, and also calcium, causing yet more complications.

I have to run at this time, so will address some other observations later, mostly regarding thyroid and some other things. Her Reverse T3 ratio to FT3 is a little low, which indicates some activity issues with the thyroid. With everything going on, it is to be expected. Have her read through this, post any comments and questions, and again we can post more later. Also, have her do some research with Dr. Uzzi Reiss and Dr. Lam. Dr. Reiss' book, "The Natural Super Woman" is 'MUST' material for your lady and everyone going through similar situations.

 

[GettingAnswers]

Thanks Chris.

She is 35 and had a hysterectomy 6 years ago. She only has one partially functioning ovary left. Obviously without a uterus she has not had a period in years.

Her body temperature is always very low. Her blood pressure is usually very low. It is very hard for her to wake up in the mornings, and hard to sleep at night. She has no sex drive. She has gained 35 pounds in the past year which we initially chalked up to quitting smoking but it is persistent. She has zero tolerance for any physical activity. She has a gluten and flax seed allergy. She has endometriosis, IBS constipation dominant, fibro, PTSD, strange inflammatory responses in joints that have cleared up greatly since eliminating gluten. She has fine hair. She is getting dark skin splotches.

I hope some of this helps and thank you very much as always.

 

[HarryCat]

In addition to Chris's excellent response I'd add that her Vitamin D is low. This can cause all kinds of problems, she needs to get it into the upper third of the reference range. Make sure she uses a good vitamin D3 supplement. When I was in her situation I started on 10,000 iu's a day for a couple of weeks and then 6000 iu's a day after that, then retest in a 6-8 weeks.

 

[Vettester Chris]

Eric, on her thyroid, start with the TSH and throw it out the door! I've seen it with many ladies on other health and thyroid related forums, where pituitary activity just keeps declining with TSH production when estrogen dominance is in play. Her FT4 is at 37% of the reference range value, and FT3 is at 30%. IMO, healthy ranges will fall in the 50% to 80% area of the range value on both. Again, as mentioned earlier, her RT3/FT3 ratio is a bit low, and I suspect it will only get worse if she tries to increase this to a 'normal' level.

The first step (again, my opinion) is that she gets with a VERY good physician that really knows what they're doing with this stuff. Not one that will say "TSH is normal" and not address anything else. With the hysterectomy, she basically started menopause very early in life, but there's no reason she can't reverse the course. The adrenals are taking a beating with the estrogen to progesterone ratio, and sadly they (the adrenals) will then double-down with even more estrogen production when cortisol is absent.

With the right physician, she should explore a BHRT program that would address all the above. The right physician would also want to progress her overall program with ensuring her testosterone gets managed (ultimately 45ng to 65ng/dl is a decent range on serum), free test, which in her case will probably be low (high E2 leading to elevated SHBG), Vitamin D3 optimization (will help with the SHBG subject), Iron/Ferritin control, B12, DHEA (once a plan with cortisol is established), and ultimately the thyroid, which can involve thyroid meds, selenium, iodine, & not to forget calcium (might address the parathyroid glands while you're at it).

However, one step before the next is needed with all of this, and GOOD physician will recognize this. E.g., Probably best not to jump on NDT or any thyroid meds until the transport and partnering variables are addressed (cortisol, iron/ferritin, B12, D3, etc.). Many physicians can design a rhythmic protocol, where in essence the exogenous hormone administration can mimic the natural monthly cycle that is engrained in the DNA if everything in the body is 'functional'. The body seeks homeostasis, and the good news is we live in a day and age where bio-identical therapy is available. A constant program can also be functional with women, and it all beats the current program.

Here's the thing, your lady needs to really take the bull by the horns on this if she wants to improve this. Even with the right doctor, it won't be completely easy. She would need to also make lifestyle changes and commit with the right diet and supplements to promote wellness. It will take further labs, treatment, labs, adjustment of treatments, trial & error, labs ... You see how this goes ... But just like with many of the guys we deal with here, there will usually come a time where you start to get the gig dialed in and managing it becomes much easier. On the skin blotches, have her review Lupus, or symptoms related thereof. Estrogen dominance can also play a role in this with the absence of progesterone. I could be way off base and it's just speculation, but I would hope a doctor would test the areas that could be contributing to this issue.

 

[Vettester Chris]

PS: Sorry team, for some reason my tablet format doesn't space my paragraphs out. Works on laptop, but not tablet Anyways, just didn't want you to think I'm the run-on paragraph type ...

 

[Rorinsmith]

PS: Sorry team, for some reason my tablet format doesn't space my paragraphs out. Works on laptop, but not tablet Anyways, just didn't want you to think I'm the run-on paragraph type ...

Must be a site related problem. My paragraphs never separate on here and I use an HP desktop.

 

[GettingAnswers]

Thanks again for the input. He has put her on 5,000iu of Vitamin D but will discuss the rest of the plan next week at her followup. I think he is going to tackle her adrenals first since they are tanked and causing major issues such as plummeting blood pressure and complete lack of energy. I doubt that alone will get her sex hormones back in shape but perhaps it will help.

My biggest challenge will be in getting her to stick to plan. She is the worlds WORST patient. If I don't lay out her meds or pills and remind her constantly to take them, then she won't. It's worse than a child lol.

Chris - your input is great and I know from typing on a tablet that it takes time so I appreciate it greatly.
Harrycat - thanks for your input too on the Vit. D.

 

[GettingAnswers]

I forgot to update the plan, but here is what he has done.

Priority 1 - He put her on 20mg (7.5,5,5,2.5) oral HC a day to get her cortisol levels up to a level that will let her function.
She is taking pregnenolone and DHEA in an attempt to backfill some hormone levels.
Vitamin D 5000 iu
sea salt and good multi

His thought was get her enough cortisol and then retest in about a month for the sex hormones to see if boosting her in that area will allow some balancing and correcting in the others. If needed we will then address thyroid and sex hormones.