Fatigue? Depression? Anxiety? Here is the blood work

[stlstudent]

This has been probably the worst 4 months of my life in regards to fatigue, mental fog, motivation, etc... Both my primary and Defy have been open to different ideas and suggestions and so far we have not nailed it. Most recently my primary suggested depression/anxiety and started me on a low dose SSRI which within a short period sent me into panic attacks/anxiety that the ER had to give me low dose Ativan. Primary took me off that particular SSRI and put me on another which led to same result, so he then referred me to a psychiatrist. He determined that I have an sensitivity to serotonin so has ruled those out for any further treatment. He started me on Wellbutrin and Provigil and where they may have helped a little, I'm still 90% where I was. Even he agrees that this may not be mental illness but will continue to treat me as such until we can find another motive.

The biggest issue is that I jolt awake around 6 am every morning and cannot go back to sleep. I feel like I got very little if any sleep. I'll usually end up on the couch and unable to get up and get going for a few hours. Then throughout the day I get hit with episodes of crippling brain fog, lack of motivation, fatigue, etc... These used to happen once or twice a day now its nearly every day for over 3/4 the day.

I've been on TRT for many years any my regiment is the following:
0.2 Test Cyp 200mg/ml every other day sub q
400 units HCG 2x week
.125 Anastrozole 2x a week or as needed
1 grain Armour Thyroid in the morning


So my primary and I tried to come up with as many tests as we could that might explain it. Here are the results of the labs I did through discountedlabs.com

Glucose: 155 (65-99) *first time its ever been this high? I fasted for 8 hours
A1C: 5.7 (4.8-5.6)
ALT: 91 (0-44)
GGT: 39 (0-65)
B12: 625 (232-1245)

EBV Ab VCA, IgM <36
EBV Early Antigen Ab, IgG <9
EBV AbVCA, IgG >600
EVB Nuclear Antigen Ab, IgG 99.9

Iron Bind 334 (250-450)
UIBC 276 (111-343)
Iron 58 (38-169) *maybe a little low because of blood donation, taking iron supplement now
Iron Saturation 17 (15-55)
Ferratin 35 (30-400)

T4 free 0.91 (0.82-1.77)
TSH 2.780
Reverse T3 13.5 (9.2-24.1)
Thyroglobulin Antibody <1
Thyroid Peroxidase 31 (0-34)
T3 Free 3.1 (2.0-4.4)

Total Testosterone 742
Free T 33 (8.7-25)
DHT 49 (30-85)
Estradiol 35 (8-35)



Anything stick out to anyone? Are there any others tests maybe I should look at? I'm at a point where I've got to figure this out because I have not doubt it is leading to depression/anxiety if not already there.

 

[Systemlord]

ALT: 91 (0-44)

Liver disease is the most common reason for higher than normal levels of ALT. Some of these antidepressants can increase liver enzymes.

Have you ever tried TRT without HCG?

Reason I ask is because this wouldn't be the first time someone didn't do well on HCG, it can cause mood problems.

T4 free 0.91 (0.82-1.77)
TSH 2.780
Reverse T3 13.5 (9.2-24.1)
Thyroglobulin Antibody <1
Thyroid Peroxidase 31 (0-34)
T3 Free 3.1 (2.0-4.4)

Personally I would want TSH lower and Free T3 higher, your Free T3 levels are a little underwhelming and are barely midrange.

 

[Vince]

Thyroid Peroxidase 31, I would be concerned about an autoimmune disease. have your doctor talked to talk about changing your diet and giving up grains.

 

[Dansk]

The biggest issue is that I jolt awake around 6 am every morning and cannot go back to sleep

I would add an adrenal stress test to check your cortisol levels throughout the day and evening. Popping a wake like this could indicate too high morning cortisol.

 

[Vince Carter]

I would retest Glucose since that's obviously out of whack and you've not see that before, labs do make mistakes.

 

[stlstudent]

Liver disease is the most common reason for higher than normal levels of ALT. Some of these antidepressants can increase liver enzymes.

Have you ever tried TRT without HCG?

Reason I ask is because this wouldn't be the first time someone didn't do well on HCG, it can cause mood problems.



Personally I would want TSH lower and Free T3 higher, your Free T3 levels are a little underwhelming and are barely midrange.

My primary has kept an eye on my liver enzymes for many years even before TRT they were not great. He was never too concerned until they 'tripled' what they should be. However, I recently had an ultrasound of my gallbladder and liver for something unrelated and gastro told me I had fatty deposits on the liver so we are trying to attack that.



When I first started TRT I used no HCG for about a year. I only added it later on because TRT made me infertile. We have had our children and will not be having any more so I guess I could stop the HCG but Defy has told me that it has many benefits as we have receptors for it all over our bodies just not our testicles. Something to consider for sure.

Agree that we could tweek those thyroid numbers a bit but they are not off to the point that I would think they would cause this much fatigue and crapiness

 

[stlstudent]

Thyroid Peroxidase 31, I would be concerned about an autoimmune disease. have your doctor talked to talk about changing your diet and giving up grains.

This is the second thyroid blood tests that shows those high. But if I had an autoimmune like Hoshimoto's wouldn't it throw all my other thyroid numbers off?

 

[stlstudent]

The biggest issue is that I jolt awake around 6 am every morning and cannot go back to sleep

I would add an adrenal stress test to check your cortisol levels throughout the day and evening. Popping a wake like this could indicate too high morning cortisol.

I've done both a total cortisol serum test which was in normal range and I also did a saliva cortisol test over the course of a day and they all came back normal. Is the adrenal stress test a different test all together?

 

[stlstudent]

I would retest Glucose since that's obviously out of whack and you've not see that before, labs do make mistakes.

Agree, that was a strange one, I do run usually on the high edge but never that high. Just wonder if I ate a piece of candy or gum or something that I forgot about. It will definitely get done again though

 

[Vince]

This is the second thyroid blood tests that shows those high. But if I had an autoimmune like Hoshimoto's wouldn't it throw all my other thyroid numbers off?

I would think it's the early stages of a thyroid autoimmune disease?

 

[Dansk]

I've done both a total cortisol serum test which was in normal range and I also did a saliva cortisol test over the course of a day and they all came back normal. Is the adrenal stress test a different test all together?

Sounds like cortisol is not your issue. Could be glucose issue as has been already suggested, being jolted awake could be an adrenal surge due to low blood glucose. just a thought.

 

[RickD]

This has been probably the worst 4 months of my life in regards to fatigue, mental fog, motivation, etc... Both my primary and Defy have been open to different ideas and suggestions and so far we have not nailed it. Most recently my primary suggested depression/anxiety and started me on a low dose SSRI which within a short period sent me into panic attacks/anxiety that the ER had to give me low dose Ativan. Primary took me off that particular SSRI and put me on another which led to same result, so he then referred me to a psychiatrist. He determined that I have an sensitivity to serotonin so has ruled those out for any further treatment. He started me on Wellbutrin and Provigil and where they may have helped a little, I'm still 90% where I was. Even he agrees that this may not be mental illness but will continue to treat me as such until we can find another motive.

The biggest issue is that I jolt awake around 6 am every morning and cannot go back to sleep. I feel like I got very little if any sleep. I'll usually end up on the couch and unable to get up and get going for a few hours. Then throughout the day I get hit with episodes of crippling brain fog, lack of motivation, fatigue, etc... These used to happen once or twice a day now its nearly every day for over 3/4 the day.

I've been on TRT for many years any my regiment is the following:
0.2 Test Cyp 200mg/ml every other day sub q
400 units HCG 2x week
.125 Anastrozole 2x a week or as needed
1 grain Armour Thyroid in the morning


So my primary and I tried to come up with as many tests as we could that might explain it. Here are the results of the labs I did through discountedlabs.com

Glucose: 155 (65-99) *first time its ever been this high? I fasted for 8 hours
A1C: 5.7 (4.8-5.6)
ALT: 91 (0-44)
GGT: 39 (0-65)
B12: 625 (232-1245)

EBV Ab VCA, IgM <36
EBV Early Antigen Ab, IgG <9
EBV AbVCA, IgG >600
EVB Nuclear Antigen Ab, IgG 99.9

Iron Bind 334 (250-450)
UIBC 276 (111-343)
Iron 58 (38-169) *maybe a little low because of blood donation, taking iron supplement now
Iron Saturation 17 (15-55)
Ferratin 35 (30-400)

T4 free 0.91 (0.82-1.77)
TSH 2.780
Reverse T3 13.5 (9.2-24.1)
Thyroglobulin Antibody <1
Thyroid Peroxidase 31 (0-34)
T3 Free 3.1 (2.0-4.4)

Total Testosterone 742
Free T 33 (8.7-25)
DHT 49 (30-85)
Estradiol 35 (8-35)



Anything stick out to anyone? Are there any others tests maybe I should look at? I'm at a point where I've got to figure this out because I have not doubt it is leading to depression/anxiety if not already there.

I'm having the same symptoms for last 2 months, out of nowhere, did you resolve yours?