Glad to join this community... looking for guidance to feel more like myself! (Lab Results In Post)

[dlello2]

Hey all!

Found this site a while ago and have been lurking a bit, but I think it's time I try taking my health into my own hands. The endo I've been working with here in Austin TX is nice, but she just hasn't been taking my issues seriously enough. A quick bit about me: I just turned 36, am quite active (daily yoga, weight lifting 3+ days a week). I eat well and generally take care of myself... prioritize sleep (7-8hours nightly), supplementation, meditation, etc. I generally eat lower sugar/carb and higher protein/fat. Very little fried/processed food.

I have low libido and my digestion is generally pretty crappy. Been fighting constipation most of my adult life, and feel like I've tried everything to dial that in (Mg is the only thing that seems to help a little). My recent DEXA scan showed lower than normal Bone Density, and the fact that my Estradiol is so low is quite concerning as Estrogen promotes the activity of osteoblasts (cells that make new bone). Below are my most recent (relevant) lab results... any advice you have would be amazing.

DEXA Scan

Bone Density Z-Score -1.8 (LOW / Osteopenia Range)

Lipids

Cholesterol Total: 332 HIGH

Cholesterol HDL: 102 / Cholesterol LDL: 224 / Cholesterol VLDL: 6 / Triglycerides: 53

Hormones:

Estradiol (Roche): <5.0 ph/ML (Range 7.6-42.6 mg/ML) LOW

Testosterone Total: 384 ng/dL (Range 264 – 916)

Testost. Free+Weakly Bound: 10.3%

Test. F+W Bound: 39.6ng/dL (Range 40 - 250) LOW

SHBG: 54.1 NMOL/L (Range 16.5 - 55.9)

DHEA-S: 7.1 nmol/L (Range 2.0-27.0)

Thyroid

T4 Free: 0.78 ng/dL (Rand 0.82 – 1.77) LOW

T3: 57 ng/dL (Range 71 – 180) LOW

TSH: 1.78 (Range 0.45-4.5)

CBC:

RBC: 4.0 M/UL (Range 4.5-6.1) LOW

Hemoglobin: 13.2 G/DL (Range 13.5-17.0) LOW

Hematocrit: 38.3% (Range 40.0-51.0) LOW

Vitamin D was low 6 months ago (33ng/mL) , but I’ve been working on that. Now 53.1 ng/ML

 

[Systemlord]

Anemia can decrease the conversion of thyroid hormones. I would run a full iron panel, ferritin, iron saturation and CBC. If ferritin is low, it’s more likely the result of your digestive issues.

 

[aneuman]

It seems you have a few metabolic issues. Dyslipidemia, low T3/T4, low estradiol, low hemoglobin. If I were you I'd be looking for an endocrinologist. If your current one is not paying you enough attention, find another one.

This is primarily a testosterone forum, so most likely people are going to recommend, guess what, testosterone. It may be the root of all evil, it may not.

Despite all the shortcomings, stupidity, profit motive, etc, western medicine still have value, I wouldn't replace it with a forum. Taking your health into your own hands may sound brave and courageous, but it could be quite dangerous too. Whatever you decide to do, be aware that there's no such thing as a free lunch.

 

[dlello2]

It seems you have a few metabolic issues. Dyslipidemia, low T3/T4, low estradiol, low hemoglobin. If I were you I'd be looking for an endocrinologist. If your current one is not paying you enough attention, find another one.

This is primarily a testosterone forum, so most likely people are going to recommend, guess what, testosterone. It may be the root of all evil, it may not.

Despite all the shortcomings, stupidity, profit motive, etc, western medicine still have value, I wouldn't replace it with a forum. Taking your health into your own hands may sound brave and courageous, but it could be quite dangerous too. Whatever you decide to do, be aware that there's no such thing as a free lunch.

I appreciate that reply. Know that I very much have my guard up posting here or any internet forum (reddit, etc.). If by chance someone sees an association that I have (or my endo has) missed, or if someone has a recommendation of a doctor/clinic local to Austin TX, that's all I'm looking for.

I just stumbled upon the connection between Estrogen/Bone Density, and I know that Testosterone really is the main way to influence Estrogen in men, so I thought I'd try presenting my case here.

Anemia can decrease the conversion of thyroid hormones. I would run a full iron panel, ferritin, iron saturation and CBC. If ferritin is low, it’s more likely the result of your digestive issues.

This was an iron panel I completed a few years ago. I'm going to get an updated panel taken shortly, and include Ferratin (and maybe Transferrin). Not sure if there are other tests I should try including. Thanks regardless!

 

[aneuman]

I appreciate that reply. Know that I very much have my guard up posting here or any internet forum (reddit, etc.). If by chance someone sees an association that I have (or my endo has) missed, or if someone has a recommendation of a doctor/clinic local to Austin TX, that's all I'm looking for.

Unfortunately, I can't help you as I'm not from that area, but I sincerely hope that some of the good Texans in this forum can point you in the right direction. I know how you feel, the desperation, and I wish you the best of luck.

I believe @Nelson Vergel lives in Texas or may know a good endocrinologist from the area, perhaps he chimes in and hopefully can provide a good pointer.

I just stumbled upon the connection between Estrogen/Bone Density, and I know that Testosterone really is the main way to influence Estrogen in men, so I thought I'd try presenting my case here.

It is true. In males, estrogen is primarily derived from testosterone through a process called aromatization which occurs, among others, in the fat tissue. It is true that low estradiol is associated with loss of bone mass mostly in elderly males, but I don't know for how long you've been that low.

Your testosterone is what current guidelines would consider "low-normal", but it doesn't justify such a low estradiol. As a reference, I'm a 60 year old man with around 20% body fat, and my most recent labs show total testosterone of 388 ng/dL and estradiol of 20 pg/ml.

The problem with the human body is that is a system, and not a collection of organs. The problem with systems is that they reach a very complex equilibrium (homeostasis) through the interaction of many different parameters (hormones in this case, as well as receptors, enzymes, etc) so even though it may seem simple to add more testosterone, so estradiol goes up, so bone density improves, it doesn't always work that way.

I don't know what your situation with money, work, insurance, family, etc, is, as all that is important, but if you can locate a reputable endocrinologist, talk to them on the phone prior to scheduling a consult and explain your situation and what you're looking for, and then decide to go ahead, that would probably increase the chances of success. Many endocrinologist, looking for a profitable business, spend so much time treating obesity and diabetes, that they forget to think critically when they see a different patient. You need to avoid those doctors. I'd venture to say that you'll have better luck by going to the endocrinology department of the school of medicine at Austin, if there's any. You may try other big cities like Dallas or Houston, although I understand the difficulties.

Speaking for myself, I would consider very risky and irresponsible to provide medical advice to someone with a complicated metabolic picture like yours, that's why my advice is, go see another doctor.

Best of luck.

 

[dlello2]

Unfortunately, I can't help you as I'm not from that area, but I sincerely hope that some of the good Texans in this forum can point you in the right direction. I know how you feel, the desperation, and I wish you the best of luck.

I believe @Nelson Vergel lives in Texas or may know a good endocrinologist from the area, perhaps he chimes in and hopefully can provide a good pointer.



It is true. In males, estrogen is primarily derived from testosterone through a process called aromatization which occurs, among others, in the fat tissue. It is true that low estradiol is associated with loss of bone mass mostly in elderly males, but I don't know for how long you've been that low.

Your testosterone is what current guidelines would consider "low-normal", but it doesn't justify such a low estradiol. As a reference, I'm a 60 year old man with around 20% body fat, and my most recent labs show total testosterone of 388 ng/dL and estradiol of 20 pg/ml.

The problem with the human body is that is a system, and not a collection of organs. The problem with systems is that they reach a very complex equilibrium (homeostasis) through the interaction of many different parameters (hormones in this case, as well as receptors, enzymes, etc) so even though it may seem simple to add more testosterone, so estradiol goes up, so bone density improves, it doesn't always work that way.

I don't know what your situation with money, work, insurance, family, etc, is, as all that is important, but if you can locate a reputable endocrinologist, talk to them on the phone prior to scheduling a consult and explain your situation and what you're looking for, and then decide to go ahead, that would probably increase the chances of success. Many endocrinologist, looking for a profitable business, spend so much time treating obesity and diabetes, that they forget to think critically when they see a different patient. You need to avoid those doctors. I'd venture to say that you'll have better luck by going to the endocrinology department of the school of medicine at Austin, if there's any. You may try other big cities like Dallas or Houston, although I understand the difficulties.

Speaking for myself, I would consider very risky and irresponsible to provide medical advice to someone with a complicated metabolic picture like yours, that's why my advice is, go see another doctor.

Best of luck.

Please know how much I appreciate the thoughts and time you took for this detailed reply. There is an incredible amount of wisdom here.

 

[sammmy]

1. Find another doctor. A competent endocrinologist would take all those suppressed hormones seriously.

2. Stop all the supplements. Most of them do not work or are harmful. It is not impossible that some of them may be causing you issues.

3. Do blood testing for vitamin deficiency. Digestive problems may lead to reduced vitamin/amino acid absorption which can lead to all kinds of metabolic problems.

4. Make sure your diet is providing all necessary nutrients. Extreme diets can be harmful.

5. Do a comprehensive digestive test like GI - MAP for possible issues. Constipation can have many causes, some of them gut dysbiosis. Have you tried probiotics that are known to induce more frequent stools, eating plain yogurt? You know what they say: "Everything starts in the gut".

 

[sammmy]

To summarize, check for digestive issues/malabsorption/vitamin defficiency and the reason for your hypothyroidism - could be autoimmune and that is not checked in the tests you posted.

This is a summary of ChatGPT:
There could be several possible causes for both suppressed testosterone and thyroid hormones in a male. One of them is hypothyroidism - Bing, which is a condition when the thyroid gland does not produce enough thyroid hormone Relationship Between Testosterone Levels and the Thyroid - Thyroid Advisor The interrelationships between thyroid dysfunction and hypogonadism in men and boys - PubMed Hypothyroidism and Low Testosterone: Diagnosis and Treatment – Thyroid Central. Thyroid hormone regulates many processes in the body, including hormonal balance, protein synthesis and metabolic rate Relationship Between Testosterone Levels and the Thyroid - Thyroid Advisor.

According to some studies, hypothyroidism may lead to a decrease in sex hormone-binding globulin (SHBG) - Bing, which is a protein that binds and transports testosterone in the blood suppressed testosterone and thyroid hormones in male - Bing This Link Between Thryoid Issues and Low T May Blow Your Mind. This may result in a decrease in total testosterone - Bing that can be delivered to your tissues and your body suppressed testosterone and thyroid hormones in male - Bing This Link Between Thryoid Issues and Low T May Blow Your Mind. Since the thyroid and the testes are part of a feedback loop system, it becomes a vicious cycle of decreasing testosterone This Link Between Thryoid Issues and Low T May Blow Your Mind.

Another possible cause is autoimmune thyroiditis - Bing, which is a condition when the immune system attacks the thyroid gland and causes inflammation and damage The effect of testosterone on thyroid autoimmunity in euthyroid men with Hashimoto's thyroiditis and low testosterone levels - PubMed. This may affect the production of thyroid hormone and also trigger an immune response against other tissues, such as the testes The effect of testosterone on thyroid autoimmunity in euthyroid men with Hashimoto's thyroiditis and low testosterone levels - PubMed. This may lead to reduced testosterone levels and impaired sperm quality The effect of testosterone on thyroid autoimmunity in euthyroid men with Hashimoto's thyroiditis and low testosterone levels - PubMed.

If you suspect you have low testosterone and thyroid hormones, you should consult your doctor for diagnosis and treatment. Some tests that may be done include blood tests for thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), total testosterone, free testosterone, SHBG, prolactin and thyroid antibodies Relationship Between Testosterone Levels and the Thyroid - Thyroid Advisor The effect of testosterone on thyroid autoimmunity in euthyroid men with Hashimoto's thyroiditis and low testosterone levels - PubMed The interrelationships between thyroid dysfunction and hypogonadism in men and boys - PubMed Hypothyroidism and Low Testosterone: Diagnosis and Treatment – Thyroid Central. Treatment may involve thyroid hormone replacement therapy, testosterone replacement therapy or both, depending on the cause and severity of your condition Relationship Between Testosterone Levels and the Thyroid - Thyroid Advisor The effect of testosterone on thyroid autoimmunity in euthyroid men with Hashimoto's thyroiditis and low testosterone levels - PubMed The interrelationships between thyroid dysfunction and hypogonadism in men and boys - PubMed Hypothyroidism and Low Testosterone: Diagnosis and Treatment – Thyroid Central.

 

[aneuman]

To summarize, check for digestive issues/malabsorption/vitamin defficiency and the reason for your hypothyroidism - could be autoimmune and that is not checked in the tests you posted.

This is a summary of ChatGPT:
There could be several possible causes for both suppressed testosterone and thyroid hormones in a male. One of them is hypothyroidism - Bing, which is a condition when the thyroid gland does not produce enough thyroid hormone Relationship Between Testosterone Levels and the Thyroid - Thyroid Advisor The interrelationships between thyroid dysfunction and hypogonadism in men and boys - PubMed Hypothyroidism and Low Testosterone: Diagnosis and Treatment – Thyroid Central. Thyroid hormone regulates many processes in the body, including hormonal balance, protein synthesis and metabolic rate Relationship Between Testosterone Levels and the Thyroid - Thyroid Advisor.

According to some studies, hypothyroidism may lead to a decrease in sex hormone-binding globulin (SHBG) - Bing, which is a protein that binds and transports testosterone in the blood suppressed testosterone and thyroid hormones in male - Bing This Link Between Thryoid Issues and Low T May Blow Your Mind. This may result in a decrease in total testosterone - Bing that can be delivered to your tissues and your body suppressed testosterone and thyroid hormones in male - Bing This Link Between Thryoid Issues and Low T May Blow Your Mind. Since the thyroid and the testes are part of a feedback loop system, it becomes a vicious cycle of decreasing testosterone This Link Between Thryoid Issues and Low T May Blow Your Mind.

Another possible cause is autoimmune thyroiditis - Bing, which is a condition when the immune system attacks the thyroid gland and causes inflammation and damage The effect of testosterone on thyroid autoimmunity in euthyroid men with Hashimoto's thyroiditis and low testosterone levels - PubMed. This may affect the production of thyroid hormone and also trigger an immune response against other tissues, such as the testes The effect of testosterone on thyroid autoimmunity in euthyroid men with Hashimoto's thyroiditis and low testosterone levels - PubMed. This may lead to reduced testosterone levels and impaired sperm quality The effect of testosterone on thyroid autoimmunity in euthyroid men with Hashimoto's thyroiditis and low testosterone levels - PubMed.

If you suspect you have low testosterone and thyroid hormones, you should consult your doctor for diagnosis and treatment. Some tests that may be done include blood tests for thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), total testosterone, free testosterone, SHBG, prolactin and thyroid antibodies Relationship Between Testosterone Levels and the Thyroid - Thyroid Advisor The effect of testosterone on thyroid autoimmunity in euthyroid men with Hashimoto's thyroiditis and low testosterone levels - PubMed The interrelationships between thyroid dysfunction and hypogonadism in men and boys - PubMed Hypothyroidism and Low Testosterone: Diagnosis and Treatment – Thyroid Central. Treatment may involve thyroid hormone replacement therapy, testosterone replacement therapy or both, depending on the cause and severity of your condition Relationship Between Testosterone Levels and the Thyroid - Thyroid Advisor The effect of testosterone on thyroid autoimmunity in euthyroid men with Hashimoto's thyroiditis and low testosterone levels - PubMed The interrelationships between thyroid dysfunction and hypogonadism in men and boys - PubMed Hypothyroidism and Low Testosterone: Diagnosis and Treatment – Thyroid Central.

Couple of things:
1.- Be EXTREMELY careful with the results offered by chatGPT or Bard (or any LLM for that matter). They are very good at language, but very, very bad at content, and with an arrogance level almost matching Elon Musk's, they will authoritatively tell you things that are absolutely false, with quotes that don't exists, with articles and references that have never been written, with authors not yet born and fake http links.

2.- And this goes to @dlello2, if I were you, I'd try to stay away from Dr. Google (or Dr. charGPT for that matter) unless you can compartmentalize information very well, are a good critical thinker, understand that correlation is not causation, that clinical studies do not necessarily represent your case, and are not prone to panic. Just as a couple of anecdotes: Anecdote #1: my daughter once found something on her lip, did a google search and found that she met all the criteria for "lip cancer", almost went into a panic attack, did not sleep for a few days and all of a sudden, the "thing" disappeared on its own. It ended up being a scratch or something o that effect. Anecdote #2, a long time ago, I read about pre-diabetes, bought a glucose meter because it was cool (and had bluetooth!), started having measurements that were not in the "optimal" range and drove crazy everybody around the house because I was about to die due to hyperglycemia, as I started having all the symptoms. Long story short, many years have passed, I'm still here and I'm not pre-diabetic (or diabetic).

Medical doctors have a saying that says "When you hear hoofbeats, think horses, not zebras", when interpreted correctly, it means that you should think first of the most likely cause, only if it fails start thinking more complex pathologies. In a sense, most people with headaches don't have brain cancer.

As I always said, take my advice, don't take advice from me.

 

[sammmy]

I agree that ChatGPT can fantasize, however it is correct in this case. It is a common knowledge on this forum and various TRT sites, that before you treat low testosterone, first you have to look for hypothyroidism, which the OP has.

 

[dlello2]

1. Find another doctor. A competent endocrinologist would take all those suppressed hormones seriously.

2. Stop all the supplements. Most of them do not work or are harmful. It is not impossible that some of them may be causing you issues.

3. Do blood testing for vitamin deficiency. Digestive problems may lead to reduced vitamin/amino acid absorption which can lead to all kinds of metabolic problems.

4. Make sure your diet is providing all necessary nutrients. Extreme diets can be harmful.

5. Do a comprehensive digestive test like GI - MAP for possible issues. Constipation can have many causes, some of them gut dysbiosis. Have you tried probiotics that are known to induce more frequent stools, eating plain yogurt? You know what they say: "Everything starts in the gut".

1.) I’m contacting my endo to give her one more shot at taking this more seriously. It’s amazing how difficult it can be to find a good doctor that is ALSO accepting new patients. It took me 6+ months to get in with this one.

2.) I’ve tried to scale down supplements quite a bit. Just taking digestive enzymes, vitamin D, K2, E, B12, Zinc, and Magnesium. You think these could be harmful?

3.) and 5.) I’ve been meaning to do this, so now is the time. Any specific panels you’d recommend?

4.) I have tried many diets, but arrived at the conclusion that moderation is key. Eating a varied omnivorous diet of mostly whole foods is what I try for.

 

[sammmy]

High doses vit D can be toxic but at your current blood levels I don't think you are taking high doses. The question is though, why you need to supplement vit D with your diverse diet - why isn't it absorbed.

High doses Zinc may be toxic too. If you are taking it for libido, it is not achieving the target so it is pointless to keep taking it - one less variable.

For the vitamin tests, usually malabsorption leads to lack of B vitamins. Have you tested your vit B12 before starting supplementing with it?

Magnesium should be ok although it would be better to try probiotics that promote more stools. The probiotics might accidentally address the digestive problems.

I've done GI - MAP digestive test. It was $370 out of pocket but it is PCR (very sensitive and quantifiable) and found all my problems - dysbiosis after antibiotic use, infections, and lack of enzymes.

 

[sammmy]

Tell your endo to test you for thyroid antibodies. This is the test that is missing in your thyroid panel.

Also, do you eat enough calories per day?

 

[dlello2]

Tell your endo to test you for thyroid antibodies. This is the test that is missing in your thyroid panel.

Also, do you eat enough calories per day?

I'll definitely ask for the thyroid antibodies test. I think I'm overconsuming calories to be honest, despite the fact that I have a hard time gaining weight. I feel hungry quite often and feel like I eat a ton. Note that I am very active and probably need the calories.