Please review and offer advice ....especially nelson

[Dansk]

Hi all, I'v been reading through the forum and what a great resourse for people.....So thanks
see my labs posted below.

Estradiol < 15 pg/ml flagged low
DHT 64 ng/dl
androstenedione 71 ng/dl LIPIDS
free T 0.70 ng/dl flagged low. TRIGS 66
DHEA 312 ng/dl. Total chol 260
SHBG 53 nmol/l flagged as high. HDL 77
cortisol 7.6 mcg/dl morning. LDL 170
FSH 4.2 miu/ml.
glucose 98
HGB A1C 5.1. Thyroid
insulin 3.6. T3 uptake 38 flagged high
HCT 48.4. T4 total 5.5
PSA 0.2. Free T4 2.1
LH 5.3 miu/ml. TSH 1.48
Progesterone <0.5 ng/ml
Prolactin 2.8 ng/ml
total T 520 ng/dl
HS-CRP <0.2
liver enzymes all great

Im 48y M 175lbs 5'9" no viseral fat, more SQ fat than Id like. with supposedly flatlined estradiol...low free T.....elevated SHBG....and high T3 uptake.
what brought me to obtaining these test was poor exercise recovery, I feel very tired 1-2 days post exercise.....Just feel like I cant stay focused, somewhat tired especially day 2. Another issue is the day of exercise I don't sleep well....fall asleep ok then wake up and find it hard to fall asleep again. This happens regardless of the intensity level. Some days I will do very light physical stuff and still get same symptoms just not as bad. I do sometimes exercise hard and have given it my all in regards to building muscle and leaning out which seems difficult for me. This past year has been very stressfull at the job and has been wearing on me. I am a low carb guy average 25-100mg of carbs per day. And I sometimes get carried away with intermitted fasting by skipping breakfast and going 16-18hrs on nothing but a few cups of decaff and cream. And water. But I feel great while doing it. I do this 3-4x per week. So my thinking was my issue was CORTISOL from the exercise/stress and fasting that was causing my symptoms. Also after seeing my labs results and thinking about it my morning erections are sometimes absent, and orgasms are uneventful. So with my lab levels (low estradiol) I had a DEXA scan done and have bad osteoporosis in my spine other areas look good my l5-s1 did give out on me 4 years ago. My MD from a supposedly great Mens Health place in Brookline Ma wants to start me on HCG 1500mcg 3x weekly for at least a year, to boost mostly my estradiol, but to also help other hormones improve also. I am a little bit hesitent to go down this road as once I start there is no turning back. So my questions are:

1. Can I start this HCG therapy and stop once hormone levels improve? My guess is no
long tearm how will HCG effect my LH hormone.
2. After looking at my lab results posted am I getting good advice? Should I seek 2nd opinion?
3. MD thinks the more estradiol I have the better. My reaserch disagrees.? He says an inhibitor is unwise due to my osteoporosis. But he may agree to small dose of estrogen inhibitor when needed.
3. Can I change my hormone levels with DHEA supplimentation?
4. Any other advce would be greatly appreciated.

 

[Dansk]

Other labs
THYROID
TSH 1.48
free T4 2.1
total T4 5.5
T3 uptake 38 flagged high

LIPIDS
TOTAL CHOL 260
trigs 66
LDH 170
HDL 77

 

[Nelson Vergel]

Please tell me what meds and supplements you are taking? Why are you fasting so much?

You can increase your estradiol taking DHEA at 50 mg per day or more. DHEA will not increase your total T although it may decrease SHBG. You have good Total T for your age. Your fasting could be causing your high SHBG.

HCG will shut down your HPT axis just like TRT will. Your LH and FSH will be suppressed. Yes, it will increase your T, DHT and estradiol.

Thyroid seems OK but Chris will probably add more comments on that.

Your HDL is super nice. That will drop with HCG.

Your triglycerides tell me you are not eating enough carbs. You may pay the price with symptoms you mention.

You need estradiol to have sex drive and strong bones.

 

[Dansk]

Nelson,
I take no prescription meds, and occasionally supp with zinc, q10, vitc, b12, mag, and dialy vit d.

you are correct about the carbs, I didn't realize there was a connection between trig levels and carbs

I am low carb, 95% gluten free, and find it difficult to obtain enough carbs through healthy non man made choices.
I started experimenting with intermittent fasting and found I felt realy good, and It became convenient to skip most breakfast days. Although I do realize I overdue it at times. ( just convenient to do so) perhaps my overall calories are too low at times also.

I do suspect that the low carb and fasting is whats creating my symptoms, This combined with occational wicked job stress and exercise stress and I may be taxing my adrenals.

I think I may start supp DHEA to help with SHBG and Estradiol, and re-test in a couple months. I don't want to go down the TRT/HCG path if I don't absolutly need to.

My thinking is supping DHEA will decrease SHBG and increase my free T, while also increasing estradiol.
do you agree?

I really appreciate your thoughts and input.

 

[Vettester Chris]

The T3 Uptake is just based on binding protein measurements. It doesn't tell us anything about your actual T3 serum level, nor will the FT Index, which calculates the Total T4 by T3 Uptake.

You need Free T4, Free T3, Reverse T3 and Antibodies (TPO & TgAb). Also, when posting the labs we need reference ranges and measurement units.

On the cortisol, the serum lab also doesn't provide any real-time information. I would highly encourage you to take a 4x saliva cortisol panel w/ DHEA correlation. If you get it, I will gladly help you with understanding and interpreting the circadian profile report, burden & load results, & correlation analysis. I would suggest doing this before administering any DHEA, that's just my .02!!

 

[Dansk]

Chris,

Thanks for your input, I know the saliva x4 cortisol is the most accurate way to measure cortisol, but trying to get MD's to order it or argee to is like trying to talk a cat off a fish truck.
I also tried on the RT3 with no luck. I will get these labs done one way or another. My T4 index is 2.1
I do appreciate how you refer to circadian profile, as I am a big believer in circadian cycles and cell timing.

how does DHEA affect thyroid??

 

[Vettester Chris]

Dansk, you can get the cortisol/DHEA kit with ZRT Labs. Reverse T3 is easily obtainable through our sponsor at the top, Discountlabs.com, or other places on the Net that use Labcorp.

DHEA is the opposing antagonistic hormone to cortisol; both produced in the adrenals. Cortisol will play the primary role with thyroid productivity, but DHEA is needed to achieve adrenal balance. In many cases with adrenal fatigue, pregnenolone will be demanded in excess to produce more cortisol, causing various "slumps" in DHEA production .. This is where you can research some of the Cortisol/DHEA correlation information, and get into the maladaptive phases, adrenal fatigue, etc. Just my suggestion that you cover the circadian base before going with any treatments ...

 

[Vettester Chris]

And yes, your LH will completely suppress with HCG. The other concern that could become a factor with going so heavy on HCG is intratesticular E2. It happens with some, and when it does you can't traditionally manage it with an AI. DHEA will convert downstream, just get your cortisol checked.

You should also look at making sure your Vitamin D is optimal. That will help with some of the SHBG/Free T concerns, plus it plays a big role with the thyroid and much more. I suspect your D3 is probably sub-optimal, so add it to the list.

 

[Dansk]

Chris,

thanks again, I appreciate your time and knowledge.

I will get the full thyroid labs done.
My DHEA is 312 and I believe thats a good level for men, so it would seen its not being stolen to make cortisol.

I have read about pregnenolone steal, and this pathway in regards to stress, I was thinking about getting a pregnenolone level also?
my Vit D came back at 44, I did stop supplimenting with D for a few weeks prior to my lab draw so I believe its pretty accurate. I do think it should be higher.

my main concern is the Estradiole and how best to improve this without having to mess with my bodies own regualatory systems, I have ruled out HCG, however there is a reason my estradiol is very low and I need to find out why and how best to fix it.

thanks again.