Question about testosterone level and constant tiredness

[Mateuszek1234]

Hey everyone,
I'm 21 and 6 month ago I diagnosed hypogonadism, my testosterone was 180-220 ng/dl (lab standard was 250-827) and i started therapy : First it was 120mg testosterone/week and 100 iu hcg every day.
After 1-2 months i checked again my hormones and testosterone was only 350 ng/dl... and I felt like a crap all the time...SOme time ago i increase the dose of T to 500mg/week ( i know that now it's not TRT, just cycle ) and my total T level is about 800 ng/dl.
My question is : why i need such a large number of Testosterone to raise it to the upper limit of normal ??
I checked rest hormones like E2,prolactin,TSH,ft3,ft4, shbg, morphology,lipids and it's ok.

What's more, even at this level of testosterone I'm still sluggish and nothing I did't want to do.
I work out at the gym and I eat properly - i think its important too.

Thanks guys and im waiting for any ideas.

 

[Nelson Vergel]

You may be a fast metabolizer of testosterone.

You may want to read these two threads for more info.

Thread: Fatigue- When Testosterone Is Not EnoughResults 1 to 10 of 10


Thread: Are you tired even with normal testosterone? Adrenal fatigue may be the problem.

 

[Mateuszek1234]

I thought about Adrenal fatigue...I have a lot of symptoms : feeling tired, run down, difficulty getting up, feeling depleted in the morning and feeling more energetic at the end of the day. And i need coffeine to do something. I checked cortisol morning and afternoon and it was ok, in the means of the standard.
What i can do now ?

 

[Nelson Vergel]

You may want to be tested for sleep apnea and possibly ask your doctor for this Genova test:

https://www.gdx.net/learngdx/clinical-concerns/adrenal-fatigue

Canary also has a test:

http://www.canaryclub.org/specializ...-zrt-stress-hormone-test-kit-c1-c2-c3-c4.html


You may want to allow Chris on here to look at your thyroid values. I am amazed how many times we have seen poor diagnosis and mismanagement of low thyroid.

 

[Mateuszek1234]

Im sure that its not sleep apnea.
My thyroid values :
TSH 1,480 lab norm 0,55 - 4,00 pmol/l
FT3 4,97 lab norm 4,7 - 7,20
FT4 13,27 lab norm 10,7 - 18,40

 

[Vettester Chris]

Im sure that its not sleep apnea.
My thyroid values :
TSH 1,480 lab norm 0,55 - 4,00 pmol/l
FT3 4,97 lab norm 4,7 - 7,20
FT4 13,27 lab norm 10,7 - 18,40

Thanks for posting labs ... What you have posted can actually be a great learning tool for EVERYONE on the subject of the thyroid and "normality" ...

So many doctors will run the TSH lab as their first course of action to review a patient's thyroid. When a patient like yourself presents a 1.48 pmol result on the TSH, the vast majority of GPs and endos will close the book and say your thyroid is spot-on! As far as TSH goes, that's a sweet zone reading if there ever was one.

Sadly, that diagnosis would be anything but sweet! Reason, you fortunately pulled both FT3 & FT4 serum labs, which paint a different picture. Take note where your values fall within the reference ranges of both of these labs

FT3 is at 10.8% of the reference range
FT4 is at 33% of the reference range

Ideally, it would be great to see both of these values in the 50% to 80% range. It would be also good to see both values relatively close to each other in their respective ref ranges; meaning if your FT4 was at 58%, you might want to see your FT3 at/around the same, maybe mid 50 percentile, indicating a slightly higher amount of reserves with the T4. This isn't a mandatory thing, especially if treating hypothyroidism with exogenous T3 (Cytomel), whereas T4 will be bypassed and remain low. In some situations this is ideal, especially if T4 isn't adequately.

If the pituitary and feedback loop were fail proof, going by your T3 & T4 readings, we should be seeing your TSH up in the 4's or 5's! This isn't the case. TSH is spot-on, but your actual thyroid hormone levels are in the tank, FT3 being the critical hormone for getting to the cells to promote energy (ATP), metabolism of proteins, fats, carbs & even vitamins & essential nutrients.

There's a few other areas that need to be reviewed before getting too deep into what options you might explore .. We really need to see a Reverse T3 lab, plus the antibodies TPO & TgAb. My suspicion is adrenal issues with cortisol, with a possible slump in DHEA-S. Adrenal problems in many cases will reflect low & normal TSH values, but will also reveal low thyroid hormone levels, which is pretty much what we're seeing with your labs .

Would like to see a 4x saliva cortisol/DHEA-S report, where we can review the circadian profile, burden, and get an idea of what stage of potential adrenal fatigue you might be dealing with. Like the thyroid, it's a wide range for the reference range, so it's real easy for most doctors to discount any issue when they see the results landed somewhere between the low and the high. Like testosterone serum, 280ng/dl to 900ng/dl on a lab, and so many doctors will say you're normal if you have a 285 or a 885 .. Anyone in the know realizes this is not correct.

The adrenals are even a little more sensitive with how they should approached when reviewing the results, based on the variances of desired reference range intervals with each saliva tube specimen throughout the course of the day. If you can get these labs, I can provide you some feedback on the circadian profile, and the Cortisol/DHEA correlation summary, which will tell us how the adrenals are adapting with stress.

Depending on different stages of adrenal fatigue, pregnenolone steal could be factored, which in turn is neglecting hormone production ability downstream in areas like DHEA, estrogen & of course thyroid hormone. Get these labs and I'm sure more information about your situation can be discovered, which in turn can help you prepare a solid plan with your physician ...

 

[Mateuszek1234]

Thank you very much Chris for the information and interest in my topic.
In the next week i will go to lab to check Reverse T3 and these antibodies. I also ordered a special samples from the laboratory to investigate the diurnal salivary cortisol levels.When I will have the results as soon as I add them here.
I have one more question now : What is the treatment of adrenal fatigue ? In our country(I'm from Poland) its difficult to find a good doctor, who will know what to do with that ... It's impossible to get T+hcg in the treatment of hypogonadism so i think with adrenals will be the same sytuation.

 

[Vettester Chris]

There are so many variables, and treatment just depends on the results. I forgot to make sure you add a ACTH lab, which will be pituitary feedback hormone, like the TSH is to the thyroid. If cortisol is elevated due to stress, environment, lifestyle, etc., then a big part of it will be just making all sorts of changes with your personal patterns, including sleep, diet, exercise, nutrients, .. Making a host of changes. Regardless, you will need to find a good physician that can assess the labs correctly and ensure there are not other factors that are contributing ..

If results are suppressed, then the same plan with a physician, as you need to rule out Addison's and/or other contributing factors. That's usually not going to be a problem, and in many cases a physician can get you on HC therapy, and/or adrenal supplements, and therapeutic protocols of vitamin C, magnesium, ... There is also the CT3M - Circadian T3 Method, where treating with a low dose of Cytomel in the early AM can be a possible effective option.

For now, labs are needed, and you might take an inventory of yourself to just get a head start on some possible solutions. Look at some of the items noted above .. Sleep, diet, medications, your lifestyle, current status on relations and employer(s) that might be effective stress, nutrients (are you getting any Vitamin C, Magnesium, Vitamin D, ...?), exercise, diet patterns, anxiety issues, illnesses ... Look at the whole 24 x7 picture and see if there's some items that could no doubt be putting your body in the line of stress.

 

[Mateuszek1234]

Hey again,
I have some results :
ACTH 18,10 pg/ml lab norm : 5.00 - 46.00
Antibodie TPO 0,31 IU/ml lab norm : 0 - 5,61
Anti Tgab 1,43 IU/ml lab norm : 0 - 4,11

What r u think about it ?

 

[Vettester Chris]

Hey again,
I have some results :
ACTH 18,10 pg/ml lab norm : 5.00 - 46.00
Antibodie TPO 0,31 IU/ml lab norm : 0 - 5,61
Anti Tgab 1,43 IU/ml lab norm : 0 - 4,11

What r u think about it ?

Nothing looks too crazy with the antibodies. Can't really make anything out of the ACTH without having a respective cortisol panel to accompany it. If you can get a saliva cortisol kit, we can go through it with you.

 

[Mateuszek1234]

Im waiting for results of panel saliva cortisol/DHEA. I think that next week I'll have them.

 

[Knut Erik Knutsen]

Please post them here.

 

[Mateuszek1234]

Hey, i have results of DHEA/Cortisol :
Cortisol morning : 3133 pg/ml lab norm : 1850-14570
Cortisol after 2 hours : 1493 pg/ml lab norm : 1300-10290
Cortisol after 5 hours : 1012 pg/ml lab norm : 760-5690
Cortisol after 8h : 763 pg/ml lab norm : 650-4380
Cortisol after 12h : 893 pg/ml lab norm : 330-3330

DHEA morning : 334 pg/ml lab norm : 154-620
DHEA after 12h : 60 pg/ml lab norm : 154-620

Correlation Cortisol/DHEA morning : 9,4 ratio lab norm : 3-100
Correlation Cortisol/DHEA after 12h : 14,9 ratio lab norm : 1-30

Opinion : suspected adrenal weakness.

 

[taylorogy]

I thought about Adrenal fatigue...I have a lot of symptoms : feeling tired, run down, difficulty getting up, feeling depleted in the morning and feeling more energetic at the end of the day. And i need coffeine to do something. I checked cortisol morning and afternoon and it was ok, in the means of the standard.
What i can do now ?

I too have this problem, and am 22 running test at 150mg/week

 

[Vettester Chris]

Hey, i have results of DHEA/Cortisol :
Cortisol morning : 3133 pg/ml lab norm : 1850-14570
Cortisol after 2 hours : 1493 pg/ml lab norm : 1300-10290
Cortisol after 5 hours : 1012 pg/ml lab norm : 760-5690
Cortisol after 8h : 763 pg/ml lab norm : 650-4380
Cortisol after 12h : 893 pg/ml lab norm : 330-3330

DHEA morning : 334 pg/ml lab norm : 154-620
DHEA after 12h : 60 pg/ml lab norm : 154-620

Correlation Cortisol/DHEA morning : 9,4 ratio lab norm : 3-100
Correlation Cortisol/DHEA after 12h : 14,9 ratio lab norm : 1-30

Opinion : suspected adrenal weakness.

Yeah, your circadian profile isn't looking all that great. The starting point in the AM should be right towards the top, but yours is in the bottom 25% area of your labs. So, there's no reserves and your cortisol level stays bottomed out.

I suspect this has been going on for awhile, but it's not clear whether this is a primary or secondary condition, and what the root cause(s) are?

I would get with a physician that knows how to treat adrenal issues properly. You might be a perfect candidate for HC therapy, but I would imagine a physician will want to run further tests and exams.

On your labs, can you elaborate on the provider and what method(s) they use? I presume these are saliva labs? I'm more used to a ZRT platform to run the graphs and all those fun reports, but your numbers are pretty clear regardless of the origin.

 

[Mateuszek1234]

Yes its saliva lab. It's impossible to do in my country saliva cortisol test in laboratory, my samples have been sent to lab in Germany - there developed, translated and sent back to me. I have some gaphs(charts) but i post here only "dry" results. I arrange an appointment with physician, what tests and exams he should do with me ? And what kind of therapy will be good solution ? I want to be prepared for the visit and possible discuss with him my treatment.

I feel my condition is getting worse, the mood is sh*t and i cant cope with stress...

 

[Vettester Chris]

Mat, thanks for the clarification on the origin of the labs. The reference values and time frames are a bit different than the ZRT standard, but none the less the results speak for themselves. I could prepare a graph on what you based, but it's easy to just see that the trend is staying on the far low end throughout the cycle.

I'm sure you are feeling down and out. You have very little reserves to start your day out with, and the well is basically dry. DHEA is also down, so to me (I could be wrong) this indicates adrenal exhaustion is in a later stage, as this has probably been evident for quite awhile.

Exams ... Yes, a qualified physician will probably want to look deeper into this. I think you need to establish if this is a primary condition (failure at the adrenal level), or if it is a secondary condition (failure in the pituitary). I would imagine tests like ACTH or ACTH Stim would come into play, possibly CRH Stim test, possibly aldosterone & renin + other sub-related tests thereof, and also he/she would more than likely look into some adrenal cortex imaging exams, probably in form of CT or MRI, to cover incidentalomas, cysts, or other image concerns that could be warranted if the root cause is leaning primary.

In essence, this has many of the same similarities of determining a diagnosis to patients with low testosterone, especially the younger ones. There's just other variables and pathways involved when it comes to the adrenals ...

In the meantime, read up on some of Dr. Lam's stuff http://www.drlam.com/index.php, and Canary Club seems to be doing some recent things with Dr. Vicki Latham that's on their site. I haven't got too deep into it, but I'm sure it wouldn't hurt on your end to do some reading as you're seeking some medical professionals.

 

[Mateuszek1234]

Thanks for help, I will go to physician as soon as its possible and give you information what he came up with my sytuation. I've done MRI of my pituitary gland when i discovered low testosterone and it was OK. You think that physician should give me DHEA+hydrocortisone in the context of therapy ? May be other avenues of treatment ?


I have one more question - Is adrenal fatigue prevents loosing body fat ? and is more difficult to build muscle mass on the gym ? Its very hard to get a good form for me...

 

[Vettester Chris]

Thanks for help, I will go to physician as soon as its possible and give you information what he came up with my sytuation. I've done MRI of my pituitary gland when i discovered low testosterone and it was OK. You think that physician should give me DHEA+hydrocortisone in the context of therapy ? May be other avenues of treatment ?


I have one more question - Is adrenal fatigue prevents loosing body fat ? and is more difficult to build muscle mass on the gym ? Its very hard to get a good form for me...

Mat, the ACTH & ACTH-Stim with or without CRH-Stim can help the physician determine if the pituitary is secreting properly. Personally, I don't think it's a secondary or sub clinical issue, I imagine other factors involving stress, environment, illness/infection(?), ...etc., a variety of factors probably played into the adrenals working overtime to keep up, and at some point the pregnenolone steal factor kicked in and contributed to other hormonal pathways being effected, e.g., DHEA, Thyroid, ... Note, this is just a speculation, but it's a pretty common course when this stuff plays out.

I would hope that most of the imaging exams (if warranted) would focus in the adrenal cortex region. That's just my .02

On your last question, YES, YES, YES ... There's a variety of variables related with this, but the one I'll emphasize the most is your thyroid. If you don't have adequate cortisol production, then it's pretty much a given that your thyroid productivity is suboptimal!! This isn't about a "normal" TSH level, or that T4 & T3 levels are in the reference range .. It's about your Free T3 level and its ability to get into the cells of the body, promotion of ATP, which is codependent on factors like cortisol, iron, D3 and few others. Free T3 needs to be factored against Reverse T3 to see the true picture. A full thyroid panel is needed to review this, but that my friend is no doubt one of the key issues you are facing with the fat/muscle scenario.

 

[Cooper]

Could there be a relationship between these issues caused from injectioning once a week and the up / down impact it has on your body and would using gel on a daily basis or injecting several times a week possibly help with this issue? Not sure there is any connection at all just wondering if it was possible ....