Please help...low T, hypothyroid, adrenal fatigue

[markw]

Hi guys, I've got a complicated issue and I hope you can help me out. I'd greatly appreciate it if you could give me some advice. Sorry if this is a long post.

28 yrs old, 5'4", 135 lbs, low T, hypothyroid, possibly with adrenal fatigue. I've probably had these problems for most of my life but I never knew. Always seemed to lack the energy and mental clarity that others had. Had a tonsillectomy at 10 which was done unnecessarily (for minor sore throats). After the surgery there was some weight gain and, I felt, maybe some slight mood changes, but nothing serious. Started puberty at 13 and stopped growing around 14 years old, around this time I started noticing some fatigue, brain fog and anxiety, but again it wasn't serious. Since 16, fatigue and brain fog started getting noticeably worse. Struggled to keep focused in school, grades took a bad hit and I became more nervous and depressed. These problems remained throughout high school and college. Now I have problems with brain fog, fatigue, anxiety, PE, slight ED (hard flaccid), extreme exhaustion after orgasm that takes days to recover from, feeling nothing mentally during sex, low libido at times, having a burned-out feeling in my head at all times. I've also developed some heart issues, possibly due to being low T/thyroid for a long time.

Last year I got a full panel of labs done:

Total Test 197 (280-1000 ng/dL)
Free Test 8.9 (8.7-55 pg/mL)
Estradiol 14 (0-56 pg/mL)
LH 11.5 (2.0-12.0 mIU/mL)
FSH 10.2 (1.0-12.0 mIU/mL)
DHT 160 (112-955 pg/mL)
SHBG 13 (10-57 nmol/mL)

Free T3 3.3 (2.0-4.4 pg/mL)
Free T4 1.0 (0.6-1.2 ng/dL)
RT3 223 (90-350 pg/mL)
Total T3 99 (72-170 ng/dL)
Total T4 7.3 (4.7-13.3 ug/dL)
TSH 3.08 (0.34-4.82 uIU/mL)

Cortisol 24H 35 (3.5-45 mcg/24 h)
ACTH 85 (10-60 pg/mL) (a.m. draw)
DHEA-S 359 (85-690 mcg/dL)
Progesterone 1.0 (0.0-0.6 ng/mL)
Pregnenolone 212 (33-248 ng/dL)

Growth Hormone 0.6 (0.0-4.0 ng/mL)
IGF-1 184 (117-321 ng/mL)
Prolactin 34.2 (1.6-18.8 ng/mL)

Insulin 10.0 (0.0-20.0 mcIU/mL)
Free Insulin 5.6 (1.4-14 mcIU/mL)
Hemoglobin A1C 5.6 (4.0-6.0%)
Est. Avg. Glucose 114 (40-165 mg/dL)

Iron 115.0 (40-165 mcg/dL)
Ferritin 197 (30-400 ng/mL)
Vitamin D 26 (30-100 ng/mL)
Iodine 50 (40-92 ng/mL)
Zinc 1.01 (0.66-1.10 mcg/mL)
Copper 0.92 (0.75-1.45 mcg/mL)
Vit B12 546 (243-984 pg/mL)

I met with an endo and we did a 10-day trial of clomid (30 mg ED) to see if I was primary or secondary. My labs after the trial:

Total Test: 458 (280-1000 ng/dL)
Estradiol: 27 (0-56 pg/mL)
LH: 13.7 (2.0-12.0 mIU/mL)
FSH: 20.8 (1.0-12.0 mIU/mL)
SHBG: 21 (10-57 nmol/L)

Free T4 0.6 (0.6-1.2 ng/dL)
Total T3 100 (72-170 ng/dL)
Total T4 5.9 (4.7-13.3 ug/dL)
TSH 1.79 (0.34-4.82 uIU/mL)

Growth Hormone 0.1 (0.0-4.0 ng/mL)
IGF-1 63 (117-321 ng/mL)
Prolactin 11.2 (1.6-18.8 ng/mL)

Cortisol AM 38.6 (no est. range)

which seem to indicate I was secondary, and I probably should've tried a restart. But the endo put me on androgel and we started at 2 pumps ED. My labs after three weeks on androgel:

Total Test: 129 (280-1000 ng/dL)
Estradiol: 6 (0-56 pg/mL)
LH: 3.1 (2.0-12.0 mIU/mL)
FSH: 4.3 (1.0-12.0 mIU/mL)
SHBG 13 (10-57 nmol/L)
Prolactin: 16.1 (1.6-18.8 mIU/mL)
Vitamin D: 42 (30-100 ng/mL)

After seeing these numbers, the endo raised the dosage to 3 pumps, then to 4 pumps a month later. Labs after a month on 4 pumps:

Total Test: 348 (280-1000 ng/dL)
Estradiol: 10 (0-56 pg/mL)
LH: 0.3 (2.0-12.0 mIU/mL)
FSH: 0.4 (1.0-12.0 mIU/mL)
SHBG: 15 (10-57 nmol/L)
Prolactin: 13.7 (1.6-18.8 ng/mL)

We switched to a 2% compounded gel, dosed at 5 pumps a day, and tried this for a month. Following lab results:

Total Test: 400 ng/dL (a different lab, I don't have the range)
LH: 0.1 (2.0-12.0 mIU/mL)
FSH: 0.4 (1.0-12.0 mIU/mL)
SHBG: 14 (10-57 nmol/L)

Free T3: 3.0 (2.0-4.4 pg/mL)
Free T4: 0.9 (0.6-1.2 ng/dL)
Total T3: 95 (72-170 ng/dL)
Total T4: 5.3 (4.7-13.3 ug/dL)
TSH: 1.69 (0.34-4.82 uIU/mL)

DHEA-S: 363 (85-690 mcg/dL)

Hemoglobin A1C: 5.2 (4.0-6.0%)
Est. Avg. Glucose: 103 (68-126 mg/dL)

I never really felt good during the 6 months on androgel and compounded gel, I felt like it was adding a lot of stress on my body and made me fatigued, nervous and irritable all the time. I stopped seeing the endo and found a new doctor who took me off the gels and tried a restart with hcg (500 IU 3x/week). The first two weeks on hcg felt good, fatigue and brain fog had lifted a bit, I felt like I was responding to it, and then it inexplicably stopped working and the fatigue returned. At first I thought e2 had gotten high but when we did labs again all the numbers came back low:

Total Test: 262 (280-1000 ng/dL)
Free Test: 10.8 (8.7-55.0 pg/mL)
Estradiol: 13 (0-56 pg/mL)
Estrone: 22 (10-60 pg/mL)
DHT: 161 (112-955 pg/mL)
DHEA: 5.0 (<13 ng/mL)

We raised the dosage to 500 IU ED and tried this for a week but saw no improvements at all. It felt like the hcg had simply stopped working, from then on every time I injected hcg I'd feel even more fatigued. So we moved on to test cyp injections + hcg, now I'm on 30 mg test cyp 3x/week + 500 IU hcg 3x/week. After taking these injections, I become really fatigued and irritable, with bad chest pains and adrenal pains. It feels like it's putting a lot of stress on my body, probably on thyroid and adrenals. I go through each day with severe fatigue and chest pains, and on most days I can barely function at all.

I'm really unsure what to do at this point, I feel like staying on TRT is a bad idea and looking back, I shouldn't have started in the first place. Maybe an hcg restart in the beginning would've been successful, or maybe treating thyroid and other deficiencies first would've been a better idea, to see how T responded? I really want to get off TRT altogether and try a restart but I don't know how to go about doing this. Should I treat thyroid and adrenals first before I come off and try the restart, and what kind of restart protocol should I follow? Are any of you guys familiar with doctors who specialize in post-TRT restarts? Who would you recommend I see in this situation? Please advise me. Thanks guys.

 

[vooch86]

How did you feel on the clomid? If you felt better or there was improvement you should've stuck with low dose long term, looks like you responded to it but 10 days isn't enough time in my opinion. Your best set of labs for the most part is from your 10 days on Clomid, just depends on how you feel on it. Nothing says you can't find a doc that will put you on a low dose for a few months to see what happens

 

[markw]

I did feel slightly better during the 10 days on clomid, without any side effects, but it wasn't enough time to really tell. I see a lot of warnings about long-term clomid use, i.e. it could cause liver toxicity, blood clots and many other problems. How safe would it be for long-term use?

 

[vooch86]

There are many studies out there showing the benefits of its use at low dose, low dose would be 25 mg or 12.5 mg ED or EOD I believe. From what I understand most of the sides come from the larger doses. I have been on it for just over a month now and my test levels came up to 650 TT last set of labs, I will saty on another month and then come off to see if it sticks. Best bet would be to make sure your adrenals and thyroid are right first.

 

[toolman]

There are many studies out there showing the benefits of its use at low dose, low dose would be 25 mg or 12.5 mg ED or EOD I believe. From what I understand most of the sides come from the larger doses. I have been on it for just over a month now and my test levels came up to 650 TT last set of labs, I will saty on another month and then come off to see if it sticks. Best bet would be to make sure your adrenals and thyroid are right first.

Vooch86 how has your libido been on clomid for a month? I have been on 25mg daily for a month now and while I am losing body fat, increased some hair growth, my libido is still non existent and I sleep very soundly finding it a chore to try and wake up on time. I have blood tests scheduled for 6 weeks and I am sure my test is up but not much of a help if my libido is gone which is why I started this journey to begin with. When I was on test, libido was great.

 

[vooch86]

Well, I think the jury is still out on the libido, I was on 12.5 mg. ED for 3 weeks, my total T came back at 646, free T was 125 19%, Estradiol sensitive 15 do recall LH and FSH but both in the upper range, SHBG 31, Vitamin D 79, DHEA 285 so basically all my numbers looked pretty good after 3 weeks on 12.5 mgs ED. in the first week I got a spurt of libido then it seemed to die off after a day or so, end of the third week same thing. So the libido seems to come and go even when nothing else changes same goes for the morning wood and nocturnal erections, although I have noticed that when I sleep well my libido is better as well as the MW seems to show up, that gives support to the importance of REM sleep. After the 3rd week the doc wanted to bump me up to 25 mg ED to see if he could get TT up and if it would support libido, honestly I haven't felt any different on the higher dose. My theory on this is, and I posted on another thread as a question, the libido thing I think is tied somehow to estrogen while on Clomid, either the body thinks that it is low on estrogen because its being blocked or there is a build up of estrogen in the body tricking the body into thinking its high, I have no clue which one is right but I do believe its tied to that one way or another. I think once off Clomid, if the TT stays high libido will come back in a normal fashion.

 

[imrj]

Man I know for me libido is all in the brain...neurotransmitters in balance by far....hormonal balance alone has never helped my libido in any consistent basis....my 2 cents

 

[vooch86]

Talk to us about the neurotransmitters, how do you balance them how do you know they are off, what causes that?

 

[markw]

My dopamine and serotonin are really out of balance...I feel burned out in my head all the time, poor memory and concentration, emotionally dull, clouded thinking. As far as libido goes, I feel nothing mentally during sex... I supplement with spirulina, chlorella, coconut oil, and krill oil to boost dopamine levels, taken together it helps a bit, but I have to keep taking it every day or I stop getting the effects. The strangest thing, though, is it seems like every orgasm leads to some sort of dopamine crash that lasts for several days, it completely wipes me out afterwards.

 

[markw]

Making a correction to my original post, during the 10-day clomid trial I was on 100 mg ED, not 30 mg. At this high a dosage, does TT at 458 seem really low? Would this still indicate secondary hypogonadism or would it lean towards primary? Also, looking back at the labs that were drawn after taking clomid, AST and ALT were really elevated. Does this indicate possible liver problems if I resume taking clomid long-term?

ALT: 44 (15-37 units/L)
AST: 91 (30-65 units/L)

Before taking clomid ALT was 24 and AST was 42.

Well, I think the jury is still out on the libido, I was on 12.5 mg. ED for 3 weeks, my total T came back at 646, free T was 125 19%, Estradiol sensitive 15 do recall LH and FSH but both in the upper range, SHBG 31, Vitamin D 79, DHEA 285 so basically all my numbers looked pretty good after 3 weeks on 12.5 mgs ED. in the first week I got a spurt of libido then it seemed to die off after a day or so, end of the third week same thing. So the libido seems to come and go even when nothing else changes same goes for the morning wood and nocturnal erections, although I have noticed that when I sleep well my libido is better as well as the MW seems to show up, that gives support to the importance of REM sleep. After the 3rd week the doc wanted to bump me up to 25 mg ED to see if he could get TT up and if it would support libido, honestly I haven't felt any different on the higher dose. My theory on this is, and I posted on another thread as a question, the libido thing I think is tied somehow to estrogen while on Clomid, either the body thinks that it is low on estrogen because its being blocked or there is a build up of estrogen in the body tricking the body into thinking its high, I have no clue which one is right but I do believe its tied to that one way or another. I think once off Clomid, if the TT stays high libido will come back in a normal fashion.

How are you doing so far on clomid, vooch86? Does it make you feel better energy-wise and mentally? How would you compare it to your previous restarts with triptorelin and nolva/aromasin/hcg?

 

[vooch86]

Well so far I think the clomid has helped me the most out of all the stuff I tried. To be fair I think the nova, aromasin and hcg really boosted my test but I didn't stay on it long enough and the sides were pretty prevelant. The triptorelin boosted my test to the 600 range but the sides sucked from that big time, I don't know who said there were no siides associated with it but it was bad initially and the things is with that is once you take the shot you can't stop it. I have had some minor sides with the clomid but energy levels a really good, mental clarity good, strength and stamina are solid in the gym. I too am hypo and am working on getting that dialed in also think I do have some adrenal fatigue due to high test levels and the stress it created while on TRT. Right now I amd doing clomid at 12.5 Ed should have labs in the next week or so, feel decent overall. I think once the thyroid is dialed in, I will be good to go. Still could use some help in e libido area but I also think it will come back when I get of the clomid. I'll update s I can. For you it looked like it was working you just didn't give it enough time, an,d you definitely don't need a dose that high, I would stick with low dose for a couple months if you can.