At Wits End - Thyroid, Testosterone, Anemia (long)

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    At Wits End - Thyroid, Testosterone, Anemia (long)


    I was sent here by the folks at MarksDailyApple. I've been pricked half a dozen times since August, trying to figure out what's wrong with my body and hopefully someone here can help.

    Extensive Background: 21 year old male, 5'11, 205lbs.

    I used to be sedentary with a poor diet, and weighed 310 lbs. Growing up, I was active but always overweight. I was diagnosed with Scheuermann's Kyphosis in 2003-04 (age 13) with no treatment. From around age 12-15, I was being seen for high cholesterol (>300 trigs) and prehypertension (145/80). Throughout high school, I had (undiagnosed) depression and social anxiety. No family history of diagnosed thyroid, pituitary, or mental health issues.

    In June 2010, I started exercising and eating better. By Christmas, I was down to around 230-240, eating mostly chicken breast, black beans, oatmeal, and other easy dorm food. In January 2011, I started having really bad depression. Episodes of negative thought, low energy, emotional instability, confusion, social anxiety, etc. Even though my diet and exercise were good, I stopped losing weight until May. I sought counseling at University and some "sit-n-talk" sessions seemed to help a bit. By June, I was feeling a little better (not great) and I was down to 210 lbs with the help of a low-carb diet. In June 2011, I started eating the primal diet. I cut out most dairy, no grains, and experimented with keto (less than 30g carbs/day) and intermittent fasting.

    In June, this got a lot worse: I started having severe energy crashes. By the time I got home from work around 4pm, I didn't have the energy to workout. I was constantly "down", tired, sore (despite less frequent exercise), and I had frequent mood swings. This past summer was by far the worst I have felt mentally in my entire life. I was angry all the time, snapped at friends and family, alternating episodes of crushing depression and rage, and just wanted to sit down all day long. My body hair growth slowed significantly (I could never grow facial hair), my libido dropped to zero (very weak erections), my muscle tone declined, I began to sweat less intensely, and I lost interest in things that I used to care about (girls, reading, music, politics). I always used to be the type of person that was really warm, always needed a fan on in my room to sleep: then I completely reversed and I am now either comfortable in hot rooms or freezing. My feet especially were freezing during the summer.

    In August, I went to my family doctor and he tested me for a variety of "malaise" symptoms, as well as my typical cholesterol stuff. Here are those results (drawn around 9am, fasted):

    Total chol: 217
    Trig: 41
    HDL: 87.9
    Chol/HDL: 2.47
    Non-HDL Chol: 129.1
    VLDL: 8
    Direct LDL: 89
    Testosterone: 259.96 (flagged low, range: 262-870 ng/dL)
    Calcium: 10.2 (range: 8.4-10.2) Normal, despite not much milk
    BUN: 23 (flagged high, range: 7-19 mg/dL)
    Creatinine: 1.0 (.8-1.4)
    BUN Crea Ratio: 23 (flagged high, 13-21)
    GFR MALE: 100
    TSH: 2.44 (.38-3.30 uIU/mL)
    Free T3: .71 (flagged low, 2.1-3.8 pmol/L)
    Free T4: .92 (.82-1.63 ng/dL)
    [Hepatic panel was all normal. I can post if you need it]
    Magnesium: 4.7 (4-6.4)
    C-Reactive Protein: <0.3 (<.8)
    [Blood panel was all normal,except two noted below. Again, I can post if you have specific question]
    Hematocrit: 40.3 (flagged low, 41-50%)
    Lymphocytes: 49.7 (flagged high, 18-47%)
    RBC: 4.47 (barely normal, 4.4-5.8)
    Hemoglobin: 13.8 (13.8-17.2)
    Vitamin D3: 86 ng/ml (50-100)

    (Looking back, it seems I was borderline anemic at that point. But it wasn't addressed.)

    My doctor put me on 30mg/day Armour thyroid and a testosterone compound cream of 30mg/ml. In the first two weeks, my energy and mood felt better. But over the total three months, things did not improve and some symptoms got worse. I still had frequent mood swings, constant depression, NO libido or morning erections, low energy, no desire to workout, no interest in music/books/friends, constant mental fog/lack of concentration, constipation (2-4 days between movements), starting having "cold" attacks in which my hands were get ice cold for no reason, low waking temperature (96 F) dry skin on hands, still no sweating, hard to raise heart rate during exercise, impatience, feeling of stress without reason, shallow breathing pattern, slow hair growth (almost none), calf cramps at night, restless sleep/no dreaming, voice began cracking at random times, I stutter and lose my words frequently, which is causing me to be very quiet/introverted. Still couldn't lose weight (would like to lose 15 more lbs to be around a healthy My quality of life continued to decline.

    I got a referral to an endochronologist in December, and was ordered off of medication for a month to do more blood work. She said that I was objectively very healthy (had gained ~5-10 lbs since August due to less exercise) but that I was obviously subjectively not well. She said that I answered yes to almost every symptom she asked about. She asked, but did not explain why, how much dairy I ate (not much). I assume to get a gauge on my calcium intake. She said that she suspected thyroid and gonad issues related to pituitary function.

    Since I quit the Armour and cream this past month, the cold attacks have gone away, my hair is growing back a little bit quicker, my muscle tone is more sustained, erections a little bit stronger, but not much. Still feeling depressed and tired, and most of the other symptoms above. Here are results (got them over the phone, sorry no units), drawn at 7:50am, fasted:

    TSH: 2.3 (.4-4.0)
    Free T4: .79 (flagged low, .8-1.8)
    Free T3: 1.8 (flagged low, 2.3-4.2)
    Testosterone (total): 374 (250-1100)
    Free T: 51.2 (35-155)
    Prolactin: 6 (2-18)
    FSH: 6.8 (1.4-18.1)
    LH: 2 (2-6)

    I got an MRI of my pituitary done, and that came back normal. The endo then did some more blood work:

    Free T4 - .99 (.8-1.80) N
    TSH - 2.9 (.40-4.0) N
    Free T3 - 2.2 (2.3-4.20) L
    Sodium, Potassium, Chloride, CO2 = all within range
    Fasting glucose - 88 (70-100) N
    BUN, Creatinine, BUN/CREATININE ratio, and GFR=all within normal range
    Calcium - 10.1 (8.5-10.4)
    TBG - 14.8 (12.7-25.1) N (but I think its low in range)
    Red Blood Cell Count - 3.87 (4.40-5.8) L
    Hemoglobin - 12.3 (13.8-17.2) L
    Hematocrit - 35.5 (41-50) L
    WBC, MCV, MCH, MCHC, RDW, PLATELET, ABS NEUTRO, ABS LYMPH, ABS MONO, ABS EOSINO, ABS BASO, NETURO, LYMPH, MONO, EOSINO, BASO = All in normal range.
    Estradiol - <30 (0-54) N
    HCG, serum - <5 (<5) N
    Testosterone - 455
    Cortisol,AM - 22 (4-22) N, but I think high in range.
    IGF - normal

    My endo "released" me back to my primary care physician. I asked why, given that I had erratic thyroid readings, and she wouldn't give a straight answer. She said "I'm not going to treat you with hormones." I said, "I'm not asking for that. Are there any more tests you can do?" "No, no more tests." She said my symptoms (which she said were plentiful) were non-specific to an endo problem. She said that my primary needed to check for anemia, but that my thyroid and pituitary were not to blame. She said that an "alternative doctor" would treat symptoms, but she doesn't. I'm confused because I wasn't really anemic in August, when my T levels and thyroid were obviously low, but now my symptoms are the same but lab results are flipped. Before I left the office yesterday morning, she did another CBC and called today to confirm that I was still mildly anemic (10 days after the last draw).

    Since getting off the T cream, my levels have steadily increased. My biggest complaints now are the low energy, bad mood, restless sleep, dead metabolism, dry skin and cold hands/feet, alternating constipation and diarrhea, low body hair growth, no sex drive, and constipation.

    I supplement a little with calcium, vit. D, B complex, and fish oil irregularly. For exercise, I try to lift (with P90X and similar programs) 2-3 days a week. I started running last week (one mile a day, once a week) and I play racquetball twice a week. I also do a little yoga, foam rolling, plyometrics, and whatever I'm in the mood for. I don't over train; I keep things under an hour most days. Due to the low energy, I can't really lift heavy or workout for a long period of time.

    Diet-wise, I get my protein from chicken, tuna, salmon, beef (a few times a month when I'm home from college), omega-3 eggs, and I used to use whey protein (cutting back a bit in the spirit of whole foods). I've been exploring the Wahls Diet for more vegetables, and I eat two salads a day with lots of color. Fats come from avocado, EVOO, walnuts, flax seed, and a little coconut oil/milk once in a while. Carbs from veggies, baked sweet potatoes, and quinoa. I avoid fruit and excess natural sugars because it gives me gas and loose stools (TMI?) I only drink water, with some yerba mate or almond milk every once in a while. Treats are decaf/small coffee (with Stevia when possible), baker's chocolate, and nut butter once in a while. I stick to 3 meals a day, not much snacking. I don't drink alcohol more than a few times a month.

    I'm seeing my primary on March 19, and I'm going to ask for iron panel and B12. Is there anything else I should ask for? Any lifestyle changes that would be advantageous? Obviously, being erroneously put on and taken off of thyroid and testosterone may have messed something up, but that doesn't address my initial problem.

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    Quote Originally Posted by cameron_cos View Post
    I was sent here by the folks at MarksDailyApple. I've been pricked half a dozen times since August, trying to figure out what's wrong with my body and hopefully someone here can help.

    Extensive Background: 21 year old male, 5'11, 205lbs.

    I used to be sedentary with a poor diet, and weighed 310 lbs. Growing up, I was active but always overweight. I was diagnosed with Scheuermann's Kyphosis in 2003-04 (age 13) with no treatment. From around age 12-15, I was being seen for high cholesterol (>300 trigs) and prehypertension (145/80). Throughout high school, I had (undiagnosed) depression and social anxiety. No family history of diagnosed thyroid, pituitary, or mental health issues.

    In June 2010, I started exercising and eating better. By Christmas, I was down to around 230-240, eating mostly chicken breast, black beans, oatmeal, and other easy dorm food. In January 2011, I started having really bad depression. Episodes of negative thought, low energy, emotional instability, confusion, social anxiety, etc. Even though my diet and exercise were good, I stopped losing weight until May. I sought counseling at University and some "sit-n-talk" sessions seemed to help a bit. By June, I was feeling a little better (not great) and I was down to 210 lbs with the help of a low-carb diet. In June 2011, I started eating the primal diet. I cut out most dairy, no grains, and experimented with keto (less than 30g carbs/day) and intermittent fasting.

    In June, this got a lot worse: I started having severe energy crashes. By the time I got home from work around 4pm, I didn't have the energy to workout. I was constantly "down", tired, sore (despite less frequent exercise), and I had frequent mood swings. This past summer was by far the worst I have felt mentally in my entire life. I was angry all the time, snapped at friends and family, alternating episodes of crushing depression and rage, and just wanted to sit down all day long. My body hair growth slowed significantly (I could never grow facial hair), my libido dropped to zero (very weak erections), my muscle tone declined, I began to sweat less intensely, and I lost interest in things that I used to care about (girls, reading, music, politics). I always used to be the type of person that was really warm, always needed a fan on in my room to sleep: then I completely reversed and I am now either comfortable in hot rooms or freezing. My feet especially were freezing during the summer.

    In August, I went to my family doctor and he tested me for a variety of "malaise" symptoms, as well as my typical cholesterol stuff. Here are those results (drawn around 9am, fasted):

    Total chol: 217
    Trig: 41
    HDL: 87.9
    Chol/HDL: 2.47
    Non-HDL Chol: 129.1
    VLDL: 8
    Direct LDL: 89
    Testosterone: 259.96 (flagged low, range: 262-870 ng/dL)
    Calcium: 10.2 (range: 8.4-10.2) Normal, despite not much milk
    BUN: 23 (flagged high, range: 7-19 mg/dL)
    Creatinine: 1.0 (.8-1.4)
    BUN Crea Ratio: 23 (flagged high, 13-21)
    GFR MALE: 100
    TSH: 2.44 (.38-3.30 uIU/mL)
    Free T3: .71 (flagged low, 2.1-3.8 pmol/L)
    Free T4: .92 (.82-1.63 ng/dL)
    [Hepatic panel was all normal. I can post if you need it]
    Magnesium: 4.7 (4-6.4)
    C-Reactive Protein: <0.3 (<.8)
    [Blood panel was all normal,except two noted below. Again, I can post if you have specific question]
    Hematocrit: 40.3 (flagged low, 41-50%)
    Lymphocytes: 49.7 (flagged high, 18-47%)
    RBC: 4.47 (barely normal, 4.4-5.8)
    Hemoglobin: 13.8 (13.8-17.2)
    Vitamin D3: 86 ng/ml (50-100)

    (Looking back, it seems I was borderline anemic at that point. But it wasn't addressed.)

    My doctor put me on 30mg/day Armour thyroid and a testosterone compound cream of 30mg/ml. In the first two weeks, my energy and mood felt better. But over the total three months, things did not improve and some symptoms got worse. I still had frequent mood swings, constant depression, NO libido or morning erections, low energy, no desire to workout, no interest in music/books/friends, constant mental fog/lack of concentration, constipation (2-4 days between movements), starting having "cold" attacks in which my hands were get ice cold for no reason, low waking temperature (96 F) dry skin on hands, still no sweating, hard to raise heart rate during exercise, impatience, feeling of stress without reason, shallow breathing pattern, slow hair growth (almost none), calf cramps at night, restless sleep/no dreaming, voice began cracking at random times, I stutter and lose my words frequently, which is causing me to be very quiet/introverted. Still couldn't lose weight (would like to lose 15 more lbs to be around a healthy My quality of life continued to decline.

    I got a referral to an endochronologist in December, and was ordered off of medication for a month to do more blood work. She said that I was objectively very healthy (had gained ~5-10 lbs since August due to less exercise) but that I was obviously subjectively not well. She said that I answered yes to almost every symptom she asked about. She asked, but did not explain why, how much dairy I ate (not much). I assume to get a gauge on my calcium intake. She said that she suspected thyroid and gonad issues related to pituitary function.

    Since I quit the Armour and cream this past month, the cold attacks have gone away, my hair is growing back a little bit quicker, my muscle tone is more sustained, erections a little bit stronger, but not much. Still feeling depressed and tired, and most of the other symptoms above. Here are results (got them over the phone, sorry no units), drawn at 7:50am, fasted:

    TSH: 2.3 (.4-4.0)
    Free T4: .79 (flagged low, .8-1.8)
    Free T3: 1.8 (flagged low, 2.3-4.2)
    Testosterone (total): 374 (250-1100)
    Free T: 51.2 (35-155)
    Prolactin: 6 (2-18)
    FSH: 6.8 (1.4-18.1)
    LH: 2 (2-6)

    I got an MRI of my pituitary done, and that came back normal. The endo then did some more blood work:

    Free T4 - .99 (.8-1.80) N
    TSH - 2.9 (.40-4.0) N
    Free T3 - 2.2 (2.3-4.20) L
    Sodium, Potassium, Chloride, CO2 = all within range
    Fasting glucose - 88 (70-100) N
    BUN, Creatinine, BUN/CREATININE ratio, and GFR=all within normal range
    Calcium - 10.1 (8.5-10.4)
    TBG - 14.8 (12.7-25.1) N (but I think its low in range)
    Red Blood Cell Count - 3.87 (4.40-5.8) L
    Hemoglobin - 12.3 (13.8-17.2) L
    Hematocrit - 35.5 (41-50) L
    WBC, MCV, MCH, MCHC, RDW, PLATELET, ABS NEUTRO, ABS LYMPH, ABS MONO, ABS EOSINO, ABS BASO, NETURO, LYMPH, MONO, EOSINO, BASO = All in normal range.
    Estradiol - <30 (0-54) N
    HCG, serum - <5 (<5) N
    Testosterone - 455
    Cortisol,AM - 22 (4-22) N, but I think high in range.
    IGF - normal

    My endo "released" me back to my primary care physician. I asked why, given that I had erratic thyroid readings, and she wouldn't give a straight answer. She said "I'm not going to treat you with hormones." I said, "I'm not asking for that. Are there any more tests you can do?" "No, no more tests." She said my symptoms (which she said were plentiful) were non-specific to an endo problem. She said that my primary needed to check for anemia, but that my thyroid and pituitary were not to blame. She said that an "alternative doctor" would treat symptoms, but she doesn't. I'm confused because I wasn't really anemic in August, when my T levels and thyroid were obviously low, but now my symptoms are the same but lab results are flipped. Before I left the office yesterday morning, she did another CBC and called today to confirm that I was still mildly anemic (10 days after the last draw).

    Since getting off the T cream, my levels have steadily increased. My biggest complaints now are the low energy, bad mood, restless sleep, dead metabolism, dry skin and cold hands/feet, alternating constipation and diarrhea, low body hair growth, no sex drive, and constipation.

    I supplement a little with calcium, vit. D, B complex, and fish oil irregularly. For exercise, I try to lift (with P90X and similar programs) 2-3 days a week. I started running last week (one mile a day, once a week) and I play racquetball twice a week. I also do a little yoga, foam rolling, plyometrics, and whatever I'm in the mood for. I don't over train; I keep things under an hour most days. Due to the low energy, I can't really lift heavy or workout for a long period of time.

    Diet-wise, I get my protein from chicken, tuna, salmon, beef (a few times a month when I'm home from college), omega-3 eggs, and I used to use whey protein (cutting back a bit in the spirit of whole foods). I've been exploring the Wahls Diet for more vegetables, and I eat two salads a day with lots of color. Fats come from avocado, EVOO, walnuts, flax seed, and a little coconut oil/milk once in a while. Carbs from veggies, baked sweet potatoes, and quinoa. I avoid fruit and excess natural sugars because it gives me gas and loose stools (TMI?) I only drink water, with some yerba mate or almond milk every once in a while. Treats are decaf/small coffee (with Stevia when possible), baker's chocolate, and nut butter once in a while. I stick to 3 meals a day, not much snacking. I don't drink alcohol more than a few times a month.

    I'm seeing my primary on March 19, and I'm going to ask for iron panel and B12. Is there anything else I should ask for? Any lifestyle changes that would be advantageous? Obviously, being erroneously put on and taken off of thyroid and testosterone may have messed something up, but that doesn't address my initial problem.
    i would ask you why you are having these issues through further evaluation asking more detailed questions.
    Your TT is workable, but your thyroid is low need to look for reason why.
    I am not a medical Dr, please keep in mind that this answer is for information purposes only, and is not intended to diagnose, treat or replace sound medical advice from your physician or health care provider.
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    My endo says thyroid isn't low enough to be concerned.
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    Quote Originally Posted by cameron_cos View Post
    My endo says thyroid isn't low enough to be concerned.
    Find a new DR because he is not properly educated and should be focusing on the person not a piece of paper. My concern is thyroid yes, but why is your iron level so low. Some times correcting why anemia is happening as I have seen in clinical cases will jump start thyroid. There are a lot more layers to your case. Endo barking up the wrong tree completely. This is not just a hormonal issue, but something which totally outside of hormones. Remember hormones are only an expressions of deeper issues..(>%95) of the time. Unfortunately this is called Work which many medical professionals do not like to do instead you end up being bounced like a ping pong ball through medical system. I have been there as this is why, I am a huge advocate of getting to the root cause of the issue rather then just dealing with symptoms or bandaid effects.
    I am not a medical Dr, please keep in mind that this answer is for information purposes only, and is not intended to diagnose, treat or replace sound medical advice from your physician or health care provider.
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    So, in addition to a more complete check for anemia (iron, B-12), what other issues do you think could be checked for? I agree, treating the cause should be the primary concern, but I'd like to be able to walk into my doctor's office with a list of suggestions to help pinpoint the solution. When I walked into my primary care doctor's office in August, he ran a bunch of tests for "malaise", saw my thyroid and testosterone were low and immediately began treatment. I think that was too quick and he didn't do enough to identify the causes of these issues (including ignoring mild anemia at the time). Since I've been eating a bit more, my testosterone is trending up and I'm less cold, but I believe there are still underlying issues of depression, low sex drive, and other symptoms.
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    Quote Originally Posted by cameron_cos View Post
    So, in addition to a more complete check for anemia (iron, B-12), what other issues do you think could be checked for? I agree, treating the cause should be the primary concern, but I'd like to be able to walk into my doctor's office with a list of suggestions to help pinpoint the solution. When I walked into my primary care doctor's office in August, he ran a bunch of tests for "malaise", saw my thyroid and testosterone were low and immediately began treatment. I think that was too quick and he didn't do enough to identify the causes of these issues (including ignoring mild anemia at the time). Since I've been eating a bit more, my testosterone is trending up and I'm less cold, but I believe there are still underlying issues of depression, low sex drive, and other symptoms.
    Where are you located at? I have a huge net work of Dr's I am associate with across the united states.
    I am not a medical Dr, please keep in mind that this answer is for information purposes only, and is not intended to diagnose, treat or replace sound medical advice from your physician or health care provider.
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    Ohio. Columbus/Dayton.

    Aside from getting a new doctor (I'm limited with insurance, transportation) what should i ask my doctor to check for?
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