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Investigating causes for Low T, Cortisol + hormone deficiencies

testosterone depression cortisol hormones

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#1 AlexCanada

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Posted 10 June 2015 - 04:21 AM


Hello. I am fortunate enough to have an Endo appointment this Thursday. I am hoping to finally get some treatment for extremely low Testosterone levels. Here are my may 25th 2015 results for reference.

 

Testosterone Total:   2.3 nmol/L               range:    8 - 32
SHBG  34 nmol/L                      range:   11-78
Testosterone, Bioavailable (calc):     1.0 nmol/L         range:  4-17
Estradiol:           <37    pmol/L                 range:   40-162 
 
And here is a test 1 year ago from may 27th 2014:
 

Free Testosterone  28              range:     31 -94 pmol/L

ACTH 2                   <10 pmol/L

Cortisol AM 191          range:   170-540nmol/L                           -other times turned out 70, and 200, 

Total testosterone 12.6            range:  7.6- 31.4 nmol/L    

LH  2              2-9 IU/L

FSH  4                            2-12 IU/L

Prolactin  8             <18ug/l   

Norepinephrine  1.2          0.8-3.4 nmol/L

Epinephrine <0.1                   <0.8 nmol/L

Estradiol  57              <157 pmol/L

 

And previous random TSH tests indicated: 5.01,  3.4, 5.6, and various ranges between 3.2 - 5.    I have not TSH tested in the past few months.  Hashimoto antibodies were tested and are <10 so that is ruled out.

 

My Symptoms:    I basically been very anhedonic, depressed, withdrawn, unmotivated, disinterested, no sex drive, social withdrawl, low energy, poor memory, uncomfortable physical anxiety on and off, poor stamina and easily drained after physical activity, carrying anything usually causes me to feel dehydrated or dreadfully worn out, irritability, brain fog, poor memory, sleep inconsistencies, hypoglycemia, prone to fungal infections, pains and tightness and possible inflammation in my neck, peripheral circulation issues, dark circles under my eyes, collagen loss and notable wrinkles around my eyes, thin skin, poor wound healing, slightly yellow skin on my face. 

 

I am early 30's. Thin composition. 5'7, 130. Low body fat aside from my legs and butt and slightly on belly. 

 

 

Potential factors for my problems: A tremendous catastrophic decline in my health when I had a life threatening reaction to Accutane when I was 18. There have been class action lawsuits and has been removed from the market in over 11 countries including the United States. Had links to endo issues, lower serotonin levels, IBS and a whole host of other long lasting conditions.   Additionally I been long withdrawing from Valium for the past 4 years. From 5mg+ I am down to 1.2mg.  Also some pregnenolone moderate dose use a few years ago combined with too quick benzo withdrawal + chronic stress... this caused me to crash hard and had what resembled an Adrenal Crisis. Slowly that would improve.  Some SSRI use over the years but not much lately (many are known to raise prolactin levels). Cymbalta was last used little over a year ago. My T was higher then than it is now.

 

What helped a bit for hormones was Royal Jelly + ginkgo Biloba but these days I have very bad reactions to royal jelly. Possible due to brand but I just really rather avoid it.  Eleuthero Root + other ginsengs I noticed had some pro-hormone effects but the side effects are often very undesirable including immense sedation (korean ginseng), palpatations, and lower blood sugar.

 

 

What I would like to know is how can I prepare myself for my endo appointment to allow him to investigate causes?  I have a list of things I feel are important to get tested.  Free T, Total T, Estradiol, LH, FSH, Cortisol Am, Cortisol afternoon, TSH, Free T3, UREA. 

 

I want to know what else I should look out for or bring to my doctor's attention? I will print out for him a few studies indicating Low T leads to depression as he is pretty old fashioned and previously recommended I just go back to my psychiatrist. But the reason I have some optimism is that he stated if my T results were slightly lower than that of the 2014 may tests then he would treat me. I will take him up on that. 

 

         "The partial androgen deficiency of aging males (PADAM) is responsible for a variety of behavioral symptoms, such as weakness, fatigue, decreased libido, depressive mood, lack of motivation and energy, lower psychological vitality, anxiety, irritability, insomnia, decreased work and sport performances, difficulty in concentrating, memory impairment and low dominance. Psychological and behavioral aspects of PADAM overlap with signs and symptoms of major depression."
 
 
I would like to get a pituitary MRI but doubt he will agree. 
 
I'm sure he will try to find the underlying cause to some extent (or am I too optimistic?) but I think I will need to provide him with some solid information from reputable studies.  If anyone has any ideas please let me know. Especially links to accutane, pituitary, and so on. 
 
 
 
 
 

 

 


Edited by AlexCanada, 10 June 2015 - 04:33 AM.


#2 AlexCanada

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Posted 10 June 2015 - 04:27 AM

I do strongly believe adrenal exhaustion/adrenal fatigue is a huge component. I don't think he will be willing to give me Cortef though. In physiological doses it does not suppress he body's natural cortisol production but I'd need to provide him reliable source if I have any chance.

 

I would like him to provide as comprehensive testing as possible but I know he will miss things just like the previous Endo from the same clinic. And that guy was the former vice president of a drug company! I kid you not. He was the kind of doctor who gave me back those May 2014 tests and didn't explain anything about them. A meager 5 minute appointment and he just called for an ACTH stimulation test which is useless for anything besides near complete adrenal failure. I had to find out from this forum that the test results indicated Central Nervous System Depression. Was one of the most robotic individuals I had ever met unfortunately. 

 

 

 

Current endo might prescribe me Testosterone but I would like to be able to treat the underlying cause as well.  I am not the most cognitively competent right now so any suggestions or advice would be extremely appreciated.  I started posting on this forum maybe a month ago. Back then it took a lot of courage for me to even make my first post. My stress response was through the roof and I additionally just had no desire to speak to anyone. I have found some great information on here from many members which I am immensely thankful and grateful for. I hope I will manage to find a road to recovery within all of this.   Thank you all for your help thus far.  It really means a lot to me. 


Edited by AlexCanada, 10 June 2015 - 04:39 AM.


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#3 AlexCanada

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Posted 10 June 2015 - 07:31 AM

http://www.ncbi.nlm....pubmed/25721216              

The effect of different doses of isotretinoin (accutane) on pituitary hormones.

 

RESULTS:

After 3 months of treatment with ISO, luteinizing hormone (LH) (p < 0.001), prolactin (p < 0.001), total testosterone (p < 0.001), adrenocorticotropic hormone (ACTH) (p < 0.001), cortisol (p < 0.001), insulin-like growth factor-binding protein 3 (p < 0.001), insulin-like growth factor 1 (IGF-1) (p = 0.002), growth hormone (GH) (p = 0.002) and free T3 (fT3) (p < 0.001) levels had decreased significantly. Furthermore, we split data into three different groups. Among the patients receiving intermittent-dose ISO, LH, ACTH, IGF-1, GH and fT3 measurements lost significance. Most of the significant measurements observed in the whole group were also significant among the patients receiving high-dose ISO. Additionally, dehydroepiandrosterone sulfate (p = 0.003) levels increased, and free T4 levels decreased significantly.


Edited by AlexCanada, 10 June 2015 - 07:31 AM.


#4 AlexCanada

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Posted 11 June 2015 - 09:19 PM

The doc prescribed me some Androgel, and I think it's covered here in Canada. If not they will switch it to something else.

 

I wish he had just listened to me 5 months ago. He didn't really want to listen to any of my symptoms or concerns over my low cortisol function. Nor did he care about trying to find out the root cause. Instead he said depression causes low testosterone.  What a load of nonsense. More like the other way around. Because who on earth would feel good, motivated, and happy in their life if their T levels were through the floor?   Can you imagine a doctor giving you Cymbalta for low T levels?  Yet this quack basically implied that's what should be done. Apparently this genius didn't get the memo that various SSRI's reduce T levels via raising prolactin.

 

 

Low T and Depression Connection: 

 

http://www.ncbi.nlm....pubmed/16760626

 

"The partial androgen deficiency of aging males (PADAM) is responsible for a variety of behavioral symptoms, such as weakness, fatigue, decreased libido, depressive mood, lack of motivation and energy, lower psychological vitality, anxiety, irritability, insomnia, decreased work and sport performances, difficulty in concentrating, memory impairment and low dominance. Psychological and behavioral aspects of PADAM overlap with signs and symptoms of major depression."

 

 

 

 

But no point getting it in with him. He is one of the biggest Endos in all of Ontario and yet he knows honestly next to nothing about TRT. He didn't even want to do a metabolic panel.  It was very rush rush, 5 minute appointment. Just like all those other knuckleheads at LMC. 

 

At least I got the prescription though.:)      



#5 Lufega

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Posted 06 August 2015 - 12:26 PM

Interesting thread.  I'd like to follow up with your progress.  I'm in the same boat as you.  Took accutane and my body hasn't been the same since.  I finally realized my T is also low and I've been trying to boost it ever since.

 

I can say with confidence that I've tried almost everything.  So I know what works and what doesn't.  Most interventions will be a dead end because they're not targeting the real problem..reversing whatever pathway was affected by accutane.

 

Royal jelly also worked for me but it only boosted my T levels by 100 points.  However, it sent my libido through the roof.  It became an annoyance after a while.

 

Ginger also worked but it was dose dependent for me and I got sides.

 

I'm entertaining the idea that using accutane disrupted the methylation pathway that's needed to make hormones like testosterone and I'm currently experimenting with it.  My current bad mood could mean that it's working.



#6 Caravaggio

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Posted 17 March 2016 - 08:47 PM

Guys, I don't think the Isotretinoin is the cause of your symptoms. Low libido may be the only symptom that is caused by it. I also got all the other symptoms Alex mentioned in the first post but I never took Isotretinoin, so I don't have the low libido.

 

But just recently I tried a Beta-Sitosterol complex to decrease my acne/oily skin and BPH. While masturbating it was really hard to keep it hard and there was no real orgasm.  :blush:

 

Then I dropped it and used my old pantothenic acid pills (1000 mg) because I read it helps with adrenal fatigue (I matched nearly all the symptoms) and I also took EGCG (tried it with L-DOPA to raise Dopamine level but it had no effect on me).

 

This combination almost turned me impotent. Then I realized that I took 3 5-alpha-reductase inhibitors at the same time which seemed to kill my DHT-level.

 

I think Isotretinoin does the same, but permanently. So my conclusion is that the adrenal fatigue causes some problem with the DHT and in combination with Isotretinoin it really kills the DHT-level.

 

I'm now also dropping the pantothenic acid and the EGCG and hope my libido will get normal again.

 

Also taking Creatine as a DHT-booster to speed it up.

 

Study about 5AR and Isotretinoin: http://www.ncbi.nlm..../pubmed/9298137



#7 Lufega

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Posted 18 March 2016 - 04:25 AM

Im having some success combining biogaia gastrus and 600 mg nac. Getting a noticeabe T boost. Voice is deeper and facial hair is coming in more. That probiotic definitely has an effect for me. Also, my energy levels are up.
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#8 Polyamine

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Posted 18 March 2016 - 10:23 AM

It has been my belief for a long time that Accutane usage decreased a large assortment of GI bacteria as shown by its high incidence of GI side effects and patients that ultimately get IBS.  I know L. reuteri often shows up in the literature but Bifidobacterium would be my main concern.  There are certainly dozens of other beneficial bacteria that were affected.  My thoughts coincide with a study published in 2014.

 

http://www.ncbi.nlm....les/PMC3879365/

 

http://www.cell.com/...90?showall=true


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#9 Polyamine

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Posted 19 March 2016 - 07:31 AM

Adding to the above post.

 

There are certainly dozens of

other beneficial bacteria that were affected.  I would anticipate an elevation of Bilophila and Bacteroides in addition to many other bacteria that can be

pathogenic when in higher concentrations.  I would attempt to change my GI flora through an altered diet low in protein and protiotics.  This is the exact opposite

from what you would want to do to increase testosterone but you need to alter your flora before you begin to ramp up the amino acids.  The good news is our GI

flora changes rapidly.  You could experience negative sequelae from this alteration in diet.  The pieces of the puzzle are here but there is no literature putting

them all together as I have done.  Good luck.


http://www.ncbi.nlm....les/PMC3879365/


http://www.cell.com/...er.com/retrieve


http://www.nature.co...jg2011308a.html


http://www.nature.co...ature12820.html


 


Edited by Polyamine, 19 March 2016 - 07:32 AM.

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#10 stolpioni

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Posted 25 March 2016 - 07:08 PM

I also had very low T (both total and free), about same as you. My TSH was 4.89, so almost as bad as yours.

I got on Levothyroxine and got my TSH down to 1.5. Now my total testosterone is over 700 ng/dl and free testosterone is

in the upper ranges.

 

Good luck!







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