Low Free Test

[eeso]

I'm off HRT, here are my most recent labs. 23, in shape, weight trainer. Was on HRT for 2 years, came off a few months ago. I've done some searching of the forums and found some similiar senarios but no answers, so I thought I'd do my own thread.


Cortisol 800 nmol/L (220 - 660) High
TSH 4.5 pmol/L (0.40 - 4.00) High

free Thyroxine (ft4) 16 pmol/L (10-20)
free T3 5.4 pmol/L (2.8-6.8)

LH 9 U/L (3-20)
FSH 5 U/L (3-20)

Estradiol 134 pmol/L (40-250) High - should be 36-110
Progesterone 2 nmol/L ( < 3)

Testosterone 21 nmol/L (10.0 - 33.0)
Free Test 61 pmol/L (60-130) Low
SHBG 15 nmol/L (13-71)


I also had DHEA done and it was midrange I think, I don't have the copy.

Anyway, my free test sucks and I feel lousy. I get pretty lethargic the day after big workouts. I generally feel "ok" but I have ZERO sex drive, and when I do get it up I seem to have premature ejac??? I've never had this before. When I was on HRT, it was a bit of guess work getting my levels right, but when I did I could go for aaages. Now I can't even get it up hardly and when I do I'm done!! Not good.

I've tried using arimidex to lower my E2 to try and boost my Free Test but I don't seem to be feeling any different.

The doc wants me to get some more blood tests in a few weeks to see if my TSH is still high. Should I get an insulin sensitivity test? Or anything else?

It's wierd because when I was on TRT my free test was really good. Like, my total test would be high 20's the day after a shot, and free test would also be right up there. But now I'm natural and total test is ok, yet free test sucks!

All comments most welcome.

Thanks

[marianco]

Originally Posted by eeso

I'm off HRT, here are my most recent labs. 23, in shape, weight trainer. Was on HRT for 2 years, came off a few months ago. I've done some searching of the forums and found some similiar senarios but no answers, so I thought I'd do my own thread.


Cortisol 800 nmol/L (220 - 660) High
TSH 4.5 pmol/L (0.40 - 4.00) High

free Thyroxine (ft4) 16 pmol/L (10-20)
free T3 5.4 pmol/L (2.8-6.8)

LH 9 U/L (3-20)
FSH 5 U/L (3-20)

Estradiol 134 pmol/L (40-250) High - should be 36-110
Progesterone 2 nmol/L ( < 3)

Testosterone 21 nmol/L (10.0 - 33.0)
Free Test 61 pmol/L (60-130) Low
SHBG 15 nmol/L (13-71)


I also had DHEA done and it was midrange I think, I don't have the copy.

Anyway, my free test sucks and I feel lousy. I get pretty lethargic the day after big workouts. I generally feel "ok" but I have ZERO sex drive, and when I do get it up I seem to have premature ejac??? I've never had this before. When I was on HRT, it was a bit of guess work getting my levels right, but when I did I could go for aaages. Now I can't even get it up hardly and when I do I'm done!! Not good.

I've tried using arimidex to lower my E2 to try and boost my Free Test but I don't seem to be feeling any different.

The doc wants me to get some more blood tests in a few weeks to see if my TSH is still high. Should I get an insulin sensitivity test? Or anything else?

It's wierd because when I was on TRT my free test was really good. Like, my total test would be high 20's the day after a shot, and free test would also be right up there. But now I'm natural and total test is ok, yet free test sucks!

All comments most welcome.

Thanks

It would be best to convert the units into conventional units rather than leave it as ISO units, so that more of us can understand what is occurring.

Cortisol = 800 nmol/L = 29.0 mcg/dl
TSH = 4.5 pmol/L
Free T4 = 16 pmol/L = 1.24 ng/dl
Free T3 = 5.4 pmol/L = 350 pg/dl
LH 9 U/L (3-20)
FSH 5 U/L (3-20)
Estradiol = 134 pmol/L = 36.5 pg/ml
Progesterone = 2 nmol/L = 0.63 ng/dl
Testosterone = 21 nmol/L = 605 ng/dl
Free Testosterone = 61 pmol/L = 16.6 pg/ml
SHBG = 15 nmol/L (13-71)

CORTISOL, PROGESTERONE: high cortisol indicates that a person is under stress. Low DHEA, low Progesterone (< 1.0), low to low normal glucose (e.g. < 93 mg/dl) are clues that adrenal fatigue may be occurring even with a high cortisol. A saliva cortisol measurement with at least four samples in a day may indicate the presence of adrenal fatigue.

TSH, Free T3, Free T4: TSH > 2.0 or Free T3 < 3.3 or Free T4 < 1.1 is suspicious for hypothyroidism. This can be verified by history and physical exam. Many people have normal thyroid hormone levels. However they are still clinically hypothyroid (by history and physical). These people may have hypothyroidism type 2 - thyroid hormone resistance due to defective mitochondrial DNA. Despite normal thyroid hormone levels, they actually need more. There is no test for hypothyroidism type 2. The best test is a trial on thyroid hormone (e.g. Armour Thyroid).

TESTOSTERONE: A total testosterone over 600 ng/dl generally would not indicate the need for testosterone replacement. If there are problems such as lack of energy, low sex drive, premature ejactulation - then there are problems with the other hormones or neurotransmitters - not with testosterone. Testosterone treatment may indirectly improve these other hormones - such as by improving thyroid hormone production - resulting in improved functioning. But it would be best to address the other hormone problems directly.

ESTRADIOL: Depending on the person, estradiol can be too high or too low. Some men, for example, benefit from maintaining estradiol below 30, some need a level closer to 40, some like it between 20-30, some like a ratio of testosterone to estradiol of about 20:1, some do better at 40:1. It all depends on the individual. High estradiol - such as from having significant abdominal fat - can increase thyroid binding globulin. This can cause a relative decrease in thyroid hormones, causing hypothyroidism. Estradiol also can compete with thyroid hormone for the thyroid hormone receptor, reducing thyroid hormone's effects.

FREE TESTOSTERONE, SHBG: Free testosterone does not indicate testosterone's activity. Total testosterone is the best measure of testosterone's activity. Bioavailable testosterone is a close second. Free testosterone is related to SHBG and Albumin. Since Albumin is usually steadily produced unless one has severe dehydration or some life threatening disease, Free testosterone is most closely linked to SHBG. Free testosterone when high or low tells us there is a problem with one of several hormones. A Free testosterone can be normal when two opposing hormonal problems cancel each other's effect on SHBG. SHBG is increased by thyroid, estradiol, progesterone. SHBG is lowered by testosterone, DHEA, insulin, growth hormone, and other androgens. Conditions where SHBG can be low include: hypothyroidism, low estradiol (low aromatase), low progesterone (such as in adrenal fatigue), high insulin (as in diabetes or insulin resistance), high testosterone or DHEA.

[eeso]

Ok so next blood work I get done, should I have an insulin resistence test done as well?

Anything else?

I'm getting all the same labs done again...

[eeso]

Oh also, I dunno if this is relevant, but I also have alpha-thallassemia-minor. Runs in the family.

It's just a blood condition where my red blood cells are oblong shaped or something or other...apparently only matters if I have a kid with a girl who is of the same condition, but that would be very unlikely, especially in Aus.

[marianco]

Originally Posted by eeso

Ok so next blood work I get done, should I have an insulin resistence test done as well?

Anything else?

I'm getting all the same labs done again...

A list of the initial labs I may do is listed here: The Labs I Run. Which ones I choose depends on the person's circumstance, and what I am interested in examining.

[jaydee]

wow marianco, your hormone profile is exactly the same as mine and i have zero sex drive and cant get it up.

My story is i came off finasteride about 6 months and have not recovered. My DHT is low but just within range. Have you ever used finasteride before? Have you checked your DHT?

I dont get it cause my SHBG and E are both in check??? I wonder WTF is going on?

[jaydee]

wow marianco, your hormone profile is exactly the same as mine and i have ZERO libido and cant get it up.

My story is i came off finasteride about 6 months and have not recovered. My DHT is low but just within range. Have you ever used finasteride before? Have you checked your DHT?

I dont get it cause my SHBG and E are both in check??? I wonder WTF is going on?

[eeso]

I used finasteride for a while when i was on HRT but i didnt really notice anything on it apart from it clearing up any acne I had.

My problem is definately free test - i dont have enough to get it up.

And that's not marianco's profile, it's another posters, it's just that the quoting thing didnt work.

[1cc]

Originally Posted by eeso

I used finasteride for a while when i was on HRT but i didnt really notice anything on it apart from it clearing up any acne I had.

Your DHT is probably whats causing your problem because of the finasteride use. Have DHT checked.

[marianco]

Originally Posted by 1cc

Your DHT is probably whats causing your problem because of the finasteride use. Have DHT checked.

When lack of energy is a symptom, generally the thyroid glands or adrenal glands or both are affected by whatever underlying problems there are.

Hypothyroidism and Adrenal Fatigue/Adrenal Depletion can result in low sex drive.

For example,

if a person has too much estradiol, the estradiol can increase thyroid binding globulin to the point of reducing available thyroid hormone excessively.

If a person has low testosterone production, then less thyroid hormone production may result, depending on the person.

If a person has high stress levels, then the adrenal glands may become depleted, resulting in fatigue.

If the pituitary ages and is not capable of producing enough TSH, then low thyroid hormone production may result.

If a person has mania of bipolar disorder, the high norepinephrine levels can lead to adrenal depletion and fatigue.

etc. etc.

[1cc]

Originally Posted by marianco

When lack of energy is a symptom, generally the thyroid glands or adrenal glands or both are affected by whatever underlying problems there are.

Hypothyroidism and Adrenal Fatigue/Adrenal Depletion can result in low sex drive.

For example,

if a person has too much estradiol, the estradiol can increase thyroid binding globulin to the point of reducing available thyroid hormone excessively.

If a person has low testosterone production, then less thyroid hormone production may result, depending on the person.

If a person has high stress levels, then the adrenal glands may become depleted, resulting in fatigue.

If the pituitary ages and is not capable of producing enough TSH, then low thyroid hormone production may result.

If a person has mania of bipolar disorder, the high norepinephrine levels can lead to adrenal depletion and fatigue.

etc. etc.

You are correct Marianco and have addressed his problem comprehensively. I forgot to qualify my post in that it was in reference to his ED problem, which he mentioned in a different thread. I know someone however you did "crash" with extreme fatigue after taking finasteride for one week.

[smitty4]

Originally Posted by 1cc

You are correct Marianco and have addressed his problem comprehensively. I forgot to qualify my post in that it was in reference to his ED problem, which he mentioned in a different thread. I know someone however you did "crash" with extreme fatigue after taking finasteride for one week.

Did you mean to say that you know someone however WHO did "crash" with extreme fatigue after taking finasteride for one week?

[1cc]

Originally Posted by smitty4

Did you mean to say that you know someone however WHO did "crash" with extreme fatigue after taking finasteride for one week?

Yep. Sorry, now I see the typo.

[eeso]

I dunno, I can't even remember the last time I used finasteride. Must be 6months ago. And as I said I never really noticed it do anything.

[marianco]

Originally Posted by 1cc

You are correct Marianco and have addressed his problem comprehensively. I forgot to qualify my post in that it was in reference to his ED problem, which he mentioned in a different thread. I know someone however you did "crash" with extreme fatigue after taking finasteride for one week.

The question would be why would finasteride cause extreme fatigue. It is unclear why it would do this.

Finasteride works by blocking 5-alpha-reductase. There are three types. Finasteride blocks one of them, but may also block the others to a lesser extent but that may depend on the person.

5-alpha-reductase transforms testosterone into dihydrotestosterone. Blocking the enzyme reduces DHT, resulting in hair-growth for some men.

5-alphe-reductase also happens to have other important functions. In the brain, it transforms progesterone into allopregnenolone. Allopregnenolone is the signal for brain glia cells to wrap neuron axons with the insulating material called myelin, so that nerve signals can travel faster. If this function is impaired, then nerves may lose their insulation, resulting in havoc in the brain. Nerve signals can be short-circuited, for example by traveling to neighbor neurons which were not suppose to receive the signal. Such a situation may take possibly a long time to correct, producing the problems from Finasteride which some people experience. Note that the large majority of men who use Finasteride do not get these side effects, as far as we know, and as far as the FDA knows. But some men are susceptible to it.

If the metabolism of progesterone and potentially other hormones which depend on 5-alpha-reductase function is disturbed, perhaps since progesterone is also made by the adrenal glands, then impairment of cortisol production may occur, resulting in a condition like adrenal fatigue. The reduction in cortisol production may also lead to an impairment in deiodinase enzyme activity, resulting in lower thyroid hormone. These and other metabolic cascades may be contributing factors to why some people with Finasteride have problems.

This is speculation on my part, though some articles note problems when 5-alpha-reductase blockade occurs.