Hello everyone. I'm hoping to get some input on my latest blood work. I'm currently seeing an endochronologist, but I'd like to hear if anyone has had similar problems, to help me through this. I heard that you guys prefer too much info to too littler, so here you go. I'll give you my life story, health wise, my diet and weight loss history, and then my blood work results.

Extensive Background: 21 year old male, 5'11, ~200 lbs.

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. Memorial Day weekend 2004, I had was riding an ATV without a helmet, had an accident, and hit the back of my head. Did not black out, but had a mild concussion. No treatment or complaints beyond a headache and mental fog. I still have occasional head aches and neck pain. From around age 12-15, I was being seen for high cholesterol (>300 trigs) and prehypertension (145/80): no medication, just general lifestyle advice. 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. 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 down on my dairy intake (calcium), 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
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)
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 the 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%)
Vitamin D3: 86 ng/ml (50-100)

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. I got the blood work done last week. 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)

The nurse said that the endo wants to get a TRH and MRI of my pituitary gland. She said the thyroid results exhibited an "abnormal pattern". I am in the process of getting that scheduled in the near future. She did not explicitly comment on my testosterone, but I asked her to mention it to the endo. An otherwise healthy, physically active 21 year old with a very healthy diet should not have a low-range T level. She obliged. I'm going to also ask for some other sex hormones and possibly cortisol tests. Any recommendations?

I currently supplement with a little omega 3 fish oil (1-3g/day), multivitamin, 5000 IU D3 and calcium every other day, Super B Complex and 1000 mg C opposite days, 250 mg magnesium/50mg zinc opposite days, and some Animal "beef aminos" on hard workout days. For the past few weeks, I've also taken a Potent Men's Formula was some guarana, yohimbe, and other herbs that are supposed to boost libido. 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 for time, twice 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.

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 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 and baked sweet potatoes. I avoid fruit and excess natural sugars because it gives me gas and loose stools (TMI?) Liquids are ice water, green/white tea, yerba mate, goat's milk once in a blue moon, and the occasional glass of red wine. 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've been toying with the idea of a Dr. Kruse-style Leptin Reset.

That's it: Any pointers? First and foremost, I'd like my mind back. I have been mentally sub-par for some time, not feeling like myself. I feel empty and small as a man. I have gone from an initially morbidly obese but loud, extroverted, comic relief jokester with manageable bouts of depression to an in-shape but loathsome, constantly depressed, mentally-fogged introvert with no energy. I WANT MY LIFE BACK. If anyone has had any similar lab work or experience with pituitary issues, I'd really appreciate your insights. I'm interested in not only figuring out my medical results, but also to know what changes I can make to help my doctor's treatment succeed (lifestyle, diet, alt. medicine).

Thanks for reading my tome haha.
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replied January 31st, 2012
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First of all, I am happy that the endo took you off of the Armour. Your TSH is in the normal range and the T3 test being low is not a reason alone to give you thyroid medication. They aren't an accurate test of thyroid function. You got a temporary boost that probably came from being hyperthyroid for a while, but then you got worse again. Plus, Armour thyroid is unreliable from batch to batch because it's made from pig thyroids. If your endocrinologist wants to put you on thyroid medication again, Synthroid (and maybe a little Cytomel if you are still feeling poorly after a few months) is a better, more reliable way.

I think some of your issues may be dietary. It sounded like a lot of your issues got worse when you started the cave man diet stuff and cut your carbs way down. The brain needs glucose to function. I know you want to lose weight, but I think you're opting for fast rather than healthy. Your diet may also be throwing your blood chemistry off, too. You need to talk to your doctor about what you've been eating and maybe ask about seeing a nutritionist. I'm sort of getting the impression that you may be getting a little obsessive about what you eat and about your weight (I apologize if that is not the case) and that isn't good either. It's good to want to be healthy and fit, but not if it's going so far that it makes you sick. Also, you seem to be chasing these fad diets, like the low carb and the leptin reset. That's not healthy, that's just fad. Just because someone wrote a book and got on a talk show doesn't mean that they know what they are talking about.

I also think that depression is an issue. Have you considered asking your doctor about an antidepressant? I don't think that is the source of all your symptoms, but I think that it would go a long way to making you feel better.

I think you should stick with the endocrinologist for now. I wish I could be of more help, but your case is rather complicated. I wouldn't delve into alternative medicine unless you talk to your doctor first. Some of those things can have side-effects that you may not know about (like thyroid side-effects). You don't need to go playing with things. Let the doctor handle it at this point.

Best of luck.
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