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Tired of feeling tired - Please help.

Discussion in 'Hormones' started by tiredofbeingtired, Sep 16, 2013.

  1. tiredofbeingtired

    tiredofbeingtired

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    Hi everyone,

    I am a 27 year old female and have been feeling "off" for quite some time now. I have been experiencing a myriad of symptoms related to a hormonal imbalance, such as: chronic fatigue, PMS, hair loss, acne, mood swings, anxiety, unwanted hair growth, cold hands/feet, hot flashes, etc.

    I got some blood work done a few months ago and will post the results below. I'm not sure if it could be hypothyroidism, PCOS or anything else that may be the root of my problems. I noticed that my estrogen levels are low and my testosterone levels are high. Any insight or opinions any of you can offer would be greatly appreciated.

    Thanks in advance.

    TSH 1.91 Reference Range 0.30-5.60 MU/L
    FREE T4 11.7 Reference Range 7.2-21.0 PMOL/L
    FREE T3 4.6 Reference Range 2.9-6.0 PMOL/L
    Vitamin B12 491 Reference Range >133 PMOL/L
    Ferritin 46 Reference Range 11-145 UG/L
    LH SERUM 0.6 Reference Range 1.2-12.9 IU/L
    FSH SERUM 1.3 Reference Range 1.8-5.1
    Testosterone 1.5 Reference Range 0.4-2.6 NMOL/L
    Estradiol 295 Reference Range 180-1068 PMOL/L
    Progesterone 17.0 Reference Range 16.4-59.0 NMOL/L
    Prolactin 14.0 Reference Range 3.3-26.7 UG/L
    DHEAS 8.2 Reference Range <11.0 UMOL/L
  2. Beyond

    Beyond 10% of discount in iHerb!--> PEZ915

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    You have low estrogen: lh, fsh estradiol and progesterone. Those defficiencies cause a myriad of symptoms on their own. Maybe artificially replenishing them would help, but being so young you will need to dig deeper to find out why you have the estrogen of someone very old. I am a male with low androgens and high estrogen (although I still look relatively virile! yes!), it is fairly typical in these "mysterious" cases that involved chronic inflammation and stuff. In my case it started exactly from using a high aluminum content antiperspirant and an epoch of high stress, although I was mildly autistic since a kid so I had genetic weakness towards toxins and inflammation. I know I have leaky gut, adrenal fatigue, hypothyroid and a detox/methylation block (low glutathione).

    Maybe you should investigate that. For hypothyroid only urine 24h is really sensitive enough for sub-clinical cases and saliva cortisol is best for adrenal fatigue. Although these are caused by *something*. Testing for food intolerances is a practical way of knowing how your gut is and getting a methylation panel will tell you about that.
  3. Crux

    Crux Senior Member

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  4. Ema

    Ema Senior Member

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    (303 ug/dl)

    Hi Tired,
    Welcome to the forum! Sorry you are feeling poorly.

    I agree with Beyond that a bit more testing might be useful.

    I'd also like to know what day of your cycle you tested estrogen and progesterone on?

    My first thought was also PCOS because of the symptoms you listed, the low estradiol and highish DHEAs. Have you tested your fasting glucose and insulin levels? Do you have troubles with weight? Taken birth control pills?

    Your FT4 could be higher...most women feel better with a slightly higher level. Same goes for your FT3 but just slightly. If you are hypothyroid, it would be subclinical for sure. Have you tried taking your basal body temperature to see if that is also low?

    I would also consider doing a saliva cortisol test to see how your adrenals are functioning.

    I keep my B12 well above 1000. Symptoms could easily start at levels such as yours. I would consider a methylcobalamin lozenge to help raise that level.

    It's hard to say much about your iron levels just from ferritin. Many doctors like to see ferritin levels between 70-90 though. I would not supplement iron aggressively though without knowing my serum iron and binding capacity (TIBC/UIBC).

    Ema
    aimossy likes this.
  5. tiredofbeingtired

    tiredofbeingtired

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    Hi everyone,

    Thanks so much for your inputs.

    I got a second round of blood work done and now my TSH is at 3.97, although my FT4 and FT3 are at around the 80% range? Why is my TSH elevated, yet my FT4 and FT3 are "normal"?

    Also, my estrogen levels are still low: LH 12 (range 14-96), FSH 5 (range 5-22), Estradiol 386 (range 315-1828), Progesterone 4.0 (range 2.4-9.4). My testosterone levels are high with testosterone being 1.9 (range <2.0) and DHEAS at 8.7 (range 2.68-9.23). I believe the combination of the high testosterone and low estrogen is definitely the root of my thinning hair/hair loss? I have started taking saw palmetto in hopes of reducing my androgen levels and I was thinking of getting some progesterone/estradiol cream to use to raise my estrogen levels. I am currently not on and never have been on birth control and I am not overweight. What do you all think of this?

    Also, I have started taking a daily vitamin B12 lozenge (methylcobalamin), as well as an iron supplement to raise my ferritin levels. What do you think of my vitamin D level being at 174 (range 76-250)? I have been supplementing with 5000IU of vitamin D daily for about 3 months and got to that level. Should I stay with that dosage or increase it to 10000IU a day?

    I also had an ultrasound done of my pelvic region to check for cysts on my ovaries and there were none and nothing abnormal. The ultrasound report stated that my ovarian sonographic characteristics are not typical of PCOS. I know it's still possible to have PCOS without the cysts, though.

    My fasting glucose result was 5.6 (range 3.6-6.00), so that is higher than what it should be.

    Could it be a pituitary issue with my FSH and LH being so low? Is it an adrenal issue? Can I still be hypothyroid (I will be taking my basal temperature for the next 4 days)? PCOS? Would a 4 point saliva cortisol test still be beneficial at this point? I would really appreciate anymore insight any of you may have into this.

    Thanks guys!
  6. tiredofbeingtired

    tiredofbeingtired

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    Thanks so much for your response.

    I got my estrogen and progesterone tested on the 26th day of my cycle.

    I got a second round of blood work done and now my TSH is at 3.97, although my FT4 and FT3 are at around the 80% range? Why is my TSH elevated, yet my FT4 and FT3 are "normal"?

    The second blood test done here was done on the 15th day of my cycle and my estrogen levels are still low: LH 12 (range 14-96), FSH 5 (range 5-22), Estradiol 386 (range 315-1828), Progesterone 4.0 (range 2.4-9.4). My testosterone levels are high with testosterone being 1.9 (range <2.0) and DHEAS at 8.7 (range 2.68-9.23). I believe the combination of the high testosterone and low estrogen is definitely the root of my thinning hair/hair loss? I have started taking saw palmetto in hopes of reducing my androgen levels and I was thinking of getting some progesterone/estradiol cream to use to raise my estrogen levels. I am currently not on and never have been on birth control and I am not overweight. What do you all think of this?

    Also, I have started taking a daily vitamin B12 lozenge (methylcobalamin), as well as an iron supplement to raise my ferritin levels. What do you think of my vitamin D level being at 174 (range 76-250)? I have been supplementing with 5000IU of vitamin D daily for about 3 months and got to that level. Should I stay with that dosage or increase it to 10000IU a day?

    I also had an ultrasound done of my pelvic region to check for cysts on my ovaries and there were none and nothing abnormal. The ultrasound report stated that my ovarian sonographic characteristics are not typical of PCOS. I know it's still possible to have PCOS without the cysts, though.

    My fasting glucose result was 5.6 (range 3.6-6.00), so that is higher than what it should be.

    Could it be a pituitary issue with my FSH and LH being so low? Is it an adrenal issue? Can I still be hypothyroid (I will be taking my basal temperature for the next 4 days)? PCOS? Would a 4 point saliva cortisol test still be beneficial at this point? I would really appreciate anymore insight any of you may have into this.
  7. tiredofbeingtired

    tiredofbeingtired

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    One more thing, I did get my TIBC/UIBC tested the first time around and my TIBC was at 62 (range 45-63) and my UIBC was at 45 (range 19-51) and my ferritin was at 46. Can I continue my iron supplements?
  8. Ema

    Ema Senior Member

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    Yes, as long as your TIBC is well above the bottom of the range (yours is at the top), I would feel comfortable taking iron to raise your ferritin levels up.
  9. Ema

    Ema Senior Member

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    You're welcome!

    This isn't ideal unfortunately because it is right before menstruation starts. Typically it is best to have sex hormones tested in cycling women on day 21 because the levels are somewhat high and stable approximately 7 days post ovulation. This gives you a reasonable level to compare to across cycles.

    In the first part of the cycle, E and P levels are negligible so it is hard to measure anything accurately (except in some cases of reproductive issues).

    Then around day 14-16, ovulation occurs and with it a rapid rise and fall in E and P levels. Again, not an ideal time.

    Right before menses, your levels are also falling back down so it is hard to know if you've caught a peak level or a trough.

    None of this is perfectly reliable, but hopefully if you look at a graph of sex hormone levels across your cycle, it is apparent why we shoot for testing on day 21.

    This is typical...it just means your thyroid needs more stimulation from the brain to keep your levels up. Generally the free hormone levels will stay up thanks to the increased stimulation for some period of time and then fall.

    I think day 15 is REALLY tricky in terms of knowing where you are in the hormone peak around ovulation. However, it does seem odd that you E would be low because you E should be at the highest point at the peak. The same goes for LH and FSH.

    P has not started yet to rise on day 15 so it is normal to be low at that time.

    I know it is a pain but I would consider doing the labs one last time on day 21 so you actually have something to compare to the literature. I would also consider doing a 30 day saliva test if you would like to see your levels across an entire cycle. You spit in a tube every other day for a month, freeze them and then send them off at the end. This can be a very helpful test as well.

    It may also be helpful to get an OTC test kit to look for your LH surge. These are sold usually near the pregnancy tests to help women trying to get pregnant. I am wondering if you are having an LH surge at all.

    One theory could be that your high T levels are inhibiting your follicle production so there is no ovulation/no LH surge and low progesterone (since P comes mostly from the corpus luteum after ovulation).

    Yes, I would agree that the high T/DHEAs and low E are probably contributing to the hair loss issue.

    I think you more than likely will end up being low in E but can't say for sure without a true baseline. I like the estradiol patches personally better than the cream and they are available from overseas pharmacies readily.

    I would also consider maca.

    That is an unusual range! What are the units please?

    PCOS is extremely difficult to diagnose and treat. I will not pretend to understand all the intricacies but, yes, you can have PCOS without the cysts. It seems bizarre! I would hope that you could see a doctor who is an expert at PCOS but I also know that they are hard to find. If the herbal interventions don't work, you may have to bite the bullet and try an androgen blocker but you would definitely need competent medical care. FWIW, it sounds like you are having the right tests and asking the right questions. So hopefully you have a good provider!

    Yes, that's higher than it should be ideally but not horribly dreadful. Are you eating low carb? Have you tried anything like metformin or touchi? Have you used a blood sugar meter to test your 2 hour post prandial levels?

    I don't think you have a pituitary issue because your TSH is also elevated but anything is possible.

    I'm not sure if adrenals are related without testing. I think a saliva cortisol test would be beneficial, yes.

    Yes, you could be hypothyroid with those levels. I think temperature will be a good clue.

    Ema
    aimossy likes this.
  10. tiredofbeingtired

    tiredofbeingtired

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    Wow, Ema, you are a wealth of knowledge - I really appreciate hearing back from you.

    I, unfortunately, have had the misfortune of dealing with "typical" doctors telling me that everything is "normal", so it's really great to be able to get a second opinion from someone who understands.

    In regards to the sex hormone reference ranges that I provided along with my results, both tests that were done provided a reference range depending on where you are in your cycle (follicular/ovulatory/luteal/post-menopausal). So, the reference ranges correlate with wherever I was during my cycle. Would I still need to get them retested on day 21? (I also have irregular periods - My last two were 22-23 day cycles, but I've had a cycle that was 31 days and the rest between 24-28).

    I purchased a progesterone and estradiol/estriol cream to use. Do I use the estrogen cream every day up until my period and then switch to the progesterone cream for the remainder of my cycle? Is it something that I will have to use infinitely to maintain those levels? I have also started taking standardized saw palmetto to lower my T and DHEA-S, hopefully the combination of the two will help with my hair loss and other undesirable symptoms (hirsutism, acne, oily skin etc.) Would you suggest adding in the maca as well on top of the creams or would that be too much? Also, do you think that my hair will grow back after these issues have been addressed?

    The units for the vitamin d levels I provided are in nmol/L. So my vitamin d is at 174 nmol/L and the range for "sufficiency" is 76-250 nmol/L. I'm currently taking 5000IU of vitamin D per day, but thinking of going up to 10000IU/day with the cold weather approaching.

    Yeah, I had a feeling my fasting glucose was a bit high for comfort. I have just recently cleaned up my diet a whole lot (it was never atrocious to begin with, but there was definitely room for improvement), not currently on any prescription medication for it, however, I have stared taking gymena sylvestre supplements to help control/lower it. Have you heard much about it? Would I be able to get a blood sugar meter from a drugstore?

    I actually just ordered a 4-point saliva cortisol test tonight from ZRT labs, so waiting for that to arrive. I know that your adrenals can be the root of the problem in regards to an under active thyroid, so I'm curious to see where my cortisol levels are at. I already know that my DHEA-S levels are elevated and I know that you need progesterone to make cortisol, so given that my progesterone levels are low, would it be safe to assume that cortisol levels will be low too? does it even make sense to have a high DHEA-S level and low cortisol levels?

    I've been taking my temperature and the readings have been on the low side.

    Thanks again, Ema. I look forward to reading your response :)
    TOBT
  11. Ema

    Ema Senior Member

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    The problem is that the reference ranges are way too wide for each period and encompass too low, optimal and too high all at once.

    I think it would be well worth your time to have a baseline that you can use in the future to see how your supplementation is going along.

    What are the dosages on the creams? How many mg/mL?

    I think it is actually OK to start the hormones before testing on day 21. It won't be a true baseline but I'm sure you are anxious to get started already.

    There are as many ways to dose hormones as women who use them. I typically use estrogen every day except for during my period. I start progesterone between day 11-14 and continue that until day 28 or my cycle starts.

    If you can figure out the root cause of the low levels and correct that, then the ovaries may begin to secrete the proper hormones again. However, if that is not possible, you may have to replace for life.

    I think the maca can be added in but I would do things one at a time and give each change a week or more so you can know what is responsible for what. You could even give each change a whole cycle since hormonal changes are usually slow.

    I personally think the trend of megadosing Vit D is a big mistake for those of us with inflammatory disorders. Some of us, including myself, seem to have some sort of problem with the Vit D receptor which does not properly regulate the conversion of the inactive form of Vit D to the active form. When the active form gets too high, it causes a reduction in immunity. I think this happens frequently in our chronically ill population and hardly anyone ever gets the active form of Vit D tested (1,25 D). So my suggestion is to keep your 25-OH Vit D level down in the lower ranges of sufficient unless you know for sure that your 1,25 D is staying low.

    http://perfecthealthdiet.com/2010/08/vitamin-d-dysregulation-in-chronic-infectious-diseases/

    Your level converts to just under 70 ng/ml...for comparison, I aim for around 50 ng/ml.

    I've not taken gymnema myself though I've heard good things. I've taken chromium picolinate and the touchi root. I am also getting ready to try berberine which also has good reviews.

    Yes, blood sugar meters are readily available from drugstores. Sometimes you can even get them free; they make their money on test strips. Do some research online and you might be able to find coupons for free meters.

    No, it isn't safe to assume that about the relationship between progesterone and cortisol. It could be your progesterone is low because all the raw materials are being shunted down the cortisol pathway. Or it could be your progesterone is low because you are not ovulating and thus creating a corpus luteum which secretes progesterone. They are related but you can't assume because one is low or high, the other will be too.

    Yes, it is possible to have high DHEAs and low cortisol. This typically happens early in adrenal dysregulation and is an intermediate step before the DHEAs drops and the levels both go low.

    Testing is the only way to know. It's also important to know your cholesterol levels since all hormones are made from cholesterol. I also find pregnenolone helpful as it is also a steroid hormone precursor that can be easily supplemented if low.

    I really like Dr Rind's method for temperature graphing. You can read about it here:

    http://www.drrind.com/therapies/metabolic-temperature-graph

    Ema
  12. tiredofbeingtired

    tiredofbeingtired

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    Hi Ema,

    The first round of blood work I got done was on day 26 and compared to the second set of blood work done at day 15, they are basically the same in the sense that my T's are high in both and my E's are still on the low side. I will still try to get all the blood work done again on day 21. Is day 15 of my cycle considered to be ovulatory or luteal? I ask because my Estradiol result of 386 has a different reference range, depending on if it was ovulatory (range 315-1828) or luteal (range 161-774).

    The estradiol/estriol cream that I got per pump is 1mg of natural Estriol USP and 0.25mg of natural Estradiol USP. It says that it is an optimal balance of 80/20. What do you think about the strength of the cream?

    The progesterone cream, for 1 full pump dispenses about 1.3 g of cream, providing 20 mg of USP Progesterone.

    I'm going to continue with the gymnema and eating cinnamon to help with the blood sugar levels. I will grab a blood sugar meter to monitor it.

    In regards to the 4-point saliva cortisol test, I know that your saliva is collected 4 times a day starting in the morning, but the thing is that I work night shifts, so my schedule is reversed. Would I still collect the saliva per the times provided by the test or do I go by my own hours (every 4 hours from the time I wake up)?

    Also when I got my TSH checked in April of this year, it was at 1.91 (range 0.30-5.60) and then when I got it done the second time in September of this year, it was at 3.97 (range 0.35-5.00). Why was there such an increase?

    My cholesterol was at 5.20 with the range being (DESIRED: <5.20), so my cholesterol is high. How come some of my hormones are low?

    Thank you as always, Ema.
  13. aimossy

    aimossy Senior Member

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    I have a problem with estrogen/ testosterone like tiredofbeingtired.
    I have found vit d helped but recommend moderation with it.(I was low)
    I have also found omega 3/ eveningprimrose omega 6 and flaxseed oil weirdly calming for nervousness but im not sure which one did that for me, have no idea what its doing but it helped,maybe blood sugars balance.
    This has been a really helpful thread for me too.:)
  14. Ema

    Ema Senior Member

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    The reason I wrote that I thought it would be OK to start the hormone creams prior to getting labs done on day 21 was because of that fact...your T is high and E is low in both cases. So I think it is fair to say that is the case but it makes it easier to compare apples to apples if you always test on day 21 fasting. If you start the creams now, you won't have a true baseline, but I think it will be close enough since hormone levels can take a while to change.

    I would consider day 15 to be ovulatory though it can vary of course. I would look for signs of ovulation like a spiking temperature increase or changes to mucus secretions that signal ovulation to know for sure.

    I think it is a pretty weak cream but standard for OTC. You can certainly try this but I would consider at least a double dose. Go by your symptoms though. It won't hurt to start low and work up.

    This one is really hard to guess at. On day 26, your level was at about 40% of the range. Progesterone on day 21 is usually best in the top half of the range. However, your levels could have been falling in preparation for menstruation. So I would start on 20 mg if it were me but many women need 40-60 mg in the latter part of their cycle if their levels are really low. I would err on the side of low in this case as progesterone dominance can be a real problem too and you are already progesterone dominant simply because of the estrogen deficiency.

    Actually, now that I write this, I believe I would start the E first, test on day 21 in your next cycle, and then decide whether or not you need supplemental P.

    Sounds like a plan!

    The single best thing you could do to help your adrenals is to switch to a day shift. It is a huge strain on adrenals to exist exactly opposite of our biological rhythms. That said, I know that life sometimes interferes with optimal health.

    Your cortisol levels are probably going to be all over the place. But that in itself can be useful information to have.

    If it were me, I would test during your typical waking hours so long as you have a somewhat regular wake/sleep cycle. I would do your first sample when you wake up, the next one about 4 hours later, the next one 4-5 hours after that and the last one right before you go to bed.

    It's typical for shift workers to have elevated cortisol levels due to the stress shift work puts on the body.

    There are lots of reasons for a variation in the TSH. Time of day influences mine quite a bit strangely. You might have eaten anti-thyroid foods more like cabbage. Thyroid levels change with the seasons so you are comparing spring levels to fall levels and those are often quite different. TSH naturally rises in colder months to provide more thyroid hormone for keeping the body warm in colder temps. It might be a lab error. It's really hard to say exactly why there might be a difference but I have found TSH to be quite variable in my experience while my free hormone levels generally are quite stable.

    Possibly because you are hypothyroid which can cause high cholesterol levels.

    I wish I could answer your second question because then I would be the richest woman in the world! LOL.

    The cholesterol isn't following the proper pathways at the moment is the only answer I can give you. Hopefully you can get that to turn around!

    Ema
  15. tiredofbeingtired

    tiredofbeingtired

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    Hello Ema,

    So, the creams just arrived today and being that I'm on day 8 of my cycle, I will use the E cream today and then do I switch over to the P cream on day 14 or when I start my period? Do I use the P cream up until my period is over or until day 1 of my next cycle and then switch back to E? I will try it once a day for the rest of this cycle and see how it goes.

    Even though I work nights, I have a pretty consistent schedule, in regards to when I sleep and wake up. Do you think it's really tough on the adrenals to go against the natural circadian rhythm or can the body adapt to a new schedule, as long as it's consistent? I will do the cortisol test according to my hours and see what the results will be like. The night shifts are just a temporary thing for now. If my cortisol levels comes back all over the place, can I supplement with the right kind of herb to help level everything out while I work night shifts? I guess we'll have to wait and see for the results to really know what the best course of action would be. The test should be arriving tomorrow actually, so hopefully will get the results soon.

    I have also started charting my daily temperature via Dr. Rind's method...figured yesterday was a good day to start since it was the 1st of the month lol. I took my temperature 4 times instead of 3 and averaged out to 98.2. Not great! I read that if your temperature fluctuates a ton, it's an adrenal issue, but if your temperature is low yet consistent, it's a thyroid issue...so I'm curious to see how my graph will turn out. I want to obviously focus on the primary issue at hand.

    The cholesterol thing boggles my mind...maybe it's not the right kind of cholesterol? Oh, I don't know if I mentioned this already, but I'm taking saw palmetto, hops and drinking spearmint tea to help lower my T, or at least block the conversion of T to the dreadful DHT. I hope this along with the creams will help with the high androgen levels.

    Hmm, I think that's all for now! Thanks Ema :)
  16. tiredofbeingtired

    tiredofbeingtired

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    Hello Aimossy,

    I'm glad that this thread has been of help to you - I know how frustrating and confusing all of this can be!
  17. aimossy

    aimossy Senior Member

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    Totally is tiredofbeingtired and hormone balance is complicated thanks for posting it and to all who have made great responses! making more sense to me now!!!

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