Testosterone - Free/Total & DHEA

[drkatzjr]

Here is my situation:

THYROID PROFILE

For last 10 years, my TSH has been suppressed.  I do not have actual labs/numbers in front of me.

T4 has always been normal, but on the borderline of low.  T3 is normal.  Dx is subclinical  hyperthyroidism  

NEW BLOOD TESTS:

Indicated both FREE and TOTAL Testosterone low; while DHEA-s was profoundly low   76   (194-400)


Given this info, and with everything else being equal, should I be concerned about such a low DHEA level?
I am a young man -- early 30's

Thanks

[horselip]

Usually the first hormone to go in a TBI is Growth hormone. Bring it up to your endo. Maybe he will check your igf-1 and or order a stim test?
Horselip

[rumpled]

Whiplash - not sure. They usually say it takes an injury that causes one to pass out.
It could be just a slow growing tumor as well.That flu may have been a crisis as well.
How is your sodium and potassium? If you are an athlete, I assume you drink a lot of gatorade and the like?

[BretBorth]

Wow, you seem to know your stuff in regard to hormonal levels!  Quick note to get your comment on.  I came down with what seemed to be a benign bout of the flu a year ago...and have yet to pull out of it.  About 6 months into this I had the following hormone levels tested, and these were the results:
total T-365
Frett T-33
Bioavailable T-78
LH-2
Prolactin-Told it was low normal
I started varying levels of testosterone injections, and am now at 450  mg/ml weekly.  I am seeing a bit of relief in regard to the unrelenting sluggishness and brain fog.  I was a triathlete and avid 10k runner prior to this,and now it feels like I have cement boots on.  My doc suspects that my pituitary gland is not functioning right...even though my t3/4 levels are normal, as was the saliva test for DHEA and Cort.  I had a whiplash concussion 11 years ago in an accident, and the base of my head/neck hurt for weeks after this.  Any chance that old injury did something to the pituitary gland?  I really have no concrete answers so far, and am really sick of feeling so bogged down all the time....

[horselip]

It is good that you have had your FSH and LH tested. were your results borderline?

Your Thyroid- your t4 level is borderline low. Yes the range is very wide. I believe that yours was just within range in your other post in this section. Most folks feel better when this level is a bit higher....your chilly feeling combined with the lower basal temperature might be the beginnings of subclinical hypothyroid. Yes, you have the definition right, but TSH is only reliable if you are 100% sure that there are no pituitary issues. I don't know if this can be said for you yet. And I have very limited information about your situation available to me.

In terms of pituitary MRI's they do not always show things and reading them is really subjective. So the clinical picture combined with your labs would have to be taken into account. Particularly if you have had "trauma" or have a very small adenoma.

What about your IGF-1? Has that ever been tested? Usually in a trauma type situation to the pituitary gland Growth hormone is the first one to go. IGF-1 is the marker for Growth hormone and if that were on the low side then a Growth hormone stimulation test might be more telling.

What about your 8 am fasting cortisol levels? a cortisol producing adenoma would cause the low testosterone

prolactin levels? ditto

Ever had High iron or elevated hemoglobin levels? hemochromatosis ruled out

Visual problems? Have you had a visual field assessment which could highlight a pituitary lesion such as a a bitemporal hemianopia resulting from chiasmal compression

Klinefelters syndrome ruled out?

Low Testosterone in men is just awful. It affects just about everything aside from the obvious.

I asked about smell because of Kallmann Syndrome.

You've possibly thought of or even done everything I've listed...but maybe I have added something that could give you and idea as find out why you've got the low DHEA and Testosterone so that it can be looked at more holistically. If you already know why then you should go ahead and supplement! As this could help you to feel better.

Horselip

[drkatzjr]

Thanks for your comment.  Yes, I have had an MRI W/ Contrast at a major hospital,with specific emphasis on the pituitary.. and was normal.

Your theory of pituitary pathology made sense to both me and my doctor,
especially when I had 2 labs which demonstrated a TSH of < 0.05
and a low T4 (on the upper-end on low, but flagged, while my T3 was normal (borderline high) but within the normal range.

Again, I evaluate my thyroid every 6mo per my doctor, and this above-mention result did only come back twice   2  out of probably 6-7
(low TSH, Normal T4 and T3.

I have also tested LH and FSH several times over the years, and they remain in the normal range.

The definition of subclinical hyperthyroisim is:"a presenting low TSH with normal T3 T4"  (so I have researched)

Also, the gland is never swollen, and antibody tests also came back normal.


Family history: Dad - Graves  Grandmother - Graves


One strange variable  (it they are not all strange) lol
is that I feel cold all the time.  My temp runs, -always-, around 96.9-97.1


Thanks!

[horselip]

I would not be as worried about the DHEA as the Free Testosterone levels.

Also obesity could skew all of this and cause you to make estrogens. Are you of a relatively healthy weight? Do you have a strong sense of smell? Ever had high iron levels?

Has secondary hypogonadism been ruled out? It could be that your pituitary gland is playing a role here.

Esp given that you have the low TSH yet normal thyroid (T3, low normal T4) That kind of points to pituitary to me.I don't think that you have subclinical hyperthyroidism because your T3 and T4 are ok. If anything it is looking like subclinical hypothyroidism. TSH is a pituitary hormone and it can be low even if your other thyroid hormones are ok, Even leads more credence to the suggestion by Rumpled to have a Free T3 done to really asesss your thyroid function. TSH is useless if you have any sort of pituitary issue.

Has your doctor ever tested your LH and FSH? That could support the biochemical diagnosis of secondary hypogonadism. (Caused by the pituitary vs testicular malfunction)

Your Testosterone and DHEA could be low because your LH and FSH are low too.

I would get your pituitary assessed. Before you go replacing stuff. Like Rumpled said high cortisol could skew thing, pituitary damage from a head injury, or a pituitary adenoma could all be possibilities to be ruled out.


Horselip