Hormone Test Results

[JAS21]

Could somebody please comment on the following blood test results from a post menopausal woman.. Blood taken just before 9am after a 12Hr fast. Anything commented on appreciated.

TSH 4.57 uIH/mL

Free T3 2.35 pg/ml

Free T4 1.03 ng/dL

Progesterone 0.25 ng/mL

Estradiol (E2) <5.0 pg/mL

Cortisol (Blood) 7.18 ug/dL

DHEA-S 123 ug/dL (was43 but has been taking 15mg DHEA/day for 3 months.

Free Testosterone

Albumin 4.88 g/dL

Free Testosterone 0.08ng/dL (0.6%)

Testosterone 13.0 ng/dL

Bioavailable Testosterone 2.0ng/dL (15.7%)

SHBG 142.1 nmol/L (this was a repeat test value)

I have to assume that it was quality testing.

thanks

[Sheryl]

thyroid (TSH, T3, T4), cortisol normal. No issues there.

albumin high end of normal, nothing to worry about

DHEA and SHBG normal

testosterone (total, free) normal

estradial and progesterone levels are consistent with a post-menopausal women not on hormone replacement therapy, i.e. substantially lower than would be the case pre-menopausally or in a woman on effective HRT. Estradial levels are well below the point at which some women suffer uncomfortable menopausal symptoms.

The decision to use HRT is a complex one which I will not go into here except to say that if there are physical or mental/emotional symptoms that prompted these tests, and provided there are no contraindications to HRT, she might wish to consider it after first carefully researching the pros and cons. If so I personally recommend using bioidentical preparations particularly progesterone as opposed to a progestin as the latter may be responsible for many if not most of the risks associated with HRT plus have unpleasant side effects. Bioidentical preparations available in Thailand are Oestrogel (a gel, use topically) and Utrogestan (oral micronized progesterone).

Regardless, given the low estradial levels this women should have a bone density scan, stress test and lipid panel (HDL, LDL, triglycerides) if she has not already and should be taking daily calcium/Vit D supplementation.

This is a nice reference for normal hormone levels in women http://www.keratin.com/ab/ab012.shtml

in some cases you'll need to convert the type of units used, in which case use this tool http://www.onlineconversion.com/

[JAS21]

Thank you Sheryl, I was hoping that you would comment.

OK, she was diagnosed CFS some 4+ years ago, in the UK, after a gradual decline following a very bad kidney infection. Two years ago you wouldn’t have known she had it except hard exercise was out for obvious reasons. Then a gradual decline over some 6-9 months.

She has improved over the last 6 months to the stage where she can play golf, twice a week, at a reasonable pace, although we do stop for breakfast after 9 holes. Appears to have no adverse effects from this in the following days.

For 3 weeks now she has being having HRT, yes bioidenticals. Testosterone cream 2mg/ml 0.5ml/day and Progesterone cream 200mg/ml 0.5ml twice/day. In addition Throid 1:2 (2 grain)…I know it's T3 T4 but I will find out exactly what this is… 2 grains means nothing it’s the mg that is important… and DHEA changed to 25mg 7-Keto. I understand that a DHEA-S level of 200 is suggested for CFS patient.

Vitamins/day are CoQ10 (100mg+100mg), Omega 3 (3000mg+3000mg), Omega7 (145mg+145mg), Bio magnesium (300mg+300mg), Bio C (1000mg+1000mg). Nevermin (B1,B6,B12) injection 2-3 times a week (I give it). Medivan course of eight (B6,B9.B12)..I can now get this cheap from Germany! Antripline 25mg just for sleep help. I am going to get some Spirulina for her to try. Also now taking Basic Mix and a multi vit.Ah also has accupuncture once a week, fortunately very cheap, at a local rehab centre.

Has some brain fog and a little short patience, the latter has only being during the last 18months. So 4 months ago took her to a clinic, the guy said Leaky Gut Syndrome..believeable?. Had an ALCAT test (I really don’t have much faith in this test either), has had 10 colonics (makes her very tired the next day) so no more, probiotics etc. Also 10 of these things where they take out a bit of blood 70cc, UV and ozone it, then put it back (not sure about this either). Now see someone else who I think is pretty up on Bioidenticals. So am going to give it 6 months.

So now she eats only fish, veg and fruit, just the odd coffee and no milk only soy.

Yes I will organise a bone density scan. By stress test you mean exercise ECG (neither of us are keen for that) maybe she should have a non-invasive look..should she? Last time the lipid profile was not brilliant. Her blood pressure was a bit up but is now normal. I know now that she should have been Lipid tested before HRT commenced but it will be done soon.

Her doctor did not recommend calcium, something to do with joint problems and nerves..I don’t understand. The Vit D she tried gave her an allergy, maybe try one with no colouring.

So maybe we will find that she is in the CFS Hormone subset. If not I am totally lost as what to do next. This is making us a bit poor, but if she get back to the lovely health person she was then wonderful.

I have seen advertised in the UK an ozone machine, just stick the tube up your nose (Airnergy) is this more rubbish or worth trying do you think? …………….thanks

[FBN]

There is more tp it here than has been reported.

There is a person behind the blood test results and one should never forget that.

Clearly, the blood tests did not show anything that would explain the little of what has been stated. As Sheryl suggested, why were these tests done?

Severe kidney infection? Lots of questions here.

Ozone? No! Ozone is toxic to humans...

Take a step back; she needs more...

[JAS21]

There is more tp it here than has been reported.

There is a person behind the blood test results and one should never forget that.

Clearly, the blood tests did not show anything that would explain the little of what has been stated. As Sheryl suggested, why were these tests done?

Severe kidney infection? Lots of questions here.

Ozone? No! Ozone is toxic to humans...

Take a step back; she needs more...

Yes you are correct, unfortunately I missed a little bit out, the guy behind the tests. As I said she has improved over the last six months, anyway this clinic came highly recommended by someone we know who has been treated there, it would not normally be my ‘cup of tea’…but as a last resort.

So a week after first going to this clinic, they have an ‘open day’ at the Oriental and we go out of interest. It really is an anti-ageing set-up so we are a bit bored. We see a guy sitting quietly, away from it all and go and sit there. To shorten, we chat, quite a while, about her problems then he tells us, that he is a Dr and has helped many CFS patients and gives us a list of what should be checked and what vits to use..his view is Hormone levels. This guy does not live here but apparently is a consultant at this clinic and visits every month or so. I looked up his CV on the internet..interesting.

Any way a couple of months later we are sitting in this clinic after her ‘treatment’ just about to go home, we basically meet him in the lift. He asks how she is..I say no better..end result he organises the Hormone tests. Like me he has little faith in ALCAT or LGS etc. One month later we meet again and we are now 4 weeks on from then.

My wife, for months now, has been resting for 3 half hour periods a day (a year ago it was 5 periods!). I now notice that these ‘half hours’ are getting much shorter and she is doing more. Having had a couple of CFS crashes, when we though she was recovering well, she is now being very sensible…not before time in my view. The last 'crash' may not have been a crash, as it came on slow, unusal!

Ozone, yes is toxic above certain concentrations.. but I have read extensively and it was even used in the 1st World War to help heal wounds.

Kidney infection, she was very ill in the UK, she initially thought it was Malaria, as we had just come back from Thailand. You can understand how bad it was and she was in hospital for a week and was back on the golf course a few days later..That was a big mistake, her not resting, but she was so strong. Three months later she couldn’t even walk a few hundred yards without resting. It was me who eventually suggested that her symptoms were CFS and arranged to see a guy who speciality it was. Since then we have just followed his advice. At that time she was still having her periods.

Maybe the illness affected her adrenal glands. She had an ultrasound kidney scan following the illness, she insisted as her father died following complications associated with kidney stones.

Step back, yes if I knew where I would. Please don’t think that I haven’t researched her problem extensively, as CFS goes she is quite lucky! Coming to live here, three years ago now, we thought would be better for her and she did improve but as I said had a couple of crashes. After the last one she didn’t bounce back.

Occasionally, we play with a golf society which has many doctors, her friend is married to one. None of them know much about CFS and I find the same with other doctors here.

Other problems, if she was not again getting better I would be very concerned. Since starting the HRT her headaches have stopped. Previously the Nevermin helped, but as a trial she stopped it for a few extra days just to see and she is still headache free.

During the last year or so she has found the heat more difficult to manage……thank you….any more opinion would be much appreciated. I am lost.

[FBN]

The wound treatment in WW2 was with hyperbaric oxygen; this is O2 but at high concentrations; usually in a special chamber for short periods as even O2 is toxic at high concentrations. Not to be confused with Ozone.

Ozone is O3 and used commercially to sterilise drinking water among others. It is toxic at any concentration and may rather add insult to injury in this case.

Kidney infections are not a usual cause for CFS (which, unfortunately has become a bit of a dumping bin of diagnoses); there has to be another cause for her symptoms. CFS means nothing more than a collection of symptoms; it is not a diagnosis and can only be made after all other differential diagnoses have been sorted. Kidney infections can not affect the adrenal glands but functions should be thouroughly reviewed in her case.

Just another question; did the lab provide reference levels (range of normal values) of the results of the tests? Sometimes values differ according to the specific lab test done.

It would also be useful to repeat tests after a 3 month period or so; a trend may be more indicative than a single evaluation.

[JAS21]

The wound treatment in WW2 was with hyperbaric oxygen; this is O2 but at high concentrations; usually in a special chamber for short periods as even O2 is toxic at high concentrations. Not to be confused with Ozone.

Ozone is O3 and used commercially to sterilise drinking water among others. It is toxic at any concentration and may rather add insult to injury in this case.

Kidney infections are not a usual cause for CFS (which, unfortunately has become a bit of a dumping bin of diagnoses); there has to be another cause for her symptoms. CFS means nothing more than a collection of symptoms; it is not a diagnosis and can only be made after all other differential diagnoses have been sorted. Kidney infections can not affect the adrenal glands but functions should be thouroughly reviewed in her case.

Just another question; did the lab provide reference levels (range of normal values) of the results of the tests? Sometimes values differ according to the specific lab test done.

It would also be useful to repeat tests after a 3 month period or so; a trend may be more indicative than a single evaluation.

Thank you FBN

TSH 4.57 uIH/mL (0.27 – 4.2)

Free T3 2.35 pg/ml (2.0 – 4.4)

Free T4 1.03 ng/dL (0.93 – 1.7)

Progesterone 0.25 ng/mL Female Post men (0.1- 0.8)

Estradiol 9E2) <5.0 pg/mL Female Postmen (5 – 54.7)

Cortisol (Blood) 7.18 ug/dL a.m as it was taken (6.2 – 19.4)

DHEA-S 123 ug/dL (was43 but has been taking 15mg DHEA/day for 3 months) (35- 430)

Free Testosterone

Albumin 4.88 g/dL (3.4 – 4.8)

Free Testosterone 0.08ng/dL (0.6%) Female Postmen (0.6 – 6.7)

Testosterone 13.0 ng/dL (6.0 – 82)

Bioavailable Testosterone 2.0ng/dL 15.75%

SHBG 142.1 nmol/L (this was a repeat test value) Female Postmen (4.1 – 68.9)

Figures in brackets on right are Laboratory Reference range..NHS Clinical labs in bangkepi did the tests.

So after her illness she went down and down. Saw her doctor several times and a ‘Consultant Physician and Rheumantologist’ both said post viral fatigue...and she was all the time getting worse. I researched and to me her symptoms were in line with ME/CFS so I asked if it would be a good idea if she could be referred to the National ME Centre at Harold Wood Hospital in Essex (UK). She saw Professor LJ Findley and he said to quote in a letter to our GP. She clearly has acute post viral syndrome. The worrying fact is that she seems to be worsening, and my concern is that she could end up with true Chronic fatigue. In addition she has cervicogenic headaches.

Now one thing I did tell the guy and it is documented is that I thought that over the previous year or so that she had slowed down a little and also her eyes were wet in the morning. She always used to be wide awake and get up at 5:30, that slipped a bit. At that time most days we gymed it and then played golf or vice verce.

She had loads of blood tests and nothing abnormal showed up. She also had a MRI brain Scan..normal. her beautiful hair and nails degenerated, although now both are much much better. The ladies at the golf club thought that she was 35 when in fact she was 50. Now unfortunately she looks more near her age.

As I said a couple of times it looked like she had got better, but if she overdid it and went down. We chatted today and both think that her skin is a little better, she can do more but still thinks her energy level is about the same. Two years ago she was so much better, now she is much better than she was 12 months ago. Her urine smells, especially in the morning, much better when she drinks a lot..maybe all the excess vits getting expelled....

Yes repeat hormone tests are planned for..after three months. As I said I am lost as where to go next. Certainly if she gets hot it makes her feel more tired..not good in Thailand!

Edited February 14, 2010 by John45

[FBN]

The slightly elevated TSH levels may indicate borderline hypothyroidism which may contribute to the general symptom complex.

Will also be useful to have LH, FSH and also blood potassium and sodium levels checked at the same time as well as "Raglands test" (BP checks in supine and standing positions when changing position suddenly)

Unfortunately difficult to get specific tests to confirm or rule out Adrenal Fatigue syndrome but must be kept keep in mind... This could have been precipitated by the kidney infection (indirectly, as any stressfull event or illness could do). There is quite a bit on the net on this as well as ideas on supportive treatment.

Why was the DHEA given? Because of the initial low level? This is perhaps the reason for the increased serum albumin. Did it change any of the symptoms?

[JAS21]

The slightly elevated TSH levels may indicate borderline hypothyroidism which may contribute to the general symptom complex.

Will also be useful to have LH, FSH and also blood potassium and sodium levels checked at the same time as well as "Raglands test" (BP checks in supine and standing positions when changing position suddenly)

Unfortunately difficult to get specific tests to confirm or rule out Adrenal Fatigue syndrome but must be kept keep in mind... This could have been precipitated by the kidney infection (indirectly, as any stressfull event or illness could do). There is quite a bit on the net on this as well as ideas on supportive treatment.

Why was the DHEA given? Because of the initial low level? This is perhaps the reason for the increased serum albumin. Did it change any of the symptoms?

I’m sure that I could do both a Raglands Test and Tilt Table test, as I have a backswing and a blood pressure monitor.

In Sept 2008 Sodium /Potassium levels were 148/4.1 mEq/L, right in the middle of the normal range. To me, from what I have read, she does not have typical Adrenal Fatigue syndrome.

Next Sat we will see her doctor and get her lipids done also retest of Sodium and Potassium. I don’t see on the Lab sheet that he uses LH and FSH tests but I’ll get her to phone him. I have taken the liberty of a PM to you.

DHEA was given because it was low. I didn't see much if any change, except on the shower room floor..think a little hair loss.

In late 2003 her mother died. Her daughter was at Uni in Thailand whilst she was living in the UK, she did worry about her.

[Sheryl]

to FBN's excellent advice I would just add that the estradial and progesterone levels you list, while normal for a post-monpausal woman, are not consistent with a post-menopausal woman on HRT. I don't know the timing of that test relative to onset of HRT but if she was already on it for any length of time I would question the preparations being used. Some of what is sold as natural progesterone cream is actually just yam extract and that is not the same.

You don't mention estrogen, is she replacing only progesterone or also on an estrogen preparation?

Of the various symtoms you describe, brain fog and lack of patience possibly menopause related or exacerbated by it.

[JAS21]

to FBN's excellent advice I would just add that the estradial and progesterone levels you list, while normal for a post-monpausal woman, are not consistent with a post-menopausal woman on HRT. I don't know the timing of that test relative to onset of HRT but if she was already on it for any length of time I would question the preparations being used. Some of what is sold as natural progesterone cream is actually just yam extract and that is not the same.

You don't mention estrogen, is she replacing only progesterone or also on an estrogen preparation?

Of the various symtoms you describe, brain fog and lack of patience possibly menopause related or exacerbated by it.

Thanks Sheryl

Yes the tests were carried out before commencing the hormone treatment. Please note that she had been taking DHEA 15mg once/ per day for the previous three months and that raised the DHEA-S level from 43 to 123. She has been on HRT, the prescribed medics below, for one month and a few days now.

The prescribed treatment now is:

Progesterone cream…200mg/ml and apply 0.5ml twice per day ( morning and evening).

Testosterone cream 2mg/ml and apply 0.5ml once in the morning.

Both creams have come in a syringe with graduated markings.

In addition she has also been prescribed a Thyroid capsule. The bottle is marked Thyroid 1:2 (2 Grain). So the 1:2 is T3/T4. I quizzed the clinic and could only get out of them that 2 grains is 130mg and that it is desiccated Natural Thyroid. So that should have made the search easy as not all manufactures call 1 grain 65mg. The capsule is blue one half and white the other half.

I went to the local pharmacy and they can’t identify it. I am still trying as I know that I’m being charged a lot for it.

She was told to take one tablet late in the evening. I will have to ask the HMC doctor why the dose is not divided up. The clinic is more for anti-aging but we went there as I said I am lost as what to do now. I did send FKN a PM with more details, so I have also PM you with the same.

I did see that Bangkok Host have an anti-aging department. At some time I would like a second opinion, is there anywhere else other than there that you know of please.

Thanks

[JAS21]

Sorry forgot and 7-keto DHEA 25mg

[Sheryl]

1. You can buy thyroid extract over the counter quite cheaply. There are 3 formulations, "Thyroid-S" and "T.R. tablets" made by a local pharmaceutical company and GPO Thyroid extract. Only disadvantage over what you are getting at that clinic is that the tablets are not scored, in the event of wanting to take less a whole. They are 60 mg tabs. The GPO formulation is the cheapest and probably most reliable quality. No need to be spending a lot of money for this.

2. It seems odd to me that she is on progesterone and not estrogen, do you know the rationale?

Need to be aware that progestrone has a sedating effect and, in some women, may cause fatigue or depression (altho for women suffering from impatience/anger issues related to menopause it is a godsend). For this reason more often given just at night. Not suggesting you change anything if it doesn't seem to be causing a problem but if she does seem depressed or more tired than before consider just using it at night.

3. An anti-aging clinic is no the best place for management of CFS. And its only advantage for management of menopausal issues is that unlike most Ob-gyns here they have at least heard of bio-identical replacement. However that disadvantage can be managed by being firm on the point, and testing hormone levels likely would be less expensive at a regular hospital than an anti-aging clinic.

4. As to where else you might go for a second opinion, I am told this doctor 9an immunologist) at Bumrungrad manages CFS but I have not gotten any feedback or heard any first hand reports on him:

Dr. Hiroshi Chantaphakul

Specialty: Medicine - Allergy & Immunology, General Medicine, Rheumatology (Arthritis)

Language: Spoken: English,Japanese,Thai

Qualifications: Medical School:

- M.D., Faculty of Medicine, Chulalongkorn University, Thailand, 1992

Board Certifications:

- Diplomate of The American Board of Internal Medicine, 1996

- Diplomate of The American Board of Allergy and Immunology, 1999

- Diplomate of The American Board of Rheumatology, 2000

- Diploma of The Thai Subboard of Allergy and Immunology, 2004

- Diploma of The Thai Board of Internal Medicine, 2008

Fellowships:

- FACR, FACAAI, USA, 2000

Special Clinical Interests:

- Allergic Diseases, Asthma, Autoimmunity, SLE and Arthritis

There are a few other TV members with CFS, could also do a search on thsi forum and PM them to see if anyone has found a doctor they are happy with...or as happy as can be expected given a syndrome for which medical science does not yet have much to offer.