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11/12/2012 07:09 PM

Lab results Pg/E2 very low, low DHEA, highish cortisol

cardiacmommy
Posts: 3
New Member

Hi all.

I have struggled for years with mainly fatigue and headaches. I had very irregular periods for years but they are regular the past 2 or so years. I've been (mis)diagnosed with PCOS due to the irregular cycles and a positive ultrasound (without labs.) I've struggled for a long time with deficient Vitamin D (not even registering on labwork.) I was diagnosed in the past with low DHEA as well.

I went recently to a new OB gyn for a new workup. She said my bloodwork showed low side of estrogen, very low testosterone, and LH:FSH of ~1. Vitamin D was again on the low side. She prescribed weekly Vitamin D of 50000 units and daily testosterone cream.She did not test DHEA or progesterone. She tested thyroid including antibodies and they were normal. She said from the labs she did my body was very stressed and that it made her think of a person with an eating disorder.

She does not do salivary cortisol so I decided before starting the testosterone I would do the ZRT testing. I just got my results today. The test were done on day 19 or 20 of my cycle per the instructions. I thought for SURE I had low cortisol so my results were quite surprising.

Estradiol 3.2 pg/ml (range 1.3 - 3.3) so high normal

Progesterone 14 pg/ml (range 75-270) so reallllly low

Ratio Pg/E2 4 (optimal 100-500 if E2 1.3-3.3) so SUPER low

Blink

Testosterone 21 pg/ml (range 16-55 age dependent) according to the included graph I'm the average 85 yr old woman! Right on low border for my age (36)

DHEAS 3.1 ng/ml (range 2-23 age dependent according to graph I'm average 75 yr old, below low for my age

Cortisol Morning (08:30) 9.3 ng/ml (range 3.7-9.5)high normal

Cortisol Noon (12:45) 4.5 ng/ml (range 1.2-3.0) above normal

Cortisol evening (16:40) 2 ng/ml (range 0.6-1.9) above normal

Cortisol night (22:40) 0.9 ng/ml (range 0.4-1.0) high normal

So..what I gather, low dhea, low testosterone, VERY low Pg/E2, and high cortisol.

Any thoughts or ideas on what to research next regarding supplements or other treatments? I'm trying to figure out the interrelationship of all this.

I've been taking the testosterone about a week now. I'm worried about it raising my estrogen even higher through conversion and throwing off the Pg/E2 more. It's interesting that my blood estrogen levels were low. Although they were also taken a little earlier in my cycle (like day 11.)

I appreciate ANY feedback!!!!! Silly

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11/12/2012 09:31 PM
bob3bob3
bob3bob3Posts: 4213
Senior Member

I am kind of at a loss! Its worth pointing out though that DHEA is a precursor to your adrenal testosterone. Progesterone too is a precursor to cortisol and aldosterone, so something is at odds there. If you haven't see the flow chart on this look up steroidogenesis. Wiki has a good one.

I don't know how relevant it is to females, but males suffer fatigue badly with low testosterone. I am trying to think in terms of a root cause for your fatigue. Like is it low blood glucose (which cortisol, Triiodothyronine (T3), Thyroxine (T4), androgens etc will affect) or something as simple as a BP drop. (Like loss of blood volume from low aldosterone) The close to mid range cortisol kind of suggest that isn't the root cause.

The low DHEA and progesterone PLUS high cortisol has created a wild thought! Maybe a cortisol producer elsewhere or maybe an adrenal growth that makes it? The logic is that the highish cortisol level will tend to suppress pituitary feedback, lowering ACTH and thus most adrenal gland output. This is only a system knowledge guess though rather than knowing of any real life cases.

I guess too you could ask for some dynamic system energy metabolism tests like a GTT or ITT.

Bob (Australia)


11/12/2012 11:27 PM
cardiacmommy
Posts: 3
New Member

Thanks for the feedback. I failed to mention while I feel fatigued most of the time, it's MUCH worse the last 2 weeks of my cycle, causing me to even miss work. Sometimes I feel like the house could be on fire and I couldn't get up.

Then the week of my cycle I'm wired and have insomnia and usually get hyper focused on something. Like tonight I've spent hours researching cell phones when I have to work tomorrow ugh.

Anyway, I have thought about some of those things too. I bought a glucose meter and my levels are good upon waking, actually a little high in the upper 90s. Interestingly, I did a random one afternoon and was in the 70s ... can't remember how long post meal it was.

I also have been checking my BP, mainly to see if it was orthostatic as I get really dizy, black vision when standing up too fast (esp from a squat position). It is a bit on the low side, 105-115 systolic. Seems to adapt to standing alright though, with a good response in my pulse to accomodate.

The prior endo I went to did check an GTT at my insistance since I was misdiagnosed prior with PCOS. It was perfect. So glucose and insulin seem okay.

I'm hoping the testosterone will make a difference for me. I'm supposed to go back to the OBGYN in February. I'm tempted though to call regarding this crazy low progesterone to see if she thinks I should possibly start supplementing that too.

I swear- my labs never seem to fit any standard scenario! lol But at least I know now I'm not crazy or lazy when I say I need to SLEEP... my body is whack with these hormones. I WILL figure this out so I can get my life back while I'm still relatively young.

Post edited by: cardiacmommy, at: 11/12/2012 11:33 PM


11/12/2012 11:31 PM
cardiacmommy
Posts: 3
New Member

Just a few more odd and possibly unrelated symptoms.... Ive had issues the past few months with briefly waking up in the middle of the night. Sometimes I can get back to sleep quickly and sometimes I have to go pee first. I thought for sure low cortisol but as you can see no. Maybe that's when it's the highest and it's waking me up...odd.

I worked night shift for 5 years up to 1.5 years ago so who knows it that messed things up. Can't remember if my periods got regular before or after changing jobs but I do know when my periods FINALLY got regular is when I could see the fatigue pattern more clearly and that it was very cyclical in intensity.

I also have a lot of foot and leg cramps ... very bad spasms at times to where the bones looked pulled out of place and my leg will ache for a few hours afterwards. I had my B12 tested a few years ago and just got the printout and found that it's on the very low normal side. Maybe I can follow up with my PCP on that and get her to recheck it.


11/14/2012 11:34 AM
bob3bob3
bob3bob3Posts: 4213
Senior Member

There have been quite a few conversations on the group here about the need to updose HC relative to the menstrual cycle. The view is that even its an energy availability and system loss thing some additional measure is needed. It would follow then if you are already borderline that the additional body stress will make you feel much worse! I don't know of actual hormone cycling has much of a direct (change) effect on metabolism.

If the standing dizzies are so sudden you probably won't see the transient in a BP test. My best guess right now is that you are just slightly systemically hypotensive. With your BG "okay" that more points to blood volume. Your foot/leg cramps kind of help prove that. Having to "pee first" during sleep too kind of negates drinking water alone as a solution. If you want to experiment, up your sodium salt intake for a few days and drink more water. You should see a measurable BP rise. If your dizzy's go you have a solution. The low retained water too is often a fatigue symptom source It cant hurt to try! Most of the AI group do some form of salt regulation since it's part if how ATCH and the adrenal glands work.

I don't know if it is relevant to you, but AI people can still have their adrenaline flight/fight stress system working. You can get a release if cortisol gets too low. Since the usual cortisol cycle dips are during sleep, its common for the reaction to wake you up and make you feel wired etc.

Okay have banged my head against the computer monitor, but I can't think of any more correlation or even way out possibilities!

Bob

Post edited by: bob3bob3, at: 11/14/2012 11:35 AM

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