29 YO Male - Lifelong ED - Help?

mlc2010

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Hi All,

I'm from uk, 29 years old, 5 foot 8 and 150 lbs. I have had lifelong ED, I always thought it was performance anxiety ( maybe it still is ) however I'm nearly 30 now and for once I would like to have sex.. so a few years ago, I started getting hormones tested, here is what I have found?

Is there a reliable growth hormone test? I tested IGF-1 and it was low.. perhaps I have had GH deficiency all my life? My symptoms aren't just ED, thats tip of iceberg.. my other main symptom is NO MUSCLE MASS.. I have literally seen more muscle mass on cancer patients. I have bad sleep, very dry droopy facial skin. scoliosis when I was young, asthma, anxiety ( the anxiety might be due to my erectile failures and my self imagine with muscle mass )

By the way, yes I have used viagra/cialis/levitra etc my next step is injections


Here is my latest bloodwork
--------------------------------

PROGESTERONE 10.7 [ 0.7 - 4.3 ] H ( This was after I took 50mg preg a day for few weeks, anyway to lower ? )
TESTOSTERONE 23.6 [ 7.6 - 31.4 ] N
LH 3.9 [ 1.7 - 8.6 ] N
FSH 4.2 [ 1.5 - 12.4 ] N
SHBG 50 [ 16 - 55] N
PROLACTIN 221 [ 86 - 324 ] N
17-Beta OESTRADIOL 70 [ 44 - 156 ] N
Somatomedin-C ( IGF-1 ) - 14.2 [ 16.3 - 39.3 ]

cortisol results
----------------------

sample 1 9am - 23.5 [ 12 - 22 ]
sample 2 1pm - 10.7 [ 5 - 9 ]
sample 3 5pm - 11.3 [ 3 - 7 ]
sample 4 10pm - 5.8 [ 1 - 3 ]

dhea mean - 0.51 [ 0.4 - 1.7 ]
dhea cortisol ratio - 0.99 [ 2 - 6 ]

All High!

Thyroid
------------
TSH - 6.33 [ 0.27 - 4.2 ]
FT4 - 19.5 [ 12 - 22 ]
FT3 - 6.2 [ 3.1 - 6.8 ]
Thyroglobulin Antibody 13.4 [0-115] N
Thyroid Peroxidase Antibodies 10.5 [0-34] N

then a week later I tested for rt3

REVERSE T3 32.1 [ 9 - 35 ]
FREE T3 4.9 [ 3.1 - 6.8 ]

ratio of 9.9 or so


so, we have High Tsh, High Cortisol, High SHBG, High Prolactin, High RT3 and Low IGF-1. My VIT D/B12 etc are all top of range. Any help would be appreciated?
 
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mlc2010

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CellularIconoclast said:
What are the units on that prolactin level?

Hello,
the tests do not say, but I'm sure they are pmol/l

I've had multiple prolactin readings, all came back top of range or slightly above
 
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Have you tried taking thyroid? That should lower your prolactin, but you could have some other problem also like a prolactinoma. Prolactin powerfully suppresses libido. I'd probably stop taking the progesterone or do a much lower dose that is physiologically normal for men.
 
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mlc2010

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CellularIconoclast said:
Have you tried taking thyroid? That should lower your prolactin, but you could have some other problem also like a prolactinoma. Prolactin powerfully suppresses libido.

I was told to take t3 only to clear my RT3, but there is conflicting claims about this
 
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mlc2010 said:
I was told to take t3 only to clear my RT3, but there is conflicting claims about this

That's a good point, with high RT3 more T4 could make this even worse. You might try more food, perhaps a super high carb+salt+protein "carb feed" meal once or twice a week. More carbs and protein might cause your liver to switch over to producing T3 instead of rT3.

I've had my libido increase significantly the day after pigging out at a high quality casino buffet.
 
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mlc2010

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CellularIconoclast said:
That's a good point, with high RT3 more T4 could make this even worse. You might try more food, perhaps a super high carb+salt+protein "carb feed" meal once or twice a week. More carbs and protein might cause your liver to switch over to producing T3 instead of rT3.

Yes, could be worth a try. I also started taking some liver supplements as I have sluggish digestion issues, sometimes I can go a week without going to toilet.. however I find when I exercise heavily, my bowels work normally.. however, I shouldn't need to bust my **** off to have a bowel movement
 

aguilaroja

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mlc2010 said:
My symptoms aren't just ED, thats tip of iceberg.. my other main symptom is NO MUSCLE MASS.. I have literally seen more muscle mass on cancer patients. I have bad sleep, very dry droopy facial skin. scoliosis when I was young, asthma,...

A few "leading" questions here. Did the medical provider/s say anything about the relation of the high TSH to symptoms?

Are you underweight? What has diet been like? Are you vegan/vegetarian or have you been for an extended time? Are the cheekbones and temples prominent (low facial muscle bulk)? Is there adequate cholesterol intake via eggs or animal food? Did the 50 mg refer to pregnenolone intake, or progesterone intake?

Have you worked through a checklist of hypothyroid symptoms? Have you tracked pulse and temperature? Is there cold intolerance or cold hands/feet? What is the sleep disturbance like-Is there trouble getting to sleep/staying asleep/waking up refreshed or a combination? the brief description sounds like things are not well in addition to the ED. It is unusual for a young man to be extremely lacking in muscle bulk even with fairly sedentary duties.
 
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mlc2010

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aguilaroja said:
Are you underweight? What has diet been like? Are you vegan/vegetarian or have you been for an extended time? Are the cheekbones and temples prominent (low facial muscle bulk)? Is there adequate cholesterol intake via eggs or animal food? Did the 50 mg refer to pregnenolone intake, or progesterone intake?

Have you worked through a checklist of hypothyroid symptoms? Have you tracked pulse and temperature? Is there cold intolerance or cold hands/feet? What is the sleep disturbance like-Is there trouble getting to sleep/staying asleep/waking up refreshed or a combination? the brief description sounds like things are not well in addition to the ED. It is unusual for a young man to be extremely lacking in muscle bulk even with fairly sedentary duties.

my medical provider said the TSH is nothing to worry about as FT3/FT4 were all in range, thats the UK for you

Yes I used to be underweight, 108lbs, but then I gained and went to around 150lbs, however It is very difficult for me to put on muscle bulk. I have never been a vegan and YES my temples are prominent and I can feel my cheekbones, however I do not look thin in the face, I just know there is no muscle mass on my face as my skin sort of droops in corner of my mouth and there is no muscle/fat under my eyes

I have never taken progesterone, only pregnenlone ( micronized lipid matrix ), although I realise this was a mistake as it seems to have made my prog levels go twice over the range

my temperature is low, I will paste it at bottom of this. Regarding sleep, I do wake up a few times during night, and getting to sleep is difficult and waking up refreshed is rare, and then I crash about 1pm or so. I do take 3mg of melatonin from time to time

temps
----
day 1 : 3hr: 35.8 6hr: 35.8 9hr: 36.1 avg : 35.9
day 2 : 3hr: 35.8 6hr: 36.0 9hr: 36.2 avg : 36.0
day 3 : 3hr: 36.1 6hr: 36.1 9hr: 35.8 avg : 36.0
day 4 : 3hr: 36.1 6hr: 36.2 9hr: 35.6 avg : 35.9
day 5 : 3hr: 35.6 6hr: 36.0 9hr: 36.2 avg : 35.9
 
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mlc2010

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CellularIconoclast said:
I think that's a pretty classic sign of high rT3 euthyroid sick syndrome.

I'm going to presume high RT3 is because of a chronic illness, well that's a tough one, where do i start with that? It could literally be anything

I read on other boards that High RT3 can be from high cortisol, which I have
 
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mlc2010 said:
I'm going to presume high RT3 is because of a chronic illness, well that's a tough one, where do i start with that? It could literally be anything

I read on other boards that High RT3 can be from high cortisol, which I have

I've wondered about how buddhist monks remain healthy as most eat only one small nutrient-poor meal, once a day.

I tried emulating this because I thought it might be a secret to health, but it was horrible- my stress and all of my health problems were enormously amplified. My libido and energy levels dropped to nothing. This made me suspect that this eating style is only possible under a virtually zero stress lifestyle.

My interpretation from Hans Selye and Dr. Peat is that stress is all about energy balance, so it doesn't have one cause but is a cumulative effect of your entire environment and it's interaction with your body. So it's usually a large number of factors, but this is encouraging because you don't need to identify and fix them all. Changing a few of the larger and easier to fix ones is often enough.

Psychological stress, physical stress, and nutritional stress synergize to create a real or perceived (anticipated) energy deficit, and improving any of these can lead to overall improvement. A good diet is an essential foundation, but there's no way for diet to compensate for an otherwise very stressful life.
 
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mlc2010

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does anyone know if I'm on the right track regarding igf-1 levels? I'm guessing I may have some sort of growth hormone deficiency, would explain all my problems.. however, the more I read about people taking GH, it doesn't exactly blow them up with muscle.. so I don't know where to start

I was offered a pituitary MRI, I have to pay for it out of pocket like all my blood tests so held off on it for a few weeks

Will having PROG levels twice over range have any negative effects on a man? I was told it was a feminizing hormone
 

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mlc2010 said:
does anyone know if I'm on the right track regarding igf-1 levels? I'm guessing I may have some sort of growth hormone deficiency, would explain all my problems.. however, the more I read about people taking GH, it doesn't exactly blow them up with muscle.. so I don't know where to start

I was offered a pituitary MRI, I have to pay for it out of pocket like all my blood tests so held off on it for a few weeks

Will having PROG levels twice over range have any negative effects on a man? I was told it was a feminizing hormone
Several years ago (before discovering Peat) I was diagnosed with a prolactinoma by blood work and MRI. What originally led to the diagnosis was igf-1 levels that were out of range. I dealt with this through the medical field for years. I'm female but think that sharing my experience might possibly help. I have zero sex drive when my prolactin is high and I've often wondered if I were male if I would even be able to perform. I also experience what is commonly thought of as depression when my prolactin is elevated. I think elevated prolactin is something that once corrected can be life changing. I never had the igf-1 issue treated because my endocrinologist at the time thought that would fall into line as the prolactin decreased. After discovering Peat's work I realized that the prolactin issue wasn't an isolated issue but a body wide issue involving many other hormones, diet and a stressful environment. From my perspective my prolactin is much easier to deal with these days as long as I pay attention to eating well, managing stress, getting enough light and staying mindful of my activity and breathing. All of this is crucial for hormone balance in my situation. I think it's probably the same for males and females. I think reading everything you can from Peat is a great place to start.
 
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mlc2010

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Blossom said:
Several years ago (before discovering Peat) I was diagnosed with a prolactinoma by blood work and MRI. What originally led to the diagnosis was igf-1 levels that were out of range. I dealt with this through the medical field for years. I'm female but think that sharing my experience might possibly help. I have zero sex drive when my prolactin is high and I've often wondered if I were male if I would even be able to perform. I also experience what is commonly thought of as depression when my prolactin is elevated. I think elevated prolactin is something that once corrected can be life changing. I never had the igf-1 issue treated because my endocrinologist at the time thought that would fall into line as the prolactin decreased. After discovering Peat's work I realized that the prolactin issue wasn't an isolated issue but a body wide issue involving many other hormones, diet and a stressful environment. From my perspective my prolactin is much easier to deal with these days as long as I pay attention to eating well, managing stress, getting enough light and staying mindful of my activity and breathing. All of this is crucial for hormone balance in my situation. I think it's probably the same for males and females. I think reading everything you can from Peat is a great place to start.

Hello Blossom
were your igf-1 levels low?
did you take cabergoline? I have taken cabergoline and lowered my prolactin levels.. 0.25mg a week, I do have a libido boost but im not sure if caber is something that needs to be continued forever
 

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I haven't had any labs recently. I used to take bromocriptine years ago but had a situation and stopped taking it. The drug you mentioned was the one my old endocrinologist said was too expensive so he put me on bromocriptine. I currently use lisuride because it is supposed to be safer. I'm doctoring myself these days. Please don't think I'm suggesting that you do that, I'm just reporting my situation. When I took the bromocriptine I was on the maximum dose and some other meds and the combination resulted in a movement disorder. Luckily that has resolved but it left me personally wary of a system that would allow me to be so overmedicated. I blame myself too. Both lisuride and bromocriptine raised my libido but I think lisuride works best for me personally. I only need 1 tablet of 0.2 mg per day to keep the prolactin down. I think that is because I do so many other Peat inspired measures that have improved my overall health. I currently go by symptoms to judge how I'm doing.
 

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Ray Peat has written about growth hormone and if you go to his website www.raypeat.com and type growth hormone in the search box it will bring up lots of valuable information. It's my understanding that it should decline with age and we are probably better off if growth hormone is a bit low. It's a different way of looking at things but so far for my situation Peat has been right about everything.
 

aguilaroja

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mlc2010 said:
...my medical provider said the TSH is nothing to worry about as FT3/FT4 were all in range..
Yes I used to be underweight...
YES my temples are prominent and I can feel my cheekbones, however I do not look thin in the face, I just know there is no muscle mass on my face as my skin sort of droops in corner of my mouth and there is no muscle/fat under my eyes
my temperature is low.... Regarding sleep, I do wake up a few times during night, and getting to sleep is difficult and waking up refreshed is rare, and then I crash about 1pm or so....

First, to be clear, it is understood the ED is no joke and concern about the overall picture is not intended to minimize the ED difficulty, only to determine if their is a more comprehensive context.

Second, yes, there is a blood test for Growth Hormone. Yes, it is possible that low IGF-1 reflects growth hormone deficiency, though I do not know of a classic association of adult growth hormone deficiency and hypothyroidism. IGF-1 action apparently can also influence thyroid function (see abstract below).

Third, it sounds like even in terms of the usual medical evaluation, you have been under-served. Among other issues, there is ED, lack of muscle bulk, insomnia, mood disturbance, constipation, high TSH, high cortisol. The guess here is that there are more symptoms not yet listed, aside from the previous asthma and scoliosis. Has there been any medical assistance other than saying "too bad".

With respect, if it is possible to get a visit with a neurologist and an endocrinologist within your provider resources, it might be a good idea. If you are reasonably well nourished and you feel the muscle bulk resembles a starved cancer patient (also drooping around the mouth and distinctive tone around the eye sockets), it would be good to have perspective from someone who could recognize muscle disease and neuromuscular disease. The probability of neuromuscular problem is low, but it would be good to have that information, even if the solution is through innovative metabolic restorative methods. Also, I would hope that an endocrinologist would not dismiss the high TSH and numerous symptoms, even if the treatment approach would be different than Dr. Peat's.

Even though you are bright and persistent, it may help to have a friend or relative assist you in advocating with the health system, for prompt access to resources. The extra perspective can speed things along.

Fourth, with notably high TSH, low body temperature, and the symptoms reported, the criteria for hypothyroidism seem met by both conventional and progressive measures. Is there subjective difficulty with cold or hot environments, more than others in the same settings?

I am not sure whether the term liver supplements means dessicated liver or nutrients intended to boost liver function.

--
http://www.ncbi.nlm.nih.gov/pubmed/23982142
FASEB J. 2013 Dec;27(12):4899-908. doi: 10.1096/fj.13-231381. Epub 2013 Aug 27.
IGF-1 receptor deficiency in thyrocytes impairs thyroid hormone secretion and completely inhibits TSH-stimulated goiter. Ock S1, Ahn J, Lee SH, Kang H, Offermanns S, Ahn HY, Jo YS, Shong M, Cho BY, Jo D, Abel ED, Lee TJ, Park WJ, Lee IK, Kim J.

Abstract: Although thyroid-stimulating hormone (TSH) is known to be a major regulator of thyroid hormone biosynthesis and thyroid growth, insulin-like growth factor 1 (IGF-1) is required for mediating thyrocyte growth in concert with TSH in vitro. We generated mice with thyrocyte-selective ablation of IGF-1 receptor (TIGF1RKO) to explore the role of IGF-1 receptor signaling on thyroid function and growth. In 5-wk-old TIGF1RKO mice, serum thyroxine (T4) concentrations were decreased by 30% in concert with a 43% down-regulation of the monocarboxylate transporter 8 (MCT8), which is involved in T4 secretion. Despite a 3.5-fold increase in circulating concentrations of TSH, thyroid architecture and size were normal. Furthermore, thyrocyte area was increased by 40% in WT thyroids after 10 d TSH injection, but this effect was absent in TSH-injected TIGF1RKO mice. WT mice treated with methimazole and sodium perchlorate for 2 or 6 wk exhibited pronounced goiter development (2.0 and 5.4-fold, respectively), but in TIGF1RKO mice, goiter development was completely abrogated. These data reveal an essential role for IGF-1 receptor signaling in the regulation of thyroid function and TSH-stimulated goitrogenesis.
 
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mlc2010

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aguilaroja said:
First, to be clear, it is understood the ED is no joke and concern about the overall picture is not intended to minimize the ED difficulty, only to determine if their is a more comprehensive context.

Second, yes, there is a blood test for Growth Hormone. Yes, it is possible that low IGF-1 reflects growth hormone deficiency, though I do not know of a classic association of adult growth hormone deficiency and hypothyroidism. IGF-1 action apparently can also influence thyroid function (see abstract below).

Third, it sounds like even in terms of the usual medical evaluation, you have been under-served. Among other issues, there is ED, lack of muscle bulk, insomnia, mood disturbance, constipation, high TSH, high cortisol. The guess here is that there are more symptoms not yet listed, aside from the previous asthma and scoliosis. Has there been any medical assistance other than saying "too bad".

With respect, if it is possible to get a visit with a neurologist and an endocrinologist within your provider resources, it might be a good idea. If you are reasonably well nourished and you feel the muscle bulk resembles a starved cancer patient (also drooping around the mouth and distinctive tone around the eye sockets), it would be good to have perspective from someone who could recognize muscle disease and neuromuscular disease. The probability of neuromuscular problem is low, but it would be good to have that information, even if the solution is through innovative metabolic restorative methods. Also, I would hope that an endocrinologist would not dismiss the high TSH and numerous symptoms, even if the treatment approach would be different than Dr. Peat's.

Even though you are bright and persistent, it may help to have a friend or relative assist you in advocating with the health system, for prompt access to resources. The extra perspective can speed things along.

Fourth, with notably high TSH, low body temperature, and the symptoms reported, the criteria for hypothyroidism seem met by both conventional and progressive measures. Is there subjective difficulty with cold or hot environments, more than others in the same settings?

I am not sure whether the term liver supplements means dessicated liver or nutrients intended to boost liver function.

Liver supplements mean milk thistle, sam-e.. detox liver symptoms as I have adult acne too ( another symptom )

I have been to see an endo and he offered a pituitary MRI, I will do this once I have seen my urologist for injections ( I will use penile injections, as finding the root cause of this may take some time ) however, if my pit MRI comes out clean, I'm not sure what he will offer. In the uk, private growth hormone treatment is around £1200, I could self dose for less but first I would try and fix my high rt3/hypothyroidism.

with regards to my local GP, he tested tsh and t4 ( not free t3 or free t4 ) and prescribed me 50mcg of levothyroxine daily, just off them results.. this made me kind of weary. It would not make sense me taking t4, if im converting to rt3. I have some t3, and have tested in past, and my temps did increase.. but I read that t3 only can rise SHBG even further

Regarding temps, I feel fine in cold weather, but any sort of heat and I do any sort of walking in it, I sweat profusely from the head, nowhere else. Facial sweating.. this may be because I wear too thick clothes as I don't like my skinny arms, so maybe not a symptom but a knock on effect

My findings have been, high cortisol causing high rt3, causing high tsh trying to pump out more hormone as its not entering cells and backfilling rt3. High prolactin goes hand in hand with hypothyroidism. My SHBG is high, but I know there is no way to lower that by itself. My T and estrogen levels seem fine

do you know what can lower prog levels? I was thinking about trying DHT gel, which opposes progesterone and perhaps can lower shbg and may be missing link in my ED jigsaw

Bear in mind, I do get morning erections, however since I took preg pills, they have vanished, but they used to be there every night which may indicate performance anxiety.. but performance anxiety spanning 10+ years is hard to break. I have even tried alpha blockers in conjunction with viagra, as AB can block the rec-constricting effect of Norepinephrine in the penis

http://www.ncbi.nlm.nih.gov/pubmed/15705088

I don't know if it's related, but last year I had my cholesterol checked, and it was ( However at the time my diet was horrible and no excercise ) is Niacin worth supplementing? There are stories online that it helps with ED

HDL CHOLESTEROL 0.8 [0.9-1.5] L
HDL % of total 18 [20-99] L
LDL CHOLESTEROL 2.7 [0-3.0] N
CHOLESTEROL 4.4 [2.3-4.9] N
 

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