extreme diet, weight loss, hypogonadism - help!

thunderchild

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I need help.

I'm a male, approx 35 years old. About 2.5 years ago I realised that I was heavily overweight and did at the time what I thought was the correct thing we are all told to do - I started eating "healthily" by cutting out fats and eating less, and I took up exercise (swimming and walking). A year later I had lost the weight but had lost the weight (I now know) too fast and in an unhealthy manner. I ended up underweight, with no sex drive, and often felt very cold.

I have since stopped the cardio exercise and upped my food intake dramatically and I've regained weight (BMI of 22) eating around 3400 calories/day and look "average" weight. However my body has not recovered hormonally. My hormon levels are:
- FSH is <0.3 U/L
- LH is <0.1 U/L
- Serum testosterone is 2.9nmol/L.

Only other abnormal readings from bloods are:
- 0.0/L eosinophil count
- MCH elevated at 33pg.

All these numbers are consistent across several blood tests months apart.

I have been going to an endochrinologist for over a year now with no real progress. I am on testosterone injections to correct that but FSH and LH remain flatlined one year on. I have had an MRI scan (no pituitary gland tumour) and the endo seems to have essentially stopped investigating and is happy just to observe me now with no futher planned treatments or investigations.

I do not sleep well. I get to sleep fine but wake up about 3am and can't get back to sleep. I am so desperate to fix this problem that I am trying to do what is within my power to control - messing with my diet and supplements, which of course is what got me into this situation in the first place.

Does anyone have any advice please?
 

franko

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Re: extreme diet, weight loss, hypergonadism - help!

thunderchild said:
I have been going to an endochrinologist for over a year now with no real progress. I am on testosterone injections to correct that but FSH and LH remain flatlined one year on. I have had an MRI scan (no pituitary gland tumour) and the endo seems to have essentially stopped investigating and is happy just to observe me now with no futher planned treatments or investigations.

Don't you mean HYPOgonadism? You put "hyper" in the title.

When you are receive Testosterone injections (or exogenous Testosterone of any kind) a flatlined FSH and LH is the expected response. No offense, but I'm surprised you didn't know that. I think this is what happens when you just do what the doctor tells you, but don't research the problems and solutions on your own.

With exogenous Testosterone in your body, the hypothalamus gets the signal to stop producing GnRH (Gonadotropin Releasing Hormone) which decreases the pituitary's release of LH and FSH, and that decreases the testicles's production of testosterone and sperm.

This is the negative feedback loop of the hypothalamic–pituitary–gonadal axis which works to keep androgens and estrogens from going to high. The inactivity of the testicles is also why testicle shrinkage is a side effect of TRT or anabolic androgen steroid usage — the difference between the two being a matter of degree.

So, if you're on T injections, low LH and FSH are expected and acceptable because you don't need them to produce T anymore because you're getting it externally. Understand?

If you're not on exogenous T, that's when low LH and FSH are indicators of hypogonadism, which could explain low T, but you can also have low T with normal LH and FSH — which is what I had.

What were your Total Testosterone, Estradiol, LH & FSH levels before you started any injections? Were they flatlined from the start?

Also, what is the conversion of 2.9nmol/L to ng/dL ? I tried it online and got 83 ng/dL which would be super low (low end of normal range is 348 ng/dL on my test results). Is that the right number?
 
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thunderchild

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Thanks for the reply franko

franko said:
When you are receive Testosterone injections (or exogenous Testosterone of any kind) a flatlined FSH and LH is the expected response. No offense, but I'm surprised you didn't know that....What were your Total Testosterone, Estradiol, LH & FSH levels before you started any injections? Were they flatlined from the start?

Yes, sorry if I didnt make this clear - my FSH and LH were effectively flatlined at zero in my initial bloods taken prior to starting testosterone injections.

franko said:
Also, what is the conversion of 2.9nmol/L to ng/dL ? I tried it online and got 83 ng/dL which would be super low (low end of normal range is 348 ng/dL on my test results). Is that the right number?

Yes, your conversion is correct. My FSH, LH and testosterone levels were all essentially negligible/well below the low end of the "normal" range.
 

tara

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:welcome thunderchild

I'm glad you started eating again. If you knocked your metabolism down by semi-starving, I think it may be common for it to take a year or two to come back up again after you start consistently eating enough. Is 3400ish cals a result of eating to appetite? If you have days when you are hungry for more, I'd encourage you to take that guidance.

There are quite a few of us who have had sleep trouble and found various things to work for us - if you hunt here you'll find a few threads. Sleep is important. For some of us it seems to be a matter of inadequate glycogen storage, which can happen ither from not eating enough carbs through the day, or from having a liver that's not currently finding it easy to store enough glycogen. If you run out during the night fast, stress hormones tend to rise, and that can wake us up. Personally, I generally can't sleeep if I'm hungry. Eating enough through the day and supper before bed helps for me and some of us. (There are others who sleep better if they don't eat just before sleep.) For a while I was waking up at night and if I had a quick snack I could usually go straight back to sleep, esp. if I could do it without sitting up or opening my eyes. I'm sleeping through most nights now.

If you want more ideas, you could post more info if you want to - eg. did you get any thyroid lab results that you want to share? Have you had a go at monitoring temps and pulse? What are you eating?
 
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thunderchild

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Thank you very much for the reply, tara.

I was certainly in a steep calorific deficit for an extended period, and I'm convinced that this has led to the hormonal problems that I now have. I have no evidence for this, and the endo seems disinterested in it as a theory, but the link is strong in my opinion.

The 3400 ish cals is actually a target that I try and hit regardless of appetite so sometimes I'm eating beyond satiety and other days I'm stopping short of satiety. This targeting of a stable caloric intake at a set level to gain weight was the general guidance I've received. Would you suggest it would be healthier to eat to satiety every day even if this leads to excess weight/fat gain? I still have a lingering fear of gaining too much weight/fat, which led me to over-cut my calories in my diet initially. I have regained weight but at a slow weight. My weight is now fine but it does cause me extra mental stress worrying about getting fat again by eating too much, so the 3400 calories is both a positive and negative mental bolster. It ensures I don't under-shoot the fuel my body needs, but it also restricts me mentally from eating more even if I'm hungry some days.

I hadn't thought of having a "snack" right before bed to boost glycogen overnight and stop me getting hungry but I'll definitely give that a go (god knows I've tried almost everything else!) Is there a particular type of food that works well here? Quick simple carb hit?

My only main outstanding question really is how I can get my FSH and LH production off baseline again and my body producing its own hormone. From the earlier response it seems like this will never happen while I'm on testosterone injections? So essentially I need to persuade endo to stop the testosterone injections do I? What can I do to help my body restart production of FSH and LH if and when I stop the testosterone injections?

In terms of what I eat, I eat a lot of protein and fats (sardines, mackerel, salmon, anchovies, coconut, almonds, eggs, avocado, peanut butter, cottage cheese) and a relatively small amount of starches/carbs (oats, green veg like broccoli, spinach). I've uploaded a recent day of eating in cronometer:

http://i.imgur.com/pjSYbLN.png
 

tara

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Hi,
I don't know enough about testosterone supplementation to comment meaningfully, other than that I would expect there's a good chance all the hormones may come up to more normal levels once the body has been up out of energy deficit for a while. I hope you have enough say that no endo is going to force you to submit to treatment against your will? If your endo is not aware that severe undereating messes with hormones, then s/he may be underinformed in this area. You may be better served if you can find a dr who has some knowledge and experience of helping people recover from undereating.

3400 doesn't seem bad, but there may be gains to be made from eating more when hunger demands. My opinions on recovery from undereating are partly informed by youreatopia (related thread here: viewtopic.php?f=11&t=4028&hilit=youreatopia), and not everyone here agrees with this. That site has posts that talk about what happens in energy deficit, and what is needed for recovery, and the usual phases of recovery, amongst otehr topics. The body sometimes needs extra for repair and recovery. I think Peat's recommendations about foods could well make it work better.

If you haven't read about the Minnesota semi-starvation expperiment, you may find that interesting too.

Peat generally recommends to get polyunsaturated fats down as low as practical - both vege and fish oils - for many reasons that you can read in his articles (tehre are several on fats), but importantly because the PUFA interfere with metabolism in several ways. He favours saturated fats (coconut oil, butter, beef, mutton) over unsaturated ones, and also tends to encourage getting a good portion of our energy from carbs, not mainly fats. He tends to favour getting sugars from fruit/juice, milk, honey etc, and not so much starchy foods, esp. grains. You can take a look at his articles on sugar, too. He encourages getting plenty of calcium, for mayny readsoons, but regulating fat is one of them. Take a look at the sticky post at the top of the Diet subforum for more ideas about food. Sometimes it takes a while for people to adjust to changes in diet.

I tend to think that when recovering from semi-starvation, eating is more important that eating perfectly. But I still think it is good to improve on this by trading out PUFAs for SFAs, and ensuring good protein, carb, mineral and vitamin supply may be even better.

Some people find sweetened milk a good supper. Salt and gelatine can also sometimes help with sleep. I keep dates by the bed in case I wake up hungry. Two dates is usually enough to get me back to sleep, though I don't need them often now.

I also found attending to breathing helped my sleep. Keeping my mouth shut at night made a difference. Slowing breathing right down can sometime help send me off, or just sticking my head half under the covers to raise CO2 levels a little can help too.
 
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thunderchild

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Thanks for all the tips and for the link to the youreatopia thread, I'll read that in full and see what I can harvest from it.

In terms of starting to eat a snack before bed to help sleep, if calcium and salt are both good then I'll just try cottage cheese first of all, it is cheap and salty and full of calcium and it has a reasonable amount of sugars too. I'll see how that goes and if it helps at all then I can refine exactly what I eat before bed further
 
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James IV

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You're eating backwards. Ditch all the nut and fish fat, and replace it with potatoes and ripe fruit/juice/honey/sugar. it's extremely difficult to eat too much sugar, and sugar (as well as high potassium starch sources) are the fuel or your body to heal. Hit your protein and saturated fat minimums to supply the raw materials, then pound the starches and sugars to provide the fuel, and keep the tank topped off. In order to heal you must provide enough constant energy to shut down all catabolic stress hormones. you can get your proteins and fats in your 3 main meals, but then drink a Mexican coke or hansens soda or glass of juice, or juice concentrate every hour or so between meals. You've got to keep your foot on the gas at all times so your body becomes a regeneration machine. Ditch the diet mindset and truly believe that you cannot eat too much sugar. Your fear of getting fat will keep you from healing. I speak from experience.
 
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James IV

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Btw. Keep a bottle of raw honey (the runny kind) by your bed at night and squirt a huge mouthful if you wake up in the middle of the night. It should put you right back to sleep.
 

charlie

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[ref]James IV[/ref], great stuff. :hattip
 

signalguy

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James IV said:
post 97451 You're eating backwards. Ditch all the nut and fish fat, and replace it with potatoes and ripe fruit/juice/honey/sugar. it's extremely difficult to eat too much sugar, and sugar (as well as high potassium starch sources) are the fuel or your body to heal. Hit your protein and saturated fat minimums to supply the raw materials, then pound the starches and sugars to provide the fuel, and keep the tank topped off. In order to heal you must provide enough constant energy to shut down all catabolic stress hormones. you can get your proteins and fats in your 3 main meals, but then drink a Mexican coke or hansens soda or glass of juice, or juice concentrate every hour or so between meals. You've got to keep your foot on the gas at all times so your body becomes a regeneration machine. Ditch the diet mindset and truly believe that you cannot eat too much sugar. Your fear of getting fat will keep you from healing. I speak from experience.

What would be your recommendation for protein and saturated fat at the 3 main meals? How many grams of each?
 
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James IV

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signalguy said:
James IV said:
post 97451 You're eating backwards. Ditch all the nut and fish fat, and replace it with potatoes and ripe fruit/juice/honey/sugar. it's extremely difficult to eat too much sugar, and sugar (as well as high potassium starch sources) are the fuel or your body to heal. Hit your protein and saturated fat minimums to supply the raw materials, then pound the starches and sugars to provide the fuel, and keep the tank topped off. In order to heal you must provide enough constant energy to shut down all catabolic stress hormones. you can get your proteins and fats in your 3 main meals, but then drink a Mexican coke or hansens soda or glass of juice, or juice concentrate every hour or so between meals. You've got to keep your foot on the gas at all times so your body becomes a regeneration machine. Ditch the diet mindset and truly believe that you cannot eat too much sugar. Your fear of getting fat will keep you from healing. I speak from experience.

What would be your recommendation for protein and saturated fat at the 3 main meals? How many grams of each?

If there is anything I have learned after 10 years in the health industry, it's not to give out specific food/macro recommendations. You will have to figure out what works best for you. You may find that starch works better than sugar, or that you can eat digest cottage cheese, but not milk or regular cheese. There are far too many variables that you will have to learn for yourself. I can offer the advice, not to take anyone's word as gospel, even Peat himself. Sometimes what works in theory, or for another person, doesn't work in practice. The only thing I can say for sure is that avoidance of PUFA is always going to be a good idea. When you find your own healing foods, you should see very immediate results in your health. When your body has sufficient energy it is very quick to start healing all the problems that have been put on hold due to lack of energy. Trust your instincts, if something doesn't feel right after giving your body time to adjust, then maybe it's time to tweak.
 
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signalguy

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James IV said:
post 99496
signalguy said:
James IV said:
post 97451 You're eating backwards. Ditch all the nut and fish fat, and replace it with potatoes and ripe fruit/juice/honey/sugar. it's extremely difficult to eat too much sugar, and sugar (as well as high potassium starch sources) are the fuel or your body to heal. Hit your protein and saturated fat minimums to supply the raw materials, then pound the starches and sugars to provide the fuel, and keep the tank topped off. In order to heal you must provide enough constant energy to shut down all catabolic stress hormones. you can get your proteins and fats in your 3 main meals, but then drink a Mexican coke or hansens soda or glass of juice, or juice concentrate every hour or so between meals. You've got to keep your foot on the gas at all times so your body becomes a regeneration machine. Ditch the diet mindset and truly believe that you cannot eat too much sugar. Your fear of getting fat will keep you from healing. I speak from experience.

What would be your recommendation for protein and saturated fat at the 3 main meals? How many grams of each?

If there is anything I have learned after 10 years in the health industry, it's not to give out specific food/macro recommendations. You will have to figure out what works best for you. You may find that starch works better than sugar, or that you can eat digest cottage cheese, but not milk or regular cheese. There are far too many variables that you will have to learn for yourself. I can offer the advice, not to take anyone's word as gospel, even Peat himself. Sometimes what works in theory, or for another person, doesn't work in practice. The only thing I can say for sure is that avoidance of PUFA is always going to be a good idea. When you find your own healing foods, you should see very immediate results in your health. When your body has sufficient energy it is very quick to start healing all the problems that have been put on hold due to lack of energy. Trust your instincts, if something doesn't feel right after giving your body time to adjust, then maybe it's time to tweak.

I'm just curious what you think since you mentioned protein and fat at the main 3 meals along with high potassium starch. Also, I found your comment to pound the sugars interesting. But I understand if you don't want to make specific suggestions and I definitely plan to eliminate pufa as much as possible.
 
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J

James IV

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signalguy said:
James IV said:
post 99496
signalguy said:
James IV said:
post 97451 You're eating backwards. Ditch all the nut and fish fat, and replace it with potatoes and ripe fruit/juice/honey/sugar. it's extremely difficult to eat too much sugar, and sugar (as well as high potassium starch sources) are the fuel or your body to heal. Hit your protein and saturated fat minimums to supply the raw materials, then pound the starches and sugars to provide the fuel, and keep the tank topped off. In order to heal you must provide enough constant energy to shut down all catabolic stress hormones. you can get your proteins and fats in your 3 main meals, but then drink a Mexican coke or hansens soda or glass of juice, or juice concentrate every hour or so between meals. You've got to keep your foot on the gas at all times so your body becomes a regeneration machine. Ditch the diet mindset and truly believe that you cannot eat too much sugar. Your fear of getting fat will keep you from healing. I speak from experience.

What would be your recommendation for protein and saturated fat at the 3 main meals? How many grams of each?

If there is anything I have learned after 10 years in the health industry, it's not to give out specific food/macro recommendations. You will have to figure out what works best for you. You may find that starch works better than sugar, or that you can eat digest cottage cheese, but not milk or regular cheese. There are far too many variables that you will have to learn for yourself. I can offer the advice, not to take anyone's word as gospel, even Peat himself. Sometimes what works in theory, or for another person, doesn't work in practice. The only thing I can say for sure is that avoidance of PUFA is always going to be a good idea. When you find your own healing foods, you should see very immediate results in your health. When your body has sufficient energy it is very quick to start healing all the problems that have been put on hold due to lack of energy. Trust your instincts, if something doesn't feel right after giving your body time to adjust, then maybe it's time to tweak.

I'm just curious what you think since you mentioned protein and fat at the main 3 meals along with high potassium starch. Also, I found your comment to pound the sugars interesting. But I understand if you don't want to make specific suggestions and I definitely plan to eliminate pufa as much as possible.

I'm sorry. I can't in good conscience give you specific numbers. I wouldn't know how to anyway. I don't believe in counting macros/calories.
Healing foods will make you feel calm (maybe even tired if you're still sympathetic nervous system dominant) and positive. They will also make you feel more confident and possibly horny. They should not make you overenergized, euphoric, or anxious. They should also make you feel lighter/leaner and hungry as they digest. Hunger is good, especially when you are trying to heal.
 
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