# Lab results show antibodies present, symptomatic, what to expect from endo?



## fttfbass (Jan 8, 2014)

Since, my PCP wouldn't run the proper tests, I went ahead and ordered them myself. Everything is in the normal range, except my antibodies were flagged as high. 6 weeks ago, my TSH was 2.54 and total T4 was 6.1 with the same ranges as below (that's all my PCP at the time would run). They both increased a bit.

TSH 2.810 (0.450-4.500)

Thyroxine (T4) 7.6 (4.5-12.0)

T3 Uptake 31 (24-39)

Free Thyroxine Index 2.4 (1.2-4.9)

Thyroxine (T4) Free, Direct 1.06 (0.82-1.77)

Triiodothyronine (T3) 120 (71-180)

Triiodothyronine, Free, Serum 3.1 (2.0-4.4)

Thyroid Peroxidase (TPO) Ab 120 (0-34)

Thyroglobulin, Antibody 14.3 (0.0-0.9)

My symptoms and brief story were previously posted here if that helps....................http://thyroidboards.com/forums/topic/10005-new-here-and-hoping-for-some-advice/

I had a CMP ran as well. Everything is within normal range, although a few things were at the extreme high end of "normal" (ie. glucose, sodium, calcium). I'll gladly post it up if anyone thinks anything could be relevant.

It looks to me like my TSH is high and my free T3 and T4 are both a bit low (if I'm understanding what I've read in other forum threads correctly).

*What should I expect from the endo? I'm clearly symptomatic and want to be prepared for my appointment on Feb 18th.*


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## fttfbass (Jan 8, 2014)

My PCP just referred me to an endo. I'm awaiting their call, which hopefully doesn't take too ridiculously long.

On a side note, I was online browsing through local endo's that take my insurance. When my PCP called, I had the endo that they are referring me to on my computer screen. Hopefully, that's some sort of good omen and not just an odd coincidence.


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## madthyroid78 (Jan 28, 2014)

I know there are many people on here who can help u. good luck!


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## fttfbass (Jan 8, 2014)

madthyroid78 said:


> I know there are many people on here who can help u. good luck!


Thanks.

I have an endo appointment scheduled for Feb 18th.


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## Airmid (Apr 24, 2013)

Well the presence of antibodies is definitely suggestive that you are on your way to developing an autoimmune thyroid disorder.

I was just talking to someone about this and this is what looks like a case of subclinical hypothyroidism. While your thyroid hormones and TSH are still in the normal range you have the antibodies present that could possibly be causing you problems and will slowly drive your other numbers out of range over time. And not everyone has a dramatic thyroid change here. Some of us, like myself just suddenly started having TSH fly from like 1 to 17 in the course of a few months (and when I asked why I was told it didn't matter at the time, I was only 25). One the other hand, others have had a slower course where it starts off rather insidious with vague symptoms that went on for yeas until either a full panel was done or their TSH finally went outside of normal range giving the doctor "justification" for running more tests.

What some do in this situation is chose to go on a dose of thyroid hormone to suppress your thyroid. You give your body what it needs, makes the thyroid less of a target as it doesn't have to work so hard and becomes less of a target to your autoimmune system's hate. Hopefully then you can also find some relief from some of the things going on.

It would probably be a good idea to have an ultrasound done, especially if you feel that your thyroid has become bigger. Both goiters and nodules can occur with hypothyroidism.

You definitely have some wiggle room to bring your TSH down a bit and your frees up. There are a lot of people here that like there TSH at around 1 or lower and their frees in the 50-75% range of normal, that's where they feel the best. Hopefully this Endo will be agreeable to starting you on a low dose and take it from there. I know some do this "watchful waiting" but if you're having issues that not really the best outcome for you. If they want to do that at least go back to your PCP and say "Look, we know my body is doing something here it shouldn't be. Let's try a low dose of thyroid hormone to see if we can help ease things up a bit."

Depression and anxiety are both part of hypothyroidism. I don't know if yours is solely caused by this or if this is just aggravating the situation. When you are taking care of your thyroid keep an eye of your depression and anxiety meds and dosages. Do you see a therapist or does your PCP prescribe these meds for you? (I do actually have issues with GP's prescribing mental health medications but that an issue for a whole other topic.) Your dosages of these medications may need to be adjusted and it's important to stay on top of that.

I hope this Endo does try you on a low dose of thyroid hormone and that it helps relieve some of the things you've been feeling at least. This is a good example of why it's important to just look for the antibodies when a patient is symptomatic, and even more so in your case with a strong family history of thyroid disease. It's also why this over-reliance on TSH is troubling at times. While hypothyroidism isn't as common in males as it is females, both men and women in your family have had issues and these tests are not hard to run or that expensive as you found out.

Good luck and I hope all goes well.


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## fttfbass (Jan 8, 2014)

Airmid,

Thanks for the lengthy and extremely informative reply. "Watchful waiting" is definitely not the course of action that I want to take. I've been feeling pretty lousy for the past 5 years or so and have begun to really take a turn in an uncomfortable direction over the course of the past year and a half. I need to get this somewhat under control, so I can get back to work. My wife has had to completely pick up the slack financially in order for us to survive as a family.

To answer a few of your questions, my GP at the time was the one who prescribed me SSRI's to begin with. I was experiencing quite a bit of irritability at the time and he ended up prescribing Prozac. This was in the Fall of 2008. Shortly after he switched me to Zoloft. I started experiencing quite a bit of anxiety like symptoms, so I was also prescribed Xanax. SSRI's never really helped much physically and seem to agitate my anxiety like symptoms quite a bit. The SSRI's also appear to make me feel mentally depressed. In early Spring of 2012, I discontinued Xanax because it wasn't helping anymore. In late Spring of 2012, after feeling completely down in the dumps and having some depressive thoughts, I discontinued the Paxil that I was on at the time. Mentally I felt much better. Since I was still feeling terrible physically, in November of 2013 my GP prescribed me Celexa because he was stuck on the depression and anxiety diagnosis. Once again, mentally I felt terrible and it did practically nothing to improve my physical symptoms. I weaned the Celexa down and discontinued it 2 weeks ago. Mentally I feel normal again. Physically I still feel like crap. I'm still currently taking Xanax. It isn't helping me, but the way I feel physically I'm not completely prepared to deal with withdrawal from a benzo at this time. I have slowly decreased the dosage in half, but I'm at the point where if I decrease any further I'm going to start dealing with the effects of benzo withdrawal. I completely understand your issue with GP's prescribing mental health meds. They seem to like to toss them out like candy, without any regard for the well being of the patient. I switched PCP's after realizing that my old PCP will never take my concerns seriously. Sadly, my new PCP offered me Ativan 4-5 times during my brief appointment this past Monday, while refusing to run anything more than TSH. Hence, why I ordered and paid for my own lab tests. This was my first visit with her and I felt that she already had a preconceived notion that I'm either a mental health case, a hypochondriac, or both. After she saw my labs, I think her attitude towards me has quickly changed. She immediately got me set up with an Endocrinologist.

I suspect that I may have been hyper most of my adult life and now I feel like I swing back and forth between hypo/hyper symptoms. I also wonder if the SSRI's exacerbated any thyroid related issues that I may have. I'm hoping the Endo will help get my physical symptoms under control. If I feel the need, I have no problem with seeing a Psychiatrist and/or Therapist, but so far my experience with antipsychotics and anti-anxiety meds has been lackluster to say the least.


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## madthyroid78 (Jan 28, 2014)

fttfbass said:


> Airmid,
> 
> Thanks for the lengthy and extremely informative reply. "Watchful waiting" is definitely not the course of action that I want to take. I've been feeling pretty lousy for the past 5 years or so and have begun to really take a turn in an uncomfortable direction over the course of the past year and a half. I need to get this somewhat under control, so I can get back to work. My wife has had to completely pick up the slack financially in order for us to survive as a family.
> 
> ...


I agree that docs love handing out antidepressants. I have dealt with this for 9 yrs. They tell me I have depression.....the they say ADD,,,,the its Bipolar,,,,lets try celexa....now wellbutrin added in....the bipolar meds. They ask me if I want to try something else. I never went on the bipolar meds. It would me funny if they found out it was all thyroid! Wish we didnt have to BEG for more then a TSH! Good luck. Seems like u are moving forward a bit.


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## fttfbass (Jan 8, 2014)

madthyroid78 said:


> I agree that docs love handing out antidepressants. I have dealt with this for 9 yrs. They tell me I have depression.....the they say ADD,,,,the its Bipolar,,,,lets try celexa....now wellbutrin added in....the bipolar meds. They ask me if I want to try something else. I never went on the bipolar meds. It would me funny if they found out it was all thyroid! Wish we didnt have to BEG for more then a TSH! Good luck. Seems like u are moving forward a bit.


It's quite sad actually. I feel like the past 5 years of my life have been a waste. It wasn't until last year that I started doing my own research to try and get a better understanding of what my symptoms are telling me. Begging for more than checking TSH got me absolutely nowhere with two doctors. I wonder how many others out there are dealing with the same problem. That's why I ended up taking the initiative to order the labs myself. I'm tired of being passive about my health. I'm hoping the endo doesn't just want to sit back and see what my levels do over time. If he doesn't order an ultrasound, I will. The timing of my appointment with him is perfect because if he doesn't order one, I can get into a health screening lab to have it done 2 weeks later. If he doesn't provide me with a low dose of thyroid hormone to help ease my symptoms, I'm not sure what to do. I have doubts that my new PCP will oblige me, if the specialist turns me down and wants to watch and wait to see what my levels do over time. But, I'll have to see what happens at the upcoming appointment before deciding what my next course of action should be.

I wish you the best of luck as well. Dealing with this crap over the course of 9 years, with what might be an incorrect mental health diagnosis, is ridiculous and something nobody should have to go through in the 21st century.


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## Swimmer (Sep 12, 2013)

Shame on those doctors for NOT doing their job!! It is SO GREAT to know that you/we have lab access and can get things moving!

When you present something in writing like labs -- it requires action!

If you can't get the thyroid you need - -just take those labs to an ND (after calling first to make sure they can prescribe something like armour) and at least you will have something!!


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## fttfbass (Jan 8, 2014)

I have a question........

The lymph nodes in my neck at the base of my jaw on both sides (the ones doctors normally feel when a patient is getting sick) have been tender to the touch since the Fall of 2012. I've been battling with a sinus/upper respiratory infection lately and they've swelled up and gotten extremely sore. I'm on antibiotics to take care of the infection and they seem to be doing their job.

But, does the fact that they've been tender to the touch (no obvious swelling that I'm aware of, although I don't know what they're supposed to normally feel like) for over a year and a half mean anything? Obviously, I'll mention it to the Endo when I see him next week, but I was curious if anyone could shed some insight on what that could potentially indicate.


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## fttfbass (Jan 8, 2014)

I saw the Endo today. He did an ultrasound. No nodules, but I do have a goiter. He diagnosed me with Hashi's. Since I'm symptomatic with levels still in the normal range, he gave me the choice whether to start on a low dose of meds or not. I opted to try something for some relief, so he prescribed 25mcg of Levothyroxine. I will see him again in 2 months. 2 weeks prior to that I'll have labs drawn. Unfortunately, he'll only be testing TSH, but at least he's listening to my symptoms. He's also checking my testosterone and AM cortisol. My PCP is having labs drawn for Vitamin D, among other things, so he wants the results for that when I see him.

Hopefully the meds will help a bit. I'm going to be making some huge dietary changes in the near future and attempt to give up the nasty habit of smoking cigarettes.

I would have rather been told that I have thyroid cancer and it needs removed, but at least I'm finally getting answers.


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## Airmid (Apr 24, 2013)

Don''t you love it - No nothing wrong with your thyroid...oh wait you have a goiter going on.

Honestly if you have high antibodies and a goiter it means your thyroid is having issues trying to cope and I personally think it's wise to start on thyroid replacement. I'm glad he's seeing you again in two months and keeping close tabs on things. Good to see after everything.

I do have an issue with GP's prescribing mental health medicines. Those issues are already so complicated and then if you have something overlooked (like say in your neck) that just complicates the issues further. You could have the issues naturally or they could be a product of struggling thyroid and the body on a suicide mission to kill off an essential gland in a process we still don't understand. Which is why they should be sending people to specialists for proper care. In emergent situations, yes they should prescribe but otherwise they need to back off. Plus even worse it slaps you with a label and the way we treat mental health patients in this country...well you'd be better off with leprosy.

The whole lymph node thing - many of us have gotten those from time to time including in the area you have now. In fact right before my thyroid went nuts my PCP (soon to by my ex- PCP if I can get reassigned since I think she actually helped caused my thyroid going haywire) found I had swollen lymph nodes in my neck including by my jaw. You have to remember that your immune system is very unhappy right now, it thinks it has this butterfly shaped enemy that it needs to all out kill and that has an affect on a lot of things. They're actually finding that people with high antibodies that had a TT still do have issues until the antibodies calm down. They may very well not be the harmless measuring stick they are seen as now.


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## fttfbass (Jan 8, 2014)

Day 1 on Levothyroxine 25mcg and I'm constantly going back and forth between feeling cold and then feeling extremely hot. I'm extremely jumpy to any noises around me. I'm struggling to speak correctly, the words I want to say aren't coming out. I felt like this back in September when I tried a Thyroid Support supplement and ended up discontinuing it as soon as I started to get a bit delirious.

I've been suspicious of having issues with my adrenals just as long as I've had an inkling that my thyroid was off. My Endo only wants to run an AM Cortisol test in 6 weeks, which doesn't show the whole picture of how the adrenals are functioning throughout the day. I just went ahead and ordered an adrenal stress profile saliva test from ZRT labs, since it appears that I have to do most of the work myself rather than relying on doctors to put the puzzle pieces together for me.

From what I've read so far, if adrenals are off, they should be addressed before taking any sort of thyroid meds or bad things could potentially happen.

*Is this typical on day 1 of meds? Should I even bother with day 2 on Levothyroxine tomorrow or wait until the results of the adrenal test come back? Opinions are more than welcome.......*


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## Swimmer (Sep 12, 2013)

I would call your doctors office and talk to the nurse or leave a message with the nurse.

I was told that I wasn't supposed to feel synthroid until two weeks had passed. Instead, I felt it the first evening... Based on my symptoms - which are different than yours -- my endo of 40+ years took me off as I was having adverse reactions.

So -- call your nurse -- she'll talk to the doc... I'd recommend doing this today.

If your timezone means the doc is already gone for the day -- then call the prescribing pharmacy and talk to the pharmacist.


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## fttfbass (Jan 8, 2014)

As of now, I'm holding off on continuing the thyroid meds. Their is a possibility that I'm on the verge of getting sick. My son is starting to show some flu like symptoms. Everytime I get sick, my symptoms get about 10 times worse, even before I start to show the flu or cold like symptoms. Lack of sleep affects me like this, too. I'll wait until I get the results from the adrenal stress profile and go from there.


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## Airmid (Apr 24, 2013)

Also keep in mind that there are different thyroid meds. My cardiac nurse told me just the other day that her friend just can't take Synthroid. Don't know why - she just reacted really really badly. Tachycardia, jumpiness, anxiety etc. She takes a different thyroid med and is fine.

You are also a harder case to treat as your thyroid is still maintaining some kind of normal function but it's swelling and you are making antibodies. So it's a hard balance to try to stop the progression of the goiter and help your symptoms while not having issues with medication. I would definitely call your doctor and tell them. Also keep in mind you can chose to split the dose, just be sure to avoid iron, calcium and soy around the time of each dose.


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## fttfbass (Jan 8, 2014)

My PCP had a nurse call me on Friday. My Vitamin D levels are low, so she called in a prescription for 50000 IU of vit D that I take once weekly. I took my first one Saturday morning, and it's definitely helping quite a bit already. I'm still waiting for the adrenal stress profile to arrive in the mail from zrt labs. If that comes back fine, I'll try the levothyroxine again. If I react poorly again, I'll give my Endo a call and request to try something else. If something is up with my adrenals, I'll try to have my next Endo appointment bumped up to a closer date.


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## fttfbass (Jan 8, 2014)

I just received the adrenal saliva test in the mail today. It looks like I'll be spitting into tubes tomorrow and then send it out Wednesday morning. UPS ground is already prepaid by zrt labs (or by me whom paid zrt labs), but I may pay extra to get it there faster. I live on the opposite side of the country from where it needs to go, so it may be worth spending the extra money to get it there by Friday and possibly know my results by the end of next week.


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## fttfbass (Jan 8, 2014)

I do have a question. If Levothyroxine doesn't work out, it seems that Armour could be a good fit for Hashi's. Is Armour expensive? I don't have a prescription plan with my health insurance. So, all of my scripts are paid out of pocket.


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## jenny v (May 6, 2012)

My Armour is $2.79 a month with my insurance; it would be about $17 without it at Walgreen's for me.


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## fttfbass (Jan 8, 2014)

jenny v said:


> My Armour is $2.79 a month with my insurance; it would be about $17 without it at Walgreen's for me.


Thank you for the information. I'm glad to hear that it's affordable.

I had my follow up appointment with my PCP about the labs that she had drawn.

Vit D was 21 with a reference range of 30-100 ng/mL

So, I'll be on the 50000 IU weekly dose for 12 weeks and then have my levels checked again to see where they are at.


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## madthyroid78 (Jan 28, 2014)

fttfbass said:


> It's quite sad actually. I feel like the past 5 years of my life have been a waste. It wasn't until last year that I started doing my own research to try and get a better understanding of what my symptoms are telling me. Begging for more than checking TSH got me absolutely nowhere with two doctors. I wonder how many others out there are dealing with the same problem. That's why I ended up taking the initiative to order the labs myself. I'm tired of being passive about my health. I'm hoping the endo doesn't just want to sit back and see what my levels do over time. If he doesn't order an ultrasound, I will. The timing of my appointment with him is perfect because if he doesn't order one, I can get into a health screening lab to have it done 2 weeks later. If he doesn't provide me with a low dose of thyroid hormone to help ease my symptoms, I'm not sure what to do. I have doubts that my new PCP will oblige me, if the specialist turns me down and wants to watch and wait to see what my levels do over time. But, I'll have to see what happens at the upcoming appointment before deciding what my next course of action should be.
> 
> I wish you the best of luck as well. Dealing with this crap over the course of 9 years, with what might be an incorrect mental health diagnosis, is ridiculous and something nobody should have to go through in the 21st century.


You and I have sort of the same story. I too have been on antidepressants for years (10 yrs). I have been told i am bipolar because of mood swings and periods of mania. I now feel like I have times of hypo and hyper thyroidism. I went and had blood done myself and got the answers i needed to diagnose myself with hypo. All the docs said I my TSH was normal. Glad your getting the help you need now. I started meds a few weeks ago and changed my diet as well. good luck!


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## madthyroid78 (Jan 28, 2014)

I am on Armour myself for a few weeks now. My mind seems a lot clearer but that could be from cutting everything from my diet too. No gluten, sugar, soy and hardly any dairy. Less body aches too.


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## fttfbass (Jan 8, 2014)

My results from my adrenal saliva test came back today. It's pretty much what I expected to see. Everything was in the normal range, until my pre-bedtime reading where it dipped just below normal. Which makes sense, since I have a tendency to finally warm up and get obnoxiously hot when I'm ready to go to sleep. The lab comments basically said that my patterns are following a normal circadian rythym, but my adrenals may be working harder to cope with mental/physical stress. So, it sounds to me like I need to get my thyroid under control and hopefully the adrenals will follow. I'm going to give Levothyroxine another shot starting tomorrow. I'll see how I react to it this time around (now that I'm not as worried about the possibility of an adrenal crisis) and go from there.

For the lab junkies:

DHEAS 14.5 (2-23) Age dependent

Cortisol AM 6.8 (3.7-9.5)

Cortisol Noon 2.1 (1.2-3.0)

Cortisol Evening 1.6 (0.6-1.9)

Cortisol Night 0.3 (0.4-1.0)


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## fttfbass (Jan 8, 2014)

It's been awhile since I've checked in. Some days I feel a little better, others not so much.

Here are all thyroid labs from the beginning:

01/29/14:

TSH 2.810 (0.450-4.500)

Thyroxine (T4) 7.6 (4.5-12.0)

T3 Uptake 31 (24-39)

Free Thyroxine Index 2.4 (1.2-4.9)

Thyroxine (T4) Free, Direct 1.06 (0.82-1.77)

Triiodothyronine (T3) 120 (71-180)

Triiodothyronine, Free, Serum 3.1 (2.0-4.4)

Thyroid Peroxidase (TPO) Ab 120 (0-34)

Thyroglobulin, Antibody 14.3 (0.0-0.9)

02/19/14:

TSH 2.52 (0.30-5.00)

I had my first endo appointment shortly after the labwork on 02/19/14 and was put on 25mcg of levothyroxine daily.

04/07/14:

TSH 2.47 (0.30-5.00)

My endo increased me to alternating days of 25mcg and 50mcg of levothyroxine. I also weened down and discontinued the Xanax that I was taking in the middle of May. I didn't notice anything different when I discontinued it, so I guess it wasn't doing anything for me anymore.

06/16/14:

TSH 2.63 (0.30-5.00)

Free (T4) Thyroxine 1.00 (0.6-1.6)

My endo increased me to 50mcg of levothyroxine daily and my next appointment is scheduled at the end of August. He says he's only going to check TSH from here on out, which is a bit concerning. I was hoping he'd continue checking Free T4 and also check Free T3. I don't even think it's an insurance thing because he made it sound like he shouldn't have bothered checking Free T4 at all.

Vitamin D labs:

02/19/14

VIT D, 25-OH D2 <4 ng/mL

VIT D, 25-OH D3 21 ng/mL

VIT D, 25-OH TOTAL 21 ng/mL (30-100)

I was on 50,000 IU of D2 for 12 weeks.

05/22/14
VIT D, 25-OH D2 48 ng/mL

VIT D, 25-OH D3 14 ng/mL

VIT D, 25-OH TOTAL 62 ng/mL (30-100)

I was diagnosed with acute prostatitis at the end of May. I was experiencing pain in my lower abdomen and testicles. My PCP put me on antibiotics for 10 days and the pain went away. Also, a few symptoms that I thought were thyroid related disappeared as well. ie. random chills and hotflashes. 2 weeks ago, the pain started coming back and so did the chills and hotflash like symptoms. My PCP is going to try another course of antibiotics again, but after reading up on prostatitis I have my doubts that it'll go away indefinitely.

My testosterone was also checked on 04/07/14. My endo told me that my levels looked good. They're in the normal range, just like my thyroid levels are. But, they don't look to me like they're in the optimal range. I was about halfway through my course of 50,000 IU of D2 weekly for my low vitamin D levels when these labs were taken. I've read that low vitamin D can affect testosterone levels.

Testosterone labs 04/07/14 (32 yr old male):

Testosterone Free (CPAL) 93.7pg/mL (50.0-210.0)

Testosterone Total 486ng/dL

I caved in and started taking 5-HTP about a week ago to take the edge off of some of my symptoms, without the negative side effects I've gotten from SSRI's in the past. It seems to be helping a little, but only time will tell.

One thing that I've noticed is that I feel much better when my body temperature is close to normal. It's usually around 97.8. Now that it's warmer out, if I spend time outside it'll usually increase to 98.2-98.6 and my symptoms will improve a lot.

This post was more of an informative rant than anything. But, as usual, any advice would be much appreciated.


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## fttfbass (Jan 8, 2014)

<Found the answer to my question in another thread>


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