What blood tests should I get for low libido, lethargy and brain fog?
February 26, 2016 6:30 AM   Subscribe

A few years back, I noticed a real dip in energy and libido with additional feelings of brain fog and depression/anxiety. What blood tests are worth checking?

I'm a 40yo male in otherwise decent health. Thin without ability to gain much weight.

A few years ago after an extremely stressful extended period of time, I began having these symptoms: low libido, lethargy, brain fog, depression. What it felt like to me is something in the adrenal system just... dropped. Although I know "adrenal fatigue" is debated.

A lot of days it seems like I'm trapped in a weird fight-or-flight mentality. I feel anxious and tingly for no reason (life and job have been fine for awhile) yet shut down below the waist, so to speak.

I live in a large city and the doctors I've seen are harried and dismissive about what might be wrong. Some things I've already had tested, although the doc doesn't seem interested in the results:

TSH: 1.98 (0.4-4.5 MIU/L)
T4: 1.0 (0.8-1.8 NG/DL)
T3: 3.0 (2.3-4.2 PG/ML)
FSH: 5.2 (1.6-8 MIU/ML)
LH: 3.2 (1.5-9.3 MIU/ML)
RT3 ratio: 13 (8-25 NG/DL)
B12: 238 (200-1100 PG/ML)
Total T: 800 (250-1100 NG/DL)
Bioavailable T: 200 (100-575)
Free T: 90 (46-224 PG/ML)
Estradiol: 38 (< 29 PG/ML)

Some things others have recommended for these symptoms:

-try 24hr saliva test
-try pituitary tumor test
-try 2hr glucose challenge test / insulin resistance test
-get ferritin checked
-check cbc
-try cypionate testosterone shots
-try thyroid meds

I don't know much about any of this. Has anyone with these symptoms ever experienced this and found treatment? Where to start and how to make a gameplan?
posted by deern the headlice to Health & Fitness (22 answers total) 10 users marked this as a favorite

Actually, low energy, low libido, and brain fog are all signs of depression. So maybe if the depression was treated, it might solve the other issues.
posted by MexicanYenta at 6:36 AM on February 26, 2016 [2 favorites]

Response by poster: ^ I should add, I'm taking 150mg/day Wellbutrin for that reason. I've seen very small improvements to energy, possibly to libido, but not really. I would believe this was all depression, I guess, if not for the sudden way it seemed to come on.
posted by deern the headlice at 6:40 AM on February 26, 2016

If you live in a non hot country/state, get your Vitamin D levels tested. My depression has improved dramatically since I got mine back around normal and took steps to keep them that way in the winter.
posted by greenish at 6:52 AM on February 26, 2016 [5 favorites]

posted by yeahlikethat at 6:52 AM on February 26, 2016 [6 favorites]

Yes, definitely get your Vitamin D tested! Also, a sleep test. My lethargy and brain fog issues were due to severe sleep apnea, as I found out after an in-lab sleep test. If you don't have a bed partner, or your bed partner is a sound sleeper, it can be hard to tell if you snore and/or stop breathing at night. Get a sleep test! After I got a CPAP my life changed for the (much, much) better.
posted by Rosie M. Banks at 7:12 AM on February 26, 2016

P.S.: yes, you certainly CAN be thin and have sleep apnea. Sometimes it's a matter of having a very small airway. So don't let anyone blow you off with "but you can't have apnea because you are thin!"
posted by Rosie M. Banks at 7:14 AM on February 26, 2016 [3 favorites]

+1 for Vitamin D.

Also, your B12 is on the low side of normal. Some doctors don't remark as long as something is "in range" but that doesn't mean your body wouldn't do better with a higher level, so you might want to look into that.

Good luck!
posted by whoiam at 7:21 AM on February 26, 2016 [1 favorite]

Response by poster: Dangit! I have actually checked Vitamin D and don't know why it wasn't pasted into those labs.

In October is was 30 (30-100 range). Since then I've taken about 5000IU/day supplements but as of last month, it continues to be about 30.
posted by deern the headlice at 7:34 AM on February 26, 2016

check out either a nurtitionist or doc thats specializes in functional medicine?

i have hypothyroidism that looks sooo mild in blood values, but wreaks havoc on my life if its outta whack (had all those symptoms you mention above). also couldnt keep weight on for the life of me when it was at its worse, which generally isnt the case..

ooh and i've found that sugar is a huge buzzkill for my libido. really helped when i cut down on it
posted by speakeasy at 7:40 AM on February 26, 2016

Are you currently drinking alcohol? As a depressant, it can have many of the side effects you listed.
posted by jpolchlopek at 7:44 AM on February 26, 2016

I should add, I'm taking 150mg/day Wellbutrin for that reason. I've seen very small improvements to energy, possibly to libido, but not really. I would believe this was all depression, I guess, if not for the sudden way it seemed to come on.

For what it's worth, it is not uncommon for depressive episodes to come on fairly quickly, and to be unresponsive to some antidepressants. You don't say exactly how quickly you mean, but before I was properly medicated there were definitely times when I declined from "fine" to "pretty miserable" in a few weeks or months.

Most clinically depressed people do develop it younger than you, but not all. You should definitely look into other possibilities, but I wouldn't consider depression totally ruled out.

(My experience is also that GPs aren't great at diagnosing or treating depression. If haven't already seen a psychiatrist, and you suspect depression for other reasons, it might be worth a try.)
posted by nebulawindphone at 7:46 AM on February 26, 2016 [3 favorites]

Are you taking D2 or D3?
posted by discopolo at 7:47 AM on February 26, 2016

Response by poster: discopolo: Vitamin D3

speakeasy: is there anything you've taken for hypothyroidism that's caused a jump in libido other than omitting sugar?
posted by deern the headlice at 7:53 AM on February 26, 2016

I should add, I'm taking 150mg/day Wellbutrin for that reason. I've seen very small improvements to energy, possibly to libido, but not really. I would believe this was all depression, I guess, if not for the sudden way it seemed to come on.

One thing to consider as you weight all of the worthy variables is that (from what I understand) 150mg/day is the minimum therapeutic level recommended for starting Wellbutrin. When I started at that level, I felt okay, but still had many of the same symptoms you described. In consultation with my doctor, we increased it to 300mg/day, and that was apparently the sweet spot. Also, Wellbutrin doesn't work for everyone. My wife takes another medication (Celexa, I think) and it changed her life.
posted by SpacemanStix at 8:38 AM on February 26, 2016 [1 favorite]

You might get the blood tests for celiac done--brain fog and lethargy are common symptoms. Low D3 that isn't responding to supplementation might indicate something going on with your ability to absorb nutrients too.

I'm sorry you're having a hard time getting a doctor to care about this. All the symptoms you mention are hard to pin down to a cause and I think that makes a lot of doctors give up before they get started.
posted by purple_bird at 8:41 AM on February 26, 2016 [1 favorite]

Seconding celiac bloodwork. I'd also add asking about the common rheumatological screening bloodwork, CRP, that sort of thing.

Do you have any potential exposure to Lyme disease?

Also, seconding sleep study. Doctors are less likely to think of it if you're of normal weight, but sleep apnea can occur at any weight.
posted by pie ninja at 9:18 AM on February 26, 2016

currently on levothyroxine. though its really taken the edge off the worst stuff (!!), hasn't really been the silver bullet i was hoping for, which is kinda why i started looking elsewhere for answers (tcm, seeing a dietician next week etc.)

to be frank, going sugar free can be pretty damn bleak (would live off croissants and chocolate if i could), and a painnn, but after a week or two you actually start feeling more together brain/energywise and all.. its one of the first things i address when i start feeling off
posted by speakeasy at 10:33 AM on February 26, 2016

If your vitamin D levels aren't improving with daily supplements, you might need to megadose to get your levels up to normal. Talk to your doctor before you try this. I have had to take 50000 iu every week for 6 weeks before when my levels dropped and wouldn't come back up.

Get some B12 sublinguals. They are easier to absorb and your levels are not super great. B12 is really good for reducing brain fog.

Also, sometimes antidepressants can suddenly stop working. The dosage may need to be adjusted, or another med might need to be added to bring back its efficacy. If you're feeling anxious, that might also be a side effect of Wellbutrin -- it can exacerbate anxiety considerably, especially the generic, if that's what you're on. So it may be that Wellbutrin is not the best thing for you to take, but there are plenty of others to try.
posted by ananci at 12:21 PM on February 26, 2016

Have you tried taking B-complex vitamins?
posted by erst at 1:58 PM on February 26, 2016

"Thin without ability to gain much weight."

Was this always the case? Wellbutrin is an appetite suppressant.
posted by mysterious_stranger at 9:05 PM on February 26, 2016 [1 favorite]

Adrenal fatigue is indeed thought to be bogus by members of the scientific community. It should also be noted that "subclinical hypothyroidism" is a trendy diagnosis, that thyroid supplement can make a lot of people feel "better" even if they're not hypothyroid, but it's not recommended for people who don't actually need thyroid supplementation because there are potential serious side effects to taking it.

Functional medicine is also highly suspect and doctors specializing in it may likely not be practicing based on evidence or guidelines.

I understand why people in your situation want to turn to alternative medical practice or theories when traditional medicine is not giving you answers, but I hope you'll keep exploring a bit further and get some opinions from other doctors practicing science based medicine. And I hope that someone has already gotten a CBC on you - that's pretty much one of the most basic things we ever order... As for ferritin, it's probably not useful if you have no signs of iron deficiency anemia, so look back at that CBC first. And please don't take testosterone injections if you don't need them. Those aren't benign either.
posted by treehorn+bunny at 11:08 PM on February 29, 2016

I feel awful with those thyroid numbers. t4 that low and t3 mid to low range = depressed and tired.
They need to check your thyroid antibodies. If you have Hashimoto's (common with hypo), you will swing between hyperthyroidism (which will make you feel fight or flighty) and hypothyroidism, which will make you feel fatigued and depressed. If you have this, you'll feel crazy until your thyroid is suppressed with enough thyroid medication and stops swinging between extremes. :)

Low iron and messed up adrenals / cortisol levels will also make it difficult for your cells to use the thyroid hormone adequately, and you'll end up feeling bad, too, even if your thyroid itself is working.
posted by chaos_theory at 5:55 PM on March 25, 2016

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