Judy, 61, had her first consult with me a few weeks ago. Her major health issue is the 10-year struggle with severe fatigue.
“I feel like it takes all the energy I have just to get out of bed in the morning,” she said. “My muscles feel like mush, and I feel like I am pushing myself through cement to get through the day. After lunch, if I don’t lie down for a few hours, I can’t get through the afternoon.
“I am taking T3 and progesterone and DHEA – things doctors said would help my energy. But I am getting worse. I can’t sleep, my heart is racing, my brain is foggy during the day, and I am so exhausted all the time. I need help. I need my life back.”
Judy’s fatigue and insomnia both began around the time her menstrual periods stopped. She didn’t have the typical hot flashes, so she didn’t connect the restless sleep and daytime tiredness with being caused by the menopausal loss of ovarian hormones. In addition to the extreme exhaustion, she gained close to 50 pounds and nothing she tried seemed to help her lose weight.
After months of worsening fatigue and poor sleep, a naturopathic doctor started her on vitamins and a “natural thyroid” product. She had a slight but short-lived improvement in her energy level, then started sliding back downhill into extreme exhaustion.
The next doctor put her on Effexor for depression. “I had a horrible reaction to that, and had to stop it after a few days,” she said.
Over the years, she saw many other doctors and tried different antidepressants and compounded hormones without success. No one gave her the most important hormone of all, estradiol, the primary one she lost at menopause!
Her latest prescriptions included compounded T3 50 mcg a day (a higher than normal dose), DHEA, compounded hydrocortisone, and compounded progesterone. Sadly, she didn’t even need progesterone since she had a hysterectomy several years ago.
When she came for her evaluation with me, I was shocked to see the serious hormone and other metabolic abnormal results on her labs. Even though she had been given DHEA and told it would “convert” to the estrogen her body “needed,” her blood level of estradiol was less than 5. That’s barely detectable. It is far too low to maintain normal energy level, sleep regulation, cognitive function, and normal metabolism. Her estradiol should be about 90-100 pg/ml for an optimal response
The hydrocortisone medicine had suppressed her own adrenal function so that cortisol was too low, adrenal androgens (DHEA and testosterone) were barely detectable.
These adrenal hormones play a role in maintaining normal energy and zest. With practically non-detectable blood levels for all of them, it’s no wonder she was exhausted all the time and felt her muscles had turned to mush. Progesterone, given alone when estradiol is too low, also caused severe fatigue. As I explained in previous blogs, progesterone also causes weight gain and low sex drive.
The high dose T3 she had been given caused a serious imbalance in her thyroid hormones. Far too low. Overstimulation with T3 causes the body to compensate by pushing free T4 levels lower and lower. This adds to the fatigue and weight gain.
Excess T3 also causes pounding, racing, fluttering heartbeats that make fatigue worse because the heart is beating too fast to pump the right amount of blood with each beat. The problems from excess T3 are worse when estradiol is critically low, as we found with Judy.
Over time, excess T3 actually damages the heart muscle fibers so that the heart muscle loses strength and doesn’t pump as well. Loss of normal heart pumping strength can lead to congestive heart failure as a late stage complication of both excess thyroid and untreated hypothyroidism.
The heavy bleeding she had prior to her hysterectomy caused loss of iron stores, and a low ferritin. When women have ferritin levels less than 60-90, it causes marked fatigue, restless sleep, and muscle aches. Judy’s ferritin was only 19, clearly another factor in her fatigue.
Judy and I are now working on getting her hormones and metabolic numbers back into the optimal ranges for her to regain her energy. Because her levels are so low, and because she is on medicines that can’t be stopped abruptly (T3, hydrocortisone) we have to go slow and take baby steps so that she doesn’t have side effects from too many changes at one time.
There is hope and help for severe fatigue. It takes getting the proper diagnostic tests first, and then working carefully with a systematic plan to restore optimal female hormone balance.
Check out the information on my website, www.herplace.com, for getting tested, and then read my book, The Savvy Woman’s Guide to Testosterone, to learn more about the many reliable treatment options to restore your energy, strength, and vitality.
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