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What do you make of normal estradiol, low progesterone, high testosterone, and high DHEAS in a pre-menopausal woman?

Commented on January 04, 2015
Created May 15, 2012 at 2:01 AM

For some background of my health issues, see this question.

To summarize briefly, I was diagnosed with celiac disease 10 months ago, and have been feeling fatigued and mentally foggy, despite success with a gluten-free, paleo diet/lifestyle, and improvements in other areas: stronger fingernails, better body temperature in the mornings during my luteal phase (from 97.5 F to 98.7 F), better stools.

My thyroid tests (TSH, free T4, and T3) are normal (even Chris Kresser normal, not just lab value normal). My cortisol levels are spot on where they should be throughout the day. My anti-gliadin antibodies are back down. I carry one copy of the bad MTHFR gene and my symptoms match a B12 vitamin deficiency, so I had my B12 and B9 tested. Unfortunately, they used the serum tests instead of the red blood cell test, so the normal values (as far as I understand) just show that my diet is good. I eat plenty of liver, so I'm not surprised at that. (Side note: blood pressure is 100 mmHg over 60 mmHg, and pulse is about 60 bpm.)

METHYLMALONIC ACID . . . . . 138 nmol/L (87-318 nmol/L)
FOLATE, SERUM . . . . . . . . . . . . 16 ng/mL ( > 5.4 ng/mL)
VITAMIN B12 . . . . . . . . . . . . . . .603 pg/mL (200-1100 pg/mL)

However, I did start supplementing with folate (metafolin) and methylcobalamin, and I started feeling a little better within a couple days.

But the really interesting thing is my hormone levels are wonky.

Estradiol (saliva) . . . . . . . . . . . . . .1.9 pg/ml (1.3-3.3)
Progesterone (saliva) . . . . . . . . . . 40 pg/ml (75-270)
Ratio: Pg/E2 (saliva) . . . . . . . . . . . 21 (Optimal: 100-500)
Testosterone (saliva) . . . . . . . . . . 96 pg/ml (16-55)
DHEAS (saliva) . . . . . . . . . . . . . 24.7 ng/ml (2-23)

My estradiol is normal, progesterone is pretty low, testosterone is very high, and DHEAS is slightly high.

The lab report suggested PCOS could be a possibility, but it doesn't sound like a good fit. My menstrual cycle has always been very regular. As a teenager, I was on a 6 week cycle, but my periods were easy: very little cramping. Then I was on the pill for 10 years. When I went off (also about a year ago), my periods came back and were regular right away, with a 32 day cycle. I do get premenstrual breast tenderness, now, but it goes away if I apply topical iodine. (Husband's note: this is much sexier than it sounds.)

Also, PCOS is associated with insulin resistance, but I got a home blood glucose monitor, and my fasting (non-morning) levels are 82 mg/dL. My 1-hour blood glucose level is 126 mg/dL, up from 98 mg/dL before I ate, and it goes back down within two hours. And my fasting morning level is 91 mg/dL. I eat about a 100 g carbs per day (e.g. potato, turnip, orange, banana). My A1c as of 10 months ago was 5.3%. I got it tested again recently and didn't hear back from the doctor, so I'm guessing it's still relatively low. Is it possible to have insulin resistance with good blood glucose levels? I am overweight by about 30 lbs: 5'3" and 155 lbs. I've always been very hungry, and that finally went away last week, seemingly related to the b-vitamin supplementation.

Oh, and lastly, my vitamin D level is low as of testing 10 months ago (and was the same 5 years ago when I got it tested): 33 ng/mL. For the past month I've been supplementing with 5,000 IU vitamin D on most days, plus laying out in the sun on sunny days. I was taking 90 mcg K2 along with the D up to a week ago when I decided to cool it on the K2 until I understand venous thromboembolism (blood clotting) better, since I'm at a very high genetic risk for developing it. I don't know where my vitamin D levels stand now, as I figured I'd get tested again at the end of the summer.

So, what could be causing this hormonal pattern? Is it just related to the rest of it: celiac disease recovery, hormonal birth control pill recovery, or vitamin B or D deficiency? If it's just a matter of more waiting to let my systems right themselves, that's fine, but if these hormone levels are an indication of something wrong, or are possibly related to the fatigue and mental fog, I'd like to look into them further. Any ideas are greatly appreciated!

9ca33bb3a0e831533acf97bf06776657

(0)

on January 04, 2015
at 08:47 PM

Hi Sarah - any updates on your hormonal imbalances? I recently discovered my progesterone is super low too and my testosterone is a tiny bit elevated (just above the reference range).

I'm attributing it to stress but I'm wondering if you found anything interesting about how to address that issue. I'm concerned that using progesterone replacement is excessive, but I'm open to exploring the possibility if it makes sense.

7841848bd0c27c64353c583fb7971242

(7275)

on June 01, 2013
at 07:30 PM

Update: I tested my salivary hormone levels again and my testosterone and DHEAS are great, and estradiol is still in range, but my progesterone was even lower, at 27 pg/ml on day 26 of a 41 day cycle. The previous test was on day 19 of a 33 day long cycle. I have uncharacteristic premenstrual cramping and breast pain, heavy periods, long cycles, and weight gain around my waist that only starts to go away when I supplement with progesterone cream.

Ce41c230e8c2a4295db31aec3ef4b2ab

(32556)

on May 15, 2012
at 11:31 PM

I'm not an endocrinologist, so I really can't draw any conclusions from your test results. If you are concerned, I would get a consult--especially if you are currently trying to conceive.

7841848bd0c27c64353c583fb7971242

(7275)

on May 15, 2012
at 10:38 PM

So, Dragonfly, do you think the high T and low p are inconsequential? Or just difficult to interpret without repetition across multiple cycles and multiple parts of the cycle. That test was taken at day 20 of my cycle (as suggested by zrt labs).

Ce41c230e8c2a4295db31aec3ef4b2ab

(32556)

on May 15, 2012
at 12:28 PM

Thanks for the interesting link! Remember that your hormonal levels will fluctuate through your cycle, so I wouldn't worry about one test result. I believe that three saliva tests are suggested at different times of your cycle to get a baseline for what is normal for you. I'd focus more on your D level, gut health and how you feel. Give it a few more months & then make any needed tweaks based on body symptoms.

7841848bd0c27c64353c583fb7971242

(7275)

on May 15, 2012
at 03:22 AM

Also, it looks like vitamin D is integral for converting testosterone to estradiol: http://www.ncbi.nlm.nih.gov/pubmed/19906814. Sometimes it reduces aromatase activity (in BCa cells and adipocytes), but it can also increase aromatase activity in the bones. My estradiol isn't exactly low, but it could make sense that the testosterone is poorly converting to estrogen, causing testosterone to stockpile in the system's attempt to drive the reaction to make sufficient estrogen.

7841848bd0c27c64353c583fb7971242

(7275)

on May 15, 2012
at 03:09 AM

Thanks, Dragonfly! I really appreciate your input, and your general approach of raising awareness of vitamin D deficiency. I've read many of your posts/answer and found your insights really helpful. I'll see if I can convince my doctor to order me another blood test for vitamin D midsummer, instead of waiting until the end of summer.

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1 Answers

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Ce41c230e8c2a4295db31aec3ef4b2ab

(32556)

on May 15, 2012
at 02:33 AM

Patience is definitely needed.

With celiac, you haven't been absorbing your nutrients well and it sounds like you need time to replenish your system--especially your D3. I would suggest testing your D again in a month and adjust your sunning/supplementation as needed.

Suggest aiming for a slightly higher D level: 60-80 ng/ml to give your body the support it needs to improve your sleep, balance out your progesterone and help your gut heal.

This article may be helpful:

http://drgominak.com/vitamin-d

7841848bd0c27c64353c583fb7971242

(7275)

on May 15, 2012
at 03:22 AM

Also, it looks like vitamin D is integral for converting testosterone to estradiol: http://www.ncbi.nlm.nih.gov/pubmed/19906814. Sometimes it reduces aromatase activity (in BCa cells and adipocytes), but it can also increase aromatase activity in the bones. My estradiol isn't exactly low, but it could make sense that the testosterone is poorly converting to estrogen, causing testosterone to stockpile in the system's attempt to drive the reaction to make sufficient estrogen.

7841848bd0c27c64353c583fb7971242

(7275)

on May 15, 2012
at 03:09 AM

Thanks, Dragonfly! I really appreciate your input, and your general approach of raising awareness of vitamin D deficiency. I've read many of your posts/answer and found your insights really helpful. I'll see if I can convince my doctor to order me another blood test for vitamin D midsummer, instead of waiting until the end of summer.

7841848bd0c27c64353c583fb7971242

(7275)

on May 15, 2012
at 10:38 PM

So, Dragonfly, do you think the high T and low p are inconsequential? Or just difficult to interpret without repetition across multiple cycles and multiple parts of the cycle. That test was taken at day 20 of my cycle (as suggested by zrt labs).

Ce41c230e8c2a4295db31aec3ef4b2ab

(32556)

on May 15, 2012
at 12:28 PM

Thanks for the interesting link! Remember that your hormonal levels will fluctuate through your cycle, so I wouldn't worry about one test result. I believe that three saliva tests are suggested at different times of your cycle to get a baseline for what is normal for you. I'd focus more on your D level, gut health and how you feel. Give it a few more months & then make any needed tweaks based on body symptoms.

Ce41c230e8c2a4295db31aec3ef4b2ab

(32556)

on May 15, 2012
at 11:31 PM

I'm not an endocrinologist, so I really can't draw any conclusions from your test results. If you are concerned, I would get a consult--especially if you are currently trying to conceive.

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