29 Yo Male, Low Libido And Low Ferritine, Ed-recovery

[Arclight]

Hi everyone,
I'm a 29 year old male. I live and work in Sweden. Did not know if this post belongs here on in Meet & greet, but since I'm here seeking advice, here goes.
Here's a summary:

Height: 184cm/6'0 ft
Weight: 65 kg/145 lbs
Waist: Jeans 31
Resting pulse: 65-75 bpm
Waking temp: 36.5-36.8 / 97.7 - 98.2

Latest lab results:
Hemoglobin - 134 (too low to get to donate blood, to high to get diagnosed with anemi. A couple of years ago I had 145)
S-TSH (Dxl) - 0.97 mE/L
S-Testosterone - 8.6 nmol/L (ref. 10-20)
S-T4 (free) - 12 pmol/L
fS-Triglycerides 0.37 mmol (ref. 0.45-2.6)
Also very low Ferritine levels. Possibly somewhat iron-defficient

Diet:
2500 cal/day,
Carrots, beets, potatoes, sweet potatoes, spinach cooked from frozen, cucumber
Eggs, goats milk, cottage cheese, parmesan cheese, cream, butter
Melons, pineapple, oranges (imported)
Orange juice, dried dates, honey. Too much roasted coconut flakes
Shrimp, mussels, beef stew, gelatin powder, cod. Started with liver a week ago

Health issues growing up: Mainly anxiety/OCD/depression-related. Started with SSRI-medication that maybe helped me in some ways, in my teens and early 20's I managed to acomplish lots of good things, thrive in school and be socially active. However when I tried to quit the medication I felt bad and experienced depression-like effects. Hard to quit the medication when working hard with studying, finding work etc.

At age 25 Went through some stressful events, starting to wake up in the middle of the night every night etc.
Then experienced some disordered eating and a rapid weight loss period.
Before I lost weight , I think I weighed about 155 lbs for quite some time (At least I think so, never really weighed myself in those days). At my lowest the spring of 2013, I was down to 134 lbs on a height of 6.0. So I was never diagnosed with anorexia, also unsure how low my bodyfat level dropped.
It was mainly the muscles on my arms as the body decided to completely devour.

I hovered around 137-138 pounds during a few months. But I often felt cold and weak and then got 50 mg exogenous Testogel-bags, daily, prescribed by my doctor after a blood test showing I had a value of 1.9 S-Testosterone.
I the decided to begin eating differently and go back to my previous weight again, maybe that could make me feel better. I then found 180 degree health and some other sane material, also the work of Ray Peat.

My doctors are still somewhat confused in why I had so very low levels, and they scanned my brain for pituary tumors etc. But everything looked normal. I'm still quite convinced that it had to do with my stress around eating "perfect" and training "healthily", and feeling miserable and stressed out in my life in general.
I was on Testosterone-gel for maybe 14 months and then stopped due to my serum levels rising very high.

I discontinued the 50 mg exogenous Testogel but the Testosterone levels dropped quickly, so i started again, with a lower dose, but then stopping once more due to the side effects of headache. Now I've been without the gel for 6 months.

I've regained weight since the restrictive weight loss period, however I'm still not back at the highest weight I had before all this, around 155 lbs. But I think that the reason my weight is lower is due to the muscle mass still being a lot less on arms and legs. I believe I'm back at my former bodyfat-procent. Maybe higher, but differently redistributed. A lot in the face and stomach.

Current health issues:
Cold hands/feet
Constipation,
Receeding hairline
Thinning of hair
Waking up several times at night
Catabolic (hard to build muscle, loosing muscle at first sight of calorie deficit. Gains abdominal fat on caloric surplus)
Fatigue and brain fog when do strenous work or strength-training.

Main interests in regards to health:
-Recovering from treatment with transdermal testogel
-Discontuniation of SSRI-meds, and manage to live a functional life from there on.
-Improve sleep
-Become more anabolic, regain some muscle
-Improving libido

Seeking advice in:
-Possible to try supplementation with T3 or Pregnenolone?
-Interpreting the low ferritine, low Hemoglobin issues. Confused about the bad effects of iron, but also concerned with possible irondefficiency anemia.
-Thoughts on libido issues

Feel free too share your thoughts and experiences! Allt the best/J

 

[meatbag]

.

 

[tankasnowgod]

It sounds like most of your issues stem from the fact that you just don't eat enough calories, plain and simple. I plugged your stats into a Mifflin St. Jeor calculator (which you can do yourself here- http://www.leighpeele.com/mifflin-st-jeor-calculator) Your RMR comes out to about 1662 calories per day. If you are very, very sedentary (like sitting at work and watching TV, and no activity or exercise), you'd be buring about 1994 calories a day. If you are moderately active, your daily burn is about 2493, which would mean you're only eating at maintenance.

I'd think the very first thing you want to do is bump your caloric intake up to about 3,000 calories a day. Maybe try to get the extra cals from whole milk, that's a favorite among body builders. Yeah, you might have some extra fat gain, but that almost always accompanies an anabolic environment. Honestly, if you're only 145 pounds at six feet, you probably need both extra fat and muscle. You may even need to go higher than 3,000 cals a day.

Since you have a history of overly restrictive eating, you should look up the Minnesota Starvation Experiement. All of the guys gained extra fat during their recovery period, but they lost it after they had been eating normally for about 6 months, I believe.

 

[tankasnowgod]

Also, if your ferritin is low, you don't really need to worry about the dangers of excess iron. The dangers of excess iron don't really come into play until your ferritin is over 70 or so, and even then, the dangers are more long term than the more immediate dangers of anemia. In general, I think it's good to avoid iron supplements (they can cause massive GI problems), much safer to bump up your meat and liver intake, and use dessicated liver pills. Much safer than supplemental iron pills.

 

[Arclight]

Hey Arclight,

i thought you might find these quotes from Ray Peat helpful if you haven't seen them;

Hey Meatbag, thanks a lot for gathering some interesting stuff!

Ray Peat :

Thyroid hormone regulates ferritin, so it doesn't indicate iron status.

..I think that's true, that coffee affects mainly non-heme iron absorption. The heme has toxic effects, forming carbon monoxide, apart from the iron.
As I understand it, the amount of non-heme iron that's absorbed increases with the extent of its reduction, with ferrous iron being absorbed much more than the ferric form. The presence of reductants in the food will increase absorption.

Not really sure how to interpret this one. I try to get a lot of heme-iron into my diet, as an attempt to raise my hemoglobine and ferritin-levels. I thought that low/no serum ferritin indicated poor iron absorption, low iron levels in the blood and thus raising the need for ironrich foods such as blood, liver and red meat.
But the low ferritin might not be the one thing causing my hemoglobin to drop then? However I still don't know how to make a good risk/benefit-decision in regards to my ironrich diet. I make my own blood sausage with 100 gr of beef blood per serving...

As for the Pregnenolone, I haven't really found enough info yet about how many 29ish-year olds who have had success with it, but I will look up haidut's writings for sure.

I've seen Redlightmans homepage, will look further into it.

Did you have either or all of a cholesterol, prolactin, PTH, vitamin D, serum calcium blood test?

There are limited possibilities in ordering private blood labs in Sweden. PTH is hard to get for example. Here are some of them though:

fP-LDL-cholesterol: 2.1 mmol/L (ref. 1.2-4.3)
P-HDL-cholesterol: 1.8 mmol/L (ref. 0.8-2.1)
P-cholesterol: 3.9 mmol/L (ref. 2.9-6.1)
S-Apolipoprotein A1: 1.7 g/L (ref. 0.9-1.8)
S-Apolipoprotein B: 0.5* g/L (ref. 0.6-1.6)
P-Apo B/Apo A1 (quota): 0.3* (ref.0.4-1.2)

P-Calcium: 2.37 mmol/L(ref. 2.15-2.5)
P-Iron: 9 μmol/L (ref. 9-34)
S-Ferritin: 7.6 μg/L* (ref. 20-275)

S-Prolactin: 8.0 μg/L (ref. for adult males: 3-19)
S-25-OH Vitamin D: 55 nmol/L* (ref. 25-74: Insufficiency, 75-250: Optimal)

 

[Arclight]

It sounds like most of your issues stem from the fact that you just don't eat enough calories, plain and simple.

Hey snowgod
Just to clarify, both the libido and sleep issues where bothering me even before the disordered eating and weightloss-period. One of the first things I tried to manage them with was restrictive eating. That didn't work though.

I plugged your stats into a Mifflin St. Jeor calculator (which you can do yourself here- Mifflin St. Jeor Calculator | Leigh Peele Presents) Your RMR comes out to about 1662 calories per day. If you are very, very sedentary (like sitting at work and watching TV, and no activity or exercise), you'd be buring about 1994 calories a day. If you are moderately active, your daily burn is about 2493, which would mean you're only eating at maintenance.

I'd think the very first thing you want to do is bump your caloric intake up to about 3,000 calories a day. Maybe try to get the extra cals from whole milk, that's a favorite among body builders. Yeah, you might have some extra fat gain, but that almost always accompanies an anabolic environment. Honestly, if you're only 145 pounds at six feet, you probably need both extra fat and muscle. You may even need to go higher than 3,000 cals a day.

Since you have a history of overly restrictive eating, you should look up the Minnesota Starvation Experiement. All of the guys gained extra fat during their recovery period, but they lost it after they had been eating normally for about 6 months, I believe.

I have read a lot about the Minnesota starvation study. It's great information. What puzzles me though is the seemingly spontaneous regain of muscles that the participants experienced, even without excercising during refeeding. That is not something I have experienced since upping calories.
My temperature has definitely increased since starting eating more (around 2 years ago). My pulse has also improved. But I have a REALLY hard time regaining muscle. Even those times I try strength-training I see very little results.
My body seems to want to hang out in a very catabolic state, and using muscle as primary fuel every time I skip a meal or try to be more active and move more. My arms, legs and chest-muscles got really hunted down by dieting/disordered eating.

I once read a book in which the authors grandfather experienced starvation during the war, and despite refeeding very properly afterwards had a really hard time regaining muscles.
So I'm beginning to wonder if other things need to be adressed other than pure calories. Eventual hypothyroid symptoms, hormonal imbalances etc. I have a lot of friends who have twice the musclemass I have, and they never seem to need a lot of calories to maintain strength. I eat more food/ more nutrientdense than most people I know. So maybe some kind of malabsorption, poor use of nutrients is in play here, since also low in ferritin/iron?

I could definitly give it a try and increase my intake a bit, but previous attempts has always resulted in feeling wired, some fat gain around the waist, and quite poor increases in bodytemp & pulse. And I guess I'm a bit hesitant because most of the stuff I've read talks about how it (caloric excess) increases inflammation and causing blood sugar swings. Also my hb1ac-levels often shows up as being at the higher end of the ref. range, so I guess I'm concerned that overfeeding might be problematic in that way.

Also, if your ferritin is low, you don't really need to worry about the dangers of excess iron.

As far as the iron goes and as far as my labs can tell, my ferritin-levels shows no sign of excess stored iron. But since Im eating pure beef blood, a lot of iron sure passes through my systems at the moment. , I will continue eating a lot of blood and liver, without coffee, for a while.
However, I'm not sure of what's most problematic. The mere act of consuming ironrich foods, or only the part when one's having excess iron stored in the body?

Thanks a lot for the advice!

 

[Blossom]

If you want to absorb more iron from your food just have some orange juice with the iron rich item. Vitamin C at the same meal increases iron absorption.

 

[Arclight]

If you want to absorb more iron from your food just have some orange juice with the iron rich item. Vitamin C at the same meal increases iron absorption.

Hey Blossom, yeah I definitely try to include some fruit with those ironrich foods. Although I once read somewhere that Vitamin C mostly helps when converting non-heme iron (from vegetables or leguems etc.) to heme-iron which is then better absorbed by the body, but works less in regards to increasing the absorption of the actual heme-iron found in blood and meat. I dont know if that's true or not. I certainly don't mind having some orange juice along with it all.

 

[Blossom]

Hey Blossom, yeah I definitely try to include some fruit with those ironrich foods. Although I once read somewhere that Vitamin C mostly helps when converting non-heme iron (from vegetables or leguems etc.) to heme-iron which is then better absorbed by the body, but works less in regards to increasing the absorption of the actual heme-iron found in blood and meat. I dont know if that's true or not. I certainly don't mind having some orange juice along with it all.

That's what I learned in human nutrition class back in the 20th century. Here is a link where one of our very nutritionally savvy members recommended against vitamin C with a heme iron rich meal for someone with the opposite scenario.
https://raypeatforum.com/community/...-it-anymore-iron-or-not.1995/page-2#post-2331

Only 2 to 20% of Non-heme iron in fruits and vegetables are absorbed.
Even if someone absorb 20% of 5 mg that is 1 mg.
With coffee this absorption will be 50% less, that is .5 mg.
Calcium would further lower the absorption.
Though vitamin C in watermelon will enhance some absorption.
It is still quite safe. Most acids , fish and meat increase iron absorption
from plant source.So, it would be wise not to eat heme iron rich food and watermelon in the same meal.

 

[Blossom]

I have read a lot about the Minnesota starvation study. It's great information. What puzzles me though is the seemingly spontaneous regain of muscles that the participants experienced, even without excercising during refeeding.

You know those guys ate pretty unrestrictedly for a while and Keys didn't notice any appreciable rehabilitation until they reliably got around 4,000 calories per day. I second what @tankasnowgod suggested that you may need to increase your calories to see any improvements in your muscles. Your body could actually be somewhat in conservation mode still and not ready to repair more expensive muscle tissue if it perceives there is still a shortage of food. I think it took me a good two years before my muscles really started coming back strong after being emaciated and I had to eat really well and enough every single day for that entire time for that to happen but I'm a middle-aged woman.

 

[Giraffe]

My doctors are still somewhat confused in why I had so very low levels, and they scanned my brain for pituary tumors etc. But everything looked normal.

Ever considered that the SSRI is causing the low testosterone and libido?

A couple of your symptoms could also be explained by low magnesium.

It's easier to replenish magnesium than to quit SSRI: If I were you I would try magnesium first and go from there.

I'm not sure of what's most problematic. The mere act of consuming ironrich foods, or only the part when one's having excess iron stored in the body?

The body needs iron, and your ferritin is extremely low. Your diet looks quite balanced, and if you add liver you will have plenty of vitamins. Some are needed to handle iron (riboflavin foremost, I think).

 

[Arclight]

Ever considered that the SSRI is causing the low testosterone and libido?

A couple of your symptoms could also be explained by low magnesium.

It's easier to replenish magnesium than to quit SSRI: If I were you I would try magnesium first and go from there.

Yes, I've thought about that. However, I was on SSRIs for a long time, several years, before the sleeping problems, and sudden lack of libido appeared. I also tried quitting the meds for almost a whole year, without experiencing any changes to either of these issues.
The meds could certainly contribute, but I think there could be other things going in hormonally as well.

What kind of symptoms is linked to low magnesium?
I take 100 mg magnesium glycinate daily, and sometimes 10 sprays of magnesium oil (Ancient minerals)

 

[EIRE24]

I think your problem is calories. Plain and simple. Eat lots of delicious food and engage in some form of weight training. I think a lot of stuff will fall into place. Don't get caught up with the small details. I wish someone had given me this advice from the start rather than trying out a lot of stupid things I picked up from the forum

 

[Arclight]

I think your problem is calories. Plain and simple. Eat lots of delicious food and engage in some form of weight training. I think a lot of stuff will fall into place. Don't get caught up with the small details. I wish someone had given me this advice from the start rather than trying out a lot of stupid things I picked up from the forum

@EIRE24
How did you realize that more calories/weight gain could resolve more of your issues than you first expected? Was there some specific experience or epiphany that made you put away the small details, trying out things picked up etc. and go back to focusing of increasing food intake as the main concern?

Waking up in the middle of the night every night and a major lack of libido could perhaps be brought on by complete starvation. But I have been eating at least 2500 kcal/day for the last 2 years. Upping them a lot more from there could maybe make me heavier and a little warmer, but the other health issues seems tied to other things than just some lingering semi-starvation.

 

[Giraffe]

Yes, I've thought about that. However, I was on SSRIs for a long time, several years, before the sleeping problems, and sudden lack of libido appeared. I also tried quitting the meds for almost a whole year, without experiencing any changes to either of these issues.
The meds could certainly contribute, but I think there could be other things going in hormonally as well.

There are reports of cases where symptoms persisted after discontination of the drug. (See for example here.) There are overlaps in symptoms in past users of SSRIs, Isotretinoin (Accutane) and Finasteride (Propecia). When I look for commonalities between users of raypeatforum who suffer from side-effects after discontinuation of those drugs, the first thing that comes to my mind is ED/low calorie intake.

What kind of symptoms is linked to low magnesium?
I take 100 mg magnesium glycinate daily, and sometimes 10 sprays of magnesium oil (Ancient minerals)

Possible symptoms include irritability, fatique, loss of appetite, muscle weaknesss/cramps/tremors/pains, insomnia ...

I have seen a study that found a correlation between low testosterone and low magnesium in middle-aged and older men, but keep in mind that magnesium deficiency rarely occurs in isolation.

I agree with the others here who advise you to eat more. After I started to look out for symptoms of stress hormones rising (cold nose, irritability, frequent urination etc.) and have a snack immediately (some fruit or fruit juice, maybe something salty), I experienced that after a few days I was constantly hungry. So I was eating a lot more. After a couple of weeks I noticed that I didn't wake up during the night any longer and that very bad carpal-tunnel-like symptoms had vanished. Most of the time I still need to supplement magnesium though to controll RLS symptoms. I gained some weight (according to my scales), but actually looked a bit slimer.

Years ago (before I "found" Ray Peat) I ceased having cold feet after I started having breakfast first thing in the morning. (Before that I often had a milk coffee only.)

 

[DaveFoster]

Hey Blossom, yeah I definitely try to include some fruit with those ironrich foods. Although I once read somewhere that Vitamin C mostly helps when converting non-heme iron (from vegetables or leguems etc.) to heme-iron which is then better absorbed by the body, but works less in regards to increasing the absorption of the actual heme-iron found in blood and meat. I dont know if that's true or not. I certainly don't mind having some orange juice along with it all.

Vitamin C negligibly affects heme iron absorption. It does affect non-heme iron absorption, however.

Source: Peatarian Reviews: Neither coffee, milk or vitamin C affects heme-iron absorption from meats

 

[Mittir]

P-cholesterol: 3.9 mmol/L (ref. 2.9-6.1)

Is that total cholesterol? 3.9 mmol/l = 151 mg/dL. In older reference ( 160 to 200+age)
range that is considered as Hypocholesterolomia . I think low cholesterol is a major
source of problems for you. Fructose can easily raise your total cholesterol level.
Fruit juices can be useful here. I would shoot for at least 200.

RP mentioned not to worry about iron level if Hemoglobin level is normal.
Your iron and ferritin level looks quite low. You are possibly iron deficient.
But to be sure you need to have both ferritin and Transferrin Saturation index test.

Liver has large amount of non-heme iron, to increase the iron absorption you
can add acidic juices. But, protein increases non-heme iron absorption.
Protein in liver should increase non-heme part too. Just avoid coffee
which inhibits non-heme iron absorption and
and calcium rich foods like milk , which inhibits both heme and non-heme iron.
with liver and other iron rich meals.

RP recommends total T3 and total T4 tests. Your TSH looks fine and free T4
is at the lower end of normal. In healthy people T4 stays lower end of normal
and T3 at higher end of normal. We do not know your T3.
Caloric intake, especially carbohydrate increases
T4 to T3 conversion. You can increase your carb intake for
few days to see if you feel better.

 

[Arclight]

Is that total cholesterol? 3.9 mmol/l = 151 mg/dL. In older reference ( 160 to 200+age)
range that is considered as Hypocholesterolomia . I think low cholesterol is a major
source of problems for you. Fructose can easily raise your total cholesterol level.
Fruit juices can be useful here. I would shoot for at least 200.

@Mittir
I find conflicting information regarding hypocholesterolemia. How come the reference range is now lowered? Accordning to Mayo Clinic, total cholesterole below 200 mg/dL or 5.3 mmol/L is desirable. And the lower end of the reference range from labs here in Sweden is set to 2.9 mmol/L or 112 mg/dL

Wikipedia: According to the American Heart Association in 1994, only total cholesterol levels below 160 mg/dL or 4.1 mmol/l are to be classified as "hypocholesterolemia". However, this is not agreed on universally and some put the level lower.

I cant find any specific information regarding what kind of symptoms that can be induced from too low serum cholesterole. In what way do you think it coukd manifest as problematic?

RP mentioned not to worry about iron level if Hemoglobin level is normal.
Your iron and ferritin level looks quite low. You are possibly iron deficient.
But to be sure you need to have both ferritin and Transferrin Saturation index test.

Some history of iron-labs, from 2 years ago, but still:
fP-Transferrin-satuariton% (ref.15-60)
2014-07-02: 28 %
2014-06-19: 27 %
2014-04-30: 15 %
2014-01-17: 32 %

P-ferritin, ug/L (25-310)
2014-07-02: 17
2014-06-19: 12
2014-04-30: 2.9
2014-01-17: 7.7

Your TSH looks fine and free T4
is at the lower end of normal. In healthy people T4 stays lower end of normal
and T3 at higher end of normal. We do not know your T3.

I think my T3 is at the lower end. Latest T3 labs, little over one year ago:
2015/03/10 S-T3, Free (Dxl): 4.1 pmol/L (ref. 3.5 - 5.4)

 

[Arclight]

There are reports of cases where symptoms persisted after discontination of the drug. (See for example here.) There are overlaps in symptoms in past users of SSRIs, Isotretinoin (Accutane) and Finasteride (Propecia).

Yes, I have read that about that. But like I said, I was on the meds several years without experiencing any loss of sexual interest or lack of libido. They may definiteliy be one of the things contributing to the problem though.
For me, a lack of sexual function like erectile dysfunction etc. is one thing, and I feel like a major loss in libido stems from something else going on as well. But I digress, they could of course be linked to each other as well.

When I look for commonalities between users of raypeatforum who suffer from side-effects after discontinuation of those drugs, the first thing that comes to my mind is ED/low calorie intake.

So you mean that it could be more common to experience problems from those drugs side-effects if you have a history of disordered eating and excessive weight loss?

 

[Giraffe]

So you mean that it could be more common to experience problems from those drugs side-effects if you have a history of disordered eating and excessive weight loss?

Undereating alone causes a host of issues.
Males, Anorexia, and Physical Side Effects