Franko's Log

franko

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Feb 25, 2015
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Male, 26, 5'11", 195lbs

Description of my issues:
http://www.raypeatforum.com/forum/viewtopic.php?f=56&t=5982.

Bloodwork

2014-9-26
Testosterone 438 | 348–1197 ng/dL
Estradiol 21.7 | 7.6–42.6 pg/mL
LH 6 | 1.7–8.6 mIU/mL
FSH 4.4 | 1.5–12.4 mIU/mL
TSH 4.6 | 0.45–4.50 uIU/mL
T3 3.1 | 2.0–4.4 pg/mL
T4 1.08 | 0.82–1.77 ng/dL
Carbon Dioxide 25 | 18-29 mmol/L
Albumin 4.5 | 3.5-5.5

2014-10-07
Prolactin 14.8 | 4.0-15.2 ng/mL

2014-11-17
Prolactin 12.2 | 4.0-15.2 ng/mL

2015-01-08
T3 2.9 | 2-4.4 pg/mL
T4 0.88 | 0.82-1.77 ng/mL
TSH 1.39 | 0.45-4.5 uIU/mL
TPO 17 | 0-34 IU/mL
Estradiol 28.8 | 7.6-42.6 pg/mL
Testosterone 328 | 348-1197 ng/dL
Free T 12.7 | 9.3-26.5 pg/mL
Prolactin 35.8 | 4-15.2 ng/mL
Cortisol 25.3 | 6.2-19.4 ug/dL (EDIT: Had incorrect range and units)
Vit D 30 | 10-80 ng/mL

2015-05-15
TSH 0.016 | 0.45-4.5 uIU/mL | LOW
T3 8.7 | 2-4.4 pg/mL | HIGH
T4 1.24 | 0.82-1.77 ng/mL
Estradiol 21 | 7.6-42.6 pg/mL
Testosterone 329 | 348-1197 ng/dL | LOW
Prolactin 23 | 4-15.2 ng/mL | HIGH
Serum Glucose 107 | 65-99 mg/dL | HIGH
ALT 104 | 0-44 IU/L | HIGH
 

tara

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HI Franko,
Is that last batch of results from 2015? Otherwise I can't make sense of your TSH change. If it's come down to 1.4, that's seems good.
I guess you know Peat suggests generous calcium intake as part of bringing prolactin down? 1200-2000mg, more Ca than P, ideally Ca:P of 1.5:1.

Have you had a go at assessing how your diet goes at meeting your nutritional needs, eg using cronometer or similar?
 
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franko

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tara said:
Is that last batch of results from 2015?

Yes, thanks for catching that mistake. It was from 2015.

tara said:
If it's come down to 1.4, that's seems good.

Yep, the thyroid appeared to be working. And my assumption is that the high prolactin in that test was the consequence of the "nipple mechanism" that raises prolactin, and not TRH.

tara said:
I guess you know Peat suggests generous calcium intake as part of bringing prolactin down? 1200-2000mg, more Ca than P, ideally Ca:P of 1.5:1.

That is one of those suggestions that I've read a bunch of times but hadn't acted on yet. I'm got a few ideas for my planned prolactin-punishing protocol and the Ca:P ratio is one of the components.

tara said:
Have you had a go at assessing how your diet goes at meeting your nutritional needs, eg using cronometer or similar?

Yes, I've done that and it seems that my most obvious deficiencies are in Vitamins E & K. And also Calcium (in proportion to Phosphorus). So yeah, I'm going to work on upping A, D, E, K and Ca:P.

I'm thinking I ought to get another blood test to verify that prolactin spike was temporary and to see where things are now that I have been just doing thyroid, aspirin and caffeine (in addition to diet of course) for a few months.
 

tara

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Some people here supplement all the fat soluble vitamins, eg with estroban, and some supplement K2 and/or E individually. There are threads about good products and about balancing E with A etc. Seen Dan's toxinless.com site?)
I think Peat's recommendations for calcium, in order of preference, are milk and cheese, clean eggshell powder, oystershell powder.
 
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franko

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Here's my latest bloodwork.

2015-05-15
Code:
TSH 0.016         | 0.45-4.5 uIU/mL  | LOW
T3 8.7            | 2-4.4 pg/mL      | HIGH
T4 1.24           | 0.82-1.77 ng/mL  |
Estradiol 21      | 7.6-42.6 pg/mL   |
Testosterone 329  | 348-1197 ng/dL   | LOW
Prolactin 23      | 4-15.2 ng/mL     | HIGH
Serum Glucose 107 | 65-99 mg/dL      | HIGH
ALT 104           | 0-44 IU/L        | HIGH

Looks like I was taking too much thyroid — so I'm going to lower my dose. But this clearly shows that it was not just TSH that was stimulating Prolactin release, and I'll need to do more than supplement thyroid to fix it.

I've started using EstroBan and calcium supplements, but I think I'll need to do more.

I've been researching DHT, pregnenolone, progesterone, cyproheptadine, exemestane, methylene blue and bromocriptine, but I'm not sure yet what to try next.
 
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franko

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Did some self-experimenting and got some new blood work.

For about 5 weeks now I've been taking 25mg of exemestane (Aromasin) every day. I have also taken tamoxifen (Nolvadex) sporadically — which I realize kind of complicates the variables here, but oh well.

Also, I lowered my thyroid supplementation to 1 grain/day because of my previous bloodwork but I didn't test for it this time.

Code:
2015-07-02

Testosterone 537      348-1197 ng/dL
Estradiol 25.4        7.6-42.6 pg/mL
LH 17.6               1.7–8.6 mIU/mL
FSH 8.3               1.5–12.4 mIU/mL
Prolactin 16.7        4-15.2 ng/mL     HIGH
ALT (SGPT) 52         0-44 IU/L        HIGH

For my thoughts on these results see here: viewtopic.php?t=7144
 
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franko

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I actually did try using Andractim (2.5% DHT gel) for my gynecomastia for about a month before trying an AI's. I felt a psychological improvement from the increased testosterone — because DHT cannot aromatise — but it did not seem to have any effect on my gyno and it was expensive so I stopped.

But I guess it did motivated me to try AI's because it was my first glimpse at the benefits of raising testosterone.
 

treelady

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I would research estrogen dominance. With Estrogen Dominance, it isn't just what you take - It's what you avoid. Our modern world is so full of synthetic chemicals, (especially plastics) that mimic estrogen. These synthetic xeno-estorgens are much more powerful than the estrogen made in the body, and there are currently no tests for them. Plastics are full of these compounds, which when heated, will leak into food.
 
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franko

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Here is my previous bloodwork that I posted about here: viewtopic.php?f=111&t=7455&p=94037#p94037

2015-08-07
• On 1 grain thyroid ED
• On 1 Month of TRT: 125mg E5D
• On 10 Days of 2.5mg Letro ED

Testosterone >1500 [348–1197 ng/dL] (HIGH)
Estradiol 5.8 [7.6–42.6 pg/mL] (LOW)
LH 21 [1.7–8.6 mIU/mL] (HIGH)
FSH 10.3 [1.5–12.4 mIU/mL]
T:E Ratio = 259
---
Cholesterol 232 [100–199 mg/dL] (HIGH)
Triglycerides 194 [0–149 mg/dL] (HIGH)
HDL 24 [39 mg/dL] (LOW)
VLDL 39 [5-40 mg/dL] (HIGH)
LDL 169 [0–99 mg/dL] (HIGH)
---
RBC 5.89 [4.14-5.80 x10E6/uL] (HIGH)
Hematocrit 51.6 [37.5-51.0 %] (HIGH)
Creatinine 1.32 [0.76-1.27 mg/dL] (HIGH)
 
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franko

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Here is my latest bloodwork:

2015-10-23
• on Thyroid 1grain ED
• on Exemestane 6.25mg ED
• on Clomid 50mg EOD
• on DHEA 5mg ED
• on Aspirin 325mg/day
• no TRT injections
• irregular supplementation of vitamin A, K, B6, Biotin, Zinc

Cholesterol 198 [100–199 mg/dL]
Triglycerides 222 [0–149 mg/dL] (HIGH)
HDL 21 [39 mg/dL] (LOW)
VLDL 44 [5-40 mg/dL] (HIGH)
LDL 133 [0–99 mg/dL] (HIGH)
---
Glucose 135 [65-99 mg/dL]. (HIGH)
RBC 5.8 [4.14-5.80 x10E6/uL]
Hematocrit 50.8 [37.5-51.0 %]
Creatinine 1.37 [0.76-1.27 mg/dL] (HIGH)
ALT 55 [0-44 IU/L] (HIGH)
---
Prolactin 19.1 [4-15.2 ng/mL] (HIGH)
Testosterone 701 [348–1197 ng/dL]
Estradiol 51.8 [7.6–42.6 pg/mL] (HIGH)
LH 26.1 [1.7–8.6 mIU/mL] (HIGH)
FSH 10.3 [1.5–12.4 mIU/mL]
T:E Ratio = 14

Analysis

• So, a T level of 700 feels good, man. Definitely worth all this trouble.

• It was the TRT that was raising my RBC/Hematocrit, so that's down now that I'm not doing any T injections. So I'm liking the strategy of reducing Estrogen / aromatization to get my T levels up. Seems to be more appropriate for what's "wrong" with me, anyway.

• Cholesterol went down a bit, I'm thinking the DHEA/pregnenolone is helping with that. But also that number is not while fasting, so it would probably be lower if fasted.

• So, I tried the Clomid so that I could get higher T levels with less exemestane. It did produces a higher LH and T levels, but now my Estradiol is higher — so I think I'm going back to 12.5mg ED of exemestane. Or I'll try to get by with 6.25 and because I'm going to try cyproheptadine and bromocriptine to lower prolactin and serotonin and those should all by synergistic.

• Acne is probably the most reliable indicator of my Testosterone levels other than how I feel. I don't want the acne, of course, but I'm a little hesitant to throw in some Vit A or Zinc to try and prevent it because there goes my best T level indicator. We'll see...
 
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franko

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haidut said:
Are you a bodybuilder?

Nope. I've just had low T (in the 300's) and have been trying to raise it to high-normal levels.

haidut said:
Why are you taking clomid or tamoxifen? Do you know how estrogenic they are? Peat's website has articles on both. They are both synthetic estrogens with slightly modified function to make them somewhat anti-estrogenic in specific tissues but overall they are still synthetic estrogens. Clomid is highly estrogenic to brain and bones, do not get fooled by studies showing it can increase T. People with MS, a brain condition from high estrogen, have died from taking clomid. Both clomid and tamofixen will fry your liver, as they are both estrogens. Exemestane is probably OK, but not until you figure the issue with prolactin.

I was taking Clomid because I thought it was anti-estrogenic and I had heard of it being used for TRT. I was just experimenting as an alternative to exemestane. But I was going to stop taking the Clomid anyway, and now I definitely will.

haidut said:
High prolactin, in the absense or pituitary issues or hypothyroidism, can be caused by liver and/or kidney issues.

I did see an endocrinologist in the early part of this year and he had me get an MRI to check for a prolactinoma, but I did not have one.

My original bloodwork over a year ago showed "subclinical hypothyroidism". I wasn't taking anything at the time:

TSH 4.6 | 0.45–4.50 uIU/mL
T3 3.1 | 2.0–4.4 pg/mL
T4 1.08 | 0.82–1.77 ng/dL

That's why I started taking 1 grain of thyroid per day. And I got this result:

TSH 1.39 | 0.45-4.5 uIU/mL
T3 2.9 | 2-4.4 pg/mL
T4 0.88 | 0.82-1.77 ng/mL

And then I tried 2 grains plus nibbling on T3 and got this:

TSH 0.016 | 0.45-4.5 uIU/mL (LOW)
T3 8.7 | 2-4.4 pg/mL (HIGH)
T4 1.24 | 0.82-1.77 ng/mL

And so I went back to just 1 grain/day.

haidut said:
Your results show potential issues with both (creatinine and ALT). I would do a full liver panel with ALT, AST, ALP, GGT, PT, and albumin. I would also stop taking whatever drugs you are taking and lower protein intake to no more than 1g/kg daily. Your kidneys need so rest and recover.

I have some of those in my latest bloodwork. Here's a link to the full results: https://img.bi/#/Rl8I6Ui!u681wHH-XIkEKjR_xPwPwA41xqAiUXV882yOy27S

In my earliest bloodwork, before taking any thyroid or hormones, did not have high creatinine or ALT. They were high normal ALT was 40 and creatinine was 1.21 so I figured that my later high values were due to the thyroid and the AI's. When I was taking 2 grains of thyroid and some T3 I actually got an ALT of 104 and so there was a correlation with taking thyroid.

I would love to stop taking all of them, but when I stop taking aromatase inhibitors I can tell that my Testosterone has dropped back down to low-normal and I start to feel pretty bad — low motivation, depression, social anxiety. These my original reasons for looking into low T and TRT.

I would probably cut out all of it but the exemestane, but I'm not sure what the risk is to my kidneys. I'll try lowering my protein intake. I have always been a big meat/cheese (protein&fat) eater, that could be part of the problem.

haidut said:
I am surprised your doctor has not said anything about kidneys and/or liver issues and suggested follow up. I would strongly suggest following up with him/her on these tests.

I stopped seeing that endocrinologist early in the year because he stopped taking my health insurance and since then I've just been experimenting on my own and getting private blood tests done.

haidut said:
Finally, since RBC and Hematocrit are also high (probably due to high T) I would do an iron panel just in case. Serum iron, ferritin, iron saturation, transferrin, copper, ceruloplasmin. Liver and kidney issues can both be caused by iron and in some cases even copper.

I'll get one or some of those iron tests next time.

haidut said:
Just my 2c..

This was worth way more than 2 cents. Thank you very much.
 

haidut

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franko said:
post 106031
haidut said:
Are you a bodybuilder?

Nope. I've just had low T (in the 300's) and have been trying to raise it to high-normal levels.

haidut said:
Why are you taking clomid or tamoxifen? Do you know how estrogenic they are? Peat's website has articles on both. They are both synthetic estrogens with slightly modified function to make them somewhat anti-estrogenic in specific tissues but overall they are still synthetic estrogens. Clomid is highly estrogenic to brain and bones, do not get fooled by studies showing it can increase T. People with MS, a brain condition from high estrogen, have died from taking clomid. Both clomid and tamofixen will fry your liver, as they are both estrogens. Exemestane is probably OK, but not until you figure the issue with prolactin.

I was taking Clomid because I thought it was anti-estrogenic and I had heard of it being used for TRT. I was just experimenting as an alternative to exemestane. But I was going to stop taking the Clomid anyway, and now I definitely will.

haidut said:
High prolactin, in the absense or pituitary issues or hypothyroidism, can be caused by liver and/or kidney issues.

I did see an endocrinologist in the early part of this year and he had me get an MRI to check for a prolactinoma, but I did not have one.

My original bloodwork over a year ago showed "subclinical hypothyroidism". I wasn't taking anything at the time:

TSH 4.6 | 0.45–4.50 uIU/mL
T3 3.1 | 2.0–4.4 pg/mL
T4 1.08 | 0.82–1.77 ng/dL

That's why I started taking 1 grain of thyroid per day. And I got this result:

TSH 1.39 | 0.45-4.5 uIU/mL
T3 2.9 | 2-4.4 pg/mL
T4 0.88 | 0.82-1.77 ng/mL

And then I tried 2 grains plus nibbling on T3 and got this:

TSH 0.016 | 0.45-4.5 uIU/mL (LOW)
T3 8.7 | 2-4.4 pg/mL (HIGH)
T4 1.24 | 0.82-1.77 ng/mL

And so I went back to just 1 grain/day.

haidut said:
Your results show potential issues with both (creatinine and ALT). I would do a full liver panel with ALT, AST, ALP, GGT, PT, and albumin. I would also stop taking whatever drugs you are taking and lower protein intake to no more than 1g/kg daily. Your kidneys need so rest and recover.

I have some of those in my latest bloodwork. Here's a link to the full results: https://img.bi/#/Rl8I6Ui!u681wHH-XIkEKjR_xPwPwA41xqAiUXV882yOy27S

In my earliest bloodwork, before taking any thyroid or hormones, did not have high creatinine or ALT. They were high normal ALT was 40 and creatinine was 1.21 so I figured that my later high values were due to the thyroid and the AI's. When I was taking 2 grains of thyroid and some T3 I actually got an ALT of 104 and so there was a correlation with taking thyroid.

I would love to stop taking all of them, but when I stop taking aromatase inhibitors I can tell that my Testosterone has dropped back down to low-normal and I start to feel pretty bad — low motivation, depression, social anxiety. These my original reasons for looking into low T and TRT.

I would probably cut out all of it but the exemestane, but I'm not sure what the risk is to my kidneys. I'll try lowering my protein intake. I have always been a big meat/cheese (protein&fat) eater, that could be part of the problem.

haidut said:
I am surprised your doctor has not said anything about kidneys and/or liver issues and suggested follow up. I would strongly suggest following up with him/her on these tests.

I stopped seeing that endocrinologist early in the year because he stopped taking my health insurance and since then I've just been experimenting on my own and getting private blood tests done.

haidut said:
Finally, since RBC and Hematocrit are also high (probably due to high T) I would do an iron panel just in case. Serum iron, ferritin, iron saturation, transferrin, copper, ceruloplasmin. Liver and kidney issues can both be caused by iron and in some cases even copper.

I'll get one or some of those iron tests next time.

haidut said:
Just my 2c..

This was worth way more than 2 cents. Thank you very much.

I would still follow up with tests on kidney/liver function after a month of normal protein diet. At your age, creatinine should not be above 1, unless you are eating a LOT of protein, which sounds like you are. So, 1g/kg is OK for most people.
After 1 month, repeat kidney tests, the full liver tests and the iron tests I mentioned. Since your testosterone dropped from 1,500+ down to 700 the RBC and Hematocrit also dropped, but are still close to the upper limit. Iron issues are so pervasive these days, and affect virtually all organs.
With prolactin below 50, there is less than 1/1,000,000 chance of you having prolactinoma so not sure what that endocrinologist was thinking. Prolactin below 50 is usually hypothyroidism, liver, or kidney disease, or low carb-diet combined with endurance exercise (in that order).
 
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franko

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haidut said:
post 106139 I would still follow up with tests on kidney/liver function after a month of normal protein diet. At your age, creatinine should not be above 1, unless you are eating a LOT of protein, which sounds like you are. So, 1g/kg is OK for most people.
After 1 month, repeat kidney tests, the full liver tests and the iron tests I mentioned. Since your testosterone dropped from 1,500+ down to 700 the RBC and Hematocrit also dropped, but are still close to the upper limit. Iron issues are so pervasive these days, and affect virtually all organs.

I will aim for the 1g/kg protein. I've been wanting to adjust my carbs:protein and carbs:fat ratios anyway, and do more cheese and less meat for the phosphorus:calcium ratio.

I will get the liver, kidney & iron tests when I do my next blood test in about a month. Also, I'm going to research these as potential causes of high prolactin because thus far prolactin has been stumping me.

Also, I'm going to research these as potential causes of high prolactin because thus far it has been stumping me.

haidut said:
With prolactin below 50, there is less than 1/1,000,000 chance of you having prolactinoma so not sure what that endocrinologist was thinking.

Yeah, that endocrinologist experience was terrible. I'll share the story because who knows who might be able to benefit from it:

The doc ordered blood tests and recommended the MRI based on a prolactin level of 36. And what makes it even worse — I had previous blood test showing a level of 15 just a few months ago, so he was aware of that. And it turned out that that 36 was a temporary spike do to manual palpation by me trying to diagnose my own gynecomastia the day of the doctor's appointment and I got my blood drawn the next day. So, if anyone was wondering if touching, squeezing / messing with your nipples can raise prolactin — Yes. It can double it for at least a day. I have the bloodwork to prove it.

And then the icing on the cake was the hospital he referred me to for the MRI was going to charge $2,000 for it even with my health insurance — which I would have had to pay in full because I had not reached my deductible. Fortunately, I did my research and found a place that charged $250. It was still a waste of money, but could have been worse.

haidut said:
Prolactin below 50 is usually hypothyroidism, liver, or kidney disease, or low carb-diet combined with endurance exercise (in that order).

Well, I've ruled out hypothyroidism as the cause. When I was on 2grains/day of thyroid I had a TSH of 0.016 a T3 of 8.7 and a T4 of 1.24 and I still had a prolactin of 23 so I think that is pretty good proof.

And I don't do low-carb or endurance exercise. So I will investigate liver and kidney issues.
 
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franko

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haidut said:
I would still follow up with tests on kidney/liver function after a month of normal protein diet.

It's been a little over a month on a normal protein diet and I got a package deal that includes most of the tests you mentioned and more. I posted the results in a new thread here:

viewtopic.php?f=56&t=8819&p=113366#p113366

I'd greatly appreciate your 2 cents again. I think/hope it will be helpful to others as well, because I seem to have the typical problematic biomarkers discussed around these parts.
 
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franko

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I haven't posted in quite some time. Summary of the last two years up until 4 months ago: My health got worse. I kept Peating, I kept trying different supplements and hormones, but nothing was working. That's the short version — I will probably make a full post in the future because it might be valuable to describe it in detail.

But there's good news: In the past 4 months, I came across some new research and changed my diet / strategy radically. So far, it's worked better than anything I've tried in the last decade. I made a post about it here:

https://raypeatforum.com/community/threads/grant-genereuxs-theory-of-vitamin-a-toxicity.24722/
 
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I think one simple contributing cause is that you just are not eating enough, and may have not been eating enough for a long time, leading to catabolism induced health problems.

I am going based on your log here: New bloodwork. Still failing to lower prolactin and others.
You say your diet is
• Carbs: ~300g
• Fat: ~45g
• Protein: ~85g

If I am correct, then that means you are eating less than 2000 calories a day:
300 grams of carbs*4=1200
45 grams of fat *9 =405
85 grams of protein *4 =340
________
1945 calories per day

I put in your stats (5'11'', 200 lbs, 27 years) into this calculator (RESTING Metabolic Rate (RMR) - GlobalRPH), which uses the Mifflin St Jeor equation, and obtained the following result, assuming a "mild" activity level:
Your estimated Basal Metabolic Rate (BMR) is 1905 kcal/day.
A rough estimate of the number of calories required per day based on your current activity level is: 2619 kcal/day.​

Mild was defined this way:
Mild activity level: Intensive exercise for at least 20 minutes 1 to 3 times per week. This may include such things as bicycling, jogging, basketball, swimming, skating, etc. If you do not exercise regularly, but you maintain a busy life style that requires you to walk frequently for long periods, you meet the requirements of this level.​

However, even if you were totally sedentary, which I really doubt it, because if you are walking around, doing errands, thinking about things, doing housework, you wouldn't be totally sedentary. But let's assume a very sedentary life:

A rough estimate of the number of calories required per day based on your current activity level is: 2286 kcal/day.​

So even assuming a completely sedentary life, you are still in a caloric deficit. How long have you been eating like this? It it has been for a while, you are in a catabolic state, or have been catabolic enough to cause you health issues. You may have a very large caloric deficit built up that has to be paid.

FWIW, I had very similar health issues as you due to chronically under-eating. They were all pretty much resolved by a significant refeeding period. Some people may need thyroid or progesterone to recover faster, but I have no experience using them.

I would recommend working with Billy Craig, because he is greatly influenced by Ray Peat and focuses on recovery from under-eating, and I believe also incorporates thyroid/progesterone into recovery if necessary. If you are worried about weight gain from increasing your calories then I would definitely work with him because I believe he has written about that as something he tries to consider.
 
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golder

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I don't suppose anyone could help me. Managed to find an old Andractim tube that I ordered ages ago but never got around to taking it as I wanted to get my before and after labs done. Now I'm in a position to do that, I've opened the box and the instructions are in French. Does anyone know the dosage? There seems to be little markings on the back of the tube that go up to the number 15? Not sure what that is, or the best application site. Thanks massively in advance!
 

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