Hairloss Much Worse After Coming Off TRT [blood Work Included]

[Broco6679]

I started TRT three years ago at 19 y/o after my levels came back at 300 ng/dL. I had three testicular torsion surgeries in my late teens, so it was presumed that the damage from said surgery caused my low levels.

I spent three years on TRT, and overall, I felt a lot worse. I had multiple issues on TRT, many of which people on here suffer with - high prolactin, high estrogen and a sub-optimal thyroid.

My hairloss started about a year and a half into TRT. I have zero hairline recession, and my loss is in a diffuse pattern only on the top. I lose about 400-500 hairs per day, and if I apply the smallest pressure to any hair on top it’ll come out. My eye brows are also thinning significantly - specifically the outer third.

What I find strange is that since coming off of TRT, many of my blood markers have significantly improved, yet my rate of hairloss has rapidly accelerated. My prolactin, estrogen and TSH all decreased, and my testosterone returned to a very respectable level. The first two sets of bloods were from when I was on TRT, and the last set of bloods is off of all medication:

16/01/19: 12.5mg Testosterone enanthate EOD and 100 iu HCG every day
Testosterone: 23.3 (8.64 - 29) nmol/L
Estradiol: 162 (41 - 149) pmol/L
Prolactin: 315 (86 - 324) mU/L
SHBG: 38.9 (18.3 - 54.1) nmol/L
TSH: 2.6 (0.27 - 4.2) mIU/L
FT3: 5.16 (3.1 - 6.8) pmol/L
FT4: 14.2 (12 - 22) pmol/L

08/03/2019: 7.5ng testosterone enanthate and 100 IU HCG every day
Testosterone: 28.4 (8.64 - 29) nmol/L
Estradiol: 220 (41 - 149) pmol/L
Prolactin: 250 (86 - 324) mU/L
SHBG: 32.7 (18.3 - 54.1) nmol/L
TSH: 2.1 (0.27 - 4.2) mIU/L
FT3: 6.09 (3.1 - 6.8) pmol/L
FT4: 14.6 (12 - 22) pmol/L

28/08/19: Off of all medication
Testosterone: 20.2 (8.64 - 29) nmol/L
Estradiol: 75.1 (41 - 149) pmol/L
Prolactin: 112 (86 - 324) mU/L
SHBG: 30.7 (18.3 - 54.1) nmol/L
TSH: 1.52 (0.27 - 4.2) mIU/L
FT3: 4.6 (3.1 - 6.8) pmol/L
FT4: 16.4 (12 - 22) pmol/L
Thyroglobulin Antibodies: <10 kU/L (Range: < 115)
Thyroid Peroxidase Antibodies: <9.0 kIU/L (Range: < 34)
Reverse T3 11 ng/dL (Range: 10 - 24)
Cortisol - Waking: 17.500 nmol/L (Range: 6 - 21)
Cortisol - 12:00: 4.680 nmol/L (Range: 1.5 - 7.6)
Cortisol - 16:00: 2.550 nmol/L (Range: 0 - 5.5)
Cortisol - Before Bed: <1.5 nmol/L (Range: 0 - 2

As you can see, both prolactin and estradiol have dropped by more than half since ceasing TRT, TSH has dropped by 0.5 - 1 (my TSH has often come back at 3-3.5 on TRT) and my cortisol levels look okay, yet my hairloss is much worse.

I have many other symptoms of low thyroid function as well as hair loss. My skin is extremely dry, my outer eyebrows are sparse (entire brow is now starting to thin), my hands and feet are always cold, my pulse is low, my armpit temps are usually between 36 - 36.5, and the soles of my feet and calluses on my hands have an orange tone suggesting hypercarotenemia.

I’m not really sure where to go from here. I don’t follow the complete Ray Peat diet philosophies, but I’m conscious of how many calories I eat (3000 - 4000 a day), I consume 400-500g of carb per day, I limit PUFA’s and I drink 1-2L of skim milk and day for the calcium content (for reference I’m M/5’11/22/180lbs/active). I do have quite bad gut issues which comes and goes; a lot of gas, bloating and stomach pain on a regular basis. Whenever I try to increase my sugar intake through juices, sweets and table sugar, my hairloss gets worse, I get bad acne and my scalp and skin feel extremely inflamed.

The only other thing to mention is that my iron blood work is looking worrying:

CRP HS: 4.05 mg/L (Range: < 5)
Iron: 32.68 umol/L (Range: 5.8 - 34.5)
TIBC: 50.58 umol/L (Range: 45 - 72)
UIBC: X 17.9 umol/ L (Range: 22.3 - 61.7)
Transferrin Saturation: X 64.61 % (Range: 20 - 50)
Ferritin: 205 ug/L (Range: 30 - 400)

After those bloods I went and donated blood to try and bring it down. Ferratin dropped all the way down to 40, but serum iron and transferrin saturation actually increased slightly. I’m currently waiting to see a hematologist to discuss these issues, and potentially have genetic testing for hereditary hematochrosis.

So that’s where I am right now; apologises the post got a bit long. Does anyone have any suggestions as to what I can do or where I should go now? Anyone notice any red flags that I’m missing? My hairloss is destroying my mental health being only 22, not only because of the significant decline in my appearance, but also because it suggests a significant underlying issue that’ll manifest as something more sinister down the line.

Thanks in advance.

 

[Aaron]

You didn't mention any supps. I'd recommend oysters, biotin, D3, creatine, taurine, magnesium citrate, organic turmeric with black pepper, and a higher fat milk for more K2, CLA, and butyric acid. Lifting weights is also great for insulin sensitivity. I still eat a lot of non-RP foods like oats, whey, wild salmon, etc but Ray's overarching principles have allowed me to thicken my hair and even reverse my IBS and mild gynecomastia over the last few years (my hair is thicker at 26 than it was at 20). Vit C and E should help somewhat with inflammation and iron. You said you limit PUFA but I recommend completely eliminating canola, sunflower, soybean oil wherever possible and take a drop of E if you happen to eat some PUFA laden crackers.

 

[Blue09]

You didn't mention any supps. I'd recommend oysters, biotin, D3, creatine, taurine, magnesium citrate, organic turmeric with black pepper, and a higher fat milk for more K2, CLA, and butyric acid. Lifting weights is also great for insulin sensitivity. I still eat a lot of non-RP foods like oats, whey, wild salmon, etc but Ray's overarching principles have allowed me to thicken my hair and even reverse my IBS and mild gynecomastia over the last few years (my hair is thicker at 26 than it was at 20). Vit C and E should help somewhat with inflammation and iron. You said you limit PUFA but I recommend completely eliminating canola, sunflower, soybean oil wherever possible and take a drop of E if you happen to eat some PUFA laden crackers.

Are those the supplements you take yourself to thicken your hair?

 

[Kelj]

Symptom Questions — The Eating Disorder Institute

What's with all the hair loss/brittleness/dryness/thinness

"So here's how the hair loss thing works. There is a natural cycle of cell death and new cell production throughout our bodies and that includes the hair follicles.

The condition of telogen effluvium is when a large amount of hair loss is noticeable and it can be traced to a severe stressful condition about 3 months prior. In those conditions the patient's hair cycle is essentially fast-forwarded to early follicle death, rather than experiencing the usual prolonged growth phase and resting phase.

This is one way in which patients may experience hair loss while they are in fact in recovery -- it is a delayed response to starvation because the normal follicle growth and renewal process is running about 3 months after the stressful starvation period occurred.

However, patients may also experience an elongated catagen phase (the regressive phase of the follicle) during their starvation period. In this situation, the hair is not aging and falling out as it should normally (about 100 odd hairs a day). And in these cases the apoptosis (natural cell death) that the catagen phase is supposed to induce is halted. The body simply doesn't have enough energy to have the cells go through their natural process.

As soon as you begin refeeding, then the process of having the follicle die and the hair fall out can now proceed and there is a back log. In these cases you may have noticed your hair was becoming increasingly brittle and opaque during the restriction phase of your condition, but did not really note much increased hair loss (if any).

While of course it is distressing, it is not a permanent state and new healthy hair will replace the old in fairly short order.

The condition of hair is directly attributable to nutritional status and that is likely why "healthy-looking" hair is important in most societies as it reflects the evolutionary value of the individual as a mate.

If you want healthy-looking hair, then pursue your health with adequate re-feeding and rest."

Refeeding is eating well above the MINIMUM calories for height, age and sex after even a short period of restriction. This letter to be copied and given to the doctors of eating disordered patients explains how much individuals have to eat just to operate all the baseline bodily function, like regulating hormone levels.

Dear Doctor: Your patient has an eating disorder. — The Eating Disorder Institute

"the complaint(s) for which they are coming to see you will not even hint at the underlying cause: a system-wide energy deficit from years of not meeting the body’s energy needs....
Know that average energy requirements for adult females and males are not 2000 and 2500 kcal/day respectively. Average intake for sedentary adult females is 2500 kcal/day and 3000 kcal/day for sedentary adult males. Between the ages of approximately 12-25 females require on average 3000 kcal/day and males 3500 kcal/day. Don’t hold back, and ask your patient to tell you what they eat on average each day and have in your mind a sense of what a 2500 or 3000 kcal/day meal plan would look like so you can compare and contrast. And don’t forget that net energy matters: if they are eating 3000 kcal/day but also work out an hour or two each day, then there will be a net energy deficit. 8"

Notice these comments from this same letter:

"Your patient’s complaints will likely include:

pruritus, rashes, skin conditions

So before you get tripped up with all the common misdiagnoses .....hypothyroidism....here are some data to help you rule in or out the causative impact of an eating disorder:....Under-eating relative to energy requirements drastically impacts gut motility, digestive enzyme production and the resilience of the gut mucosal layer. Symptoms of IBS, GERD, pruritus, skin rashes, distention, flatulence, severe constipation, so-called food sensitivities are all common signs of under eating relative to energy requirements. 11, 12.....

hypothyroidism.....represent various ways in which the body catabolizes itself to release energy from living cells into the blood stream and suppresses all non-essential biological functions to stay alive as long as possible when faced with an ongoing energy deficit. If you treat these symptoms in the absence of getting the patient to re-energize with enough food to rectify the energy deficit, then you will be pushing the living system and overriding its inherent life-saving energy usage reduction mechanisms. 13

it’s easy to overlook that reproductive atrophy and dysfunction are common signs of an eating disorder in men as well. Eating disorders take up residence as readily in men as women. If there’s erectile dysfunction, lowered or absent libido, and/or lowered volume of ejaculate, then ask about food intake and exercise regimes. 18

An optimal homeodynamic state cannot be realized by treating average energy requirements (as listed in item 1 in this section) as a maximum intake value for someone trying to recover from the cumulative energy deficits of an eating disorder. Your patient will have to rectify energy deficits and repair the damage associated with catabolism by eating more than average and the body may overshoot its optimal weight set point temporarily during that recovery process."0

You say you eat, daily, 3,000 to 4,000 calories? 3,000 is too low. If you have ever eaten below 3500, you may need to eat above even 4,000 to address the energy deficit issues.

You say, when you try to increase sugar your hair loss increases, and your scalp and skin feel inflamed, you also get acne and you mentioned orange-tinted palms. I think you have initiated recovery from an eating disorder (knowingly ?....unknowingly ?). Notice how these are the very symptoms of finally getting enough energy according to this article:

Symptom Questions — The Eating Disorder Institute

"You may develop acne or rashes"

"You may find your hair is falling out in clumps."

"All these symptoms are occurring now because the body is working hard on repairing a lot of major physical and systems damage. Respond to your need to sleep more (but never in place of eating enough food). The hair is simply regenerating."

"The acne, rashes, night sweats an hot flashes are all the reproductive hormones getting back up to speed."

"Is this symptom (see list below) to be expected during recovery?

Skin sensations: tingling, burning, prickliness, numbness, itching, rashes.....

Hair falling out, dry and flaky skin, nail breakage....

range colored skin (particularly palms of hands).

the above list is a fairly comprehensive list of the common symptoms you can experience in the early phases of recovery from an eating disorder. All these symptoms are indicative of either damage that was done while restricting and/or signs that healing is underway. All these symptoms should steadily improve throughout the recovery process."

These occur when you eat more sugar, because the sugar is giving you easily obtainable glucose to advance your healing. Your thyroid will return to normal function if you do not restrict anything...neither sugar nor calories. All who have recovered from restrictive eating just ride out the symptoms. They eventually go away.