POTS! (but Not Pans. )

[Jennifer]

Yes, so some of my supplements have wild yam root, parsley, saw palmetto, dandelion and rhodiola! I couldn't say whether these have any effect, I wouldn't know which substance to attribute any of my symptoms to. To be honest as I'm not improving I doubt any of them work for my body, at least in a significant enough way.

That's interesting, I think i'm the exact opposite! Because my adrenals are so shot I get hypoglycemic easily, so low protein high fruit is killer - I crash sooo hard. Easiest for me is pretty much 30/40/30 ratio for F/C/P

Congratulations on getting your cycle :)

Thank you! :)

Ohh, yeah! My diet definitely left me feeling wiped out for a bit because it took away all stimulating foods and supplements, which pretty much revealed to me where my adrenal and thyroid glands stood in terms of their weaknesses. Because I went so long running on adrenaline without knowing, I crashed hard with the switch. Thankfully, this forced me to rest, which in my experience, there is no supplement or food that can replace rest.

How is your sleep? Do you get to bed early and sleep well through the night?

 

[Jennifer]

I'm not sure if you are concerned about the wild yam root or if wild yam is different from wild yam root but it looks like it's a phytoestrogen.
My Very Positive Experience And How I Did It

That was the one ingredient that really concerned me knowing Ray's work. The thing that stumped me is the isolation of diosgenin versus the whole root. Is it a case of when God created the poison, he packaged the antidote with it?

In that thread link you gave, aguilaroja wrote:

"In _From PMS to Menopause_, on the very last page, Ray Peat writes that "Diosgenin, sometimes called wild yam extract, is toxic.' "

Is diosgenin, sometimes called wild yam extract, the same as the whole wild yam root?

Dr. Morse has read Dr. John Lee's work (If I remember correctly, he was one of Ray's students?) and even states in his videos and book that many women are estrogen dominant and doesn't use herbs like black cohosh because it's estrogenic. He only recommends it in very rare cases where someone is truly estrogen deficient. He writes in his book:

"Estrogen must always be counter balanced by a steroid called progesterone. Progesterone is a steroid produced in the ovaries and the adrenal glands. Progesterone needs a pro-hormone, DHEA, produced in the adrenal glands, to be produced properly. Therefor, when the adrenal glands are hypoactive, this can affect the production and release of progesterone, leaving a women estrogen dominant. This causes a domino effect, creating extensive cellular acidosis, and leads to ovarian cysts, uterine fibroids, fibrocystic issues, female cancers and other conditions."

And under the section of female imbalances he writes:

"Without proper progesterone and other anti-inflammatory steroids a woman becomes estrogen dominant. The estrogen levels in her body, especially ovarian estrogen, dominate without the counterbalance of progesterone. Most estrogens are acidic, especially ovarian estrogen, which breaks down the inner lining of the uterus each month. Of course progesterone stops this, and heals inflamed tissue while repairing the damaged cells.

Because of estrogen's ability to break down the uterine lining, birth control pills are made from estrogen. Estrogen stimulates a women's natural menstruation cycle. with all this in mind, ask yourself: "Why does a medical doctor give a woman more estrogen after removing the uterus?" Also, with the above information, would estrogen build up bones or tear bones down? Yes, tear down. This is why estrogen replacement programs usually make the problems much worse."

Since Dr. Morse is aware of the dangers of estrogen dominance, I figured he wouldn't make a formula, or recommend the herbs to make our own formulas, that would be estrogenic or "acidic" as he calls it since he is about reducing acids in the body, not creating more.

So what are your thoughts, Blossom or anyone? Do you guys think the whole wild yam root is toxic like an extract of diosgenin? Does anyone happen to have any links to studies done on the whole root? I tried finding some before I ordered the formula, but came up short. I don't want to keep taking the endocrine formula if wild yam root is truly toxic.

 

[Blossom]

Yeah, I honestly don't know if the root is the same as the extract! Forum member @moss seems to be very knowledgeable about herbs so perhaps she would know?

 

[Emstar1892]

Thank you! :)

Ohh, yeah! My diet definitely left me feeling wiped out for a bit because it took away all stimulating foods and supplements, which pretty much revealed to me where my adrenal and thyroid glands stood in terms of their weaknesses. Because I went so long running on adrenaline without knowing, I crashed hard with the switch. Thankfully, this forced me to rest, which in my experience, there is no supplement or food that can replace rest.

How is your sleep? Do you get to bed early and sleep well through the night?

Aah, well thank god you were able to rest! I know I'd be a million times better if i could just spend a month abroad doing nothing but wandering around in sunlight.

Dayuum! Sadly life is not so atm...

My sleep is laughable (except I cry..) I go to bed around 11 and fall asleep around 1am, then wake up at 5.30am, then at 6.30am, which is when people in my house get up and make SO much noise it's a joke. I don't need to get up till 7.30 so i just spend the first hour of my day sad with my eyes closed hoping to nod off for the remaining time but it never happens. Literally any noise makes my heart pound hard in my chest and my cheeks flush - seriously, even a light switching at the end of the hall makes my heart race for about 2 minutes.

 

[Blossom]

Literally any noise makes my heart pound hard in my chest and my cheeks flush - literally, even a light switch at the end of the hall makes my heart race for about 2 minutes.

I found honey or fruit juice helpful when I would wake up feeling that way and usually I could fall back asleep.

 

[marteagal]

That's possible, yes, however the first time I was diagnosed with Bradychardia and hypotension (they occured together almost overnight) was in 2010, so I'd guess the root causes are much more severe than K2 excess.

Oh, yes, I see. It was just a guess...

Another quote, have you already read this? The description seems to fit with your symptoms, and, then, it would hint to unopposed estrogen:

Some problems that become very common by middle age are "palpitations," orthostatic hypotension, orthostatic tachycardia, and varicose veins. The negative inotropic effect of estrogen in the heart has a parallel in the smooth muscle of veins, in which the muscles are weakened, and their distensibility increased, when estrogen isn't sufficiently opposed by progesterone. This allows the veins in the lower part of the body to be distended abnormally when standing, reducing the amount of blood returning to the heart, so that the volume pumped with each stroke is small, requiring faster beating. The reduced blood volume reaching the brain can cause fainting. When it becomes chronic, it can lead to the progressive distortion of the veins. An excess of estrogen is associated with varicose veins in men, as well as women. (Raj, 2006; Ciardullo, et al., 2000; Kendler, et al., 2009; Asciutto, et al., 2010; Raffetto, et al., 2010).

Notes:
1.) You appear very far from middle-aged! :)
2.) I think you mentioned earlier that your problems do not seem to have to do specifically with estrogen ... Have you measured your prolactin level as a proxy for your estrogen tissue levels? Or, since blood tests seem to be expensive in the UK, maybe you could give it at least priority on your to-be-tested list? Sorry, if redundant.

 

[Jennifer]

Yeah, I honestly don't know if the root is the same as the extract! Forum member @moss seems to be very knowledg

Thanks for the suggestion, Blossom! I'll check with moss. :)

Aah, well thank god you were able to rest! I know I'd be a million times better if i could just spend a month abroad doing nothing but wandering around in sunlight.

Dayuum! Sadly life is not so atm...

My sleep is laughable (except I cry..) I go to bed around 11 and fall asleep around 1am, then wake up at 5.30am, then at 6.30am, which is when people in my house get up and make SO much noise it's a joke. I don't need to get up till 7.30 so i just spend the first hour of my day sad with my eyes closed hoping to nod off for the remaining time but it never happens. Literally any noise makes my heart pound hard in my chest and my cheeks flush - seriously, even a light switching at the end of the hall makes my heart race for about 2 minutes.

Aww...I'm really sorry to hear that, Emstar.

The sensitivity to noise, the heart pounding and flushing cheeks are what I used to get. Well, more like my face would burn up, as well as my ears. I can't remember exactly, but I recall Ray saying that if you wake between certain hours, one indicates high adrenaline and the other cortisol. I think 11-1:00am was adrenaline and 3-4:00am was cortisol. I also recall Ray saying that being sensitive to noise indicates a possible potassium deficiency. I'll see if I can find the quotes.

What Blossom suggested worked well for me, too. I used to keep some raisins or juice by my bedside for the times I would wake up. For me, it was always around 3-4:00am. I'd have a stressful dream, wake up and need to pee. I assumed it was from my sugars crashing.

For the noise, have you tried earplugs? I buffer the noise from other people in the house by listening to my iPod. I have earbuds that are pretty good at blocking background noise, but I find music to be soothing where others might find they can't sleep with it.

 

[Blossom]

For the noise, have you tried earplugs?

I second that suggestion. I've been using earplugs and an eye mask while sleeping for years.

 

[marteagal]

I skimmed through one of Peat's references [Raj (2006) The Postural Tachycardia Syndrome (POTS): Pathophysiology, Diagnosis & Management]. It was an interesting read. In the following, some excerpts. The full article can be accessed via The Postural Tachycardia Syndrome (POTS): Pathophysiology, Diagnosis & Management

"Symptoms include mental clouding (“brain fog”), blurred or tunneled vision, shortness of breath, palpitation, tremulousness, chest discomfort, headache, lightheadedness and nausea. While pre-syncope is common in these patients, only a minority (~30%) actually pass out. The chest pains are almost never due to coronary artery obstruction, but are sometimes associated with electrocardiographic changes in the inferior leads, particularly when upright [6]."

"Many patients complain of significant exercise intolerance and extreme fatigue. Even activities of daily living, such as bathing or housework, may greatly exacerbate symptoms with resultant fatigue. This can pose significant limitations on their functional capacity."

"The disorder primarily affects women of child-bearing age. The female:male ratio is 4:1. The reason for the strong female predominance is not known [note by marteagal: in the Peat world it *is* known], but it should be noted that orthostatic tolerance is reduced in normal healthy females [7]. Others disorders such as autoimmune diseases and irritable bowel syndrome are seen commonly in patients with POTS, and also have higher prevalence in women."

"Patients frequently report that their symptoms began following acute stressors such as pregnancy, major surgery, or a presumed viral illness, but in others cases, symptoms develop more insidiously."

"We often measure plasma norepinephrine levels in both a supine and standing position (at least 15 minutes in each position prior to blood sampling). The supine norepinephrine is often high normal in patients with POTS, while the upright norepinephrine is usually elevated (>600 pg/ml), a reflection of the exaggerated neural sympathetic tone that is present in these patients while upright. [...] There are some cases, however, in which the primary underlying problem seems to be excessive sympathetic discharge. These patients often have extremely high levels of upright norepinephrine. While we require the upright norepinephrine level to be >600 pg/ml for the diagnosis of POTS, the hyperadrenergic subgroup often has upright norepinephrine level >1000 pg/ml and it is occasionally >2000 pg/ml. These patients sometimes have large increases in blood pressure on standing, indicating that baroreflex buffering is somehow impaired."

"Some patients with POTS have co-existent mast cell activation. These patients have episodic flushing and abnormal increases in urine methylhistamine (the primary urinary metabolite of histamine) [20]. Methylhistamine should ideally be measured in 2 hour aliquots at the time of a flushing episode and not just in a random 24 hour period. Other associated symptoms include shortness of breath, headache, lightheadedness, excessive diuresis, and gastrointestinal symptoms such as diarrhea, nausea, and vomiting. Flushing can be triggered by long-term standing, exercise, premenstrual cycle, meals, and sexual intercourse."

"Non-Pharmacological Treatment of POTS
[...] It is important to educate the patient about the nature of the disorder. The patient should avoid aggravating factors such as dehydration, and extreme heat. In order to ensure adequate hydration, we ask our patients to consume 8-10 cups of water daily and to rapidly drink 16 fl oz of water to lower their heart rates [35]. In addition, they are asked to aggressively increase their sodium intake up to 200 mEq/day. This is often hard to achieve without NaCl tablets 1 gm/tablet TID with meals."

 

[Emstar1892]

I skimmed through one of Peat's references [Raj (2006) The Postural Tachycardia Syndrome (POTS): Pathophysiology, Diagnosis & Management]. It was an interesting read. In the following, some excerpts. The full article can be accessed via The Postural Tachycardia Syndrome (POTS): Pathophysiology, Diagnosis & Management

"Symptoms include mental clouding (“brain fog”), blurred or tunneled vision, shortness of breath, palpitation, tremulousness, chest discomfort, headache, lightheadedness and nausea. While pre-syncope is common in these patients, only a minority (~30%) actually pass out. The chest pains are almost never due to coronary artery obstruction, but are sometimes associated with electrocardiographic changes in the inferior leads, particularly when upright [6]."

"Many patients complain of significant exercise intolerance and extreme fatigue. Even activities of daily living, such as bathing or housework, may greatly exacerbate symptoms with resultant fatigue. This can pose significant limitations on their functional capacity."

"The disorder primarily affects women of child-bearing age. The female:male ratio is 4:1. The reason for the strong female predominance is not known [note by marteagal: in the Peat world it *is* known], but it should be noted that orthostatic tolerance is reduced in normal healthy females [7]. Others disorders such as autoimmune diseases and irritable bowel syndrome are seen commonly in patients with POTS, and also have higher prevalence in women."

"Patients frequently report that their symptoms began following acute stressors such as pregnancy, major surgery, or a presumed viral illness, but in others cases, symptoms develop more insidiously."

"We often measure plasma norepinephrine levels in both a supine and standing position (at least 15 minutes in each position prior to blood sampling). The supine norepinephrine is often high normal in patients with POTS, while the upright norepinephrine is usually elevated (>600 pg/ml), a reflection of the exaggerated neural sympathetic tone that is present in these patients while upright. [...] There are some cases, however, in which the primary underlying problem seems to be excessive sympathetic discharge. These patients often have extremely high levels of upright norepinephrine. While we require the upright norepinephrine level to be >600 pg/ml for the diagnosis of POTS, the hyperadrenergic subgroup often has upright norepinephrine level >1000 pg/ml and it is occasionally >2000 pg/ml. These patients sometimes have large increases in blood pressure on standing, indicating that baroreflex buffering is somehow impaired."

"Some patients with POTS have co-existent mast cell activation. These patients have episodic flushing and abnormal increases in urine methylhistamine (the primary urinary metabolite of histamine) [20]. Methylhistamine should ideally be measured in 2 hour aliquots at the time of a flushing episode and not just in a random 24 hour period. Other associated symptoms include shortness of breath, headache, lightheadedness, excessive diuresis, and gastrointestinal symptoms such as diarrhea, nausea, and vomiting. Flushing can be triggered by long-term standing, exercise, premenstrual cycle, meals, and sexual intercourse."

"Non-Pharmacological Treatment of POTS
[...] It is important to educate the patient about the nature of the disorder. The patient should avoid aggravating factors such as dehydration, and extreme heat. In order to ensure adequate hydration, we ask our patients to consume 8-10 cups of water daily and to rapidly drink 16 fl oz of water to lower their heart rates [35]. In addition, they are asked to aggressively increase their sodium intake up to 200 mEq/day. This is often hard to achieve without NaCl tablets 1 gm/tablet TID with meals."

Wow, thank you for posting all of that.

Do you know how to generalise 200 mEq to get an mg estimate?

 

[marteagal]

Hey it was actually meant to point to sodium consumption in general, not that you eat this specific amount of sodium. :)

On the other hand, you stated earlier that you have tried upping your sodium and it seemed to help a bit. Maybe it was just too little?

But to answer your question: I've never come across this particular unit, "mEq", but online conversion calculators such as www.nafwa.org/convert1.php give the following formula:

mEq= mg/atomic weight * valence

-->

mg = mEq * atomic weight / valence

With atomic weight = 23, and valence of sodium = 1, the amount of 200 mEq sodium is the same as 4600 mg = 4,6 g sodium - in Peat world, not that large an amount.

What is your current daily sodium intake on average?

 

[Emstar1892]

Ooo interesting,

Hey it was actually meant to point to sodium consumption in general, not that you eat this specific amount of sodium. :)

On the other hand, you stated earlier that you have tried upping your sodium and it seemed to help a bit. Maybe it was just too little?

But to answer your question: I've never come across this particular unit, "mEq", but online conversion calculators such as www.nafwa.org/convert1.php give the following formula:

mEq= mg/atomic weight * valence

-->

mg = mEq * atomic weight / valence

With atomic weight = 23, and valence of sodium = 1, the amount of 200 mEq sodium is the same as 4600 mg = 4,6 g sodium - in Peat world, not that large an amount.

What is your current daily sodium intake on average?

Ooo interesting, thanks! It's about a teaspoon added, no idea how much in natural foods...probably not much, today I had prawns, crab, mangos and pineapples! Will have some oatmeal later though, I usually cover that in salt haha

 

[Emstar1892]

In other news, I've been advised to take florinef!

 

[marteagal]

In other news, I've been advised to take florinef!

You won't do that, will you?

"Fludrocortisone (also called 9α-fluorocortisol or 9α-fluorohydrocortisone) is a synthetic corticosteroid with moderate glucocorticoid potency and much greater mineralocorticoid potency. Therapeutically, it is used for its mineralocorticoid activity and not for its glucocorticoid activity.

Side effects
Sodium and water retention
Swelling due to fluid retention (edema)
High blood pressure (hypertension)
Headache
Low blood potassium level (hypokalemia)
Muscle weakness
Fatigue
Increased susceptibility to infection
Impaired wound healing
Increased sweating
Increased hair growth (hirsutism)
Thinning of skin and stretch marks
Disturbances of the gut such as indigestion (dyspepsia), distention of the abdomen and ulceration (peptic ulcer)
Decreased bone density and increased risk of fractures of the bones
Difficulty in sleeping (insomnia)
Depression
Weight gain
Raised blood sugar level
Changes to the menstrual cycle
Partial loss of vision due to opacity in the lens of the eye (cataracts)
Raised pressure in the eye (glaucoma)
Increased pressure in the skull (intracranial pressure)"

(Wiki)

Doesn't sound good to me. Maybe more knowledgeable members can give you advice.

 

[Emstar1892]

You won't do that, will you?

"Fludrocortisone (also called 9α-fluorocortisol or 9α-fluorohydrocortisone) is a synthetic corticosteroid with moderate glucocorticoid potency and much greater mineralocorticoid potency. Therapeutically, it is used for its mineralocorticoid activity and not for its glucocorticoid activity.

Side effects
Sodium and water retention
Swelling due to fluid retention (edema)
High blood pressure (hypertension)
Headache
Low blood potassium level (hypokalemia)
Muscle weakness
Fatigue
Increased susceptibility to infection
Impaired wound healing
Increased sweating
Increased hair growth (hirsutism)
Thinning of skin and stretch marks
Disturbances of the gut such as indigestion (dyspepsia), distention of the abdomen and ulceration (peptic ulcer)
Decreased bone density and increased risk of fractures of the bones
Difficulty in sleeping (insomnia)
Depression
Weight gain
Raised blood sugar level
Changes to the menstrual cycle
Partial loss of vision due to opacity in the lens of the eye (cataracts)
Raised pressure in the eye (glaucoma)
Increased pressure in the skull (intracranial pressure)"

(Wiki)

Doesn't sound good to me. Maybe more knowledgeable members can give you advice.

I don't plan to, no. Any corticosteroid can be a very slippery slope to terrible, serious health consequences in the long run.

What I want to do is find the cause of my low daytime cortisol, and I'm still very much convinced that it's infection.

Problem is until I get my cortisol levels up, I can't take thyroid, so I'm stuck.

Such a bummer man! I'm looking into methylene blue atm...thinking this is a good potential avenue?

 

[Blossom]

I wondered if you'd read this from WiKi,
Cortisol
[Jefferies and Safe Uses of Cortisol] I don't think his arguments are correct. The amounts he sometimes prescribed weren't always safe.

[Cortef] I think William Jefferies' book created a lot of interest in that. Since ACTH can interfere with ovarian function, cortisol can sometimes help the ovaries to make progesterone, by suppressing ACTH. But I knew people who followed his prescription and got Cushing's symptoms. Pregnenolone is something that can always be used with thyroid, to guarantee an easy adrenal response.

The doses they prescribe as "replacement" are much more than the adrenals would produce, so they in themselves are diabetogenic. William Jefferies told people that, since the adrenals produce 20 mg of cortisol per day, they should take 30 or 40 mg, as a replacement dose, because only half of it is absorbed. They got fat faces quickly. Using pregnenolone, they were able to taper off the cortisol in a month or two.

[Cortisol - Cortisone - Cortef] Cortisol works in the body although the body can convert cortisol to cortisone. Synthetic cortisol-like drugs, such as prednisone are more like cortisol. Also, hydrocortisone is a drug that acts like cortisol. The body makes 20 mg of cortisol daily. Taking 10 mg of prednisone is equivalent to about 50 mg of cortisol or 2.5 times the daily amount made in-vitro. Cortef is Hydrocortisone which acts like cortisol.

[Cortisol & weak adrenals] Cortisol is a little more water soluble than progesterone, and a diurnal cycle can be seen in the saliva, but the absolute amounts aren't as meaningful as in the serum. Thyroid is needed for the adrenals to function well, and adequate cholesterol, as raw material. It's popular to talk about "weak adrenals," but the adrenal cortex regenerates very well. Animal experimenters can make animals that lack the adrenal medulla by scooping out everything inside the adrenal capsule, and the remaining cells quickly regenerate the steroid producing tissues, the cortex. So I think the "low adrenal" people are simply low thyroid, or deficient in cholesterol or nutrients.

Addison's disease, with adrenal cortex degeneration, can cause cortisol deficiency, in which case progesterone would compensate, but doctors often tell people they "don't have enough cortisol" without proper confirmation. [Would pregnenolone correct this?] Pregnenolone should usually do it, but progesterone is more certain if the adrenals are really destroyed.

 

[tara]

What I want to do is find the cause of my low daytime cortisol,

Can't remember if you've said what your cholesterol levels are like? Have you got good substrate for steroid production?

 

[Emstar1892]

I wondered if you'd read this from WiKi,
Cortisol
[Jefferies and Safe Uses of Cortisol] I don't think his arguments are correct. The amounts he sometimes prescribed weren't always safe.

[Cortef] I think William Jefferies' book created a lot of interest in that. Since ACTH can interfere with ovarian function, cortisol can sometimes help the ovaries to make progesterone, by suppressing ACTH. But I knew people who followed his prescription and got Cushing's symptoms. Pregnenolone is something that can always be used with thyroid, to guarantee an easy adrenal response.

The doses they prescribe as "replacement" are much more than the adrenals would produce, so they in themselves are diabetogenic. William Jefferies told people that, since the adrenals produce 20 mg of cortisol per day, they should take 30 or 40 mg, as a replacement dose, because only half of it is absorbed. They got fat faces quickly. Using pregnenolone, they were able to taper off the cortisol in a month or two.

[Cortisol - Cortisone - Cortef] Cortisol works in the body although the body can convert cortisol to cortisone. Synthetic cortisol-like drugs, such as prednisone are more like cortisol. Also, hydrocortisone is a drug that acts like cortisol. The body makes 20 mg of cortisol daily. Taking 10 mg of prednisone is equivalent to about 50 mg of cortisol or 2.5 times the daily amount made in-vitro. Cortef is Hydrocortisone which acts like cortisol.

[Cortisol & weak adrenals] Cortisol is a little more water soluble than progesterone, and a diurnal cycle can be seen in the saliva, but the absolute amounts aren't as meaningful as in the serum. Thyroid is needed for the adrenals to function well, and adequate cholesterol, as raw material. It's popular to talk about "weak adrenals," but the adrenal cortex regenerates very well. Animal experimenters can make animals that lack the adrenal medulla by scooping out everything inside the adrenal capsule, and the remaining cells quickly regenerate the steroid producing tissues, the cortex. So I think the "low adrenal" people are simply low thyroid, or deficient in cholesterol or nutrients.

Addison's disease, with adrenal cortex degeneration, can cause cortisol deficiency, in which case progesterone would compensate, but doctors often tell people they "don't have enough cortisol" without proper confirmation. [Would pregnenolone correct this?] Pregnenolone should usually do it, but progesterone is more certain if the adrenals are really destroyed.

Yes, I'm very familiar with the negative effects of corticosteroids, I would never supplement more than 5mg, and I would exhaust every other avenue first! Since the adrenals regenerate quite easily I think it's important to acknowledge that they've probably shut down for a good reason.

In my case, I need to find out what that is. So far I've tested lyme and ebv, but am trying to get free testing for much more. The fact I keep getting anaemic really strongly indicates to me that it's bacterial, and my symptoms mirror something like borrelia (IMO)...

Thanks for posting :)

 

[Emstar1892]

Can't remember if you've said what your cholesterol levels are like? Have you got good substrate for steroid production?

Hey tara, no, I haven't had it tested. It's another one to add to the list!

I haven't prioritised it because:

1. I'm hypothyroid, so it's probably not great

2. I'm stressed, so it's probably not great

3. My swollen lymph glands, low white blood cell count and anaemia, at least to me, tell more of a story than cholesterol would.

But I'd still like to know all the same.

 

[tara]

I haven't prioritised it because:

Hey tara, no, I haven't had it tested. It's another one to add to the list!

Just seems like part of the chain, if you are looking for causes. Can't make steroid hormones if there isn't any cholesterol to make them out of. But as you say, you probably don't need to test it, since you have so many other indicator to go by.
I'm picking root cause of a fair bit of this could still be the effects of chronic energy deficiency from undereating.