For some background of my health issues, see this question.
To summarize briefly, I was diagnosed with celiac disease 10 months ago, and have been feeling fatigued and mentally foggy, despite success with a gluten-free, paleo diet/lifestyle, and improvements in other areas: stronger fingernails, better body temperature in the mornings during my luteal phase (from 97.5 F to 98.7 F), better stools.
My thyroid tests (TSH, free T4, and T3) are normal (even Chris Kresser normal, not just lab value normal). My cortisol levels are spot on where they should be throughout the day. My anti-gliadin antibodies are back down. I carry one copy of the bad MTHFR gene and my symptoms match a B12 vitamin deficiency, so I had my B12 and B9 tested. Unfortunately, they used the serum tests instead of the red blood cell test, so the normal values (as far as I understand) just show that my diet is good. I eat plenty of liver, so I'm not surprised at that. (Side note: blood pressure is 100 mmHg over 60 mmHg, and pulse is about 60 bpm.)
METHYLMALONIC ACID . . . . . 138 nmol/L (87-318 nmol/L)
FOLATE, SERUM . . . . . . . . . . . . 16 ng/mL ( > 5.4 ng/mL)
VITAMIN B12 . . . . . . . . . . . . . . .603 pg/mL (200-1100 pg/mL)
However, I did start supplementing with folate (metafolin) and methylcobalamin, and I started feeling a little better within a couple days.
But the really interesting thing is my hormone levels are wonky.
Estradiol (saliva) . . . . . . . . . . . . . .1.9 pg/ml (1.3-3.3)
Progesterone (saliva) . . . . . . . . . . 40 pg/ml (75-270)
Ratio: Pg/E2 (saliva) . . . . . . . . . . . 21 (Optimal: 100-500)
Testosterone (saliva) . . . . . . . . . . 96 pg/ml (16-55)
DHEAS (saliva) . . . . . . . . . . . . . 24.7 ng/ml (2-23)
My estradiol is normal, progesterone is pretty low, testosterone is very high, and DHEAS is slightly high.
The lab report suggested PCOS could be a possibility, but it doesn't sound like a good fit. My menstrual cycle has always been very regular. As a teenager, I was on a 6 week cycle, but my periods were easy: very little cramping. Then I was on the pill for 10 years. When I went off (also about a year ago), my periods came back and were regular right away, with a 32 day cycle. I do get premenstrual breast tenderness, now, but it goes away if I apply topical iodine. (Husband's note: this is much sexier than it sounds.)
Also, PCOS is associated with insulin resistance, but I got a home blood glucose monitor, and my fasting (non-morning) levels are 82 mg/dL. My 1-hour blood glucose level is 126 mg/dL, up from 98 mg/dL before I ate, and it goes back down within two hours. And my fasting morning level is 91 mg/dL. I eat about a 100 g carbs per day (e.g. potato, turnip, orange, banana). My A1c as of 10 months ago was 5.3%. I got it tested again recently and didn't hear back from the doctor, so I'm guessing it's still relatively low. Is it possible to have insulin resistance with good blood glucose levels? I am overweight by about 30 lbs: 5'3" and 155 lbs. I've always been very hungry, and that finally went away last week, seemingly related to the b-vitamin supplementation.
Oh, and lastly, my vitamin D level is low as of testing 10 months ago (and was the same 5 years ago when I got it tested): 33 ng/mL. For the past month I've been supplementing with 5,000 IU vitamin D on most days, plus laying out in the sun on sunny days. I was taking 90 mcg K2 along with the D up to a week ago when I decided to cool it on the K2 until I understand venous thromboembolism (blood clotting) better, since I'm at a very high genetic risk for developing it. I don't know where my vitamin D levels stand now, as I figured I'd get tested again at the end of the summer.
So, what could be causing this hormonal pattern? Is it just related to the rest of it: celiac disease recovery, hormonal birth control pill recovery, or vitamin B or D deficiency? If it's just a matter of more waiting to let my systems right themselves, that's fine, but if these hormone levels are an indication of something wrong, or are possibly related to the fatigue and mental fog, I'd like to look into them further. Any ideas are greatly appreciated!