I'm somewhat hesitant to post this publicly but I'm empathetic with where you are at and maybe it will be helpful to you or others so here goes:

I’ve been chasing a similar symptom cluster: low-grade depression, anhedonia, "burnout", fatigue, poor sleep, stress intolerance, low motivation / executive function, loss of positive emotions including the ability to be "attracted" to things or feel affectionate, and low libido.

For years, I thought this was a mental/emotional health issue. But nothing I did seemed to impact it, including less stress and a sabbatical, and I finally started to wonder if it was more physiological than psychological. My symptoms were psychological (ish) but I started to wonder if there were underlying biological causes that amounted to more than "not handling life well, not trying hard enough, etc."

I eventually ran into a functional medicine practitioner who, for the first time ever, described a process that can happen in our bodies that fit my symptoms to a T. I don't have a good summary of it to post but, essentially, inflammation can cause the brain to become chronically fatigued (in the sense of not having the energy it needs), which can lead to hormone problems, which then recursively cause additional brain health issues. I'm doing a poor job describing it but, when it's described to me, it fit what I experienced almost exactly.

FWIW, it was incredibly liberating when I finally had a reason to think maybe this whole thing was something happening to me instead of being caused by me. A hormone specialist described it as: complex hormonal dysfunction secondary to chronic stress and inflammation.

A functional medicine workup found a mix of hormone-utilization issues, thyroid conversion issues, low-ish usable testosterone despite decent total testosterone, low iron availability despite elevated ferritin, and some inflammation markers. I also have a couple genetic variants that may matter in this context: MTHFR and APOE 3/4.

Mold/mycotoxin exposure is another possible contributor in my case. I’m not convinced it’s “the answer,” but testing suggested past exposure and possible ochratoxin involvement, so it’s now part of the differential rather than something I’d dismiss.

Some non-standard labs that they have started looking at in my case: free+total T, SHBG, estradiol, pregnenolone/DHEA-S, free T3/free T4/reverse T3, iron/TIBC/ferritin/transferrin saturation, B12/folate/homocysteine, inflammatory markers, and mold/home-environment testing if the history fits.

At a recent visit with my provider, she mentioned that just the low free T, thyroid, and iron would be enough to knock someone down and feel terrible. And I have other things going on besides that.

I work with Ashley Giles from Origin Medical in Georgetown, Indiana (USA). I believe she can work with people who aren't local. What I appreciate most about Ashley is that she's willing to look at the whole pattern — endocrine, nutrition, inflammation, sleep, stress physiology, and environment together. And she really knows her stuff.

I'm about 10 months into treatment and expect this to be a 2-3 year process to get back to normal. I'm better than I was...I'm at least mostly functional now on a day to day basis. But a lot of my symptoms are still present in one degree or another. So, no magic bullets here.

If anyone wants to discuss: randy@syrings.us

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