What Causes Irritation, Low Sex Drive Along With Foggy Mind?
Hormones
Detailed Answer:
I am sorry to note your challenges in getting to the bottom of your main symptom of low libido.
I see you have healthy habits and body weight.
I have reviewed your attached laboratory results.
1 Your Testosterone, estrogens, DHEAS, Prolactin, vitamin D, A1c, Progesterone, Insulin and IGF1 are all normal.
This is very good news
2 Your elevated cortisol of 33 or so is considered robust. It says on the lab report that this sample was drawn close to 8 am. If this is true, it makes the result meaningful in interpreting.
What this means is that you do not have adrenal insufficiency.
When non-experts see the high cortisol in the morning they get worried when actually this test is not meant to be interpreted for detecting excess. As logical as it may seem to many, a higher than normal cortisol level in the morning still does not imply cortisol excess in the body. It is one of the many complex facts of endocrinology.
To diagnose cortisol excess there are other tests such as Midnight Salivary cortisol levels but these are typically ordered only when the endocrinologist suspects the condition to be present. Simply ordering such tests for detecting excess leads to unnecessary further testing
3 Random low Growth hormone (GH) levels also have little meaning if any. So I tell my adult patients to not be concerned about it. Again, if GH deficiency is suspected, an endocrinologist goes about it in a very systematic fashion that starts with a thorough physical examination and ends with complicated 'Dynamic tests' such as Insulin Tolerance test (to name one example)
4 The FSH and LH are expected to be high because that is how clomiphene acts and raises blood testosterone levels. So that is not abnormal in the context of things either.
5 The only true abnormality I see on this lab is the slightly high TSH with a low normal Free T4. It raises the possibility of an under active thyroid, called 'Subclinical Primary Acquired Hypothyroidism'.
This requires detailed assessment too.
To start with, when I see someone like you in my practice, in addition to a physical examination I tend to order
TPO antibodies
Anti Thyroglobulin antibodies
If either of these are positive then there is a chance that long term permanent under activity of the thyroid may occur. Treatment with medication typically provides benefit.
Another alternative is to recheck TSH and Free T4 in 6 weeks and see if it normalizes spontaneously.
Regardless such a mild abnormality cannot explain such significant libido problems that you are experiencing .