Feeling very weak and tiredness

[emma5410]

I am almost six months post op and lately I have started to feel very weak and tired. This is not like the initial post op tiredness. I had that and it passed and I have been back at work full time for over three months.

I have had a full blood test and everything is fine apart from high cholestorol. But even that is an improvement on the last test. My GP says that if it is not physical then it must be psychological. Some kind of reaction to the surgery.
I wonder if he is not projecting is own feelings about the surgery as I have nothing but positive feelings about it. I have been lucky and had no complications or infections. The dilation is going well and I have not lost any depth.

Has anyone else experienced this? Any idea what it might be?  It is affecting my job as some days I have to leave early because I feel so tired and unwell.

[suzifrommd]

My GP says that if it is not physical then it must be psychological.

IMO, this is an irresponsible diagnosis.

There are any number of conditions that can cause the sort of fatigue you're talking about. I would have a lot of concerns about a doctor who declares that something is has a psychiatric cause simply because he hasn't found a physical cause.

I didn't have anything like this (I did have a bout of depression around that time, but it didn't manifest itself that way).

[Rejennyrated]

Well I'm not yet a qualfied doctor, but from my studies so far I would say the full workup for that would FBC (Full blood count), U&E (Urea & Electrolytes), LFT (Liver function test), KFT (Kidney Function Test), TFT (Thyroid Function test), HbA1c, CRP, ESR and monospot.

For good measure one might possibly add an ECG to rule out cardio, and maybe if neuro causes were suspected, a Lumbar Puncture and an evoked potential test, to rule something like MS.

If all of those were done and showed up nothing its unlikely (although not imposible) that the cause is physiological as one or more of those markers would likely be off if there was something seriously out of whack... which leaves us with the imponderables, as we might say a "functional disorder" - which is a polite way of saying we don't really know.

As you probably know there are things like post viral fatigue and chronic fatigue syndrome, which we know are VERY real conditions, but which embarrassingly do not yet have known aetiology.

[AnonyMs]

Just a guess, but it could be low testosterone.

[Rejennyrated]

Just a guess, but it could be low testosterone.

Actually thats not a bad thought - if your adrenal androgen output was too low...

Yeah could well be worth titrating all your steroid hormone levels too.

[Laura_7]

You could have a look here:
https://www.susans.org/forums/index.php/topic,190296.msg1695059.html#msg1695059

I personally would try to eat fruit and a few smoothies regularly... a few minutes exercise every day...

and concerning a psychological influence...
some peole might unconsciously pick up some remarks during surgery for example...

so it might be an idea to concentrate daily for a few minutes on the joy of the result...


hugs

[emma5410]

Thanks for the replies.  My testosterone is well within the female range and the same as it was before the op. Obviously I am not taking an anti-androgen.  It was a very comprehensive blood test. It is good news that the results all came back normal but I am feeling a bit lost with it. It seems to be getting worse and there is no solution.

[Laura_7]

Thanks for the replies.  My testosterone is well within the female range and the same as it was before the op. Obviously I am not taking an anti-androgen.  It was a very comprehensive blood test. It is good news that the results all came back normal but I am feeling a bit lost with it. It seems to be getting worse and there is no solution.

Is your nutrition healthy ?

Do you have some regular exercises, like taking a walk...

Did you have a change in meds ?

[AnonyMs]

Its difficult when everything comes back as normal and yet you know you have a problem. I've had that before and it took a couple of years and a number of specialists before I found out what it was. I kept at it though. And at the end of it all it seems quite obvious what it was, which I really don't understand.

I'd suggest seeing some other doctors. One them may be able to work out what it is. I see an endocrinologist who specializes in trans medicine and he's got a huge amount of experience. I'd be a lot more confident seeing him than any GP I could imagine.

[OCAnne]

Hello everyone, you can add me to the list of those feeling a little out of it post, post SRS.  In week 8 my eyes started getting tired, sunk in and skin lost its glow.  My cheeks also deflated.  Weight remained the same but low energy.  I would describe it as something is not right.  I recently cut out progesterone and today stopped taking Sprio (much reduced) from pre-op.  Trying to drink much more water.  Recent blood test/CBC work, for July 29th rhinoplasty indicated all was well.
Gee could I really be way too low in T?
Thank you,
Anne

AnonyMs: Help a girl out, what was causing your tiredness?

[Laura_7]

Gee could I really be way too low in T?

You could ask your endo to get you some t gel for some time... you could try a bit different dosage and how it makes you feel...

and estro should be high enough imo... not necessarily only at menopausal levels...

and bioidentical progesterone might help... it might even out some side effects of estrogen and help with mood...

[Jenna Marie]

I was impressively fatigued after GRS, but it steadily if slowly improved; I'd be quite concerned about a recovery in which the fatigue had mostly faded away and then *returned.* That doesn't sound like it's necessarily surgery-related at all, and I agree with Suzy that it's highly irresponsible for a doctor to assume that a) it's due to GRS and b) it's psychological. You may need to keep looking until you find someone willing to work with you instead of dismissing it out of hand.

[Lady Smith]

My CFS/ME started in the aftermath of my orchi surgery, but then I was physically run down before surgery and I came down with the worst case of the 'flu after surgery.  I'd had a rough time too with getting over whatever it was the anesthetist had used to knock me out.
CFS/ME usually occurs after a viral infection when your system is at a low ebb and is difficult to diagnose because there is no definitive test for it.  I was fortunate that my GP at the time knew about CFS/ME and I was not the first patient he'd ever seen who had the illness. Even now some GPs still don't think CFS/ME is a real illness so I was lucky to have such an excellent doctor who knew what he was doing.

[AnonyMs]

AnonyMs: Help a girl out, what was causing your tiredness?

My problem wasn't tiredness; it was completely unrelated so I didn't mention what it was, only that the process of diagnosing problems can be very difficult. I'm also avoiding putting some personal details on this site so anyone who knows me won't be able to identify me. In the end I only found out what it was because I took the effort to keep trying. The individual doctors did their bit, but gave up when they couldn't find what was wrong.

I've read about low testosterone post-op a few times before, but I don't recall where.

I had testosterone below female range (due to spiro) and my endo told me that the test is not accurate at low levels. I'm not tired so I didn't worry about it. I wonder if its possible for the test to incorrectly show normal range when its actually too low?

If it were me I'd try extra T, because why not? You might get lucky and find it fixes things.

I asked my endo about high testosterone post-op (I always take the opportunity to ask stuff). A minority of people need to take an anti-androgen post op, and he prescribes a low level of spiro for about a year until the body adjusts. The standard blood test he does only measures one form of testosterone, and it's possible to have high T post op while the blood test to show its extremely low.

[Serenation]

Hello everyone, you can add me to the list of those feeling a little out of it post, post SRS.  In week 8 my eyes started getting tired, sunk in and skin lost its glow.  My cheeks also deflated.  Weight remained the same but low energy.  I would describe it as something is not right.  I recently cut out progesterone and today stopped taking Sprio (much reduced) from pre-op.  Trying to drink much more water.  Recent blood test/CBC work, for July 29th rhinoplasty indicated all was well.
Gee could I really be way too low in T?
Thank you,
Anne

AnonyMs: Help a girl out, what was causing your tiredness?

how come you take T blockers post-op?

[genderirrelevant]

If you spend much time outdoors you might want to get checked for Lyme disease. It's notoriously difficult to diagnose.

[OCAnne]

how come you take T blockers post-op?

I felt the T coming back.  Hair and skin a little oily.  Since starting on HRT I unfortunately appear to have acquired a nose for the smell of DHT.  Or as I call it 'the dirty hair smell'.  Usually its others around me. But when my T is not suppressed I smell it on my own hair.

Went to bed early full of food and water.  Feeling fat but better this morning, skin looks nicer.  Could be a T or hydration issue.
Thank you,
Anne

[Laura_7]

I felt the T coming back.  Hair and skin a little oily.  Since getting on HRT I unfortunately appear to have a nose for the smell of DHT.  Or as I call it 'the dirty hair smell'.  Usually its others around me. But when my T is not suppressed I smell it on my own hair.

Went to bed early full of food and water.  Feeling fat but better this morning, skin looks nicer.  Could be a T or hydration issue.
Thank you,
Anne

Well it might be possible to use a bit higher estro levels to drive t down... there is a well known effect doing this.
It can be safely done in a bit higher doses only internally, with implants or injections.
Its possible there are not high e doses needed if only small or medium amounts of t are produced by some glands.

Bioidentical progesterone might compliment this, with some antiandrogen effects, and it might even out some side effects of e.

[OCAnne]

Well it might be possible to use a bit higher estro levels to drive t down... there is a well known effect doing this.
It can be safely done in a bit higher doses only internally, with implants or injections.
Its possible there are not high e doses needed if only small or medium amounts of t are produced by some glands.

Bioidentical progesterone might compliment this, with some antiandrogen effects, and it might even out some side effects of e.

I cut out progestrone prior to SRS and again just recently because it appears to have a androgen effect on me.

I found E to be a happy energy up pill prior to SRS.  I could stay up late and get up very early with a smile on my face.  Perhaps my E is now too low.  Last test showed E to be in the 300's.  Anything wrong with going for 1000 post-op?

I recently underwent rhinoplasty.  General anesthesia was once again used.  Does it take a while to get over the impact of the anesthesia?

Thank you,
Anne

[Laura_7]

I cut out progestrone prior to SRS and again just recently because it appears to have a androgen effect on me.

was it bioidentical progesterone or synthetic ?
Bioidentical should come as capsules, gel or as implants, synthetic in pills.

I found E to be a happy energy up pill prior to SRS.  I could stay up late and get up very early with a smile on my face.  Perhaps my E is now too low.  Last test showed E to be in the 300's.  Anything wrong with going for 1000 post-op?

Well many endos go primarily not only for levels but how people feel.
You might tell them.

I recently underwent rhinoplasty.  General anesthesia was once again used.  Does it take a while to get over the impact of the anesthesia?

Yes. It might take a while. A good nutrition might help, flushing out and healing.

With any op, post op depression might be a point.