Why am I not losing weight in spite of exercise and diet?

Hello,

Welcome to icliniq.com. Firstly, I want to assure you to take a deep breath and remain calm. To better understand your situation, could you please provide some important details? Have you been diagnosed with PCOS (polycystic ovarian syndrome), as it could be a factor contributing to hormonal imbalances? Additionally, what is your TSH level, and do you experience constipation, cold intolerance, or any hair and nail issues? Have you been screened for hypertension and diabetes? If your BMI is not accurately 32.6, kindly provide your height and weight. Has the weight gain been recent, and did it coincide with starting the gym, supplements, or hormones? Could you describe your gym routine, including the number of days you go and the duration of each session? Furthermore, it would be helpful to get an outline of your meals, including breakfast, lunch, and dinner, as well as whether you consume snacks and what they typically consist of. Lastly, an estimation of your daily calorie intake in 24 hours would be beneficial for further assessment. Thank you for providing this information; it will assist in better understanding your situation and finding appropriate solutions.

Hello,

Welcome back to icliniq.com. Thank you for providing me with information, here is what I am thinking. We have to rule out medical causes of hirsutism (increased facial and chin hairs), that is our lead. Usually, we classify by the presence or absence of menstrual irregularities. I am not sure how your cycles are since you have started taking the hormones. Based on the marginally elevated serum total testosterone, along with other potential features such as obesity, difficulty in losing weight, and hirsutism, PCOS could be a possible diagnosis. To confirm this, an ultrasound of the ovaries would be helpful. However, other conditions like Cushing's syndrome, hyperprolactinemia, congenital adrenal hyperplasia, and 21-OH deficiency should also be ruled out before proceeding further. Additional blood work is needed, including early morning serum free testosterone, prolactin level, cortisol level, DHEA-S (dehydroepiandrosterone), and 17-hydroxyprogesterone levels. Keep in mind that gaining muscle mass can contribute to weight, and checking body fat may reveal a positive change. The need for T3 supplements and progesterone supplementation should be re-evaluated. Progesterone levels can fluctuate during the menstrual cycle, so timing matters for accurate assessment. Feel free to share any concerns, as this is not the final diagnosis, and I want you to understand the potential causes of hirsutism and weight gain and the appropriate steps to be taken. If you have the mentioned blood work and ultrasound or CAT scan results, please provide them for further evaluation.

Hello,

Welcome back to icliniq.com. Yes, she should know to order these investigations. I would also suggest getting FSH (follicle stimulating hormone), LH (luteinizing hormone), estrogen and progesterone levels. Are you still taking estrogen or progesterone supplements?

Hello,

Welcome back to icliniq.com. The dizziness you are experiencing could have several underlying causes, including orthostasis, which refers to your body's inability to quickly adapt to changes in position, leading to dizziness when changing posture abruptly. It's essential to understand if you feel dizzy only when you change positions or if it persists even when lying down. Additionally, observe if you experience dizziness during workouts and whether it occurs before or after exercising. Regarding the fat on your belly, it could indeed be related to the endocrinological disorders mentioned earlier, such as Cushing's syndrome and PCOS. To gain a more comprehensive understanding, it is necessary to consider other symptoms such as abdominal pain, nausea, vomiting, or diarrhea. Evaluating all these factors will aid in the proper diagnosis and management of your condition.

Hi,

Welcome back to icliniq.com. Considering the symptoms and the situation, PCOS does seem to be a likely possibility. Diarrhea can indeed cause dizziness, especially if multiple episodes occur in a day. It would be beneficial to note if there is any association between the diarrhea and specific foods or milk consumption. Adequate hydration is crucial, so please share how much water you typically drink in 24 hours. Additionally, it is essential to know if you use any weight loss or protein supplements as part of your routine. Gaining a comprehensive understanding of these factors will assist in determining the appropriate course of action and management for your condition.

Hello,

Welcome to icliniq.com. Thank you for providing further information. With the new details of excessive urination, difficulty tolerating dairy, and a negative ultrasound for cysts, it indeed suggests a potential change in the diagnosis. Have you ever tried a gluten-free diet, and if so, were you able to tolerate it well? Additionally, do you notice that your urine color appears very white or transparent rather than having a normal lime color? Regarding PCOS, I initially considered it due to your mentioned symptoms like facial and chin hairs, central obesity, elevated testosterone, and progesterone deficiency. To confirm the diagnosis, a pelvic ultrasound is typically conducted to check for the classic "pearl in string" appearance associated with PCOS. I would like to know when you had the ultrasound, and were the testosterone and progesterone levels obtained at the same time as the other tests? If PCOS is confirmed, the treatment approach is usually straightforward. For female patients seeking pregnancy, Metformin may be tried, while hormone replacement is an option for those who do not wish to conceive. Accurate diagnosis and proper treatment are crucial, and I'll be here to assist you throughout the process.