What could be the causes of weight gain, hair loss, and osteopenia in a 46-year-old woman?

Hello doctor,

I am a 46-year-old female with regular cycles. At the age of 42, I was diagnosed with osteopenia, but doctors have been unable to determine the cause. There is no family history of osteopenia, anorexia, drug use, or autoimmune issues. However, I did experience a car accident that left me disabled, resulting in a stressful five years. Around nine months ago, I started noticing weight gain and hair loss, leading to extensive testing, including bloodwork and urine analysis. My cortisol level is within the range of 4 to 50 mcg/dL, with my measurement at 49.1 mcg/24h. Additionally, my SHBG level is elevated at 138 nmol/L, compared to the normal range of 17 to 124 nmol/L. Unfortunately, the testosterone levels were not provided in the description. After my first spine surgery five years ago, I unexpectedly suffered a fracture in the sacral region while walking. Initially, it was suspected to be a hardware issue, but further scans, such as CT and MRI, revealed the fracture without significant trauma. This prompted ordering a bone density exam, which led to the diagnosis of osteopenia, technically classified as osteoporosis due to the unexplained fracture. Subsequently, I underwent hip surgery four years ago and spinal surgery the year before. Although no medications have been prescribed specifically for osteopenia or osteoporosis, my doctor considers my bone health within normal limits. Currently, my medication includes the following:

1. Ambien for sleep.

2. An allergy medication.

3. Hydrochlorothiazide for edema caused by nerve damage.

4. Adderall for ADHD.

5. I take Adderall once or twice daily at a dosage of 20 mg.

I need your valuable suggestions regarding my health. Please suggest. Thank you.

Hi doctor,

Thank you for the reply.

My GP is well aware of my issues and has referred me to the rheumatologist, hematologist, gastroenterologist, and OBGYN. The OBGYN internal scan showed that my ovaries and estrogen levels are fine. Now, I have been referred to an endocrinologist. Specifically, I was asking about the high cortisol, high SHBG, and low testosterone levels. My testosterone level is under 3 ng/dL. I was seeking an endocrinologist because these three values are the only ones out of range. I want to understand why they are abnormal and what potential effects being out of range for an extended period can have. I have experienced 15 pounds of weight gain in six to seven months, hair falling out in clumps, and thinning fingernails. None of these symptoms are normal, and they all started around the end of last year. I want to know if these values sound normal from an endocrine perspective. Could adrenal fatigue or a pituitary or adrenal tumor be potential causes? A postmenopausal woman should have a minimum testosterone level of 10 ng/dL, ideally ranging from 20 to 40 ng/dL. Mine is under three. Interestingly, my 73-year-old mother has better bone density numbers than I do. I have already seen a gastroenterologist, and there are no signs of celiac disease, internal bleeding, or gastrointestinal issues. I had a colonoscopy two years ago and underwent a pill cam study last month. I spent two years seeing a rheumatologist but have not received a diagnosis of any autoimmune condition.

I have never had children and have never experienced an eating disorder or engaged in drug or alcohol abuse. As I mentioned earlier, I had no health issues prior to the accident. All my other blood work, including liver and kidney function, is perfect. Should I continue with vitamin D and calcium supplements? Both my calcium and vitamin D levels are fine. Last year, I received a Reclast treatment for bone density. I stopped taking birth control pills two years ago. I need suggestions regarding my health issues. Thank you.