u/Specialist_Bar_2589

*This is NOT a medical question, I am just asking where I can find the right professional. Although a very brief overview of symptoms will be provided as context. I have also posted it in the subreddit, since the NHS has told me to investigate it on my own.

I have some pretty weird cognitive symptoms like having a constant, and very stable "blank mind". General Apathy and Anhedonia, and a lack of any sort of ego or drive, low libido, among many other things.

My GP basically insinuated that after getting blood tests, that I should pursue psychiatry privately if I am able to. Since consultants seem to cost around ~£300, I agreed that It would probably be best considering wait times in my area. I asked if I would need an "open referral" or anything, and he said no. I thought it would be simple enough to find the right psychiatrist, but I was wrong.

The crux of the issue is that it doesn't really fit into any one diagnosis in the slightest, and I am struggling to find a consultant that can deal with something like that. I still am not entirely sure that another medical causes can be crossed off.

Thanks for any help!

18M. In the UK. Have a weird set of cognitive symptoms and I am wondering what sort of specialist I need to see.

Will keep the list of symptoms brief:

• The main problem is that it is extremely hard to initiate and develop any thought. It is not like traditional "brain fog" since it is not at all fatigue related, more just an absent ability to think in my own head - if I try, it will just blank or will go around in loops. But the default state of my mind is just nothingness. It is also not like traditional brain fog in the sense that I do not forget words mid sentence.
• Weirdly I can "think" out loud but only in conversation. Don't stumble over words
• I do not feel "fatigued"
• Very stable over time, does not ever seem to get better or worse
• Has been a thing for at least 4 years, perhaps 7+
• Low(ish) mood and low energy, little drive or ambition
• Very low libido and attraction
• Basic blood tests done and lifestyle factors like exercise and food addressed

My Question

Are these symptoms addressable by "biohacking":

18M. I have had pretty unusual cognitive symptoms that have wrecked my life that I am really only starting to try and get to the bottom of. However, I am unsure about whether this is likely to do with the "physical" side of things (like this subreddit addresses), or a psychiatric issue. I have had some basic bloods done so was thinking about going to a psychiatrist next. (Although I have seen a lot of negative things about psychiatry)

Any good advice could genuinely be life changing, so any replies are massively appreciated

Symptoms

• The main problem is that it is extremely hard to initiate and develop any thought. It is not like traditional "brain fog" since it is not at all fatigue related, more just an absent ability to think in my own head - if I try, it will just blank or will go around in loops. But the default state of my mind is just nothingness. It is also not like traditional brain fog in the sense that I do not forget words mid sentence.
• Strangely, the only way I can think at all is in conversation, or when typing like this, although I will never be able to actually "grasp" what I am saying unless I put in strenuous mental effort.
• The reason why I am thinking it is not a "physical" cause is becuase of its relentless stability. It does not ever get noticeably better, and this has been going on for at least 4 years, and could have been going on for more than 7. I feel like if it was a deficiency it would fluctuate at least a little bit?
• I am also pretty much aromantic + asexual (don't feel much attraction at all despite wanting to) although I used to and I still do to a very slight extent. This has been a "problem" for as long as the brain fog, and has gotten "worse"
• Very little ambition or desire for anything
• Rarely have a lot of energy or interest despite being 18 and rarely feel excited about anything
• No fatigue to any significant extent
• (probably unrelated) I am significantly smaller than all of my male relatives - not just short in height but I have small hands and feet too.
• Family thyroid issues although tests have shown this is unlikely to be the issue
• Lift weights for 4 hours a week, and do 10k steps a day - hasn't helped.
• Do not eat much processed food
• I sleep enough, although It does take me a little while to go to sleep and getting slightly too little sleep (like 7 hours) can have large effects on me. Although no signs of a sleep disorder (can't ever sleep during the day)

Bloods

• Serum Testosterone: 17 nmol/L (was thinking about getting a comprehensive panel with SHGB, LH, FSH, allium and prolactin next)
• TSH level: 2.85 mu/L
• Free T4 level: 12.5 pmol/L (was thinking about getting T3 and thyroid antibodies tested next)
• Total 25-hydoxy vitamin D level: 60 nmol/L
• Ferritin level: 40 ug/L (I am aware this is borderline, but I also think it is unlikely to be the sole cause. It is being addressed)
• Folate level: 7.5 ug/L
• Serum Vitamin B12 level: 350 ng/L (Will start supplementing)
• Haemoglobin concentration: 155 g/L
• Mean cell volume: 90 fl
• Red blood cell count: 5.4 1012/L
• Mean cell haemoglobin level: 29 pg

Again if anyone could help me pick the right path it would change my life, so any advice is really appreciated

*In the UK

If the Ferritin level is 40 ug/L

Apparently this is not deficient, but not optimal?

Would it be safe to take 200mg of ferrous sulphate every other day for 2 months?

Thanks for any replies

Brief summary of the problem (necessary context)

I have a weird problem of "brain fog" / cognitive impairment where it is extremely hard to initiate and sustain thought with low mood / drive aswell as low libido, although without the usual symptoms of fatigue etc... I wont go into more detail but the point is its weird and the symptoms don't line up with anything

I have no idea what the cause might be, it could be

• An endocrine issue
• Deficiency
• Neurodevelopmental issues
• Neurological issues / differences
• Something else

My question

Since I don't know what specialist to see, and the GPs I have seen have been extremely unhelpful, what do I do?

A note is that I am willing to pay some money to go externally if I know I am not going to end up in a bout of "specialist ping-pong".

Furthermore, I am covered under an Aviva health insurance plan by a family member. However, "mental health" is not covered so I don't think I can get help there.

I am not sure if this is the right subreddit to post this on, but I am pretty desperate so I will give it a try

Also sorry about the long post, I don't expect many answers. But this is something I really need help with so if you have any knowledge about this or have had similar symptoms, I would really appreciate some guidance of what the cause could be and what to do next. I will try to structure it with subheadings so it is easier to read.

Symptoms

18M. I have had this pretty rare and debilitating problem for many years, where It is extremely hard to think but not like traditional "brain fog". It is hard to initiate thought (even if I am a room doing nothing, I naturally won't think about anything - it will just be nothing) and it is also hard to sustain thought (to keep a though in mind is extremely difficult, my mind will either blank or go in circles). It is not so much that I am too fatigued to think, just that thinking is always extremely hard and fuzzy. It just feels like my mind is not there. In order to have any hope of thinking, I have to shut myself in my room in pitch black and put a fan on to drown out any noises - but even then that doesn't ever really suffice.

In addition, it is extremely hard to "grasp" things. In order to actually comprehend something, I have to expend a huge amount of time and mental energy.

Furthermore, I don't naturally have any retrospective or forward-thinking thought, leading to me becoming extremely confused about life. I am also just generally "confused" about life since it is hard to think through it at all anyway. When I occasionally can reflect on a moment in my life, I feel like I do not comprehend it and it doesn't fit into a wider autobiographical narrative. For years at a time it just feels like I am on autopilot.

I also have very little ambition. I have no wants / desires or goals in life and do not have any sort of ego whatsoever. I also do not often feel excited or happy about anything, although this could of course be a separate issue. Interests also fizzle out very quickly. I am pretty sure I used to be a lot more ambitious, but I am not exactly sure what my mental state used to be like.

I have little to no romantic attraction, and certainly way less than normal but not completely absent sexual attraction. Although again this might just be how I am. Low testosterone is usually the main cause of this, although I have no other symptoms other than a small stature + small hands and feet, and have had free testosterone tested (results below).

However, people often do not believe me when talking about this, since unlike with most people who report having "brain fog", I am relatively eloquent when speaking and do not forget words mid-sentence. Speaking or typing is a lot easier than thinking in my head. Although I still won't properly grasp the things that are being said unless I really think about it. I can also do decently academically when I am in the right headspace.

I also find It quite hard to be situationally aware, thus leading to some near misses while driving. I also can never remember routes when driving or walking unless I really try.

I am very sensitive to sleep. If I have less than 8.5 hours of sleep (even as much 7.5 hours), my confusion gets a lot worse and I become extremely miserable. Although weirdly, I cannot sleep more than 8.5 hours, and I have never been able to take a nap in the day. I also feel slightly tired much of the time, but nothing indicating a sleep disorder.

Pretty poor long term and working memory. Never can remember lyrics to songs even if I try. Can't remember names without drilling it into my head. Often can't reminisce about old times with friends since I cannot remember an awful lot. Although I don't think my poor long term memory is related.

Pretty awkward socially and get anxiety from any speaking Infront of multiple people. Also hate physical contact / affection / being touched. I know this probably isn’t relevant but I think it’s worth mentioning

I never usually feel physically fatigued or mentally fatigued unless tired, its more just an inability to think, and a lack of any sort of desire.

One thing that is probably unrelated but worth mentioning is that I am a lot shorter than all male relatives on both sides of my family, and have small hands and feet.

I alternate between being a completely unaware vegetable with no regard for myself or anything (I will literally have no thoughts of reflection for months on end), and a horrible state of stress and confusion (like now).  I literally cannot think or reflect about anything no matter how bad I want to. It feels like mental constipation.

What I have tried

I lift weights and often do 10k steps a day so I do not think inactivity is a problem. I pretty much always get more than 8 hours of sleep. I limit use of short form content and make sure I do not become overstimulated. I often fight against not being able to think and just brute force thought, which can alleviate the complete blankness to a very marginal extent, but nothing significant. I do not eat a lot of sugar or processed foods either.

 I have been to the doctors a few times, but they have been no help whatsoever

How often the Symptoms are there

It is extremely stable and unwavering - it does not often get any better, and even in the extremely rare case it does, it's not by much at all. Even if I drink a bunch of caffein, it doesn't ever get better. It is permanent and I can’t even remember what it is like to be otherwise

How long this has been a problem for

I have noticed it since I was about 14 years old (although it certainly started long before then - probably around 11 years old). However, I don't think it has been a thing forever since I somehow remember having quick lapses of spontaneous thought when I was a young child.

It must have had a very gradual onset because I can't remember it suddenly getting bad.

Thinks I have thought it could be

Deficiencies - had bloods checked (below). Some like Iron, B12, Vitamin D are sort of low, but not enough to cause this, or at least I don’t think they are.

CFS (Cognitive Fatigue Syndrome) - this is what my doctor thinks it could be, but I don't get PEM (post exertional malaise) to any noticeable extent. I also don't really feel fatigued a lot of the time either.

Inattentive ADHD - I have read about peoples experiences with ADD / Inattentive ADHD and I do not feel my symptoms match. I do not feel the need to fidget all the time, and inability to think doesn't really seem to be that common of a symptom?

Thyroid problems - family history of such. However, the only sign I have is the fact that I am quite small compared to all male family members. I don’t feel cold often, I don't have brittle nails, I don’t have thin hair and I don't feel fatigued often.

Anxiety through developmental years. When I was about 10 through to perhaps 13, I had an extreme bout of anxiety with frequent almost daily panic attacks. Not sure if this is relevant but some part of me thinks that that could have screwed me up. Since if my brain learnt that thinking = panic attacks, it may have just decided to stop thinking. This probably was around the point this started too, but I can't remember.

Bloods

*have had more tests, and they also came back "satisfactory", but here are the main ones:

Serum Testosterone: 17 nmol/L

TSH level: 2.85 mu/L

Free T4 level: 12.5 pmol/L

 

Total 25-hydoxy vitamin D level: 60 nmol/L

"performed by immunoassay which detects 100% Vit D3 and 82% of Vit D2"

 

Ferritin level: 40 ug/L

Folate level: 7.5 ug/L

Serum Vitamin B12 level: 350 ng/L

 

Haemoglobin concentration: 155 g/L

Mean cell volume: 90 fl

Red blood cell count: 5.5 1012/L

Mean cell haemoglobin level: 30 pg

 

What should I do next?

Obviously if someone has any idea what this could be, that would be extremely helpful.

In the UK. Willing to do private tests since this is such a significant problem. Was thinking about first maybe getting more bloods done and seeing a neurologist to rule out physical causes. And then after I was thinking about seeing a psychiatrist? I think that it that is the right profession for this case?

Does anyone else have any ideas about how to cope in the meantime?

Thanks for reading and thanks for any advice anyone has.

Sorry about my long post, I don't expect many answers. But this is something I really need help with so if you have any knowledge about this or have had similar symptoms, I would really appreciate some guidance of what the cause could be and what to do next. I will try to structure it with subheadings so it is easier to read.

Symptoms

18M. I have had this pretty rare and debilitating problem for many years, where It is extremely hard to think but not like traditional "brain fog". It is hard to initiate thought (even if I am a room doing nothing, I naturally won't think about anything - it will just be nothing) and it is also hard to sustain thought (to keep a though in mind is extremely difficult, my mind will either blank or go in circles). It is not so much that I am too fatigued to think, just that thinking is always extremely hard and fuzzy. It just feels like my mind is not there. In order to have any hope of thinking, I have to shut myself in my room in pitch black and put a fan on to drown out any noises - but even then that doesn't ever really suffice.

In addition, it is extremely hard to "grasp" things. In order to actually comprehend something, I have to expend a huge amount of time and mental energy.

Furthermore, I don't naturally have any retrospective or forward-thinking thought, leading to me becoming extremely confused about life. I am also just generally "confused" about life since it is hard to think through it at all anyway. When I occasionally can reflect on a moment in my life, I feel like I do not comprehend it and it doesn't fit into a wider autobiographical narrative. For years at a time it just feels like I am on autopilot.

I also have very little ambition. I have no wants / desires or goals in life and do not have any sort of ego whatsoever. I also do not often feel excited or happy about anything, although this could of course be a separate issue. Interests also fizzle out very quickly. I am pretty sure I used to be a lot more ambitious, but I am not exactly sure what my mental state used to be like.

I have little to no romantic attraction, and certainly way less than normal but not completely absent sexual attraction. Although again this might just be how I am. Low testosterone is usually the main cause of this, although I have no other symptoms other than a small stature + small hands and feet, and have had free testosterone tested (results below).

However, people often do not believe me when talking about this, since unlike with most people who report having "brain fog", I am relatively eloquent when speaking and do not forget words mid-sentence. Speaking or typing is a lot easier than thinking in my head. Although I still won't properly grasp the things that are being said unless I really think about it. I can also do decently academically when I am in the right headspace.

I also find It quite hard to be situationally aware, thus leading to some near misses while driving. I also can never remember routes when driving or walking unless I really try.

I am very sensitive to sleep. If I have less than 8.5 hours of sleep (even as much 7.5 hours), my confusion gets a lot worse and I become extremely miserable. Although weirdly, I cannot sleep more than 8.5 hours, and I have never been able to take a nap in the day. I also feel slightly tired much of the time, but nothing indicating a sleep disorder.

Pretty poor long term and working memory. Never can remember lyrics to songs even if I try. Can't remember names without drilling it into my head. Often can't reminisce about old times with friends since I cannot remember an awful lot. Although I don't think my poor long term memory is related.

Pretty awkward socially and get anxiety from any speaking Infront of multiple people. Also hate physical contact / affection / being touched. I know this probably isn’t relevant but I think it’s worth mentioning

I never usually feel physically fatigued or mentally fatigued unless tired, its more just an inability to think, and a lack of any sort of desire.

One thing that is probably unrelated but worth mentioning is that I am a lot shorter than all male relatives on both sides of my family, and have small hands and feet.

I alternate between being a completely unaware vegetable with no regard for myself or anything (I will literally have no thoughts of reflection for months on end), and a horrible state of stress and confusion (like now).  I literally cannot think or reflect about anything no matter how bad I want to. It feels like mental constipation.

What I have tried

I lift weights and often do 10k steps a day so I do not think inactivity is a problem. I pretty much always get more than 8 hours of sleep. I limit use of short form content and make sure I do not become overstimulated. I often fight against not being able to think and just brute force thought, which can alleviate the complete blankness to a very marginal extent, but nothing significant. I do not eat a lot of sugar or processed foods either.

 I have been to the doctors a few times, but they have been no help whatsoever

How often the Symptoms are there

It is extremely stable and unwavering - it does not often get any better, and even in the extremely rare case it does, it's not by much at all. Even if I drink a bunch of caffein, it doesn't ever get better. It is permanent and I can’t even remember what it is like to be otherwise

 

How long this has been a problem for

I have noticed it since I was about 14 years old (although it certainly started long before then - probably around 11 years old). However, I don't think it has been a thing forever since I somehow remember having quick lapses of spontaneous thought when I was a young child.

It must have had a very gradual onset because I can't remember it suddenly getting bad.

Thinks I have thought it could be

Deficiencies - had bloods checked (below). Some like Iron, B12, Vitamin D are sort of low, but not enough to cause this, or at least I don’t think they are.

CFS (Cognitive Fatigue Syndrome) - this is what my doctor thinks it could be, but I don't get PEM (post exertional malaise) to any noticeable extent. I also don't really feel fatigued a lot of the time either.

Inattentive ADHD - I have read about peoples experiences with ADD / Inattentive ADHD and I do not feel my symptoms match. I do not feel the need to fidget all the time, and inability to think doesn't really seem to be that common of a symptom?

Thyroid problems - family history of such. However, the only sign I have is the fact that I am quite small compared to all male family members. I don’t feel cold often, I don't have brittle nails, I don’t have thin hair and I don't feel fatigued often.

Anxiety through developmental years. When I was about 10 through to perhaps 13, I had an extreme bout of anxiety with frequent almost daily panic attacks. Not sure if this is relevant but some part of me thinks that that could have screwed me up. Since if my brain learnt that thinking = panic attacks, it may have just decided to stop thinking. This probably was around the point this started too, but I can't remember.

Bloods

*have had more tests, and they also came back "satisfactory", but here are the main ones:

Serum Testosterone: 17 nmol/L

TSH level: 2.85 mu/L

Free T4 level: 12.5 pmol/L

 

Total 25-hydoxy vitamin D level: 60 nmol/L

"performed by immunoassay which detects 100% Vit D3 and 82% of Vit D2"

 

Ferritin level: 40 ug/L

Folate level: 7.5 ug/L

Serum Vitamin B12 level: 350 ng/L

 

Haemoglobin concentration: 155 g/L

Mean cell volume: 90 fl

Red blood cell count: 5.5 1012/L

Mean cell haemoglobin level: 30 pg

 

What should I do next?

Obviously if someone has any idea what this could be, that would be extremely helpful.

In the UK. Willing to do private tests since this is such a significant problem. Was thinking about first maybe getting more bloods done and seeing a neurologist to rule out physical causes. And then after I was thinking about seeing a psychiatrist? I think that it that is the right profession for this case?

Does anyone else have any ideas about how to cope in the meantime?

Thanks for reading and thanks for any advice anyone has.