you are a functional nutritionist. get to know tyler and tell me if everything suggested here is strongly research based and effective- anything that you would change? what would you modify/improve/add or remove from the existing treatment plan? # Tyler Wambeke — Case History **Demographics:** Male, DOB 08/05/1995 (age 30), Grayslake, IL, USA. Height 6'1", weight 175 lbs, BMI 23. **Presenting concern:** Primary infertility, trying to conceive for 8 months (as of intake). Semen analysis and diagnostic imaging already performed (results not detailed in intake). Suspected contributing factors per patient: smaller-side undescended testicle (surgically corrected) and significant stress/anxiety. Family history of infertility present. No fertility specialist consulted yet; no fertility treatments or hormone replacement therapy to date. **Birth/early history:** Born via C-section, two months premature. Mother had at least one ectopic pregnancy; family history of fertility issues but mother otherwise healthy prior to conception. Walking delayed slightly (attributed to head size). Breastfed; vaccinated on schedule; not colicky; no childhood hospitalizations. **Surgical history:** Corrected undescended testicle at approximately age 8 (2003); affected testicle remains smaller. Previously treated by a cardiologist (no longer following). **Allergy/immune:** Seasonal allergies (grass, mold, pollen, ragweed) and allergic rhinitis. Food sensitivities to raw almonds, walnuts, apple skin, and parsley. Intolerant to certain smells. History of COVID-19 (not hospitalized). Skin rashes and dandruff present. **GI:** No significant bloating, ulcers, constipation, diarrhea, or flatulence reported. Unformed stools noted as the one positive GI symptom. Low fecal elastase identified on functional workup (mild pancreatic enzyme insufficiency), addressed via bitters and digestive enzyme protocol. **Mental health/psychosocial:** Anxiety (self-reported, health-anxiety scored 8/10). Grief from a stillborn son in 2024 (rated 4/10 at most recent intake, previously higher). Work-related stress 5/10, family stress 4/10; financial, educational, relationship stress low. No history of physical, sexual, or emotional abuse. **Cardiovascular:** Heart palpitations reported "most of the time." No shortness of breath. Previously on a beta blocker for 4 months in 2020. **Sleep:** Averages 8.5 hours/night; wakes with good energy; no difficulty falling asleep; some night sweating reported. **Lifestyle:** Non-smoker, does not drink alcohol, no substance use. Exercise: kettlebells 4x/week, rowing 2–3x/week, daily light walking, ~45 min/session. **Medication history:** Allergy shots (2010–2013), Accutane (4 months, 2013), beta blocker (4 months, 2020), antibiotic course (1 week, 2022). **Family history:** Infertility and cancer present in family history. 10 maternal siblings. --- ## Functional Lab Trend Summary (Two Most Recent Panels) | Marker | Previous | Current (05/2026) | Trend | Functional Significance | |---|---|---|---|---| | Cortisol AM | 4.08 ng/ml | 6.42 ng/ml | ↑ Worsening | HPA axis hyperactivation | | Cortisol Noon | 1.37 ng/mL | 1.50 ng/mL | ↑ Worsening | Sustained axis dysregulation | | Cortisol Night | — | <0.2 ng/ml | Blunted nadir | Impaired diurnal rhythm | | LDL Cholesterol | 201 mg/dl | 242 mg/dl | ↑ Worsening | Possible saturated-fat hyper-response + cortisol-driven synthesis | | Total Cholesterol | — | 326 mg/dl | High | Above lab and functional range | | HDL Cholesterol | 63 mg/dl | 70 mg/dl | ↑ Improving | — | | Chol:HDL Ratio | 4.3 | 5.0 | ↑ Worsening | At lab cutoff | | hs-CRP | 2.9 mg/L | 1.3 mg/L | ↓ Improving | Inflammation reducing | | Homocysteine | 13.9 umol/L | 10.7 umol/L | ↓ Improving | Still functionally elevated | | ESR | 18 mm/hr | 22 mm/hr | ↑ Worsening | Low-grade systemic inflammation | | Ferritin | — | 483 ng/ml | High | Likely inflammatory, not hemochromatosis (normal TIBC) | | Vitamin B12 | — | 1689 pg/ml | Supra-physiologic | Driven by methylated B complex; now stopped | | Vitamin D (25-OH) | — | 52 ng/ml | Below functional optimal | Target 60–80 ng/ml | | Reverse T3 | — | 24.8 ng/dL | At functional ceiling | Cortisol-driven deiodinase shunting, not primary thyroid disease | | TSH / Free T3 / Free T4 | — | Normal | Stable | Thyroid gland itself unaffected | | Fasting Glucose | — | 92 mg/dl | Mildly elevated | Functional target 75–86 | | ALT | — | 38 U/L | Upper-normal | Mild hepatic stress | **Clinical synthesis:** The dominant pattern is a worsening hypothalamic-pituitary-adrenal (HPA) axis dysregulation (rising AM/noon cortisol with a blunted nighttime nadir), occurring against a backdrop of unresolved grief (stillbirth, 2024) and elevated health anxiety. This cortisol pattern is interpreted as the likely upstream driver of several other abnormal markers: rising LDL (via impaired thyroid-hormone-mediated LDL receptor expression and hepatic cholesterol synthesis), elevated ferritin and ESR (inflammatory, not classic iron-overload), and Reverse T3 at ceiling (cortisol inhibits peripheral T4-to-T3 conversion, shunting to inactive rT3). Markers that responded favorably to Phase 1–2 interventions (hs-CRP, homocysteine, HDL) confirm partial treatment efficacy, while cortisol and lipids require intensified, more targeted intervention. --- # Most Recent Treatment Protocol Summary (Phase 3, 12 Weeks) **Primary goals:** Regulate the HPA axis; reduce LDL; reduce ferritin; correct supra-physiologic B12; optimize Vitamin D; lower Reverse T3; continue improving sperm parameters; further lower homocysteine. **Supplement changes:** - Stopped: Methylated B complex (B12 excessively high) - Increased: Vitamin D3+K2 (10→15 drops), Magnesium glycinate (240→400mg) - Added: Ashwagandha KSM-66 (300mg BID), Phosphatidylserine (400mg at dinner), Berberine (500mg BID), Rhodiola Rosea (200mg AM), Milk Thistle (150mg BID), Glycine (3g at bedtime), Zinc picolinate (30mg), L-carnitine (1g), Omega-3 (2g) - Continued unchanged: L-glutamine, digestive enzymes, CoQ10, nattokinase, creatine, collagen, colostrum, ox bile - Reduced frequency: organ meat supplementation (daily → 3–4x/week) **Diet:** Replace tallow/butter cooking fats with EVOO/avocado oil; cap raw milk at 3x/week; remove standalone pre-breakfast honey; add oats, flaxseed, and psyllium husk for LDL reduction; pair red-meat meals with black/green tea to reduce iron absorption; protein-first breakfasts; highest-carbohydrate meal moved to dinner; no caffeine before 10am. **Exercise:** Reduce kettlebell sessions to 3x/week (35–40 min cap); reduce rowing intensity to Zone 2, 20 min; train only between 4–7pm, never before 10am; add weekly restorative yoga/yoga nidra; daily post-dinner walk (20–30 min) retained as non-negotiable. **Lifestyle:** Strong recommendation for somatic therapy or EMDR given unresolved grief; consistent wake time; 60-minute pre-bed screen curfew; morning sunlight exposure; cold shower finish; scrotal cooling practices (loose cotton underwear, no hot baths/saunas); blood donation every 8–12 weeks to reduce ferritin; EFT tapping increased to 15 min/day. **Re-testing schedule:** Salivary cortisol and B12 at 6–8 weeks; lipid panel, ferritin, and Vitamin D at 8–12 weeks; semen analysis and Reverse T3 at 12 weeks.