Adrenal Thread

[1cc]

This is pretty good.

http://www.goodhormonehealth.com/adrenal-cecils.pdf

[love_en]

I agree with everything you have said. For the very reasons you pointed out, I am extreemly skeptical of ANYONE with the letters of MD or ND after their name. I have said it many times: those integrated and alternative practitioners have zero credibility with me because they do not get to the point. When I walk into a doctor or practitioner's office, my intelligence will be gravely insulted by being offerred strange diets, unproven supplements, drugs to treat symptoms and lastly, unproven diagnostic procedures. What I do expect, is for a doctor to see that my LH, FSH, testosterone and cortisol are low. I am amazed, that given the number of conventional and alternative doctors I have seen since age 7, all of them missed it. My adrenal issues started way before I became hypogonadal. Your list of symptoms for adrenal fatigue described what I have lived with since age 7. The icing on the cake was not going through the lightning bolt of testosterone that most young men get to experience.

[SPE]

Originally Posted by love_en

I agree with everything you have said. For the very reasons you pointed out, I am extreemly skeptical of ANYONE with the letters of MD or ND after their name. I have said it many times: those integrated and alternative practitioners have zero credibility with me because they do not get to the point. When I walk into a doctor or practitioner's office, my intelligence will be gravely insulted by being offerred strange diets, unproven supplements, drugs to treat symptoms and lastly, unproven diagnostic procedures. What I do expect, is for a doctor to see that my LH, FSH, testosterone and cortisol are low. I am amazed, that given the number of conventional and alternative doctors I have seen since age 7, all of them missed it. My adrenal issues started way before I became hypogonadal. Your list of symptoms for adrenal fatigue described what I have lived with since age 7. The icing on the cake was not going through the lightning bolt of testosterone that most young men get to experience.

Couldn't have said it better.

[love_en]

The only bright spot in this disaster, is that Florinef and prednisolone are not DEA regulated. The worst that can happen to me is to have my medication confiscated by Customs. My enanthate is another story.

[marianco]

Originally Posted by love_en

The only bright spot in this disaster, is that Florinef and prednisolone are not DEA regulated. The worst that can happen to me is to have my medication confiscated by Customs. My enanthate is another story.

What is interesting is that almost everything needed to treat adrenal fatigue can be obtained over-the-counter, even Cortisol (Hydrocortisone) as a 10 mg per gram (approximately a flat 1/4 teaspoon) skin cream (1% cream for use on rashes and hemorrhoids), and progesterone (as a menopausal skin cream).

[marianco]

Originally Posted by magic8989

i still do not feel completely right. I have great erections and morning wood but no real libido. Also i have trouble sleeping, anxiety, lethargy and fatigue more often than i should. This is what my hypothesis is:

Based on what has been posted on progesterone i think my problem is this. My choesterol is sort of low at 170. This would mean the synthesis of it into pregnenolone to progesterone would be reduced along with the conversion into DHT or DHEA. This would explain a possible cortisol problem, my low prolactin, and low estrogen levels on my lab results. Also i noticed my endo has never checked for progesterone or DHT.

Estradiol and Estrone are made from Testosterone by the Aromatase enzyme. Low estrogen levels in the face of normal testosterone levels may mean low aromatase enzyme activity - e.g. from lack of body fat.

Low brain dopamine activity in the pituitary leads to the release of prolactin from the pituitary. There are many causes of low dopamine activity including low testosterone, antipsychotic medications, medications which increase serotonin, Parkinsonism, ADHD caused by dopamine resistance, etc.

The primary rate limiting step in the production of steroid hormones is the first step - the conversion of cholesterol to pregnenolone by the cytochrome P450scc enzyme. Luteinizing Hormone from the Pituitary increases the activity of cytochrome P450scc enzyme. Insulin increases Luteinizing Hormone's effect on increasing the activity of cytochrome P450scc enzyme.

Even when testosterone level is optimized, when adrenal fatigue exists, one does not feel "right". Libido is impaired. Anxiety, irritability, difficulty dealing with stress, feelings of desperation occur. Difficulty in falling asleep and excessive sleepiness occurs. Lethargy occurs.

Signs of adrenal fatigue include: low normal cortisol, low to low-normal DHEA-s, low to low normal progesterone, low sodium or low potassium, low blood pressure, etc.

Progesterone has important actions including: improving concentration, stabilizing mood, reducing depression and anxiety, increasing energy, increasing serotonin, dopamine, norepinephrine activity, improving thyroid hormone activity, acting as a precursor to cortisol and testosterone, increasing potency of estrogen, increasing bone density, improving blood flow, blocking the production of estrogen from testosterone, blocking the production of dihydrotestosterone (DHT) from testosterone, etc. I think it also plays a role in libido.

It is important to not have excessive progesterone. Excessive progesterone can strengthen estrogen's actions to the point of negating the benefits of progesterone.

Estrogen increases serotonin, norepinephrine, and dopamine in the brain by acting as a monoamine oxidase inhibitor. It increases serotonin primarily. Low estrogen and high estrogen both result symptoms including low libido, depressive and anxiety symptoms, insomnia, etc.

Unless cortisol and DHEA-s are checked with saliva tests, progesterone level is an important clue to the presence of adrenal fatigue. I would check for it.

In regard to libido, mood and wellness problems, adrenal fatigue is a very common cause. Just today, every patient I saw had adrenal fatigue as a primary contributing factor for anxiety, depression, alcoholism, lethargy, obesity, loss of libido, concentration problems, irritability, insomnia, and even a miscarriage.

[love_en]

Originally Posted by marianco

What is interesting is that almost everything needed to treat adrenal fatigue can be obtained over-the-counter, even Cortisol (Hydrocortisone) as a 10 mg per gram (approximately a flat 1/4 teaspoon) skin cream (1% cream for use on rashes and hemorrhoids), and progesterone (as a menopausal skin cream).

I have read that putting corticosteroids on the skin is not good. Something about it deteriorating the skin. I have tried the 1% hydrocortisone creams. I don't think I am absorbing enough for it to work. Then again, if this were a good method, we would be seeing the equivalent to Androgel to treat Addison's.

[Vforcer2]

Originally Posted by marianco

Estradiol and Estrone are made from Testosterone by the Aromatase enzyme. Low estrogen levels in the face of normal testosterone levels may mean low aromatase enzyme activity - e.g. from lack of body fat.

Low brain dopamine activity in the pituitary leads to the release of prolactin from the pituitary. There are many causes of low dopamine activity including low testosterone, antipsychotic medications, medications which increase serotonin, Parkinsonism, ADHD caused by dopamine resistance, etc.

The primary rate limiting step in the production of steroid hormones is the first step - the conversion of cholesterol to pregnenolone by the cytochrome P450scc enzyme. Luteinizing Hormone from the Pituitary increases the activity of cytochrome P450scc enzyme. Insulin increases Luteinizing Hormone's effect on increasing the activity of cytochrome P450scc enzyme.

Even when testosterone level is optimized, when adrenal fatigue exists, one does not feel "right". Libido is impaired. Anxiety, irritability, difficulty dealing with stress, feelings of desperation occur. Difficulty in falling asleep and excessive sleepiness occurs. Lethargy occurs.

Signs of adrenal fatigue include: low normal cortisol, low to low-normal DHEA-s, low to low normal progesterone, low sodium or low potassium, low blood pressure, etc.

Progesterone has important actions including: improving concentration, stabilizing mood, reducing depression and anxiety, increasing energy, increasing serotonin, dopamine, norepinephrine activity, improving thyroid hormone activity, acting as a precursor to cortisol and testosterone, increasing potency of estrogen, increasing bone density, improving blood flow, blocking the production of estrogen from testosterone, blocking the production of dihydrotestosterone (DHT) from testosterone, etc. I think it also plays a role in libido.

It is important to not have excessive progesterone. Excessive progesterone can strengthen estrogen's actions to the point of negating the benefits of progesterone.

Estrogen increases serotonin, norepinephrine, and dopamine in the brain by acting as a monoamine oxidase inhibitor. It increases serotonin primarily. Low estrogen and high estrogen both result symptoms including low libido, depressive and anxiety symptoms, insomnia, etc.

Unless cortisol and DHEA-s are checked with saliva tests, progesterone level is an important clue to the presence of adrenal fatigue. I would check for it.

In regard to libido, mood and wellness problems, adrenal fatigue is a very common cause. Just today, every patient I saw had adrenal fatigue as a primary contributing factor for anxiety, depression, alcoholism, lethargy, obesity, loss of libido, concentration problems, irritability, insomnia, and even a miscarriage.

Marianco, I am curious how much progesterone cream that you prescribe your adrenal fatigue patients that have low progesterone, and what you actually consider low, and what you actually consider to be a good level for 40 year old man. Last I checked my progesterone was 0.6 (0.3-1.2 range). My DHEA is around the top of the range since starting supplementation, and I also take 2-3 Adrenal Extract capsules per day.

[Legenden1999]

Originally Posted by marianco

Signs of adrenal fatigue include: low normal cortisol, low to low-normal DHEA-s, low to low normal progesterone, low sodium or low potassium, low blood pressure, etc.

Sometimes I see you write DHEA, and sometime I see DHEA-s, what if someone has high DHEA and low-normal DHEA-s ?

Reading http://www.drlam.com/A3R_brief_in_do...al_fatigue.cfm I can see DHEA tells you in what stage you are, but can a high DHEA rule out adrenal fatigue 100% ?

JH

[love_en]

Dr. Lam is another example of the naturopathic doctor that has a diet and some vitamins to sell you. I cannot imagine living on 2.5 oz of meat per day. I also have a hard time believing that you can get 600 calories from raw vegetables. This is the same semi-vegetarian bullshit that damaged my health in the past. Eat bulky foods that are nutrient and calorie poor, then make up the difference with supplements, no thanks. Dr get to the point! If cortisol and DHEA production are inadequate, replace it. Those testimonials from what appears to be mostly overweight women, are what can happen to anyone when they stop eating processed foods and too much carbohydrates. Hardly a miracle to me.

[marianco]

Originally Posted by TylerR

i have fatique, lack of morning erections, weak erections, inability to orgasm, absolutely no libido. lack of emotions, my problems appear to be from the use propecia like a few others here, i have not taken any other medications. my urologist has also said i have also have an enlarged prostate, i assume its from the high estrogens in my system. i'm in my early 30's height 5feet 7" weigh 160. i have been off propecia for 2 yrs yet the symptoms still persist, having taken it for 8 months.

gonadal:
testosterone = 465 range 250-850
free testosterone = 14 range 9.3-26.5
estradiol = 45 range <54
dht = 36 range 30-85

adrenal:
progesterone = 2.6 range <4.0
cortisol = 399 range < 175 - 685 (done in the morning)
dhea-s = 6.8 range 5.2 - 14.2

thyroid:
tsh = 1.3 range 0.47 - 4.2
free t3 = 4.3 range 4.0 - 6.8

pancreatic:
glucose fasting = 4.7 range 3.3 - 6.0

liver panel:
albumin = 46 range 35 - 50

lipids:
cholesterol = 4.67 range 2.0 - 4.59

I wish the units were included to help translate them into units commonly used in the U.S.

Often I wonder how men who previously used Propecia developed seemingly permanent problems from it despite stopping it. Unless Propecia causes some genetic damage (and there is no evidence of this), it is very unlikely that Propecia is the cause. I would look to other persistent problems instead that may have been overlooked.

One possible scenario: a man who is living a stressful life realizes he is losing hair. Hair loss is a possible consequence of stress alone - for example, by causing a loss of zinc. The man takes Propecia to try to help reduce the hair loss. Along the way, he developes fatigue, loss of libido, erectile disturbance, depression or other mood problems. The problem is blamed on Propecia. Propecia is stopped. The problems persist. What happened? A possible answer is that the stressful life, which caused the hair loss, also caused adrenal fatigue - which can cause all of the symptoms described.

Diagnosising adrenal fatigue via blood tests is difficult because it is based on looking at small deviations from the mean. The diagnosis is helped by history and physical exam. On physical exam, often the blood pressure is low - or blood pressure drops between the sitting and standing measurements. There may be sensitivity to sunlight, weakness of pupillary constriction to light. Other historical clues include sugar or salt cravings, craving for chocolate, fatigue and sleepiness in the afternoon, difficulty in falling asleep at night, a desire to sleep most of the time, increased energy at night, etc.

Blood test clues include:
1. Low normal cortisol
2. Low normal DHEA-s
3. Low normal progesterone
4. Low normal blood sugar
5. Low sodium
6. Low potassium
7. high normal to high albumin
8. high cholesterol

The best test for adrenal fatigue is a saliva test with cortisol at four times in a day, and DHEA-s at least twice in a day.

James Wilson's book "Adrenal Fatigue" is a good place to start for information.

One mistake I see many people make when doing hormone balancing is to treat thyroid deficiency simultaneously with adrenal fatigue. The problem is that thyroid hormone forces the adrenal glands to increase output. Increasing output is exactly what the adrenal glands have a problem doing. The result is a worsening of adrenal fatigue and the patient does not get better.

Interestingly, in some people, treating adrenal fatigue (such as with progesterone and hydrocortisone), often results in a return of morning erections even when testosterone is as low as 170 (300-850).

[SPE]

"Interestingly, in some people, treating adrenal fatigue (such as with progesterone and hydrocortisone), often results in a return of morning erections even when testosterone is as low as 170 (300-850)."

I found this to be very true for myself. Even after T therapy and being in the upper quartile of the range, my libido didn't completely return 'till I addressed my adrenals.

In the results above, it looks like your problem could very well be adrenal. Your DHEA, TSH, and cortisol are all fairly low. Your FT3 is also in the gutter. If you had normal adrenal function, your TSH would be much higher, revealing your thyroid issues to most docs.

[Legenden1999]

Originally Posted by marianco

Often I wonder how men who previously used Propecia developed seemingly permanent problems from it despite stopping it. Unless Propecia causes some genetic damage (and there is no evidence of this), it is very unlikely that Propecia is the cause. I would look to other persistent problems instead that may have been overlooked.

Most of us guys with "permanent propecia damage" has low-normal T and/or high estrogens. Of the ones who had bloodtests for adrenal fatigue, I often see low-normal DHEA, and low morning cortisol.

I'm not saying propecia causes permanent damage by altering genes, but I think propecia causes hypogonadism and adrenal fatigue in some of the users who are genetic disposed for it. And once you are in it, it seems like we are stuck.

I know for a fact that Testosterone replacement has helped my fysical symptoms such as libido, sencitivity in the penis, mucsle wasting, and I even have my scalp itzy-ness back, so Im pretty sure my Testosterone levels has been higher before propecia.

I don't know if I have adrenal fatigue or not, but many things points in that direction. I just started to take isocort 20mg/day, but its still to soon to tell if it will help.

Just because there is no evidence, that does not mean thats its unlikely that propecia caused the symptoms. I would rather say, if everything was fine before propecia and no other drug was taken, its likely propecia that are the cause of these symptoms.

JH

[marianco]

Originally Posted by T Man

I am trying to get a right to the point answer about what tests my doc should run for my adrenals. Than I need to know where these levels should be for optimum adrenal functioning. The adrenal thread is very hard to follow. Can anyone post this info??? She told me if I get the info she will run them. She just wanted a TSH and I told her we needed more. So she said ok get me the info.

Blood Tests:
1. Cortisol AM and PM
2. DHEA-s AM and PM
3. Progesterone
4. Comprehensive Metabolic Panel - to obtain the following:
a) Sodium
b) Potassium
c) Albumin
d) Fasting Glucose
5. Hemoglobin A1c with calculated mean blood glucose
6. Lipid Panel

Saliva Tests (highly sensitive test for adrenal fatigue):
1. Cortisol - at least 4 times in a day, approximately 3-4 hours apart.
2. DHEA-s - at least 2 times in a day.

Urine Tests:
1. 24-hour urine Cortisol (Some practitioners prefer using this. I don't think it is sensitive enough for early stages of adrenal fatigue.)

ACTH Stimulation Test:
This test is useful for primarily Addison's Disease rather than adrenal fatigue. In adrenal fatigue (particularly the early and mid-stages), the adrenal glands may be able to produce cortisol but they have difficulty sustaining the production, creating a "sputtering" pattern of production - where cortisol is normal one moment, then low the next. The ACTH test may show up normal then depending on when it is administered - yet adrenal fatigue is present.

Note that the extreme presentations of low adrenal function (where cortisol production is consistently below the reference range) are cases of Addison's Disease, not Adrenal fatigue.

Adrenal fatigue is a condition where cortisol (and other adrenal hormones)production is impaired (often has non-sustained levels where there are normal levels and low levels or high levels depending on the response to stresss) but is not consistently below the reference range.

[Legenden1999]

Marianco, how much do you weight temperature messurements when diagnosing adrenal fatigue ?

JH