Review of my hypothesis?

[magic8989]

I have trying to find out more and more about my endocrine system since i am on HRT. Through lots of reading on here and some thinking i think my problem progesterone. I say this because my T levels are optimal, my thryoid levels might be optimal as i go back for a final test of my new dosage. In spite of this 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. I plan on this changing when i go back in a few weeks.

Comments?

[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.

(reposted to adrenal thread)

[chap]

what treatment protocal did you put them on to address the adrenal fatigue?

[magic8989]

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.

Wow! Thanks alot. I do have some comments to add. You talked about aromatase enzyme activity and mine is probably low as i am no more than 10 or even 11% bodyfat and attempting to get to single digits.(It's been a goal of mine for 2 years.)

Also because of my pituitary tumor my LH and FSH levels are effected by this as it they are always very low so this limit the P450scc enzyme. Also i probably do have higher DHT as my facial hair since begining HRT is a lot thicker, and i shaved my head 2 years ago because i was going bald at age 20.

I will check into what you have reccomended. Thanks again for helping me link all this together.

Originally Posted by chap

what treatment protocal did you put them on to address the adrenal fatigue?

I have nerve been tested for adrenal fatigue. I wouldn't be surpirsed if was close to having it though as i ingest a lot of caffeine and other preworkout energizers.

[hackskii]

Nice post marianco.
That was alot of information.

[marianco]

Originally Posted by chap

what treatment protocal did you put them on to address the adrenal fatigue?

James Wilson's book "Adrenal Fatigue" is a good place to start with basic ideas of how to treat adrenal fatigue, applicable for the majority of people.

I do not have a fixed protocol for adrenal fatigue. Rather, I have a "toolchest" of medications, supplements, and psychosocial interventions. The components of the treatment is customized to each patient.

By the time a person is referred to me, they are often in pretty bad shape, with a complex behavioral neuroendocrine and immunologic illness of which adrenal fatigue is one component, and have had inadequate response to treatments with other specialists. To overcome the inadequacy of response, I have to address patients at multiple levels from the biochemical to organ system relationships to the psychosocial and environmental, by necessity, what I do is complex, one-size does not fit all, and is definitely an art fused with science.

Since I focus on treating patients with mental illnesses - where the brain may by structurally different from the norm - the response to treatment varies greatly. For example, a patient with psychotic symptoms can have significantly different responses from expected since there may be extra brain tracts that don't exist in non-psychotic patients. Similarly with the brain damaged patients I treat (such as cases of fetal alcohol syndrome) where sensitivity to different medications vary widely.

The full "toolkit" has more than 700 medications and supplements with the choice of combination treatment depending on multiple factors including the associated mental problems, age (I treat patients in the usual range of 3 to 90 years-old), sex, health problems, medications, supplements, adverse effects, politics, cost, preferences of the patient, the patient's future plans, ability to adhere to treatment, simplicity or complexity of treatment desired, aggressiveness of treatment desired, risks the patient wants to take compared to the benefits, etc.

Treatment areas to consider include:
1. Environmental (relationship, work, avocational, educational) changes needed to reduce stress (since stress leads to adrenal fatigue).
2. Psychological changes needed to adapt to stress (including internalized stress from past traumatic experiences).
3. Biological interventions to improve brain response to stress and/or reduce the perception of stress (including anxiolytic, sedative, antidepressant, antipsychotic, mood stabilizing, stimulant, cardiovascular gastrointestinal, neurologic, gastrointestinal, herbals interventions, etc.).
4. Biological interventions to allow the adrenals to rest and recover, while still functioning (including hydrocortisone, DHEA, 7-keto-DHEA, progesterone, salt, dietary changes, adrenal extracts such as Isocort or Adrenal Stress End, licorice, etc.)
5. Biological interventions to improve ongoing adrenal function (including nutritional interventions including Vitamin B5 (pantothenic acid), Vitamin C, B-complex multivitamins, magnesium, other antioxidants, etc.)
6. Biological interventions to address other endocrine problems (such as insulin resistance, reproductive hormone imbalances, thyroid problems) since like dominoes, when one endocrine system imbalance occurs, others may also occur and the present of one endocrine imbalance may contribute to another (for example, low testosterone levels in men allows the adrenal glands to "overheat" due to uncontrolled levels of stress).
7. The above interventions may also address immune system problems but there are other more specific immune treatments in development which may be used in the future to address mental illness and their related problems.
8. Other interventions to address associated physical health problems.
9. Coordination of all the treatments, addressing adverse effects, integration of treatment with the patient's other illnesses and conditions, and adjusting treatment over time - thus having plan A, B, C, D, etc. when adjustments need to be made (for example, the initial treatments for severe mood instability, insomnia, and anxiety may need to be reduced as adrenal function improves, otherwise oversedation and impaired functioning may occur). The process is like riding a bucking bronco until the person's condition stabilizes.
10. Tincture of time - each intervention has it's own time schedule for change, thus patience may be needed to give each intervention time to adequately work.
11. etc.