Men's Health Forum: This is a discussion on Adrenal Thread within the Anabolic Steroids forums, part of the extensive steroid information at MESO-Rx; I have a couple of questions for you guys, Chris and SWALE:
1) My pre-treatment thyroid results were TSH 2.27 ...
I have a couple of questions for you guys, Chris and SWALE:
1) My pre-treatment thyroid results were TSH 2.27 (.35-5.5), FT3 3.1 (2.3-4.1), Total T4 6.5(4.5-12). This was also before I started testosterone replacement, as my Total T was low. Unfortunately I was dieting at the time as well. BOTH could have an impact on my thyroid function, right?
2) My AM Cortisol was a little low at 17 and my DHEA was also VERY low. Could fixing these alone improve my thyroid function?
3) It seems that the adrenal function is often overlooked here. Could you clarify how important this is and how to interpret ranges and results?
Also, SWALE any comments are appreciated! I know you treat high cortisol with PS, but how do you determine what is high? From what Chris has said, normal cortisol for men is often above the upper limits.
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Adrenal Fatigue
I believe that when you seek to balance one neurotransmitter/hormone system, you have to also examine and balance the rest. They are all closely connected in their functions. From a mental health point of view it is important to optimize functioning in the neurotransmitter/hormone systems involved in reproduction (e.g. estrogens, testosterone, progesterone), adrenals (e.g. cortisol, DHEA, norepinephrine, epinephrine, dopamine, etc.), thyroid, pancreatic (e.g. insulin), besides the brain-involved neurotransmitter/hormone systems.
For example, in order for the thyroid hormone activity to function, adequate serotonin is necessary.
One of the important functions of testosterone is to limit adrenal activity - essentially to quell the stress response so that it does not rage on uncontrollably. Testosterone both causes a reduction of ACTH production from the pituitary, and directly reduces adrenal activity - both reducing the production of cortisol. Testosterone, by also increasing brain dopamine production, causes a reduction in norepinephrine production from the locus ceruleus. Norepinephrine is a signal for stress.
A high cortisol is one indicator of the amount of stress a person is experiencing and is trying to cope with - unless one is dealing with an adrenal disease state such as Cushing's Syndrome. Another would be high norepinephrine levels.
If anything, I think the best ways to reduce such stress include: 1) behavioral and environmental interventions to reduce stress, 2) increasing serotonin to help provide a buffer against the perception of stress - i.e. things hurt emotionally less, 3) optimizing testosterone level to control the adrenal stress response. When these don't work, other measures - often other psychiatric medications - are used. Improving the brain's ability to produce GABA, for example, is one of the alternatives - GABA being an inhibitory neurotransmitter than can help induce calmness - which is modulated using anxiolytic and other medications.
I am not sure that limiting adrenal output is necessarily the best thing to do because that also limits a person's ability to generate energy and get the body ready to respond to stress. The adrenal glands are like a car's transmission, where the brain is the engine. If the transmission is regulated, then the cars ability to accelerate when needed may be compromised. I think it would be better to reduce the stresses that necessitate increased adrenal output in the first place - before the adrenals fatigue.
Adrenal fatigue is a highly important condition to treat. It is a very common condition in our highly stress-filled lives. Adrenal fatigue is like having a transmission that is broken or is stuck in neutral. Pressing the accelerator pedal accomplishes nothing - which is what people with adrenal fatigue feel - the inabilitiy to generate energy on-demand.
Adrenal fatigue is most easily determined using saliva tests of DHEA and Cortisol levels done multiple times in one day. This is more sensitive than the blood tests. Adrenal fatigue can be evidenced also by low DHEA, low Cortisol, low progesterone levels. Hypothyroidism often occurs with Adrenal fatigue - possibly from the resulting impairment in production of neurotransmitters necessary for thyroid function, such as serotonin.
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Mariqanco--Do SSRI's increase T4 to T3 conversion (outside of their ability to through stated purpose of reducing stress for the patient)?
SPE--That is not a low cortisol level.
Hypothyroidism is linked to adrenal fatigue in that the adrenal glands have been trying to, through stress hormone production, make up for the lack of thyroid. Once the adrenals burn out, then both are left in a deficient state.
This is also why adrenal function must be evaluated first prior to treating the deficient thyroid. An uncovered adrenal deficiency could literally kill a patient if thryroid supplementation is initiated first.
Mariqanco--Do SSRI's increase T4 to T3 conversion (outside of their ability to through stated purpose of reducing stress for the patient)?
SPE--That is not a low cortisol level.
Hypothyroidism is linked to adrenal fatigue in that the adrenal glands have been trying to, through stress hormone production, make up for the lack of thyroid. Once the adrenals burn out, then both are left in a deficient state.
This is also why adrenal function must be evaluated first prior to treating the deficient thyroid. An uncovered adrenal deficiency could literally kill a patient if thryroid supplementation is initiated first.
This is what happened to me. My cortisol was never checked before starting thyroid meds. I ran into alot of trouble about 3-4 months into it with bad anxiety and literally crashing everyday between 1-5pm.
This is what happened to me. My cortisol was never checked before starting thyroid meds. I ran into alot of trouble about 3-4 months into it with bad anxiety and literally crashing everyday between 1-5pm.
The best and most accurate way to measure cortisol is with a Saliva test, as marianco mentioned. Blood cortisol is not accurate at all.
The best and most accurate way to measure cortisol is with a Saliva test, as marianco mentioned. Blood cortisol is not accurate at all.
My next step in a few weeks is an ACTH Stim test, measuring cortisol, ACTH, and DHEA. I'm pretty sure he'll put me on something like Cortef after seeing the results.
My next step in a few weeks is an ACTH Stim test, measuring cortisol, ACTH, and DHEA. I'm pretty sure he'll put me on something like Cortef after seeing the results.
If you do Saliva, then you won't need an ACTH stim test.
My understanding was that the gold-standard cortisol test is a 24-hour urine cortisol/creatine test. I've read posts that saliva testing can be tricky depending on when exactly you take it and what you've recently put in your mouth. Plus, the higher variability of that test seems to be in question by some endos so I've rarely heard any doctor want to use it over a 24-hour urine test except as a screen to rule IN a cortisol problem. It's probably good at detecting people that have very high, or very low, cortisol levels but maybe not as good as a 24-hour urine when someone may be closer to the normal range.
I have no professional exp other than reading about it and talking to a few endos about it. Obviously it's not a bad first test but I'm not sure how conclusive it is when it results in near normal levels. It certainly is cheaper and less of a hassle. I ended up having a 24-hour urine myself because I wanted to be sure.
If you do Saliva, then you won't need an ACTH stim test.
As I understand it, the ACTH Stim is THE FINAL say wrt adrenal issues. It measures how your body reacts under stress with cortisol. If the response is low, then your response to stress is low. Individuals with cortisol levels in the normal range as identified by a saliva test, could have very poor responses to stress and therefore feel bad. This is also adrenal insufficiency.
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