I'm inquiring on behalf of a friend of mine what to do about his condition. Over the years, he has been prescribed large doses of anti inflammatory meds for his arthritis, and many of these were cortisol based. In effect, he has had to suffer from chemically induced supraphysiological cortisol levels for a long time, and as a result of that has lost much of his once powerful physique. He has many of the classic high cortisol symptoms, even those of relative severity, such as pseudo-cushing's fat accumulation in the face (loss of facial features, droopiness, loss of skin elasticity etc) and so forth, and bouts of anxiety, borderline panic attacks.
Even after discontinuing many of the meds he was on; all of them as I understand it, he still has above range cortisol and all the symptoms. I theorized that this is caused by his chronic joint inflammation and pain. He also has high prolactin in the absence of a prolactinoma/brain odema (he had an MRI done and all was as it should be). His total
test and free
test were both very low (with low LH), which would be explained by the high cortisol + prolactin combo. His thyroid seems to be in good order, though, and E2 on the low side of normal.
Furthermore, he started developing hair loss a while ago, which lead him to take
finasteride (turns out it was not
DHT based, but most likely tied to his high cortisol). He had no knowledge of its harmful nature; indeed, having been convinced by his doctor that it was completely safe, so it took him by surprise when he developed serious sexual side effects; numbness, lack of bloodflow, even pigmentation changes downstairs, and they persisted even after he stopped taking the
DHT blocker.
Here are his lab values. Apparently there were no reference ranges given, but I know the ranges for most of these tests, so I'll post them when possible:
LH 1.5 (!) (2 - 8)
FSH 2.1 (don't know this one)
TSH 1.5 (0.6 - 4.0)
Free
T4 18 (10 - 22)
Free T3 5.3 (3.5 - 6.5)
Prolactin 377 (!), previous
test even higher at 418 (50 - 300)
Free Cortisol 159 (!) (no idea of the reference range on this one, but apparently well above range)
Free
Testosterone 228 (150 - 600)
Total
Testosterone 13 (14 - 38 nmol), up to 17 on a subsequent
test; still too low.
S-SHBG 25 (13 - 62)
E2 0.06 (0.03 - 0.16)
DHT 1.1 (no idea of the ref. range on this one)
He also had some blood specific tests done, and they came back good.
He's currently taking
Dostinex (prescribed) to get his prolactin down, and reports feeling slightly better, but what else could be useful? I told him he might want to try some
hCG to juice up his balls (which obviously work; they just aren't getting a signal because of low LH, which is probably the result of his high cortisol + prolactin). What else could be done to lower his cortisol to a healthier level, other than getting his T up to the upper end of the normal range?
It is my subjective assessment that he will recover from his
finasteride induced sexual side effects because he only took it for a short while (and that most of his sexual sides are hormone specific; certainly aggravated by the finasteride, but nothing that can't be fixed), but it would be good to get some more opinions on this. Certainly his messy blood values would indicate that upon improving certain parameters, his sexual health would also be regained?
Any input is highly valued!
My friend - high prolactin, high cortisol 
Unless, of course, the account is free, in which case I just might be able to convince him. It certainly would be interesting to be able to read all those articles!
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