My friend - high prolactin, high cortisol

[Sargovar]

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!

[JanSz]

Originally Posted by Sargovar

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!

Start with this test:
GDX NutrEval Profile

GDX NutrEval Profile
and
Genova Diagnostics EstroEssence
Genova Diagnostics EstroEssence

This tests comes with a list of recomended supplements and their daily dose.
Buy the supplements at Lef.org

Eat those supplements for 3-4 months.
Keep eating and repeat that test.
Eat modified list.

They have other tests but this one is really good start.

In the mean time keep:

E2~(0.45 - 0.6)
BioavailableT~575
FreeT3~top range

Use this tests at Quest Diagnostics for monitoring and dose adjustment for this three items.

Estradiol, Free, LC/MS/MS (36169X)
Testosterone, Free, Bio/Total (LC/MS/MS)
FreeT3

Keep taking Dostinex (prescribed) to get his prolactin down
but most likely it would be agood idea to be totally clean for about 6 weeks of all supplements before first NutrEval Profile.

I know you are in Sweden, Quest and Genova can be reached from Sweden.
Ask your Father to get account at Genova Diagnostics (over internet plus phone (may be)
That account, available to doctors or nutritionists only, comes with:

UserName
pasword

Read educational material accessible only to people with this access,
it will open your eyes,
and you will understand why I am recomending them.
You should be able to direct his treatment further and possibly get more tests if required.

[Sargovar]

Thanks for the recommendations, Janz!
I'm in Finland, though.

I'll see what I can do about my father.. could be a hard case trying to get through to him. I'll try for what it's worth, but I suspect it will be an uphill battle. 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!

[JanSz]

Originally Posted by Sargovar

Thanks for the recommendations, Janz!
I'm in Finland, though.

I'll see what I can do about my father.. could be a hard case trying to get through to him. I'll try for what it's worth, but I suspect it will be an uphill battle. 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!

Opening account is free to the doctor.
Costs (to the patient) is very resonable.

Better yet, in UK one can order these tests over internet and pay with credit card.
Similar like we have in USA with blood tests bought thru LEF.
Possibly you can travel to UK or just talk to them, ask for suggestions.

Start with bottom left tab "Genova UK"
GDX - Connection Newsletter Archive

IWDL Genova Test List
Our Tests

SP14 NutrEval:
NutrEval
Pricing
Description
(RRP) Price
NutrEval Profile �550
NutrEval PLUS Profile �650
============================
To order test go to Having a Test
How to Have a Test

[0ranki]

Hello. I'm the friend in question. I'm meeting a RA-doctor on monday and am afraid that he will subscribe prednisolone for my RA. The pain is so severe that even Arcoxia 90mg/day does not do the trick (COX-2). You can only imagine my feelings with this pain combined with the awful sides i got from finasteride. Prednisolone might help with the pain, but I'm afraid it will worsen the other symptoms.

I have noticed that my skin has now turned thin and dry and my masculine facial features are melting away (I used to have an awesome jaw) and my hair is dry and extremely thin. I am also all "wobbly" and my muscles have become weak. My E2 was in check, so it must be either the cortisol or prolactin?

Could TRT help with the increased cortisol, bloodsugar, - pressure and prolactin? I feel truly sh1tty and can't see a way out