Adrenal Insufficiency Support Group

for the last 10years ive been fighting with on and off fatigue and strang symptoms. ive had lymes since atleast 2002. it seems to be under control.

back in 2008 i went on an extreme diet and overtrained like crazy. at my current healthy weight im 190 at 6 foot tall. during my diet i droped to 145 and thats when all my problems started my thyroid went in the dumps my testosterone went low and my cortisol was borderline low. at this time my cortisol a.m serum was 14 and my 4x saliva was normal at 6am low normal at 12 then low the next two readings. i tried a bunch of things tried a trial dose of hc nothing really helped. i started eating more got back to my healthy weight over time my thyroid numbers came back in line.

to make a long story short last year after countless tries to raise testosterone naturally i decided to go on t-shots. i felt great for first month and then bam i had serious low cortisol symptoms. i went off the t after 2 months and got an adrenal 4x saliva test i was low across the board and my A.M cortisol serum was 7 . so this time i decided to try t shots with 25-30 mgs of hc. for the first 2 weeks i felt nothing then the 3rd week i felt great for two weeks then i crashed again. i got all the way to 35 mgs and still felt crummy most of time now i weened all the way down to 5mgs and still feel almost the same so i guess my question is is the hc even doing anything for me and should i get all the way off and see what happens.

the only difference is when i was on testosterone and no cortisol i was waking up alot at night and had painful pimples all over my head.

this time on t and hc i sleep through the night most nights and only get a pimple here and there but energy levels and such are pretty much the same.

Okay some system stuff first. The biological, production of testosterone is actually started in an adrenal substrate of sorts. In simple terms ACTH creates DHEA androgen and then some way downstream in steroidogenesis T happens. The upshot of this is that of you have secondary AI and take HC your ACTH falls and thus so does testosterone. Mine for example fell from about mid range to below range, so I now use patches. How much it falls may of course still have it within refrange and you may not be symptomatic. I don't know if it's commonplace, but when mine was "repaired", my HC fatigue/peak cycles became less shallow, or of you like the T had a moderating effect.

Its a good idea to quote ref ranges when you give test results. Different labs, different countries, different units etc.

Testosterone shots will also cause HPA feedback problems similar to SAI. ie all your natural production stops so you become fully reliant on the shots. I have no idea how long this takes to recover the natural system, but I would guess being a slow moving steroid could be months or years. Of course it is nowhere near as critical as cortisol. That can also explain why you felt good for a week on T then it all dropped off. That's common when you start HC dosing as well.

I'll admit I don't know the T/cortisol correlation as far as HPA feedback and control is concerned. Maybe LH gets affected by cortisol. Sorry I have no info on this at all.

Assuming you are trying to get your system back to a more normal state, I think you need some up to date test data rather than going on symptoms. You have at minimum a two dimensional problem and with interdependencies it is probably far more complex than that. That means at least a testosterone and cortisol test. Even with that data its still going to take a few stabs to get right and you'll have to consider any HC you are currently taking as affecting the outcome. eg if you find both are low and you take more HC, that will lower your testosterone. You also have to think in terms of natural recovery or just full replacement. ie if you assume your T system is completely broken then just full replace that with gel/patches to the nearest dose size. At 200lb that's basically "2 doses" of the standard size.

Sorry kind of getting convoluted here. In short I think its kind of important to see where you T is currently at before you start fiddling with HC. That's contrary to normal doctrine in a way, but very important if you have super low levels of T.

Bob (Australia)

Blood draw was at 10am.

My testosterone Is perfect as far a lab results go on the t- cypionate. My doctor is among the top docs in the trt field so I'm not worried about that.

I guess my real question is if I'm not feeling much difference on 35mgs of hc vs 5 Mgs. Is it really doing anything. And would it be ok to just come off and see how it goes.

Blood draw was at 10am.

My testosterone Is perfect as far a lab results go on the t- cypionate. My doctor is among the top docs in the trt field so I'm not worried about that.

I guess my real question is if I'm not feeling much difference on 35mgs of hc vs 5 Mgs. Is it really doing anything. And would it be ok to just come off and see how it goes.

My only concern is when I was on t shots the first time with no hc. It really seemed to tank my cortisol levels. I couldn't stay asleep and felt that terrible fatigue most of the time.

Mm okay. Surprising at the 5 vs 35mg HC. You'd expect some big differences. Of course both high and low BG can manifest as feelings of fatigue. BP then might be a better indicator. Too much HC is seen as high BP and too little as low. This might all may mean that something between the two limits is your actual requirement!

But

Depending on the dosage change time frame too your natural system will tend to ramp up and down to maintain the same level of cortisol. That may mean that when you are taking 5mg you are producing most of your need naturally, but at 35mg only a small amount. How fast the natural system changes/adapts varies though. When increasing or first trialing HC it can be as little as 3-4 days but when coming off it that can be much longer. This does kind of seem unlikely in your case, but its worth knowing.

In the end - not enough info. If you can equate the crummy feeling to low vs high BG and or BP then you'll have more to work with. You should also feel cycles of fatigue within the dose cycling times. ie the 3 or so HC doses (per time of day) you take should see a distinct peak and trough of sorts over the 3-4 hours after each. HC works real fast, but the resultant cortisol rises and falls quickly.

I wonder at your final comment though. "Tanking cortisol" would tend to make you sleep, not keep you awake (unless your body was panicking into adrenaline production). The fatigue may even have been from resultant high BG. Dunno sorry! (look up Cushings symptoms?)

My blood pressure runs between 110-125 over 70-85. Most times. And ever time I take my blood glucose it's great. I'm just lost I have low cortisol in my 4x saliva low normal blood cortisol. And plenty of the symptoms. Shouldn't I have felt better on 35 Mgs.

I have read that HC will suppress androgens. I have also been told this very thing by my Dr.

Have you tried supplimenting with high quaility DHEA instead of testo shots?

It may take a slower route, but may be kinder on your system.

As a female, my Dr wants me supplimenting DHEA,(various reasons). Being female, my DHEA & testo won't be near a man's...

Dr told me if I feel like crap on DHEA to up my HC, he said it happens.

I wanted to know why, but still don't really. He just told me DHEA raises the need for cortisol sometimes, & to dose my HC by symptoms.

So, since DHEA is the precursor to testo, maybe the same thing happens.

Personally, I have NOT started the DHEA supps.

I'm just getting the hang of proper HC doses & enjoying the fact that I am NOT breaking out as a 40 yr old woman. I was breaking out a lot pre-HC.

Thinking once I really have HC down to a science, maybe them I'll play with the other stuff--only if needed.

I see both an Endo & a HRT specialist.

4x saliva test

cortisol,morning 1.44L-------1.8--3.8ng/ml

cortisol,noon 0.25L-----------0.3--1.4ng/ml

cortisol,evening .09L-----.1----1.1ng/ml

cortisol,night---<.01L-----.1----0.8ng/ml

my blood am cortisol was taken at 10.am im not sure how much of a difference the levels change by 10am

7.2mcg/dl---4.0----22.0am

In 2009 when all my problems started my am bllod cortisol was 14.1 ---4.0--22.0 but that test was taken at 645am how much can that time difference make in our levels. is it enough to cut it in half.

ive been off hc for 3 days now and i really do not feel much difference. thursday i went to the gym and had a pretty intense workout then came home and spent 3 hrs moving furniture around putting my house back after getting new carpets.friday i woke up groggy and not feeling that well but that is the norm for me then i got to work and i had a very good day.after work i went to the gym again and had another decent workout then i got home and i started to feel crummy. got dizzy some fatigue and started complaining to my wife. we went to dinner i felt a bit better from eating. then we went to movies. i got home and went to bed 12 pm. today i had a hard time getting up like usual my head feels strange but i dont feel to bad.

Im so lost as to why i feel no different on or off the meds. with my levels i should feel pretty damn bad i would think. dont get me wrong i still geet bad days with fatigue.Whats strange is when i went back on testo and started hc i worked my way up to 20 mgs felt great in 2 weeks then one week later it fell of i uped the dose felt good for a week then fell off. i did that till i got to 35mgs. then i started to back down week by week with the same pattern continued i felt good for a week then crummy. all the way till now and im off the meds.

sorry if this was a confusing post but it should be cause i am truly confused

My webspace has some diurnal curve graphs if you want to look at blood levels between times. Basically though from about 08:00 to 12:00 it about halves. HC ingested into a system with no natural cortisol peaks in 30-60 mins and half life's in about 150 minutes. That is heavily modified by whatever else you have in your stomach though.

Very important to keep in mind that unless you are right on the borderline, major low cortisol symptoms DON'T happen on the same day you lowered the dose. One of the common things that befall those on the group is crashing two days after a major exercise event because they forgot to updose for it. The logic there is your body has a kind of BG cellular reserve that has to be depleted before you feel the ramifications. It gets complex because there are varying depletion rate "energy stores" in your body. The brain tends to degrade before the limbs for example. (Blood vs cell stores)

Also note that testosterone has a slow uptake in terms of downstream effects. You'll get very little end effect variation by daily dosage changes. It took mine about 6 weeks to reach what I would call stable.

ie what it all means is that what you feel will lag in time behind your dosage changes. That's both what system is providing the adverse feeling and what drug is being varied!

Bob

Post edited by: bob3bob3, at: 04/07/2012 01:49 PM