Re: Low cortisol and low testosterone

Thanks for all this info.. this all agrees with my research but this is much
better organized. Thanks!

"Robert1" <Goldentouchman@xxxxxxxxx> wrote in message
news:7ecb070e-e1ec-4b52-849a-cc953901893d@xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
On Apr 18, 7:39 pm, "NoReply" <nospample...@xxxxxxxxxxxxxxx> wrote:
I hope someone reading this will be able to help me decipher what is going
on. I've been to a number of endos and DOs.

I'm 32 years old, used to be in excellent shape but I overtrained last
year
with weight lifting. It has been a full 12 months and I still cannot
exercise.

Was diagnosed with hashimoto's thyroiditis in 2002 and I am on 1 grain of
armour, this keeps my FT3 right at the top range.

I've had low testosterone for at least two years. Free T is 20% below the
low range.

My urine and saliva cortisol tests showed very low cortisol. In fact my DO
wanted me to take 15mg of cortisone daily, but I don't want to become
dependant on that, so I haven't tried it yet, still thinking about it.

I have *severe* exercise intolerance plus most of my muscle has been lost
(30 lb lost starting from 7% body fat!!) and I have fat accumulating
around
my waist now.

#1: When I take testosterone, this causes my DHEA to sky rocket, up to
4000%
above the normal reference range. It goes back down to normal when I stop
taking it.

#2: When I take testosterone cream (I can't stand shots), my cortisol also
goes very high out of the normal range and my estradiol goes way out of
range. They go back to normal when I stop it.

#3: The more armour and testosterone I take, the more I feel drained, with
brain fog and tiredness. I guess the T3 and testosterone cause my adrenals
to work harder?

#4: I feel like I'm running on adrenaline when I'm taking testosterone. I
get very anxious and startled easily.

Question #1: Should I take the 15mg of cortisone? Will I become dependant
on
it? I never had an ACTH stim test. He said the urine and saliva tests were
accurate enough.

Question #2: Should I just leave my low testosterone alone, or would my
adrenals be OK if I used the testosterone and arimidex that he prescribed?

He told me that if I felt better a week after taking cortef, I should try
adding the testosterone back but I wonder if this will just put more
stress
on my adrenals. I certainly don't want to be stuck on cortef for the rest
of
my life.

Its just that when I am taking testosterone (small amounts, under doctor
care), I am very wired up and have anxiety so bad that I've been to the ER
twice with a pounding pulse in my neck and severe panic attack. This
doesn't
happen when I'm not on testosterone.

Thanks in advance for any clues.

Just some comments which reflect my understandings and don't hold me
to them without confirming them.

There is a sequence involving HRT because of the interconnection of
the endocrine system. It can be very complicated and one psychiatrist
online posted this order.
The order is usually
1. Cortisol
2. Aldosterone
3. Thyroid
4. Sex hormones
5 Growth hormone

Autoimmune disease like Hashimoto's can often be associated with other
autoimmune disease like primary adrenal insufficiency. I would have
been nice to see other confirmations such as with 21-OH adrenal
antibodies. The other classic findings of hypotension, unexplained
fever, altered mental state with lab findings of low cortisol low
DHEA, potassium, low sodium and low glycohemoglobin pertain to adrenal
failure.

Putting that aside anyone taking thyroid hormones will stress the
adrenal gland. The key is an adequate target TSH where one is not hypo
or hyper. Giving T3 promotes serotonin production. Some patients with
depression are given thyroid hormones to that when they are refractive
to antidepressants.

With regards to testosterone, excess testosterone is converted to
estradiol by the Aromatase enzyme peripherally by fat tissue. Estrogen
increases serotonin levels and low estrogen and high estrogen levels
can both cause anxiety symptoms, and insomnia. Testosterone reduces
pituitary ACTH secretion which in turn reduces cortisol production.
It helps in limiting chronic stress. Even when testosterone levels are
optimized according to that psychiatrist, one does not fell "right"
when "adrenal fatigue" coexists with anxiety, irritability, feelings
of desperation occur. High cortisol levels can be due to low
testosterone or high stress and can lead to suppresion of TSH, and
impair conversion of T4 to T3 and impair serotonin function, reduces
serotonin receptor density, increases serotonin reuptake etc.

So with that in mind your doctor seems to be inclined to treat the
adrenal deficiency if it exists as the testosterone didn't make you
feel better and see how the rest falls into place based on the order
above on HRT.

My understandings on Cortef is that it doesn't shutdown adrenal
production like the other glucocorticoids. That's basically what I
have without the original references.


.

Relevant Pages

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