My GI Dr thinks the low cortisol is a result of tapering off prednisone. Said some people follow the taper, but still end up with adrenal suppression. He is recommending 10 mg prednisone for 2 days, 9 mg for two days, and so on down to 0 over 20 days. Thinks I would feel better immediately and this would do the trick to kickstart the adrenals again.
I am apprehensive as the last time I was on prednisone (albeit a much higher dose for a flare-up) I ended up with three significant soft tissue injuries. Anybody have thoughts on this? I asked about hydrocortisone and he said no, that only take this if your adrenals aren’t producing any cortisol.
Anyway, here is a CBC, CMP, and CRP that was ordered by my GI doctor. This was fasted at 7 am. Started Androgel around 3 weeks ago.
Yes, I’ve looked at the site/links. Thanks for the recommendation, lots of useful information. I’ll have to go through it again too. I’m just trying to figure out why I went from elevated to suppressed so fast (and think I may have found the answer) before just jumping on a blanket prescription…low cortisol = takes this. I did start with some Isocort, but no real changes with that. Anybody heard of fixing low cortisol with prednisone like my Dr recommended above?
Why not use something less repressive like Cortef? You will feel restored on that then can taper off slowly. Prednisone caused the problems. Perhaps the taper was flawed, perhaps prednisone and you are not a good combination.
Yes…this is exactly my thinking. I definately don’t feel like we are a good combination…haha. I’ve read cortef is much less potent and generally safer. I asked about this and he said hydrocortisone isn’t for me. Something along the lines of only use hydrocortisone when the adrenals don’t produce any cortisol and that isn’t my problem. My problem is they are suppressed due to coming off prednisone, so he wants to start back up on a very low dose and then taper again over 20 days. Seemed very confident that this would work and said he has seen it before with some patients responded poorly to the prednisone taper and that I would feel better immediately if i did this. Just doesn’t make that much sense to me and I would like to avoid this drug if at all possible. We agreed that I would see an endocrinologist who visits his office once a week. I will be seeing him tommorrow.
Update…met with the endocrinologist, wants to do more assessing and get more information before putting me on anything. Scheduled for the ACTH stim test and more hormonal testing next week. See him the week after.
Your LH/FSH shows that your HPTA is deeply shutdown, as one would expect. No need to test for those ever again.
Your T levels are not very good. You are absorbing, but poorly [perhaps another indicator of a thyroid problem]. Going to 20gr Androgel might take you to a reasonable TT=950, but that is nuts. And doing that would also lead to much higher E2 levels.
Given that you started with TT=407, I have to call this a failure. You feel better or worse?
Right now, your E2=31 is having a negative effect when your T levels are where they are.
You should consider injecting T. Time to review the protocol for injections sticky.
Prolactin is a great number.
FT levels are quite variable when on transdermals and levels are somewhat determined by lab timing. TT is a better indicator in some respects.
Note that with frequent injections or implants, FT and TT levels are quite steady day to day and FT levels are much more meaningful, with lab time concerns off of the table. However T levels are falling between implant renewals.
Don’t feel any different (so not good). Maybe a little stronger in workouts, but other than that haven’t noticed a thing…no changes in any of my symptoms. I guess I’m not expecting anything to change until the cortisol issue gets figured out and fixed. We did discuss injecting the T and will re-visit that after next appointment.
Very good recovery of LH and FSH. TT is decent. E2 would be good to know, as it might be lowering FT. Looks like you will be better off without TRT and doing things to optimize your own production.
These numbers are prior to starting were from late October prior to starting. Free T has always been on the low side. I think E2 may be high from DHEA at the time (adrenal protocol). Not sure how my cortisol saliva was so bad and then a month later blood cortisol seems fine.
Total T4 7.1 (4.5-12.0 ug/dL)
Free Thyroxine Index 2.6 (1.2-4.9)
Free T4 .93 (.7-1.53 ng/dL)
FSH 11.1 (1.5-12.4 mIU/mL)
T3 Uptake 37 (24-39%)
T3 Free 4.0 (2.0-4.4 pg/mL)
Total T3 132 (71-180 ng/dL)
SHBG 49.2 (14.5-48.4 nmol/L) ***outside range
Progesterone .8 (.2-1.4 ng/mL)
Prolactin 7.7 (4-15.2 ng/mL)
Testosterone Total Serum 612 (280-800 ng/dL)
% Free T 13.0 (9.0-46.0%)
T F+W Bound 79.6 (40.0-250.0 ng/dL)
TSH 1.82 (.35 - 5.50 uIU/mL)
Vitamin B12 788 (211-911 pg/mL)
Ferritin 90 (5-244 ng/mL)
PSA 0.17 (0.00-4.00 ng/mL)
E2 47 (11.6 - 41.2 pg/mL) ***outside range
Cortisol Response to ACTH
30 min 23.02
60 min 30.07
Range: 4.3-22.4
They messed up the lab draw on the ACTH stim test (didn’t put the initial draw on ice). Dr. also wanted to see numbers after 10 days off Androgel and get the initial cortisol numbers too:
My T levels have always been very low on my Saliva Cortisol tests. Which to my understanding is free, unbound hormone levels (i realize most on this forum discount that).
from an quick initial glance it looks like your high Estradiol could be to blame for all of your issues (including your high SHBG).
any chance to go on a trial run of generic Arimidex?
your TSH is also slightly elevated which is a concern, your ft4 is low, but your ft3 looks good (high even). Normally, I would suggest testing for Reverse T3 to see if that is causing interference but your Cortisol levels are good. RT3 could still be an issue, but it is less likely with good cortisol levels.
This was on the original order, but the lab messed it up. Went back in and had it done. Yes, I’m thinking that E2 and Free T levels may be the issue and not the Total T. I would/am considering the arimidex, what do you mean a generic? Should I stay on Androgel during this (arimidex)? Maybe move to injections?
Really confused by the horrible saliva test and then 2 months later the blood work looks fine?
my doc says that RT3 =< 120 ideal and that RT3 > 300 is a serious problem.
225 is smack dab in the middle between ideal and a serious problem, but is probably just something to keep an eye on. If you address your E2 issues and have your other systems in balance but are still having problem, then maybe come back to the RT3 issue.
There is a cheaper generic version of Arimidex that just hit the US a couple of months ago I think. Much cheaper at the pharmacy.