Endocrinologist May be Half-Assing This

Pharma TRT
21

Thanks for responding, PC.

I hadn’t previously heard of thyroid-rt3.com. I will look into it when I have a chance.

I am going to push hard for rT3 and ferritin with the NP when I see her. D25-OH was 46 ng/mL last time it was checked. I’ve since upped my Vit D supplements from 2k IU to 6k IU daily - was there a specific reason you suggested checking D25-OH again?

What I’m seeing for IsoCort on Amazon is this: http://www.amazon.com/Bezwecken-Isocort-240-pellets/dp/B002D2A6HU/ref=sr_1_1?ie=UTF8&qid=1296072276&sr=8-1

A couple of red flags are raised about that - no dosage information, no ingredient information, etc. Are you sure this is something reliable? If it is a reliable product, how should I be dosing? My understanding of cortisol is that it being too high is a very bad thing (looking at the list of effects that cortisol has on the body on Wikipedia seems to support this belief).

Effects of cortisol: Cortisol - Wikipedia
Information on glucocorticoid therapy: Glucocorticoid - Wikipedia

I am a high risk for diabetes (overweight, relatively sedentary, some family history). I am especially concerned about glucocorticoid therapy’s tendency to exacerbate hyperglycemia.

I’m also aware that cortisol is necessary for basic organ functionality, so I agree that my low cortisol is an issue that ought to be addressed. My goal would be to raise it into an acceptable range without putting it so high that it causes long-term damage to my body.

Regarding an AI: I already have mild gynecomastia (certainly not surgery-grade, but enough that it bothers me). Is there any harm in getting a script for an AI and using it sparingly? Forum protocol for adex/anastrozole is 1.0mg per week in divided doses - would there be any harm in me taking, say, 0.5mg/wk in divided doses? Keep in mind also that I am significantly overweight, and I’m certain that this contributes to my E2 levels. On the bright side, I’ve noticed a significant decrease in hunger today (which happens to also be the first day I’ve noticed any positive effect from the T shot).

Thanks again, PC - and everyone else here! I’m confident that my quality of life is going to improve far beyond what I had ever expected it to be before I knew I had a physiological issue.

22

sorry about the D recommendation. too many threads, just keep doing what you’re doing.

check out STTM for more info on Isocort. it is reported by some to have about 2.5mg of cortisol in it. if you take up to 8 pills a day you would somewhere around the ideal level and supporting your system, not causing you to be too high.

a Cortisol result of 6 is not good. I am told that zero cortisol = dead. 20 = good / 0 = dead… and you are at 6 - so you are closer to death then to ideal health… sound about right given how you are feeling?

you can start AI, but you should only change one thing at a time otherwise you will never be able to pin down what is causing what. so you would then have to wait a month or more to see the impacts of AI before starting cortisol support. I still strongly suggest addressing cortisol first.

there are other sites that list ingredient information.

23

8 pills a day? Ouch. I’m going to need to get a bigger pill case… and a fatter wallet. Still, it’s worth it if it makes me feel better.

BTW, I forgot to Google-fu before I asked about the ingredients. It’s supposedly a 5mg tablet that contains some ‘adrenal cortex’ (though who knows how much). Source: http://www.isocort.net/ingredients Not FDA approved, or approved by any other recognized institution that I can tell, which always concerns me.

I’m leaning towards talking to a GP/NP about hydrocortisone. Considering how low my levels are, it should be trivial to get a prescription for hydrocortisone, and that’ll only cost me $10/mo. (assuming it’s generic, which I bet it is). Before I do that, would you (or anyone else) strongly advice against hydrocortisone for any reason?

Edit: my SO looked into cortisol treatment, apparently cortisol supplements like hydrocortisone are not primary treatments due to the potential for further adrenal harm… sounds like IsoCort has the same problem. Not sure what to do, then. Problems, problems, everywhere…

That sounds likely, as cortisol helps regulate organ function. No cortisol = no regulation, no regulation = plop, dead.

And yes, up until today that describes very well how I had been feeling. I know I’m heavy, but by day 8 after the T injection I felt like I weighed three times as much as I really do. By day 12, I wished I were dead. I slept through wake-up alarms (I never do that), forgot things like turning off my car, was going to bed 2-3 hours earlier, had even less energy than usual, etc.

Today I am feeling a lot better, but that is probably at least partly due to the T injection yesterday (100mg as mentioned earlier). I am concerned that by day 6 I will be feeling like complete shit again (I meant to inject 50mg, but stupidly forgot that my vial is 200mg/mL), and it sounds like that’s largely cortisol-related (T, too, but both combined = blargh).

Thanks for the advice. You’re absolutely right about only changing one thing at a time. Stupid me, I have no right to call myself a scientist for even asking that question - never change more than one variable at a time! :slight_smile: Too bad I don’t have a clone that I could use as a control…

I will hold off on considering AI until after cortisol levels are brought to a reasonable level.

24

read the information about adrenal support on the thyroid-rt3 site and on the adrenal section of STTM. Those are trusted sources of information by many.

the warnings about cortisol are all talking about high levels of supplements. There is a strong concensus that 20-30mg daily does not have the potential to cause any harm. Higher levels of cortisol can, but we are only talking about providing what your body SHOULD normally produce.

think about diabetics taking insulin. What would happen if they took x4 or x10 the recommended amount of insulin? would there be additional harm? probably… well then don’t take x4 the recommended amount. Same thing with cortisol. Take what your body would normally produce (20-30mg and slowly work your way up to that dose, don’t start all at once that is too dangerous), then let your system get back into balance, and then slowly try and wean off and see if your system can pick back up. Some can, some can’t… so you might be on medication for life (just like a diabetic).

and the Isocort pills are about half a tictac.

25

Some people recommend treating one thing at a time, and this is generally sound advice, but if I were in your situation I wouldn’t hesitate to treat E2 and cortisol at the same time, as they are both evidently a problem!

I would say your forgetfulness is probably due to high E2…

Your Cortisol can be supported by means other than hydrocortisone…

I would look at the cortisol production line (pregnenolone, progesterone, cortisol) for deficiency and support what is needed…I think most people can benefit from pregnenolone if cortisol is low, as long as the adrenals are up to the task…this has the side benefit of letting your body decide where to put its building blocks…

As your cortisol improves, your E2 should lower in response…

26

good point VT. some do treat with pregnenolone. It didn’t work for me, but does work for others. Isocort or HC is more direct. my pregnenolone kept going lower when supplementing pregnenolone, and higher once I stopped. go figure.

my only concern with treating the cortisol issue and E2 issue at the same time is that an increase in cortisol can result in a decrease in E2 and it would be hard to know how much or how fast that will happen, and combined with AI, you could easily drive your levels too low and suffer all of those symptoms and not know if it is due to low E or too much cortisol.

HCG can also help cortisol production because HCG causes an increase to 17-hydroxyprogesterone which then converts to Cortisol. No LH/FSH (or no HCG) = no 17-hydroxyprogesterone = low cortisol

27

That’s a fair point, but I wouldn’t let it influence my decision to treat both at the same time…I think it would be hard to drive cortisol too high if using therapeutic doses of preg…maybe more likely is treating with HC…

Regardless, from waht I hear, if you drive E2 too low you are gonna know it and can easily adjust your adex issue down and be fine within a week…to me, that is a good trade off and will allow me to start feeling better almost immediately instead of fixing one hormone for a while (months) while one is still out of whack…

28

Hmm. LH and FSH levels are low, so PC may have a point there. I’m angry at my doc for refusing to check pregnenolone (he did do a check for progesterone, but has only so far told me that “it’s low” - hopefully I’ll get the numeric results in the mail today or tomorrow and I’ll be able to post them).

So. Next steps: see NP, request adex? (smallest dosage available, perhaps I’ll need to find a compounding pharmacy to get something like a 0.1mg dosage made so that I can control dosage more easily), request hCG? (if so, how do I advocate for it?). Talk to PCP about referral to Mayo - I’m going to give it a try, maybe I’ll get lucky. Criticism or advice, anyone?

29

Alright, got the results in the mail today. Nothing too surprising here other than what I’ve already reported, though I guess progesterone is high, not low. Tests were taken at 8:45 AM on a Friday.

TEST = RESULT (LAB NORMAL)

Estradiol = 54 pg/mL (0-33)
AM Cortisol = 6.1 ug/dL (5.0-23.0)
TSH = 1.99 mIU/L (0.2-4.5 - lab uses AACE RRT 2007 results, http://www.aace.com/pub/positionstatements/subclinical.php - I consider these to be bullshit, as the AACE published a press release in Jan. 2003 stating that 3.04 should be the upper limit, and the NACB predicts that 2.5 will become the upper limit in the future)
fT3 = 3.7 pg/mL (2.3-4.2)
fT4 = 1.4 ng/dL (0.8-1.8)
Progesterone = 1.0 ng/mL (Male: 0.3-1.0 ng/mL)

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(link removed, see most recent post)

31

Your E2:FT ratio is horrible and that alone might be repressing your LH. FSH is probably a better indicator of LH because LH is peaky. You need to take that E2 pressure off of your HPTA. A trial with a SERM would indicate whether your HPTA has basic functionality. hCG would test the testes, but not involve the hypothalamus and pituitary.

With TRT, LH and FSH should be low. What was your TRT protocol for the last labs? If injecting infrequently, some of you problems are expected.

When taking a SERM, E2 will increase. If you get a full T response, I would expect that you would need a full TRT dose of adex. With E2=52, perhaps more. I agree, anastrozole is needed.

Why is E2 so high when there is so little T to drive T–>E2? My gut reaction is liver function. Something wrong or liver is too busy metabolizing other things to be able to manage E2. We can expect high SHBG and lower FT fractions too. Review CBC results for liver markers, review OTC and Rc meds for effects on liver enzyme pathways that need to clear E2.

fT3 and fT4 look good, low cortisol could have rT3 up and there that could lead to hypothyroid symptoms while your existing labs suggest the opposite. Did you post waking body temps?

Cortisol needs to be fixed. Progesterone is right upstream from cortisol production, so low cortisol is not rate limited by low progesterone. Would be interesting to see if ATCH is up, trying for more cortisol. If ATCH is also low, the top end is not right.

<insert questions about stress, accidents, surgeries and major stress events>

Progesterone does have some HPTA repressive and anti-libido effects. Possible there is some connection between high E2 and elevated progesterone. Both together may be a bigger problem. Perhaps reason behing flawed E2 clearance in the liver also not clearing progesterone.

The liver converts hormones into water soluble structures that get dumped into the gut via bile. There can be adverse gut flora that restore the hormones to active forms, then they are absorbed via the gut. High E2 levels can result. You can try a good quality probiotic to make a demographic change in gut bacteria. Should be from a vitamin store or elsewhere where the product is sold from refrigeration.

Any progress on increasing cholesterol? Repeat test?

I did not scan all of the posts in this thread, so may be partly off target.

32

The latest labs, 1/21/2011, were taken on day 9 after my first TRT shot (administered at the endo’s office) of 200mg. I can see that screwing up numbers, but the fact that my E2 is that high 9 days after the shot worries me a ton. As mentioned earlier in the thread, I didn’t find this site (and relevant E2 information, etc.) until after my first shot, so I wasn’t able to get a baseline E2 test beforehand.

Not yet. I keep forgetting to take them.

Stress: I do not deal well with stress at all. It’s never taken much to set me off - a poor grade, getting a ticket, a hurtful comment - just about anything will make me feel stressed out and down. Hell, this morning someone posted a note on my car asking me to not park in the back alley because I didn’t shovel any of the snow; I did shovel, and that note pissed me off for maybe 3-4 hours. I know at least some of that is psychological, but I really think there’s got to be something physiological related to that (e.g. cortisol).

Accidents - quick summary (they’re mentioned in the first post): one concussion, one moderate traumatic brain injury, possibly more head injuries (I was very accident-prone growing up), history of very frequent chronic migraines (age 13-17). Three bones broken (trauma-related).

Surgeries - (also posted in first post): tonsils and adenoids taken out around age 4, undescended testicle corrected at age 19.

Major stress events - eh, nothing much. Migraines were always stressful, as were trauma incidents. No family deaths, no major car accidents, etc.

Wouldn’t hurt to try - my SO just bought a large order of them, no reason I couldn’t take some myself and see if it improves how I feel.

No idea. I have increased protein ratio in my diet, but I’m also reducing calories simultaneously in order to lose weight. I’m getting some serious pushback from my primary about ‘testing things over and over’ as he put it - also got a shitton of pushback about most of the tests done. I barely got him to do the E2 test (glad I did!). The other one I pushed hard for was rT3, but no luck there.

I will be seeing my SO’s doc (an NP) next week, and I think she’s a lot more open-minded and will order the tests I want.

I’ll post again once I’m able to get more tests done. I’ll probably post temp soon, I need to find my thermometer first.

Edit: I forgot to mention this, but it’s probably relevant: I don’t smoke (never have), pretty much don’t drink (maybe a glass of wine a month), and don’t use any drugs - well, not other than OTC/prescribed drugs.

Current meds are on page 1.

Edit 2: I forgot to mention that I also had antibody TPO checked - result is 2.0 IU/mL on a range of 0.0 - 9.0.

33

Thanks for bringing things back in focus.

You sound like an adrenal fatigue case.

We have seen a lot of guys with T, thyroid and adrenal issues. I do not agree with treating and attempting to finalize one then the other as the systems are coupled. Adrenals need to be able to follow the demands of TRT and thyroid drugs. So that should be layered in a bit sooner than the others.

Maybe you can package some of this for the NP.

I can’t see that we have discussed iodized salt. Is there iodine in your vitamin?

34

I’m fairly certain that there isn’t. It’s just a typical adult Centrum vitamin. I did recently add a stress B-Complex vitamin that is supplementing a few things that Centrum doesn’t, but I don’t believe that it has iodine.

35

I strongly recommend cortisol treatment first.

your thyroid and hormones can’t get balanced if your cortisol stays too low. boosting your thyroid without enough cortisol will just causes your system to crash harder. taking extra T without enough cortisol will cause your system to dump the excess T into estradiol (regardless of how much AI you take).

option 1 = start pregnenolone (transdermal probably won’t work because you have hypothyroid symptoms) so I would recommend trying lipid matrix micronized pregnenolone pills (50-300mg daily in split doses) to boost your cortisol (but without HCG to boost your 17-hydroxyprogesterone conversion, the preg might not convert to cortisol).

option 2 = isocort up to 8 pills daily split doses (build up to 4 upon waking, 2 at lunch and 2 at dinner)

option 3 = hydrocortisone start at 5mg and every 2-7 days boost by 5mg till you are taking 20mg - something like 10 upon waking, 5 at 11am, 2.5 at 3pm, and 2.5 at 6pm)

36

PC: "Progesterone = 1.0 ng/mL (Male: 0.3-1.0 ng/mL) "

Isn’t that enough raw material for cortisol production?

Pregnenolone has other benefits as and may be beneficial in any case.

37

yes. preg can help. I didn’t help me, but others have said it has helped them greatly.

progesterone convert to 17-hydroxyprogesterone and then 17-hydroxyprogesterone converts to cortisol, but 17-hydroxyprogesterone is stimulated by LH or FSH.

no HCG = no or very low 17-hydroxyprogesterone. 17-hydroxyprogesterone also correlates almost directly with T production in the testicles (per a focused research study)

taking extra pregnenolone will hold up at progesterone or go down the DHEA route if you don’t have sufficient LH (or HcG).

38

Correction from above: my daily multivitamin does have iodine (150mcg, 100% recommended D.V.).

39

according to some that is a tiny dose. RDA = meaningless.
I take 12.5mg EOD iodine (not yet sure if it is helping or not)

40

I have only done three temperature tests so far, but the results seem very relevant so I am posting them right now:

Wake - 8:30 AM
Temp 1 - 96.6F @ 9:20 AM
Temp 2 - 97.3F @ 11:30 AM
Temp 3 - 97.3F @ 2:30 PM

I have an appointment with my SO’s PA (not NP as I had previously believed) on Monday, so hopefully I’ll have some good news then.

Thanks again for all of the help, everyone.