Hi, I am hoping to get some help even though I am a female and most of you guys are … well guys. 
I have been struggling with this for a long time, which means I have gathered some good information and have a lot to discuss and of course I am looking for answers (why isn’t this common knowledge - yeah I know, nobody is dying from it and/or it doesn’t make any pharmacies any money).
I recently determined I am low on testosterone - proven by experimenting with gel and finding that adding about 2 mg (in gel) daily makes a HUGE difference on how I feel.
I have known I had high cortisol since about 2003, though over the years my symptoms have changed and I have learned more about how to control it (more later), and some of this might always have been low testosterone (it was not tested when my cortisol was tested).
Below I will discuss my symptoms, my lab results, my experience so far with hormone supplements, and some questions about next steps.
I encourage any discussion, feedback, questions, shared experience about anything I write here, whether it matches what I am saying or is directly against what I write.
Teasing these things apart to figure out what causes what and what effects what takes time, effort, attention, any short cuts I might get from any of you is much appreciated. And hopefully I can help some with your symptoms.
SYMPTOMS: I have had/have now:
HIGH CORTISOL Symptoms:
I was diagnosed, by a functional Dr, with High Cortisol about 10 years ago when I was on the quest of why the normal model of lower calories and increase exercise and have a calorie deficit didn’t create weight loss. Saliva testing was done over a day of DHEA & Cortisol (sex hormones were not tested). I was given DHEA (I reacted poorly to that with lots of anger, even on Ã?¼ of a baby dose. I was told it could also kick up progesterone and testosterone). I was given an herbal supplement which helped some.
Feeling the difference with the supplement in me, I could tell when my cortisol was high or low and the symptoms. For me, my high cortisol symptoms are that wide awake feeling, not needing a lot of sleep or not feeling sleepy even late at night and into the morning hours, just that wide awake feeling. I crave sugar (craving carbs is a standard symptom, for me it is craving sugar). Speedy inside, I call it like running at 5000 or even 7000 rpm inside. High cortisol feels great typically, I don’t need to sleep or eat and I feel like I am riding in a convertible on a nice summer day out in the country with the top down. I have always been able to short change sleep, including multiple all nighters and still function pretty good. However it makes it harder to lose weight and I personally believe will have long term health consequences of some kind.
I do have a sugar spiral - High Cortisol makes me crave sugar but eating the sugar when my cortisol is high is never satisfying, I just want more. And eating sugar kicks up my cortisol. Nasty spiral. But if I grab a cortisol lowering supplement instead and hang on for 30 minutes, voila I could care less about sugar.
I have always had a tight posterior chain, it builds from calves up to hamstrings to hip area. As I got older and hormones became more unbalanced (menopause), that posterior chain tightness became worse. I think that cortisol or cortisol interacting with other hormones causes this and no I can’t give any science that might back it up. But it is one of my symptoms that hormones are off and I have had this I think my whole life.
Note: I have read about adrenal fatigue, I have not had any of those symptoms (despite people telling me I must have them after several years of high cortisol). I do know what low cortisol feels like (when I have over controlled it) and that is not a common sensation for me. I think I was born with high cortisol (I can go into this more of conditions that might have caused it), or at least had it since early childhood.
My cortisol is raised by head down working hard days that are long, by food allergies, and by intense exercise without using weights (e.g. HIIT with body weight exercises kicks it up, but HIIT with a heavy weight in my hand doesn’t kick up my cortisol). “Stress” such as a rough life event does not kick cortisol up for me. When I get sick (e.g. flu), my cortisol drops and stays low until I am better (nope, I don’t know the science of why, but repeatedly this happens).
My cortisol is lowered by exercise with weights that really work my muscles (I am guessing this raises testosterone which lowers cortisol?), higher protein in a meal/day, and getting enough sleep & down time. Note: Deep sleep lowers cortisol, and higher cortisol makes it harder to fall asleep and stay asleep, another nasty spiral.
OTHER SYMPTOMS:
During menopause when the sex hormones started shifting (I am guessing testosterone lower, progesterone lower, and estrogen still fairly high because of being overweight), my symptoms got worse.
That first year, the muscle tension got worse. I realized that eating a cup of brown rice a day kept things at bay (manganese?). I really followed eating what I felt like (lots of soy, bitter salads) and kept the bulk of the symptoms at bay so other than the tension didn’t have a lot of symptoms (but I worked it hard).
A year or two later, I got muscle burning like crazy, an acid burning feeling inside the muscle (not like the burn while working out). Sort of like after doing a huge workout the day before but worse and that burning sensation on top of it, and it was all the time even if I had not worked out for a few days. It got in the way of workouts and general life it was so bad. I found some better cortisol controlling supplements and stabilized things. I did go to a menopause naturapath and was given a long list of supplement to try. Massive Vitamin E made a big difference.
A few years later (about a year ago) things seemed to shift again. I had lots of muscle aches that were out of proportion for my workouts, again at a level that was interfering with life. I went looking for more cortisol info and found PS and started using that supplement. I think I have been low with PS my entire life.
Shortly after that, I had my sex hormones tested along with cortisol & DHEA - saliva tests. Yeah, I know you guys don’t mess with those, but if anyone is interested check out ZRTLABS. They do a write up that is pretty complete that tells you where you fall and where different age people fall (just reporting the statistics of all the tests they have taken). I was taking Keto-7, which I thought was a DHEA substitute, but the lab said that Keto-7 can raise DHEA and can falsely report high Testosterone but also can actually raise testosterone . My lab results came back with cortisol controlled when I thought it was and high when I thought it was, with my estrogen high (for post menopausal non HRT female my age), and my DHEA high and my Testosterone thru the roof. So I quit taking the DHEA.
Over the next several months I think things got worse, I think the DHEA was raising my testosterone and it began to crash some after this.
I started feeling jittery/vibrating inside, something I had to be quiet and pay attention to my muscles to feel. Without focusing on this, I just felt not calm, not relaxed, maybe just a touch agitated. I also had the muscle achy feeling and something that I had felt over the year before that I call brittle bones feeling - it feels like if someone had a long bone of the arm/leg balanced with the middle on something solid and pressing down on each end so it felt like it was going to snap. I would feel this across my hips (posterior), in my longer bones, and in general. I was thinking cortisol and upping my supplements made it better but I felt like I was chasing after it and not winning (e.g. throwing in more and more pills to try to control it).
I started experimenting. Progesterone, nope, I didn’t need that stuff at all (every time I try it I quickly feel bad). I tried some testosterone gel and voila, the muscle achy and brittle feeling all went away. The jittery/vibrating feeling went away. I slept great!!! And I could take about Ã?½ the cortisol supplements I was previously taking to control my cortisol.
With testosterone in me, my cortisol is lower and I don’t have to use as many supplements to control it, I sleep better, I am much more comfortable in my body.
LAB RESULTS:
I recently went to a Dr that specialized in bio-available hormones, my first appointment was the day I had said hey, testosterone really makes a difference (I take something, quit taking, and take it again - several times, to make sure that is what is making the difference, not just a coincidence with something else making the difference).
This office is maybe better than a typical Dr, but still big problems, I need to remember don’t believe what they say.
Lab results - from labcorp I believe (NOTE: I had no gel testosterone for 3 days prior, I was taking my cortisol lowering supplements, and yes I as feeling like crap.)
TSH 1.31 (.82-1.77)
T3 free 2.4 (2.0-4.4)
Reverse t3 serum 18.1 (9.2-24.1)
T4 free 1.310 (.45-4.5)
Dr determined by these test results that my thyroid was low. They said that T3 was low and TSH was high as it was kicking out a lot to try and raise T3.
TT (testosterone serum) 14 (3-41)
FT or bioT. Not tested - Note, I asked if this was tested and they said they look at this more for guys but don’t test it in women at all (and sounded like not always in guys?). This forum seems to recommend this should always be tested.
Dr said I was about 10% of what I should be. Note: The nurse practitioner said that their men clients seem to feel best at 1200, and other things they have said have not turned out to be true and/or not true for me, so I am taking everything they say from now on with a huge truck of salt grains.
E2 11 (<6-54.7 postmenopause, 12.5-498 for different cycle phases for women still having periods)
Dr said this was low. I was suspicious as I am significantly overweight, but she said my fat cells must have stopped producing estrogen and I was definitely low.
The items below were tested but the Dr didnâ??t discuss them.
FSH 56.3 (25.8-134.8 postmenopause)
LH 34.4 (7.7-58.5 postmenopause)
[LH/FSH] .61 (< 2 normal? One study claimed this was accepted information).
Aldosterone serum lcms 5.4 (0-30)
ACTH plasma 24.1 (7.2-63.3)
Prolactin 6.6 (4.8-23.3)
DHT not tested
DHEA 49 (> 19 yrs old range is 31-701)
DHEA-Sulfate 67 (35.4-256)
Cortisol 5.9 (2.3-19.4) being lowered with supplements such as PS
Vit B12 1353 (211-946)
Vit D, 25-hydroxy 70.6 (30-100)
All other test results in normal ranges and cholesterol number are good (very low triglycerides and ldl, high hdl), which I credit to grass fed beef & hard exercise.
INFORMATION ABOUT ME:
Female,
Age 54
Height 5’7"
Waist 44â??
Weight @ 260, ideal 150 (low fat with good muscles)
Body & Facial hair - I always been on the light amount of hair for a women
I have never bulked even with heavy weight lifting
Thin as kid, gained the 10-20 lbs as young adult, went thru very stressful times in mid 30s and weight went on quickly. Since then I have to work about 3x as hard as someone else to lose and it comes back on very quickly when I am not sticking to my food & exercise plan (vacation, move, tragedy, etc).
I typically gain weight in hip/thigh area with a flat stomach and hourglass figure, but now I have extra fat everywhere and more lately I have more belly fat which is not typically where I carry fat.
health conditions â?? none, ever, except for cortisol and hormones - see more below
OTC - advil when needed for muscle soreness. Supplements - mostly for cortisol including Vit B & E & ZMA which high cortisol depletes. Vit D & coQ10 & general multi Vit cause it is supposed to be good for me (though there are mixed reviews about multi vitamins).
I eat what I call a fuel and fill diet - first I fuel my body and second I fill my stomach to a reasonable level. It is a quasi paleo diet, with high protein (120-140 g avg on a typical day). At least half is whole eggs & non fat Fage (greek yogurt). The rest is grass fed beef, pasture chicken, seafood (fish, calamari, etc). My healthy fat is coconut (oil to cook, coconut butter, raw fresh coconut) and avocado and occasionally olive oil. I don’t do a lot of grains and they are always whole boiled grains (quinoa or brown rice short grain).
I eat beans when I feel like it, home made from dried beans, on and off as I feel like it but probably a couple of servings per week every other week. I don’t typically eat potatoes but sometimes I will have them (I have been craving potassium, white potatoes, celery, and coconut water the month before I started supplementing testosterone, - things I normally don’t eat, somehow related to the imbalances, as I get in more testosterone I desire less - go figure). I eat small amounts of fruit, mostly black berries about a cup a day and several times a week something else, typically citrus or apple or strawberries and sometimes melon.
I typically eat 5-10 servings of veggies most days, cooked or raw. I don’t eat a lot of processed food; I am allergic to flour and stay away from sugar which cuts out most processed food, I get real consequences from eating it so it keeps me pretty good about it. My treat is a little 85% dark chocolate that I have as desired (on average about 150 calories worth a week). When I eat out, I eat at restaurant that cook (quality and type of food) like I do at home. Yes, sometimes I eat something “bad” for me, but not often, probably one a week on average (though I can go weeks without then might eat something 1-2 times on a bad week).
I eat about a 500-800 calories deficit a day.
Exercise I do: Crossfit type exercises with a trainer, sleds, sledgehammers on tires, Olympic barbell, dumbbell, kettlebell, pushups, pullups. He is a very good evil trainer (e.g. wear out your arms so they can’t cheat and help you with barbell cleans so all they start feeling heavier). I swap out pure cardio like jump rope, running, jumping jacks with things like kettlebell swings as that works better with my cortisol issues. Workouts are typically 45 minutes 6 x a week. I also throw in other exercise, sometimes long slow recumbent bike ride or other ST exercise (sandbag, kettlebells, etc.).
I have always liked heavy weight lifting more than cardio (though I liked sprints and sprinting sports like racquet ball when I was young). I wonder now if it was because it helped increase my testosterone and so I felt better afterwards (I know I felt better afterwards).
BEFORE SEEING THE DR, TAKING TESTIM:
Before seeing the Dr I was trying most to get rid of the deep vibration in my muscles, with the achiness in my muscles an the brittle feeling in my bones/muscles.
I tested with natural progesterone and it made these sensations worse -? a clue.
I played with testosterone (I was nervous about this before, after all we hear women aren’t supposed to need any testosterone, but I was desperate enough I experimented using a fair amount and was surprised it really made a difference. With testosterone in me I felt a lot better, I no longer felt any of the achy brittle feelings, I slept wonderfully, and I felt more settled in my body (no agitation, no vibration deep in the muscles, no jitteryness).
I was taking about 1/5 of a standard tube of testim gel. There is 50 mg in a tube, so I was taking about 10 mg. I read a few places (but not scientific research) that about 10% is absorbed, this means I got about 1 mg a day in me. Yes, I know this varies a lot.
When I had tried Ã?½ of that amount (@ .5 mg a day), it didn’t really relieve my symptoms (barely any difference than no testosterone).
When I tried a little larger amount, I felt real hot all day long, I felt like there was an agitation more on the surface of my body (vs the deep vibration without any testosterone) and I felt uncomfortable. So I knew somewhere about 1/5 a tube/1 mg a day was a good amount for me. Of course I told the Dr all of this (no progesterone it made things worse, yes testosterone and this much is what seemed to help).
AFTER SEEING THE DR:
So the Dr pushed pellets for estrogen and testosterone. I had read just a little about them. I was unsure (you can’t take them out), but I knew I needed the testosterone and they started on the low side, so I agreed with the pellets (big mistake, don’t trust Drs - more later on that).
They put in:
E2 18mg
T 137.5 mg,
They proscribed Armour Thyroid 30 mg tablets.
They proscribed 100 mg progesterone (Note: I was told this was because they have to give this whenever they give estrogen to prevent uterine cancer, they didn’t say anything about if I needed it or not). I believe the premise is flawed, it is based on a study where estrogen was given to women whether they needed it and about 1 in 1000 had a serious side effect -? cancer/heart attack/stroke, and I think but would have to confirm this, that these women were given synthetic estrogen. Whoever decided that giving progesterone would lower the risk. I don’t know if significant studies were ever done to prove that progesterone with estrogen lowered the risks when given randomly to people whether they needed it or not.
I wanted to space things and not dump 4 things in at once, so I could tell what was doing what so I didn’t take any progesterone or thyroid medicine for 2 weeks.
I overall felt a lot worse than before the pellets when I was adding in just testosterone, and I am not able to describe all of how I felt bad, but here is some of my new symptoms.
I had the same symptoms of not enough testosterone (achy muscles & the brittle feelings) as if I had no testosterone in me at all.
I was fatigued and had very low energy with the pellets in me, (both with just the pellets they put in me and also when I added more testosterone to what they gave me). I had significantly less energy than before I had pellets put in me. I am guessing this is a symptoms of too much Estrogen (it could have been because thyroid was lowered, but that didn’t test out to be true, and it could have been that I didn’t have enough T in me, but before I started to test with T I didn’t have that very low energy feeling).
I had known symptoms of too much estrogen (swollen tender breasts and nipples, hmmm do guys get those same symptoms?). I also had uterine cramping, again I believe that is from too much estrogen as I didn’t have them before even when I added testosterone.
I started adding testosterone, trying to get rid of the symptoms I had before I had the pellets put in. I had to use about the same amount I had been using before the pellets were put in to get rid of the achy and brittle feelings (about 1/5th a standard tube a day). But I didn’t feel as good, I was hot a lot, I was uncomfortable, nothing like when I did this before the pellets and felt great.
I tried the progesterone pill - one pill made me feel awful right away, way too much. I waited a few days for it to ware off, and tried some natural progesterone cream. Starting at about �½ a normal dose and going down from there. I took it at night (when told to as it has a sedative quality). I would wake up groggy and be feeling a little draggy and doped up all day. Even going down to 1/10th of the specified dose, I would be groggy during the day (progesterone has a sedative side effect). Overall I felt worse, not better with this in me so I quit taking it. I started waking up with a clear head without it.
I tried the thyroid pill, and one pill kicked up my heart rate 25% (from my typical @ 60 beats per minute, a result of my workouts). My pulse also didn’t feel strong and solid like it typically does, it was wobbly/thready and not strong beats, more like sloshing water? It didn’t feel good. Also overall I felt worse. I played with smaller doses and at 1/10th my pulse felt normal, but I didn’t feel any better, so why bother. Note: It didn’t improve the draggy feeling, even when it kicked up my pulse.
Information I found out about the pellet absorption rate:
For pellets of 75mg, “It has been found that approximately one-third of the material is absorbed in the first month, one-fourth in the second month and one-sixth in the third month. Adequate effect of the pellets ordinarily continues for three to four months, sometimes as long as six months.” DailyMed - TESTOPEL- testosterone pellet search for absorption to find this paragraph.
This is from one of the manufactures - testopel, and the compound pharmacy that created my pellets said that the absorption rates are the same for all pellets as they all have the same ingredients (what is added to the testosterone). Note: The size of the pellet makes a difference, so if someone had a pellet larger or smaller than a 75mg one, it might vary some. See Endocrine Press | Endocrine Society which gives a calculation based on pellet size.
As always it can vary some, putting the pellet in fat might mean it is absorbed into the fat and released into the body slower, but I have read things on the internet (not bothering to go look for them right now) where there was problems with natural hormone creams including testosterone that women used rubbing them into fat as directed (e.g. belly), and then there being a buildup of the hormone in the fat that took some time to get out of the body when the woman was overdosed with the hormone. I also saw something somewhere about injecting testosterone into fat vs into muscle saying it would be released into the body at a slower more steady rate than a shot that is put in the muscle every 1-2 days.
If I would have know that about 1/3 the pellet gets absorbed over the first month and �¼ the next month with much less the following months, with a very small amount the 3rd thru 6th month, I would not have agreed to pellets. I had been told it was a steady release over time, like a pill that was time released.
Gel absorbtion - I have seen others talk about the variations in gel absorption. I find that if I do some exercising after applying the gel, that uses the muscles (for me a little weight lifting), my body absorbs and seems to process?? The T a lot better. That ties into for me that if my cortisol is high and flooding thru my body, if I am working my muscles (weight in my hand vs something like jump rope), I don’t get that high cortisol hit. It is somehow absorbed and metabolized. I don’t know the science behind this, I can just tell you it feels real different to me.
I am still playing with this as well as playing where I apply the gel (e.g. on a major muscle and then use that muscle for 10 minutes of exercise).
Also this month with things messed up, my legs have lost strength and my arms have lots. For example this week doing front squats with 60 lb barbell felt way too heavy, I couldn’t go deep into a squat. But push pressing the same weight was piece of cake (ok not easy, I had to work but I was hardly doing any dip and push, mostly just pressing). The squats should have been much easier than the presses. In the past I have squatted more with a much better squat and not pressed as much weight. I had been putting the testosterone on my shoulders/upper arms. So I am playing now with putting it on my legs to see if that makes a difference, maybe - it has only been one day so hard to tell at this point.
Anyone else notice anything like this?
ANSWERS I STILL NEED:
For now, I am going to stick to the Testim gel, because it works for me and I can adjust it daily or even more often (e.g. not enough, add in a pea size more). I like the idea of adjusting based on symptoms, I understand there is absorption issues and I am willing to play with it to understand how it works for me better.
I see the Dr this week for a followup (labwork done last week at the 4 week mark).
I am going to insist on SERM (thanks you guys for this info), I strongly believe that I didn’t need the estrogen they gave me, and I might have too much in me even without what they gave me. I will ask for it in a cream (vs a pill) as that is easier to play with smaller doses. Yeah, I know I will have to go in with exactly what I want (name, dosage) and expect resistance from them.
I probably should also get an AI, so I have that to play with also, just in case. And at some point I may need it.
I will work to feel my best with the SERM and T gel, then retake labs.
Thyroid - I understand the Drs argument that Tsh is a little high and T3 a little low. But from my tests of how I feel when taking even a small amount of the thyroid pill, I don’t need the thyroid pills. I know that if my testosterone is low that can pull down my thyroid, so next test I will have my testosterone at a level I think is good and see what my thyroid numbers are then. Other than Armour thyroid, anything else to try if indeed my thyroid is low?
Could the Estrogen they gave me be causing the dragging feeling / fatigue I am getting. It has calmed down (now at week 5 after the pellets) to just wanting to sit and not move vs feeling weighed down/pulled down? If not this or thyroid, what could cause it to show up after they pellets were put in? I didn’t feel it before the pellets, regardless if I was adding in some T or not.
Should I push for FT/bioT testing?
What are normal ranges for LB/FSH ratio? Or concerns for this if LH and FSH are both ok?
What role does Aldosterone, prolactin, and ACTH play (I know they are hormone related) and where in the lab range is more optimal?
DHEA -? what is the optimal number for this? Middle of the lab range?
Should I try taking some DHEA since it is low as well as T? Yes, I know that I responded poorly to this before but it has been over 10 years and my hormones have changed so it might be worth trying again. I know this is over the counter now, anything to watch for to get a good brand.
Thanks in advance for your help.