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About Kierkegaardian

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  1. Good thoughts. I'd say that provided that your problem is thyroid and adrenals (and nothing else), then it shouldn't be too precise a deal to get both of them in line; i.e., you have a decent amount of wiggle room to try and adjust a medication or supplement to feel good. But there are some people whom endocrinologists refer to as being "brittle", meaning they have a narrow window for any medication before they feel good. But I respond to this by saying that being brittle and having such a narrow window could indicate that there's another hormonal (or other bodily) system going on that isn't being accounted for. For example, I started feeling good when I got on a good dose of testosterone (which unfortunately faded), but I was pretty darn brittle -- had a pretty small window of how much I could take. Only later did I realize I had thyroid and likely adrenal issues as well (low cortisol and aldosterone).
  2. Your endocrinologist, respectfully, is wrong. Low cortisol has been implicated in depression, and you can find a study or two on my thread on cortisol, e.g. this post on "hyperdrive" level of CRH (which is elevated in either primary or secondary adrenal insufficiency, and you sound like you might be secondary), or look at the next post I made that talks about low cortisol being associated with suicidal ideation, and at least 90% of people with suicidal ideation have depression, meaning low cortisol is indirectly at the very least linked to depression. Honestly, given his lack of research on the subject, his pride might deserve to be dented. If you come to the forum I referenced above, you'll find *plenty* of "endo horror stories," and we're all still scratching our heads as to how endos can in general be so awful and downright ignorant with cortisol, thyroid, and testosterone-related conditions. This is why I'd say the vast majority of guys who get appropriate cortisol or thyroid help do it through primary care MDs or even NDs and sometimes DCs (chiropractors) and other alternative docs. Second, and this is another thing supported by the research (albeit somewhat on the fringes given the popularity of medical dogma), the ACTH stimulation test can be insensitive and downright wrong, with many false negatives. This is especially the case if you're looking at a secondary adrenal insufficieny situation, where (like you said) the problem is with your pituitary, which would mean low ACTH (which is released from the pituitary), and low ACTH would mean not just low cortisol, but all adrenal hormones given that ACTH stimulates pregnenolone, progesterone, DHEA, testosterone, estrogen, and cortisol (among others) all at once. ACTH stimulation tests are least unreliable when it comes to measuring primary adrenal insufficiency, where cortisol is low but ACTH (in response to low cortisol via negative feedback) is high. That's what I appear to be dealing with, but because my ACTH is high but in range, and same with low cortisol still in range, I really doubt I'd get a confirmation of adrenal insufficiency via the ACTH stimulation test and so would be cast on the street with a possible useless and even harmful antidepressant medication (I don't think antidepressant meds are generally harmful, quite the opposite, but if you put a person with low dopamine on an SSRI you can really screw this person up while he's on it, which is what happened to me when I tried fluoxetine/prozac for 6 days of hell) while my life went on crappily around me. Secondary AI means low cortisol because of low ACTH, which stimulates cortisol. How much HC were you on? Because unless you're supplementing with DHEA and possibly pregnenolone (MLM oral or transdermal forms), getting on HC when your ACTH is low is just going to suppress your ACTH even further, meaning you're getting even less pregnenolone, etc. stimulation (see this chart for an idea of what you're missing). Dr. Mariano (whom I'd recommend flying out to Monterrey, CA to see if you have money for the flight and consultation, see his site at www.definitivemind) says that HC can actually make people feel worse because of too much ACTH suppression, because if ACTH is too low then other hormones like progesterone that are needed to make you feel good are squashed. This can be overcome by getting on a good dose of pregnenolone and DHEA, both of which you can buy online or at a good vitamin store. Ok, so let's go a little further. You have CRH, ACTH, and cortisol in the adrenals that constitute a basic negative feedback loop; also, CRH and norepinephrine in the brain are in a positive feedback loop, meaning CRH increases NE and NE increases CRH. With secondary AI, your ACTH and therefore cortisol can be low, but often your CRH (which is in the hypothalamus and stimulates ACTH in the pituitary) is high, sometimes scary high. Why? Because of negative feedback: cortisol is low, so the hypothalamus picks up on this in the blood and says "ok, let's keep pumping out CRH until we reach the level of cortisol we need," which is going to be much, much slower if you have an adrenal problem, meaning CRH piles up in the blood, but because of whatever reason (brain trauma, enzyme problems, etc.) your pituitary doesn't release nearly enough ACTH despite CRH screaming at it full volume. Well, what happens with high CRH? It increases NE in the brain, and NE in the brain travels immediately down to the inside of the adrenal glands, called the medulla, where it stimulates norepinephrine and epinephrine (adrenaline) in the blood. This is why many people with adrenal problems have insomnia, anxiety, are very sensitive to stress (and stress takes a long time to "get out of their system"), and so on. Their NE is often elevated because CRH is elevated. Even though I'm primary adrenally insufficient, I still have the same effect even if my ACTH is high normal. So it's possible that you just had too low of adrenal hormones because of low ACTH which was made even lower with HC, and/or your HC dose was too low or too high, among other possibilities. What are your symptoms? Remember this is all my opinion, and I'm not a medical practitioner.
  3. In the last two years I started suffering from what now looks to be a pretty significant low cortisol and hypothyroid condition. The cortisol is almost certainly causing my thyroid to be more suppressed, given that cortisol is needed to get thyroid into cells, therefore low cortisol means low thyroid. Dr. Jefferies refers to this in a breathtakingly good section in his book Safe Uses of Cortisol, where he mentions how people with insufficient (not even necessarily low) cortisol and either insufficient conversion of T4 (the mostly inactive thyroid hormone) to the active T3 (the engine of the thyroid that really does all the work) or inappropriately high levels of T3 because thyroid isn't being used by the cells and so is kicked back to the blood, giving the impression of normal thyroid status. Well, I've had a moderate version of anhedonia in the last few years, and didn't notice it until I started getting my hormones straightened out. Especially when I was lowering my thyroid dose I would notice the lack of pleasure -- reading and even watching movies or shows wouldn't be interesting, and I just distracted myself by playing on the Internet and doing easily distractable things that superficially kept my attention. There were at least two week or so times in length when I had what would be called major depressive disorder had the symptoms remained for two weeks, which they didn't, all focusing around the symptom of anhedonia. In my case, though, even lowering my thyroid dose almost certainly negatively affected my cortisol -- both work interdependently together, so if one is off the other can be as well -- so it's somewhat doubtful that it was "just" my thyroid that was to blame. In related news, the STAR*D study, literally the biggest study on antidepressants yet done, showed that the most potent medication with the least side effects for people with depression was T3, the active thyroid hormone, and known by its medical name as triiodothyronine, brand name Cytomel. If you get your thyroid pulled, do not just trust doctors to tell you things are okay. This is because doctors are trained in the false dogma of TSH worship, meaning they only look at a single hormone that actually isn't even a part of your thyroid but rather a part of your pituitary. The real meat and potatoes of thyroid testing goes with free T4 and especially free T3, the latter hormone the one you really want to focus your attention on. Even if it's in the middle of the range you might try and find a doctor who's willing to put you on a trial of Armour thyroid, which contains both T4 and T3. Many patients have unsuccessful ventures with T4-only medications like levothyroxine, because they're not able to convert it properly to T3, meaning their brain picks up on a lot of T4 and so lowers TSH, even though the person might have lower T3 on this medication than before! So get TSH, free T3, and free T4. Now, just a bit of a word of warning here: you don't want to start T3, like me, when your cortisol is insufficient (i.e., insufficient adrenal reserve, where your body doesn't produce enough cortisol relative to ACTH stimulation, which happens all day long in relation to diurnal rhythm and is exacerbated, obviously, during stress), because that can make you feel worse. It's possible to precipitate an Addisonian (i.e., very low cortisol) crisis by taking too much thyroid hormone. So you absolutely must find a doctor who know a thing or two about cortisol, and is willing to pull ACTH and cortisol at the very least, and if possible also cortisol binding globulin, DHEA-S, and aldosterone (a minerocorticoid that is often down when cortisol is chronically down as well). You can also take things into your own hand and get testing from the Life Extension site (buy the order online, print it off and take it to your nearest applicable lab), or go to canaryclub.com and order a 4x/day salivary cortisol test, and take it on a day when you're feeling least stressed. There are answers out there. One of the reasons, at least in my case, as to why anhedonia develops is high norepinephrine (which is typically raised with hypothyroidism) can lower dopamine, given that both hormones are in the same hormone line: tyrosine --> l-dopa --> dopamine --> norepinephrine --> epinephrine. If your body has enough of a demand for norepinephrine, such as in the locus coeruleus in the brain (where the entire sympathetic nervous system response starts, with NE here triggering both NE and epinephrine in the adrenal medulla simultaneously with CRH, itself triggering ACTH, and ACTH triggering the adrenal cortex, including cortisol), it can lower dopamine. Dr Datis Kharrazian, in his new book Why Isn't My Brain Working?, spends a whole chapter on dopamine, including supplements you can take to increase it naturally.
  4. Yeah, that might be because of the B12 (doubtful), the iodine (possible), or something else. I recommend getting selenium and iodine pulled. Did you know, for example, that flouride can wreck your thyroid? It can even basically inactivate iodine, and your thyroid is *all* about iodine, selenium, and tyrosine -- actually the terms T4, T3 etc. refers to a bit of tyrosine and the number of iodine molecules attached to each, I think. I also took a thyroid med at the rec of my wonderful doctor, but it made me feel worse. Why? It had tyrosine in it, which is the raw material from which dopamine, norepinephrine, and epinephrine are made. Well, it's very possible for the tyrosine to just skip by dopamine and overconvert to norepinephrine -- a chemical that I have plenty of, I'm sure. Your supplement didn't have tyrosine in it, but it might be worth giving Gaia's Thyroid supplement a try for this reason. The full site is www.peaktestosterone.com. Go to the upper left and there is a forum area. Lee, the owner, who goes by PeakT, is a great guy. Come on over.
  5. Good luck! I'm a moderator at hormone replacement site, peaktestosterone.com, where you'll get access to a very active forum with great info and support. I'm currently trying to push the thyroid and cortisol part more, so you're welcome to drop by and talk about your symptoms.
  6. Great questions, and thanks for your kind words. Yes, there is a delicate balance with hormones, but if you work with a good doc and read up on your own, you shouldn't have too many problems, provided that your diagnosis is valid. For example, I was diagnosed with hypogonadism (low testosterone) almost two years ago, and getting on treatment -- with the exception of two wonderful weeks -- didn't really do much to make me feel better than a few months before my diagnosis (during which I was having awful anxiety, depression, suicidal thoughts, insomnia, SSRI-induced akathisia, etc., all related to a dumb doctor taking me off thyroid meds when I needed them and undiagnosed adrenal problems). Well, it turned out that I really had three key hormonal deficiencies: testosterone, thyroid, and cortisol. Getting on testosterone without addressing these other issues made me actually feel worse in some ways (while clearly better in others). Moral: make sure you get comprehensive testing. Going to the Life Extension site and looking up their comprehensive male/female hormone panel is a good idea of a wonderful place to start -- and the price is well worth it if you can't get a doc to pull all this stuff. At the same time, so long as you have the appropriate diagnoses -- testosterone, estrogen, thyroid, growth hormone, insulin, etc. -- then it really isn't a matter of having to tweak things really precisely in most cases. You have wiggle room, which is why many people can have terrible thyroid levels on paper and feel just fine; it's probably the interaction of a technical thyroid deficiency with other hormones and biological systems that culminates in clinically significant distress for the patient. In my case, testosterone almost certainly inhibited cortisol (and slightly increased ACTH by negative feedback). Another example: estrogen increases thyroid binding globulin, decreasing free thyroid levels. And so on. The good news is it takes time to completely suppress the hormone you're replacing -- 4-5 months with testosterone, and probably at least a few months for something like cortisol. I'm a big fan of going by symptoms given the limitations of bloodwork, and utilizing trial dosages of hormones or whatever. That's exactly what the best thyroid and adrenal experts recommend with thyroid and cortisol meds: sometimes the only way to know if you have a diagnosis is when you get better by trying out a treatment for a few weeks. Bloodwork can be massively helpful, but sometimes it gives a false negative, making you think things are fine just because things are "in range"; and there are very serious critiques of the ranges of bloodtests anyways, seeing how with hypothyroidism, for example, the range includes a big chunk of people in the general population who are hypothyroid! This means the ranges for diagnosing hypothyroidism should be considerably smaller; for this reason Dr. Mariano recommends starting someone on thyroid meds if he has symptoms and a TSH above 2.0 OR free T3 below 3.2. Many times there isn't any unpleasantness, if you have a good doc and/or really know what you're looking for. I've heard countless stories of people who have tried naturally dessicated thyroid (anything with T3 in it tends to work better for many folks than just T4 meds, which work pretty well for me, fwiw) and have felt better within days, with no side effects. Same thing with HC and testosterone. IMO, the reason for unpleasantness goes back to not considering multiple diagnosis and honing in on one instead, and also with dosing, such as with doctors who prescribe guys like me 200 mg of testosterone every two weeks rather than the more reasonable 40 mg every three days. As for supplements, it depends. Supplements can in many cases be as potent or more powerful than medications. I think about the botanical herb berberine for insulin resistance, which works better than metformin an dis over the counter! I generally recommend testing before trying supplements, but it's usually cool to try low doses of stuff.
  7. You're very welcome, and please ask as much as you'd like, because I'm learning this stuff too (I don't have depression, but I do have weird anxiety, fatigue, and brain fog issues that come and go). Note that the book is a bit technical (written sorta for laymen but also sorta for physicians), but unfortunately there isn't a lot of good information on adrenal problems other than the mega-abundance of many times vague or contradictory information on "adrenal fatigue" -- a very real illness (see an article call "Hypocortisolism: An Evidence-Based Review" for an excellent overview, which you can find by googling). As for HC and thyroid, yes, you're right on the money. Right now my doc and I are playing with the idea of improving cortisol so my thyroid meds might kick in better; I've previously had very bad response to Armour at vastly different doses, and given that my iron and ferritin are good, this means my adrenals are weak (called "low adrenal reserve" by Jefferies and other folks). Basically cortisol is the fuel and thyroid is the throttle when it comes to your cells. You don't want to pull all the way back on your throttle when you have little fuel or you'll peter out (with sometimes bad symptoms); you also won't get anywhere by restocking your car's gas to the brim when your throttle doesn't work too well. Janie Bowthorpe (patient and patient advocate of the wonderful Stop the Thyroid Madness site) says that maybe up to half of hypothyroid folks have some type of adrenal problem. Dr. Romeo Mariano (my Internet hero much in need of a book) says that hypothyroidism, with its excessive sympathetic nervous system-activating levels of norepinephrine (supported by the research, meaning not only is fatigue and depression a common set of symptoms for hypothyroidism, but so is insomnia and anxiety), can wear down at the adrenals, causing adrenal fatigue (i.e., temporary adrenal insufficiency). Cortisol helps get thyroid into cells; not enough cortisol and thyroid does nothing or causes bad symptoms (brain fog, hyperthyroid symptoms, etc.). Dr. Peatfield mentions how thyroid also helps out cortisol at a mitochondrial level. So it seems like thyroid and cortisol reciprocate one another; if you have one out of whack (e.g., too high or too low cortisol) it impacts the other, and vice-versa. It's also important to note that HC isn't the only option, especially (and I'd say exclusively, given that other forms of adrenal problems, like primary or secondary adrenal insufficiency, Addison's disease, and the super interesting Congenital Adrenal Hyperplasia are usually not temporary or acquired in a way that can be ameliorated through supplements and other approaches) with adrenal fatigue, the latter which can be treated with adrenal glandulars (I use Wilson's Adrenal Rebuilder) and adaptogens, such as rhodiola and ashwagandha (I get both and more with Gaia's Adrenal Health supplement), in addition to behavioral changes (reducing stressors, getting good sleep, etc.). And guess what I just found tonight? A key stress hormone call CRH (corticotropin releasing hormone, which stimulates ACTH, which in turn stimulates cortisol) at a "hyperdrive" level is associated with major depression. What is a main reason why CRH can be high? When cortisol is low: low cortisol --> high CRH in response by the hypothalamus --> high ACTH; CRH is also in a positive feedback loop with norepinephrine in the brain (meaning CRH stimulates NE and vice-versa, until cortisol gets off its can and gets high enough to slow things down), so CRH can cause nasty things in addition to depression, such as stuff we basically associate with sympathetic activation: anxiety, low appetite (a huge number of anorexics have low cortisol, for example), insomnia, things like that. What else can happen if you have excessive norepinephrine, as with hypothyroidism (and possibly a low cortisol situation, given that cortisol lowers CRH, and CRH influences NE)? Well, dopamine can be depleted, given that dopamine creates norepinephrine (which creates epinephrine), and it can apparently happen that if you have such a strong demand for (in this case) NE, you can "suck up" the precedent hormone that helps create it. I seem to experience this with my high NE levels: sometimes I'll get hours of anhedonia (don't want to read, or even watch movies), which makes sense in my case given high NE levels that deplete dopamine. Even sex doesn't feel good! Bottom line; depression can totally be a low cortisol situation, either directly (through high CRH, seen in people with low cortisol) or indirectly (as with people with hypothyroidism who don't feel better on thyroid meds because they don't have enough cortisol to make the thyroid meds work). Note: it's important to note Thierry Hertoghe's (international hormone genius) recommendation of taking DHEA with HC. Of course, always get pretest levels when it comes to cortisol (or any hormone, thyroid or otherwise), such as ACTH and cortisol via blood, preferably with cortisol binding globulin, and only getting bloodwork pulled if you're not freaked by needles or stressed by being in your doctor or phlebotamist's office. Otherwise, I recommend a 4x/day salivary cortisol pull, such as through canaryclub.com, preferably with ACTH (if you can get it, and note that somewhat technically DHEA-S is a little useless with saliva). I personally am coming to prefer blood levels, because here you can get ACTH and cortisol (and also more complicated adrenal hormones related to possible enzyme deficiencies, such as 11-desoxycortisol or 17-hydroxyprogesterone), whereas with salivary cortisol (without ACTH) can tell you a lot of information, but there are adrenal problems where cortisol can be just fine but only because CRH/ACTH are at overdrive to make sure cortisol is stimulated to a normal level, best examples being some versions of congenital adrenal hyperplasia and at least the early forms of primary adrenal insufficiency -- meaning that you can easily have a "low cortisol" problem that's relative rather than absolute, giving the appearance (through just cortisol being pulled without ACTH) that your cortisol is fine when it might not be. I know this is a lot, but ask me anything. I also have other recs for treating depression that don't involve medications, such as fish oil, light exposure, etc.
  8. Look into physiologic doses of hydrocortisone, such as espoused by the great William Jefferies: starting dose of 20 mg in four divided doses (every four hours) throughout the day. Your good feelings could instead come not from a lack of cortisol (and a lack of cortisol will jack up CRH, which increases when cortisol is low, and CRH is associated with depression: http://www.ncbi.nlm.nih.gov/pubmed/15196881), but possibly from an increase in dopamine from acute increase in cortisol. So you might consider asking your doctor/professional about a dopamine agonist, especially if your depression in the past has had a strong anhedonia (lack of pleasure) and possibly lack of motivation feel.
  9. Hi folks! I ran across this topic randomly on the Interwebs, as I'm doing research on hydrocortisone, which is man-made cortisol. I'm very likely suffering from what you call hypocortisolism or hypoadrenia, i.e., my cortisol levels are too low. Per the OP, a few possibilities you could get a "high" from prednisone is because, according to neuroendocrinologist Robert Sapolsky, glucocorticoids (of which cortisol is the main one, "gluco" referring to influence on blood sugar and "corticoid" referring to the adrenal cortex) stimulate dopamine, the "feel good" neurotransmitter and hormone that's involved in our reward system. Interestingly, there are three theories on how depression works according to depletions in key neurotransmitters: low dopamine, low norepinephrine, and low serotonin. Some people argue that there isn't just one monolithic type of depression out there, but that people can have three versions (at least) depending on which deficiency is most predominant. Low dopamine shows itself as a lack of pleasure or motivation, low norepinephrine as a lack of energy/lethargy, and low serotonin as obsessive thoughts or rumination. So it's possible you got a kick of dopamine from high cortisol. This is also why we speak of feeling great after getting on a rollercoaster, which is obviously a stressor, but involves a rush of dopamine following the glucocorticoid release. The other possibility -- and one I think is more likely to be the case in general for folks -- is that you also have a low cortisol situation going on. It might only be a "partial" form of adrenal insufficiency, or even what's called adrenal fatigue, and for this reason might not be picked up on an ACTH stimulation test, which tests for cortisol deficiencies. Low cortisol can directly or indirectly cause depression; indirectly through causing problems at the cellular level with thyroid hormone, for example, meaning your body doesn't utilize thyroid hormones at the level of the cell and so stays in serum, giving the impression of good thyroid status (meaning blood levels can actually insidiously be higher than they really are). Taking a physiological dose of what's called hydrocortisone can fix this situation, as well as depression not involving low thyroid and just low cortisol. The thing with prednisone is it's potency: take it for too long, especially if it's at higher than 10 mg a day, and you can easily shut down your own production of cortisol. Hydrocortisone is one-fourth as strong as prednisone, and when taken at physiological doses (i.e., mimicking the levels your body naturally makes, as opposed to huge doses as with prednisone and other synthetic cortisol drugs) *doesn't* shut down your own supply, and also doesn't cause side effects (water retention, buffalo hump, increased blood pressure and blood sugar, etc.). I highly, highly recommend buying a book called Safe Uses of Cortisol by William Jefferies for much more valuable information about cortisol and hydrocortisone, as well as beginning the many times difficult task of finding a doctor (NOT an endocrinologist usually) who tests for adrenal issues. You might consider calling doctors in town and seeing if they prescribe hydrocortisone for adrenal issues, for example, and if so setting up an appointment. There's a chance, quite frankly, that you have low cortisol. Or you're getting a dopamine kick, which could indicate a trial with a dopamine agonist. Best, K
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