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Secondary Adrenal Insufficiency

swim15

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Jun 8, 2013
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After a two year long battle with ulcerative colitis I finally have it mostly under wraps. In remission with all lingering inflammation under control as far as I can tell. Targeted biofilms, major diet changes, the works. Currently have my diet down, loads of herbs, spices, and natural anti-inflammatory's.

It seems like I’ve got most of my issues squared away which were due to lingering inflammation that didn't show on CRP or ESR blood levels. However, I’m out of ideas on the things I'm dealing with now so thought I’d just get some thoughts. I know we have some incredibly knowledgeable memes like Stewie and others on here.


Current - suffering all the symptoms of adrenal insufficiency.
That's constant fatigue, no sex drive, poor sexual function, days to recover from workouts (from physical soreness but also from mental tiredness , ie lack of 'gumption'), couldn't wake up in the morning and had a hard time falling asleep at night. Just generally messed up sleep cycles. Muscle aches, more frequent urination, overly sore joints...those are the major ones.

I've exhausted docs and going to look into some naturopathic functional medicine providers but have already dished out a lot of $$ over this so want to be as specific as I can be.


Bloods - would have more but its been like pulling teeth to get them drawn and tried to go through docs because it was all free with insurance.

Pregnenolone: 29 (22-237)
DHEA-S: 200.1 (85-690) ------ previous draw 2 years ago 430

Cortisol (8am) - 7.7 (range 5.4-18.5) ----- previous draws 13.5 and 15.8 2 and 3 years ago respectively (down ~50%)


TSH:
3.504 uIU/mL (range 0.34-4.2) ----- previous draws from a were 0.813 and 0.931 (~4x as high)

Free T4: 0.84 (range 0.58-1.70 – doesn’t list value but assuming ng/dl) ----- previous draw was 1.22 (range 0.61 - 1.12 ng/dL - ~50% lower)

Free T3:
Free T3: 3.4 (range 2.50 – 3.90) ----- previous draw was 3.1 (range 2.3-4.2pg/ml)


Other random draws from a couple months ago were
Prolactin: 12.3 (range 2.6-13.1)
Copper: 61 (80-180)



Have been supplementing copper (no zinc). Zinc level was normal. Vitamin D, B, and folate are all at the high end of the range. CBC and CMP's are all normal. HRT is ~37.5mg TE and 15mg TP 5 days a week, so about 275mg. Estrogen runs high but haven't checked it super recently. No symptoms and have always felt like trash running an AI. Last estradiol (sensitive) 8 months ago was 99pg/mL (range <29). Felt great then and that was on about 350mg per week.


I added 25mcg T3 this past Friday after I got the thyroid labs because I suspected subclinical hypothyrodism and after about 3-4 days it helped my energy tremendously. I didn't feel like dI had tons of drive per se but I could wake up in the morning and didn't want to nap all the time. After 3-4 days though I was overstimulated/wired which I have never had happen with T3 before even at higher doses in my competing days. Doc actually wrote a script and gonna play with 15-20mcg per day. While the thyroid takes care of the energy problem to an extent its weird to have energy but not really feel like doing a lot. None of the drive to do things and the general alpha-male 'come at me' with life feeling that I have had most of my life. No general sense of well-being and motivation I guess.


At this point I have trialed/error-ed and recorded responses to a lot of things from caffeine, to DHEA, to amphetamine and other supplements trying to narrow things down.
- All stimulants make me feel wired and on edge whereas they used to make me feel great from adderall to coffee
- Pregnenolone makes me feel stimed out and wired (even just 10mg) even though it used to make me feel good/focused
- DHEA is unnoticeable entirely at any dose
- Holy basil helps some at night as far as sleep and waking up a little easier
- Melatonin (SL) works well with getting to sleep (until I added T3 and then doesn't work at all)
- Dianabol used to increase energy and sex drive but no longer does
- Cabergoline used to help but doesn't do anything noticeable and haven't used it in a while
- Yohimbine or DMAA don't help sex drive at all like they used to
- Maca does nothing

Have tried lots of other things but those are the ones that come to mind immediately. Just tired of low energy and zero sex drive at 26.



My next thought right is dropping the T3 for a few days and already have a lab to do a 4x daily saliva cortisol test to measure the rhythm. Then check progesterone probably.

Sorry, not really a TLDR. Will answer any questions I can about labs or symptoms. Any thoughts on next moves?
 

nothuman

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Looks like you are suffering with the same thing as me. I just received cortisol saliva results yesterday and they're just as awful as they were six months ago. It's really defeating :(

My DHEA and pregnenolone are also low. I started taking them again. My progesterone is high. I am on the fence about using an AI to keep e2 and progesterone down to normal range. If it was just about lowering E2, I wouldn't do it, but I worry about high progesterone effects.

My copper is also low. Seeing yours low makes me wonder what the connection is. My zinc was on the low side too, so I am now taking 100mg zinc and 10mg copper, which seems high but I cant afford those deficiencies.

I'm currently on 75mcg T3 a day. My FT3 level was 3.0 off thyroid medication, which is not adequate. Yours was a bit better than mine. I did successfully get my reverse T3 down recently.

I just don't know what else to do to get my cortisol up. It just seems impossible. I can't get an ACTH stim test during covid, which drives me insane. I need to know if I developed AI. My morning cortisol on a blood test was 11, ACTH and aldosterone are within normal, but renin is high.

It's impossible to live like this and no doctor has been properly trained enough to treat it because there is no middle ground between healthy and adrenal insufficiency to them.
 

IronLion2

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Have you tried coming off?
 

Sides

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Jul 26, 2006
Messages
636
After a two year long battle with ulcerative colitis I finally have it mostly under wraps. In remission with all lingering inflammation under control as far as I can tell. Targeted biofilms, major diet changes, the works. Currently have my diet down, loads of herbs, spices, and natural anti-inflammatory's.

It seems like I’ve got most of my issues squared away which were due to lingering inflammation that didn't show on CRP or ESR blood levels. However, I’m out of ideas on the things I'm dealing with now so thought I’d just get some thoughts. I know we have some incredibly knowledgeable memes like Stewie and others on here.


Current - suffering all the symptoms of adrenal insufficiency.
That's constant fatigue, no sex drive, poor sexual function, days to recover from workouts (from physical soreness but also from mental tiredness , ie lack of 'gumption'), couldn't wake up in the morning and had a hard time falling asleep at night. Just generally messed up sleep cycles. Muscle aches, more frequent urination, overly sore joints...those are the major ones.

I've exhausted docs and going to look into some naturopathic functional medicine providers but have already dished out a lot of $$ over this so want to be as specific as I can be.


Bloods - would have more but its been like pulling teeth to get them drawn and tried to go through docs because it was all free with insurance.

Pregnenolone: 29 (22-237)
DHEA-S: 200.1 (85-690) ------ previous draw 2 years ago 430

Cortisol (8am) - 7.7 (range 5.4-18.5) ----- previous draws 13.5 and 15.8 2 and 3 years ago respectively (down ~50%)


TSH:
3.504 uIU/mL (range 0.34-4.2) ----- previous draws from a were 0.813 and 0.931 (~4x as high)

Free T4: 0.84 (range 0.58-1.70 – doesn’t list value but assuming ng/dl) ----- previous draw was 1.22 (range 0.61 - 1.12 ng/dL - ~50% lower)

Free T3:
Free T3: 3.4 (range 2.50 – 3.90) ----- previous draw was 3.1 (range 2.3-4.2pg/ml)


Other random draws from a couple months ago were
Prolactin: 12.3 (range 2.6-13.1)
Copper: 61 (80-180)



Have been supplementing copper (no zinc). Zinc level was normal. Vitamin D, B, and folate are all at the high end of the range. CBC and CMP's are all normal. HRT is ~37.5mg TE and 15mg TP 5 days a week, so about 275mg. Estrogen runs high but haven't checked it super recently. No symptoms and have always felt like trash running an AI. Last estradiol (sensitive) 8 months ago was 99pg/mL (range <29). Felt great then and that was on about 350mg per week.


I added 25mcg T3 this past Friday after I got the thyroid labs because I suspected subclinical hypothyrodism and after about 3-4 days it helped my energy tremendously. I didn't feel like dI had tons of drive per se but I could wake up in the morning and didn't want to nap all the time. After 3-4 days though I was overstimulated/wired which I have never had happen with T3 before even at higher doses in my competing days. Doc actually wrote a script and gonna play with 15-20mcg per day. While the thyroid takes care of the energy problem to an extent its weird to have energy but not really feel like doing a lot. None of the drive to do things and the general alpha-male 'come at me' with life feeling that I have had most of my life. No general sense of well-being and motivation I guess.


At this point I have trialed/error-ed and recorded responses to a lot of things from caffeine, to DHEA, to amphetamine and other supplements trying to narrow things down.
- All stimulants make me feel wired and on edge whereas they used to make me feel great from adderall to coffee
- Pregnenolone makes me feel stimed out and wired (even just 10mg) even though it used to make me feel good/focused
- DHEA is unnoticeable entirely at any dose
- Holy basil helps some at night as far as sleep and waking up a little easier
- Melatonin (SL) works well with getting to sleep (until I added T3 and then doesn't work at all)
- Dianabol used to increase energy and sex drive but no longer does
- Cabergoline used to help but doesn't do anything noticeable and haven't used it in a while
- Yohimbine or DMAA don't help sex drive at all like they used to
- Maca does nothing

Have tried lots of other things but those are the ones that come to mind immediately. Just tired of low energy and zero sex drive at 26.



My next thought right is dropping the T3 for a few days and already have a lab to do a 4x daily saliva cortisol test to measure the rhythm. Then check progesterone probably.

Sorry, not really a TLDR. Will answer any questions I can about labs or symptoms. Any thoughts on next moves?

So much of this resonates with me, and I have many of the same symptoms, although I am twice your age. I'll be following this thread closely.

A couple of thoughts:

You say estrogen runs high, but you have no symptoms, yet you list low sex drive and poor sexual function. Are you sure high estrogen couldn't be part of the problem? I sympathize, though, because like you, even micro-doses of an AI always make me feel worse, not better.

Your free T-3 seems to be at a good level, but your free T-4 is low and your TSH is relatively high. Have you thought about adding T-4 rather than T-3? Both are necessary for good health, although we tend to focus on T-3. But I've always read that your free T-4 should be up around 1.6-1.7. Adding T-4 will probably be my next move for addressing my own thyroid problems, as I have never been able to get the dosing right with T-3 with it's short half life, and constant feelings of ups and downs.

I am the same way with a lot of things in your post. I always loved stimulants, caffeine and ephedrine and yohimbine, but now they make me jittery and anxious rather than just up, and the while the yohimbine used to help with getting an erection, the negatives seem to outweigh the positives these days. But when I first wake up, I'm groggy and need something to get me going. And I'm constantly sore and beat up now, and take longer to recover from working out. And getting fatter while keeping my diet the same, due to the thyroid problems.

Doctors haven't been much help. As long as you are in the range, they don't want to treat it, just say "Well wait 2-3 months and we'll retest to see how you're coming along." Of course, that's easy for them to say, as they don't have to live with it.
 

swim15

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Interesting info guys, thanks for the input. Is there any other tests you guys have gotten done or things that you feel have helped or made things worse? Triggers or any feel for why/when things started?

I may try coming off completely but I’ve had random weeks over the past 8 months where everything returns to normal for a short time and all symptoms go away only to return which has kept me too hopeful.

On a time crunch so trying to figure this out in the next couple months but feel like I never will.
 

Sides

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Messages
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@Sides - Have you had cortisol or any other hormones or anyrhing checked?

LOL I think I have had everything checked now, at some point or another over the last year when I've been struggling to figure out what is wrong with me. Other than the nutrients like zinc, copper, etc, never had those done but I do supplement with 30mg of zinc per night, magnesium, fish oils, multi-vitamins, Vitamin D.

Total blood cortisol I last checked in February and it was CORTISOL, TOTAL 12.2 NORMAL mcg/dL 01 Reference Range: For 8 a.m.(7-9 a.m.) Specimen: 4.0-22.0 Reference Range: For 4 p.m.(3-5 p.m.) Specimen: 3.0-17.0

Thyroid levels on 4/21/20 were:

T3, FREE 2.6 NORMAL 2.3-4.2 pg/mL
T4, FREE 1.1 NORMAL 0.8-1.8 ng/dL
TSH 1.50 NORMAL 0.40-4.50 mIU/L

All I can think to do now is to supplement with T-4, and hope to accordingly raise my T-4 and T-3 levels.

I've tried to add just T-3 for over two years now, and while it seemed to work well in the beginning, eventually I felt bad adding T-3 and it made me feel worse, not better.
 

swim15

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Sides - also sorry just saw your question.

I don’t think estrogen is part of the problem because taking dianabol for a while was mitigating symptoms whereas I could never take it before due to strong e2 sides.

May have to play around with it though.
 

swim15

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@nothuman thats interesting on your copper as well. Gonna get mine rechecked I think.

What was your saliva cortisol test like?

Is there anything that seemed to trigger all of this for you?
 

IronLion2

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Funny this week people very close to me all told me they've come off recently and how much better they feel, likely all for different reasons but the sentiment remains the same.
 

swim15

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Funny this week people very close to me all told me they've come off recently and how much better they feel, likely all for different reasons but the sentiment remains the same.
Funny this week people very close to me all told me they've come off recently and how much better they feel, likely all for different reasons but the sentiment remains the same.

Not opposed to it per se. I was off for about a month earlier this year but may not have been long enough to notice much.

The people you know using HCG or any type of PCT? Would be one of the first real times in 8 years since starting AAS
 

swim15

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Funny this week people very close to me all told me they've come off recently and how much better they feel, likely all for different reasons but the sentiment remains the same.
Funny this week people very close to me all told me they've come off recently and how much better they feel, likely all for different reasons but the sentiment remains the same.

Not opposed to it per se. I was off for about a month earlier this year but may not have been long enough to notice much.

The people you know using HCG or any type of PCT? Would be one of the first real times in 8 years since starting AAS
 

IronLion2

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Not opposed to it per se. I was off for about a month earlier this year but may not have been long enough to notice much.

The people you know using HCG or any type of PCT? Would be one of the first real times in 8 years since starting AAS

One did the two others didn't. If the issue is quality of life like all three were, going cold turkey won't be as bad as people make it out to be. None of them were on HRT because they couldn't get hard or they wanted to be IFBB, so coming off had no negatives for them. I am however not advising to go off without pct, I just think it's more applicable for a general HRT user than a blast and cruise guy.
 

Sides

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One did the two others didn't. If the issue is quality of life like all three were, going cold turkey won't be as bad as people make it out to be. None of them were on HRT because they couldn't get hard or they wanted to be IFBB, so coming off had no negatives for them. I am however not advising to go off without pct, I just think it's more applicable for a general HRT user than a blast and cruise guy.

While I understand the notion of coming off everything, to do a "hard reset" of the system, surely the utility of that is to a large degree dependent on the length of time that a person has been on? If you've been on test and other steroids for a long time, I believe most of the research shows that you are always going to be hypogonadal and will never regain normal testosterone levels, and of course having low or no testosterone levels is associated with a tremendous amount of negative health conditions. Hence why we have TRT to help those who are permanently hypogonadal. I imagine the same is probably true for thyroid administration as well.

For instance, I have been on test and other steroids for over 28 years now, off and on but mostly on. The last break I took was for 3 years from 2008-2011, when I was in federal prison for selling anabolic steroids. During that 3 year break from taking steroids, I never had one erection, and I am sure I had low testosterone levels the whole time (impossible to get blood tests when you are in prison, of course LOL.)

When I got back on test again, I regained my libido and ability to get an erection, and I've been back on test for over 9 years now without a break. Although I have my share of problems now, I can only believe that going off completely will make the problems worse, not better.

The same is probably true for thyroid administration. I started taking 25mcg per day of T-3 back in November of 2017, which was great for me at first, but slowly my levels and symptoms got worse with time. I increased to 37.5 and then 50mcg per day, and felt better, before I eventually started feeling worse again. Now my endocrinologist wanted me to go off everything to see if my own natural thyroid levels recover. But I've been off for over 2 months now, and I feel much worse, and my thyroid blood test results (listed earlier in the thread) don't seem to be getting any better.

I have to believe that with thyroid, as with testosterone, once you've suppressed your own natural system for so long, it's probably impossible to recover, and you will need supplementation for the rest of your life, as we do with TRT.

I would like to believe that I'm wrong, and eventually everything will bounce back to normal again. But sadly, it just doesn't seem to be so.
 

IronLion2

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While I understand the notion of coming off everything, to do a "hard reset" of the system, surely the utility of that is to a large degree dependent on the length of time that a person has been on? If you've been on test and other steroids for a long time, I believe most of the research shows that you are always going to be hypogonadal and will never regain normal testosterone levels, and of course having low or no testosterone levels is associated with a tremendous amount of negative health conditions. Hence why we have TRT to help those who are permanently hypogonadal. I imagine the same is probably true for thyroid administration as well.

For instance, I have been on test and other steroids for over 28 years now, off and on but mostly on. The last break I took was for 3 years from 2008-2011, when I was in federal prison for selling anabolic steroids. During that 3 year break from taking steroids, I never had one erection, and I am sure I had low testosterone levels the whole time (impossible to get blood tests when you are in prison, of course LOL.)

When I got back on test again, I regained my libido and ability to get an erection, and I've been back on test for over 9 years now without a break. Although I have my share of problems now, I can only believe that going off completely will make the problems worse, not better.

The same is probably true for thyroid administration. I started taking 25mcg per day of T-3 back in November of 2017, which was great for me at first, but slowly my levels and symptoms got worse with time. I increased to 37.5 and then 50mcg per day, and felt better, before I eventually started feeling worse again. Now my endocrinologist wanted me to go off everything to see if my own natural thyroid levels recover. But I've been off for over 2 months now, and I feel much worse, and my thyroid blood test results (listed earlier in the thread) don't seem to be getting any better.

I have to believe that with thyroid, as with testosterone, once you've suppressed your own natural system for so long, it's probably impossible to recover, and you will need supplementation for the rest of your life, as we do with TRT.

I would like to believe that I'm wrong, and eventually everything will bounce back to normal again. But sadly, it just doesn't seem to be so.

Who are we talking about here? OP is 26....

We're not talking about hypogonadism children were talking about exogenous hormone use, most users had a functional amount sex hormones prior to starting.

Micromanaging systems in which you don't have full control of is a poor choice for most people. Theres a reason endos are known as quacks and it's not because their not smart or trying, it's a nearly impossible task for some. The amount of effectors you have to control for is just to much.

I suggested he hasn't explored all possibilities, as there was another option. Never suggested a reset, I told him if it makes you feel like shit than stop doing it.
 

swim15

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@Sides - I get what you are saying. Thyroid is different from testosterone production, however, from the studies I’ve seen and there was one where people unnecessarily put On thyroid medication for 10 years were able to regain natural function.

I just came across some stuff that may help you (and me) though. Take a look at the info from Dr. David Brownstein on iodine consumption. Lots of anecdotal evidence that people who increased their iodine intake were able to get off meds and feel good with normal thyroid function. Think I may have th at a go.


@IronLion2 I doubt my issues were caused by HRT considering that this all started with an auto immune flare. I’ve heard some of the same anecdotal evidence from people as you though and not opposed to trying to let my body regain homeostasis on its own.

Gonna go get some labs drawn soon and work with a functional medicine doc I think to see if I can dig into some of this stuff.
 

KillerStack

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I'm curious about the copper. Seems like it might be a bad idea to supplement especially in high doses. For example if you check the neurology section here:

But I don't really know much about it. I checked it out awhile back because I read it boosted igf-1, but I was put off by the examine page.

Though I remember Poliquin saying it helped joint pain in some.
 

Sides

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Who are we talking about here? OP is 26....

We're not talking about hypogonadism children were talking about exogenous hormone use, most users had a functional amount sex hormones prior to starting.

Micromanaging systems in which you don't have full control of is a poor choice for most people. Theres a reason endos are known as quacks and it's not because their not smart or trying, it's a nearly impossible task for some. The amount of effectors you have to control for is just to much.

I suggested he hasn't explored all possibilities, as there was another option. Never suggested a reset, I told him if it makes you feel like shit than stop doing it.

OP is 26, but has been on exogenous hormones for most of the last 8 years, almost a third of his life.

Hence while he probably had a functional amount of sex hormones prior to starting, after 8 years he almost certainly will have secondary hypogonadism now. His body will, at least in the short run, be unable to produce a functional amount of sex hormones. Whether his system can recover in the long run, or whether he will require TRT to be functional, remains to be seen. His relative youth works in his favor, however, the length of time he has been on exogenous hormones works against him.

I understand you are offering him another option to explore. Going off completely is certainly a valid option. It certainly is the simplest option (Occam's Razor.) However, it is fair to warn him that going off completely will almost certainly make him feel much worse before he feels better...if he ends up feeling better.
 

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