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Messages - Kierkegaard

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1
I don't do well with beers either (most likely the wheat/gluten).
Would be interesting to see how you do otherwise.............Vodka seems like it's the easiest on me, then rum, then whiskey.
I limit myself to 2 if I'm partaking and don't have any issues.

I thought wheat and gluten as well, then looked it up and beers have mg levels of gluten whereas bread has g levels, and I don't experience anything close with bread as I did with beer.

I think it's an estrogen thing for me.

2
Thierry Hertoghe (i.e., world's best endocrinologist, which isn't that hard really) labeled pregnenolone the "memory hormone".  According to Dr Mariano, it's a "crapshoot hormone" given that it can metabolize in many different directions, including progesterone and cortisol (good) or estradiol (bad).

3
The is purely anecdotal, but I've seen a lot of people on Reddit lately say that their e2 rose when switching to SubQ. Have any of you noticed this? I thought that was initially a concern quite a few years ago but turned out not to be true, but I'm reading a lot of people say it really is. Or maybe it's variable according to the individual?

Which reddit are you following for HRT?

All the research I've done, including women on hCG and more generally animal models comparing subq to IM injections of whatever substance, has indicated what C mentioned: longer half life coinciding with a lower peak and smoother overall curve. 

4
...
I started Sub-q yesterday, Hopefully I will have a different experience this time around.

I think I've mentioned before that switching from IM to subQ will result in a temporary dip in hormones if other parameters are unchanged—dose, ester, injection frequency.

I second this, and noticed it in myself when I did the switch from IM to subq.

5
Injection schedule is daily IM.

Sub-Q is another thing I could try now that weight is down. Sucks to try, transitioning from IM to Sub-Q has sent me into a tailspin in the past.


Wish I could afford Defy, just not possible at this time.

Daily IM?  How much are you injecting?

What about the tailspin when transitioning? 

6
Flyingfool, thanks for your thoughts.

If I go to bed later, I still wake at 3am. There are also these strange states of sleep where I'll awaken at say 2am, then I am kinda asleep but not really.

I am going to raise my dose, hopefully e2 wont run rampant.

What's your injection schedule?

If you do more frequent injections, and also subcutaneous (assuming you're on cypionate/enanthate), you should lower your E2 signficantly.  Otherwise you might consider setting up an appontment with Dr Saya at Defy Medical to get on an aromatase inhibitor. 

7
I have read in multiple places and anecdotally from many folks that low T causes poor sleep. The commonalities and frequency of in particular men stating that when they had low T the woke up between 3 and 4 AM was staggering to me. It not only was poor sleep or sleep disturbances. But the focus on 3-4 AM was very common specifically.

I know that natural T production for men they get a burst of T in the morning. Does anyone know how early in the morning that burst of production takes place?  It would be amazing if that burst occurs at about 3 to 4 AM and may explain why if that burst is too low, that sleep disturbance occurs around that time.

Also at least my experience again anecdotally even whe I was young was “old people” were always extremely early risers. It always seemed odd that when retired and had all the time in the world to sleep in and they are up before the sun. But when young was always hoping to sleep in.  I wonder now if this has to do with the depletion of T with age. And when they wake up due to low T at 4am they simply stay awake!

I know that when younger I had no problems sleeping. Now as my T levels have decreased, I do find myself waking and looking at my clock. And interestingly, it is almost exclusively between 3 and 4 am when I awaken.  Hummmm

Also it seems like many people sleep improves when they get proper hormone levels. This includes thyroid as well as testosterone and I suspect cortisol as well. Cortisol also has a wake response burst or peak early in morning but generally occurs about wake time in the 7-8am or so range.

to me this might be the chicken or egg scenario. I am not sure if low T causes poor sleep or rhe other way. But I suspect it is a negative cycle. Once one gets out of balance, I think the negative spiral build momentum.

My understanding is norepinephrine, cortisol, testosterone, and other hormones (though probably not all of them) peak together at around 6:00 am for the healthy circadian rhythmed person.  The sleep disturbances and especially the early morning awakenings could be a combination of a slightly off-kilter circadian rhythm and the burst of norepinephrine magnified and/or improperly moderated by low testosterone, cortisol, and/or thyroid function, all of which are essential for managing norepinephrine and therefore the entire stress response cycle. 

The 4 am wakings were downright freaky for me.  There was a period for perhaps a year where I would wake and see it still dark out and be like, "okay, this time surely it's at least 5:00 am," and sure enough it was within five minutes of 4:00 am EVERY TIME.

8
When my T got too low when things were really bad, I could only sleep 5-6 hours per night and would wake up like clockwork approximately at 4 am.  TRT took that away, and within a year I tried experimenting by reducing my dose as much as I could and seeing what happened, and when I got too low (something like 20 mg every 4 days), I noticed I was waking up like clockwork at 4 am again.

any possibility it could be related to low e2?

Definitely. 

9
When my T got too low when things were really bad, I could only sleep 5-6 hours per night and would wake up like clockwork approximately at 4 am.  TRT took that away, and within a year I tried experimenting by reducing my dose as much as I could and seeing what happened, and when I got too low (something like 20 mg every 4 days), I noticed I was waking up like clockwork at 4 am again. 

10
I'm not a boozer, but lately since I've been feeling better (thanks to 1500 mg of potassium bicarbonate per day given my barely hypokalemic/low potassium blood levels, as well as 500 mg of phenylalanine, the amino acid that becomes dopamine and norepinephrine) I've been getting more social, and since I'm basically divorced and have lots of free time, I've drank basically more in the last week (two occasions) than I have in the past 4-5 years.

I don't plan on making this a habit.  Nelson Vergel points out how chronic alcohol use can elevate estrogen levels, and I've seen studies to confirm this, such as one that points out that women who consumed over 15 grams of alcohol per day had a 26% elevation in estradiol; other studies I've seen were animal studies and showed similar trends. 

I know the answer is "stop drinking so much," and I plan on doing that if not cutting it out entirely.  The other possibility is that since all the drinks have been beers that my likely sensitivity to gluten has been causing difficulties as well.  I am planning on hanging out soon and will drastically reduce my alcohol intake and try clear liquor like vodka if the urge hits me to try and control for this confound. 

Anyone have experience with this? 

11
Any of the enzymes involved in the adrenal cascade can be affected, as seen by this picture:



The rectangular areas are enzymes.  Because of the feedback loop involved with the hypothalamus-pituitary-adrenal axis, downregulation of any enzyme can have different effects.  The body always has in mind a "set point" for where cortisol should be and will jack up pregnenolone via ACTH (and therefore norepinephrine) to reach this set point. 

For example, in women who have 3B hydroxysteroid dehydrogenase, 21 hydroxylase, or 11B hydroxylase downregulations, you often seen excessive body hair or other masculine secondary sex characteristics.  Why?  Because when one of these enzymes is downregulated/lowered, the body has to pump out *that much more* ACTH/norepinephrine and therefore pregnenolone and other adrenal hormones preceding the downregulated enzyme.  Given that women get half of their testosterone from the adrenals, and higher testosterone goes along with this increased pump out of pregnenolone on down adrenal hormones, you get considerably higher levels of all adrenal hormones before cortisol, including DHEA, androstenedione, and testosterone, the latter two which are "male" hormones. 

So there are different types of symptoms you get depending on the enzymes that are affected.  From the site I just linked on 3B hydroxysteroid dehydogenase enzyme deficiency/downregulation:

"3β-Hydroxysteroid dehydrogenase (3β-HSD) deficiency, due to HSD3B2 gene mutation, is a rare form of CAH characterized by increased levels of pregnenolone, 17-hydroxypregnenolone, and DHEA and decreased levels of all other adrenal steroids (Table 1). Affected individuals usually present in infancy with signs of adrenal insufficiency. Female (XX) infants will typically have mild virilization, and a nonclassic form may appear at adrenarche or at puberty. Phenotypic variation in male (XY) infants may range from hypospadias to complete male pseudohermaphroditism."

This site refers to types of what's called congenital adrenal hyperplasia, and despite the "congenital" term there are two types that aren't congenital and are "acquired".  However, you can have partial downregulations of adrenal enzymes such that you don't qualify for CAH but can still have problems if some of your hormone levels are "on the edge".  Importantly, exogenous testosterone has been shown to slightly reduce enzyme activity of 3B-HSD and possibly (it's been a while since I've looked through the research) one or two other enzymes. 

So if you really want to comprehensively rule out adrenal issues, it's important to get ACTH and cortisol in the same blood draw; the higher the ratio (more ACTH and less cortisol) the more you know that *somewhere* in the adrenal cascade you have an enzyme that's downregulated.  If so, just "backfilling" with pregnenolone doesn't help given how pregnenolone is at the top of the cascade; DHEA often doesn't help either but might (if you have 17 ketosteroid reductase downregulation -- which hasn't been shown to be effected by TRT).  All you can do is take low doses of supplemental hydrocortisone (synthetic cortisol) to correct the ACTH:cortisol imbalance.

So not only does exogenous testosterone (less so with hCG given that the body recognizes it as LH, and not at all with clomid given that it stimulates LH and FSH) cause LH and FSH to drop to zero, leading to less overall pregnenolone and therefore all adrenal hormones; it also slightly (or perhaps in some people moreso) lowers the 3B-HSD enzyme, slightly (or more) unbalancing the ACTH:cortisol ratio in favor of higher ACTH given lower cortisol (which leads via feedback to the hypothalamus to higher accumulation of CRH, and in turn higher ACTH from the pituitary). 

But again, I wouldn't let this worry you if you're on exogenous testosterone; in the vast majority of cases "backfillng" with pregnenolone and DHEA should be more than enough given that most of the effect is with LH and FSH going to zero, not so much 3B-HSD being downregulated -- but again, if you're already low in some adrenal enzymes, exogenous testosterone could put you "over the edge".  If so, it still isn't testosterone by itself that's to blame, but rather your precedent flagging adrenal physiology. 

If anyone wants I can try and dig up more detailed threads on this stuff. 

12
TRT doesn't burn out adrenals.  It tends to slightly downregulate adrenal hormone production because LH and FSH also regulate the conversion of cholesterol into pregnenolone (which converts to other adrenal hormones, including cortisol), leaving all the work on ACTH to stimulate pregnenolone.  Many people don't notice anything, but even if they don't this is why it's recommended to take pregnenolone and DHEA to "backfill" the loss of these hormones when getting on exogenous testosterone.

The dizziness and other feelings you're talking about could be low cortisol, but point more toward low aldosterone (which regulates water retention and therefore blood pressure), but it might be something else entirely.


i have a doubt. what if i scored normal in cortisol but high in urine + acth of 44(considered high) is this from too much stress?

That's a hint that your body has high ACTH and possibly high cortisol (sometimes urine is better than saliva, sometimes not).  If your cortisol is normal, your body is "screaming" ACTH at the adrenals to create enough pregnenolone that becomes a normal level of cortisol, meaning you have a possible downregulated adrenal enzyme.  You more likely are just high in sympathetic activity if we assume high ACTH and high cortisol, which leads to physical and psychological stressors to consider.  Hypothyroidism can cause sympathetic arousal given higher norepinephrine (leading to higher ACTH and therefore adrenals).  Food allergies can be stressors.  But so can boring old psychological stress.  If you've ruled everything you, you might look into adaptogens or phosphatidylserine for cortisol.

13
TRT doesn't burn out adrenals.  It tends to slightly downregulate adrenal hormone production because LH and FSH also regulate the conversion of cholesterol into pregnenolone (which converts to other adrenal hormones, including cortisol), leaving all the work on ACTH to stimulate pregnenolone.  Many people don't notice anything, but even if they don't this is why it's recommended to take pregnenolone and DHEA to "backfill" the loss of these hormones when getting on exogenous testosterone.

The dizziness and other feelings you're talking about could be low cortisol, but point more toward low aldosterone (which regulates water retention and therefore blood pressure), but it might be something else entirely. 

14
If you have hypotension, especially orthostatic hypotension (whether or not it's associated with dysautonomia), you should look into testing aldosterone and renin numbers.  Aldosterone is a water-retaining hormone that works through osmosis via salt regulation.  You can try drinking a glass of water mixed with half a teaspoon of unrefined sea salt. 

15
Curt's death still hasn't sunk in and I suspect it never will given that he was known *as* his words on this forum to so many, and his words will always be here.  So there's no way I'll be able to process Dr C's death.

As a licensed therapist with hundreds of hours working with suicidal clients: please get help.  There are tons of options both psychological and physiological to deal with depression and the alienation that goes with it.

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