Well I can only say that for me a peak of 1200 ng/dl is too much. Now im sure there are many who do not have a problem with this - meaning they dont get too much cortisol suppression.
Are you able to try more frequent injection protocol - like every other day? That could balance both ends of the scale so you dont get too much cortisol supression.
Regarding the increase in ACTH - and thus cortisol - I think that the effects should come about pretty fast. For me I saw an noticeable increase in my cortisol levels in a matter of two weeks.
During the first weeks the side effects were also stronger and they eventually lessened as the treatment continued. There seems to be many who quit this treatment during the first weeks. So if you decide to try this route I suggest you stay on the treatment for at least 6-8 weeks.
For me the use of HCG is not a must but it does have enough benefits to take it regularly.
Regarding morning a healthy morning cortisol levels here is a quote from dr Mariano:
"A person at rest who is un-stressed (e.g. hasn't lifted weights the day before) generally will have a morning cortisol level of between 17-20 ug/dL
. If stressed, the cortisol should be higher. This means the person has mounted an adaptive response to the stress to stay healthy and functional. For example, if a person lifts heavy weights the day before, the stress of this may raise the morning cortisol to around 30 ug/dL. This may be "elevated". But it is a normal healthy state. Thus interpreting cortisol also means taking into account the stresses a person is experiencing.If cortisol becomes substantially lower than 17 ug/dL, then that person is failing to adapt to stress
. And past a certain level, that person will become frankly ill. Examples of this state includes posttraumatic stress disorder. Addison's disease is a condition where one is unable to make cortisol due to damage to the adrenal glands. In PTSD, the problem is not the adrenal glands. The problem is that the brain is unable to produce sufficient ACTH in response to stress (norepinephrine signaling). This results in insufficient cortisol to respond to the stress to keep a person healthy and functional.
The failure to produce sufficient Cortisol means one is unable to reduce norepinephrine signaling in response to stress - Cortisol's most important function. One cannot immediately calm oneself down in response to stress. The other adrenal hormones are released along with Cortisol. This means they too would be at deficit. Progesterone and Testosterone for example are calming to the nervous system. Mood then becomes unstable as norepinephrine stimulates the negative subcortical emotional systems of FEAR, RAGE, and PANIC-GRIEF. In children, you see them having tantrums. In adults, you may get anger outbursts or panic attacks, among its many manifestations. Failure to produce sufficient Cortisol also means inflammatory signaling is not controlled. As inflammatory signaling goes up, energy production is shut down, depressive syndromes occur, etc.""
Now my cortisol tests have mainly been in the nmol/l range and I see 450-550 nmol/l as a healthy level for me. So I would say that having morning cortisol at the upper end - not over the range - is an indicator of a healthy HPA-axis.
I have also been suffering with low HPA-Axis activity in the past so I want to offer my own experiences.
I know that doctor Mariano has used low dose SSRI to treat the hypoactivity of the HPA-axis. At least he has done this in the past. Im not sure what is he's stance today.
Here is an excellent write up on how low dose SSRI might help with low cortisol:
I have tried this route myself and I do feel that it works. For me the most important thing was to keep the dose low enough so that you avoid the unwanted side effects.
I was using 2,5mg of escitalopram for over a year and at some point I just felt that I did not need it anymore. I did a slow taper and noticed that my cortisol stayed in good range even without the SSRI. Other thing that made me want to stop it was the emotional numbing that SSRI's often cause.
Other things that I have tried are nicotine patches which improve the activity of the HPA-axis by increasing the release of ACTH from the pituary gland. For me this route is more of an first aid than a long term treatment option. But I do feel that it works. The idea is to use the patches is small portions. For example if you have a patch which has 24mg of nicotine - released in a period of 24 hours - you can cut the patch in quarters and take one quarter a day.
At the moment nicotine patches are more of an nootropic for me than a way to increase cortisol.
Other things that have been a big factor for me are:
- If I dont sleep enough it will eventually lead to a lowered cortisol output. So good sleep hygiene is a must for me
2. Keeping my testosterone dose low enough
- If I go too much past the 1000 ng/dl mark of total testosterone, that will eventually lead to low cortisol also. Keeping the dose low enough and using a EOD injection protocol has worked great.
3. Using HCG
There are anecdotals where people have reported that using hcg with test injections has improved their cortisol levels. I cannot say for certain that this has been the case for me.
4. Thyroid hormones
if you are hypo that can eventually lead to low cortisol levels. So having a healthy levels of thyroid hormones may increase ACTH output. Here's one study that showed just that: https://www.ncbi.nlm.nih.gov/pubmed/2553572
Now I have also tried pregnenolone in the past but I cant say - without labs - that it helped with low cortisol. I do think it improved my sleep a bit.
Thank you for such a great in-depth response!
What would you think if a person's TRT dosage puts them at around 1200 for a day or so and by the end of the week they are around 500-600, is that too much and will cause cortisol suppression?
How long does it take to notice they effects of the low dose SSri? Did you experience any side effects at the beginning of the SSri treatment?
Would you say Hcg is a must if on TRT?
With your current knowledge what would you say is a good morning serum cortisol level?