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Author Topic: What happens when adrenal fatigue reverses?  (Read 4970 times)

ADHDandOCD

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Re: What happens when adrenal fatigue reverses?
« Reply #15 on: February 03, 2019, 09:44:51 pm »
Hey all, so from what I have read about the stages of adrenal fatigue, it is essentially as follows:

Stage 1: Chronic stress causes cortisol to go high and remain high. In this phase, you usually feel "wired and tired" but always feel on edge and usually have anxiety and difficulty sleeping (which in turn causes more demand for cortisol). Other hormones may start to be affected.

Stage 2: Adrenal glands start to exhaust due to long term demand of high cortisol production. As a result, you now get fluctuations of cortisol from high/low. You fluctuate between being wired and feeling fatigued. Other hormones, like thyroid and sex hormones are usually affected.

Stage 3: Adrenal glands are more exhausted and can no longer produce enough cortisol to meet demand. As a result, you no longer feel wired but more tired all the time, regardless of how much sleep you get. You may also feel cold all the time and feel like you have no physical "energy".

Stage 4: Adrenal glands are extremely fatigued and are producing little cortisol. You will feel fatigued all the time and will over react to even the slightest stress. You may be completely bed ridden at times and unable to function.

I can tell you that what I experienced was exactly this. I went through each of those stages. The question is I am wondering what happens as adrenal fatigue reverses? Does anyone have experience recovering fully from adrenal fatigue? Do you go back through the stages but in reverse? This seems to be what is happening to me. I reached stage 4 and was there for several months. Then after supplements, other therapies and rest, I am no longer exhausted ALL the time, but instead seem to be back in stage 2 almost stage 1 again.

I have been to stage 3 a LOT, but thankfully I've only hit stage 4 a number of times.  I am currently sensing I'm in stage 2 as I go from I'm so happy I have great energy to oh my god I feel like I just took 3 Sleeping Pills. 

I am not certain long-term what happens with that as hormones fluctuate a lot with age, stress, genetics, etc.  I personally find myself (unfortunately) not able to ever fully recover to how I felt with no adrenal fatigue, but I definitely have felt better with reducing stress, reducing stimulants, and trying to just laugh more and feel happier. 

I mean I have "good days" about once every 2-3 months where I feel a little peppier and less tired, but that usually (in my opinion) is when it is just better weather more than adrenals probably. 

D3 honestly makes me feel so much better so I have been supplementing with that and I think it is helping my energy on a side note, just NOT too high of doses as that does kind of the opposite for me and makes things worse. 


Kierkegaard

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Re: What happens when adrenal fatigue reverses?
« Reply #16 on: February 03, 2019, 11:13:37 pm »
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.
"The same thing that makes you live can kill you in the end." -- Neil Young

March 2014: Dx low T (158ng/dl)
September 2015: Dx hypothyroidism, other adrenal hypofunction
2016: chronic fatigue, unspecified

Depression and anxiety guide: http://www.peaktestosterone.com/Help_Anxiety_Depression.aspx

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Re: What happens when adrenal fatigue reverses?
« Reply #16 on: February 03, 2019, 11:13:37 pm »


Redrak

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Re: What happens when adrenal fatigue reverses?
« Reply #17 on: February 04, 2019, 07:36:26 am »
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.

i see and sorry for being a noob about this but from what i understood is, i should be doing less weight training or powerlifting (what i do) and reduce less psychological stress (duh) which is whats causing the high cortisol urine level and acth? for some reason doc wants to rule out cushing

ADHDandOCD

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Re: What happens when adrenal fatigue reverses?
« Reply #18 on: February 04, 2019, 05:10:59 pm »
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.

i see and sorry for being a noob about this but from what i understood is, i should be doing less weight training or powerlifting (what i do) and reduce less psychological stress (duh) which is whats causing the high cortisol urine level and acth? for some reason doc wants to rule out cushing

Yeah, my doc made me do labs to rule out Cushing's syndrome.  I honestly felt like I had Addison's, yet my endo dr. blew me off and told me it was likely my OCD making me think that. 

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Re: What happens when adrenal fatigue reverses?
« Reply #18 on: February 04, 2019, 05:10:59 pm »


ADHDandOCD

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Re: What happens when adrenal fatigue reverses?
« Reply #19 on: February 04, 2019, 05:17:39 pm »
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.

What adrenal enzyme(s) are you thinking of here? 


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.

Kierkegaard

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Re: What happens when adrenal fatigue reverses?
« Reply #20 on: February 04, 2019, 07:14:41 pm »
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. 
"The same thing that makes you live can kill you in the end." -- Neil Young

March 2014: Dx low T (158ng/dl)
September 2015: Dx hypothyroidism, other adrenal hypofunction
2016: chronic fatigue, unspecified

Depression and anxiety guide: http://www.peaktestosterone.com/Help_Anxiety_Depression.aspx

Redrak

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Re: What happens when adrenal fatigue reverses?
« Reply #21 on: February 04, 2019, 08:32:04 pm »
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.

thanks for sharing!

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Re: What happens when adrenal fatigue reverses?
« Reply #21 on: February 04, 2019, 08:32:04 pm »