New tests show that my cortisol output is elevated above the range – What does it mean? Is it good news?

[Johnny]

Hello Dr Mariano and others,

After three years of struggling and being on TRT for the last 6 months without any improvement in symptoms, I finally was able to test my saliva and urine cortisol. I suspected it would be low, but results came back and shows that my total output is way above the top of the range and my evening cortisol is also high.

Could this explain my low testosterone symptoms, fatigue, lack of energy, cold hands and feet, brain fog and how I easily gain fat despite a thyroid that looks good?

What does it mean and how can it be treated? Is this good news? Reading online, it seems to suggest Cushing or high stress. I used to live a stressful life, but I`m not any longer and have not been for over a year. Mild stress, yes, but nothing severe. I don`t think it could be Cushing, but I suppose I should be tested for that. My doctor just shrugged it off.

Quick comment on BW:

– This is 10 weeks after my last Nebido shot and no HCG, so testosterone is lower than on the prior test, but still higher than pre-TRT.

– Insulin is down 28 points from the last test.

– High vitamin B and Zinc. I have been supplementing with zinc, so that probably explains it. Not Vitamin B though.

– TSH is actually down from the last test and T3 is even a little higher.

Thyroid

TSH 2,44 mIU/l (0,5-3,6)
Free T4 18,3 pmol/l (8-21)
Free T3 7,9 pmol/l (3,6-8,3)
Thyroxine 110 nmol/l (60-150)
Triiodothyronine 1,7 nmol/l (1,2-2,7)
Reverse triiodothyronine 0,28 nmol/l (0,14-0,54)
TBG 15,1 mg/l (12,0-28,0)
Anti-TPO <10 kIU/l (<35)
Anti-thyroglobulin <20 kIU/l (<40)
TRAS <0,9 IU/l (<1,8)

Gonads

FSH <1,0 IU/l (1,4-12,0)
LH 2,5 IU/l (1,8-12,0)
Prolactin 177 mIU/l (50-700)
Estradiol 0,08 nmol/l (<0,18)
Progesterone <1,0 nmol/l (<3,0)
Total testosterone 15,0 nmol/l (8,0-35,0)
SHBG 15,0 nmol/l (8-60)
Free testosterone index 10,0 (3,0-14,7)
DHT 1,99 nmol/l (0,90-3,10)
Androstendione 3,2 nmol/l (<6,2)

Adrenals

Serum cortisol in blood 08:30 AM 464 nmol/l (138-690)
Serum cortisol in blood 08:30 AM 1034 nmol/l (138-690) (the day after at another lab)
Saliva cortisol 08:30 AM 16,6 nmol/l (4,0-27,0)
Saliva cortisol 10:00 PM 6,6 nmol/l (<6,0)
Free cortisol in 24 hour urine 377 nmol/24h (45-272)
ACTH 08:30 AM 2,6 pmol/l (<10,2)
17-OH-Progesterone 2,5 nmol/l (1,8-10,4)
DHEA-Sulfate 5,9 umol/l (3,4-17,0)
11-Deoxycortisol <2,3 nmol/l (<4,6)
Aldosterone 320 pmol/l (70-800)
Renin activity 1,0 nmol/l/t (<1,5)

Growth
Growth hormone 0,2 mIU/l (<11,5)
IGF 1 30,8 nmol/l (17-63)
IGFBP-3 73 nmol/l (49-176)

Special Tests

Leptin 417 pmol/l (<465)

Iron Panel

Ferritin 175 ug/l (20-300)
Serum iron 11,8 umol/l (9,0-34,0)
TIBC 62 umol/l (49-83)
Transferrin saturation 19% (15-57)

Miscellaneous

Vitamin D 74 nmol/l (50-150)
Vitamin K 0,2 ng/ml (0,1-2,2)
Vitamin B12 749 pmol/l (170-650)
Serum copper 14,2 umol/l (12,0-25,0)
Serum zinc 17,1 umol/l (9,0-17,0)
Insulin 57 pmol/l (18-173)
C-Peptide 337 pmol/l (270-1290)
Fasting plasma glucose 5,3 nmol/l (4,0-6,0)
Parathyorid hormone 3,1 pmol/l (1,2-8,4)

[hardasnails1973]

@Johnny 4891 wrote:

Hello Dr Mariano and others,

After three years of struggling and being on TRT for the last 6 months without any improvement in symptoms, I finally was able to test my saliva and urine cortisol. I suspected it would be low, but results came back and shows that my total output is way above the top of the range and my evening cortisol is also high.

Could this explain my low testosterone symptoms, fatigue, lack of energy, cold hands and feet, brain fog and how I easily gain fat despite a thyroid that looks good?

What does it mean and how can it be treated? Is this good news? Reading online, it seems to suggest Cushing or high stress. I used to live a stressful life, but I`m not any longer and have not been for over a year. Mild stress, yes, but nothing severe. I don`t think it could be Cushing, but I suppose I should be tested for that. My doctor just shrugged it off.

Quick comment on BW:

– This is 10 weeks after my last Nebido shot and no HCG, so testosterone is lower than on the prior test, but still higher than pre-TRT.

– Insulin is down 28 points from the last test.

– High vitamin B and Zinc. I have been supplementing with zinc, so that probably explains it. Not Vitamin B though.

– TSH is actually down from the last test and T3 is even a little higher.

Thyroid

TSH 2,44 mIU/l (0,5-3,6)
Free T4 18,3 pmol/l (8-21)
Free T3 7,9 pmol/l (3,6-8,3)
Thyroxine 110 nmol/l (60-150)
Triiodothyronine 1,7 nmol/l (1,2-2,7)
Reverse triiodothyronine 0,28 nmol/l (0,14-0,54)
TBG 15,1 mg/l (12,0-28,0)
Anti-TPO <10 kIU/l (<35)
Anti-thyroglobulin <20 kIU/l (<40)
TRAS <0,9 IU/l (<1,8)

Gonads

FSH <1,0 IU/l (1,4-12,0)
LH 2,5 IU/l (1,8-12,0)
Prolactin 177 mIU/l (50-700)
Estradiol 0,08 nmol/l (<0,18)
Progesterone <1,0 nmol/l (<3,0)
Total testosterone 15,0 nmol/l (8,0-35,0)
SHBG 15,0 nmol/l (8-60)
Free testosterone index 10,0 (3,0-14,7)
DHT 1,99 nmol/l (0,90-3,10)
Androstendione 3,2 nmol/l (<6,2)

Adrenals

Serum cortisol in blood 08:30 AM 464 nmol/l (138-690)
Serum cortisol in blood 08:30 AM 1034 nmol/l (138-690) (the day after at another lab)
Saliva cortisol 08:30 AM 16,6 nmol/l (4,0-27,0)
Saliva cortisol 10:00 PM 6,6 nmol/l (<6,0)
Free cortisol in 24 hour urine 377 nmol/24h (45-272)
ACTH 08:30 AM 2,6 pmol/l (<10,2)
17-OH-Progesterone 2,5 nmol/l (1,8-10,4)
DHEA-Sulfate 5,9 umol/l (3,4-17,0)
11-Deoxycortisol <2,3 nmol/l (<4,6)
Aldosterone 320 pmol/l (70-800)
Renin activity 1,0 nmol/l/t (<1,5)

Growth
Growth hormone 0,2 mIU/l (<11,5)
IGF 1 30,8 nmol/l (17-63)
IGFBP-3 73 nmol/l (49-176)

Special Tests

Leptin 417 pmol/l (<465)

Iron Panel

Ferritin 175 ug/l (20-300)
Serum iron 11,8 umol/l (9,0-34,0)
TIBC 62 umol/l (49-83)
Transferrin saturation 19% (15-57)

Miscellaneous

Vitamin D 74 nmol/l (50-150)
Vitamin K 0,2 ng/ml (0,1-2,2)
Vitamin B12 749 pmol/l (170-650)
Serum copper 14,2 umol/l (12,0-25,0)
Serum zinc 17,1 umol/l (9,0-17,0)
Insulin 57 pmol/l (18-173)
C-Peptide 337 pmol/l (270-1290)
Fasting plasma glucose 5,3 nmol/l (4,0-6,0)
Parathyorid hormone 3,1 pmol/l (1,2-8,4)

Means further evaluation is needed with urine or saliva test to confirm
Your body is in a major inflammatory response state with cortisol high /DHEA low
Indication of possible pathogen, or allergen,
Whole blood histamine may be good indicator
CD 57 stricker panel, with possible further evaluation into immune markers. What about lyme, or other viral infection?

[Johnny]

@hardasnails1973 4902 wrote:

Means further evaluation is needed with urine or saliva test to confirm
Your body is in a major inflammatory response state with cortisol high /DHEA low
Indication of possible pathogen, or allergen,
Whole blood histamine may be good indicator
CD 57 stricker panel, with possible further evaluation into immune markers. What about lyme, or other viral infection?

I already took a new test with urine and saliva, but unfortunately, it was on one of my rare good days, so I hope it does not come back “inaccurate” of my condition. I will get the new results in two weeks.

So, can I just start on probiotics like VSL then? And drop coffee and start with phosphatidyl serine to lower cortisol?

FWIW, my DHEA have been higher earlier and was actually above range when supplementing with it. Still felt the same.

[hardasnails1973]

@Johnny 4903 wrote:

I already took a new test with urine and saliva, but unfortunately, it was on one of my rare good days, so I hope it does not come back “inaccurate” of my condition. I will get the new results in two weeks.

So, can I just start on probiotics like VSL then? And drop coffee and start with phosphatidyl serine to lower cortisol?

FWIW, my DHEA have been higher earlier and was actually above range when supplementing with it. Still felt the same.

Your vitamin D and A are very low. This may indicate possible bile acid problem which goes back to potential sluggish liver. Even though the liver parameters look good it does not show true functionality. If levels are still elevated I would get evaluated for CAH. I would also recommend 5HIAA 24 hour urine test to rule these out. You may also want a 24 hour catecholamine test urine to see if other parts of the adrenal glands may be effected. I would serious dig into the immune system issues to rule out any chronic viral, pathogenic load as elevated cortisol levels are a response of an immune system reactions. Upping vitamin D is fine, but vitamin A, E, K also have to be balanced as well. Eating yams, sweet potatoes will help to get the proper vitamin A. One may want to explore options of heavy metals which can cause elevated cortisol. Prolong elevation of cortisol can lead to memory loss and other neurological imbalances. Why you need to look at all parts of adrenal function: Aldosterone, DHEA, catecholamines, cortisol.

Optimal for vitamin D – 120-130 provided other fat soluable vitamins are in check.

[Johnny]

@hardasnails1973 4928 wrote:

Your vitamin D and A are very low. This may indicate possible bile acid problem which goes back to potential sluggish liver. Even though the liver parameters look good it does not show true functionality. If levels are still elevated I would get evaluated for CAH. I would also recommend 5HIAA 24 hour urine test to rule these out. You may also want a 24 hour catecholamine test urine to see if other parts of the adrenal glands may be effected. I would serious dig into the immune system issues to rule out any chronic viral, pathogenic load as elevated cortisol levels are a response of an immune system reactions. Upping vitamin D is fine, but vitamin A, E, K also have to be balanced as well. Eating yams, sweet potatoes will help to get the proper vitamin A. One may want to explore options of heavy metals which can cause elevated cortisol. Prolong elevation of cortisol can lead to memory loss and other neurological imbalances. Why you need to look at all parts of adrenal function: Aldosterone, DHEA, catecholamines, cortisol.

Optimal for vitamin D – 120-130 provided other fat soluable vitamins are in check.

I don`t see vitamin A on my list?

I will keep supplementing with vitamin D. Should I supplement directly with vitamin K also?

I have started probiotics now. Udo`s Choice Super 8. 30 billions per capsule. From what I read, probiotics can aid in the production of vitamin K.

I tested for heavy metals, but it came back normal, I think.

Liver values have at least been consistently normal, but was elevated on the test before this one, but then came back normal on the latest one.

I don`t think we have the 5HIAA test here in Norway, but we have catecholamines in urine.

After I quit coffee, I feel more relaxed in my body and more tired, so I think maybe my cortisol has come down. My flaccid penis seems to be fuller and hanging better, but I have not improvements in libido, erectile quality or the other issues.

Still waiting for the phosphatidyl serine.

I`m considering looking into trying 5-HTP and see if that can help, if there is something with my dopamine and serotonin levels that are out of whack with my low libido.

Thanks for writing, HAN. Appreciate it a lot!

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