Progesterone & Hydrocortisone – Need Dr. Opinion on this one…

[jroe]

Hi,
I am new here, so I am not sure who is responding to these threads, but it would be great to get an opinion on this.

I am currently taking HC For Adrenal Fatigue / CFS and find I need 25mg a day. I just got some other hormone test results back today and my progesterone is basically as low as it can be for someone who is not in Meno yet. ( I am 36 ).

Now that I know that, makes sense that I have Adrenal Fatigue and could not get out of bed for a few weeks in Jan…

I had tried using Progesterone cream before I started the HC and had great results for about three weeks. Then I started to feel hyperactive as if it was all converting to Cortisol or something. Then I developed severe tension headaches and TMJ…very weird!

I stopped taking it and started HC. My question is, can I take the two together? Will that just create more cortisol than I need? Will one compete with the other and mess up the ACTH suppression method I am trying to test out on my adrenals.

When I do not have enough HC, the ACTH is still yelling at my adrenals for Cortisol and all I get back is adrenaline…which feels terrible.

Other details…my Estrogen is off the charts high. How does one correct all this and where do you start? This all seemed to happen after a long 4 years of intense stress. I noticed the gradual changes in my body, but no Dr. could figure it out – until I crashed of course! Isn’t that the way things go…:p

[DrMariano2]

I no longer use the term “Adrenal Fatigue” since the adrenal glands do not fatigue.

Often, they are instead suppressed in function.

Many times this is part of sickness behavior – triggered by immune system inflammatory signaling, as part of an interaction involving the nervous system, endocrine system, immune system and metabolism in response to both internal and external stresses.

When choosing to do an adrenal support treatment – such as by the addition of cortisol or progesterone – one has to be aware of downstream metabolites and their interactions.

For example, progesterone can be converted to testosterone or one or more of the estrogens. Progesterone and testosterone may have beneficial effects on the nervous system, endocrine system, and immune system. However excessive estrogen may have negative effects – e.g. reducing free thyroid hormone by increasing thyroid binding globulin, increasing immune system inflammatory activity, stimulating sympathetic nervous system activity and aggression – which can lead to an increase in stress, etc.

Hyperactivity often involves an increase in sympathetic nervous system norepinephrine signaling – which both increases stress and stimulates cellular metabolism (increasing ATP production) via multiple pathways.

Cortisol may improve blood sugar production from the liver and may reduce immune system inflammatory signaling. Both of these can improve energy levels. Cortisol also helps reduce norepinephrine signaling, thus reducing the stress often associated with suppressed adrenal function.

The sensation of adrenaline (epinephrine) is generally the sensation of excessive sympathetic nervous system activity, which stimulates epinephrine and norepinephrine (noradrenaline) production from the adrenal glands – as long as the connection is present.

The last link before a crash from stress is changes in immune system function which stimulates sickness behavior (automatic defensive behaviors against infection and large wounds) in the nervous system as well as structural and other functional changes in the nervous system. These can persist in the nervous system long after the stress ends.

Generally, the treatment involves addressing identified contributory problems involving all the systems since the causes are often multisystemic.

For example, this can even involve gut-related problems in some patients. Note that most of the immune system’s circulating cells – the white blood cells – are circulating in the gut protecting us from a common site for infection. The activity in these cells is monitored by the nervous system. Gut problems can often lead to immune system and nervous system problems as a result.

Best,

Dr. M
@jroe 2836 wrote:

Hi,
I am new here, so I am not sure who is responding to these threads, but it would be great to get an opinion on this.

I am currently taking HC For Adrenal Fatigue / CFS and find I need 25mg a day. I just got some other hormone test results back today and my progesterone is basically as low as it can be for someone who is not in Meno yet. ( I am 36 ).

Now that I know that, makes sense that I have Adrenal Fatigue and could not get out of bed for a few weeks in Jan…

I had tried using Progesterone cream before I started the HC and had great results for about three weeks. Then I started to feel hyperactive as if it was all converting to Cortisol or something. Then I developed severe tension headaches and TMJ…very weird!

I stopped taking it and started HC. My question is, can I take the two together? Will that just create more cortisol than I need? Will one compete with the other and mess up the ACTH suppression method I am trying to test out on my adrenals.

When I do not have enough HC, the ACTH is still yelling at my adrenals for Cortisol and all I get back is adrenaline…which feels terrible.

Other details…my Estrogen is off the charts high. How does one correct all this and where do you start? This all seemed to happen after a long 4 years of intense stress. I noticed the gradual changes in my body, but no Dr. could figure it out – until I crashed of course! Isn’t that the way things go…:p

[jroe]

Hi,
Thank you so much for your response. I guess it is hard to tell what really happened first. Seems like a combination of stress, allergies and gut related problems. I am treating the gut problems with high strength probiotics. I took another blood test this month and my estrogen has gone back down to normal, if not low / normal. Progesterone on both tests has come in really low…signaling no ovulation.

I really wish I could take the HC and Progesterone together, but they seem to cause a really weird competition sensation where it reduces the overall benefit ( physically ) I get from either.
I have asked a few Dr’s and they do not know what this happens. My theory ( just based on studying hormone charts myself ) is they compete for the same cell receptors. Have you heard of this?

You seem so knowledgeable on the inter-relationship on hormones. Do you ever treat patients via the phone?

Thanks!

[DrMariano2]

@jroe 3001 wrote:

I guess it is hard to tell what really happened first. Seems like a combination of stress, allergies and gut related problems.

I am treating the gut problems with high strength probiotics.

I took another blood test this month and my estrogen has gone back down to normal, if not low / normal.

Progesterone on both tests has come in really low…signaling no ovulation.

I really wish I could take the HC and Progesterone together, but they seem to cause a really weird competition sensation where it reduces the overall benefit ( physically ) I get from either.

I have asked a few Dr’s and they do not know what this happens. My theory ( just based on studying hormone charts myself ) is they compete for the same cell receptors. Have you heard of this?

You seem so knowledgeable on the inter-relationship on hormones. Do you ever treat patients via the phone?

Generally, many problems have multiple simultaneous underlying causes. Since many if not most practitioners are trained to look for one cause or the simplest cause of a problem, they may not be aware enough to look for multiple contributing causes. I call this the problem of Occam’s Razor.

Without ovulation – such as during the follicular phase of the menstrual period, most of the progesterone is produced by the adrenal glands. A low progesterone then would imply adrenal dysregulation.

Signals in the body often have multiple actions. Some actions may oppose the other actions. It is the sum of the actions of groups of signals that determines the direction of function.

When exogenous hydrocortisone is given to a person, being the only hormone that provides direct negative feedback to the brain for ACTH production, the hydrocortisone suppresses production of the other adrenal cortex hormones. Thus, with hydrocortisone treatment, one may become further deficient in pregnenolone, progesterone, DHEA, testosterone, estradiol, etc. These all are active signals in the brain. For example, progesterone can increase GABA signaling and reduce norepinephrine signaling. These changes have further downstream actions – akin to a domino effect on a system. If the signal deficits from hydrocortisone are significant, one can have adverse effects – such as anxiety from treatment with hydrocortisone. Hydrocortisone also has other actions, including increasing insulin resistance, suppressing immune system inflammatory cytokine signaling, etc. Whether or not one experiences adverse effects from these depends on interactions with other signaling systems.

Progesterone has effects on the nervous system directly or via its metabolites – such as allopregnanolone, estrogens, testosterone, etc. The cascade of signaling changes that occur with Progesterone can have good or bad effects, depending on the individual.

When Hydrocortisone and Progesterone are given together, the sum of the positive and negative changes determines the final outcome. For many people, it is a positive experience, for others, it may be negative. The characteristics of the adverse effects can give clues as to the cause. For example, if aggressive behavior increases, then perhaps there is excessive estrogen production overall as a result of the treatment. Estrogen can trigger aggressive behavior.

For my patients who are out of the area, I see them in person at least once a year and do phone follow ups in between.
Otherwise, I provide educational consultations where a physician-patient relationship is not created. Often these are done on the phone.

Best,

Dr. M

[jroe]

Hi,
Thanks again for your response. I would like to have a phone consult if you are able. I live in the UK, so it would be tough to see you in person. I am actually from California, so it is a shame I am not there anymore. Let me know if you are open to having a phone consult / how you take payment. I do have a very helpful Dr. here and he is open to me doing research on this, and is also trying to do the same as I think he is short on answers at this stage..

Thanks!

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