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Yeesh dr m, you should run seminars! $$$$!!
@hardasnails1973 3068 wrote:
When given the opportunity on other forums where guys are looking for best drs on west coast my first recommendation is Dr M. I have spoken to him on the phone and just in the first 10 minutes I learned so much information it was staggering. Actually majority of the principles which we do is based off Dr M information found in a 512 page documentation of his posts from all over the internet. I refer to this from time to time to refresh my memory. Now with the help of DR M we are now starting to look into cytokins imbalances which may be a hidden trigger for alot of hormonal imbalances.
I’ve been on Concerta for 9 years. Could excessive norepinephrine signals be causing my impotence? I’ve noticed that sexual excitement just isn’t there. Testosterone didn’t really help, my thyroid levels are stable, AM cortisol is normal, prolactin is non-existent…when I was younger, I too jacked it constantly. I still do at least 1-2 times a day, but not nearly the same as when I was younger. I don’t get “aroused” by anything anymore and I swear it’s like a mental block when I try to think of sexual things. After running the gamut with TRT and my hormones, I really think it’s a mental thing and the excessive concerta fried my circuits…is there a “PCT” for Concerta people or is there dopamine replacement?
@DrMariano 2884 wrote:
I think “excessive masturbation syndrome”, which I would consider a subset of “sexual exhaustion syndrome”, is a condition where there are predisposing underlying problems.
The addition of sexual activity past a certain amount stresses then collapses compensatory mechanisms that had previously allowed one to function well.
If these underlying problems did not exist, then sexual exhaustion syndrome would not occur.
Common underlying problems include thyroid problems, immune system inflammatory activity, hypothalamic-pituitary-adrenal dysregulation, chronic infections, nutritional deficiencies, insulin resistance and diabetes, nervous system dysfunction, environmental stress, hypogonadism, etc.
Sexual function involves information processing activity involving the brain’s libido circuits and the primary seeking circuit. There are many intercellular signals involved including dopamine, norepinephrine and oxytocin, testosterone, estradiol, etc. These promote interpersonal connectiveness, sex drive, sexual pleasure and excitement. Dopamine signaling helps trigger the primary seeking circuit to determine the form of sexual behavior that satisfies the libido circuitry. Norepinephrine signaling occurs within the sympathetic nervous system as a component of the libido circuitry. It helps promote excitement during sex. And a pulse of norepinephrine triggers the orgasm.
One problem with the circuitry is the use of norepinephrine as a signal. Norepinephrine has multiple systemic actions aside from sexual function. It is the primary signal for stress (thus sex itself can be considered a stressful, though enjoyable activity). Norepinephrine also triggers energy on demand. It increases thermogenesis. It can lead to changes in thyroid function – up or down. It can lead to insulin resistance, increasing the need for insulin production. It can change renal function, leading to the loss of zinc, iodine and other minerals. It can activate immune system pro-inflammatory signaling. Etc.
If there are underlying problems which already increase stress or demand for norepinephrine signaling, then the sum of these and additional sexual activity can increase norepinephrine signaling excessively leading to the problems one can experience with sexual exhaustion. Some of the changes can lead to positive feedback signaling loops which are self-perpetuating – resulting in a prolonged illness, if triggered. Some of the positive feedback loops prolong sympathetic nervous system, i.e. norepinephrine, signaling. Some changes can result in nutrient deficiencies which cause prolonged dysfunction if not addressed.
In briefly reviewing the symptoms listed on the internet for over-masturbation or sexual exhaustion syndrome, I found the following:
anxiety
depression
insomnia
lack of energy
impaired memory
mood swings
loss of libido
erectile dysfunction
headaches
body pain
blurred vision
flushed face
constipation
frequent urination
dizziness
palpitations
hair lossNote that these symptoms indicate a systemic problem. Generally, the systems involved include the nervous system, endocrine system, immune system, metabolism and nutrition.
Some simple associations between function and a few of the signals or nutrients that are most often affected are as follows:
Anxiety: norepinephrine, serotonin, cortisol, CRH, thyroid, dopamine, testosterone, progesterone, etc.
Depression: dopamine, inflammatory cytokines, iron, Vitamin A, B-vitamins, vitamin D, testosterone, etc.
Insomnia: norepinephrine, thyroid, cortisol, iron, etc.
Lack of energy: thyroid, inflammatory cytokines, norepinephrine, cortisol, insulin, iron, vitamin A, B-vitamins, salt-intake, etc.
Impaired memory: dopamine, norepinephrine, thyroid, inflammatory cytokines, B-vitamins, Vitamin A, etc.
Mood swings: norepinephrine, inflammatory cytokines, cortisol, testosterone, estradiol, thyroid, iron, Vitamin A, B-vitamins, protein intake, etc.
Loss of libido: norepinephrine, inflammatory cytokines, testosterone, estrogens, thyroid, cortisol, iron, zinc,
Erectile dysfunction: norepinephrine, inflammatory cytokines, testosterone, estrogens, thyroid, cortisol, nitric oxide, protein intake, etc.
Headaches: inflammatory cytokines, norepinephrine, cortisol, etc.
Body pain: inflammatory cytokines, norepinephrine, cortisol, thyroid, iron, aldosterone, etc.
Blurred vision: norepinephrine, thyroid, inflammatory cytokines, iron, etc.
Flushed face: norepinephrine, thyroid, inflammatory cytokines, iron, etc.
Constipation: thyroid, norepinephrine, etc.
Frequent urination: norepinephrine, thyroid, inflammatory cytokines, iron, etc.
Dizziness: norepinephrine, inflammatory cytokines, aldosterone, cortisol, nitric oxide, salt-intake, etc.
Palpitations: norepinephrine, inflammatory cytokines, cortisol, etc.
Hair loss: norepinephrine, thyroid, inflammatory cytokines, testosterone, estradiol, DHT, DHEA, zinc, biotin, etc.
Treatment of sexual exhaustion syndrome would involve assessing and addressing the psychosocial factors, nervous system factors, endocrine system factors, immune system factors, metabolic and nutritional factors that are involved to cause dysfunction once sexual activity is added to the system. Often there are multiple underlying problems. Generally, mental dysfunction (e.g. sexual dysfunction) indicates the presence of multiple underlying problems, often involving multiple body systems.
I’m no doctor but I had TT levels of 227 with LH of 1.5. Everyone is different, but most (not all) people with those levels of LH are usually in the normal range in terms of TT.
HAN—Would something non-organic like stress/depression etc. usually cause hypogonadism at the testicular level or the pituitary level?Also, don’t fall into the trap of “oh, maybe I drank too much Dr. Pepper” or “I did this wrong”…failing to look at the big picture will not only cause you to be too hard on yourself, but you may miss the underlying cause. Cutting out Diet Dr. Pepper won’t cause a miraculous rebound in your symptoms and you will probably just miss out on your favorite beverage. I’m the same way and I hate to see people fall victim to the same trap.
@DBall 1967 wrote:
Well, I can’t wait any longer. I started supplementing today and am open to suggestions of supplements as well as amounts. Thanks for your help!
I am going to pick up some iron later today but here’s what I’ve taken so far:
-5000 MCG Vitamin B12
-1000 MG Vitamin C
-2000 I.U. Vitamin D
-standard multi-vitamin and mineral formula
-I already take prescirption fish oil called LovazaWhat else should I be taking?
Here’s my labs with ranges. If there are multiple results they go from oldest to newest, left to right.
I am going to see a Dr. Mariano in california in a few weeks. Hopefully he will be able to help. I am just sick and tired of being exhausted, unmotivated, etc. Any suggestions, comments would be appreciated.
I bolded items I thought stood out even if some are in range. Some are obviously out of range too.
insulin-Like Growth Factor 198 115-307
LH 7.6 1.5-9.3
FSH 3.5 1.4-18.1
Growth Hormone, Serum <0.1 0.0-6.0
Prolactin 7.0 2.1-17.7
Ferritin, Serum 17 22-322
Cortisol AM 11.6 4.3-22.4
Glucose, Fasting 76 65-99
Glucose, 1 hour 92 65-199
Glucose, 2 hour 66 65-139
Glucose 83 70-110 87 65-99 83 65-99
Uric Acid 5.6 2.4-8.2 7.1 2.4-8.2
BUN 9 7-25 14 5-26 9 5-26
Creatine 1 .5-1.5 1.01 .76-1.27 1.06 .76-1.27
BUN/Creatine Ratio 14 8-27 8 8-27
Calcium 8.8 8.2-10.4 8.9 8.5-10.6 9.1 8.5-10.6
Phospherus 3.1 2.5-4.5 2.8 2.5-4.5
Total Protein 6.5 6.0-8.0 6.7 6-8 6.8 6-8.5 6.1 6-8.5
Albumin 4.7 3.2-5.0 4.8 3.2-5 4.2 3.5-5.5 3.9 3.5-4.5
Total Globulin 2.6 1.5-4.5 2.2 1.5-4.5
A/G Ratio 1.6 1.1-2.5 1.8 1.1-2.5
Total Bilirubin .7 0-1.2 .7 0-1.2 .5 .1-1.2 .3 .1-1.2
Direct Bilirubin .1 0.0-.3 .12 0-.4 .09 0-.4
Indirect Bilirubin .38 .1-.8 .21 .1-.8
Alkaline Phosphatase 67 40-120 62 40-120 119 25-150 106 25-150
LDH 156 100-250 147 100-250
AST (SGOT) 21 3-45 27 3-45 16 0-40 14 0-40
ALT (SGPT) 28 3-45 27 3-45 15 0-55 12 0-55
GGT 22 0-65
Sodium 139 131-145 139 135-145 141 135-145
Potassium 3.8 3.5-5.6 3.9 3.5-5.2 4.2 3.5-5.2
Chloride 105 98-110 103 97-108 104 97-108
CO2 24 22-31 19 20-32 19 20-32
Cholesterol 182 140-200 169 140-200 179 <200 160 100-199
Triglycerides 280 25-150 138 25-150 287 <150 198 0-149
HDL 32 40-60 37 40-60 29 >40
Cholest/HDL Ratio 5.69 2-4.5 4.57 2-4.5
LDL 94 70-130 104 70-130 93 <100
LDL-P 2239 <1000
Small LDL-P 1870 <600
LDL Particle Size 20.1 Pattern A
Large HDL-P .8 >3.9
Large VLDL-P 5.9 <5
TSH, Ultra Sensitive 2.3 .4-5.5 3.497 .45-4.5 2.000 .45-4.5
T4 Free 1.42 .61-1.76 1.31 .61-1.76
T3 Free 4.2 2.3-4.2
Anti-Thyroglobulin Ab <1.0 Negative
Anti-Thyroid Peroxidase Ab 1.6 0-20
Calcitrol 43.3 15.9-55.6
Vitamin D, 25-Hydroxy 25.4 32-100
Vitamin B12 339 211-911
Testosterone, Serum 227 241-827
WBC 5.0 4.3-10.0 6.5 4-10.5 5.3 4-10.5
RBC 5.62 4.5-6 5.91 4.1-5.6 5.91 4.1-5.6
Hemoglobin 16.2 13-18 15.9 12.5-17 15.3 12.5-17
Hematocrit 46.8 39-54 46.3 36-50 45.6 36-50
MCV 83.2 80-100 78 80-98 77 80-98
MCH 28.8 27-34 26.8 27-34 25.9 27-34
MCHC 34.6 32-36 34.3 32-36 33.5 32-36
Red Cell Distribution 11.9 7-16
RDW 14.1 11.7-15 14.4 11.7-15
Platelet Count 212 135-450 258 140-215 277 140-415
Mean Platelet Volume 8.1 6.9-10.9
Absolute Neutrophils 2.9 1.8-7.8
Segmented Neutrophils 53.7 42-71 65 40-74
Absolute Lymphocytes 1.8 .7-4.5
Lymphocytes 35.7 24-44 27 14-46
Absolute Monocytes .4 .1-1.0
Monocytes 7.1 2-12 7 4-13
Absolute Eos .2 0-.4
Eosinophils 3.1 0-8 1 0-7
Absolute Baso 0 0-.2
Basophils 0.4 0-2 0 0-3Urine
Specific Gravity 1.010 1.005-1.030
pH 6.5 5-7.5
Urine-Color Yellow Yellow
Appearance Clear Clear
WBC Esterase Negative Negative
Protein Negative Neg/Trace
Glucose Negative Negative
Ketones Negative Negative
Occult Blood Negative Negative
Bilirubin Negative Negative
Urobilinogen, Semi-Qn .2 0-1.9
Nitrite, urine Negative Negative
Folate, Serum 14.2 >5@TexasGirl541 2047 wrote:
Well I can’t wait for the book! Anyone have any idea when it is scheduled for release? I might buy several copies to distribute to my various doc’s that got me into this mess to begin with. 🙂
IDK but I hope it becomes staple med-school literature. I’ve never met anyone who has a better understanding of the endocrinological system than he does. IDK how he can reply to posts so quickly in a “off the top of my head” manner that yields results that are 500x more informative than any doctor I’ve ever seen.
Hmm, I would think that it would probably be highest in the morning since any excess testosterone is aromatized. However, estradiol has a much longer half life than testosterone (6x actually). It also is probably correlated with the luteinizing hormone surges experienced during the day.
I was using the lab ranges given by LabCorp.
For a hypothetical 20 year old male:
ACTH=17 (6-48)
Cortisol=19.4 (5.0-22.0)
TSH=0.039 (0.40-4.50)
T4=0.97 (0.70-1.76)
T3=2.7 (2.3-4.5)
Test, serum=168 (241-827)
Estradiol=23 (<54)
LH=1.3 (1.5-9.3)
FSH=3.2 (1.4-18.1)
GH=0.3 (0.0-6.0)
IGF-1=468(116-258)
IGF-BP3=4.8In addition, “hypothetical” was on Testim 5% for 2 weeks prior to the blood test. None applied that morning. Taking L-thyroxine 0.137 for congenital hypothalamic hypothyroidism (no TRH) plus Advair. I just thought it was so weird that testosterone was so low and IGF-1 and cortisol were so high (comparatively).
DrMariano;1438 wrote:There is no “normal” indication.The usual process is that one has to look at the patient first to determine is something is wrong. Then one has to correlate the findings in the history and physical exam with the lab findings.
To go the other way, requires the actual data.
The terms “low” and “high” are relative. It would depend on the patient’s age, condition, and other factors whether or not it is “high” or “low” or neither.
Thus, it would be helpful to have the raw data – the actual numbers, to help determine what possible conditions may be present – i.e. a differential diagnosis.
IGF-1, for example, can be considered high at 400 in an elderly adult, but low in a teenager. Without additional concrete information, an IGF-1 of 400 has no meaning.
This makes sense Dr. M. Considering the popularity of Advair, I am really surprised that there is not more information out there regarding its impact on the HP axes, especially with so much concern nowadays with adrenal fatigue etc.
BTW-Dr. M, did you prepare for the MCATs or did they prepare for you? haha jk.
@DrMariano 1377 wrote:
Advair contains fluticasone – the glucocorticoid.
The brain determines how much of a glucocorticoid signal it wants for its functions by measuring how much of a signal it is receiving.
Total Glucocorticoid signal = Cortisol + Cortisone.
The brain then sends out ACTH to the adrenals to determine how much of a glucocorticoid signal the gland will produce.
If the brain already is receiving a glucocorticoid signal from Fluticasone, then it doesn’t have to send out much ACTH to get the total glucocorticoid signal it wants.
Total Glucocorticoid signal when using Advair = Fluticasone + Cortisol + Cortisone.
Thus when adding Advair, Cortisol production is reduced since Fluticasone replaces some of the Cortisol signal.
To determine if the Glucocorticoid signal is high, add the Fluticasone signal to the cortisol signal to see if it is over a physiologic level one expects depending on one’s stress levels.
Advair contains a glucocorticoid – i.e. an artificial cortisol which is more potent than cortisol itself. Thus, the use of Advair may reduce cortisol production by the adrenal glands since Advair already provides some of the glucocorticoid signal requested by the brain via ACTH production.
So if the AM cortisol test is HIGH and ACTH is LOW is it plausible to suspect that the cortisol is in fact coming from the Advair vs. the adrenal glands?
i.e., ACTH 16 (6-48)
Cortisol 19.4 (4.3-22.4)
