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It depends a lot on SHBG.

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That is definitely really high NE, it seems I have the opposite problem.

Could that be caused by an infection?

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Hmmm, I’m definitely not diabetic. I’ve been tested and routinely monitor my own glucose at home without any issues.

I had assumed that my low epinephrine was from my still impaired adrenal signaling as well as low NE.

The question of course is why NE is so low and why HC was the trigger point for all of this.

Do you regularly test for certain infections in your patients or do you look at cytokine testing first?

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So, I have had some more testing done. I don’t have exact numbers yet but here’s the basics.

Dopamine: Slightly Elevated
Epinephrine: LOW
Norepinephrine: VERY LOW
Serotonin: LOW

I also had a new cortisol test that showed lower levels than before I started HC.

This sort of verifies my thoughts that low catecholamines are my issue. Perhaps because HC interrupted the excessive NE signaling I was left so bad off.

The question becomes why is my dopamine high yet the others low? I still feel absolutely horrible…and suffer from marked hypotension on standing as well as feeling horribly lethargic.

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One thing…I never know what tests are really needed to determine catecholamine levels…serum? urine?

I had a 24hour collection and the results were:

Epinephrine 9 (0-32)
Norepinephrine 26 (0-140)
Dopamine 267 (65-610)

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Thank you Dr. Mariano for such a complete response.

I have no doubt that a lot more investigation should have been done before I started on hydrocortisone.

I believe that at least part of my problem is genetic. Most of the males on my side of the family suffer from nervous complaints, are underweight and end up with some serious medical issues as they age.

I eat mostly a “paleo” diet and have been gluten/dairy/egg free for coming up on a year now. I can’t say it’s done much.

I’m still taking testosterone although I have lowered my dosage with my doctor’s approval as higher doses seem to exacerbate these autonomic/orthostatic problems.

I’m also taking DHEA and pregnenolone. They seem to help my mood some but have not done much for my major issues.

I have wondered about an immune system element in this as well but don’t even know what to ask my doctor to test. The more HC I took the worse I became to the point where literally anything over 30mg of HC would have me bedridden with unbelievable heart palpitations and fatigue and once I dropped below 10 (slow taper) I started to feel somewhat human again.

Sadly, your above post hit more important points that any of the doctors I’ve seen.

I see you offer educational services now. If I were to schedule a phone consult with you do you think you might be able to suggest some further testing I could recommend to my doctor? I understand I would not be a patient of yours this way and you would not be able to prescribe treatment

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3 months later and I’m no further into figuring out what the hell has gone wrong with me. I no longer believe the testosterone injection was necessarily the cause of my problems, rather just a catalyst. It must be something with either the cortisol replacement or brief thyroid meds that I took.

Prior to the testosterone injection I was on the T cream and my E2 was rather high and I was retaining a lot of fluid. I believe that for whatever reason when I switched to the injections my E2 dropped to a lower level and that’s when all hell broke lose. One of the things that seems to somewhat reduce my symptoms is reverting to the T cream that raises my E2 levels again to too high levels. I have some possible theories why higher estrogen levels seem to help me and also shielded me from these symptoms right away.

1. I appear to be hypovolemic and suffer from orthostatic intolerance. The higher E2 levels may have caused me to retain fluid/sodium that overcame this effect. Florinef and DDAVP have been tried without result to improve this though.

2. I may be rapidly metabolizing hormones, perhaps my higher E2 slowed down my liver metabolism thus allowing me to hang to hormones longer.

3. The higher E2 would have raised binding globulins perhaps when I switched to T injections I had a thyroid/cortisol “dump” which caused my symptoms…this would not explain why they have not resolved with time though.

4. Estrogen increases norepinephrine. Low norepinephrine is associated with orthostatic intolerance and fatigue/depression. Perhaps my body could not handle the transition from high norepinephrine signaling to low NE signaling. Or perhaps the HC has had some suppressive effect on this. This theory seems to explain a lot of things.

Those are just some of the theories I have. I have no idea how I managed to get hammered with all these crippling symptoms that I did not have before hormone replacement. Maybe my body was in an adaptive hypometabolic state and by increasing it I triggered this.

I really have absolutely no idea, and seeing multiple doctors who all basically say, “yes, you’re obviously very sick but I have no idea why.”

The only thing that helped a little was I recently got a few B12 injections. I felt better for a few days after the first couple of injections which I thought was promising, but later injections didn’t repeat this effect.

I’m pretty much lost here…

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@Drew 2596 wrote:

Those are low cortisol symptoms. The half-life of HC is anywhere from 1-8 hours. If your dosing HC 4x daily and it lasts 6-8 hours in your body, you should be fine. Others metabolize it far too quickly to gain any benefit (myself included). My guess is you would have to switch to something like medrol (methylprednisolone) which has a much longer half-life. 1mg medrol = 5mg HC.

Hi Drew, if you look at my original post you’ll see that I’ve tried Medrol without result.

I do believe this is adrenal related but I’m wondering if it could perhaps be low aldosterone? I did try florinef before but maybe I need a higher dose or something?

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@wondering 2575 wrote:

Maybe you just don’t need that much.

What are your T3 / Free T3 levels when you take 5mcg , 7.5mcg, 10mcg?

Did you get Reverse T3 retested once you were on T3?

Some people have a hard time with it.

What are your T4 / Free T4 levels?

Are you taking any nutritional supplements – particularly Iodine and Selenium to help with Reverse T3?

My last results before my latest attempt were:

FT4: 1.57 (.61-1.76)
FT3: 3.0 (2.3-4.2)
rT3: 507 (90-350)

So then I worked up to 25mcg per day of cytomel. I was telling my doctor that I was feeling my above listed symptoms so he pulled me off the cytomel and had me go in for labs thinking I was hyper.

The morning I went in for labs I was a wreck. Shaking, dizzy, weak. It was warm out and I felt like I was going to collapse in the heat. I was certain I was hyper…results show no such thing.

FT4: .90
FT3: 3.2
rT3: 270

Not even close to being hyper…I had these symptoms for days after discontinuing the cytomel.

It’s like my body cannot handle faster metabolic states. Something is seriously wrong with me but I can’t find it.

I take 300mcg of Selenium daily and iodine as well (1-2 iodoral). I’m not aware of iodine’s effect on rT3 though.

I’m not certain what’s wrong with me.

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@leanguy 2572 wrote:

Did you slowly ramp up the HC at least 2 weeks *before* starting any T3? Did you then slowly ramp up the T3 dose or start right away on 25mcg?

I’ve been on HC for nearly a year now. The T3 was ramped up over weeks starting at 2.5 twice per day. I started noticing these symptoms once I hit 10mcg per day but they just got worse and worse. I can’t seem to tolerate it at all.

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Heavy metals get stored in the body’s fat and bone. This is one way the body tries to “lock them up” to minimize damage. Mercury especially will not show in urine, hair or blood unless a chelating agent is taken prior to the test.

My wife had a provoked urine test (a chelating agent was used) and her mercury levels were pegged above the top of the range, well above what the FDA even considers safe. Her doc, who runs these tests often said it was the highest result he had seen in awhile. She had multiple amalgam fillings. Prior to this a hair, urine and blood test all showed almost no mercury at all.

If a chelating agent is not used then hair testing will often show the symptoms of deranged mineral transport. The body will often displace large amounts of minerals like calcium or magnesium because of the effects of heavy metals on the body. There is a book about this here:http://www.noamalgam.com/hairtestbook.html

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@ssavanna 2489 wrote:

Hi everyone. I am going to get a saliva cortisol test done asap, however the test my doctor gave me is from Neuroscience and they are over $275. Im sure there are much more affordable options.

Could someone provide me with the name of a good affordable saliva test? Also, as far as sending it in, would my doctor need to authorize it? I have Blue Cross PPO but I dont think they will cover saliva testing. Any ideas?

Is this a salivary cortisol? Labcorp offers one if so. Your insurance would most likely cover that one if doctor-ordered.

Salivary tests for sex hormones are known to be rather inaccurate.

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Check this out…my SHBG has always been low but I just got results today and it was a 7 (8-48)!

That’s one of the lowest I’ve seen anywhere.

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@dano 2462 wrote:

@Figuring 2461 wrote:

Range was 7.6-42.6 pg/ml, I came in at 81.2. Absolutely no sex drive, no erections. What do you think?

Thank you.

I think you have a major E2 problem with numbers like that.

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@dano 2455 wrote:

@Figuring 2453 wrote:

The other one won’t tell you anything of value unless your levels are very very high or very very low.

Just wondering about this because Labcorps website states that actually the sensitive is to detect low levels in males as follows?:

The analytic range of the assay is appropriate for the assessment of the low levels of estradiol typically observed in men

Yes, the sensitive will more accurately reflect low levels.

I just meant that the regular test is inaccurate for men and really won’t alert you to anything unless you’re showing at the bottom of the range or way above range. If your twice the top of the range on the normal E2 test I’d still say you have a problem!

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