T Nation

Adrenal Insufficiency

I think people that aren’t optimized on TRT are usually looking at wrong places like injection frequency or high E2. Sure daily injections offer more stable levels or E2 TT balance is important for health and such but underlying cause for not being optimized is mostly other hormones, mineral/vit. deficiencies or other health issues and not the TRT protocol itself. This may not be news to most of you but after seeing my 4 point cortisol saliva test results i now know what my actual cause for not being optimized at all and i need help. Results are as below ;

(07:00 - 09:00) 0.42 ug/dL 0.27 - 1.18 ug/dL

(11:00 - 13:00) 0.06 ug/dL 0.1 - 0.41 ug/dL

(15:00 - 17:00) <0.05 ug/dL 0.05 - 0.27 ug/dL

(22:00 - 24:00) <0.05 ug/dL < 0.14 ug/dL

After doing some research i stumbled upon this article : https://www.omicsonline.org/open-access/overtraining-exercise-and-adrenal-insufficiency-2165-7025.1000125.php?aid=11717
It suggests that overtraining can cause adrenal insufficiency… For the last 1,5 years i have been working out 4-5 days a week and this may further lowered my already low cortisol or it may be the root cause of my adrenal insufficiency. I guess we will never know that… Either way the damage is done and i have fatigue , unrefreshing sleep , no motivation , can’t build muscle , very slow recovery from illness or muscle/tendon damage and many other symptoms during my 7 months on TRT. Most importantly i have extremely elevated HR during mild exercise or walking at moderate speeds , like 135bpm at 3.5mph.(i think it’s also due to low cortisol not being capable of dealing with stress and thus increasing HR.) My FT3 is also not optimal and only midrange but that’s a topic for another day because first i have to treat my cortisol. My low SHBG of 13.5 (18.3 - 54.1) is worth mentioning too since it can also be related to adrenals somehow. Not sure.

My questions are ;

  1. What does a man on TRT with low cortisol the whole day do to overcome this situation?

  2. Can this be related to TRT shutting down LH? Can HCG fix this and increase my cortisol to normal levels?

  3. Do i have to start hydrocortisone therapy? And if start taking HC , do i stress dose when i train?

  4. Should i stop weightlifting altogether to not to further damage my adrenals?

@unreal24278 @johann77 @Christian_Thibaudeau

I’m 36 and protocol is MWF total 150mg Enanthate weekly. (Was twice a week prior to this protocol).
I also just posted this on @dbossa 's FB group.

Man, interesting stuff, but this is nothing new. The human body can adapt to great stress, if it is allowed to happen gradually. We were always told that the most important element of training was recovery. That is difficult for athletes to accept, especially those that reach a high level without a lot of natural ability, because they often got there by outworking the competition. Even now, at my age. with no competition except with myself, I regularly find myself overdoing it. Sometimes, less is more.

The communist block countries, Soviet Union, East Germany, Bulgaria, etc. were way ahead in this area. I know, they were drugged. However, they used heart rate, blood tests, blood pressure, bodyweight, temperature, etc. as methods to evaluate training recovery.

For example, blood pressure, first thing in the morning, before even getting out of bed, they checked BP. If it was 10% above morning baseline, or the day before, you have not recovered from the previous days training and a lighter load with decreased intensity was in order that day.

They had graduate programs in sports performance. I met Alexander Medvedev, world champion and later USSR national coach. He was in his 70s, spoke little English, but he wanted me to know he was “Professor” at university, which I knew. The Chinese are like this now.

Anyway, as for you, re-evaluate your training program. Don’t stop, maybe take a break or change it, active rest, etc. TRT will help you, but it is only part of the solution. Research various recovery methods, find what works for you. Keep detailed logs of your training, diet, bodyweight, temperature, BP, etc., on a daily basis.

Good luck.

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Not really sure if this result really demonstrates andrenal insufficiency.

  1. The problem with morning cortisol assessment is the wide range of morning serum and salivary cortisol in normal subjects (43, 65, 66). Not surprisingly, measurements of basal morning levels of salivary cortisol alone are not useful for the diagnosis of primary or secondary adrenal insufficiency (67). The sensitivity and specificity of the measurement of an 0800 h serum or salivary cortisol for primary adrenal insufficiency is less than 35% (43). Therefore, the measurement of morning salivary cortisol is not particularly useful by itself in the diagnosis of adrenal insufficiency.
  1. A recent study looked at the sensitivity of salivary cortisol to detect AI. Only 34% of subject could be diagnosed correctly by the salivary test. The highest level a subject with AI had was 5.9 nmol/L (0.21 ug/dl) morning salivary cortisol. Your morning level ist def higher.

Talk to your physician about this result and if you are convinced that it warrants a follow up you need to do an ACTH test.

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I don’t have a physician at the moment and don’t think i will find a good one in near future.
Where i live , it’s tough to a find a doctor that actually listens and knows his stuff. Don’t trust one and it will be my last resource.

Really interesting… FYI information i did the test twice and the other results were quite similar. The 2 tests are 1 month apart from each other. Maybe i should do the ACTH test? I mean how else one can diagnose AI? Cortisol serum is a no go… Maybe need 24h urine cortisol too?

What sort of treatment is involved if you do have adrenal insufficiency? I’ve heard the term over and over but it always seems to be this black box of “something” is wrong but I’ve never seen anything on what to actually do about it.

Thank you man… I am thinking of going with full body workouts 3x weekly instead of 4-5 times of split. Since starting TRT i’m having problems with quality of sleep and that may be also restricting me from recovering… I now lowered my dose and switched to more frequent injections and hope to see some improvement on my sleep… My SHBG is crazy low and and wonder if that has anything to do with all this…

Of note, my SHBG went from 15 to 26 after I dialed back exercise. I was in an overtrained state for a while. I think there is an overriding mindset of these bodybuilding type splits. Personally i was too focused on the amount and intensity of weight going up. Focusing on form and my breath I was able to get to a point where I felt good after a workout. I also am a crossfitter which places a big emphasis on intensity. I had to learn how to manage my need to go hard all of the time. I am aware where that ‘line’ is now and instead of blasting through it as part of some ego trip, i respect it. Im healthier and ultimately in better shape and my body looks better and i feel better.

Jumping on HC treatment wouldnt be advised. Try taking some time off from lifting. Start walking and focusing on your breath. Do that until you can walk briskly and keep your heart rate down and feel refreshed after. Then start adding in some weights again and focus again on your breath and not worrying about the weights going up. The numbers will come back, but not at the expense of your health.

On the HCG front, i feel better on it. There is evidence that Leutinizing hormone and HCG mediate cortisol synthesis. You might try backfilling some pathways with low dose DHEA and Pregnenolone also.

It depends on how low and how many lows you have during 4 times of the day.
If very low , usually hydrocortisone replacement therapy is advised , such as Cortef.
If not too low then Adrenal Cortex may help like the one Thorne has.

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I don’t wanna go that route also… I will try adrenal cortex (ACE) pills first.

I actually took a break from training for 2 weeks to see if affects my SHBG but no change at all… I think my TRT protocol has some role with my low SHBG so i lowered my dose last week…

Thank you for the encouragement… My overly elevated HR may or may no be about my adrenals… Just received some lab results on CV health and it doesn’t look good…
Apolipoprotein B/A1 1.30 RATIO
Above 0.9 is considered “Very high risk”

Apo B/Apo A-I Ratio is Statistically A Better Predictor of Cardiovascular Disease

@kemosi Man, I know from where exactly you are reading about adrenal insufficiency. I’ve read the same things and other as well. Dont rely on them too much to self treat yourself. There is a lot of truth in what you have read, but you cannot start adrenal treatment based on saliva cortisol, forum advices and what you read in books.

You need to find a good doctor that understands this stuff and hormone optimization as well. I can recommend you two in the USA. One will want you to go physically to him so he will work with you, the other can make you a remote consultation if you proved him all the tests he needs. For this email me.

Morning serum levels of cortisol and DHEA-S are much better markers for adrenal insufficiency as salivary cortisol is.

You are doing the right things. Cut back in training and reduce your T dose.

After doing a lot of research i decided not to do cortisol serum test… Especially after reading this article on STTM website…

Why did wise patients start using saliva cortisol testing instead of blood??

"Saliva not only tests our “available-for-use, cellular, unbound” cortisol, but at four key times. Blood does neither! Blood is measuring a combination of both bound and unbound cortisol, of which 80% or more can be bound and unusable! And blood testing, which is usually done once, doesn’t tell us what is going on the rest of the day.

Additionally, when in the early years patients were using both saliva and blood, some saw themselves with HIGH or good blood cortisol at a particular time, whereas the saliva showed LOW. And our symptoms FIT the low. That was insightful. So we quickly learned to say no to blood, and only use saliva cortisol testing."

This was also the case for me… I have good enough cortisol levels on morning serum test… But terrible results with saliva…

Mine was low but got it up to high range after supplementation…

However saliva DHEA result shows midrange.

I live in Istanbul. I am yet to find a capable professional to help me here. Maybe i should consider over the phone consultation.

Thanks. I will email you soon.

This website is run by a woman with no scientific/medical education whatsoever. Its doing more harm than good.

There is no scientific study available whatsoever which demonstrates a meaningful level of sensitivity or specificity of salivary cortisol to diagnose AI.

There is plenty of good studies available on the other hand for morning serum cortisol and DHEA-S.

Same thing with reverse T3.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6917573/

Would you say supplementing DHEA and Preg along with adrenal cortex such as Thorne’s help elevate cortisol?

( @johann77 , can you also check my other topic regarding cardiovascular health? Just tagged you today. )

I would say that you need to base your treatment actions on the basis of sound lab results. Salivary cortisol is just not appropriate to conclude anything.

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I believe dhea can suppress cortisol