T Nation

Getting Off Cortef/Cortisol Cause Back Pain?


Hi guys,
KSman in particular wanted to know your opinion but posting in case it benefits others. Im on a full blown HRT program including thyorid and cortisol for adrenal fatigue and other medical issues....my estrogen was SKY HIGH (111) so I started an AI to get that down, at same time my cortisol was higher than normal so we were going to try getting off Cortef (20mg daily)...I started off cold turkey but KSman told me to taper, Im probably doing too little at 5mg day past few weeks so thinking about bumping it up...only thing thats different is Ive had achy lower back/hip pain with unusual achyness in my lower body too...seems all the weight supprting structures but most noticably back and hips hurt....

now yea I train alot so might have tweaked something, but Im usually good at knowing when I do something as Im a long time veteran of jacking myself up in sports and training...so going from 20mg daily of Cortef to 5mg is probably too fast of a taper any opinions? would cortisol dropping too fast off and if my body doesnt kick it in ASAP to normal levels somehow cause back/joint/muscular aches and pains? Or would it be sky high estrogen then taking AI to bring it back down cause some sort of weirdness in last 2 weeks?


Could also be E2 as well, so need another round of tests. U could also cross taper your cortisol with pregnenolone and then totally replace your cortisol with pregnenolone. Use transdermal preg creams as they are more evenly released into your system. I would be looking at tapering aroung 5 mg a week, so drop from 20mg to 15 mg, to 10 mg etc a week, u could probably start pregnenolone at 25mg and increase it 25 mg as u drop cortef every 5 mgs.

let us know how u go.



Thanks Danny!


cortisol is necessary for living.
stopping cortisol cold turkey or tapering off too quickly can result in life threatening issues.
cortisol and aldosterone issues seemed linked for many.
low Aldosterone can present with hip, ankle, knee pains - water retention, easy sweating or freq need to urinate. can be partially treated by taking 1 teaspoon sea salt daily with water not with food.

I thought I had high estrogen issues due to my symptoms, but it turned out to be an Aldosterone issue.


pure chance, whats your thoughts on cross tapering it with pregnenolone?


there are a number of people and doctors that swear by pregnenolone.

me personally, well I tried all types - transdermal, oral tablets, and Lipid Matrix Micronized Oral tablets. Transdermal did nada since I can’t absorb through my skin for some reason and the other two gave me weird side effects (like it was overconverting to Progesterone and sitting there cancelling out my DHT). The same thing happens to me with oral DHEA (it seems like I over-convert DHEA right to Estrogen).

that being said it can be worth trying and may provide some benefits for certain people, but everyone has different dosing advice from 50mg to 300mg (some even say 600mg).

when I was on Preg and DHEA, I only had levels of Pregnenolone at 90, 110, and 60… after I stopped my DHEA and pregnenolone, my blood levels jumped up to 150. No real idea what was happening with me, just theories. I just know I feel better without external pregnenolone or DHEA.

ACTH signals your system to convert LDL to pregnenolone. High Cortisol produces feedback which suppresses ACTH production. So if you take too much pregnenolone or it overconverts to too much cortisol (or you take too much cortisol) you can suppress your ACTH - which then shuts down your natural pregnenolone/cortisol production.

That is why you can’t just stop external cortisol. if your ACTH is suppressed AND you stop external cortisol, then your system will have no cortisol and since cortisol is one of those critical elements necessary for cellular function/survival, well… No Cortisol = no living (which is considered a bad thing generally)


Yikes…well doc said to go back on 20mg, and taper slowly, a week or two at 20mg, to 17.5, to 15, 12.5, 10, etc…and just taper ever so slowly…said yea thats why my back hurts most likely and explained all kinds of stuff I cant re-explain simply that the likes of bright minds like yourself probably could and would understand much better…

When I first started HRT I was on DHEA and Preg, my DHEA was sky high before I started HRT, one of the docs (not current one) put me on DHEA and Preg, forget reasons why, then eventually I got off those two things…but regardless my DHEA is still typically on the “Hight” out of range still even though Im not on it…


i have used dhea on its own and it increased my dhea levels but increased my E2 sky high. I then tried dhea50mg/preg50mg transdermal cream, the first 2 days were absolutely great, i thought i finally got things right then i started getting really bad insomnia(which i have anyway) and felt very agitated, tried lowering the dose with no luck. Then i just switched to preg cream 50mg and so far so good, im feeling quite well with it, im also on arimidex as well, i get blood results next week, so we will see how preg has effected all the other hormones, by the way my dhea levels were really low too, total T was good, freeT low and E2 high. E2 has come down with arimidex. Its all trial and error juggling act, everyone is different.


The slower taper looks alot better too.


To answer your question, I would say the pain is probably from inflammation if it wasn’t present before and nothing has changed except for stopping cortef…stopping cold turkey like that sounds VERY dangerous and I’m surprised a doctor recommended that…I dont know how long it really takes your adrenals to “wake back up” once the artificial source is removed, but I wouldnt think it to be that quickly–hence the need to taper…

I just tapered off cortef…I was on 10 mg/day for adrenal fatigue…

First plan of action was to take pregnenolone to backfill cortisol passageways…was on that for a couple weeks, then began the taper…2.5 mg drops every 10 days…

I took my last dose on the 13th, and feel great right now…I’ve got a blood test and 4 sample saliva test coming up next week, so we’ll see where everything falls, but right now I feel awesome, adrenal wise…still experiencing some lingering issues from E2 out of whack though…


Thanks VTBalla. Do you have the specific names and companies of those tests? I can probably get the doc to swing them for me.

Yea the cold turkey thing didnt work obviously…back pain continues but jumped back on today, will do full dose remainder of this week then start taper…

Where you training in DC? Looks like a nice deadlift you got going there. I lived in the DC metro area about 7 years, didnt know of any hard core gyms with powerlifters except one up in MD. I trained at the college I coached at so luckily had racks, platforms, bumpers, all the good stuff.


The blood test is just a general blood test in which we are testing for the cortisol hormone cascade (pregnenolone, progesterone, and cortisol), among others. Cortisol you want to do morning version (8 a.m. is ideal)…there is a free and total cortisol test to go along with that, but I don’t know how to interpret it or know of any doctor that uses those values, so just the morning one is what I get…

Going to also be testing testosterone, E2, Vit D, thyroid, etc…all the usual suspects…

Do you have any idea where your E2 is at now that you’ve started the AI? 111 is the highest ive ever seen on this board…

The 4 sample saliva test is through Genova Diagnostics…they take my insurance, but it still costs me $79 out of pocket because they have some weird Pay Assured program, that ends up hurting me instead of helping me…which isn’t the intent…oh well…your doc will need to request the kit on your behalf at Genova I think

You may be able to find other companies that don’t require a doctor (maybe check LEF.org) and your insurance may cover all…not sure!

I hope your full dose alleviates the back pains…I’m having some terrible joint problems, which I suspect is from E2, but the cortef drop could also be playing a roll…I suspect it will take some time to get everything back in alignment with my natural production…

Thanks for the DL compliment…its not all that high compared to some people on this site, but I do what I can…you’re right about the DC metro area not having any hardcore gyms though! I’ve carved myself out a little niche at a Gold’s in Rosslyn and am cool with the gym staff, so they don’t give me shit about deadlifting heavy, lifting barefoot, chalk, etc…though if I started oly lifting and dropping bars from above my head, I think I would still be escorted out in a hurry :slight_smile: haha

Good luck with the tests man…keep us posted…


i would also be curious to see if preg is suppressing the ACTH as well so it would be good to check that as well in the variety of blood test. Glad you are feeling better that his the most important part. I cold turkey cortef from 20 mgs a day to 0 having no issues. I also made sure my nutrients in check so I had the building blocks to help keep hormone production. Preg can also lower DHT so people with high DHT may benefit.
Again every body is different people may have different reactions


Thanks bro! I lived in Courthouse for most of my stay and in Ballston, so know exactly where you are. Surprised you found a doc in that area to do HRT! I went to many who said my hormones were toast but because of my age wouldnt help and said not to worry, basically “your alive and breathing get used to feeling like crap its part of life”…

No idea where E2 is, probably will do bloodwork again in a few weeks to check…my cortisol at 8am on the last test was 22.2 (range 6.2-19.4) and I didnt take my cortisol that morning or day before, so doctor thought maybe it being high without taking it that morning or day before meant I could try to get off…I did a saliva one of some sort 1.5 years ago, maybe with a group called neuroscience or something…but going to talk to doc about doing possibly yours.

Oh Im so hoping it gets rid of back pain, barely slept last night…lifted really light last night, debating whether to lift rest of week and do my physical therapy or just relax it hurts pretty bad…and its not typical back pain from injury or overuse, its a strange achy achy deep pain…

As for dropping bars from above your head, yea I know of no where in Arlington/Fairfax/DC you can do that…other than Georgetown University (where the former head strength coach was a product of infamous Bill Starr! Definetly lots of heavy sh$t flying around, getting thrown and dropped when he was there)


Take naproxin for the aches and pains. Then see what is left in terms of how your mind and body are doing.