Cortisol is near expected range throughout most of the day and is following a normal circadian rhythm; however, a significant number of symptoms commonly associated with adrenal stressors are self reported. Under stress situations the adrenal glands normally respond by increasing cortisol output. However, when cortisol levels are within normal range under situations of excessive stress, as reported herein, this suggests they may be overworking to keep up with the demands of the stressors, which could eventually lead to adrenal exhaustion. Adrenal exhaustion is most commonly caused by stressors which include:
psychological stress (emotional), sleep deprivation, poor diet (low protein-particularly problematic in vegetarians), nutrient deficiencies (particularly low vitamins C and B5), physical insults (surgery, injury), diseases (cancer, diabetes), chemical exposure (environmental pollutants, excessive medications), low levels of cortisol precursors (pregnenolone and progesterone) and pathogenic infections (bacteria, viruses and fungi). A normal daily output of cortisol is essential to maintain normal metabolic activity, help regulate steady state glucose levels (important for brain function and energy production), and optimize immune function. Depletion of adrenal cortisol synthesis by a chronic stressor, sleep deprivation, and/or nutrient deficiencies
(particularly vitamins C and B5) often leads to symptoms such as fatigue, allergies (immune dysfunction), chemical sensitivity, cold body temp, and sugar craving. For additional information about strategies for supporting adrenal health and reducing stress(ors), the following books are worth reading: "Adrenal Fatigue", by James L. Wilson, N.D., D.C., Ph.D.; "The Cortisol Connection", by Shawn Talbott, Ph.D.; "The End of Stress As We Know It" by Bruce McEwen; "Awakening Athena" by Kenna Stephenson, MD.
Estradiol (blood spot) is within observed range for a male.
Progesterone is within the expected reference range for a male.
Testosterone is low and SHBG is high, resulting in a very low bioavailable fraction of testosterone determined by the Free Testosterone Index (FTI = T/SHBG). Low testosterone in men is commonly seen beginning in the fourth decade of life, and is associated with symptoms of aging referred to as andropause. The expected blood (blood spot, serum, or plasma) levels for testosterone in a male range from 250 to 1200 ng/dL; however, when values drop below about 350-400 ng/dL symptoms of andropause are more frequent. Testosterone is an important anabolic hormone that helps to maintain both physical and mental
health: it prevents fatigue, helps to maintain a normal sex drive, increases the strength of all structural tissues (skin, bone, muscles, heart) and prevents depression and mental fatigue. Testosterone deficiency is associated with symptoms such as erectile dysfunction, decreased sex drive, decreased mental and physical ability, apathy, and loss of muscle mass. Low testosterone in men is closely associated with insulin resistance/metabolic syndrome. Stress management, exercise, proper nutrition, dietary supplements (particularly adequate zinc and selenium), and androgen replacement therapy (testosterone) have
all been shown to raise androgen levels in men and help counter andropause symptoms. Testosterone therapy is worthwhile considering if PSA is within normal range. Weight reduction with proper diet and exercise, and stress reduction (lowers cortisol) are important components to androgen replacement therapy.
SHBG (Sex Hormone Binding Globulin) is high, strongly suggesting exposure to a high level of estrogens. SHBG is a protein synthesized by the liver in response to estrogen exposure. All forms of estrogens (endogenous, phytoestrogens, and xenoestrogens) will increase liver production of SHBG. Hepatic induction of SHBG by estrogens is inhibited by testosterone, high insulin from insulin resistance, and low thyroid (hypothyroidism). Phytoestrogens found in many foods, spices, and herbs as well as xenoestrogens derived from petrochemical pollutants induce hepatic production of SHBG but are not detected with the
immunoassays for the endogenous estrogens (estradiol, estrone, or estriol); therefore, a high SHBG in the absence of a high level of endogenous estrogens suggests exposure to other exogenous estrogens. Testing for estradiol and estrone in saliva is recommended.
DHEAS (blood spot) is within mid-normal range.
LH is within expected range.
FSH is within expected range.
Free T4 is within normal range but reported symptoms indicate thyroid deficiency. This might suggest that hepatic conversion of T4 to T3 is impaired or T4 is being converted to reverse T3 (both conditions increased under conditions of high stress/cortisol). It would be worthwhile to evaluate steroid hormones by saliva and correct any hormonal imbalances (eg. high estradiol, low progesterone, low testosterone, high or low cortisol) that might impede optimal thyroid function.
Free T3 is within normal range but symptoms indicate thyroid deficiency. A normal T3 does not exclude the possibility of a
"functional" thyroid deficiency caused by other hormonal imbalances such as excess estrogen, low progesterone, low
testosterone, low or high cortisol, and low growth hormone (IGF-1). Testing for these hormones is recommended.
TSH is high. Although most laboratories have a TSH range of 0.35-5.50, new studies are finding that the mean and median values are 1.0-1.5mU/l . TSH levels >3.0 are now considered abnormal due to changes by the endocrinology association - see www.aace.com for more information. Some experts believe that TSH should be kept below 2.0 for optimal health. Elevated TSH is often associated with symptoms of hypothyrodism, which include fatigue, decreased stamina, depression, rheumatic pain,
sleep disturbances, cold extremities or feeling cold, reduced body temperature, brittle nails, dry course hair, hair loss, infertility, low libido, puffy eyes and face, decreased sweating, menorrhagia, and/or constipation. Periodic TSH monitoring is recommended if clinical symptoms of thyroid deficiency persist. Thyroid therapy may be worthwhile considering if T4 and/or T3 are low and symptoms of thyroid deficiency are problematic.
Thyroid peroxidase (TPO) antibodies are low indicating that Hashimoto's autoimmune thyroiditis is unlikely.