T Nation

Props to Hardasnails and Dr. O


I want to say thanks to these guys for the progress that we are making in my TRT treatment and well being. I am a very impatient individual when it comes to my health and I'm sure I've had Shawn thinking I'm crazing but he stuck with me and were heading in a positive direction.

I've been screwed up and down by so many so called specialists over the past 10 years and I was skeptical of this one at first to but took the chance and I'm thankful I did. Any of you guys just joining and looking for GOOD TREATMENT Hardasnails and Dr. O are a GREAT choice.


I will echo this...when I first started seeing Dr. O and HAN in July, my T levels had fallen to an abysmal 352. My most recent blood test first of October had me at 650. They were able to identify a cortisol problem inidicative of adrenal fatigue that had been plaguing me for years, and once we got that settled all my hormone levels improved, including T, E2, and thyroid.

Can't say enough positive things about these two.


It's been a pleasure working with both of you guys as well as all the men on other forums as well. Yes oscar at times things did get alittle tense between us, but we stuck it out and look where we are know. I told you in the beginning it would not happen over night, but finally we are seeing a light at end of the tunnel I do have to mentioned not all cases are identical or the same and sometimes we will run into areas that we are not to familar with.

We do our best to try to help patients to get to the root cause of the problem and to improve their quality of life. The biggest thing I can not sress enough is that what happened to people did not happen overnight and will not get corrected overnight. Due to peoples bioindividuality what is suppose to work in a normal situation may not work in their cases. As our patient knows we work together as a team to push the envelope while having medical justification for treatment.

One of our goals is to have that strong patient/Dr interaction that other practioners may lack. We look forward to pushing on in our practice by constantly learning new avenues in cutting edge medicine.


Tangent? When an uncomplicated case of low cortisol levels is treated, and assuming that the first dose was good from the start; how do guys respond and in what time frames. If one is natural, T might recover and one would also feel that. For someone on TRT, that would simplify things.


We like to get guys that have not taken the plunge into TRT yet to hopefully isolate the cause of their low levels. By correcting the cause of the issue it give them a greater chance to avoid unneccesary medications. It does not guarrantee that TRT is not needed down the road but for now it is avoided. Some thing is draining the low cortisol so the lost logical course of action is to find out why and correct it so the adrenals have ability to recover. I have been come good as isolating the potential cause laying out a specific chain of events. Some times it can be resolved other times it may not be. Some times combination of altering brain chemistry with SSRI and other psyhiatrist drugs are needed as a temporary band aid untill the body is able to rebalance or the source of the issue is found and dealt with.


Does Dr. O accept insurance to cover visits, bloodwork, etc?


Yes. But if your not in the area its $100.00 for your phone consult. You can't turn it into insurance if your not physically there. But after your dialed in you wont need many consults. You must also have a one on one visit each year. All meds will be called into pharmacy you ask for.


Yes. But if your not in the area its $100.00 for your phone consult. You can't turn it into insurance if your not physically there. But after your dialed in you wont need many consults. You must also have a one on one visit each year. All meds will be called into pharmacy you ask for.



What adrenal issues did you have and how did you correct them?


My body wasn't producing cortisol...in a normal functioning system, your cortisol will be highest in the morning (around 8 am) and slowly decrease throughout the day, with (I think) a slight increase before bedtime and a sharp decline while you sleep....

I did a 4 sample saliva test (over one day) and my cortisol output was basically a flat line throughout the day...I just wasn't producing cortisol in the right amounts at the right times....

This lead to all sorts of other issues...lowered T as my body tried to put resources to making cortisol (you can live without T, you can't live without cortisol)...thyroid issues since thyroid receptors require cortisol in concert with thyroid hormones to activate gene expression...

I was ill tempered, and just felt like shit....depressed sometimes...just a general asshole to be around...

The treatment plan I am on is 10 mg of Cortef (a hydocortisone/corticosteroid) divided into two doses per day (one upon waking, another 4 hours later).

As a band-aid until all my systems are back online and fully functioning, I am also taking:
-Wellbutrin @ 300 mg/day (dopamine & other neuro transmitters)
-Arimidex @ 0.75 mg/week (to try for E2=22)...though I'm doubting the potency of my product

I also take between 6k-10k IU/day of Vitamin D3, 4 Biotest Flameout & FA-3 capsules/day, 7 Biotest elite mineral support at bedtime, a multivitamin (men's pro edge one a day), and 2000 ug Vitamind B-12

I believe it is all of these working in concert that has improved my health....I intend to keep using the vitamins, minerals, and fish oils indefinitely, and will start to wean off the arimidex, wellbutrin, and cortef as the doctor advises.

KSMAN: To answer your earlier question, I personally started seeing results after about 2 months of treament. I started the Cortef in late July, and by September I was feeling much better, but still having maddening erection issues (inconsistent, there and gone, etc.). Wellbutrin and Vit B-12 seemed to help a bit.

Now nearly 4 months later, erections are rarely an issue. Im kicking ass and taking names in the gym, depression is gone, and Im loving life....good stuff man...Doc says sometimes takes up to 6 months or longer to see full repair at cellular level, so hoping it only gets better from here....


Thanks, HardAs did not address my Q at all. Cortef biologically has immediate effects. A time delay, as you describe, implies that other systems and the mind take time to respond. In your case, the result of the Cortef cannot be separated from the effects of the Wellbutrin and the supplements etc.


Is this because once you start TRT, it's hard to stop it and create your own T again? My doc hasn't been clear with me about this at all... So wondering what your take is? I was under the impression maybe I could get off of it down the road once we work out my other issues.


I have guys that came off TRT which where very younger <30 and once the root of the imbalance where found and dealt with they were able to get going on their own. We have cases that had several factors that were discovered traditional medicine would have never found taking the time to dig to find the answer. The possiblity is always there. I would have look for imbalances in several factors so there is a clincal explamation to why your levels are low supported by some type of clincal data. If after looking at these issues and no imbalances where found then I would not recommend coming off HRT.

Again this is a choice of the patient and is encourage when there is data supporting it. Even going natural route with my clients if after 4 months there is no improvement I would move them to the next step not allowing them the quality of life that they deserve. Basically every one is different which can make this extremely challenging, but so rewarding in the end. As to cortef one can feel effects in matter of a single dose.


What were your cortisol numbers? I'm contemplating looking into cortef. I'm a little apprehensive as I was on a dose of prednisone last spring and it really messed me up. I had three significant soft tissue injuries in one month.

HAS, is there any sites/articles/references that you would recommend that I look at and learn more?

My latest cortisol readings were:

5.5 (13-24)
5.0 (5-8)
2.3 (4-7)
2.1 (1-3)

This was taken in October. Last December the first two readings were outside the range - high.


You also need to check your DHEA levels and perhaps progesterone, which is what is converted to cortisol.


J man the cause of the why cortisol levels are low is the first step that needs to be done.Once the cause is identified one supports the system accordingly while the cause is dealt with accordingly. Low cortisol levels are usually due to excessive inflammation for prolong period of time. Some time the cortisol may be diverted to cortisone pathway. SO you may enough cortisol it just being shifted to another pathway. These issues need to be idenified as well as comprehensive blood work on thyroid , testosterone, e2, vitamin D, ferritin, CBC, cMP, progesterone, ect. Once all the data is gathered then a more clincal approach can be taken.