Brain estrogen, TRT, Hypothyroidism, Adrenal fatigue, etc.
DAVID said:
oestrogen is 54, is to much
testosterone is high normal
for adrenal fatigue = 30 mg each day
for thyroid = levothyrox 150 + 1 grain armour thyroid
to lower estrogen = arimidex, but exhausted the next day;
tyrosine, moclobemide, B vitamin have some help but so much. I think it's more difficicult to increase the brain NA CONTENT than brain dopamine.
If you lower estrogen you increase MAOA very quickly and feel depress.
1. It is far easier to increase brain norepinephrine than it is to increase dopamine. Ritalin and Amphetamine) increase norepinephrine and dopamine - often norepinephrine more than dopamine. Wellbutrin (Bupropion) specifically increase norepinephrine. Strattera specifically increases norepinrphine. Cymbalta increases norepinephrine and serotonin. Effexor increases norepinephrine and serotonin. Stress increases norepinephrine. Caffeine increases norepinephrine. Getting out of bed increases norepinephrine levels.
2. Increasing brain dopamine would give a person a sense of pleasure, reward, interest, intrinsic motivation and drive that other neurotransmitters do not give. Other than with testosterone, there is yet no clean way to increase brain dopamine levels without causing problems, i.e. there is no happiness pill.
3. Estradiol and the other estrogens are MAOI inhibitors. MAOI inhibitors increase serotonin, norepinephrine and dopamine - mostly in that order, which is one reason both low and high levels pose problems. If estradiol is too low, for example, then depression may occur. For example, if estradiol is too high - particularly if other factors such as thyroid hormone already raise serotonin levels - then depression can worsen.
4. Estrogen and Thyroid hormone interact. When estradiol is too high, it competes with thyroid hormone for thyroid hormone receptors, blocking the receptors. It also increase the production of thyroid binding globulin, trapping thyroid hormone. This leads to a reduction in the effectiveness of thyroid hormone, and fatigue.
5. Progesterone can counteract estrogen's effect on thyroid hormone. When a person has adrenal fatigue, however, progesterone production is reduced - in favor of shifting production to cortisol. Excessive progesterone can, on the other hand, can causes fatigue and sleepiness because of its sedative properties on the brain.
6. Testosterone can stimulate thyroid hormone production. However, testosterone at too high a level, independent of estrogen, can also reduce thyroid hormone production.
7. Testosterone helps protect the adrenal glands from fatigue by reducing ACTH production and directly reducing adrenal activity. However, testosterone, particularly at too high a level, can instead lead to worsening of adrenal fatigue.
8. 1 grain of Armour Thyroid (approximately 60 mg - but is actually 64.8 mg) is approximately equivalent to 100 mcg of Levothyroxine.
9. Thyroid hormone increases brain serotonin production.
10. Excessive serotonin in the brain can lead to a reduction in dopamine production, resulting in anxiety, depression, agitation, restlessness, insomnia - a condition of motor restlessness called akathisia.
11. Without doing a lumbar puncture to get a cerebrospinal fluid sample from which one can measure brain neurotransmitter content - at least indirectly - it is difficult to say that one has low brain norepinephrine levels, or other neurotransmitter level.
12. Measuring urine neurotransmitter content can give us an idea of whole body neurotransmitter content - which can roughly correlate with brain neurotransmitter content in many cases.
13. Increasing brain norepinephrine levels excessively can worsen adrenal fatigue. This is a limitation of using stimulants and Wellbutrin. Stimulants and Wellbutrin will stop working once adrenal fatigue is worsened. Increasing brain norepinephrine levels is useful since it increases awakness, alertness, attention - but excessive amounts can cause anxiety, depression, and adrenal fatigue.
14. High peak testosterone levels results in more aromatase conversion of testosterone to estradiol. One solution when using depo-testosterone injections is to use smaller doses and more frequent doses - such as twice a week doses rather than once a week doses.
15. In treating adrenal fatigue with cortisol/hydrocortisone at 30 mg a day, it is important to divide the dose to prevent peak cortisol levels which may stop adrenal function.
16. Adrenal fatigue is one result of having had prolonged and excessively high levels of norepinephrine in the brain.
17. Treatment of adrenal fatigue lowers brain norepinephrine levels. Cortisol feeds back to the brain to reduce CRH. The reduction in CRH reduces norepinephrine production, essentially calming the brain down, reducing stress.
18. Treatment with testosterone increases brain dopamine production. The higher dopamine levels can reduce brain norepinephrine levels, thus reducing stress.
19. Treatment with thyroid hormone increases brain serotonin production. This can reduce sympathetic nervous system activity and lower brain norepinephrine levels - thus reducing stress.
20. Treatment with serotonergic antidepressants reduce brain norepinephrine levels - thus reducing stress. Serotonin is also necessary to produce thyroid hormone.
21. Mental illness such as depression makes hormone replacement therapy much more complex since multiple neurotransmitters, hormones, and immune system cytokines are more intricately involved - each has to be optimized to closer tolerances in order to achieve a sense of wellness. Psychiatric medications may have to be used to help modify neurotransmitter levels to improve functioning, particularly when the illness has a genetic basis affecting the brain itself rather than just occurring from hormone imbalances.
22. Psychiatric medications have their own effects on hormones and cytokines. Knowledge of how they work in these areas, outside of neurotransmitter control, is thus important to do fine tuning of treatment.
23. Depression itself result in an increase in pro-inflammatory cytokine production.
24. Pro-inflammatory cytokines can reduce serotonin production, leading to depressive symptoms.
25. Antidepressants and other psychiatric medications (such as some antipsychotics) reduce pro-inflammatory cytokine production as an effect independent of the neurotransmitter effects.
26. Estrogen can possibly increase pro-inflammatory cytokines, under certain circumstances.
27. Thyroid hormone and testosterone can generally reduce pro-inflammatory cytokine production.
Given these highly interelated factors:
in a person with:
A. Testosterone deficiency - corrected with a depo-testosterone injection, but testosterone is high.
B. Adrenal fatigue - treated with cortisol 30 mg a day - hopefully in divided doses of 10 mg each, or 15 mg in the morning, 10 mg at noon, and 5 mg dose later in the day.
C. Hypothyroidism - currently treated with the equivalent of 250 mcg of Levothyroxine a day - a relatively high dose.
D. High estradiol level - which is causing side effects such as gynecomastia, perhaps depression or anxiety - for which Arimidex blocks aromatase and reduces estradiol - but fatigue and depression worsen.
E. Depression - which is partially treated through hormone replacement
Thoughts I have would be:
1. Why reduce estradiol with arimidex when estradiol can be reduced by reducing the dose of depo-testosterone or by dividing the dose and giving more frequent injections - all to reduce high testosterone levels which causes more conversion of testosterone to estradiol?
2. Reducing estradiol results in higher thyroid hormone activity. Higher thyroid hormone activity can worsen adrenal fatigue (and depression and fatigue as a result), particularly when the adrenal glands are not healthy enough to tolerate high thyroid hormone levels.
3. Should the testosterone dose be reduced given the conversion to estradiol and testosterone's ability to worsen ongoing adrenal fatigue?
4. In a person with a complex problem, mental illness and high sensitivity to problems in treatment, if I had to start treatment over, it would be in this order:
First treat adrenal fatigue. This would include a serotonergic medication to treat depression and to reduce the perception of stress - thus protecting the adrenal glands from stress.
Second, after about a week of adrenal treatment, start treating hypothyroidism. Adjust thyroid hormone until energy level is maximized. Give the adrenal glands time to improve - approximately 6 months. The additional thyroid hormone, itself, will help strengthen adrenal function. Do final adjustments of thyroid hormone level. The person should have then normal or near normal energy and a significant reduction in depression.
Third, start introducing testosterone treatment, while controlling estrogen if necessary. This would then further improve mood and address sexual dysfunction. Sexual dysfunction itself may be reduced once adrenal and thyroid function is optimized. The initial treatment of adrenal fatigue and hypothyroidism sets the groundwork for testosterone treatment. It makes it easier also to use lower doses of testosterone to achieve a sense of well-being, while minimizing side effects such as from excessive estradiol levels.
Fourth, if depression is primarily a result of hormone imbalances, then an attempt to reduce the serotonergic antidepressant may be considred. If depression involves brain dysfunction, then the antidepressant treatment need to continue, though the dose might be reduced if possible without recurrence of depression.
