My experience with adrenal fatigue (what a load of dog waste)

Discussion in 'Men's Health Forum' started by Structure, Jan 24, 2011.

  1. Structure

    Structure Member

    I'd post this on the existing adrenal fatigue thread, but that thread is long enough (eight pages already). Years ago, I was given a diagnosis of "adrenal fatigue." The following recount is my own personal experience with adrenal fatigue, and my opinion of the diagnosis in general.

    Years ago, I went to see an endocrinologist for various non-specific symptoms, including fatigue, anxiety, insomnia, and mood disturbances. Failing to find anything wrong with me except an impaired glucose tolerance test, he told me that my symptoms were due to prediabetes, and that I would feel much better if I adopted the Atkins diet.

    Being a well disciplined and compliant patient, I took to the diet wholeheartedly. Nothing but chicken breasts and leafy greens all day every day (I'd be surprised if I had over 20 g carbohydrates on any given day). I was already quite skinny at the time, but I lost a shit-load of weight anyway. To give you an idea: I wasn't working out at the time, but I would routinely register a 6% bodyfat reading on those (albeit inaccurate) bodyfat reading scales.

    I had noticed some other changes as well: elevated heart rate, increased moodiness and anxiety, tremors, etc. My blood pressure was routinely on the lowish side at 100/70. I would often "brown out" when I stood up. I felt like shit.

    I brought my complaints to my endocrinologist, and he tested my adrenal glands. My ACTH was highish, usually in the 40s (but sometimes in the 80s), and my cortisol was high as well. He told me that I had adrenal fatigue, and prescribed me .5 mg tablets of dexamethasone, to be taken once per day.

    I was suspicious. I knew that GCs were nothing to fuck around with, so I decided I would try a small dose first. I started on 1/4 of a .5 mg tablet. I didn't notice any change at all, so I decided to increase my dose to 1/2 a tablet. At this dosage, I couldn't be sure if I actually felt better, or if it was just the placebo effect. In any case, I decided that I'd just keep taking it, since it was such a small dosage, I figured that it couldn't really suppress my HPA axis.

    I noticed that my morning blood sugar readings were slowly creeping upwards. I went from the low to mid 80s up to the mid 90s all of a sudden. My skin was oily all the time, and I was getting some acne.

    My blood work was still coming back with highish cortisol, so my doctor insisted that I take the full dosage. I agreed, and went up to the full .5 mg tablet, once per day.

    Within a few weeks, my acne got pretty bad. And suddenly, my morning blood sugar was 105. I was on my way to becoming diabetic. I brought this concern up to my doctor, and he assured me that if and when I became diabetic, that there were good treatments available.

    That was enough for me. I got a 2nd and 3rd opinion, and both of them said "Get off the glucocorticoids!!" Needless to say, I didn't go back to the first doctor.

    I did some research, and found that keeping your body in a perpetual state of ketosis (a la the Atkins diet) often raises cortisol levels. I decided that I would treat my "prediabetes" with a low-glycemic diet (as opposed to low carb), and most importantly, I started exercising regularly.

    My fasting blood sugar came back down to normal, I gained a significant amount of muscle, and I was feeling better. My blood tests showed normal ACTH and normal cortisol levels.

    I don't expect to convince anyone that adrenal fatigue is a fictional diagnosis, nor do I expect to convince anyone that I didn't have adrenal fatigue; I understand that this issue has some pretty intense advocates with equally intense feelings fueling their opinions, and most people reading this thread will leave with the same opinion that they started with. However, I would like to point out the following:
    • Glucocorticoids can and will fuck you up. They have dangerous side effects. This is why so many doctors don't support the diagnosis of adrenal fatigue: the treatment can be worse than the disease.
    • Far too many people are getting diabetes. There are obviously serious health consequences from diabetes that I won't mention, but I will mention the often overlooked ones: ED, fatigue, and moodiness. Sound familiar? These are symptoms of adrenal fatigue. In other words, treating these symptoms with glucocorticoids can make them permanent!
    • If you really believe you have something wrong with your HPA, then get it tested properly. This includes a dexamethasone suppresion test, an ACTH stimulation test, AM cortisol and ACTH blood tests, 24 hour urinary cortisol, etc. If there is anything wrong with your HPA, this will find it. In my opinion, I just had a form of chronic stress (lack of carbohydrate) that was keeping my cortisol elevated, and taking dexamethasone was just helping my body catabolize its own tissues! Sure, I felt better, but that was probably just due to the catabolic effect of the GCs (my brain was getting all the sugar it needed).
    • Lastly, consider the dose that you will be taking. The dexamethasone suppression test is meant to completely suppress HPA activity. The dosage given for this suppression is 1 mg. That is equivalent to 26.67 mg of hydrocortisone, 6.67 mg of prednisone, or 5.33 mg of methylprednisolone. Do you really want to completely suppress your adrenal glands, even if only for part of the day? (See Corticosteroids conversion calculator (hydrocortisone, dexamethasone, prednisone, methylprednisolone, betamethasone for a calculator to determine steroid equivalence.) If you must use GCs for adrenal fatigue, use a very low dose, and have your ACTH tested while on this dose. If your ACTH is being suppressed, then you are taking too much.

    My opinion: glucocorticoids are a miracle drug for those who actually need them. For everyone else, they are just a great way to help your body destroy itself, even if you feel better in the short term.
  2. zkt

    zkt Member

    You are exactly correct. GCs will fuck you up as surely as meth, crack or opiates of you let your pleasure center do your thinking. If not, and you understand the risks and side effects, GCs and the others are useful drugs.
    I have considerable experience whith GCs and will recount them sometime.
  3. 2yung4this

    2yung4this Member

    Have you ever read or seen the documentary on how GC's first got synthesized? Good ole mayo clinic, they saw it as a wonder drug, arthritis was cured!.....and then the side effects were known, how the adrenal gland works was uncovered....its very interesting. Especially the way the the doctors freely gave away the patent on the drugs, and any drug maker who wanted to could process the drug.
  4. zkt

    zkt Member

    Im not aware of the politics and the manifestation of greed re. this particular instnace.
    But I must credit the medical profession in curtailing the aformentined.
    See thread in GD re stickies.
  5. imrj

    imrj Member

    i am one of those that gets great benefits from GC......I have a messed up pituitary and my ACTH is ALWAYS on the low AM cortisol tested several times via blood serum and saliva is always below range.....yet my adrenal has not atrophied and cranks out a shit load of cortisol when properly stimulated

    this has now led me to believe that adrenal fatigue is a bunch of most be HPTA dysfunction and that it may not be tru that the adrenals atrophy if the arent producing their normal required amount of mine has proven

    my question is why cant they come up with a drug that stimulates adrenals to make ttheir own natural cortisol? like hcg or something...?? this to me would make more sense than taking HC
  6. They do ACTH lol but it be impossible to dose. Cortisol needs to fluctuate do to a stress response testosterone can stay consistant with out a problem
    Posted from my iPhone
  7. sako

    sako Member

    You were taking a big dose at one point of the day, of course it would supress your system.

    You also had HIGH cortisol, why the fuck would they give you cortisol if it was already high? Thats just malpractise.

    GC's are effective when they're actually used PROPERLY and in the right doses. Let's not write them off like this.
  8. imrj

    imrj Member

    thank you Sako !!
  9. GoatBoy

    GoatBoy Junior Member

    It sounds like the treatment worked. Taking dexamethasone is supposed to give your adrenals a break, so they can heal up. When you stop taking it, that's when the adrenals should kick back in and start functioning like they should have been. Doesn't matter if your blood glucose went up a few points during treatment, that's probably normal.
    I think your doc was on the right track, sounds like you've recovered well.
    pumpingiron22 likes this.
  10. Millard Baker

    Millard Baker Member

    Ironic that corticosteroids are considered the "safe steroids" while anabolic steroids widely considered dangerous and deadly.
  11. imrj

    imrj Member

    who said they are safe? no steroid is safe when used improperly.....the only difference is that anabolics can be used to gain an elegant benefit of looking great and addin solid muscle...thus immediate reward which everyone seeks with satiety.....same for opiates, stims and the likes
    why arent corticosteroids look at in this same positive manner? very simple, they dont give you anything as such, no incentive reward, no euphoria.....they are just bad because they make you fat, kill your body and cause stress, right??

    WRONG.....corticosteroids are your fukin hero man.....they dont cause any stress, they come to SAVE you from stress....everyone has it all wrong...hardly anyone out there knows that corticosteroids are the only steroid you CANT live w/o....imagine useless and malignant of a steroid it is that has such a miniscule purpose....who would want to take such thing.....well I do, if it werent for this devilish little hormone I be in a freakin box six feet under long ago.....
  12. Millard Baker

    Millard Baker Member

    In the context of the steroids in sports dialogue, the media and general public have demonized anabolic steroids while often making sure they are not referring to corticosteroids which are generally referred to as good and safe in contrast with the bad and dangerous anabolic steroids. This dichotomous thinking is silly. They each have their risk/benefit just like any other drug.
  13. vantage108

    vantage108 Member

    Me too.

    And I realize we're going back several months at this point, but to Structure, I quibble with that conversion calcuator: My experience and that of others in the Addison's community suggests that 1 mg of dex is more like 50-60 mg of hc (or 10-15 mg of prednisone) in overall impact -- but it's effectively time-released because of the long half-life, so doesn't feel quite the same. (And that's another thing to remember -- hydrocortisone's effective life is a few hours, but dex hangs around for over 24.)

    Put another way, a starting GC dose for an adult male with Addison's might be 25 mg HC (split into 3-4 daily doses), 7.5 mg prednisone (split into 2 doses) or 0.5 mg of dexamethasone (once daily on waking). These are roughly equivalent in effect (though subjectively, they feel very different from one another). Long story short, 1 mg of dex is a lot of GC.
  14. Structure

    Structure Member

    The evidence does not support you conclusion. I say this because (1) there was no proof that there was anything wrong with my adrenal glands, and (2) the steroid treatment did not result in me feeling better (neither during treatment, nor in the time following discontinuation).

    I maintain that people should not be taking steroids unless there's evidence that the adrenal glands are malfunctioning. A few elevated ACTH readings does not comprise evidence; anxiety alone can result in this (i.e., being worried that there is something wrong with you that is evading diagnosis).

    Of course, I know that there are some people that are really comforted by the idea of "adrenal fatigue." The only problem I have with it is the lack of an objective means to diagnose it. Again, if there is actually something wrong with one's adrenal glands, you should be able to prove it with tests of the HPA axis.

    Imrj's arguments here have always struck me as misplaced --- he's got Addison's. Addison's disease (i.e. hypocortisolism) is not adrenal fatigue. To support the existence of "adrenal fatigue" (which has no diagnostic criteria) by citing the effectiveness of corticosteroid treatment for hypocortisolism (which has very clear diagnostic criteria) is like saying all tired people should take T4 because it is an effective treatment for hypothyroidism.
  15. zkt

    zkt Member

    You can buy 10% hydrocorttisone cream OTC. They push it at WM during the summer as anti itch medication. Which it is, and not too bad either. You wont see testosterone there tho.
  16. imrj

    imrj Member

    am not picking on you, is not my type but you have some good points but some ones not totally accurate also....I am not addisons either, I actually have perfectly working adrenals...however I have pituitary damage so it barely produces ACTH. Now here is the kick, I never had atrophied adrenals to begin with neither have they atrophied at all in the presence of exogenous GC which I been on over a year, so you go figure...this whole nonsense of "oh if you take any HC your adrenals will shrink out of existence" is perhaps not applicable to everyone either and a bit overhyped
    I do agree with you that Adrenal fatigue is BS....I definitely believe is all HPTA signaling issues, the only way I can see adrenals not working entirely but not completely failed either would be under the presence of some viral or autoimmune attack to the adrenals themselves.....

    my comment was merely around the bad rap that cortisol gets around the here and all around, I believe you can do yourself just as much harm with anabolic steroids than with all relative. There is this huge misconception than cortisol causes stress hence it has to be bad...and its just completely wrong....the only specific danger with GC treatment, unlike anabolic steroids, is that when taken long term they cannot be stopped cold turkey until the HPTA stabilizes again....and what makes this problematic is just because its the only hormone you cant live w/o because it saves your @ss every time you go looking for stress......
  17. GoatBoy

    GoatBoy Junior Member

    I hear ya. Proper diagnosis is key. I'm just a little biased right now because I'm taking dexamethasone for adrenal fatigue and it's working really well.
    My symptoms were:
    -Low DHEA-S
    -Low energy/strength
    -Tired often
    -Difficulty waking up
    -Low libido
    -Sore adrenal glands
    -Sore joints and tendons
    -Poor vascularity
    -Feeling worse after testosterone injections

    It's been only 4 days of treatment and most of those symptoms are gone already. The real test will be to see how well my adrenals recover after ceasing the corticosteroid treament. But so far things are looking good.
  18. imrj

    imrj Member

    I dont think you want to risk a "wait and see" approach on your adrenals, you should monitor your fasting glucose daily and your weight gain, specially moon face development.....all markers of high cortisol, which will tell you if you are maybe too high on the dosage....dont wait until you have completely suppressed your own production to take a turn back....
  19. Structure

    Structure Member

    I think that you and I essentially agree, although it is not technically incorrect to refer to your condition as Addison's disease, despite the fact that most cases of Addison's are primary:

    Knowledge Base - Disorders | Pituitary Network Association
    Addison's disease - Wikipedia, the free encyclopedia

    I agree that there is a bit of demonization of corticosteroids around here, but I'd be the more trustworthy posters would be the first to admit that when there is a legitimate medical reason to take corticosteroids, you should definitely be taking them!! (For example, I recently went on steroids for a month or so to reduce inflammation in my wrists, and they were a Godsend for that...) Holistic practitioners have been pushing cortisol on to people that don't need it, and this is where a lot of us take issue (myself included). Adrenal fatigue is one of these abused "diagnoses".

    I'm glad to hear that you are feeling better, but I can't say that I support the diagnosis without seeing any tests of adrenal function. One caveat I have for you: corticosteroids are known to make you feel good at first, even if there is nothing wrong with you. In fact, euphoria is listed as a side effect.

    In my own experience, I found that this effect wears off within a week or so, as your body adjusts to the exogenous cortisol. Dexamethasone is notable because of its extremely long half life, so it does tend to alter the pulsatile pattern of cortisol levels that you would otherwise see. For some, that means fewer mood swings. For others, that means more trouble sleeping at night. YMMV.

    Also from my own experience: while I was never dependent on dexamethasone, quitting still sucked. I felt like shit for a week or so. Very run down. I hope you fare better.

    After your trial of dex, if you are still concerned about adrenal function, you might want to try getting some ACTH and cortisol measurements (including AM and 24 hour urinary cortisol), as well as an ACTH stim test. Luckily, adrenal disorders are pretty easy to diagnose. And even if your doctor was completely wrong to give you steroids, its not like a short run is going to fuck you up for life or anything. But I do advise that you get a proper diagnosis...
    Last edited: Oct 24, 2011
  20. hammer12

    hammer12 Junior Member

    I think adrenal fatigue occurrs, its just the name is inappropriate. I agree that its something higher up in the brain thats not working to send the messages to the adrenals to make adrenal hormones, not the actual adrenals being tired. Plus alot of us know the lab ranges for blood work are very broad, so being in the low/normal morning cortisol range many doctors would say everything is ok, but how do they know what u normally run at, maybe normal for you is at a higher level. Plus if testing dhea(which most docs dont test for) levels there is usually a corresponding drop as cortisol levels rise and then fall with chronic stress. Besides trying to reduce stress, good diet etc, u dont need cortisol and its synthetic relatives with supressive effects to treat such a condition. Hormones like pregenolone and dhea which dont have any negative feedback problems can used with great help and will not supress your own natural production. Many people have been helped with this sort of stuff.

    I dont know why people get so upset by the name 'adrenal fatigue' we all know what most people are talking about, maybe we could call it 'poor signalling from the hypothalamus to the adrenal glands' , it just doesnt roll of the tongue.