Hello,
I received these results today. I would appreciate it so much if someone could give me a steer on the DHEA aspect. I understand cortisol very well and clearly I have some form of adrenal insufficiency.
I have 2 questions -
1. Do you think I need hydrocortisone from these results or can I get away with just using Adrenal Cortex Extract?
2. What is the relevance of DHEA?
Thank you so much 
I don’t know much about this but replying to bump it up in the hope someone who knows their adrenal stuff will answer. What do you make of it? Untrained eye suggests results below range and specialist medical advice would be best no? 🦋💚🦋
that’s kind, thanks so much for the bump. Yes very low results – I think having high DHEA rules out Addisons disease, which is a relief. I am trialling adrenal cortex… But it would be really nice to hear from someone who understands adrenals. They seem to be quite a mysterious entity with few people really understanding their significance. I can’t tolerate any Thyroid medication And apparently the poor cortisol production might be why.
hi humanbean SeasideSusie hope it’s ok to tag you both here, this post has been pushed down the list and I saw you guys had answered on a similar one today. 🦋💚🦋
The cortisol results I would say speak to your GP about further testing because I don't know if high DHEA rules out Addisons. In fact I don't know enough about DHEA to be able to comment on your high level I'm afraid.
thank you. I have pcos and I believe this can be a sign.
I'm going to use the standard reference range rather than the optimal result given because I don't know how the optimal results were arrived at.
Remember I'm not a doctor, so you'll have to decide for yourself whether the way I approach this seems valid to you. There is nothing to stop you from going through the same process with your numbers using the optimal ranges if you want to. But even sample 1 is below range when compared to the optimal ranges, and the other three samples are below range even with the much wider reference intervals.
Your results:
Sample 1) 13 (7 - 30) --- 26% of the way through the range
Sample 2) 1.1 (2.1 - 14) --- Below range
Sample 3) 0.83 (1.5 - 8) --- Below range
Sample 4) < 0.33 (0.33 - 7) --- Below range
Results which are of the type < X are impossible to do calculations with. So I'll make the assumption that your result for sample 4 is half way between 0 and 0.32 i.e. 0.16. It probably isn't really valid but it gives me a number to work with. It will make very little difference to the actual overall results of what I'm doing.
Optimal results for saliva cortisol are given at this link (see Example 1) :
rt3-adrenals.org/cortisol_t...
• Morning at the top of the range --- 30 with your range
• Noon approximately 75% of the range --- 11.025 with your range
• Evening close to 50% of the range --- 4.75 with your range
• Nighttime at the bottom of the range - 0.33 with your range
We need to compare your results to the optimal results and see what comes out of it.
Sample 1 : Optimal = 30 --- Yours = 13 --- You produce 43% of the cortisol you should.
Sample 2 : Optimal = 11.025 -- Yours = 1.1--- You produce 10% of the cortisol you should.
Sample 3 : Optimal = 4.75 --- Yours = 0.83 --- You produce 17% of the cortisol you should.
Sample 4 : Optimal = 0.33 --- Yours = 0.16 --- You produce 48% of the cortisol you should.
Totals : Optimal = 46.33 --- Yours = 15.09 --- You produce 32% of the cortisol you should.
DHEA 340 (106 - 300) --- Above range
...
I'll start with your DHEA - although my knowledge of DHEA is limited.
This link discusses six possible causes of high DHEA - you'll have to decide for yourself which of the listed causes may apply to you. You may have more than one cause that applies.
restartmed.com/high-dhea-le...
The article is helpful but is not 100% good - in Cause #1 it talks about balancing cortisol for example, but doesn't say what that actually means. (Writers talking about "balancing" anything is one of my bug bears because writers don't say what they are balancing with what.)
The article also mentions ashwaghanda, which is an adaptogen. Please don't take adaptogens like ashwaghanda. In many people they reduce cortisol, and yours is far, far too low already. Personal experiences of adaptogens are discussed in this link.
healthunlocked.com/thyroidu...
One thing I do know is that in healthy people their levels drop as they age, but your profile tells me you are still young. Despite this, I very much doubt that DHEA should be well above range at any age!
...
I'm concerned about your over the range DHEA and your extremely low cortisol.
I'm also very, VERY concerned that you have written this post where you say you have high cortisol :
healthunlocked.com/thyroidu...
If you are taking anything at all that lowers cortisol you are going to get even more unwell than you are already. I think I saw a reference to Seriphos in one of your posts which is a supplement that can reduce cortisol quite drastically.
Why did you think you had high cortisol? What kind of test was it (blood, saliva, urine), and what was the result?
Many people on the forum have discovered that low cortisol and high cortisol have symptoms that seem to be very similar to each other. It isn't safe to just compare your symptoms to a list and say "Yes, I must have high cortisol" or "Yes, I must have low cortisol". It is essential to do the right test.
...
When cortisol levels are tested in blood and when they are tested in saliva, they aren't measuring the same thing. As a result high cortisol in blood doesn't necessarily mean that you have enough cortisol for your needs.
When cortisol is moved around the body via the bloodstream it is attached to transport proteins. These are Transcortin (also known as corticosteroid-binding globulin - CBG) and albumin.
en.wikipedia.org/wiki/Trans...
en.wikipedia.org/wiki/Serum...
The body can't make use of cortisol when it is attached to transport proteins.
Bound cortisol is cortisol that is attached to transport proteins.
Unbound ( "Free" ) cortisol is cortisol that is NOT attached to transport proteins i.e. it has been detached from its transport proteins.
The amount of unbound cortisol is really tiny compared to the amount of bound cortisol.
Total Cortisol is the sum of bound and unbound cortisol.
When testing blood for cortisol it is Total Cortisol that is measured.
When testing saliva for cortisol it is Unbound / Free Cortisol that is measured.
There was one member ( McPammy - healthunlocked.com/user/mcp... ) who had normal or slightly over the range cortisol in blood and cortisol in saliva which was way under the range. She found that improving or taking T3 improved her saliva (unbound) cortisol enormously. [I hope I've remembered those details correctly.]
I've never been able to find a description of the process by which Cortisol is separated from its transport proteins. Obviously low T3 can cause problems but I doubt it is the only reason for cortisol to be high in blood and low in saliva.
...
I'm going to post this. I'll reply again with stuff about cortisol but it could be later today or tomorrow.
Hi HumanBean,
Thanks so much for your thoughtful response, I really appreciate your time and insight.
Answers & Qs below (if that’s OK):
I have a history of PCOS, so high DHEA may be explained by that.
I have never taken adaptogens and do not intend to start them. Quite agree that “balancing” of anything is infuriatingly vague.
Re. Seriphos; When I take NDT/T3/T4/T3+T4 combo I experience dreadful anxiety (suicidal levels) high temperature, flu-like symptoms, and from what I was reading I thought it was due to high cortisol (as I understand that thyroid hormone raises cortisol) so I took a capsule of Seriphos at night time - I didn’t do it for very long and have definitely stopped this. It has been a learning curve to not fiddle about with anything without testing to back up a theory.
I used this list rt3-adrenals.org/symptoms_c... and found I qualified for 70% of the high cortisol sx, and 69% of the low cortisol symptoms, so I assumed I had high night time cortisol (as I do get a surge of energy at that time) and presumed low across the rest.
I did a Medichecks blood draw on Monday that included blood cortisol, so when those results are back we will be able to see if it’s more of a Transport Protein issue if that result comes back high/high normal.
Ever since I did the Keto diet I have had extreme issues tolerating thyroid medication (even T4), after an initial 14 months of problem-free ketosis I suddenly plummeted into overt, terrible hypothyroidism that I’d never had before even at the point of diagnosis with additional symptoms of adrenal “fatigue” that was then diagnosed as dysautonomia (POTs etc.).
I now know that ketosis long term can cause electrolyte imbalance, nutritional deficiencies & is very tough on the adrenals since they are recruited to maintain blood glucose levels in the absence of exogenous glucose via carbs. This test seems to prove that I have, indeed, fatigued my adrenals terribly, and an OAT demonstrated lots of deficiencies that I am now supplementing religiously to overcome.
After I got these results I began taking Adrenavive Bovine adrenal cortex. I took 300mg and oh my god the difference. I was absolutely transformed - depression that I’ve had for 17 years was minimal, I had energy and some drive to actually get off the sofa, I was actually annoying my bf with all my new energy (he was overjoyed to be annoyed though after all my struggles). However, over the next 5 days I have developed the same symptoms I get when I am not tolerating the medication (currently I take 0.75 grains of NDT, but I don’t tolerate it well and have lots of anxiety with unresolved symptoms - I realise this dose is far too low, but when I try to increase it I get suicidal anxiety so it isn’t an option).
In Barry Peatfield’s book he suggests that people with adrenal “fatigue” remove thyroid medication before initiating adrenal support, otherwise the presence of cortisol can so much improve thyroid hormone uptake (?? If this is truly how cortisol is influencing things, I’m not entirely sure) you became what he terms “thyrotoxic.” So now I am removing the NDT slowly, and remaining on the cortex, then restarting the NDT (as per Peatfield’s book). Since removing the NDT I am 65% less anxious with the benefits of the adrenal cortex still hanging around, which is good. It may also be worth mentioning I historically have low Vit D (as I spend a lot of time bed bound with depression & anxiety) which I understand is essential for the final step in thyroid hormone use at the site of the mitochondria according to STTM.
Here is my Q: I realise that T3 & cortisol work synergistically, and that T3 raises cortisol. However, I am also of the impression that low cortisol/poor adrenal function can make thyroid medication tolerance difficult - which would make sense as far as my symptoms go, but finding any hard science on this has been near impossible. My concern is tolerating NDT/T3/T4 going forward. I have been profoundly hypo for nearly a year now (TSH: 10) but getting the medication into my system is proving such a challenge. I have tested for folate, B12, iron & vit D.
If you have any suggestions, I’d be very grateful to hear them... And if you got this far you're a real hero.
I just noticed I promised you a further reply to this post and didn't actually do it.
Regarding the relationship between cortisol and thyroid this link might be helpful:
hypothyroidmom.com/cortisol...
I used this list rt3-adrenals.org/symptoms_c... and found I qualified for 70% of the high cortisol sx, and 69% of the low cortisol symptoms, so I assumed I had high night time cortisol (as I do get a surge of energy at that time) and presumed low across the rest.
A difference of only 1% is not significant. And you can't assume that all symptoms carry the same weight when thinking about the relationship between thyroid and adrenals.
A personal anecdote... Nearly ten years ago, when I was a newbie in terms of thyroid/adrenal knowledge I decided I had low cortisol just on the basis of symptoms, but I decided to do a saliva test anyway.
So, I ordered the saliva test, did the recommended preparation in terms of giving things up, timing etc, then carried the test out and posted it. I was so convinced my cortisol was low I bought an adrenal supplement. After sending off my saliva test I started taking the adrenal glandular, then the following day I went on holiday for two weeks with my husband and various members of his family.
The adrenal glandular did not agree with me at all.
My already dreadful insomnia got much, much worse. I hardly slept for two weeks. My limited energy disappeared and I could no longer manage one flight of stairs. My mood became practically homicidal. I was furiously angry almost the entire time. I sweated copiously. I got dreadful cramp and restless legs every night. It was a nightmare.
When I got back home my results were waiting for me. Out of four saliva samples three of my results were above range, and the sample which wasn't above range was about 90% of the way through the range. I stopped the adrenal glandular immediately and have never taken one since.
I'm not the first person to make such mistakes. Cortisol must be tested before making any attempt to treat it.
A year later I repeated the test and my results were still high. I haven't been able to do such a test since then because my saliva is almost non-existent. I may have Sjogren's Syndrome but haven't sought testing, diagnosis, or treatment.
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an OAT demonstrated lots of deficiencies that I am now supplementing religiously to overcome.
Did you find the OAT test helpful? Are you feeling any better as a result of acting on the test results? Since my health is deteriorating I've decided I must get more testing done. But trying to work out how to get the most out of my limited resources is difficult.
I now know that ketosis long term can cause electrolyte imbalance
I went on a keto diet and felt a bit better for a while. But one of my many problems, health-wise, is that I suffer from chronic pain, take painkillers including an NSAID for it, and have to take a PPI for my gut to protect it from the NSAID. It may be the biggest cause of my lack of energy, taking that damn PPI.
As I posted earlier today or yesterday I would like to take a test of all the B Vitamins, but it seems it is out of reach for me, financially. I have the same issue with electrolytes. I'd like them all tested, but such a test doesn't seem to exist. If I am reduced to paying for individual tests the cost will be beyond my means.
I am also of the impression that low cortisol/poor adrenal function can make thyroid medication tolerance difficult
I had terrible problems tolerating both Levo and NDT i.e. anything with T4 in. I eventually found that I could just about tolerate T3 on its own. I stayed on T3 alone most of the next 7 years. During that time I did occasionally trial adding some Levo, or trying NDT, but my tolerance was very poor.
In the end, after the 7 years of mainly T3 only, I found I could tolerate Levo, which was a surprise. It wasn't great, but it improved when I started adding in a small dose of T3. I'm still taking Levo and a small dose of T3.
The difference between starting thyroid hormones and starting to tolerate Levo was caused, in my opinion, by optimising as many nutrients as possible, and finding something that helped me to lower my high cortisol.
Perhaps you could try optimising your nutrients as far as possible, and raising your low cortisol - slowly.
Thanks so much for your reply!
I've been tolerating the NDT so so so much better with the cortex. I still experience some symptoms of agitation, but since using cortex I don't get flu symptoms or the unbearable suicidal feelings - it's amazing! The only draw back is that the Adrenavive supplements make me feel nauseous even if I take them on a full stomach, so my appetite is really really diminished. I also only take the cortex when I am having overt symptoms of intolerance, which I find suits me best as when I take heaps of cortex regularly I can feel twitchy and agitated.
It's really interesting that you were finally able to tolerate the T4 with the T3 after so many years, I really appreciate your insights re. Optimising nutrients to improve tolerance and think that is also contributing to my improvements. I am basically rattling with supplements these days but if that means I can feel better I will take it!
Re. OAT - I got a lot of improvements from doing an OAT and the subsequent bespoke supplement that was created for me, it cleared up my eczema - I posted a picture of myself before the supplement and a month later, I will tag you I still had some around my eyes in that image but now I have none at all save a patch at the back of my neck that I quite enjoy scratching 😂
I'm so sorry about your chronic pain, that's really tough. Have you ever tried LDN? I've heard it works wonders for chronic pain. How is your diet? I really enjoy the Ray Peat diet (Pro-Metabolic). It might be worth looking into?
This is a fascinating topic, did you get the blood cortisol results back?
Hi So my blood cortisol was: 265 @ 10am (166 - 507) AND that was having adrenal cortex in my system, so I think that this means I am definitely just producing very little cortisol and it's not a protein transporter issue. I am very hypothyroid though, so it might just be that my adrenals are down because my thyroid hormone production is so low. In any case, I've made a lot of improvements tolerating the dose increases using cortex whenever I get symptoms.
Interesting, I've only got an old blood cortisol reading from 18 months ago, very similar figure to yours, my T3 has been low for years so I guessed my adrenals had been holding me up, I started taking Pure's Adrenal Complex last week and I certainly feel a whole lot perkier 💃 I've also added in Vit C and a salty drink... before a biscuit 😉to hopefully give a little back to my poor old adrenals
Oh lovely! Have you heard of adrenal cocktails? I absolutely swear by the - maybe something to enjoy with your biscuit? 😀
Heard but not actually put one together, not got the cream of tartar is it? I've long used Himalayan pink salt as the sea is in such a sad state. I've just got some clementines so I can do a deconstructed one maybe?
I could do it like a tequila slammer alternative😏
What do you put in yours?
😂 I like that idea! I do yogurt, orange juice, salt, cream of tartar (could do coconut water but so expensive) it is delicious!!
hmm…sounds a weird combo 😕 I’ve the liquid from coconut cream I usd for the chicken liver pâté..,,
I’ve just had clementines with warm tiger nut drink and lions mane with added salt
I’ll get the tartar 😉
Would you mind sharing the quantities for this recipe? I would really like to give it a try.
It's good that you are finding some improvements.
Assuming your blood cortisol test was done around 8am - 9am it should be around top of the range or close to it. Perhaps a higher dose might be helpful? I don't actually know what products are available these days though.
Incoguto here is the interesting cortisol thread. Have to wade through me rambling on a bit but there is a useful bit here about unbound and bound in blood vs saliva xx
I've flagged this chat up to Joyya
oh yes be great to know what she thinks!
I think humanbean has some great knowledge to pass on too
Cortisol/Test/DHEA 
Which cortisol test?
Cortisol results: Low at 3 out of 4 readings.
