"When one takes DHEA it can combat the production of another hormone called cortisol. Cortisol is the stress hormone. Higher levels of cortisol is usually present in the body when the levels of DHEA decline. If a high level of cortisol is allowed to circulate freely in the body it can damage the endocrine system and hypothalamus and bring about disease that will adversely affect bodily functions. Since DHEA can help lower cortisol levels it is a good supplement for those who are aging or stressed to take. The micronized DHEA has more bioavailability and is more readily absorbed. Low DHEA levels are directly correlated with heart disease and mortality."
I take micronized DHEA because my levels are low... Must admit high cortisol is not my issue but this is the first time I've read this effect and didn't know if it was of interest to those dealing with high cortisol?
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I'd just read your success with raising your DHEA levels 👏 and J972 and I were chatting DHEA so I revisited micronized and don't remember reading this before!
Thought I'd put it out there to see what others have found... 🤷♀️
I'm due a full blood check up mid Feb so I shall be interested to see what has changed, then maybe cortisol saliva test...
We are away for a while so I thought I’d do a cortisol test when we get home to see if levels have improved. I’d love to hear what your levels are, will keep an eye out for your post.
And me yours! I started taking 15mcg DHEA last August and then swapped to micronized 10mcg early Jan so I'm intrigued to see where I'm at... started at 72ish (saliva) or 7 (blood)
It will be interesting to see when you compare like with like as blood and saliva results don't necessarily relate
Cortisol and DHEA oppose each other, meaning DHEA will lower high cortisol, or lower cortisol if DHEA levels are too high.
Were you low in both cortisol and DHEA? If so taking both I would assume would raise both cortisol and DHEA in a balanced fashion. Have you read Dr Myhills view on supplementing these?
Morning Radd... glad to have you onboard 🤗 I'm sure I must have read all of this and it has leaked out of my brain over the last 6 months! 🤭I tend to research thoroughly come up with a plan and then lose the knowledge
I have been supplementing both for the last 6 months as low in both... I'm sure I must have read Dr Myhill at the beginning when I came up with my regime 🤔 🙃
I have no recollection of DHEA being useful at lowering high cortisol, so I must have skipped that bit before as irrelevant to me 🤷♀️have you heard of anyone that has used it successfully?
I don’t but then I don’t think any of my friends take it. I have it tested every 6 months now as part of a standard package agreed between my endo and GP because I’m on T. Also still suffer low sodium but DHEA levels remain fine.
As I understand DHEA won’t lower cortisol unless levels are unnaturally high.
I’ve never supplemented HC or DHEA but would assume you are fine doing what you are doing. Have you retested levels recently, especially as you are taking T as well?
My blood serum DHEA looks fine (above range now they have lowered it, presumably age related, though my level hasn't changed in the last 3 years, ) but my saliva level is low... I've stopped the 5mg HC and now back on glandular, I've a blood test booked for mid Feb and depending on those results I might check my saliva levels again
Which to believe eh...? Free's are generally the more useful?
E, this was my previous DHEA result in 2015. That's Dr P's handwriting (god bless him 🥰). Both DHEA & cortisol recovered hugely after starting T3. Now they within range but it took several years.
Typical Dr handwriting! I can only make out the first bit 😅
My DHEA saliva level has dropped slightly along with my waking cortisol since adding T3 January 2023 result was 91 by August it was 74... no change in serum level
Am30 went from 19 -12
Interesting that DHEA has a circadian rhythm which we don't see now as they only give one result... presumably the average?
Edit!! Just had to rewrite that as got it the wrong way around!! Americans write their dates about face which totally threw me 😬
I think (but not 100% sure) only one DHEA test is is made because it gets sulphured so circulates mainly as DHEA-S, switching back to DHEA in various tissues.
Following on from the working memory theme below, similar to the hormones classed within HRT, I think it will eventually become more standard practice to prescribe DHEA. Research shows the age related DHEA decline results in the unbalanced ratios and unopposed cortisol (that doesn't decline) risks creating neurodegenerative disease.
Does your endo do a blood test? I’m assuming they won’t do a saliva test? When my endo did a blood test it was DHEA-S, but the saliva was DHEA. Can they do a DHEA blood test and which is more reliable please?
Not sure if you are asking me or Eeyore100. 😂 But anyway I’m only taking DHEA as it will lift those levels and hopefully also raise my afternoon/evening cortisol. At least that’s what I understood.
🤔. ... errr, you are the original poster E. Maybe taking DHEA makes you forget your name 🤣.
I think both saliva & blood are good. Saliva tests alone can freak members out because if free cortisol is very low, they don't always understand thats not the total amount!
I can't get at my Dr Myhill book atm coz its packed.
At least your brain is working even if your legs aren't 😕🤗have you not sorted yourself out with a mobility buggy to terrorise the neighbourhood?.... Let's hope I can find my way back home 🫣
My memory used to be terrible and I thought it due to low thyroid hormones but there’s quite a bit of thought about the DHEA/cortisol ratios affecting working memory. Higher DHEA improves working memory whereas higher cortisol worsens it, but the best outcome is a balanced ratio of both.
Ironically I can’t remember the ratio 🤣 but in his book Dr P also refers to good ratios meaning it is better to have both low, or both middle or both high than have one low and one high.
It does seem worth a shot for people struggling with high cortisol doesn't it, otherwise it's a case of lifestyle changes which aren't necessarily do'able
Not found the ratio yet but one line that caught my eye "I am certain that in time, replacement of DHEA will be as important as replacement of sex hormone (HRT) for both sexes"
I have literally just been reading this section of Dr P’s book tonight then stumbled across your post. I wish to god my GP had even heard of DHEA! HRT hasn’t raised my T or O and I’m sure Dr P is so right!
That is a really good, simple, well presented article explaining what many of us have experienced but what medical professionals refuse to acknowledge.
He refers to quite high doses of HC. Wish I had known this when I was in the throes of adrenal insufficiency for all those years as my recovery would have been much quicker. You are brave to take matters into your own hands but now backed with the knowledge that is being uncovered, I think it a wise move 😊
That's because you are using noradrenaline calculation instead of DHEA. They’re specific to the molecular weight of the substance so I’ve looked it up and DHEA is
1 pg/mL = 0.288184 nmol/L
(to get from pg/mL to nmol/L you divide by 3.48).
Therefore, 74 pg/mL x 0.288184 nmol/L = 21.32
Your DHEA is 21.32 nmol/L
Then add up your cortisol results = 4.1616.67, and divide by the number of results (4) to get the mean - 4.16
(D)21.32/ (C)4.16=5.125
These are good results. Your screenshot reply above shows a healthy DHEA:cortisol ratio to be approx 5:1 to 6:1.
helvella you are the star of measurement conversions. Does this right?
Hello. This is a very interesting discussion. Thank you Radd for explaining these calculations. I’ve just plugged mine in and got 7.71:1 so not so good. I’m seriously thinking of taking some DHEA after following this thread.
Hi radd whilst on the topic of DHEA, I wonder if you’d mind explaining something please? I’ve been re reading Dr P’s book and on his DHEA flowchart, I see Androstenedione mentioned. I seem to have had the other hormones in the flowchart tested - DHEA-s, Oestradiol and Testosterone (am low in them all), but I’ve never come across Androstenedione. Is this not usually tested, should it be and if not why not please? Thank you 😊
To assess andogens I think you are better off using the Free Androgen Index but yes, you can have have androstenedion tested, either as a stand alone but usually part of a hormone profile. I’m not sure how useful it is in determining adrenal fatigue/ovary failure as its another midway precursor to testosterone and oestrogen, and has more metabolites further up the cascade.
My Dr P book is packed away in large box as I’m moving house in two weeks. What does he say?
Hi Radd I thought I’d replied to this but can’t see it now. Dr P added this flow chart but I haven’t yet read any narrative in relation to it.
Do you think that test would be available on the nhs if you’ve passed the sst? I’ve also just posted a question on the insulin tolerance test which I’m wondering about. Thank you.
I haven’t read of a forum member having androstenedione tested on the NHS. I had its function tested as part of my DUTCH (dried urine) which assessed the workings of hormones and their metabolites, and Lifecode Gx (genetics) Hormones Report. I haven’t had a blood serum test. I’m still wondering why you want this tested?
Regarding the insulin tolerance test, I doubt you would be further investigated if your adrenals have been shown to respond to the stim test.
Ok thanks. I don’t want it tested as such, I was just curious why when it’s in the same pathway as all the other hormones I’m low in, why it’s not tested. I know virtually nothing compared to you, so am on a huge learning curve!
I will hopefully get a Dutch test soon with my new FD as I know you’ve recommended that to me previously.
I was told that the insulin tolerance test is to see if the pituitary is working, and as my adrenals seem ok, it seemed a logical test to me. Is that a no chance on the nhs in my situation? Would it be something that might help diagnose the problem if it were available privately?
I can’t carry on with insomnia for much longer so am on a desperate mission to see why my hormones are low and hopefully fix the insomnia.
I agree to fully analyse HPA axis function theoretically you would need an ACTH stim, a CRH stim and an ITT. The stress mechanism triggered by the induced hypoglycaemia should release ACTH and GH. They usually do this test to assess growth hormone deficiency, but I'm not sure about ACTH.
Have you had a blood test for pituitary hormone levels tested? It controls so many hormones even a partial loss of function should show identifiable insufficiencies.
I think the DUTCH will be informative to you and your practitioner will able to make recommendations based on your results. This may put your mind at rest as to addressing shortfalls, as its not always about replacing deficiencies (unless they are serious) but making things work better so levels balanced out naturally.
If this were me I would go down the DUTCH road first and give it several months before looking at private pituitary tests.
Could you tell me if ACTH stim, a CRH stim and an ITT are ever available on the NHS?
I have my functional doctor appointment in 11 days but have been referred to another NHS endo for a second opinion, which should be around June I think. So I can get the ball moving and hopefully cash in on anything free the NHS might offer. I cannot work ant present and don’t take benefits so every free test would be a bonus!
radd Do you know if these tests are available on the NHS please? I’m hoping my endo appointment comes through soon and wondered whether to ask for them.
Ps just done a DUTCH test so will post results in due course, which hopefully will shed some light! Thank you.
Yes, all available on the NHS but obtaining the tests is down to whether your endo determines which is helpful, which he generally uses in his investigations (eg his speciality), and which tests that hospital lean towards. I thought you have already had an ACTH Stim test?
Many members have Stim results within range because the ACTH supraphysiological dose forces the adrenals a more normalised response. As the adrenals are then seen to be capable, further medical investigations are dropped but what is not considered or recognised is our usual daily cortisol output when not artificially stimulated is often too low to allow wellbeing.
When adrenocortical atrophy is suspected, this 'stim-supraphysiological-dose-test' can mask the issue, so an ITT is used for assessing HPA axis integrity. It is also used for cortisol and growth hormone insufficiencies (and possibly ACTH). The test induces hypoglycaemia where you risk feeling faint, sweaty and experience double vision, etc which an endo might use as a barrier for you having this test. An alternative is glucagon which mimics a stress response to changes in blood glucose levels (glucagon is produced by the pancreas and helps blood sugar level control) but it depends what exactly he is trying to assess.
There is only one ACTH test (also called synacthen, cosyntropin or tetracosactide) commonly used for adrenal insufficiency and then there is a CRH stim test that can also be used for adrenal insufficiency as helps differentiate between primary (adrenal failure) or secondary (pituitary or hypothalamus failure. However, as I understand it the CRH stim test is mainly used for suspected Cushings to find the source of excess cortisol in more complex cases such as an ectopic tumor that develops outside of the pituitary (lungs, pancreas, etc and can produce ACTH).
The Dutch results will be immensely complex. You can read tips on how to interpret the immediate data but you really need a practitioner who knows your full medical past and present history to unpick the results correctly and in-depth enough to be of help to you.
Wow thank you so much, this is all really useful. Yes I have had a Short Synacthen Test, I was just interested to know if there’s anything else relevant I might get on the NHS at my second opinion endo appointment.
I have a functional doctor who will help interpret the DUTCH, but always appreciate your views with your immense knowledge. 😀
Am already feeling so much better on hydrocortisone, liquorice extract and DHEA. She’s also clearing out some heavy metals. I feel like a 20 year hangover has cleared and finally have energy in an afternoon and evening. Just need to sort out the insomnia and I’ll be a new woman 😊.
Oh, this is wonderful news. I am so pleased you have found someone who can help you.
Re Dutch - my knowledge is really only superficial and any in-depth I have is only related to my own make-up, but do let know what she says as its always interesting to discuss 😁.
1 Sorry for all the questions, just so I can be clear, are ACTH stim, a CRH stim and an ITT all different from a short synacthen test?
2 What are the blood tests for pituitary function please? The GP has ran various bloods over the years, but has never mentioned the pituitary. I can check my results.
1 Just so I can be clear, are ACTH stim, a CRH stim and an ITT all different from a short synacthen test?
ACTH Stim - inject synacthen (which mimics ACTH to encourage cortisol release). These tests can be short or long. Long is rarely preformed as used to differentiate between primary and secondary or tertiary dysfunction, and the treatment is identical in each (unless a tumor). Both short & long tests can rule in secondary adrenal insufficiency but not rule it out.
CRH Stim - inject Corticotropin-Releasing- Hormone to identify tertiary impairment (used more to diagnose Cushings together with suppression drugs).
ITT - inject insulin to check glucose and cortisol levels as lowering blood sugar causes stress that should cause the body to secrete cortisol and GH.
2 What are the blood tests for pituitary function please?
It depends what they are looking for but generally ACTH, growth hormone, IGF-1, prolactin, TSH (useless when we’re medicating replacement), possibly sex hormones. Depending on results you may be offered a scan.
Also have you been tested for adrenal antibodies? And if you were taking HRT when you had your stim, did you notify them as it can raise cortisol levels.
Great thanks for explaining radd . I will add those to my list to ask the FD and second option endo about. Would you know in my situation which of those pituitary blood tests might be relevant please?
Yes I was in HRT when I had my SST, and only found out myself I probably shouldn’t have been the night before my test when I was reading up on it. I informed the nurse who got hold of the endo who said to just continue. She hadn’t mentioned anything about HRT and the SST.
Fortunately at the time it was spray Lenzetto, which from my own research I understand is ok for a SST and shouldn’t skew results? I did spend weeks worrying after the test that the result was probably wrong as had no information or feedback whatsoever from the endo!
I have not been tested for adrenal antibodies as far as I’m aware. Does that have a specific name please? I’ll get on the case if you think it’s worth it.
As your issues have gone on for so long it is worth eliminating pituitary issues and some members are diagnosed with adrenal insufficiency (primary or secondary). However, be aware for many of us it comes down to poor signalling issues driven by years of our poor thyroid health conditions. I even paid for a private pituitary MRI I was so sure there was something dreadfully amiss.
All my HPA-axis health issues have improved since being optimally medicated on thyroid hormone replacements for several years, and I realise yours are on going so I guess what I trying to suggest is give your practitioner time to see if she can help you over the next year before you go spending loads on private endocrinology tests that may not be required.
Radd has answered that above (her answers are always better than mine 🤗).... I was wondering if anyone has used it successfully as so many people ask how to lower cortisol
Thanks for this I am dealing with low cortisol even though I take steroids and wondered why when I took DHEA recently it gave me worsening symptoms of adrenal insufficiency- I have no DHEA at all but was under the impression that DHEA ‘made’ or enhanced cortisol production - it doesn’t - I think I proved that and thanks for this to confirm my own findings !
That's what I thought it did - it was used in previous times for people trying to come down on steroid medication - it helped raise the cortisol so they could drop down their dose and I must admit when I first tried it I did drop my medication and it worked fine but this time and having read that comment above that it reduces it - I wonder now - perhaps it was doing something different this time because I must admit I am struggling with coeliac issues so might be that my cortisol is disrupted trying to cope with the inflammation due to gluten issues.
It seems it's all about getting the balance/ ratio right of all these things and just when you think you can juggle with 3 balls you have to add in a couple more 😕
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