very low energy and hormone imbalances

[sue]

Hi- I hope im posting this in the right place?

Im brand new here- 39 years old, and always tired. For years I have pushed myself to work a crazy schedule,and lived a high stress active lifestyle, but I am exhausted at this point. I am just starting to train for an event -sort of like a crossfit type- to take place in 9 months, and I am far from where I need to be in strength and stamina. after a 12 hr work day, and never enough sleep- I have a very hard time dragging my butt to the gym, nevermind putting in the effort I need to in order to get results.

In addition I have very low iron levels( sitting at 16, but doc says should be around 90) very high cortisol levels also, as well as chronically high prolactin levels due to 2 microadenomas in my pituitary gland.
Thyroid levels are fine although I suspect that has not always been the case since about 11 years ago my entire left eyebrow disappeared for about a year( came back after being on vitamin supplements for a while and has remained since). Also because of chronic acne, I take oral spironolactone( androgen inhibitor) to keep chronic hormonal acne in check. I have also noticed my hair has been slowly thinning over the years and my skin and hair is very dry.

My eating habits need improvement- I don't consume enough protein or water, but do eat plenty of fruit and veggies, and keep other carbs to a minimum. ive been taking liquid whole food based floradix for the low iron issues, but in 3 months hasn't made a difference on my bloodwork, or in how I feel, and iron tablets make me vomit within 10 minutes of taking one, even with a meal.

my boyfriend takes a steroid /test stack and is considering adding hgh and thought maybe hgh would help give me the energy boost I need plus help me reach my training goals. Anyone here have any experience with females on hgh and the pros and cons of it?Any other suggestions or advice for me? coffee just doesnt cut it-I really need some serious energy here....any help is appreciated, thanks.

[GirlyGymRat]

Hi- I hope im posting this in the right place? Im brand new here- 39 years old, and always tired. For years I have pushed myself to work a crazy schedule,and lived a high stress active lifestyle, but I am exhausted at this point. I am just starting to train for an event -sort of like a crossfit type- to take place in 9 months, and I am far from where I need to be in strength and stamina. after a 12 hr work day, and never enough sleep- I have a very hard time dragging my butt to the gym, nevermind putting in the effort I need to in order to get results. In addition I have very low iron levels( sitting at 16, but doc says should be around 90) very high cortisol levels also, as well as chronically high prolactin levels due to 2 microadenomas in my pituitary gland. Thyroid levels are fine although I suspect that has not always been the case since about 11 years ago my entire left eyebrow disappeared for about a year( came back after being on vitamin supplements for a while and has remained since). Also because of chronic acne, I take oral spironolactone( androgen inhibitor) to keep chronic hormonal acne in check. I have also noticed my hair has been slowly thinning over the years and my skin and hair is very dry. My eating habits need improvement- I don't consume enough protein or water, but do eat plenty of fruit and veggies, and keep other carbs to a minimum. ive been taking liquid whole food based floradix for the low iron issues, but in 3 months hasn't made a difference on my bloodwork, or in how I feel, and iron tablets make me vomit within 10 minutes of taking one, even with a meal. my boyfriend takes a steroid/test stack and is considering adding hgh and thought maybe hgh would help give me the energy boost I need plus help me reach my training goals. Anyone here have any experience with females on hgh and the pros and cons of it?Any other suggestions or advice for me? coffee just doesnt cut it-I really need some serious energy here....any help is appreciated, thanks.

I am not an expert in this area but hopefully angel bites jumps in here. I feel for you and it sounds awful!

If you have recent BW please post but sanitized of personal information.

[thisAngelBites]

What did your doc suggest for your very low iron levels? Did he suggest the tablets that make you sick? And when were your thyroid levels last done? Are you taking a dopamine agonist for the microadenomas or any other hormonal therapy? Are you menstruating regularly?

I will be happy to look at your bloodwork (I assume your doc is watching your hormone levels due to prolactinomas), but you should know that if your iron levels are in the tank and your cortisol is high, starting into some intense training for a crossfit event is just likely to make things worse.

I would say just from what you said that you need a little TLC and not more pushing at this point. Imperatives would be eating plenty of good protein, including red meat and the juices from it (which contain a lot of highly bioavailable iron) making sure you get enough good fat in your diet and a reasonable amount of healthy carbs. If I were you, I would also try a high quality, easily digested iron supplement, like heme-iron (it's gentler on the tummy, and doesn't cause nausea), and you could take it just before bed in case you're still worried about feeling ill. I don't know what time you arise in the morning, and where on this planet you live (so I don't know how long the days are) but I would suggest getting yourself to bed early, like a couple of hours after the sun goes down at the latest, and avoiding screens in the evening, and get yourself some proper sleep. Seriously. So many important things happen in your body at the cellular level when you sleep, and if you have been shortchanging yourself all this time, you really to need to reset and give your body what it needs. I'm in my 40s, and I know I could get away with burning the candle at both ends (I would have burned it at three ends, if I could) when I was younger, but I just can't anymore, not without feeling like crap.

If you are lucky this is primarily an iron problem, but it is it still unlikely to be turned around right away and without some effort. At worst you could be dealing with hormonal imbalances, and I'm sorry to tell you that it is unlikely that any super stuff, like hgh, that is just going to turn it around. This is all complicated stuff and I think you should consider relaxing your training goals a bit and spending a little bit of time working on your overall well-being.

[sue]

Thank you thisangelbites for your response.

I am taking floradix ( liquid whole food based iron supplement)- and have no problems taking it, but my iron levels are not improving. I did take iron supplements from sangsters, but couldn't keep them down. I have never been much of a meat eater, unfortunately, but I have been adding in more red meat to get my iron up. And avacados & coconut oil, as well as cod liver oil and krill oil are also in my diet. I will google heme- iron and see if I can order some( thanks for the suggestion)

I had ongoing hemorrhaging issues following a miscarriage about 7 years ago and have struggled with low iron ever since. also following that miscarriage, my estrogen levels tanked and I have been taking Yasmin 42 days straight ,( to keep both estrogen up and to reduce bleeding due to so much blood already lost) then 7 days off to have a period, which occurs sometime during that 7 days off, but have never really had regular periods- ever- most likely due to hyperprolactinemia ( at least that's what my endocrinologist tells me.) I attempted to go off the Yasmin about 3 years ago and turned into a very angry person very quickly, however, dropped 8 pounds within a month without effort( which was nice, because I gained 15 pounds within 2 months of going on it, and cant seem to get rid of those extra pounds). endocrinologist was having BW done every month to monitor hormones during that time, and estrogen plummeted and endocrinologist said I had to go back on Yasmin and would most likely have to be on it for the rest of my life- even past menopause.(I was not impressed with that outlook and have recently started to see a dr who specializes in bio-identical hormones hoping maybe that would be a healthier alternative). within 2 weeks of being back on the Yasmin- my anger mellowed out again- thank God!

I was taking bromocriptine in my early 20s for a couple of years in an attempt to lower prolactin levels, but had no effect and was discontinued. I was on dostinex for a couple of years as well and it did improve my levels slightly. I have an MRI done annually, but there has been no changes .

I do usually sleep well- im exhausted most days and fall asleep fast, and do sleep as much as I can- even squeeze a nap in here and there if I can, because by afternoon sometimes I can hardly keep my eyes open. I live in bitterly cold Saskatchewan Canada, and my schedule is all over the map, because of my business, I am on call every day, but im usually up fairly early( 5 to 6 am).I usually get at least 5-6 hrs of sleep and if I ever get the chance to sleep in- I will usually sleep for a good 10 hrs.

ok- here is my latest bloodwork results:
High Sensitive CRP 3.6 mg/L ( elevated,normal is 0-7)
wbc 5.22 x10e9/L units
rbc 4.31 x10e12/L
hgb 132 g/L
hct 0.392 L/L
mcv 91.2 fl
mch 30.6pg
mchc 336 g/L
RDW 13.3 %
platelet 290 x10e9/L
MPV 7.8 fl
neutrophils 2.86 x10e9/L
lymphocytes 1.87 "
monocytes 0.39 "
eosinophils 0.05 "
basophil 0.04 "
nucleated RBC 0
NRBC/100 WBC 0
Albumin 36 g/L ( normal is 35-52, so a bit on low end)
total cholesterol 7.06 mmol/L ( high)
triglyceride 1.12 mmol/L
HDL 3.80 mmol/L ( high)
LDL 2.75mmol/L
chol. ratio ( T/HDL-C) 1.9
Ferritin 16 ug/L ( low- normal is 60-120)
cortisol 853.8 mmol/L( very high) ( bloodwork was taken at 8 am and at 4 pm to get this result)
prolactin 26.1 ug/L ( high- but this result is actually pretty good for me- it used to be between 40-60 for years)
TSH 1.50 mIU/L
Free T4 13.8 pmol/(12-22 is normal)
free T3 4.99 pmol/L ( 3.9-6.7 is normal)
homocysteine 8.77 umol/L
DHEA-S 1.95 umol/L on the low side (normal is 1.65-9.23)

I was really hoping for a miracle quick energy fix. im tired of being tired, but not willing to screw up my hormones worse, and I would not ever try hgh without getting my levels checked first- its just sounded like it had a lot of possible great benefits that I thought may make a difference. my job is somewhat physical, and im not in too bad of shape, but I would like to lose about 20 pounds of fat, and gain lean muscle,strength, and endurance. Exercise is supposed to help reduce stress ( cortisol) levels and lifting weights help stave osteoporosis which im more prone to because of high prolactin, and since im not getting any younger, I was hoping to get into better shape and take on this fitness challenge. My boyfriend is trying to be helpful and suggested anavar and hgh- the anavar I would be leary to try because I have struggled with acne too long and take spironolactone to keep it manageable. Hgh sounded better, but I am so new to some of this. I also read on this site that an eca stack, garcinia cambogia, and clenbuterol are things that have helped some people reach their fitness goals. I work in the oilfield, and since oil prices are low right now, work is slower, so I would still like to attempt getting into shape, while giving myself some TLC like you suggested....

I look forward to your response, and thanks for taking the time for me!

[thisAngelBites]

Hey Sue,

I've seen your response, but I have had a couple of quite busy days, and there are a lot of little things I want to mention in response - I'll try to get some time to do it tomorrow, but did want to let you know that I will respond as soon as I can!

[thisAngelBites]

Ok Sue - I'll tell you what I see. Know that I am not a physician, and of course what someone on a forum writes should not supercede what a physician who is more acquainted with your personal situation advises. Having said that, I'm glad you're seeing someone who works with bioidentical hormones, and the best scenario would be finding someone who is a functional medicine doc (find one here - https://www.functionalmedicine.org/p...ch.aspx?id=117) or an anti-aging doc (find one here -http://www.a4m.com/directory.html). I personally think Yasmin is awful stuff and it's good you're looking into better hormones.

The three main issues are : anaemia, hypercortisolism, and inflammation.

Your situation with high cortisol and high inflammation (hs crp) is a problem and needs to be worked on as a priority (as well as the anaemia). High cortisol and high inflammation are the beginning stages of many many serious disease states (cardiovascular disease, hypertension, atherosclerosis, cancer - you get the idea).

The first thing we need to make sure of is that your adenoma(s) is(are) not secreting cortisol. I cannot imagine that your endo has not been watching your cortisol levels all along, and I would think if this was happening, you would already know about it. If you don't know this to be true, I would ask whether this was checked back when you were diagnosed and discuss this possibility with the doc with whom you have been working.

Now, leaving aside the possibility of the adenomas causing the hypercortisolism, the extra pounds are probably a big contributor to the inflammation and the inflammation and the high cortisol are likely inhibiting the weight loss. The high cortisol causes other problems as well, like blocking your growth hormone production.

Additionally, the high cortisol screws up your whole hormone cascade. When stressed, the body increases production of LDL to make more cholesterol, which is a substrate of your other hormones, including cortisol, but also sex hormones and other precursors to them. Having enough cortisol is always the body's priority, and that means that your body is shunting resources to make more cortisol because it thinks it desperately needs it. As a result, your DHEA is low, your pregnenolone is almost certainly low, your vitamin D is very probably low, and you don't have enough sex hormones either (you saw this when you dropped the Yasmin).

Also, the high cortisol state blocks TSH, so we cannot get a proper read of thyroid function when your cortisol is this high, and this is the reason your T4 is lower than it should be: as your high cortisol is likely keeping your TSH artificially low, your thyroid does not get signalled to make the hormone it should be making. This is what happens to people when they are in a super stressed state (like starvation) so that the body can hold on to fat, etc., so this is really not helping you lose the weight you want.

And I'm not sure I agree that exercise categorically lowers cortisol. I think exercise can cause a stress response in the body, and the more strenuous the exercise, the higher the stress response. For example, I think crossfit is exactly what you don't need at the moment. You said you are active at work, so it doesn't sound like not moving is the problem. I am sure this is going to go against your way of thinking, but I think you should move your body a lot, but in gentler ways. Lots of walking as a priority, and maybe pilates or yoga if you like that sort of thing, and if you do weights, do them, but not in an intense, balls-to-the-wall sort of way. Leave the crossfit and hair-on-fire stuff until your cortisol and inflammation are in a better state. At this time, I do not think that intensity of exercise equals benefit for you.

Sleep is super important for your adrenal glands (and your growth hormone production), and shift work or erratic hours really feed into health issues (and is acknowledged in many parts of the world as contributing to cancer, which I take to mean that it is linked to systemic health problems, some of which are probably just not proven yet). If I were you, I would make a very serious effort to get to bed early, super early, and get your sleep for 8-9 hours every single night. I cannot emphasise this enough. Turn the lights off early (there is increasing evidence that messing with circadian rhythms causes a lot of health problems, and while people who are young and healthy can tolerate being up half the night and sending confusing signals to their brain that it is daytime due to the blue light entering their eyes, people who are not well do not do well with this). After dusk, lower the lights in your house to very low levels, or better yet, get some red LED lights and use them after sundown, so that your melatonin production is not impaired (this is an important brain antioxidant) and that your sleep is as restorative as it can be.

As for diet and supplements: definitely try the heme iron. I used a product called Energizing Iron made by a company called Enzymatic Therapy when I was anaemic and it worked very well, but others may work just as well if you can't get that one in Canada.

If I were you, I would also take 100 mg of pregnenolone for a few months, to give your body more of this hormone it needs while it is still preferentially making cortisol out of the substrates. The same rationale applies to taking some DHEA. If it were me, I would take 15 mg a day. If you get any side effects (masculinising - like facial hair, hair loss, oily skin, acne, or rapid heart beat or insomnia) switch to the 7 keto DHEA or else halve the dose. I would guess you are so deficient that this won't happen at this low dose, but it's good to know what to do if it does, which is why I mention it.

Growth hormone actually could work for you, because it decreases cortisol levels, and helps prevent osteoporosis. It also will help with the anaemia, but please don't take your boyfriend's steroid source's GH - it is almost assuredly fake as GH is very expensive to make - and instead is likely to be cocktail of various things intended to mimic the side effects of GH. That stuff is less of a risk to a healthy bodybuilder than it is to you in this current state of health. If you really want it, find an anti aging doctor to prescribe it for you, or lobby your endocrinologist for it (I assume he is a medicare doc) based on the benefits I mentioned.

Quit coffee for your adrenals - it's extremely taxing for people with adrenal problems. You will suffer for a couple of days, and then feel better for it.

Consider take some B complex vitamins in the morning, and some magnesium at night.

What about seafood? Omega 3s and DHA, in particular, are absolutely vital, help to lower inflammation and seafood is much better than the oils you are taking, which have a different form in them. If you like oysters, they are outstanding, as is salmon. That will up your protein intake too, which you need.

Well, I wrote an awful lot - I hope you read it all and can find something helpful in all of this! If you have any questions, I will try to help.

[sue]

Ok Sue - I'll tell you what I see. Know that I am not a physician, and of course what someone on a forum writes should not supercede what a physician who is more acquainted with your personal situation advises. Having said that, I'm glad you're seeing someone who works with bioidentical hormones, and the best scenario would be finding someone who is a functional medicine doc (find one here - https://www.functionalmedicine.org/p...ch.aspx?id=117) or an anti-aging doc (find one here -http://www.a4m.com/directory.html). I personally think Yasmin is awful stuff and it's good you're looking into better hormones.

The three main issues are : anaemia, hypercortisolism, and inflammation.

Your situation with high cortisol and high inflammation (hs crp) is a problem and needs to be worked on as a priority (as well as the anaemia). High cortisol and high inflammation are the beginning stages of many many serious disease states (cardiovascular disease, hypertension, atherosclerosis, cancer - you get the idea).

The first thing we need to make sure of is that your adenoma(s) is(are) not secreting cortisol. I cannot imagine that your endo has not been watching your cortisol levels all along, and I would think if this was happening, you would already know about it. If you don't know this to be true, I would ask whether this was checked back when you were diagnosed and discuss this possibility with the doc with whom you have been working.

Now, leaving aside the possibility of the adenomas causing the hypercortisolism, the extra pounds are probably a big contributor to the inflammation and the inflammation and the high cortisol are likely inhibiting the weight loss. The high cortisol causes other problems as well, like blocking your growth hormone production.

Additionally, the high cortisol screws up your whole hormone cascade. When stressed, the body increases production of LDL to make more cholesterol, which is a substrate of your other hormones, including cortisol, but also sex hormones and other precursors to them. Having enough cortisol is always the body's priority, and that means that your body is shunting resources to make more cortisol because it thinks it desperately needs it. As a result, your DHEA is low, your pregnenolone is almost certainly low, your vitamin D is very probably low, and you don't have enough sex hormones either (you saw this when you dropped the Yasmin).

Also, the high cortisol state blocks TSH, so we cannot get a proper read of thyroid function when your cortisol is this high, and this is the reason your T4 is lower than it should be: as your high cortisol is likely keeping your TSH artificially low, your thyroid does not get signalled to make the hormone it should be making. This is what happens to people when they are in a super stressed state (like starvation) so that the body can hold on to fat, etc., so this is really not helping you lose the weight you want.

And I'm not sure I agree that exercise categorically lowers cortisol. I think exercise can cause a stress response in the body, and the more strenuous the exercise, the higher the stress response. For example, I think crossfit is exactly what you don't need at the moment. You said you are active at work, so it doesn't sound like not moving is the problem. I am sure this is going to go against your way of thinking, but I think you should move your body a lot, but in gentler ways. Lots of walking as a priority, and maybe pilates or yoga if you like that sort of thing, and if you do weights, do them, but not in an intense, balls-to-the-wall sort of way. Leave the crossfit and hair-on-fire stuff until your cortisol and inflammation are in a better state. At this time, I do not think that intensity of exercise equals benefit for you.

Sleep is super important for your adrenal glands (and your growth hormone production), and shift work or erratic hours really feed into health issues (and is acknowledged in many parts of the world as contributing to cancer, which I take to mean that it is linked to systemic health problems, some of which are probably just not proven yet). If I were you, I would make a very serious effort to get to bed early, super early, and get your sleep for 8-9 hours every single night. I cannot emphasise this enough. Turn the lights off early (there is increasing evidence that messing with circadian rhythms causes a lot of health problems, and while people who are young and healthy can tolerate being up half the night and sending confusing signals to their brain that it is daytime due to the blue light entering their eyes, people who are not well do not do well with this). After dusk, lower the lights in your house to very low levels, or better yet, get some red LED lights and use them after sundown, so that your melatonin production is not impaired (this is an important brain antioxidant) and that your sleep is as restorative as it can be.

As for diet and supplements: definitely try the heme iron. I used a product called Energizing Iron made by a company called Enzymatic Therapy when I was anaemic and it worked very well, but others may work just as well if you can't get that one in Canada.

If I were you, I would also take 100 mg of pregnenolone for a few months, to give your body more of this hormone it needs while it is still preferentially making cortisol out of the substrates. The same rationale applies to taking some DHEA. If it were me, I would take 15 mg a day. If you get any side effects (masculinising - like facial hair, hair loss, oily skin, acne, or rapid heart beat or insomnia) switch to the 7 keto DHEA or else halve the dose. I would guess you are so deficient that this won't happen at this low dose, but it's good to know what to do if it does, which is why I mention it.

Growth hormone actually could work for you, because it decreases cortisol levels, and helps prevent osteoporosis. It also will help with the anaemia, but please don't take your boyfriend's steroid source's GH - it is almost assuredly fake as GH is very expensive to make - and instead is likely to be cocktail of various things intended to mimic the side effects of GH. That stuff is less of a risk to a healthy bodybuilder than it is to you in this current state of health. If you really want it, find an anti aging doctor to prescribe it for you, or lobby your endocrinologist for it (I assume he is a medicare doc) based on the benefits I mentioned.

Quit coffee for your adrenals - it's extremely taxing for people with adrenal problems. You will suffer for a couple of days, and then feel better for it.

Consider take some B complex vitamins in the morning, and some magnesium at night.

What about seafood? Omega 3s and DHA, in particular, are absolutely vital, help to lower inflammation and seafood is much better than the oils you are taking, which have a different form in them. If you like oysters, they are outstanding, as is salmon. That will up your protein intake too, which you need.

Well, I wrote an awful lot - I hope you read it all and can find something helpful in all of this! If you have any questions, I will try to help.

Wow! I am surprised and thankful for your response ( thisangelbites)!

Actually the doctor who is looking into replacing the Yasmin with bio-identicals for me is a functional medicine doctor, and I am continuing to see him on all of these issues. I had to request a referral for one from my family dr- who did so reluctantly- she just wanted to prescribe me more meds to mask all my bad pms symptoms rather than get to the root of the problem, but I held firm and got my wish. So glad I did!! He has done further testing as you suggested to figure out if the elevated cortisol is being caused by the micro- adenomas and concluded that it was not, so it is definitely stress induced. He has told me a lot of the same things you have ( are you sure you are not a doctor???because you seem extremely knowledgeable on these topics). my endocrinologist has told me that stress aggravates hyperprolactinemia, but has not ever tested my cortisol levels. This is the same endo that told me I would have to take Yasmin till the day I die. Being in Saskatchewan - having access to a specialist is not always easy. There are few specialist available and we have to drive for hours and take the day off work to go see one and the waiting time can be up to a year to get in to see one for the first time, so you cant really be too picky on which specialist you get referred to- we are just happy to finally get seen by one.

However- I did raise some questions in my post that I had not yet raised to my doctor, and I very much appreciated your response and the amount of time and energy you put into it. I plan on taking your advice and following up with these issues with my dr. as well. I will hold off on intense training till my levels improve.

I can get 'energizing iron' shipped to me here in Canada through 'swansons' vitamins website. do have any particular brands you can recommend for the other things you suggest?(magnesium,b complex,, dhea, pregnenalone )

DHEA and pregnenalone supplements were not something my doc brought up however, which kind of surprises me, because he seems quite thorough. My husband is going in for a vasectomy in the coming weeks, and once that takes effect, I will finally be starting on the bio-identicals .

I already know my vitamin d levels are low, especially during our awful winters, so I do supplement it, but probably not enough., and I have not had my levels tested in at least a year.

I will keep you posted on how things go- it does feel good to finally take control of these issues. I am very much looking forward to having energy and thriving again!

Once again, than you so much for your very informative response!

[thisAngelBites]

It must be awful to be in place where it is so difficult to get quality health advice. Having said that, I am not far from London (UK) and I travel to Brussels to see my doc, so I do understand.

You are lucky that you've found this new doctor, and it sounds like he is willing to address and investigate the concerns that you raise, and that is a very good quality in a physician.

As far as supplements, I've used DHEA and pregnenolone from several different makers with no problems. I like Life Extension Foundation's products, but I have used others (like NOW, which is usually pretty reasonably priced), and if you check a place like iherb, you can get cheap international shipping, and there are lot of reviews of products to help you decide which one (and you can search for dosage to get just the right products (I like them and order from them myself).

You can certainly run those supps past your doc - I am sure if you mention the pregnenolone steal (which is what the body shunting resources to cortisol production is usually called), he wouldn't have any problem with these low dose supps.

Thanks for being so gracious about the time I spent to write to you. It was my pleasure to do it because I thought I could help, but it is nice to think that my efforts are appreciated. I'm happy to help you think through any other aspects that come up, if I feel I can say something you can use.

Lastly, you might want to know that it might take a couple months for all this to kick in, so don't get discouraged, and of course you might start to feel incrementally better much sooner. I can't emphasise enough that trying to get your circadian rhythm as close to daylight hours has a really great effect. When I started doing this, I went from feeling sort of chronically exhausted and waking up feeling unrested to going to bed early (like 10-ish), and waking up just as the sun was rising, feeling wonderfully rested and happy to get up. I think off-kilter circadian signaling impacts well-being more than we realise, but those are quantum effects and quantum biology of my big interests. I don't think your doc would necessarily endorse that, but I'm sure he will say it wouldn't hurt. I think you should try it. :-)

[Bonaparte]

Your doc prescribed you spironolactone for acne?
Seems odd to mess with a diuretic/anti-androgen when there are much more effective solutions that are more permanent and likely work a lot better (lose dosed accutane comes to mind).

Also: good to see your back, Angel!

[thisAngelBites]

Bonaparte -

Good to see you too! I take it you have been busy at work...?

I still do hear of spironolactone being prescribed for women's acne, but often they are women with PCOS, and Sue didn't mention that. There's lot of reason to be unimpressed with Sue's former doctor.

I wonder about whether her acne, thinning hair and dry skin isn't a lack of thyroid hormone being masked due to the cortisol suppressing TSH release. Maybe after the cortisol improves, her TSH will raise a bit and her thyroid will respond with more hormone, or else it will become clear she needs replacement.