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.
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Originally Posted by sue
