Address underlying issues like obesity, insulin resistance, leptin resistance, and inflammation to improve adrenal function, especially if free cortisol is low but metabolites are ample, as lifestyle management is key.
If experiencing symptoms of hypothyroidism, request a full thyroid panel including TSH, free T4, free T3, and reverse T3, as TSH alone is often insufficient for accurate diagnosis.
For women, consider initiating hormone replacement therapy (HRT) during perimenopause, 1-2 years before full menopause, rather than waiting for complete hormone decline, to manage symptoms and support long-term health.
To ameliorate significant PMS symptoms caused by progesterone withdrawal, take a low dose of oral progesterone (approximately 50mg) daily for seven days, starting around day 21 of a regular cycle.
To suppress evening cortisol production and facilitate sleep, especially for jet lag or time zone adjustments, take 400-600 milligrams of phosphatidylserine.
If standard T4 treatment for hypothyroidism is ineffective or causes worsening symptoms due to conversion issues, consider using T3 (e.g., compounded control-release T3) to bypass the body’s conversion process.
If prescribed compounded control-release T3, take it generally in the morning to ensure its potency is reduced by evening, improving tolerance and mimicking natural rhythms.
When treating hypothyroidism, prioritize fixing the patient’s symptoms and overall well-being over solely optimizing lab numbers, using whatever treatment approach proves effective.
If you miss a dose of T4 (levothyroxine), simply take it the next day and do not double up, as T4 has a long half-life and a single missed dose is not critical.
Due to its much shorter half-life compared to T4, it is important to consistently take T3 medication as prescribed to maintain stable levels and therapeutic effects.
Do not use hydrocortisone, prednisone, or other glucocorticoid replacements for general low free cortisol symptoms; reserve these treatments for severe distress or conditions like Addisonian crisis.
To accurately assess adrenal function, use a urine or saliva test (like the Dutch test) to measure free cortisol and its metabolites, as blood tests for total cortisol are unhelpful.
Only consider testosterone replacement therapy (TRT) if there is a clear symptomatic case for low testosterone (e.g., low libido, low mood, difficulty building muscle) and free testosterone levels are relatively low (below the 50th percentile).
If initiating TRT, conduct a trial for 8 to 12 weeks to assess both biochemical improvement and, more importantly, the resolution of symptoms.
If symptoms do not improve after an 8-12 week trial of TRT, even if testosterone levels normalize, discontinue the treatment unless it’s for a specific reason like bone health.
For men with osteopenia or osteoporosis, use TRT to achieve high testosterone and estradiol levels, combined with heavy training, to increase or maintain bone mineral density, even if other symptoms are not present.
Be cautious about using Clomid (clomiphene) to increase testosterone, as it blocks estrogen receptors in the brain, which can negatively impact mood and may not improve symptoms despite raising testosterone levels.
Generally avoid using anastrozole to lower estradiol during TRT unless levels are excessively high (e.g., >50-60) or causing symptoms, as estrogen is beneficial for men’s bone health and mood.
Be aware that testosterone replacement therapy can accelerate hair loss in susceptible individuals due to increased conversion to dihydrotestosterone (DHT).
Overweight men on TRT may convert more testosterone to estradiol due to higher aromatase activity in adipose tissue, potentially leading to higher estrogen levels.
Understand that taking exogenous testosterone will shut down the body’s natural testosterone production, potentially permanently within one to two years.
Gain an understanding of the profound physiological changes and hormone withdrawal women experience during the end of the luteal phase to foster empathy for those struggling with PMS.
For a much deeper understanding of the thyroid, adrenal, and sex hormone systems, watch the accompanying video series, as visual aids provide significant clarity.
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