#1

I know this is a bit controversial, but does anyone have any thoughts on taking hydrocortisone to replenish sub optimal cortisol levels for the purpose of energy, brain function, anti aging, etc?

Dr. Thierry Hertoghe is a big proponent of this.

(This would not be advisable for someone with too high cortisol.)

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#2

Dr Hertoghe is really worth to listen to. He’s been advocating hormones replacement therapy against aging since at least the 90’s. His Hormone Handbook is really good. It was amusing to see Dr Fahy recently rejuvenating the Thymus with growth hormone, dhea and metformin. Hertoghe was spot on, years before that.

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#3

He offers training course’s

#4

No, not for anti-aging, but low-dose prednisone has been helpful in hard times.

#5

I’m specifically referring to it being a long term or forever thing. Prednisone is good for specific instances as you mentioned but as a long term thing, there is far greater risk of permanent adrenal gland suppression than hydrocortisone.

#6

We’d want a salivary 4-5 point cortisol/melatonin curve, and a blood AM cortisol and DHEA-S to better understand the issue. Many people have dysfunctional cortisol curves and this is the problem rather than overall insufficiency. This is the type of thing I address with patients daily. It is complex, and the jump to taking HC is a big one, and there are multiple steps before doing that.

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#7

Doctor, I just want to say that you are a real saint on this forum. I find your comments to be as thoughtful as they are useful. I really appreciate your contributions.

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#8

Interesting to see you say this. I’ve heard mixed views on whether the 4 point salivary tests were useful or not, with the counter argument being that they change a lot and can be thrown off by a poor night of sleep.

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#9

I think you have to pick a reasonable day to do it after decent rest. Given that you start it in the AM on waking, you’ll know if it is a good day to do the test or not. The main things we are looking at is some bad patterns with a flat curve either being too high across all measures (which is modest increase in mortality) or being globally low which is a much worse outcome, and is the continuation of burnout from being globally too high. It’s much easier to treat the former. Most people with global low don’t have Addison’s disease, they have lifestyle issues, stressors, etc that have led to this dysfunction. So sometimes we’ll use a little HC, but it isn’t the first step.
I find these tests incredibly useful and I’ve not seen massive changes with most people - on serial testing we see the same pattern in most individuals, but then see improving or worsening, but often the flatness of the curve only slowly changes.
On my last time, I did it a day I was working in the ER, and come mid day, they tell me I have no PA (supposed to have double coverage). I was literally spitting mad. Shockingly, totally normal cortisol curve despite the crappy day.
@Alex Thank you so much. I gain more than I give on this forum for sure.

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#10

That’s great insight. Thanks for breaking it down

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#11

I understand the range of possible issues that face an individual but I would urge caution. Corticosteroids can suppress IgG levels and upset the immune system in other ways. There may be safer ways to upregulate cortisol levels.

#12

Absolutely, and I agree. The issue is that blood levels unless done repetitively really don’t give a good idea of what is going on. As much as folks on the forum love to self manage, this is an area with significant risk and self management should be discouraged. Seeing an expert with formal education is important. This usually is a functional medicine or anti-aging medicine physician.

I also see so many people jump in to testosterone replacement when that isn’t the problem, or even if it is, something like enclomiphene or hcg.

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#13

With salivary cortisol being better, is there a particular optimal range of 8am blood cortisol that you look for? The range is 10-20 on most labs. I have seen mine at 14 the last two times personally.

#14

This is the issue, as your waking up cortisol is on the rise, depends on timing, 30 minutes post waking it should be at a solid peak and then decrease the rest of the day. I often use 10,000 LUX lamps for 10-15 minutes on wakeup for patients who are low … and it works generally.

I think he pattern provides the information on what is going on. If you are at 14, I’d be staying away from HC. But I’d look at the pattern with salivary. Your concern might not be cortisol related - I’d be more interested if the level was 3.

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#15

https://drmyhill.co.uk/wiki/Hydrocortisone_-_how_to_use_it_safely_and_without_causing_adrenal_suppression

#16

On reading the discussion, it actually is sensible, but basically brings up, no HC without clear adrenal hypofunction, and that even modest doses of HC end up causing adrenal suppression.

It’s super easy to start down such a pathway, but once you realize it is a mistake, backing out is a real mess. The smart move is never heading down the pathway to begin with unless it is absolutely a certainty. There is a good likeness to testosterone replacement, where is is easy to jump into, and the minority of people heading down this pathway need it … and backing out is a mess and often isn’t done, and you’re committed to life long treatment.

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#17

It does seem like a delicate balance. Low doses can be useful for several reasons if someone doesn’t produce enough cortisol, but going over that dose threshold is risky.

To be fully transparent, I was having some rough symptoms a few years ago (thyroid related to be specific). I had given 20mg HC a shot spread over the day, after getting the four point saliva test that showed low cortisol at all four times of the day. I then read about adrenal suppression and got nervous so I tapered off for about a week. I had absolutely no issue coming off at all, fortunately. The 8am blood cortisol of 14 a few times happened after stopping. Looking back on it, I was feeling pretty good when I was taking it. Just my one anecdote.

#18

Have you had a morning cortisol test recently?

#19

Not a saliva test. Just morning blood cortisol when it was 14, around 5-6 months ago. Higher than it was several years ago before taking HC

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#20

This is a pretty thorough breakdown

  • Cortisol affects metabolism, inflammation, blood pressure, blood sugar, energy production and even the sleep-wake cycle.
  • Studies generally find low cortisol levels are present in ME/CFS/FM
  • A huge study involving about 80 doctors and 600 people with fibromyalgia and 25 with ME/CFS (and over a 1000 others with other diseases) found that about 75% benefitted from low dose hydrocortisone (Cortef) supplementation (<15 mgs/day).
  • The study included an induction period in which everyone took hydrocortisone for a month and then a flare reduction period in which the participants took it for five days following the beginning of a flare. Some people took it throughout the month while taking a hydrocortisone holiday on weekends.
  • The amount of hydrocortisone given during the three-week induction period was extremely high – up to five times higher than a dose which produced adrenal suppression in some ME/CFS patients – but over several months.
  • The authors asserted that the low dose of the drug plus the holidays prevented adrenal suppression where the adrenal glands stops producing cortisol from occurring. While the authors stated that the average dose during the flare period was 12 mgs/day, if some of the participants took the drug five days a week 4 times a month they could be taking almost 20 grams a day – and be in danger of adrenal suppression.
  • Tests for adrenal suppression were not done but the authors reported so signs of it occurred.
  • From the simplistic monitoring system to the lack of blinding or cortisol testing etc. the study was rudimentary indeed.
  • Past placebo controlled hydrocortisone studies in ME/CFS, while small, do suggest that a subset of patients may significantly benefit from supplementation. Baseline cortisol testing, does not, however, reveal who might benefit. Why some benefit and others do not is unclear.
  • Several ME/CFS experts do embrace hydrocortisone supplementation in low levels (5-15 mgs. depending on the doctors.) They assert that adrenal suppression does not occur at these levels.
  • Some studies have been able to use mind/body and behavioral techniques to normalize cortisol levels. Other studies have not.
  • The large, long term studies needed to fully assess the efficacy and safety of low dose hydrocortisone supplementation have not occurred in these diseases.

“Dr. Myhill pointed out that the results were complicated by the fact that baseline cortisol levels did not predict who benefitted from the treatment, and that baseline levels were within normal reference ranges”