Starting Fludrocortisone - Anything I need to be aware of?

Iii

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I didnt see that this post is old​

 
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Dr. B

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Honestly I don't know. Pregnenolone sits atop the whole hormonal cascade and in my opinion it's difficult if not impossible to predict where it's gonna end up, also depends on your physiological state at any given time, whether you're going through any stress at the time, etc. There's some evidence that pregnenolone itself is a CRH/ACTH antagonist which would help lower cortisol (Pregnenolone Is The Most Potent Inhibitor Of The Stress Signal (CRH)), and it also converts into progesterone which has potent anti-cortisol effects. I feel way better taking progesterone vs pregnenolone and I think personal experience is the best way to gauge if something is beneficial or not.

If you want to lower excessively high cortisol I would eat lots of carbohydrate and eliminate stress in your life.
a naturopath i talked to said she prescribes pregnenolone to people with low cortisol to bring it up.
she also believed progesterone, usually, lowers cortisol, even though its a precursor.
she uses things like 7 keto dhea to lower excess cortisol, and a few other herbs maybe ashwagandha...
however, I gained weight from both pregnenolone, and 7 keto dhea, however, 10 days of 50mg pregnenolone per day = 12 pounds weight gain, whereas 30 days of 100mg 7 keto dhea per day equalled 10 pounds weight gain, the keto dhea didn't have the testicle shrinking effect or any severe hair shedding effect whereas pregnenolone had severe hair shedding and teste shrinkage effects, both were the same brands , pure encapsulations, no filler ingredients. it seems like pregnenolone is necessary when you have a fast metabolism, you obviously produce pregnenolone for the sex steroids etc, but at the same time if you just pour pregnenolone into a slow metabolism, attempting to bypass things, it seems it actually goes straight to cortisol... so that is probably why the body itself downregulates pregnenolone production when metabolism is slow.
you can probably do fine supplementing squalene or lanosterol or cholesterol, but pregnenolone is the key thing which you have when metabolism is high, and you dont have when its slow. some people seem to have had good experiences with it, so its possible if metabolism is fast, the pregnenolone gets used up for positive hormones, whereas when its slow it goes to estrogen/cortisol.
although when I asked Peat he thinks its not possible for pregnenolone to turn to estrogen/cortisol. but doesn't the body itself create estrogen/cortisol from pregnenolone...
i can see some sort of rebound effect happening where, similar to the steroids, maybe supplementing cortisol or pregnenolone, suppresses the bodys production of those things?
 

Ganne

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"Another clue that your aldosterone may be too low?? Never finding stable DATS–you just keep going higher and higher with the HC or Adrenal Cortex and end up on too much!!"
- If hydrocortisone supplements don't work it means that you can have low aldosterone and sodium.

"Hi ********
I started a long mail, got interrupted and when I got back to it, there were so many posts to you on the subject and the all overriding advice from Dr. Peatfield, which is, of course, the one to follow.

However, just to explain a little about Florinef and how it works. So, for what it’s worth, below is what I had written earlier. You might find it helps a little to detangle the confusion you are in at the moment. It’s just a little background info on Florinef from a practical point of view. As I see it, you need to know exactly how Florinef works, in order to determine whether or not it might be what you need.

In my opinion it would be wrong and not without risk to try Florinef without testing.

I don’t know your full story, and without being aware of the full picture it would be wrong, even be dangerous, for me to give any advice. However, in my personal view, it is highly risky to experiment with glucocorticoids and/or mineralcorticoids without the proper guidance of a doctor.

30 mg HC are according to Dr. Peatfield (in his chapter on the adrenal connection) above the physiological replacement dosage of 15-20 mg/day. There is a big distinction between physiological cortisone replacement and therapeutic cortisone dosages and in my view, by going up to 30 mg you might be going into deep waters if you did it off your own accord.

Florinef is a mineralcorticoid (as opposed to a glucocorticoid) and it is the drug that is used for people with primary Addison’s disease or at least it *should* be used, rather than the HC, which most doctors are using instead, because not many endos have hand-on experience with Addison’s. Primary Addison’s in humans is extremely rare – I read that 1 in 100.000 people suffer from it; although I have come across Addison’s in dogs hundreds of times on our forums AD in dogs it is no longer rare at all, although the knowledge of proper treatment for them lags behind with most vets just as much as it lags behind with human endocrinologists.

However, the point of my message is . be very careful if experimenting with Florinef. The function of Florinef is to bring up the sodium and to lower the potassium which is why it is the right drug for Addisonian people. Someone with Addison’s will have very low Sodium levels and very high potassium levels and this is a life threatening condition.

In my view it would make more sense to try and find out what your adrenals are really doing. Since you are having trouble getting an aldosterone test, one very simple way of finding out if something is seriously adrift is to ask your GP for an Electrolyte test that would be checking Sodium (Na) and Potassium (K) and it’s a cheap standard test. I would imagine, that you might have low sodium levels . but the burning question is where is your potassium? You need to know, because if your potassium were low as well as your sodium, and you then took Florinef, you could do damage. The Florinef would lower your potassium even further, whilst your sodium would rise. you might finish up with serious heart and kidney complications.

Just as a guideline for you Lab ref ranges differ slightly, but usually the ref range for Na (sodium) is between 138-160 or thereabouts. The ref range for Potassium (K) is roughly between 3.8-6.0 as I said, the exact figures differ from lab to lab and you’d need to find out the figures your lab is using.

A healthy Na:K ratio would be one that turns out to be in the low to mid thirties, a worrying one is below 27. But I have to stress that one can’t judge by the ratio figure alone. You’d need to look at the whole picture and the relation between sodium and potassium figures.

You get the ratio be dividing the lower figure (Potassium) into the higher figure (Sodium) – for example. lets say for arguments sake that the Na is 140 and the potassium 4.8

140 divided by 4.8 = ~29.2 – which would mean, that the adrenals are not functioning brilliantly (the sodium is too low) but this is not Addison’s disease. If with a reading like that you’d take Florinef, the potassium -which is a good reading with 4.8, and you did not really want it to come down (!) would come down, whilst the sodium goes up. It’s a very fine balance, and if you got it wrong, you could finish up in dire straights.

As a rule of thumb good figures to aim for would be a sodium in the middle of the norm range (around the 145-148 mark) and a potassium figure around 4.5 certainly not above 5 and not below 4."
How would one raise sodium, mine is 139 and not lower my already low aldosterone at 3? My potassium is 4.1. I have horrible edema.
 

Ihor

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@Ganne I read studies about attempts to raise low cortisol with pregnenolone and although in theory the pregnenolone conversion pathway downstream of steroidogenesis goes to cortisol, in practice pregnenolone did not raise cortisol, the same about the futility of raising cortisol with pregnenolone I have heard from people in practice. The same is true when trying to raise cortisol with progesterone, that is, about the conversion of progesterone into cortisol, which, based on experience, although it can turn into it, at the same time blocks cortisol receptors even more, which will further worsen the situation if cortisol is already low.
Regarding the conversion of pregnenolone to other hormones, I met the opinion that this happens only during sufficient synthesis of ATP, that is, with adequately functioning thyroid hormones, when low thyroid cortisol does not work, and t3 either accumulates or turns into reverse t3, so the addition of pregenolone can also accumulate it and do nothing or cause problems that you write about.
Yes, the addition of cortisol exogenously suppresses the production, the more and the longer you add, the more it suppresses, but if the cortisol is low and cannot be raised in other ways, then adding up to 10 mg a day for several weeks if done correctly may be necessary for recovery. In my reports somewhere there were studies on the degree of suppression depending on the dose and duration, it also states that after cessation, if all is well, the body resumes its own production over time.
Well, increased salt intake, fludrocortisone can increase sodium levels and decrease potassium, fludrocortisone as I remember also can inhibit aldosterone production.
So if blood cortisol, dhea, aldosterone are low it can signalize about adrenal gland deplate.
 

Ganne

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What would someone do for adrenal gland depletion? Is that what you mean in the last line of your post? My doctor suggested cortisol 5mil once a day and salt. B vitamins.
 

Dr. B

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@Ganne I read studies about attempts to raise low cortisol with pregnenolone and although in theory the pregnenolone conversion pathway downstream of steroidogenesis goes to cortisol, in practice pregnenolone did not raise cortisol, the same about the futility of raising cortisol with pregnenolone I have heard from people in practice. The same is true when trying to raise cortisol with progesterone, that is, about the conversion of progesterone into cortisol, which, based on experience, although it can turn into it, at the same time blocks cortisol receptors even more, which will further worsen the situation if cortisol is already low.
Regarding the conversion of pregnenolone to other hormones, I met the opinion that this happens only during sufficient synthesis of ATP, that is, with adequately functioning thyroid hormones, when low thyroid cortisol does not work, and t3 either accumulates or turns into reverse t3, so the addition of pregenolone can also accumulate it and do nothing or cause problems that you write about.
Yes, the addition of cortisol exogenously suppresses the production, the more and the longer you add, the more it suppresses, but if the cortisol is low and cannot be raised in other ways, then adding up to 10 mg a day for several weeks if done correctly may be necessary for recovery. In my reports somewhere there were studies on the degree of suppression depending on the dose and duration, it also states that after cessation, if all is well, the body resumes its own production over time.
Well, increased salt intake, fludrocortisone can increase sodium levels and decrease potassium, fludrocortisone as I remember also can inhibit aldosterone production.
So if blood cortisol, dhea, aldosterone are low it can signalize about adrenal gland deplate.
dont people usually have excess cortisol? and supplementing it especially would cause cushings or cushings like symptoms?
 

Ihor

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What would someone do for adrenal gland depletion? Is that what you mean in the last line of your post? My doctor suggested cortisol 5mil once a day and salt. B vitamins.
Did you try already? How do you feel in it?
 

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