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<blockquote data-quote="Rand McClain DO" data-source="post: 91861" data-attributes="member: 90"><p>Hi ta406,</p><p>This is a tough question(s) because it is too complex to answer in a forum setting. Some general comments though that I hope may be helpful:</p><p>You say you have to get serial therapeutic phlebotomies (or just volunteer)? If they are therapeutic, then I would question the reason for the H/H increases. Most likely, they are the result of some form of sleep apnea. If you are not getting enough oxygen during sleep, you are going to be in "fight or flight" mode during the night (or whatever time you get your sleep). Being in chronic sympathetic nervous system mode will increase your cortisol levels (at least initially) and if this happens each night, your body will start to "gear up" for this (what I call) "training (hypoxic) in your sleep". What I find in practice is that most patients with sleep apnea will "sleep" (read: remain unconscious) fairly well through the first sleep cycle (four hours) of the night, but will be aware of there sympathetic nervous system response during the second sleep cycle. In addition, if your circadian rhythms are in sync, you naturally begin to produce more cortisol in the early morning hours in preparation for waking and getting busy with your day.</p><p>If you are under CHRONIC stress, we find that your cortisol levels flip flop and you begin to produce more at night and less in the morning (just FYI, I typically see a spike in cortisol levels in the morning and by noon or early afternoon these are reduced to almost nil). If one starts TRT, occasionally one can see an initial imbalance in cortisol levels because less of the precursors to T (including pregnenolone, progesterone and DHEA) are being diverted to T and can be used therefore to "overproduce" cortisol. This usual resolves fairly quickly though (weeks if not days).</p><p>Supplements that can be used to reduce cortisol are phosphatidylserine (800mg po qday minimum), holy basil, ashwaganda and Relora, to name a few. There is a pretty good formula made by Integrative Therapeutics called "Cortisol Manager" that I have used with patients with success. There are other supplements that can be used such as magnolia bark which activate GABA receptors which can help one relax (and thereby reduce cortisol).</p><p>Propanolol is a fairly non-specific beta blocker. It could help reduce sympathetic nervous system stimulation therefore, but could also slow your heart rate too much (and there are other contraindications you need to consider), make you feel depressed, or decrease you BP too much.</p><p>I would submit to a sleep study if I were you first and foremost if you experience unexplained elevations in H/H.</p></blockquote><p></p>
[QUOTE="Rand McClain DO, post: 91861, member: 90"] Hi ta406, This is a tough question(s) because it is too complex to answer in a forum setting. Some general comments though that I hope may be helpful: You say you have to get serial therapeutic phlebotomies (or just volunteer)? If they are therapeutic, then I would question the reason for the H/H increases. Most likely, they are the result of some form of sleep apnea. If you are not getting enough oxygen during sleep, you are going to be in "fight or flight" mode during the night (or whatever time you get your sleep). Being in chronic sympathetic nervous system mode will increase your cortisol levels (at least initially) and if this happens each night, your body will start to "gear up" for this (what I call) "training (hypoxic) in your sleep". What I find in practice is that most patients with sleep apnea will "sleep" (read: remain unconscious) fairly well through the first sleep cycle (four hours) of the night, but will be aware of there sympathetic nervous system response during the second sleep cycle. In addition, if your circadian rhythms are in sync, you naturally begin to produce more cortisol in the early morning hours in preparation for waking and getting busy with your day. If you are under CHRONIC stress, we find that your cortisol levels flip flop and you begin to produce more at night and less in the morning (just FYI, I typically see a spike in cortisol levels in the morning and by noon or early afternoon these are reduced to almost nil). If one starts TRT, occasionally one can see an initial imbalance in cortisol levels because less of the precursors to T (including pregnenolone, progesterone and DHEA) are being diverted to T and can be used therefore to "overproduce" cortisol. This usual resolves fairly quickly though (weeks if not days). Supplements that can be used to reduce cortisol are phosphatidylserine (800mg po qday minimum), holy basil, ashwaganda and Relora, to name a few. There is a pretty good formula made by Integrative Therapeutics called "Cortisol Manager" that I have used with patients with success. There are other supplements that can be used such as magnolia bark which activate GABA receptors which can help one relax (and thereby reduce cortisol). Propanolol is a fairly non-specific beta blocker. It could help reduce sympathetic nervous system stimulation therefore, but could also slow your heart rate too much (and there are other contraindications you need to consider), make you feel depressed, or decrease you BP too much. I would submit to a sleep study if I were you first and foremost if you experience unexplained elevations in H/H. [/QUOTE]
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