Very high cortisol - results attached

[trc007]

After years of classic low t symptoms (weight gain, no energy, sleep issues, no sex drive at all, brain fog etc) I've been paying for private tests (UK) and have recently had a 4 tube saliva cortisol test done. As you can see the results are extremely high which would go hand in hand with the symptoms. I don't have any stress, or depression etc and try to lead a healthy lifestyle with a good diet and exercise. What would now be the next step looking at these results?
9am - 82.17 (7.45 - 32.56)
1pm - 23.01 (2.76 - 11.31)
5pm - 27.41 (1.38 - 7.45). All in nmol/L
12am 3.13 (0.83 - 3.86)
DHEA AM - 2.11 (0.25 - 2.22)
DHEA PM - 1.29 (0.25 - 2.22)

 

[CoastWatcher]

Welcome to Excelmale. How old are you? What medications/supplements (if any) are you taking?

 

[trc007]

Hi, no medications or supps. Have tried various vitamins in the past but all had no effect. Have had total testosterone done a few times which is on the low side for my age - I'm 27. I'm now thinking the lower t could be the cortisol?

 

[CoastWatcher]

Hi, no medications or supps. Have tried various vitamins in the past but all had no effect. Have had total testosterone done a few times which is on the low side for my age - I'm 27. I'm now thinking the lower t could be the cortisol?

Post up any other lab values you might have and I believe you'll generate some worthwhile discussion.

 

[MG123]

Have you noticed any changes to your body such as a rounded face, a hump between your shoulders, or abnormal stretch marks?

 

[trc007]

I am very prone to stretch marks although haven't had any recently. I have large stretch marks on my stomach, thighs, arms. I'm 6,1 and 95kg. My stomach and chest carry fat yet my arms and legs are normal/small

 

[dzd]

go to endocrinologist, make MRI, your pituitary or your adrenals are not working properly, you may have a tumor on one of this glands. dr will have to make dexamethasone test, synacten test or even more. good luck

 

[Vettester Chris]

Agree, a physician needs to look deeper into the primary and secondary end of it, and other markers that could factor "Cushings" into the discussion. I would think at these levels you would be experiencing symptoms like anxiety, sleep disorders, etc.? Something's amiss ...

 

[trc007]

Thankyou. Yes I do have very bad sleep issue too but it's odd as my problem is waking up. Once asleep (which is very late) I just cannot get up. No matter how many alarms I set etc

 

[Nelson Vergel]

Thankyou. Yes I do have very bad sleep issue too but it's odd as my problem is waking up. Once asleep (which is very late) I just cannot get up. No matter how many alarms I set etc

As melatonin goes down and testosterone goes up around 4-6 am, cortisol also increases to wake us up. Low AM cortisol can make it difficult for some people to get out of bed.

 

[trc007]

That the odd thing though, my am cortisol is absolutely sky high yet I can't get out of bed

 

[Nelson Vergel]

You may want to talk to your doctor about Cushing's diagnosis.

This chart uses 0.112 micrograms/dL for nighttime salivary cortisol as a cut off (which converts into 3 nmol/L, which is what your midnight one was)

https://arupconsult.com/sites/default/files/Adrenal Hyperfunction Testing algorithm.pdf

Diabetes and metabolic syndrome could also cause high salivary cortisol. What is your glucose? Weight? Have you had your testosterone and free T3 tested? Do you have lots of stress?

If you are in shape, I doubt that you have Cushing's, though.

 

[MAD King]

Keep us updated, please.

 

[trc007]

Many thanks for everyone's input so far. It's much appreciated. I will list previous results and symptoms below.
Symptoms
No sex drive at all
No morning or spontaneous erections
Anxiety issues
Lack of energy
Sleep issues (issue with waking and never feel tired enough to fall asleep)
Elevated heart rate which causes issues with exercise ( a light jog and my HR is up around 190bpm
Excess weight on chest and stomach but nowhere else
Muscle weakness
Concentration issues

Results
I am 27 and weigh 95kg have always been fairly active with walking and jogging. No stress, very relaxed job
Total test 14nmol/l (7.6-31.4)
SHBG 37nmol/l (16-55)
Prolactin 238miu/l (86-324)
TSH 1.6miu/l (0.27-4.2)
Free thyroxine 18.2pmol/l (12-22)
T4 109nmol/l (59-154)
Free T3 6.3pmol/l (3.1-6.8)
Thyroglobulin antibody 24iu/ml (0-115)
Thyroid peroxidase antibodies 6.3iu/ml (0-34)
Blood sugar has Been checked multiple times and is always fine.

 

[Nelson Vergel]

trc007

I would definitely talk to your doctor about his/her thoughts about this algorithm.

https://arupconsult.com/sites/default/files/Adrenal Hyperfunction Testing algorithm.pdf




It may be time for step 2: low dose dexamethasone suppression test

 

[trc007]

Thankyou nelson. I'm in the UK and the docs here are beyond useless. Went to see one the other day who didn't even know what cortisol was. I've had these tests done privately. I will have to try and find a private specialist to take it to the next level

 

[Nelson Vergel]

I found these


https://csrf.net/resources/cushings-doctors/

 

[trc007]

Much appreciated, I have sent them an email

 

[MAD King]

No sex drive at all
No morning or spontaneous erections

could also caused by low estradiol.
I had this problem before. Testo level was great, but estradiol was very, very low. Lowered the dose of Anastrozole and it went up and also my erections.

 

[trc007]

Unfortunately I can't find the sensitive estradiol test in the uk. I've it had it tested before but the result comes back as below a certain figure. Not a precise result as such