Post by Chris Jackson on Nov 19, 2008 18:27:05 GMT -5
Written by Chris Jackson Oct 17, 2007
I decided to write this now, but wish I had put this out a long time ago. I would have liked to title this
"My explanation of how to increase your odds of success with HRT", but that wouldn't fit the space allotted.
Many of you have mentioned that you don't see successes, so I'm putting forth my ideas of why that is and
what you can do to hopefully increase your odds of optimizing your HRT and be a success story.
This article is a work in progress and although adrenals and thyroid treatment are mentioned, the advice I give in
this article is meant to apply to all types of HRT including, but not limited to adrenals, thyroid, sex hormones
and growth hormone. Details of how to treat for all known hormone therapies obviously can't be covered here.
I welcome your ideas and suggestions to help me improve this sticky.
Am I describing you? ;-)
1. You want to be put back to where you were before your
health started going downhill. No one would blame you
for wanting that and wanting to reach it quick, but it probably
won't happen since I've not seen anyone, even those people
who optimized their HRT report getting to where they had
hoped to get, but those few who are successfully treating
report they are doing pretty well.
Keep in mind depending on how many therapies you are on,
it can take 1 to 5 years to get to optimal treatment IF you
follow the guidlines I've put forth here. If you don't follow
these guidlines you greatly decrease your chances of
optimizing all your HRT.
2. You don't do research, but get all your info from
reading health forums. You'll understand things even
better if you do your own research. Always be aware of when
the information was written. Something 10 years old may not
be accurate today. I recommend spending at least an hour a
day. In my first year, I spent 2 to 3 hours a night every night
researching and studying medical books (took weekends off),
second year, 1 to 2 hours, 3rd year, 1 hour per night. My fourth
year, didn't do much research, maybe 5 hours a month. Now
halfway through my 5th year, do about 2 hours per month
research. THEN there is the time spent reading posts and
learning from others. Who knows how much time I spent
there. Endocrinology is so interesting to me, it kind of became
a hobby for a while.
I highly recommend you search info on the web and look at
the recommended book list (in FILES) on my Yahoo group
health.groups.yahoo.com/group/Hypopituitary_Support/
and buy some of them. I've gotten most of my books, including
endo medical books (also in a separate book list) from Ebay.
Also on my group (closed to posting, but you can search and
read posts), there are 100 files and over 500 information links
on all sorts of topics.
3. You don't get the proper adrenal and thyroid testing before
starting steroid and or Armour. No understands better
than me how hard it is to wait until you've been tested. After
suffering for 2 years I had to wait and suffer another 9 months
after I figured out I needed cortisol testing. I was tempted to
just start treating myself without testing, but I wanted to be
sure I needed steroid and wanted to know if I was primary or
secondary which you can't test for if you are already on
steroid. You want to know what is going on first don't you?
Treating with any hormone is serious business which is easy
to forget. Get tested first. You'll be glad you did. You want
to treat in this order, but all these must be tested first-
cortisol
DHEA (don't recommend, in women tends to cause virilation, tends to convert to excess E2 in men)
aldosterone and or vasopressin
B-12
iron
thyroid
sex hormones (including LH, FSH, SHBG, men must use
estrogen blocker first if E2 is high)
growth hormone
If you treat out of this order, you might as well go home.
4. You are dead set against going very high on HC even
though we (knowledgeable people) all say you have to
reach at least 25 mg. You can't treat your thyroid if
your cortisol isn't properly addressed. If you are going into it
with the thought of not going above 15 mg HC, you might as
well go home because you'll be wasting your time. In fact,
you may make yourself worse (see sticky, "My explanation of
how thyroid meds suppress the thyroid", that explanation
works the same for cortisol) If it was possible to get by with
less steroid, we'd have figured that out a long time ago.
5. You started yourself on Armour before properly testing and
treating your adrenals or you allowed your doctor to start you
on Armour first. If this is your case, then you have set
yourself up to fail. I've seen countless people who started this
way and in every case, they have an horrendous time
trying to get their steroid started and or figured out while in
the middle of dosing Armour. Trust me, starting Armour
before steroid is started and properly dosed is one of the
worse things you can do.
6. You don't keep a detailed journal with daily entries of your
vitals, dose changes, how you feel, other thoughts, etc.
I bet at least 80% of you don't do this. I bet 80% of that 80%
are sporadic in their use of their journal, skipping days, not
taking vitals, don't weigh on scale at least once a week, etc.
If you don't keep up religiously with your journal, you might
as well go home as you've set yourself up to fail from the get
go. I've not seen even one person report they got all their
HRT optimized without keeping a detailed journal.
Only those who religiously kept up with a journal reach
optimal treatment on all their HRT from what I've seen.
7. You adjust hormone dosing to often / keep at a dose to
long. You must have patience which I know is hard to
have when you feel bad, but if you don't go slow and
deliberate, you might as well go home as you'll find out in
hindsight that you wasted months of your time and have to
greatly back track or even start over. All hormone therapies
need time to build or decrease in the body. Armour is famous
for not being used properly. Only after cortisol is properly
addressed (20% of you will actually need Medrol) and going
well for at least 2 weeks (I like to see a month), I recommend
starting with 1/4 to 1/2 grain and 1/4 grain increases every
two weeks until one reaches 2 1/2 grains (this is protocol I
learned from others a long time ago and people have come
back to me to say it worked for them, moderators on these
forums may have different opinions on how to increase
armour) and sit there for 6 weeks, then increase to 2 3/4
grains and sit there for 6 weeks and so on. The other end of
the spectrum we see is someone who has stayed at the same
low dosage for months.
You must keep careful track of your vitals in your journal or
you'll likely will go past your optimal dose. If you increase
faster than what I described, YOU WILL go past your
optimal dosage and YOU WILL be chasing your tail, not
able to figure out what is happening.
8. You change more than one hormone at a time. If you
do that, you won't be able to figure out which change is doing
you good or bad. Doing that you may screw things up so bad
you can't figure out how to get back on track. Change
something, sit there for at least a week (or more depending on
what you did) and then change the other hormone therapy
when the proper amount of time has gone by. Once in a while
dose adjustments is what will get you optimal. If you adjust
everyday, you might as well go home.
9. You don't read and study informational stickies on these
or any other forums. They are put there to benefit you. What
more can I say about that?
10. You think you know more than the people who have
been helping others for years. If you are that arrogant or
ignorant, then you will probably be screwing up on 1 through
9 on this list.
You are poised to FAIL before you even begin.
I've seen moderators report they give someone advice, but
that person doesn't take it, then comes back asking why things
are going wrong. Why ask for our advice and not follow it?
That is very frustrating for us and wastes our time.
--------------------------------------------------------------------------------------
I admit, I broke number 7 back in 2004 when I started Armour and did raise it to fast thinking 6 weeks is being to careful, so I did 4 weeks and after two to three months had reached 4 grains, but couldn't figure out what was happening. I lowered down to 2 1/2, sat there for 6 weeks, following the protocol put forth by knowledgable people. Every 1/4 grain raise sat on it for 6 weeks. I found my optimal dose was 3 3/8 grains.
Of course I 'broke' (for lack of a better word) number 1, but everyone 'breaks' that one.
--------------------------------------------------------------------------------------
If you fail to follow even one of these 'rules', the odds of you successfully optimizing all your HRT is near zero in my opinion .
--------------------------------------------------------------------------------------
Also see in General forum
forums.realthyroidhelp.com/viewtopic.php?t=2529
and
Janie's (on STTM)
"Mistakes Patients Make (or their Doctors make for them!)"[/color][/size]
I decided to write this now, but wish I had put this out a long time ago. I would have liked to title this
"My explanation of how to increase your odds of success with HRT", but that wouldn't fit the space allotted.
Many of you have mentioned that you don't see successes, so I'm putting forth my ideas of why that is and
what you can do to hopefully increase your odds of optimizing your HRT and be a success story.
This article is a work in progress and although adrenals and thyroid treatment are mentioned, the advice I give in
this article is meant to apply to all types of HRT including, but not limited to adrenals, thyroid, sex hormones
and growth hormone. Details of how to treat for all known hormone therapies obviously can't be covered here.
I welcome your ideas and suggestions to help me improve this sticky.
Am I describing you? ;-)
1. You want to be put back to where you were before your
health started going downhill. No one would blame you
for wanting that and wanting to reach it quick, but it probably
won't happen since I've not seen anyone, even those people
who optimized their HRT report getting to where they had
hoped to get, but those few who are successfully treating
report they are doing pretty well.
Keep in mind depending on how many therapies you are on,
it can take 1 to 5 years to get to optimal treatment IF you
follow the guidlines I've put forth here. If you don't follow
these guidlines you greatly decrease your chances of
optimizing all your HRT.
2. You don't do research, but get all your info from
reading health forums. You'll understand things even
better if you do your own research. Always be aware of when
the information was written. Something 10 years old may not
be accurate today. I recommend spending at least an hour a
day. In my first year, I spent 2 to 3 hours a night every night
researching and studying medical books (took weekends off),
second year, 1 to 2 hours, 3rd year, 1 hour per night. My fourth
year, didn't do much research, maybe 5 hours a month. Now
halfway through my 5th year, do about 2 hours per month
research. THEN there is the time spent reading posts and
learning from others. Who knows how much time I spent
there. Endocrinology is so interesting to me, it kind of became
a hobby for a while.
I highly recommend you search info on the web and look at
the recommended book list (in FILES) on my Yahoo group
health.groups.yahoo.com/group/Hypopituitary_Support/
and buy some of them. I've gotten most of my books, including
endo medical books (also in a separate book list) from Ebay.
Also on my group (closed to posting, but you can search and
read posts), there are 100 files and over 500 information links
on all sorts of topics.
3. You don't get the proper adrenal and thyroid testing before
starting steroid and or Armour. No understands better
than me how hard it is to wait until you've been tested. After
suffering for 2 years I had to wait and suffer another 9 months
after I figured out I needed cortisol testing. I was tempted to
just start treating myself without testing, but I wanted to be
sure I needed steroid and wanted to know if I was primary or
secondary which you can't test for if you are already on
steroid. You want to know what is going on first don't you?
Treating with any hormone is serious business which is easy
to forget. Get tested first. You'll be glad you did. You want
to treat in this order, but all these must be tested first-
cortisol
DHEA (don't recommend, in women tends to cause virilation, tends to convert to excess E2 in men)
aldosterone and or vasopressin
B-12
iron
thyroid
sex hormones (including LH, FSH, SHBG, men must use
estrogen blocker first if E2 is high)
growth hormone
If you treat out of this order, you might as well go home.
4. You are dead set against going very high on HC even
though we (knowledgeable people) all say you have to
reach at least 25 mg. You can't treat your thyroid if
your cortisol isn't properly addressed. If you are going into it
with the thought of not going above 15 mg HC, you might as
well go home because you'll be wasting your time. In fact,
you may make yourself worse (see sticky, "My explanation of
how thyroid meds suppress the thyroid", that explanation
works the same for cortisol) If it was possible to get by with
less steroid, we'd have figured that out a long time ago.
5. You started yourself on Armour before properly testing and
treating your adrenals or you allowed your doctor to start you
on Armour first. If this is your case, then you have set
yourself up to fail. I've seen countless people who started this
way and in every case, they have an horrendous time
trying to get their steroid started and or figured out while in
the middle of dosing Armour. Trust me, starting Armour
before steroid is started and properly dosed is one of the
worse things you can do.
6. You don't keep a detailed journal with daily entries of your
vitals, dose changes, how you feel, other thoughts, etc.
I bet at least 80% of you don't do this. I bet 80% of that 80%
are sporadic in their use of their journal, skipping days, not
taking vitals, don't weigh on scale at least once a week, etc.
If you don't keep up religiously with your journal, you might
as well go home as you've set yourself up to fail from the get
go. I've not seen even one person report they got all their
HRT optimized without keeping a detailed journal.
Only those who religiously kept up with a journal reach
optimal treatment on all their HRT from what I've seen.
7. You adjust hormone dosing to often / keep at a dose to
long. You must have patience which I know is hard to
have when you feel bad, but if you don't go slow and
deliberate, you might as well go home as you'll find out in
hindsight that you wasted months of your time and have to
greatly back track or even start over. All hormone therapies
need time to build or decrease in the body. Armour is famous
for not being used properly. Only after cortisol is properly
addressed (20% of you will actually need Medrol) and going
well for at least 2 weeks (I like to see a month), I recommend
starting with 1/4 to 1/2 grain and 1/4 grain increases every
two weeks until one reaches 2 1/2 grains (this is protocol I
learned from others a long time ago and people have come
back to me to say it worked for them, moderators on these
forums may have different opinions on how to increase
armour) and sit there for 6 weeks, then increase to 2 3/4
grains and sit there for 6 weeks and so on. The other end of
the spectrum we see is someone who has stayed at the same
low dosage for months.
You must keep careful track of your vitals in your journal or
you'll likely will go past your optimal dose. If you increase
faster than what I described, YOU WILL go past your
optimal dosage and YOU WILL be chasing your tail, not
able to figure out what is happening.
8. You change more than one hormone at a time. If you
do that, you won't be able to figure out which change is doing
you good or bad. Doing that you may screw things up so bad
you can't figure out how to get back on track. Change
something, sit there for at least a week (or more depending on
what you did) and then change the other hormone therapy
when the proper amount of time has gone by. Once in a while
dose adjustments is what will get you optimal. If you adjust
everyday, you might as well go home.
9. You don't read and study informational stickies on these
or any other forums. They are put there to benefit you. What
more can I say about that?
10. You think you know more than the people who have
been helping others for years. If you are that arrogant or
ignorant, then you will probably be screwing up on 1 through
9 on this list.
You are poised to FAIL before you even begin.
I've seen moderators report they give someone advice, but
that person doesn't take it, then comes back asking why things
are going wrong. Why ask for our advice and not follow it?
That is very frustrating for us and wastes our time.
--------------------------------------------------------------------------------------
I admit, I broke number 7 back in 2004 when I started Armour and did raise it to fast thinking 6 weeks is being to careful, so I did 4 weeks and after two to three months had reached 4 grains, but couldn't figure out what was happening. I lowered down to 2 1/2, sat there for 6 weeks, following the protocol put forth by knowledgable people. Every 1/4 grain raise sat on it for 6 weeks. I found my optimal dose was 3 3/8 grains.
Of course I 'broke' (for lack of a better word) number 1, but everyone 'breaks' that one.
--------------------------------------------------------------------------------------
If you fail to follow even one of these 'rules', the odds of you successfully optimizing all your HRT is near zero in my opinion .
--------------------------------------------------------------------------------------
Also see in General forum
forums.realthyroidhelp.com/viewtopic.php?t=2529
and
Janie's (on STTM)
"Mistakes Patients Make (or their Doctors make for them!)"[/color][/size]