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  1. #1
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    Default DHEA results from a 24 hours urine analysis

    Hi,

    Just had my last 24 urine analysis and I'm quite please with it, except for DHEA.

    Previously to HRT :

    Amount Excreted in ug/24hour
    Estrone : 0.3 (3 - 11.4)
    Estradiol : 0.2 (0.8 - 4.6)
    Estriol : 3.1 (3.5 - 13.7)
    Pregnanediol (progesterone metabolite) 440 (70-1050)
    DHEA 239 (100-2000)
    Testosterone 60 (20-200)
    Androsterone 938 (2000-5000)
    Etiocholanolone 361 (1400-5000)
    Pregnanetriol 500 (200-1500)
    Cortisone 139 (31-209)
    Cortisol 101 (30-170)
    Tetrahydrocortisone 3274 (2100-7400)
    Allo-Tetrahydrocortisol 1877 (700-3800)
    Tetrahydrocortisol 1725 (1200-4500)
    Aldosterone 12.1 (Normal Diet : 6.0-25.0, Low Salt : 17.0 - 44.0, High Salt : 0.0 - 6.0)
    Allo-Tetrahydrocorticosterone 453 (130-600)
    Tetrahydrocorticosterone 115 (30-240)


    four months later on testosterone shots (43 mg E3D), DHEA TD 75 mg and 25 mg cortef :
    Estrone : 2.6 (3 - 11.4)
    Estradiol : 1.5 (0.8 - 4.6)
    Estriol : 12.9 (3.5 - 13.7)
    Pregnanediol (progesterone metabolite) 567 (70-1050)
    DHEA 16 (100-2000) (I took DHEA as usual on the day of the test)
    Testosterone 194.3 (20-200)
    Androsterone 2729 (2000-5000)
    Etiocholanolone 773 (1400-5000)
    Pregnanetriol 190 (200-1500)
    Cortisone 241 (31-209)
    Cortisol 187 (30-170)
    Tetrahydrocortisone 6589 (2100-7400)
    Allo-Tetrahydrocortisol 6359 (700-3800)
    Tetrahydrocortisol 3955 (1200-4500)
    Aldosterone 19 (Normal Diet : 6.0-25.0, Low Salt : 17.0 - 44.0, High Salt : 0.0 - 6.0)
    Allo-Tetrahydrocorticosterone 479 (130-600)
    Tetrahydrocorticosterone 86 (30-240)


    What is going on with my DHEA levels? I've been taking prasterone (DHEA) for many months now, 75 mg TD. Could it be possible that this form of DHEA is undetectable in urine analysis or am I just not absorbing it at all (from hypothyroidism)? That really odd, my doc just switched to 25 mg oral DHEA to start with and we will retest in 6 weeks. He did offer much explanation. He also said to reduce cortef to 20 mg, not sure about that....

    If you have any thought on my results, feel free to share of course

    Thx
    male 29 - hypothyroid, hygonadism

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    Default Re: DHEA results from a 24 hours urine analysis

    Quote Originally Posted by gu3vara View Post
    Previously to HRT :

    DHEA 239 (100-2000)
    Cortisone 139 (31-209)
    Cortisol 101 (30-170)
    Allo-Tetrahydrocorticosterone 453 (130-600)


    four months later on testosterone shots (43 mg E3D), DHEA TD 75 mg and 25 mg cortef :

    DHEA 16 (100-2000) (I took DHEA as usual on the day of the test)
    Cortisone 241 (31-209)
    Cortisol 187 (30-170)
    Tetrahydrocortisone 6589 (2100-7400)
    Allo-Tetrahydrocortisol 6359 (700-3800)

    What is going on with my DHEA levels?...or am I just not absorbing it at all (from hypothyroidism)?
    Hypothyroidism most likely is preventing absorption of your transdermal DHEA, combined with your cortef dose resulting in the maxing out of your cortisol, combined with your T shots maxing our your T, resulting in your testicles and adrenals reducing their local DHEA production since they detect (via feedback loops) that less DHEA is needed.

    Discuss with your medical professional adviser to monitor your thyroid hormones, ie:

    a) thyroid antibodies, ie TSH antibodies and thyroid peroxidase antibodies.
    b) free T3
    c) free T4
    d) total T3
    e) total T4
    f) reverse T3
    g) TSH

    You may discover that if you switch to boosting your thyroid hormones, you may be able to reduce your cortisol boost, maybe even to zero.

    Ie: you may be feeling fine now, but you're maxing out your daily average cortisol levels (from urinary cortsol metric) to achieve that result.

    That's downregulating your cells response to the testosterone present in your body, which is why your T levels have to be so high for you to feel OK. So that's less-than-optimum hormone balance.

    So if you do need a thyroid hormone boost, then carefully monitor your cortisol levels, and your symptoms, to see if you can reduce your cortisol dose.

    You may want to use 4 x salivary cortisol testing, rather than a complete urinary hormone profile, to save $$$.

    ###

    From memory, your hormone dysfunction is more serious than vanilla adrenal fatigue, so I doubt that you'll be able to successfully optimize your hormones by swapping cortisol supplementation for thyroid hormone supplementation. I suspect you'll need both.

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    Default Re: DHEA results from a 24 hours urine analysis

    Thx for the reply!

    Yeah my hormonal problems are quite widespread indeed, I'm taking 2 grains of dessicated thyroid, I'm Hashimoto. (I was hyper on 2,25 grains) when I did that urine analysis. My TSH was 0.04 and both FT4 and FT3 were top range, I will feeling really hyper, no doubt about that. I'm going to retest in two weeks (5 weeks after the reduce dose, I might still be a bit hyper, not sure).

    Interesting thing is that my testosterone blood test show mid range levels for both total and bioavailable T. I'm guessing that being on shots might be the cause of increase urine results, because levels are stable all day long. Makes any sense?

    I have now added HCG to the protocol so my T might be higher now, I might have to lower shots. I'll now soon.

    About the urinary cortisol, is it a reliable test? My salivary cortisol was extremely depressed while my urinary cortisol didn't look that bad before HC (139 on a range of 31-209). My blood cortisol AM was on the low normal side. I could try to lower my dose to 22,5 for a few days and see how it goes but there is a but : thyroid was hyper at the time of the test, couldn't it increased cortisol clearance.

    EDIT : I found this
    (http://www.endocrinology.org/educati...4/ss04_arl.htm)
    Urinary 24-hour free cortisol excretion has been advocated for monitoring of replacement quality. However, after exogenous glucocorticoid administration, urinary cortisol excretion shows considerable interindividual variability. More importantly, following glucocorticoid absorption cortisol-binding globulin (CBG) will be rapidly saturated, resulting in transient but pronounced increases in renal cortisol excretion. Thus, one cannot refer to normal ranges for healthy subjects when judging urinary cortisol excretion during replacement therapy in AI. However, in cases of suspected under-replacement, e.g. due to non-compliance, urinary cortisol measurements may be helpful.

    To measure a random serum cortisol without knowing the exact time of preceding glucocorticoid administration is not helpful in monitoring glucocorticoid replacement. Some authors have suggested regular measurements of serum cortisol day curves during replacement therapy aiming at serum cortisol concentrations within the normal range. However, due to their pharmacokinetic properties, none of the exogenous glucocorticoids currently used is suitable to mimic the diurnal cortisol pattern found in healthy subjects.

    Thus, in the absence of objective parameters indicating replacement quality, the physician has to rely primarily on clinical judgment, carefully taking into account signs and symptoms potentially suggestive of glucocorticoid over- or under-replacement. Under-replacement bears the risk of incipient crisis and significant impairment of well-being. Conversely, chronic over-replacement may lead to substantial morbidity including impaired glucose tolerance, obesity and osteoporosis. With currently recommended doses of 15 to 25 mg hydrocortisone osteoporosis is not to be expected. Therefore, bone mineral density measurements are not required for regular monitoring in AI.
    I started oral DHEA yesterday too, it's a rip off, it's prescription only in Canada, I pay 40$ a month for it...!
    Last edited by gu3vara; 08-29-2009 at 08:53 AM.
    male 29 - hypothyroid, hygonadism

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    Default Re: DHEA results from a 24 hours urine analysis

    I've reordered your responses in order of their impact on your health:

    Quote Originally Posted by gu3vara View Post
    About the urinary cortisol, is it a reliable test? My salivary cortisol was extremely depressed while my urinary cortisol didn't look that bad before HC (139 on a range of 31-209). My blood cortisol AM was on the low normal side. I could try to lower my dose to 22,5 for a few days and see how it goes but there is a but : thyroid was hyper at the time of the test, couldn't it increased cortisol clearance.
    Boosting thyroid will sometimes boost cortisol metabolism, sometimes not.

    Eg: boosting thyroid will greatly boost your cortisol metabolism if your cortisol was low because your overall metabolic rate was low from naturally low TSH.

    This is highly likely in your case, because you have high thyroid antibodies, and the body's natural response to high thyroid antibodies is to lower TSH below optimum.

    Eg: boosting thyroid will barely boost your cortisol metabolism if your cortisol was low because of adrenal fatigue.

    I believe you've now shown that you did not have a typical case of adrenal fatigue.

    ###

    But when you and your medical professional adviser boost your thyroid way high, in an attempt to shutdown TSH, then you speed up your body's metabolism way high, including cortisol metabolism.

    So you wind up having to take too high doses of all of your hormones (including cortisol) so that you can reduce the frequency of the doses.

    If you really had to boost your thyroid so high, then you should really be taking smaller doses of hormones more frequently - but it's very annoying.

    Boosting thyroid thus causes you to "turn over" your body's cells faster, ie: it causes you to age faster.

    One of your objectives, in consultation with your medical professional adviser, should be to try to reduce your thyroid hormone dosages to be less than they are now, and hopefully that will actually be optimum.

    If you do agree to gradually reduce your thyroid hormone dosages, then while that's occurring (after some delay for stabilization) you should also be able to reduce the dosages of your other hormones, while maintaining the same frequency of administration.

    In so doing, you should maintain your health, while remaining just as active, but for a much longer term (you'll age more slowly).


    Quote Originally Posted by gu3vara View Post

    I've commented on the statements made in that report, because it presents some very common misconceptions which are being propagated by less-well-trained medical professional advisers.

    Here are my comments:


    Urinary 24-hour free cortisol excretion has been advocated for monitoring of replacement quality. However, after exogenous glucocorticoid administration, urinary cortisol excretion shows considerable interindividual variability.
    That's directly related to whether you're a fast metabolizer of cortisol, or a slow metabolizer of cortisol, which is usually related to your thyroid levels.

    In your case your high thyroid levels are most likely driving your cortisol metabolism faster.

    More importantly, following glucocorticoid absorption cortisol-binding globulin (CBG) will be rapidly saturated, resulting in transient but pronounced increases in renal cortisol excretion.
    Only true for those who metabolize HC/cortef (hydrocortisone/cortef) quickly, or who take more hydrocortisone than they need (usually because they metabolize cortisol quickly, so they take more HC than they need so they don't have to take it so often)

    Those of us whose metabolism is normal paced, and who only need a little HC / cortef, don't experience such a discrepancy.


    Thus, one cannot refer to normal ranges for healthy subjects when judging urinary cortisol excretion during replacement therapy in AI.
    This is a generalization which should only be applied to untrained medical professional advisers - who shouldn't be modulating cortisol in the first instance.

    A trained medical professional adviser will learn from the urinary cortisol test that the patient is metabolizing cortisol too quickly, and take appropriate action (too many to list)


    However, in cases of suspected under-replacement, e.g. due to non-compliance, urinary cortisol measurements may be helpful.
    as they are for optimum-replacement and over-replacement too.


    To measure a random serum cortisol without knowing the exact time of preceding glucocorticoid administration is not helpful in monitoring glucocorticoid replacement.
    Very true.

    Some authors have suggested regular measurements of serum cortisol day curves during replacement therapy aiming at serum cortisol concentrations within the normal range.
    Not necessary because 4 x salivary cortisol measurements are comparable to serum cortisol measurements, but 4 x salivary cortisol measurements are more "portable" than multiple serum cortisol measurements, which is why I recommend you and your medical professional adviser should use 4 x salivary cortisol measurements.


    However, due to their pharmacokinetic properties, none of the exogenous glucocorticoids currently used is suitable to mimic the diurnal cortisol pattern found in healthy subjects.
    Which is why you may want to keep monitoring all new developments on slow-release hydrocortisone, ie:

    http://allthingsmale.com/forum/showp...6&postcount=13


    Thus, in the absence of objective parameters indicating replacement quality, the physician has to rely primarily on clinical judgment, carefully taking into account signs and symptoms potentially suggestive of glucocorticoid over- or under-replacement.
    UK endocrinologists are years (perhaps decades) behind USA medical professionals. 4 x salivary cortisol testing provides those objective measurements.

    And we always consider symptoms and reliable labs together, when labs are available, and in the case of cortisol, we do have reliable labs (both urinary and salivary).


    Under-replacement bears the risk of incipient crisis and significant impairment of well-being. Conversely, chronic over-replacement may lead to substantial morbidity including impaired glucose tolerance, obesity and osteoporosis.
    Correct.


    With currently recommended doses of 15 to 25 mg hydrocortisone osteoporosis is not to be expected. Therefore, bone mineral density measurements are not required for regular monitoring in AI.
    That's a generalization which should never be accepted.

    Monitor bone density regularly, whether on any form of hormone modulation therapy or not.


    #######################


    Quote Originally Posted by gu3vara View Post
    Interesting thing is that my testosterone blood test show mid range levels for both total and bioavailable T. I'm guessing that being on shots might be the cause of increase urine results, because levels are stable all day long. Makes any sense?
    True. But the reason you feel OK at such high T (testosterone) levels is because your cortisol is in excess (excess cortisol downregulates our cells response to T), and your cortisol levels are in excess because you're metabolizing cortisol very quickly (most likely due to excess thyroid hromones), so you're taking higher doses of HC / cortef to reduce the frequency of your HC / cortef doses.

    I doubt that your cortisol needs to be so high.


    Quote Originally Posted by gu3vara View Post
    I have now added HCG to the protocol so my T might be higher now, I might have to lower shots. I'll now soon.
    I suspect your medical professional adviser added HCG before analyzing the urinary profile. You and your medical professional adviser should test again as soon as possible, rather than potentially allowing your T to go high above physiological for weeks (if your testicles respond to the HCG - as they should).
    Last edited by chilln; 08-29-2009 at 08:42 PM.

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    Default Re: DHEA results from a 24 hours urine analysis

    Thx for this long reply, really

    I would just like to understand something here, what is the meaning of the high in range testo in urine and mid-range blood testosterone?

    Is it clearly a hint of over replacement? I actually thought blood testing was more reliable than urine for testo. Am I exceeding my capacity for testo and thus dumping more of it in urine? I know that every individual have different optimal targets.

    I'm thinking about a blood test to know more about HCG efficacy (I have a baseline on testo only to compare). I've been on Ovidrel for a month, should it be enough time to wake up the testis from 5 months of suppression? I'd like to know to avoid wasting money on a test ;)

    Thx!
    Last edited by gu3vara; 08-30-2009 at 08:38 AM.
    male 29 - hypothyroid, hygonadism

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    Default Re: DHEA results from a 24 hours urine analysis

    Quote Originally Posted by gu3vara View Post
    Thx for this long reply, really

    I would just like to understand something here, what is the meaning of the high in range testo in urine and mid-range blood testosterone?
    You can only link the two together when you know SHBG.

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    Default Re: DHEA results from a 24 hours urine analysis

    Total T : 656 (288 - 864 ng/dL)
    Bioavailable T : 343 (132 - 541 ng/dL)
    Free T : 577 (223 - 915 pmol/L don't know how to convert it to USA value)
    SHBG : 30 (12-46)

    That was done 2 weeks apart from the urine analysis.
    male 29 - hypothyroid, hygonadism

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    Default Re: DHEA results from a 24 hours urine analysis

    Quote Originally Posted by gu3vara View Post
    Total T : 656 (288 - 864 ng/dL)
    Bioavailable T : 343 (132 - 541 ng/dL)
    Free T : 577 (223 - 915 pmol/L don't know how to convert it to USA value)
    SHBG : 30 (12-46)

    That was done 2 weeks apart from the urine analysis.
    Because of your SHBG, if you are able,
    aim at TT(1000-1150)
    ================================================== ====

    Where did you do your blood analysis, yeah, outside of USA?

    Your BAT looks (much) too high considering your TT & SHBG
    Consider not looking at your BAT and FreeT values.

    Use TT, SHBG and a chart to guide you.
    .
    Going by chart

    FreeT=150

    desirable range
    FreeT(160-300)

    but you want to be in upper quarter of that range.
    In mean time you are below desirable range.

    .
    Last edited by JanSz; 08-30-2009 at 09:56 AM.
    I am not a Dr, any opinion that I have is based on my own experience.
    Any changes in my regime are always discussed with and are approved by my doctor.

    Diabetes is not a disease. It is how mammals signal for the coming winter. You can cure it naturally.
    ...all legitimate rights have one thing in common: they are rights to action, not to rewards from other people."
    Failure is the spice that gives success its flavors………….If you don’t do the fear, you won’t get the courage.

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    Default Re: DHEA results from a 24 hours urine analysis

    Quote Originally Posted by gu3vara View Post
    (I took DHEA as usual on the day of the test)
    :
    Sigh..You know your not supposed to take DHEA the day of the 24 hour urinary analysis right?

    It will render DHEA and most of the steroid metabolites invalid.

    Not your fault. Your Dr should have told you.

    Or he/she did, and you forgot....
    Save $10 bucks on your order at iherb.com - Use promotion code PAC113

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    Default Re: DHEA results from a 24 hours urine analysis

    Quote Originally Posted by Wise Guy View Post
    Sigh..You know your not supposed to take DHEA the day of the 24 hour urinary analysis right?

    It will render DHEA and most of the steroid metabolites invalid.

    Not your fault. Your Dr should have told you.

    Or he/she did, and you forgot....
    I guess the doctor's goal was to know if I was absorbing any DHEA from the cream. Considering the results, it looks like I don't.

    However, I don't really understand why not to take DHEA during an urine analysis. Would metabolites really be falsely increased or would reflect the action of DHEA in the hormonal chain? Would it cause falsely elevated estrogens?

    Please inform me if you are the info, I'm trying to learn more about the urine analysis but it can't seem to have the full picture from anybody.
    male 29 - hypothyroid, hygonadism

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    Default Re: DHEA results from a 24 hours urine analysis

    Quote Originally Posted by gu3vara View Post
    I guess the doctor's goal was to know if I was absorbing any DHEA from the cream. Considering the results, it looks like I don't.

    However, I don't really understand why not to take DHEA during an urine analysis. Would metabolites really be falsely increased or would reflect the action of DHEA in the hormonal chain? Would it cause falsely elevated estrogens?

    Please inform me if you are the info, I'm trying to learn more about the urine analysis but it can't seem to have the full picture from anybody.
    Obviously, she/he didn't know what they are doing.

    A DHEA-S serum marker is the one you want to run to find out if your absorbing the DHEA cream.

    You can take it the day before you run your 24 hour analysis. You take DHEA that day as usual. It is cheap, usually 50 bucks out of pocket, or is usually covered with insurance.

    You cannot test for DHEA replacement with a 24 hour urinary analysis, because you cannot take it the day of the test.

    I hate to say it, but at bunch of tests on your 24 hour analysis had been rendered inaccurate.

    Its these little things, these little details.....This is why I only would trust the top thinkers in the field with my care. Many just simply do not know what they are doing.

    I'm going to add this thread to my "Wise Guy's Gala of Information" thread http://allthingsmale.com/forum/showthread.php?t=4144 so others can learn. There is good info here.

    There is also the issue of absorbtion. There is also the issue that maybe you have a bunk DHEA cream and possibly then the test is accurate.

    I dunno....
    Last edited by Wise Guy; 08-30-2009 at 02:56 PM.
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    Default Re: DHEA results from a 24 hours urine analysis

    My main goal here is to keep my E levels in check and I can't have an ultrasensitive E2 done in Canada.

    Are you telling me that not taking DHEA the day of the test will give me an accurate reading of my E levels?

    I wonder cause I figure that not taking the DHEA will show lower E levels that I'm normally having with DHEA. I'm just looking to the best way to monitor my E with the only tool I have access to, the urine analysis.

    I will use DHEA-S blood test from now on, that's not a problem, I've done it in the past.

    That's all I need to know really, how to get accurate E readings with this test considering I usually take DHEA.

    I would love to see top notch docs like Dr J about my complex case but I'm in Canada, have very limited monetary resource and I'm quite disabled with CFS already. My doctor is trying is best to help but he's much more knowledgeable with women HRT. If I get desperate enough I might get a loan someday to fly to a top doc.

    Having a precise answer on the best way to proceed to check those E levels would mean a lot to me, I could pass the info to my doc.

    Thx guys
    male 29 - hypothyroid, hygonadism

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    Default Re: DHEA results from a 24 hours urine analysis

    Quote Originally Posted by gu3vara View Post
    My main goal here is to keep my E levels in check and I can't have an ultrasensitive E2 done in Canada.

    Are you telling me that not taking DHEA the day of the test will give me an accurate reading of my E levels?

    I wonder cause I figure that not taking the DHEA will show lower E levels that I'm normally having with DHEA. I'm just looking to the best way to monitor my E with the only tool I have access to, the urine analysis.

    I will use DHEA-S blood test from now on, that's not a problem, I've done it in the past.

    That's all I need to know really, how to get accurate E readings with this test considering I usually take DHEA.

    I would love to see top notch docs like Dr J about my complex case but I'm in Canada, have very limited monetary resource and I'm quite disabled with CFS already. My doctor is trying is best to help but he's much more knowledgeable with women HRT. If I get desperate enough I might get a loan someday to fly to a top doc.

    Having a precise answer on the best way to proceed to check those E levels would mean a lot to me, I could pass the info to my doc.

    Thx guys
    Answer depends on question you ask.
    ================================

    Speaking of TRT and how to monitor your E2 when you are not able to have E2-sensitive but able to have E2 from 24hr urine.

    -------

    #1---Change to EOD schedule of (T + HCG), so any day you collect urine for testing is as good as any other day. Best would be ED schedule.

    #2--- use E2 from urine analysis to guide your use of Aromatase Inhibitors (AI) if any.

    #3 --- presently you are within range and do not require AI

    #4--- you need to increase your TotalT significantly (see my post #8), your E2 situation may change.

    #5--- If you use EOD schedule for (T & HCG) you may find out that your E2 is still within range because it is very E2 friendly schedule

    ---------------

    Right now you are doing 43mg/E3D--->100mg/week

    You should not waste much time and change to 175mg/week=50mg/EOD=25units/EOD

    That may not be enough if you continue without HCG
    That may be too much if you start using HCG and your testis respond to stimulation.

    Do not sweat too much, there is another adjustment possibility 3,4,6 months latter.
    ---------------

    About thyroid, make sure that you do no do partial analysis, wait until you are able to get full panel.

    In the mean time support it as best as you can,
    eat lots of liver and blood, not only for iron but also minerals.
    vit D and other.
    .
    .
    .
    Last edited by JanSz; 08-30-2009 at 06:44 PM.
    I am not a Dr, any opinion that I have is based on my own experience.
    Any changes in my regime are always discussed with and are approved by my doctor.

    Diabetes is not a disease. It is how mammals signal for the coming winter. You can cure it naturally.
    ...all legitimate rights have one thing in common: they are rights to action, not to rewards from other people."
    Failure is the spice that gives success its flavors………….If you don’t do the fear, you won’t get the courage.

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    Default Re: DHEA results from a 24 hours urine analysis

    In regards to what's been posted...for those of us already on HC...are you saying that both saliva and urine testing can be used to determine if we are on appropriate doses? Or does the supplementation render these tests worthless?

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    Default Re: DHEA results from a 24 hours urine analysis

    Quote Originally Posted by JanSz View Post
    Answer depends on question you ask.
    ================================

    #4--- you need to increase your TotalT significantly (see my post #8), your E2 situation may change.

    .
    Thx for your recommendations, but regarding total T, you seem to have an opposite thought to what chilln wrote previously, he was thinking I was high on T based on my urine testing. My blood labs were done just before my T shot, 3 days after the previous shot. Don't know how much higher it would be the day following the shot.

    It seems there is no easy answer in HRT, I won't change anything right now and wait for blood tests. I will get tested this week with the HCG I'm taking since 1 month to see if it does anything to my T levels.
    male 29 - hypothyroid, hygonadism

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