All of my books are focused on providing information on how to go about thyroid diagnosis and treatment in a safe, sensible and effective way. My work is based on modern research findings and on a lot of pragmatic experience with thyroid patients.
My main aim has always been to provide information that can help thyroid patients recover from hypothyroidism as fast as possible.
The majority of my written material is about the correct use of thyroid hormones. However, because so many thyroid patients have low cortisol problems, I also deal with the treatment of low cortisol in my books.
To correct very low cortisol levels, I created the Circadian T3 Method (CT3M). I first wrote about CT3M in my Recovering with T3 book. Since then, CT3M has helped thousands of thyroid patients correct their low cortisol levels. My Blog on this website has a great deal of information about CT3M and low cortisol.
In some patients, the use of Low Dose Naltrexone (LDN) can also be helpful in raising cortisol levels.
However, in some low cortisol patients, there is simply no choice for them other than to use the steroid hydrocortisone (bio-identical cortisol) or an adrenal glandular that contains cortisol.
Many patients do well on hydrocortisone (HC) tablets, particularly if they have someone who is very capable working with them to get the dosing right. However, some patients have problems getting their HC doses and timing right. For instance, some need a bedtime dose; some individuals must avoid a bedtime dose. Some do best with one large HC dose in the morning, and some need 2 to 4 doses spread out (in just the right amounts and timing). It can be a lot of work to try and get the HC to work well.
However, inevitably there are patients with low cortisol that appear to never do well on HC or adrenal glandulars. They may try to change the doses over months and years but they still remain very ill.
This is not really a surprise. Oral HC doses are quite large and do not represent what a healthy body actually does, i.e. they do not drip feed cortisol on an on-going basis with larger amounts at the start of the day and smaller amounts towards the end of the day. The bottom line is that taking oral HC is not as physiological as cortisol delivered by a cortisol pump.
Insulin pumps have been around for a while. Over recent years this type of pump technology has started to be used to deliver cortisol. The Cortisol Pump has started to be used. In the UK one of the pioneers of cortisol pump technology and treatment is Professor Peter Hindmarsh.
Cortisol pumps deliver cortisol in a programmable manner which makes it possible to more closely mimic what a healthy person’s cortisol levels would actually look like. The bottom line is that cortisol levels in the blood from a cortisol pump are more physiological than taking oral HC.
I believe that for those patients who cannot fully recover using my CT3M protocol, or LDN, or using HC or adrenal glandulars, the cortisol pump technology might prove helpful.
There are two cortisol pumps that I am currently aware of:
- The Crono P that delivers cortisol in pulses over 24 hours.
- The Medtronic Pump delivers cortisol continuously and can be tuned to replicate the natural pattern of cortisol over 24 hours.
This is an extract from an email I received very recently from someone who was kind enough to update me on his progress:
“For the past 3 years, I have been extremely ill with low cortisol symptoms. The symptoms are exactly the same as you describe in your books (hell on earth) and that’s putting it mildly. Six months ago I discovered the cortisol pump and my life has changed so dramatically that I find it incredible. In fact, I would say I am functioning at 90% of my old self.
What I have discovered is that cortisol has to be dosed per circadian rhythm just like thyroid hormone. Oral steroids and current treatment practices are wrong. You cannot wake up and then take your first dose of hydrocortisone (HC), as this is completely against the way the body works. The other major problem with oral steroids is you cannot micro-dose with them as the body does.
With an insulin pump, you can micro-dose as low as 0.1 mg of cortisol.
I only take 7.55 mg of cortisol a day between 3:00 am and 11:00 am along with 1.5 grains of NDT in the morning and 5 mcg of Cytomel (T3) at 2:00 pm. With cortisol, it is not about the milligrams, it is about the distribution of the drug. I honestly believe that almost everyone on oral steroids is most likely over-dosing even on low doses like 20 mg because they are taking it the wrong way, which in turn makes the body need even more to feel somewhat normal.
Anyway, I thought you would be interested in how well the pump can work. I am amazed by this technology and the fact that nobody really knows about it. This needs to be taken seriously by doctors. In fact, my doctor is so impressed by this that he wants to put more of his patients on the pump.”
For those patients who cannot correct their low cortisol through correction of T3 levels, CT3M, or the use of oral HC, the cortisol pump technology offers a potentially excellent solution.
Because cortisol pumps use micro-doses of HC, the cost of hydrocortisone is significantly less than the cost when taking it in tablet form. Note: that the gentleman above only requires just over 7 milligrams of cortisol per day, which is a relatively tiny amount compared to oral HC dosing. However, there is the initial outlay for the pump itself to be paid for.
This obviously raises the question over why low cortisol issues have occurred.
Some researchers are starting to consider whether the paraventricular nucleus of the hypothalamus (PVN) could be behind the low cortisol issues, i.e. a Hypothalamic-Pituitary (HP) system issue.
Others researchers believe that the reason HC medication does not work in some patients is due to chronic infections. For such people, the non-physiological ups and downs with tablets make them worse, and any decline in cortisol from a higher level increases their immune reaction to the infection and makes them worse. Clearly, in these cases eradicating the chronic infection is critical but sometimes this can be very difficult. Cortisol pumps appear to work more effectively in these cases.
It also makes me wonder whether Chronic Fatigue Syndrome, which has so many overlapping symptoms with low cortisol, could also be an HP system issue, and whether some CFS patients with low cortisol could also benefit from cortisol pumps.
It can be quite difficult to begin using a cortisol pump and it definitely requires a great deal of analysis and set up work with support from a knowledgeable medical professional. In the USA, a 24-hour blood draw is done to see how well the individual is absorbing and excreting the medication and do the set up based on that. In Canada, typically a morning and evening blood cortisol test is done. I understand that there are target levels of cortisol. The pumps are then adjusted until the targets are achieved and the patient responds symptomatically.
In the UK, I believe that endocrinologists will only assist those patients who have had a diagnosis of Addison’s disease (via a failed Synacthen Test) to obtain and set up a cortisol pump. The gentleman who wrote to me uses a Medtronic insulin pump. Currently, Medtronic will sell anybody a pump as long as they have a reference letter from a doctor (a prescription is not needed). However, there are online groups who are devoted to assisting patients to obtain a cortisol pump.
This is a link I was given about one low cortisol sufferer. It is her story of how a cortisol pump helped her get her life back:
https://cortisolmusings.wordpress.com/2020/06/10/4-years-with-the-cortisol-pump/
Interestingly, the idea behind cortisol pump delivery of microdoses of HC has also been pioneered with oral HC. This article by a patient explains this:
https://www.pituitary.org.uk/news/2017/08/hydrocortisone-regime-–-gail’s-story/
As I mentioned at the start, my own work is aimed at returning thyroid patients to good health and good cortisol levels without ever resorting to the use of oral steroids. However, in some cases, medications like HC just have to be used. For some of these low cortisol patients (and potentially some CFS patients), cortisol pumps might offer a great solution.
I am not currently planning to write more about cortisol pumps, as using hydrocortisone in any form is not one of my main focus areas. This blog post contains just about all I know about the technology. However, I felt that I ought to share it as it might just be that some readers ultimately find that a cortisol pump is the best solution for them.
I hope this also serves to explain to readers that I am not fundamentally against using cortisol medications when there is no other possible solution. I just prefer to find simpler and more natural ways and be certain that cortisol meds are actually necessary before people take that path.
I hope some of you found this interesting.
Best wishes,
Paul
