Found this on another board and thought it was worth sharing…
JH
Hi Legenden,
From where did you get this? Yahoo?
This post was taken from forum.mesomorphosis.com , Men’s Health forum.
Dr. Marianco is a doctor who posts there regularly on men’s health issues, steroid abuse, hormones etc. and has treated a number of men shutdown from steroids, or that have secondary hypogonadism.
Yup!
If one would like to know more about adrenal fatigue, hypothyroidism, hypogonadism and neurotransmitters and stuff, Dr. Marianco is the guy.
Go to meso and click on his nick and read his posts. There is a huge amount of information, and personally I consider Dr. Marianco to be THE best doctor in this field.
If only we could get him to join this forum also 
JH
As opposed to such a complicated speculative theory, which is somewhat equivilent to Chaos Theory lol
What about the fact that Finasteride often;
A) results in lowered fre testosterone which is known to cause fatigue
B) Often does the above by elevating SHBG which binds testosterone.
C) Sometimes reduces free testosterone with or without elevating SHBG by elevating estradiol.
D) In cases where estradiol is increased this also has a known knock-on effect of reducing GnRH and LH- in effect causing a reduced total testosterone and free testosterone level via a secondary hypothalamic/pituitary mode of action. somnething Detailed in Eugeen Shippens book The Testosterone Syndrome and known as hypogonadotropic in origin via a metabolic cause.
Take a look at hypogonadism and notice how often the symptoms mirror those seen here.
Is there another mechanism of action relating to adrenals or the thyroid?
I wouldn’t rule it out, but I would say that the evidence is currently lacking and that it is better to first and foremost concentrate on the known mechanisms of action.
The direct mechanism of action of Propecia’s principle ingredient Finasteride- the lowering of DHT is also improitant in its own right regarding the separate issues of libido and erectile function.
P.S
So far when looking at peoples pathology I have almost always seen problems that are evident in the sex hormones that need rectifying before any consideration of other matters are considered.
Let me turn that one 180 degree. If it was as simpel as hypogonadsim, everyone here would be out partying by now, instead of writing post after post!
I agree hypogonadism is PART of the equation, but is not THE anwser. Dr. John Chrisler and Shippen who both has propecia patients will tell you the same thing.
I strongly disagree, about trying to correct sex hormones before getting to the bottom of the case.
All good hormone doctors agree you have to correct hormones in this order:
-insulin
-adrenal
-thyroid
-sex hormones
-etc.
See how far down testosterone is on the list?
The reason is that hormones are influencing at each other and correcting one might correct another. Another reason, is that correction the wrong hormone before another, can hurt you more. Like: you must not use thyroid support if you have adrenal fatigue, cause it will stress your adrenal even further. And if you have adrenal fatigue/low thyroid, all the T in the world will not make you feel right, so first thing first.
Read mine and others profiles, look up the posts on propecia on meso, and you will see quite many of us has tried to have healthy testosterone levels for months after using Clomid/nolva and some of us also tried TRT without much improvement.
I value having you here, because you know lots about hypogonadism, and are willing to share your knowledge, but Im afraid you do not hold the key to our cure.
JH
Categorically wrong!
Who said treating hypogonadism or sex hormone related issues was always so simple?
What we are often looking at here is a form of hypogonadism/androgen to estrogen affects of a complicated origin/mechanism that are difficult to treat.
This much was stated by Dr Eugene Shippen a good few years ago in correspondence we had.
In fact I have helped patients obtain correct treatment for such problems before.
In one such instance I helped Dr Eugene Shippen arrive at a treatment option that I believed would rectify one mans problems given his pathology. In that instance the patient had already been told by numerous endocrinologists that he had NO imbalance relating to sex steroids, but that in fact he had a thyroid issue. I spoke on behalf of the patient with one of his endocrinologists and wrote to another one detailing the problem that he had and what medication was likely required. Both endocrinologists who were highly qualified disagreed with my position and insisted that their patient had no such problem because of an overly simplistic approach when viewing pathology. I managed to get this patient to obtain a consultation with Dr Shippen. At first Dr Shippen disagreed with my thought and tried additional thyroid medications. The patient remained ill having continued problems that he had experienced since using finasteride. Dr Shippen then trialed the medication that I had detailed (more than a year earlier). He has since made a full recovery from the ill effects of finasteride. Dr Shippen has since told him he may require this medication for life.
Now this is not the only person I have helped in this regard, so please do not presume that these issues are simple because they are not and do not presume just because an endocrinologist or a given specialist has not been able to help that I cannot help, because I have shown on a number of occasions that I can help.
Now of course, the medication that was most appropriate in the above example is not something that will necessarily be helpful in another persons case. Endocrine health is not a simplistic business and the mechanism of action in finasteride are numerous and less than simplistic and people are often affected differently.
Now taking the above into account;
Finasteride has a long history of use in the setting of prostate cancer in order to chemically castrate men. It is a known anti-androgen and it’s principle mechanism of action is in lowering dihydrotestosterone. It’s other known mechanisms of action, something that I have found very often is in the elevation of estradiol and in particular SHBG.
All of the above relates to the sex steroids.
There is an enormous amount of detailed information that relates to the anti androgenic/estrogenic actions of Finasteride.
How much quality information in terms study relates to its effects on the thyroid or on the adrenals etc?
Please present it?
What I am reading at present is a pet theory of one specialist which may or may not have some credence. It is a very complicated theory and to my knowledge has no provable information backing it up.
I am not saying that finasteride categorically does not or cannot affect the thyroid or adrenals. But what I am saying is that I do not see anything showing that it does in fact effect these parts of the endocrine system and until such time that I see such hard facts I will continue to focus on the known provable cause and effect relationships seen in finasteride use- namely the sex steroids.
If you or anyone else can provide information that enlightens the current position and proves or at least details associations between finasteride and the adrenals, thyroid etc then I will gladly accept it.
I would welcome any information that forwards this cause and will not act dogmatic in any way if correct information is brought to the fore in that regard.
If such information is not brought to the fore or until such time that it is, then I hope you can understand why I will continue to focus on the proven issues as opposed t the speculated ones. In doing so all I am doing is applying the modern principles medical science.
I agree hypogonadism is PART of the equation, but is not THE anwser. Dr. John Chrisler and Shippen who both has propecia patients will tell you the same thing.
Mmm not sure if what you are saying is true here regarding Dr Shippen. In any regard I point once again to the fact that we know that finasteride has mechanisms of action that relate to the sex hormones, whereas I think information relating to other mechanisms of action are unproven and speculative. Unless quality information on the contrary can be shown, I think we have to stick to proven cause and effects. Also I think that even if speculated mechanisms do exist, until they are pinned down that the principle mechanisms of actions should be viewed VERY carefully first and foremost.
I have read this much quoted theory on my support boards. I must say from my point of view it smacks of Chinese whispers, because I have never found any satisfactory information that has shown that it is best to consider sex hormones after consideration of the order you have suggested. I know of at least three person on differing boards that have sent this theory spinning into the stratosphere and has resulted in it being endlessly quotes. I questioned people about this theory and not one person has been able to point to a valid quality source that shows this to be anything other that….a pyramid theory.
Note: I concur that the adrenals should be checked out and treated if necessary prior to any thyroid issue. This is a separate point.
Again all the above said if you can do what others have not an point to a valid quality source for this theory that proves this to be so then I will accept it and in fact be grateful for such.
Again I have to say; I have yet to see a strong connection between finasteride and adrenal or thyroid issues.
Most people seem to have reasonable cortisol and TSH levels and where I have seen free T4 and FreeT3 levels and urine cortisol they too have been reasonable. This is in stark contrast from a numbers point of view when looking at the amount of men and the connection/evidenced problems seen in pathology of the se4x hormones.
That means next to nothing, sorry but it just doesn’t. I know of men that have been getting TRT wrong for 25 years!!! I also know many men struggling on TRT who have been on it for years who have VERY complicated issues relating to the sex steroids.
Months when you are dealing with some of the complications that can occurs is very little time. When cases are complex throwing medications at them will often not result in answers. In fact answers are often far less forthcoming than the questions involved in this area of medicine and it can be a case of a Russian doll syndrome with one answer just revealing another question that needs to be asked as opposed to offering a resolution to the problems involved.
I know this may sound unforgiving, but it is unfortunately the nature of the beast.
I will say this and you can put it to any specialist you care to see.
Nobody!! And I mean Nobody! Can know what exactly what will happen to a man’s endocrine system even when throwing something as simple as TRT at it; such are the potential knock on effect/cascade of events and the individual nature of our endocrine systems (like our own personal chemistry sets).
All that one can do is focus on the most likely cause and provable connection first and foremost and take it from there. If nothing can be found then speculation may become the name of the game, but it isn’t the logical starting point of the game.
I do not pretend to hold out a key or a cure. However I have already identified a number of men with sex hormone based problems on this site (some of whom have been told they have no such problem by inadequate endocrinologists) in the short time I have been here and I am proceeding to help them where I am able to do so.
I am not prepared to base any of the help I offer on speculation.
If you can provide good quality information that supports any/all of your thoughts I most honestly and warmly welcome it. I know this sounds terribly adversarial because our thoughts have been at loggerheads, but this is just good healthy debate and anything that can enlighten your/mine or anyone else’s current thoughts on this and get men proper help……well that is all that matters 
I apologise for anything at all that may sound unfair- these message boards can be awkward forms of communication sometimes.
I think this is getting to deep now.
Neither one of us has solid evidence for our guessings, but I base my guesses on the fact that hypogonadism related to propecia was discovered loooooong time ago on the old yahoo forum. TRT was tried for many patients. Some of them saw Dr. John and Shippen, but according to Dr. John it wasn’t the silver bullet.
BTW. Dr. John, who is known to be great at TRT, was a member of the old propecia yahoo group!
Hornestly, dont you think the combination of 500 guys who had hypogonadism cause of propecia, and one of the best TRT doctors in the same group would have showed us something. I have not heard of even ONE person beeing cures by Dr. John!
JH
P.S. Read this:
http://health.groups.yahoo.com/group/finasteride_side_effects/message/3768
http://health.groups.yahoo.com/group/finasteride_side_effects/message/1180
No I do not go along with your assertions.
The fact of the matter is finasteride is a KNOWN ANTI-ANDROGEN and KNOWN and long PROVEN to cause problems related to the sex steroids.
Unless you can show evidnece/proof that the same link exists between finasteride and the thyroid and adrenal disorders, then you are ONLY left with speculation.
Once again if you only have speculation then you have to consider the PROVEN cause and effects first and foremost.
I am appliying sound medical scientific reasoning here.
As for Dr John and him not curing anyone with finasteride based problems, I can’t comment. I can only say that I have found cures for a number of people. Perhaps the issue relates to the fact that Dr John is in the US and the US didn’t in the past pay enough due attention to SHBG. But then again that would be speculation on my part something I too shouldn’t indulge in too much.
I asked for evidnce of other assertions in the last mail, but again I see no evidnece/proof being forwarded for these beliefs, so again I have to regard them too as just speculation.
You are entiled to believe in what is you clearly believe, I shall not until I see substantive evidence that shows any of this to be anything more than speculation and chinese whispers/a pyramind thought pattern.
We will just have to agree to disagree, no bad thing really. Strong words yes- but no problem whatsoever between you and me from my perspective.
Out of interest do you want me to look through your new bloods when you get them?
I will gladly help if I can.
I can see where you are comming from, but like you can’t prove that propecia ONLY causes hypogonadism, I can’t prove propecia causes MORE than hypogonadism.
Actually my theory doesn’t end with just speculating that propecia causes hypoadrenal, hypothyroid and hypogonadism. I think propecia can somehow hurt the pituitary and affect all or some of the hormones it produces. How this is possible still remains a mystery, but I think it has to do with some of the neurotransmitters getting fucked up somehow by propecia. Maybe like Dr. Marianco wrote…
I would really LOVE to be wrong, cause that would mean our chance of beeing “cured” is much higher, but I have seen to many examples of propecia sufferes not gettig better on TRT treatment, even when done right.
Like you say, lets just agree that we disagree. If we all were searching in the same direction, our chances for a cure would derease, and who wants that.
About the bloodwork, then I already know for a fact Im hypothyroid, but I might ask you to take a look later on when I get back on TRT. Thanks for the offer anyway.
JH
No I can’t but then again that is because it is often impossible to prove a negative. I can’t prove that the outside of the universe isn’t made out of a giant Tacco Bell either. I know that my example is bizarre in the extreme, but then it is meant to be.
You see your statement is trying to turn thousands of years of scientific reasoning on its head.
THE scientific standard is that someone proposing a theory of any kind, whatever the field HAS to evidence their theory and prove its validity amongst their peers. The burden of proof lies SOLEY with the proponents of such ideas. The onus is NEVER I repeat NEVER shifted onto those who doubt such theories.
This means that I do NOT need to prove the negative that something does not exist (which can’t really be done in many cases anyway), rather the burden of proof in this regard lies with Dr Marianano or you/other advocates.
If it cannot be substantively proven, or at least shown somewhat likely then in scientific terms, it is not regarded as valid.
And all this said and done;
I am not actually against the idea that Finasteride could cause problems relating to the thyroid or the adrenals. I just demand correct high standards of evidence and until such time as I receive it, I continue to stick to the known facts, known associations/known cause and effect relationships- namely the sex steroids.
Even IF evidence does come to light regarding any mechanism of action relating to the thyroid or adrenals, I would still need to see substantive evidence that such problems are more significant than the already known mechanisms relating to the sex steroids before I would say it would be worth considering them first. Either that or I would need to see substantive evidence that the theory of sex steroids being further down the list was valid.
Once again in the absence of any evidence I stick with what is factually known, I look at the known cause and effect relationships and try and spot what is wrong there with a view to helping anyone I can where at all possible.
None of this means you are wrong in terms of outcome or what you believe in the long run. You and Dr Marianano and other could well be proven right in the course of time.
If your ideas have validity then I hope the evidence is forthcoming sooner rather than latter so people can get the help that would be required, something I would be onboard with in terms of trying to point men in the right direction.
I personally have no ownership of any idea that you are wrong, I am just deal with the proven facts of the day.
So my bottom line thoughts are sex steroids first and foremost for now based on proven verified cause and effects, adrenal and thyroid effects possible- up in the air let’s wait and see.
Either way let’s hope this drug is taken off the market sooner rather than later- until then do what we can to help men with resultant problems in the best way we can.
That was my awfully long winded way of saying Yes lets agree to disagree.
I read through your story, I may well be able to help in one regard or another. High minded disagreement thrown aside, I’ll pull out the stops to help you in any way I can. So please put the bloods my way and your thoughts prior to commencement of TRT and see if I can help- because I’d like to if I can.
Thanks hypo, even though I don’t agree with you all the way, I appreciate having you here!
Let me get back to you when I get on TRT. My recent bloodwork taken a month ago is simular to the ones already posted here (before TRT): http://www.propeciahelp.com/forum/viewtopic.php?t=10 My T is 10.1nmo/l now though.
JH
Hi Legenden_1999,
As you obviously know 10.1nmol/l is far too low a testosterone level, if your SHBG is in the mid 20s as well- even more so.
What I do notice throughout your treatment is a slight upward curve in SHBG and a quite dramatic increase in estradiol (very unusual by the way to see it tested for in the nmol/l range. In Europe it is more commonly tested in the pmol/l range and in the US the pg/ml range).
Anyway it is entirely possible that elevations of the nature described could significantly reduce the effectiveness of TRT/testosterone and result in continued symptoms of androgen deficiency.
Now when you were on Clomid the estradiol result was invalidated and means nothing; because Clomid as a SERM (Selective Estrogen Receptor Modulator) doesn’t lower estradiol in the blood as an aromatase inhibitor would, but blocks estradiols effect at the receptor level.
Now we don’t know then whether your free estradiol was still too high or even if it was too low (can also cause problems) when you were on the Clomid. We just know that things did not work out for you on Clomid.
What I can tell you is a problem is that as the Clomid’s effects wore off the estradiol that was increased and sitting in the blood would then have been able to act on the body. You would most likely have suffered from a rebound effect and a much reduced androgen to estrogen ratio after treatment. I would not be surprised if you started feeling worse after Clomid than you did before it?
Estradiol did start coming down off Clomid, but it was still much higher than it was before hand 0.4 before hand 0.7 afterwards.
Again this level could account for a poor response to TRT. Furthermore I dod not see any bloods after commencement of TRT. Given this would have elevated testosterone, we can expect it would have increased estardiol yet again.
If you are not increasing your androgen to estrogen ratio, if in fact this is decreasing or at least not improving then- due to shifts in SHBG and estradiol;
That could potentially be the cause of your continuing problems whether it is on or off treatment.
You need to get bloods on TRT this time around. On that note it would be helpful if you could get estradiol evaluated on a more sensitive reference range such as pmol/l or pg/ml.
If estradiol is in the upper third of the normal range or SHBG increases then you need to be able to step on then. If estradiol in particular becomes high you need to be prescribed small amounts of arimidex and have follow-up bloods in order to dose correctly.
The form of TRT is also an issue. Either a gel or the ethanate injections with the aforementioned appropriate bloods and if need be medications might be the way to go.
This doesn’t equate to THE answer- but you never no- you can but try.
Let me know your thoughts and let me know what TRT and dosage you are considering…I might have already been there myself or know people who have and be able to give a pointer.
Hello to everybody,
It seems that most of the old yahoo support group have migrated to this new forum. I´m sort of new here but I see some of the old names. Well, my first message is to say that Dr. Marinaco is the third person I read who mentions the potential side effects of 5 alpha reductase blockers in the brain and how 5AR helps progesterone convert into another esential substance for the well being of the brain.
A couple of guys in the yahoo support group have achieved great results by rubbing natural progesterone cream in their scrotums and as of today it´s been 5 days that I have been doing the same.
Do any of you finds merit in this progesterone idea? I remember that Smithpulitzer (one of the guys who calims full recovery thanks to progesterone) also sent some medical study relating the blocking of 5AR enzymes and the progeterone and alloprogesterone deficiency…
Please share your thinking.
Any improvement?
JH
Nothing yet but it´s too early to say. I´ll consider it a waste of time and effort if i don´t see improvements in 2 or 3 months. As you well know, improvement for our condition comes freakingly slow.
Legend,
Just to let you know. Some people do better on T cream then they do on shots, and hormones are very hard to balance. For some people it takes years to find the proper balance of hormones.
I know you realize it’s not an easy task, but just to let you know, it takes a lot of trail and error to feel normal again on HRT.
Thanks for your response, but rubbing progesterone cream is NOT considered as HRT, or is it?