Secondary adrenal insufficiency

[Edward Chaires]

Mr. Rippetoe,

I recently had lab results reflect low cortisol and ACTH levels. My oncologist informed me these low levels could suggest secondary adrenal insufficiency. From what I have read, the common remedy is to take a corticosteroid daily, possibly for life. I am scheduled to meet with an endocrinologist next week. Do you have any advice of alternative treatments? Questions I should ask the endocrinologist? How to approach training? I’ve not been able to train with any regularity over the last couple of years due to fatigue, health issues, and surgeries. I am, however looking forward to feeling better and getting in to the gym to get my weight up and get stronger. I have the blue and gray books. 41 y.o. 6’1” in height. 176lbs. Skinny and weak. Thank you for your time.

[Mark Rippetoe]

What are your testosterone levels?

[Edward Chaires]

Testosterone 380 ng/dL
Testosterone, Free 6.12 ng/dL
Testosterone, % Free 1.6%
Testosterone, Bioavailable 169 ng/dL
Sex Hormone Binding Globulin 41.8 nmol/L
Albumin 5.1 g/dL

[Satch12879]

What prompted this diagnosis, really lab analysis? Why do you see an oncologist?

Might want to consult with Dr. Wittmer or Dr. Nichols.

[Mark Rippetoe]

Why do you see an oncologist?

What is your cancer?

[Edward Chaires]

I had neuroendocrine cancer in 2022 and intrahepatic cholangiocarcinoma last year. I had for each instance, followed by oral chemotherapy for the cholangiocarcinoma. I am under surveillance for both conditions for a number of years to come. My oncologist ordered these labs after I recently reported experiencing extreme fatigue, brain fog, and migraines.

[Mark Rippetoe]

Has your oncologist recommended against TRT, or against strength training?

[Edward Chaires]

I have spoken to him about strength training. He is in favor. I have not inquired about TRT thus far.

[Mark Rippetoe]

Do so.

[Edward Chaires]

Will do. Thank you.