Hormone Changes With Burnout

At the 22nd Annual A4M Las Vegas Conference in mid December 2014 Dr. Thierry Hertoghe, an endocrinologist from Belgium gave a lecture on “Burnout: A multiple hormone deficiency syndrome”, in short: hormone changes with burnout. I have heard him speak on several congresses before. He is always very thorough and extremely knowledgeable. I decided to use this topic as a separate blog.

He said that burnout is common in teachers, soldiers, emergency room physicians (who have to deal with life and death situations) and firefighters. In essence they burn out their hormones. In burnout several hormones are affected, with the cortisol axis being the main one (low cortisol readings and flattening of the diurnal hormone curve), but at the same time other hormone glands are affected as well. As a result endocrine glands age prematurely and symptoms of fatigue, exhaustion, gastrointestinal problems, anxiety, depression and aggressiveness develop.

When hormone levels are measured, there is a lack of cortisol, thyroid deficiency, growth hormone deficiency, testosterone/estrogen and progesterone deficiency and oxytocin deficiency. Holocaust survivors were found to have lower 24 hour cortisol levels. With burnout already the morning output of the adrenal glands is reduced. The health care provider must check prolactin levels, because if prolactin is not high, cortisol will work; however, if prolactin levels are high, cortisol will be ineffective and high prolactin levels have to be addressed first. There is a questionnaire that has been originally developed for teachers (teacher’s burnout scale) to monitor whether burnout is imminent. Soldiers who return from combative situations will also benefit from being assessed with the teacher’s burnout scale; they often suffer from burnout or from PTSD. In suspected cases hormone laboratory tests give concrete answers about hormone deficiencies.

In men growth hormone, melatonin, thyroid, testosterone, cortisol, DHEA and aldosterone have to be replaced to bring the hormone balance back to normal. Instead of aldosterone (a adrenal gland hormone) fludrocortisone is used. In women missing hormones are replaced by bioidentical progesterone and estradiol, but small doses of testosterone are also required.

Dr. Hertoghe discussed cortisol deficiency and its replacement at some length, as this is the main stress hormone that is deficient with burnout. Different treatment protocols for cortisol replacement are used as dosing varies for different degrees of burnout. Other hormones must also be replaced as necessary, possibly for a prolonged period of time, if not life long. Supportive counseling sessions have been shown to elevate cortisol levels and several studies were discussed. A counsellor or psychiatrist will help to tone down increased brain activity and help regain the internal balance. Balanced hormones are necessary on a cellular level to regulate the metabolism of every cell in the body.

Hormone balance and symptoms of various deficiencies

Cortisol is placed on one side of the scales and is balanced by androgens (DHEA), estrogens in women and testosterone in men, growth hormone and melatonin on the other side of the scales. When fainting is part of the burnout, it is because of extremely low aldosterone from the adrenal glands. The best treatment for this is fludrocortisone, which will bring the blood pressure up and remove the hazardous symptom of fainting. Symptoms of “slow thinking, slow moving” and tiredness are often from hypothyroidism. The best treatment for this is T3/T4 (Armour thyroid) treatment. Many physicians still use either T3 or T4, which is not physiological. Symptoms of “poor resistance to noise” are due to DHEA deficiency. In addition there often can be moderately poor resistance to stress and joint aches (arthralgias).

When permanent fatigue is present it is time to measure sex hormone levels. If deficiencies are found in a woman, bioidentical estrogen (Bi-Est) is given transdermally from day 5 to 25 of the cycle, and progesterone transdermally from day 15 to 25 of her cycle. Depending on how severe the hormone deficiency is hormone replacement doses in women range from 2.5 to 5.0 mg for bioidentical estrogen and from 100 mg to 150-200mg for bioidentical progesterone per day.

Sports fatigue

In this age of exaggerated sports activities a new entity of burnout, the sports fatigue has emerged. A low free testosterone/cortisol ratio is a reliable marker for overtraining. When this ratio shows a decrease of 30% or more, it shows that there is a temporarily incomplete recovery from intensive training. In the lab often an increase in the sex hormone-binding globulin (SHBG) can be measured, which leads to a lack of free testosterone. In a study of Chinese over-trained soldiers there was a complete recovery from this sports fatigue with multi-vitamins and a liposomal testosterone gel.

Sleep abnormalities

Restless, non-restorative sleep can be a symptom of melatonin deficiency and happens more often in people above the age of 50 as there is a natural hormone decline with age in the older generation. Treatment consists of replacement, which is easily achieved either with sublingual tablets (mild: 0.05mg, moderate: 0.15 to 0.5 mg, severe: 0.5 to 1mg). Oral melatonin doses are more problematical as there are average absorbers and poor absorbers. For mild, moderate to severe symptoms of insomnia the dosages are for average absorbers 0.2mg, 1 mg, 2mg and for poor absorbers 0.3mg, 1.5mg and 10mg. One should use the lowest effective dose of melatonin as it opposes cortisol and when melatonin is overused, adrenal gland weakness can be the result.


An overpowering feeling of exhaustion can be due to growth hormone (GH) deficiency. This is diagnosed by taking insulin-like growth factor-1 (IGF-1) levels. When these are low, daily subcutaneous injection of low-dose human growth hormone is given. Depending on how severe growth hormone deficiency is, different GH doses are administered. The patient self-injects with an insulin injector. Mild GH deficiency requires 0.05 mg (1 click) per day, moderate deficiency 0.1 mg (2 clicks) per day and severe deficiency 0.15 mg (3 clicks) per day.

Adrenaline deficiency

Dr. Hertoghe pointed out with the help of a publication where runners had developed overtraining syndrome that adrenaline deficiency can be part of burnout. Laboratory tests on these runners showed that overnight catecholamine (metabolized adrenaline) excretion was only 50% of healthy runners. Often this is associated with thyroid deficiencies (in males and females) or with estrogen deficiency in women. Treatment consists in rectifying the thyroid and sex hormone deficiencies (estradiol and progesterone treatment in women).

Hormone Changes With Burnout

Hormone Changes With Burnout

Treatment of burnout

Dr. Hertoghe suggested a 5-step treatment protocol.

  1. Improve the diet

This involves the removal of sugar and starch as both lower the levels of essential hormones. He specified that sweets, chocolate drinks, soft drinks, milk, bread, pasta, commercial mueslis and high temperature cooked meats need to disappear from the diet plan.

The consumption of animal protein is desirable, but the food should be cooked at low temperatures. Fresh vegetable and fruit consumption should be increased. I like to add that these foods are best consumed as organic foods. These foods will increase your natural hormones and produce energy in your cells (ATP, NADPH).

  1. Improve your sleep

This requires a dark bedroom at night and day light exposure in the morning. Avoid TV’s, electrical alarm clocks, i-phones, computers at the bedside (EMF can disturb your sleep). If your environment is noisy, you may require ear plugs to shut out the noise. In case of hormone deficiency, it may be necessary to replace missing melatonin, growth hormone, see hormones above (especially progesterone in women), and oxytocin.

  1. Treat adrenal deficiency, if present
    The missing hormones here to be replaced are cortisol, DHEA and often aldosterone, which is replaced with fludrocortisone.
  2. Treat other associated hormone deficiencies

The other hormones, which are often overlooked, are growth hormone, thyroid hormones, estradiol/progesterone in women and testosterone in men.

  1. Treat nutritional deficiencies

The most common missing minerals and vitamins are iron, magnesium, folic acid, vitamin B12, vitamin E and others. Replacement of these along with the missing hormones is essential for normal cell function.


In an attempt to add to our physical fitness we may overlook our limits and run into a burnout situation without noticing it. Your medical care provider should think about multiple hormone and nutritional deficiencies that can be treated, although treatment can be multifaceted. If in doubt ask for a referral to an anti-aging physician.

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Suppression Of Estrogen Affects Cognitive Function

Female patients with gynecological problems such as fibroids and endometriosis can be treated with leuprolide acetate depot (LAD) or Lupron. LAD suppresses ovarian function and decreases estrogen to the levels of postmenopause. In menopause estrogen levels show a natural drop. In this group the estrogen levels were chemically suppressed. The patients ranged in the ages 25 to 40 years of age-all of them well before the age of menopause. The researchers were able to observe the effects of estrogen on cognitive function without the brain changes associated with normal aging.
Dr. Barbara Sherwin, PhD, professor for psychology and obstetrics at Mc Gill University in Montreal stated that previous research has shown a connection between decreased estrogen and the deterioration of verbal memory. Taking estrogen during menopause can prevent this deterioration. The current study also showed a significant decrease in working memory and scores regarding mood in the women who are taking LAD.
Dr. Sherwin suggested also that some research points to a window of opportunity around the time of menopause where estrogen will protect.

Suppression Of Estrogen Affects Cognitive Function

Effects of estrogen (=E2) on the brain

But beyond that time, such as at the age of 65 or older, estrogen treatment does not provide these benefits. As shown in the Women’s Health Initiative study it may be detrimental.

Reference: The Medical Post, August, 22, 2006, page 45

Comment on Nov. 13, 2012:   There is a big difference between conventional hormone replacement therapy (HRT) and replacement of hormones with bio-identical hormones. The former (HRT) is what was proven by the Women’s Health Initiative study to be detrimental to postmenopausal women; the latter (bio-identical hormone replacement) is what a lot of European women have done for decades and what has benefitted them tremendously without side-effects whatsoever. Inform yourself and read more about treatment of menopause under this link (Nethealthbook).

Last edited December 6, 2012


Magnetic Therapy For Depression

Depression is a psychiatric condition, which is experienced by a lot of people. It is more than just a transient feeling of the “blues”. Depression can be a chronic and disabling disease, and in severe cases there is the risk of suicide. Great advances have been made from removing the social stigma from psychiatric illness, and cognitive therapy and effective medications can help most the patients to lead full and productive lives.
For a few patients however, depression can be drug-resistant and as a result, effective therapy will be much more difficult.
According to research by Dr. Gary Hasey at Mc Master University in Hamilton, Canada, magnets may have a future role in the treatment of mood disorders. TMS (standing for transcranial magnetic stimulation) has shown promising results in the treatment of some types of depression. A so far unpublished study found that 27% of 50 patients with drug -resistant depression achieved full response with TMS.

Simulated treatment in a control group did not produce this result in any of the patients. MRI scans have shown that depressed people have below-average brain activity in the frontal cortex of the brain. A magnetic field, which is created by passing an electric current through a hand-held magnetic coil, is aimed at the patient’s pre-frontal cortex, which stimulates the brain activity in this area. This treatment is vastly different from the well-known electro-shock treatment (ECT), where the patient needs sedation and close observation in a hospital setting. Contrary to this, TMS can be done without sedation.

Magnetic Therapy For Depression

Magnetic Therapy For Depression

The patient is conscious and can resume his normal activities after the treatment. The therapy was first discovered in the 1980’s, but a lot of research had been necessary before treatment could be made available. Other trials are also running in Great Britain, and promising results have been published in the medical paper “The Lancet”. Dr. Hasey cautions that there are still some details that have to be worked out. In the meantime Health Canada has approved TMS as treatment for drug-resistant depression.

More information about depression: http://nethealthbook.com/mental-illness-mental-disorders/mood-disorders/depression/

Reference: The Medical Post, February 1,2005, page 28

Last edited October 27, 2014

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Less Multiple Sclerosis (MS) With Vitamin D Supplement

In multiple sclerosis (MS) the body’s immune system appears to attack the insulation material of nerve cells (called “demyelination”) leading to areas of focal inflammation. These areas can be depicted with MRI scans (see white MS lesions, compared to a normal brain). A new study showed that vitamin D supplementation (as part of a multivitamin supplement) was reducing the risk of developing MS in women when compared to women who did not take supplements. This study was published by Munger et al. from the Department of Nutrition, Harvard School of Public Health, Boston/MA, in the Jan. 13, 2004 edition of Neurology.

The study is based on data from two large nurses health studies (NHS with 92,253 women followed from 1980 to 2000 and NHSII with 95,310 women followed from 1991 to 2001). The study material was pooled into one database. Among these 187,563 women 173 developed MS during the course of the original studies. When the group of women who took 400 IU or more of Vit.D supplements (as multivitamins) were compared to the group who took less than 400 IU or none, the investigators found that they were 40% less likely to develop MS. Other factors that can lead to higher frequencies of MS such as smoking or latitude at birth had been adjusted for. There has not been a change in the results of the protective effect of Vit.D. With food being the only source for vitamin D (skim milk, fish) the protective effect against MS was not demonstrable. However, when food vitamin D was combined with additional multiple vitamin tablets (with vitamin D) the protective effect against MS was observed.

Less Multiple Sclerosis (MS) With Vitamin D Supplement

Less Multiple Sclerosis (MS) With Vitamin D Supplement

In the introduction the authors pointed out that Vit. D has been shown in other studies to be an immune response modulator weakening autoimmune reactions. This effect has been shown clearly in a mouse model of MS, called experimental autoimmune encephalopathy. There are also data available from human research, which showed that certain cytokines are released in the presence of vitamin D so that the immune cells are less likely to attack the brain tissue. There were also seasonal variations that could be demonstrated in this study, which indicated that MS lesions were progressing at times when vitamin D levels were low and that they were regressing when vitamin D levels were high.

The authors of this study stressed that this is the first study to suggest a protective effect of vitamin D against MS, which would have to be confirmed in other studies that preferably would also include males. It shows a very strong statistical connection, but cannot conclusively prove causation. The investigators said that further studies will also be needed to confirm the notion that vitamin D may be beneficial as part of the treatment in MS patients.

Link regarding vitamins and minerals: http://www.nethealthbook.com/articles/vitaminsmineralsandsupplements.php#vitaminsandminerals

Last edited December 8, 2012


Blood Clots In Legs Can Be Caused From Long Flights

A new study from Australia has shown that the risk for developing blood clots in the legs (deep vein thrombosis) is increased 4-fold in the first two weeks after a long-haul airplane flight. This was published on Nov. 8, 2003 in the British Medical Journal (BMJ. 2003;327:1072) with the lead author being Dr. C.W. Kelman of the Commonwealth Department of Health and Ageing, Canberra.

Data was collected of 5,408 patients who had been hospitalized to Western Australian hospitals for deep vein thrombosis between 1981 and 1999. A total of 153 Australians were admitted with blood clots in the leg veins within 100 days of international flights. 46 of these patients developed their blood clots within 14 days of arrival, which was much more than would have been expected in the general population. The researchers found that between 15 days and 100 days following a long-haul flight the risk of developing clots in the deep veins of the legs was not increased from the background rate of the general population. The patients who had developed their blood clots within 14 days of a long flight had a risk that was 4.17-fold higher than the average population’s risk. Of these patients 76% were thought to have developed the clots as a result of a flight. In terms of a yearly risk, if a person does one long-haul flight per year, the probability of developing a clot in the leg veins would be about 12% higher than in a non-traveling comparison group. As this condition is treated effectively with blood thinners, the death rate is quite low, approximately 1 per 2 million long-haul flights.

Blood Clots In Legs Can Be Caused From Long Flights

Blood Clots In Legs Can Be Caused From Long Flights

This would be much lower than the risk of death from car accidents. The authors suggested that more study is needed to determine the risk factors for developing flight induced deep vein thrombosis. When this is known, investigations will be able to concentrate on blood clot prevention from air travel.

Link to a chapter on pulmonary emboli, which can develop from a deep vein thrombus that breaks loose.

Last edited December 9, 2012