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Från Danny Roddy’s nyhetsbrev ett tag sen.

“A Bioenergetic Context for ?PFS?

One of my favorite quotes by Dr. Ray Peat is:

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If we learn to see problems in terms of a general disorder of energy metabolism, we can begin to solve them.

? Ray Peat, PhD

Energy is needed to maintain the coherence of cells, and cells form tissues, tissues form organs, and organs form whole organisms. (Hair follicles are often referred to as “mini-organs”). If your eyes glazed over while reading the last sentence, just remember that the ?efficient? energy production (i.e., glucose to carbon dioxide) is central in all physiological processes from hair growth, to libido, to creativity, to consciousness.

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Energy is the only life and is from the Body and Reason is the bound or outward circumference of Energy.

? William Blake

?PFS? or ?Inefficient? Energy Metabolism?

I?ve corresponded with more than dozen ?PFSers? over the years, worked one-on-one with three of them, and browsed hundreds of labs posted on various propecia-side-effect related forums. From a “bioenergetic” perspective, these gentlemen appeared to be hypometabolic?which I think can explain many of their symptoms.

Just to be completely clear, I don?t think that ?PFS? is an unsolvable problem like many have suggested, and instead that Propecia might have powerfully suppressed (or interfered with) the metabolic rate in those who were already borderline low thyroid (as evidenced by hair loss in the first place).

Because I don’t necessarily expect anyone to trust what I’m saying, moving forward with an evidence-based approach utilizing self-diagnostics and lab work is probably useful. However, there are different interpretations of these tests, which I plan on attempting to clarify below.

BODY TEMPERATURE & PULSE

Self-diagnostics such as measuring the body temperature and the pulse rate are the most basic things one can do in order to start gathering relevant information about themselves.

The body temperature reflects the intensity of the metabolic rate, which, in turn, governs the amount of heat that is generated. Anything but merely a sign of excess food intake, the production of heat is needed to maintain the temperatures for the continued optimal functioning of all the enzymes in the body, and thus, processes such as tissue renewal and repair. After all, nearly all the food we eat is ultimately converted to heat, in one way or another. An intense metabolic rate also ensures a continuous supply of energy (while limiting the storage of the food we eat as fat), which is essential for the organization and functioning of all living cells.

The idea of maintaining a higher body temperature is controversial given Raymond Pearl’s “rate of living” theory, which, if you recall, reflects a mechanical and unrealistic conception of organisms (discussed more in HLAF). In point of fact, conditions as diverse as obesity, diabetes, and senescence are associated with lower-than-normal diet-induced thermogenesis.[23]

The intolerance to cold is often disregarded, yet seems to be highly common among people, especially among women. From my own research and observations, cold intolerance ? in the hands, feet, genitals, and nose ? is among the most intolerable symptoms I?ve ever encountered. Keeping track of your body temperature (I recommend the axillary [armpit] temperature) every morning, afternoon (after lunch), and evening (before bed) for about a month will help to reveal your temperature rhythms, and therefore your state of health and metabolism. The famous ?thyroidologist? Dr. Broda Barnes found that those temperature readings should hover around 97.8 to 98.6 degrees,[24] rising to a peak in the afternoon.

It is important to bear in mind that although the body temperature is a relatively accurate means of assessing your metabolism and state of health, it can be misleading because the stress hormones can also elevate the body temperature to apparently optimal levels ? especially during times of intense stress. However, you can easily determine whether the stress hormones are keeping your body temperature up: If after eating breakfast your body temperature rapidly declines, then the stress hormones are at play, and you have some work to do.

The pulse rate, another self-diagnostic tool that complements the body temperature, reflects the rate at which the heart is pumping blood, oxygen, and nutrients to cells throughout the body. While many physicians subscribe to idea that ?lower is better,? they tend to justify this theory using athletes as shining examples. Besides the fact that it is not uncommon for athletes to spontaneously drop dead, a lower pulse rate is suggestive of reduced blood flow, which, in effect, limits the rate at which cells can generate energy. Similar to the body temperature, there are some caveats to a higher pulse rate. In stress, the pulse rate can be maintained by adrenaline, sometimes elevating the pulse rate to over 100 beats per minute (BPM). Instead of feeling pleasant, elevated adrenaline causes anxiety and poor sleep. In all, a pulse rate of about 85 BPM and body temperature of about 98.6 degrees are suggestive of high rates of efficient energy production, rather than a metabolism maintained by the stress hormones.

TOTAL CHOLESTEROL

Together with body temperature and pulse, measuring one’s total cholesterol level can be revealing. While there are many opinions about the meaningfulness of cholesterol levels, most of these viewpoints are the product of science that only a sleepy 8-year-old would appreciate.

In an adaptive process, cholesterol seems to increase during stress to provide the raw material for steroid synthesis. For example, in an experiment with college students, cholesterol levels went up before exams, and returned to normal after.[25]

Unsurprisingly, elevated levels of cholesterol are closely related with low thyroid.[26] In fact, anecdotally, I “overdosed” on thyroid hormone a few years ago and dropped my normal cholesterol level of ~200 mg/dL to 120 mg/dL. After words, it was very clear that I could effortlessly modulate my cholesterol level based on how much thyroid hormone I was taking.

Conversely, If cholesterol is too low, which is popular among the depressed, the suicidal, and violent criminals, one of the best ways to increase it would be to consume more fructose in the form of fruit sugar.

THYROID STIMULATING HORMONE (TSH)

TSH is often “high” in those with “PFS,” however, it is usually not a concern as physicians tend to be comfortable with an extremely broad range of this hormone. For instance, TSH has gone through quite a few changes over the years. While 7.0 microIU/ml was considered normal at one point, years later the cutoff was 6.4. Still later, the cutoff was moved to 5.5 and then 4.2. While taking a thyroid supplement, some doctors prefer the lower limit of TSH to be 1.0, while some others are comfortable with 0.5. Thyroid specialists in the University of California Medical Center in San Francisco like to see the corrected level of around 0.2, which is slightly below the normal range of 0.4-4.0.

Regardless of lab values, it’s helpful to think about any given hormone in context. Pituitary hormones like TSH increase in stress and aging,[27] and tend to interfere with “efficient” respiratory energy,[28] which is essentially the glue holding the organism together. One study found that “normal” TSH was a marker for fatal coronary heart disease.[29] In on study, depression was best ameliorated when the TSH was suppressed.[30]

When your physician tells you that “everything is normal,” it’s not unreasonable to suspect that they may be unaware of the broader implications of various hormones and signaling substances on energy metabolism.

PROLACTIN

Prolactin is another hormone that seems to be intimately related to “PFS.” Released from the pituitary in stress,[31] one of the most important functions of prolactin “is its ability to suppress thyroid function, thus decreasing the metabolism level, which results in reduction of oxygen consumption??[32]. There have been several studies suggesting that Propecia increases prolactin levels thus lowering the rate of metabolism.

Higher levels of prolactin are associated with water retention (edema),[33] hair loss,[34] and cancer.[35]

Prolactin is increased by both estrogen[36] and serotonin.[37] All three substances synergize increasing various markers of inflammation, pain, and degeneration.

Keeping thyroid function up, and consuming enough calcium (in relation to phosphate), fructose, and sodium are simple yet effective ways of restraining the excessive release of prolactin. Measuring parathyroid hormone along with vitamin D can help put prolactin into context, because it can sometimes come back falsely low given that the hormone tends to ?surge? in some people.

TSH increase prolactin,[38] so measuring them both may be better than attempting to interpret either of them alone. In my experience, lower levels of prolactin (around ~4 or so ng/mL) are desirable for fertility, metabolism, and general health (males).

A Logical Starting Place

I think these are some basic tests one can get if they are experiencing ?PFS.? As I have mentioned throughout the years, finding the best information available, collecting data, and self-experimentation are the best ways to overcome any health problem. Those suggesting (and believing) that health problems are unsolvable are suffering from a lack of imagination, which contributes to the problem by imposing limitations on the possibilities of growth and recovery.

While interactions between these substances may seem somewhat dizzying, a therapeutic anti-inflammatory diet containing milk, cheese, fruit juices, eggs, shellfish, caffeine, and salt to taste is probably helpful. Additionally, sometimes a small amount of the fat-soluble vitamins (e.g., vitamin K, D, A, and E) that contain minimal excipients are worth experimenting with. For some, a trial of thyroid hormone is warranted.

For those that cannot tolerate dairy products, finding milk without added vitamins and cheese made with only milk, salt, and animal rennet can help overcome a dairy allergy. Homemade ground eggshells is another alternative, although in the long run, figuring out what’s behind a dairy intolerance is probably useful. The general point is to obtain a significant amount of calcium in relation phosphate no matter the source (e.g., milk, cheese, eggshells), which is discussed more in HLAF.

References

1. Rushton, D., et al. Causes of hair loss and the developments in hair rejuvenation. Int J Cosmet Sci. 2002 Feb;24(1):17-23.

2. Vermeulen, A., et al. Hormonal effects of a 5 alpha-reductase inhibitor (finasteride) on hormonal levels in normal men and in patients with benign prostatic hyperplasia. Eur Urol. 1991;20 Suppl 1:82-6.

3. Schmidt, J.B., et al. Hormonal parameters in androgenetic hair loss in the male. Dermatologica. 1991;182(4):214-7.

4. Cailleux-Bounacer, A., et al. Impact level of dihydrotestosterone on the hypothalamic-pituitary-leydig cell axis in men. Int J Androl. 2009 Feb;32(1):57-65. Epub 2007 Oct 11. (Thanks Haidut)

5. de Lignieres, B. Transdermal dihydrotestosterone treatment of ‘andropause’. Ann Med. 1993 Jun;25(3):235-41.

6. Moreno-Ramírez, D., and Camacho Martínez, F. Frontal fibrosing alopecia: a survey in 16 patients. J Eur Acad Dermatol Venereol. 2005 Nov;19(6):700-5.

7. Krajcik, R.A., et al. Transplants from balding and hairy androgenetic alopecia scalp regrow hair comparably well on immunodeficient mice. J Am Acad Dermatol. 2003 May;48(5):752-9.

8. Randall, V.A., et al. A comparison of the culture and growth of dermal papilla cells from hair follicles from non-balding and balding (androgenetic alopecia) scalp. Br J Dermatol. 1996

Mar;134(3):437-44.

9. Hamilton, J.B. Effect of castration in adolescent and young adult males upon further changes in the proportions of bare and hairy scalp. J Clin Endocrinol Metab. 1960 Oct;20:1309-18.

10. Hamilton, J.B. Patterned loss of hair in man; types and incidence. Ann N Y Acad Sci. 1951 Mar;53(3):708-28.”The regions where common baldness occurs in men are the same ones which are most prone to baldness in newborn babies, in individuals who have been subjected to irradiation, as described by Liebow in this monograph, and in subjects with dietary deficiencies.”

11. Greenwald, A.E. [Oral contraceptives and alopecia]. Dermatol Iber Lat Am. 1970;12:29-36.

12. Lynfield, Y.L. Effect of pregnancy on the human hair cycle. J Invest Dermatol. 1960 Dec;35:323-7.

13. Venning, V.A., Dawber, R.P. Patterned androgenic alopecia in women. J Am Acad Dermatol. 1988 May;18(5 Pt 1):1073-7.

14. Su, L.H. & Chen, T.H. Association of androgenetic alopecia with metabolic syndrome in men: a community-based survey. Br J Dermatol. 2010 Aug;163(2):371-7

15. González-González, J.G., et al. Androgenetic alopecia and insulin resistance in young men. Clin Endocrinol (Oxf). 2009 Oct;71(4):494-9.

16. Arias-Santiago, S., et al. Sex hormone-binding globulin and risk of hyperglycemia in patients with androgenetic alopecia. J Am Acad Dermatol. 2011 Jul;65(1):48-53.

17. Ahouansou, S., et al. Association of androgenetic alopecia and hypertension. Eur J Dermatol. 2007

May-Jun;17(3):220-2. Epub 2007 May 4.

18. Arias-Santiago, S., et al. [Male androgenetic alopecia and cardiovascular risk factors: A case-control study]. Actas Dermosifiliogr. 2010 Apr;101(3):248-56.

19. Cela, E., et al. Prevalence of polycystic ovaries in women with androgenic alopecia. Eur J Endocrinol. 2003 Nov;149(5):439-42.

20. Starka, L., et al. Premature androgenic alopecia and insulin resistance. Male equivalent of polycystic

ovary syndrome? Endocr Regul. 2005 Dec;39(4):127-31.22

21. Lotufo, P.A., et al. Male pattern baldness and coronary heart disease: the Physicians’ Health Study. Arch Intern Med. 2000 Jan 24;160(2):165-71.

22. Yassa, M., et al. Male pattern baldness and the risk of prostate cancer. Ann Oncol. 2011 Aug;22(:1824-7

23. Tappy, L, and Jéquier, E. Fructose and dietary thermogenesis. Am J Clin Nutr. 1993 Nov;58(5 Suppl):766S-770S.

24. Barnes, O. Hypothyroidism: The Unsuspecting Illness. 1976

25. Grundry SM, Griffin AC. Effects of periodic mental stress on serum cholesterol levels. Circulation. 1959 Apr;19(4):496-8. “The effects of quarterly final examinations on serum cholesterol levels in two large groups of freshman medical students were studied. During the 2 periods of examinations studied the mean cholesterol levels were elevated significantly over control periods of relative relaxation. The 2 groups of 50 and 47 male students showed a 16.5 per cent and 11 per cent increase in serum cholesterol levels during winter and spring quarter examinations, respectively.”

26. Sundaram V, Hanna AN, Koneru L, Newman HA, Falko JM. Both hypothyroidism and hyperthyroidism enhance low density lipoprotein oxidation. J Clin Endocrinol Metab. 1997 Oct;82(10):3421-4.

27. Nicolau, G., et al. Endocrine circadian time structure in the aged. Endocrinologie 1982 Jul-Sep;20(3);165-76. “…aged seem to expereince an earlier arousal of their endocrine system which may be related to certain disturbances of old age e.g., sleep.”

28. Denckla, W.D. Role of the pituitary and thyroid glands in the decline of minimal O2 consumption with age. J Clin Invest. 1974 February; 53(2): 572?581. “Resting O2 consumption rate (BMR) or minimal O2 consumption rate (MOC) declines with age. Data are presented that suggest that a newly described function of the pituitary may be responsible for a considerable part of the total 75% decline in the MOC with age. The new function appears to decrease the responsiveness of peripheral tissues to thyroid hormones. Response curves to injected thyroxine indicated that immature rats were three times more responsive to thyroxine than adult rats. All the major endocrine ablations were performed in this and earlier work, and only pituitary ablation (a) restored in adults part of the responsiveness to thyroxine found in immature rats and (b) arrested the normal age-associated decrease in responsiveness to thyroxine in immature rats. Bovine pituitary extracts were found that decreased the responsiveness of immature rats to thyroxine. Experiments with the new pituitary function suggested a possible endocrine mechanism to explain why partial starvation doubled the lifespan for rats only when started before puberty.”

29. Asvold, B.O., et al. Thyrotropin levels and risk of fatal coronary heart disease: the HUNT study. Arch Intern Med. 2008 Apr 28;168(:855-60. “Thyrotropin levels within the reference range were positively and linearly associated with CHD mortality in women. The results indicate that relatively low but clinically normal thyroid function may increase the risk of fatal CHD.”

30. Rosenthal, L.J., et al. T3 Augmentation in Major Depressive Disorder: Safety Considerations. The American Journal of Psychiatry, VOL. 168, No. 10

31. Kerstin Foitzik, Ewan A Langan and Ralf Paus. Prolactin and the Skin: A Dermatological Perspective on an Ancient Pleiotropic Peptide Hormone. Journal of Investigative Dermatology (2009) 129, 1071?1087; doi:10.1038/jid.2008.348; published online 25 December 2008.

32. Strizhkov, V.V. [Metabolism of thyroid gland cells as affected by prolactin and emotional-physical stress]. Probl Endokrinol (Mosk). 1991 Sep-Oct;37(5):54-8.

33. Kenneth McCormick and Moira Shea. Hyperprolactimenia In Congenital Hypothyrodism. Pediatric Research (1984) 18, 171A?171A.

34. Schmidt JB, Schurz B, Huber J, Spona J. [Hypothyroidism and hyperprolactinemia as a possible cause of androgenetic alopecia in the female]. Z Hautkr. 1989 Jan 15;64(1):9-12.

35. Zumoff B. Hormonal profiles in women with breast cancer. Obstet Gynecol Clin North Am. 1994 Dec;21(4):751-72.

36. Kathleen, C., et al. Experimental estrogen-induced hyperprolactinemia results in bone-related hearing loss in the guinea pig. Am J Physiol Endocrinol Metab 293: E1224?E1232, 2007.

37. Martin, C. Endocrine Physiology. 1985.

38. Blackman, M.R., et al. Basal Serum Prolactin Levels and Prolactin Responses to Constant Infusions of Thyrotropin Releasing Hormone in Healthy Aging Men. J Gerontol (1986) 41 (6): 699-705.”