Hi Melissa,

Testosterone and other sex hormones made by males in the adrenal glands is usually in very minimal amounts I would think compared to the amount that is usually made by the gonads or testicles.   It is only in the cases of CAH where the testosterone made by the adrenals can exceed that of what is made by the adrenal glands in Females and Males.  I would say in all honesty that if after cortisol, the rest of the cholesterol is shunted down the metabollic pathway via the adrenals, that this has the effect of increasing all sex homrones after cortisol production (androgens =anabolic steroids)  to such an extent that they exceed that of what the gonads would normally make over time.    Hence why some CAH women make so much androgen they suffer male pattern baldness and hirsutism.  Also their hair would change in color and density probably in some areas of their bodies.  Males have much coarser hair than females on the whole and this is why the density changes for women.

I think what is causaotry of this however is the testosterone that is circulating in the blood serum at the time.  That is what keeps the testicles shutdown completely and the sperm count ceases or falls.  The testosterone made by the adrenals and testicles is of course of no difference in it’s abilities to effect various symptoms.  In other words, once cholesterol is converted to testosterone in either the adrenal or the testicles and is released into the blood serum, it has the same effects on sexual charachteristics and reproduction.  It is the testosterone in the blood levels that needs to be lowered drastically in this scenario before the overall problem can be dealt with.  I am not really sure if when sperm production shuts down in the testicles that also testosterone production shuts down.  There may be some negative feedback via the gonads because that is a separte axis all to itself where the hypothalmus is concerned.  Probably they stop production of testosterone when they sense the testosterone in the blood serum is very elevated?  I can almost see that happening, but at the end of the day it is only because the testosterone in the blood serum is extremely high due to the adrenals malfunctioning.  The hypothalmus would not be aware of where the overproduction of testosterone is from in this case I guess and it would send hormone messengers for both adrenals and gonads to quit production I think.   Therefore although gonads sghut down production possibly, adrenals would not as we know.  This testoserone then produced by the adrenals would really still then have the same effect on body and mind I feel than if say it were produced by the gonads.  High sex drive one would assume then going by the effects of elevated testosterone in body builders--who still make adequate levels of cortisol.

So in the CAH male, without those readings and issuing high doses of corticosteroids to bring down the anabolic steroid levels, there is the same problem and the testes remain shut down in reposne and this causes infertility.  As testosterone has been associated more with increased sexual desire not the opposite, and this is what the blood levels would reflect in Michelles’s husband now we know he has not taken med’s regularly, I feel it is more than likely other factors that have caused the loss of libido which is separate from the fertility issue in this scenario.

That is why I feel that it  is more than likely due to other factors such as very low cortisol ---in fact so low that he has slipped into hypoglycaemic state and possibly eventually would becmone very ill if he did not sort the matter out asap.   As the bulletin suggests the hypoglycaemic personality would be similar to having major depression and anxiety and this would affect not just moods butlibido.  He would be less able to cope with stress and if stress were very high such as from marraige break up or financial problems then this would only compound his situation anyway where the adrenal glands were concerned.  

The theory about lack of cortisol and hypoglycaemia would make sense really because we also know now from Dr Merkes study that also adrenaline is produced less when cortisol levels fall very low, so this is bound to also compound where handling stress is concerned and depression as you would have a sense of not being even able to handle simple everyday stresses let alone financial and insurance problems etc.   

Whatever it is, I felt the key is that cortisol is the only thing that should be put right and that all else will follow suit when that is done.    As the opposite problem (too much cortisol) can also cause the same problem, it is hard to differentiate without blood tests, except for if an adrenal crisis is obvious and a distinct tan due to ACTH over secretion.  

I hope that you get it all sorted out soon Michelle.

Regards

Anne-Marie