I’ve been searching around and studying the increase in ACTH.  Every where I look it seems to state that ACTH increases cortisol and adrenal hormones only and suggests that insulin is raised as a direct result of cortisol levels.  However, being that the above boy has insulin resistance and supposedly lowered levlels of cortisol, I just decided to look into it further.  or atleast take a pot at the reasons why has this when cortisol levels are supposedly relatively low in comparison to many other kids just on conventional treatment I assume or even cortisol levels in children without CAH.  It occured to me that if ACTH does not stimulate insulin directly and only cortisol does this as I suggested above, and that insulin raises only in people who have released higher amounts of cortisol in response to ACTH, where is the problem cropping up?  Go back to the androgens being blocked or lowered from their normal physiological levels or more than they are in convetionally treated children for a minute.    They have a more balanced negative feedback happening between all three hormones --ACTH---cortisol---androgens.   However, the NIH study children do not---they have been given two man made levels---cortisol at a certain dose which does not reflect what the ACTH levels are doing and also cortisol levels that do not reflect what the andrgoen levels are at ANY given time within the whole period of their dose.  This means when it is high in the blood just after taking and also low in the blood several hours after taking.  

Most folks will know that insulin is an endogenous protein hormone and is important for metabolism of sugar’s, but it is only such in the presence of the right anabolics or HGH factor.  It increases muscle mass by stimulating protein synthesis.  I’d say the fact that there is a lack of one hormone and an abundance of cortisol in "comparison" your still creating a suppression of both HGH and androgens.  In other words, you haven’t got them all right in relation to eachother and have just induced a lack of growth and weight gain like you would if you were to give too much cortisol.  Cortisol suppresses anabolic hormone.  To my mind that is no different to suppressing it with an adrogen blocker?   

I have this feeling somehow that a "lower" than normal anabolic level in a child combined with an insulin levels that are possibly too high for the anabolic level will produce the same results as I described above though.  Insulin resistance.  I mean although the cortisol is lower in these NIH kids, you have to ask yourself what the possibilities are when you lower anabolic hormones in the presence of a specific cortisol level and assume you don’t have to adjust the cortisol dose because you are giving them MUCH lower than the physiological levels anyway.  If that sounds completely confusing excuse me lol!  Hard to put into words what I am trying to convey.  

In NON-CAH children these things adjust and fluctuate from day to day--negative feedback, whereas in the above situation they are at two totally "man made" levels that may not particularly reflect what would normally be happening if it were only ONE that was a "man made" levels such as cortisol.    In conventionally treated children, even if the cortisol causes an insulin spike just after a dose, you can bet your bottom dollar that they will have a balnce of that at the other end where insulin lowers and also androgen raises a little to balance it out.  these NIH kids dont have that same negative feedback response to the lowered cortisol levels.    I.e. allow for a little rise in te andogens enough to faciliate growth and also correct the balance and lower insulin.  You get this up and down stuff going on normally in conventionally treated kids between doses, which is as close to what your ever going to get where negative feedback between these hormones are concerned in normal children.   To my mind muscle mass would decline if anything and be replaced with a higher body fat percentage.  Every time they get a dose of cortisol they store the excess glycogen in the fat cells and when th cortisol falls low, the fat is trapped I’d say in the fat cells due to the androgen’s being blocked or substantially lowered to below the right physiological levels?

Just looking at testolactone briefly, teslac is neither an anabolic nor androgenic steroid. It is actually just considered a sex hormone that is a relative of testosterone and was developed for women for medical purposes. Teslac is widely used in the steroid community as an anti-estrogen.

However, what confuses me is if it IS anti estrogen why the fat gain in this boy?  Estrogen in itself is a hormone that usually causes fat gain in women.  If they are giving these kids anti estrogen  drugs also, it can’t be estrogen levels causing the fat gain surely unless the dose is of course not high enough to block the level of estrogens the child is making?

Just been pondering on it all and trying to figure out what is happening there to cause all that.  Excuse my rambling and thinking aloud.  :)