Why Both Time and Dose Size Adjustments Need to be Done in the Circadian T3 Method (CT3M)
People frequently ask me about the difference between adjusting the CT3M dose time in the Circadian T3 Method (CT3M) and adjusting the CT3M dose size.
I have just been asked why don't we just start at a time four hours before we get up and just adjust the dose size. This is a good question.
So, why does time have to be adjusted (titrated) as well as circadian dose size?
It certainly HAS to be done the way I have written it in the book - there is no doubt about it in my mind.
The majority of people with low cortisol (adrenal insufficiency) have it as a secondary consequence to hypothyroidism. The low cortisol may have been made worse by issues such as immune system stresses, overall health issues, or personal stress. However, in many people the low cortisol is occurring due to low free T3 levels that have been present for too long. The results that have been seen using the CT3M prove that this is the case. The vast majority of people suffering with low cortisol issues easily pass an ACTH stimulation test (Synacthen test). So, their adrenal glands are healthy.
I believe that only those with proven Addison's disease or hypopituitarism really require hydrocortisone (HC) or adrenal glandulars. A large number of patients using these medications would be better off if they had tried CT3M first. I also do not believe that adrenals get 'fatigued' and need to be 'rested'.
I believe that low FT3 is the real reason for a great many thyroid patients having low cortisol.
I also now believe that it is the direct effect of changing the FT3 level to the pituitary that makes CT3M work. The pituitary is responsible for the ACTH signal to the adrenal glands and it is low FT3 within it that causes a low ACTH signal and low cortisol.
Right, let me discuss the 'time' vs. 'dose size' question.
These two titration methods are quite different.
Adjusting the Time of the Circadian Dose of T3 Containing Medication
The adjustment of the time of the circadian dose provides a gentle change of FT3 level to the pituitary gland. A later T3 dose means slightly less FT3 arrives inside the pituitary and we get less response. An earlier T3 dose allows slightly more FT3 within the pituitary cells. Once the T3 dose being used is big enough then the time changes provide a seemingly linear improvement in cortisol level for those patients that have relatively undamaged adrenal glands (and most have quite healthy adrenals - even those who have been encouraged to use heavy duty adrenal hormones).
Once the circadian dose is at the 1.5 hours before waking time and the dose is high enough (often 15 mcg of T3 or 1.5 grains of natural thyroid) then the response by even moving the CT3M dose 15-30 minutes earlier is often apparent.
Consequently, adjusting the time of the CT3M dose is the fine-tuning dial in the CT3M.
Adjusting the Circadian Dose Size in the CT3M
T3 acts like a wave. This is described in my 'Recovering with T3' book thus:
"For each divided dose of T3, I discovered that there was definitely a ‘threshold level’ that had to be exceeded before any real benefit was experienced from the hormone. As I increased the dose beyond this threshold level then the effects were greater. If I exceeded the threshold too much then I experienced symptoms of tissue over-stimulation. My threshold level tended to be lower as the day progressed. So, later in the day I required lower doses of T3 to achieve the same effect. This perception may be due in part to some cumulative effect of the previous doses of T3 but the interaction with other hormones, which reduce in level during the day, may also be relevant.
I often use a specific analogy to describe to other people how T3 appears to behave:
Imagine a sandy beach, which is sheltered from the sea by large rocks. Only a wave that is large and powerful enough is capable of striking the rocks and sending a spray of seawater over them to drench the sand beyond."
The way this works is that as you increase the circadian dose the size of that wave increases and significantly more FT3 becomes available to the cells (including the pituitary gland, which we are trying to encourage to work properly).
Adjusting the size of the CT3M dose by even 2.5 micrograms can produce a profoundly different effect.
Consequently, adjusting the size of the circadian dose is the rough-tuning dial on our cortisol production in the CT3M.
We Need Time and Dose Size Adjustments.
For the CT3M to work we need a rough adjustment and we need fine-tuning. It is too easy to cause too much cortisol to be generated in some people and in others their system takes longer to recover and we need to have a CT3M dose that is as good as it can be without over-straining the system.
So, the process works quite well. I suggest using it, rather than trying to short cut it.
In summary the typical steps are:
a) The circadian dose size is adjusted so that it begins to work starting typically at around 1.5-hours (possibly 2 hours) before someone gets up on a morning.
b) Then the time of the circadian dose is adjusted.
c) Once an optimal time is found then the circadian dose size may be titrated once again.
d) Once this circadian dose size appears to be about right then the time adjustment is our friend again and we can subtly adjust our cortisol output (as well as other adrenal hormones).
It is a little iterative but there is no way around that.
(Updated in January 2019)