# Ho to convince doc to test cortisol?



## Jezahb (May 17, 2012)

Ok, so I am going to go see my doc soon (hopefully, calling tomorrow to make appt) and I would really like her to test my cortisol along with my TSH. I also need to convince her to test my antibodies. This is a very, minimalist doctor to say the least who would rather I come in one every 3 months for a simple TSH test then send me home.

I am concerned about my cortisol levels, since though I have lost a good amount of weight the past 2 months (14lbs) my belly is still quite large. I don't carry weight anywhere else as heavily as I do my stomach (annoyingly). I have narrowish hips, a thin face, a large bust and HUGE stomach. I have no idea where the weight is coming off since my belly hasn't shrunk an inch. I really think I might have an issue with my cortisol, since supposedly that causes stomach fat.

So my question is, how do I convince my doc to do these needed tests? I as diagnosed with Hashi's by an endo who did limited tests and at that point one one of my antibodies they measure was high which he found odd...that was over a year ago and I didn't see him again. So it needs to be done, I just need to convince her!


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## allowingtoo (Mar 31, 2012)

I don't know what kind of Insurance you have but I have a really good Insurance plan and they pay for just about anything and everything we've thrown at it. I'm trying to remember (and somebody correct me if I'm wrong here but) from when I had my cortisol (Saliva) test done - I don't think Insurance covers it. I had to pay for it out of my own pocket and it was about $200. Still, I'm glad I had it done.

My Dr did it for Hormone testing - the cortisol was just included. We used ZRT for my test kit.

There is a book out called Syndrome W: which you can preview on Google books. I bought it and hoped it would work for me as I have all the symptoms but alas - I can't take Metformin because of liver damage.

*Q. So what differentiates midlife weight gain from Syndrome W?*
Syndrome W is about weight gain that starts at the waist. This contrasts with weight gain that hits the hips and the butt and then the arms and on and on. The classic Syndrome W woman was thin throughout her childhood, adolescence and early adult years. She was not the chunky child that struggled to stay size ten or twelve in the teen years. Early on, Syndrome W women do not look "fat." In fact, they may be normal weight by current US and world standards that are based on the BMI (body mass index) a measure of body "fatness." It's all about where you've gained that weight that determines if you have Syndrome W.
*Q. What's the characteristic contour of Syndrome W?*
Women with classic Syndrome W have what I call the prophetic pregnancy profile. Early on, they look like women in their first trimester. Their waists thicken while, initially, there's no change in hip dimension. As their waists continue to expand, they begin to look more "mid-trimester," as the defining defect-hyperinsulinemia, worsens. Eventually, they become those women in their fifties who look five months pregnant perennially! Look around and you can see Syndrome W in every crowd of over-fifties.


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## BlindMag (May 17, 2013)

Ask your doctor for a cortisol blood serum test with your other bloodwork, saying that you'd like to know what it is to make sure your thyroid meds are doing all they can. Tell her you read an article from NIH's pubmed talking about the correlation between thyroid function and cortisol levels, (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3520819/) and that you'd at least like to make sure there isn't anything going on there that could get in the way of you feeling better.  That way if your blood test comes back out of range, you can then push for the saliva test. 

Maggie


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## bigfoot (May 13, 2011)

First off, at 26, you're waaay too young to be languishing with some ho-hum doctor who spends a few minutes with you in the office a couple of times a year. That is just not right. There are good docs out there, and while it can be frustrating looking for them, they do exist. You might search out naturopaths, anti-aging MDs, D.O.'s, and out-of-the-box MDs.

Instead of you having to "convince" your doctor, it should be they who are turning over every stone looking for pieces to this puzzle. I started out being sick in my late 20's and have been dealing with various health issues for years. A humble piece of advice -- don't waste your time with docs that aren't going to listen to you and work with you. You might ruffle a few feathers or bruise a few egos, but so be it. Ultimately, it's about your health.

You probably need to get quite a few labs run. It doesn't sound like the doctor you are seeing right now is very receptive. At a minimum, this is what I would suggest. This would give you some sort of baseline to go with, even though it sounds like you have likely been dealing with thyroid and iron issues already. Still, you need to know where you stand.

* TSH, Free T3, Free T4, TPO Antibodies, Thyroglobulin Antibodies, Reverse T3
* Liver Panel, CBC and CMP, A1C
* H. Pylori, Celiac Disease, Gluten Sensitivity (not one in the same as Celiac)
* Lyme Disease, ANA w/reflex, CRP, etc.
* Cortisol (in the form of a 24-hour take-home test, either urine or saliva broken up into 4 time periods)
* DHEA, Estrogen, Testosterone, SHBG, etc.

You absolutely need a doc who is well versed in hormones and thyroid issues. No question.

hugs6


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## CA-Lynn (Apr 29, 2010)

I think the best way is just to say,

"For my own peace of mind, can we please add these tests? Just so I can have a baseline?"

Make it simple and direct.

Your doctor might not want to add these tests if:

1. She is an HMO doctor,
2. She has a "capitated" contract with the insurance company [under these contracts the physicians earn more money by NOT ordering tests],or
3. She has to justify to the insurance company why she's ordering these tests.


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## allowingtoo (Mar 31, 2012)

I looked up my Endo's degree in Medicine and it was Internal Medicine. I only went to him twice and I couldn't stand him - so I started looking for a Board Certified Internal Medicine Doctor and I found the one I go to now. He specializes in Bio Identical Hormone treatments and Holistic medicine. He's pretty good but he's not a GP or anything like my last Dr was. But he said the weight gain (for me) could be from hormones which is why he tested me. He wanted me to go on Progesterone and prescribed it for me but I tried it for like a week and gained 7 pounds and told him "No way no how am I doing this anymore" You know how you craved to eat when you were pregnant? That was me with progesterone. I had it compounded and I called the Pharmacy and they said "oh yes, that can be a side effect". I normally only eat once a day, but with that I was stuffing my face all day long.

It really depends on your Insurance. Call and see what yours covers. If you think you just have to have the tests, you can just order them yourself and pay for them out of pocket if the Insurance won't pay for them anyway. They might not tell you that much though. Mine only really said I had high nighttime Cortisol levels, which was a big help to me, since we could treat that.


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## Jezahb (May 17, 2012)

It is sad because I am seeing a DO, but she just seems to not care. I told her my hair was still falling out, and she didn't even LOOK up from her chart and said "Go see a dermatologist then"...not even a glance at my hair. I told her I was dieting and she critisized my diet plan saying it wasn't tough enough on me, which actually made me quit it since she made me feel like unless I starved myself and kicked my own bum at the gym I was never going to lose a pound. I recently went back on that diet plan and have lost 13 lbs...she is an idiot. I just feel like she doesn't even listen to me or care, like dealing with Hypothyroidism is below her. The endo I saw just creeped me out, he also didn't listen to me and made me feel like I was an idiot. Not having great luck with doctors. I hope my insurance covers Cortisol testing, because I have no savings to pay for that


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## bigfoot (May 13, 2011)

Like what CA-Lynn mentioned, you might be running up against a wall here. Either way, whether it's that, or you doc just has a very poor bedside manner, it might be time to start looking around...


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## Jezahb (May 17, 2012)

Yea, I am seeing my current doc on June 20th (other issue is this, she is only in like 2 days a week so it is impossible to get an appt within 2 weeks) and if I struggle with her again, I will be finding a new doc. I am very annoyed with this current doctor but I have only seen her twice, and so maybe she just needs to get to know me? I don't know, but I really hope she cooperates because having had Thyroid issues for over a year and hardly any real testing done makes me nervous. Like I said before, the endo I saw once did an antibody test and noticed one antibody was sky high and the other normal, something he had never seen before and was concerned over. A year later and no follow up on that makes me worry


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## bigfoot (May 13, 2011)

I think those are very legitimate worries, and you should voice those to the doc. I would also kindly 'suggest' to the doctor that you want to get a full baseline of where you stand right now in regards to labs, and if treatment is necessary (for whatever condition), that you wish to optimize it, not just get it "in range".

And this is getting ahead of ourselves, but if it turns out there is a thyroid component and you need medication, I would ask the pointed question of whether or not the doc goes by Free T3 and Free T4, in addition to TSH, when adjusting dosages. Many only follow the TSH test, which can make for problems down the road when you want to optimize things.


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