Replacement dosing

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Cortisol is the wake-up hormone. The body produces it around the
clock, but the highest levels are early in the morning which gets us
going and gives us energy. As the day goes on, progressively less and
less cortisol is produced until nighttime, when low levels allow us to fall
asleep. This is called a diurnal curve (relating to or occurring in a
24-hour period). Among the available glucocorticoids, using
hydrocortisone in physiologic replacement dosing most closely mimics
the amount and pattern of cortisol produced by healthy adrenals.   

Women
A physiologic replacement dose of hydrocortisone for a woman should
be 25 mg, dosed as follows.

waking 10 mg
+4 hours 7.5 mg
+4 hours 5 mg
bedtime at lights out 2.5 mg

Note: Some women will require an increase in HC while they are
menstruating and progesterone is at its lowest.

Men
A man should start with 30 mg. A dosing schedule of 3 (or 3-1/2) hours
allows a fourth daytime dose that may more closely follow the natural
curve. The idea is for the last dose to be at least 5 or more hours
before bedtime.

waking 10 mg
+3 hours 7.5 mg
+3 hours 5 mg
+3 hours 5 mg
bedtime at lights out 2.5 mg

Precautions
• Take with food to avoid stomach irritation
• If eating is not convenient, a tablespoon of heavy cream or coconut
oil can be substituted
• Potassium must be maintained at no less than 4
• verify potassium level before starting and after two weeks 
• under 4 should be addressed with sustained release potassium
• Track daily average temperatures to evaluate dosing
Stress dose whenever needed

For higher doses (above 25 for women, above 30 for men)
• Maintain the descending curve
• No more than 10 mgs in any one dose for regular dosing
• Last dose no less than 5 hours before bedtime
• Reduce time between doses if necessary

If adrenals are damaged or not functioning such as in Addison’s
Disease, glucocorticoids and mineralocorticoids are taken for life.
Otherwise, over time, one can expect adrenals to heal and for
replacement therapy to no longer be needed.

When stable temperatures cannot be achieved with adequate cortisol
support, aldosterone or sex hormone imbalance may be the problem.

Safety note: Everyone taking a physiological replacement dose of
hydrocortisone or other glucocorticoid should carry an emergency
medical card that states "adrenal insufficiency" and lists the drug and
dosing schedule. In case of an accident or other health emergency,
medical personnel will know to maintain replacement glucocorticoids to
avoid a life-threatening adrenal crisis.
Emergency card sample here