Hormone Abnormalities Following Traumatic Brain Injury: Deep Dive

My last post was a light dive into the connection between neurosteroids and traumatic brain injury (TBI). I have great respect for Dr. Gordon who developed the neuroendocrinology TBI protocols and I have great respect for my doctor, Dr. Donaldson, for helping me get my life back with these protocols.

The hypothalamic-pituitary axis is often affected by brain injury leading to hypopituitarism. While every brain injury is different and unique, the root of each is an inflammatory state in the brain. I highlighted growth hormone and its importance in my last post, however, I want to give all of the hormones the attention they deserve.

Hormones have been found to affect neuroplasticity, or the brain’s ability to regenerate and grow new connections. If the hormones are depleted, what does this mean for the brain’s ability to heal those damaged areas and neurons? What would the number of post concussion syndrome (PCS) patients look like if there were a screening process in place for these hormonal deficiencies? Would it still be as high as up to 60% of patients going on to experience PCS?

Did you know that up to over half of all individuals who sustain TBI will become depressed within the first year after the injury with some research showing up to 77% and greater than 60% within seven years?^1-3 Various research articles suggest a two to three-fold increased risk of suicide following brain injury versus those who had not suffered brain injury.

Rather than identifying the driving force of the depression, most patients are placed on one antidepressant or a combination. Or like myself, you start to go down the entire list of them because the side effects are intolerable. One might say, “Well, the cause of the depression was the brain injury.” But that doesn’t actually identify the underlying cause. This is if the association to the brain injury was made. What exactly occurred in the brain from the trauma that led to the depression? And why might depression not develop or present in these patients until years later? Now we are looking back at this cascade in the brain and long-term inflammation, damaging neuro-connectivity and leading to the hormonal disruption described here.

Here is an interesting Table from Dr. Gordon’s TBI book showing just how many articles have been published on the association between depression and hormone deficiencies from 2000-2012 alone:

I was actually quite surprised seeing the numbers. This is way more than expected and surprising as hormonal deficiencies are most often not explored or investigated as a cause of depression prior to starting antidepressants despite literature being readily available for many years.

Hormones are powerful and quite miraculous messengers. They work as a team throughout the body with a system of checks and balances. The organs secrete the hormones, these messengers travel to their target destination where they find a specific receptor just for them. When the specific messenger has reached the receptor and binds, cell behavior changes which allows the specific function of the organ or process to change and act.

After taking my idea of hormonal involvement to several of my doctors and didn’t get very far, I sought out care from a functional medicine doctor. The only hormone testing done was for cortisol, which was found to be low throughout the day, though this was predicted and was not surprising. I still had this feeling like there was more out of balance than just that but this was the expert who was trained to look at the big picture, and at that point I was sort of clueless about hormone treatment so I went with it.

If hormonal deficiencies are identified, standard hormone therapy may only replenish one or two deficiencies, but others are often overlooked. This leads to further imbalance in the system. The hormones of the body all working together is like a magical symphony. If just one hormone is insufficient or lacking, others will follow and not function effectively. They all play such an important role and getting them to function collectively and optimally is a careful process that requires fine tuning.

I think of tuning my violin. The big pegs at the one end of the violin just beyond the neck are the initial doses of hormones while the small fine tuners at the opposite side of the violin beyond the bridge are what is needed to very meticulously and finely adjust the dosage. If you turn the big peg of one string too much, another string may reactively go out of tune. The result will be a lack of balance and lack of harmony, just the same as hormones. The small fine tuners of the violin often save the day; moving it just a millimeter will allow the perfect pitch. When playing for long periods of time, you have to continuously reassess and fine tune the strings. Through time, each hormone is reassessed and fine-tuned, similar to tuning the violin. This is an ongoing, meticulous process, that requires a delicate balance.

Let’s give these powerful messengers the credit they deserve! I now realize fully just how important each individual hormone is to function optimally. Even small changes in hormone levels can lead to big changes in the body and wreak havoc. Case in point – my life over the past 2.5 plus years.

It is important to note that there are broad ranges given for all of the hormones and if your lab result falls into the “normal” range you may not be treated even though that may not be optimal. A low-normal result, or sub-optimal result, can cause a multitude of symptoms as well.

What happens if certain hormones go haywire? What symptoms might one experience with specific deficiencies? In this post, I will dive deep into the hormonal abnormalities and symptoms that can arise with each. The symptoms overlap for many. If you take only one thing away from this, let that be that hormones are so powerful and if we channeled the time spent on picking out the next pharmaceutical drug for a patient on finding the underlying cause of the symptoms, we would be in a much better place.

Command, do you copy?

The command centers of the hormones are located in the brain in the hypothalamus and pituitary gland. Signals are received by the brain which are then sent to the hypothalamus where the signals are translated into the hormone language. This is passed along to the pituitary gland which then causes further signaling, to release a particular hormone. These will either act directly on certain processes or indirectly by signaling other endocrine glands downstream.

The hypothalamus resides between the pituitary gland and the inner brain, connecting the endocrine and nervous systems. It plays such an important role in the release of hormones such as growth hormone-releasing hormone (GHRH) which regulates growth hormone production, thyrotropin-releasing hormone which regulates thyroid hormone release, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) which regulate sex cell production, corticotropin-releasing hormone (CRH) regulating adrenocorticotropin release which regulates the stress response through cortisol production. If damage or inflammation occurs in the brain throwing off any of these hormones, these powerful messengers are unable to signal the proper channels.

The pituitary gland is the size of a pea and is small but mighty. Do not underestimate its power or role. We must protect the pea! It resides at the base of the brain and is considered the “master gland” as it plays the central role in the endocrine system. The gland has an anterior and posterior lobe which in combination regulate the reproductive organs, adrenals and thyroid. The messengers come from the hypothalamus and in turn, the pituitary releases growth hormone, stimulates the thyroid gland to produce thyroid hormones by releasing thyrotropin, the adrenal gland to produce cortisol by releasing corticotropin. It also secretes prolactin, allowing new mothers to produce milk but is also involved in many other functions.

The posterior lobe of the pituitary releases antidiuretic hormone (vasopressin) helping to maintain water balance in the body and oxytocin which has been called the “love hormone,” but also serves other functions too. Serving as the master gland and having such a governing role in the body, you can imagine that damage or inflammation can lead to inhibition or activation of these hormones and the regulatory processes, leading to many issues.

Growth Hormone

I’m starting with the boss. I call growth hormone (GH) the boss because it influences every other hormone in the body. Not only that, but GH is found in every tissue in the body. If something happens to the boss who is supposed to communicate with the workers of the body (cells and other hormones down the line) and tell them what to do, the system fails. The communication is dysfunctional, the workers don’t do their jobs effectively or go on strike. It can turn into a mess.

When you think of growth hormone, you may think of its importance in childhood only. This is what allows you to grow and become an adult. The importance carries on into adulthood, in a big way.

Effect: mood, stress, energy, memory, sleep, immune system, sex, circulation, bones, joints, weight, skin and hair.

GH deficiency can lead to: depression, anxiety, fatigue, difficult recovering from physical activity, thinning hair, weight gain, slack muscles, loss of muscle mass, thin or dry skin, wrinkles, saggy cheeks, poor sex drive, difficulty relaxing, poor endurance, dream infrequently, sleep for long periods but do not feel refreshed, sensitivity to sun, slow wound healing or easy bruising, grey hair, thick folds of skin, fat hump on upper back, loss of muscle mass or strength, tense muscles, poor sleep, memory problems, high blood pressure, irritability, worried, poor cardiac artery health, high cholesterol or high LDL and low HDL (good), arthritis, bone loss in the spine, stomach saggy, labs showing low immune function.

DHEA

Dehydroepiandrosterone (DHEA) and when sulfated to its active metabolite, DHEA-S, play a significant role in the brain but also peripheral organs. DHEA-S is able to stimulate glial cells into making myelin, the insulating sheath around neurons. DHEA transforms down the chain to become testosterone and estrogen. More DHEA will be secreted over your lifetime than any other hormone! DHEA helps enhance immunity, memory, decrease joint pain, increases energy levels, and quells excess cortisol levels, among many other functions.

Effect: mood, stress, energy, memory, sleep, immune system, sex, circulation, bones, joints, weight, skin and hair.

DHEA deficiency can lead to: depression, flabby muscles, loss of muscle mass, lack of hair in the pubic area, low libido, lack of sexual odors, dry hair, excessively dry skin, dry eyes, fat belly, noise intolerance, memory problems, high cholesterol, high blood pressure, bone loss in the spine, easily worried or excitable, difficulty recovering from physical activity, labs showing low immune function, low antibodies.

Testosterone

Contrary to popular belief, testosterone is one of the most important hormones for men and women both! Naturally, decline in women starts in the 20s and for men in the 30s. Not just important for libido of both sexes, it also reduces the risk of heart disease by protecting the arteries, and protects the kidneys and pancreas. It is important for the prevention of osteoporosis, joints and muscles, hair growth, energy and stabilizing mood.

Effect: mood, stress, energy, memory, sleep, sex, circulation, bones, joints, weight, skin and hair.

Testosterone deficiency can lead to: depression, loss of muscle tone, belly becomes flabby, damaged arteries or atherosclerosis, weak heart beat, tired constantly, low libido, face with more wrinkles, difficulty recovering from physical activity, excessively dry skin, lack of sexual odors, pale skin, thin skin, wrinkles at the corners of the eyes, dream infrequently, fat hump on upper back, poor sleep, slow wound healing, arthritis, memory problems, easily worried or excitable, sensitivity to the sun, hair turning grey, high cholesterol, high blood pressure, bone loss in the spine. Specific to men – feeling less confident, dream infrequently, hot flashes, tired with physical activity, breasts become fatty, decreased sexual performance, hair loss to top of head, lower abdomen, chest or legs.

Progesterone

When many think of progesterone, the first and maybe only thought is its importance in the menstrual cycle but its role goes much beyond that. Progesterone has been found to be highly protective of the brain, quelling inflammation, swelling and protecting the blood-brain barrier (regulates what passes into the brain). Progesterone has a calming effect as it binds to GABA receptors in the brain, which in turn can help with anxiety, sleep troubles or restlessness.

The sparked interest in progesterone and its role in TBI recovery stems from a study of female rats in which they experienced induced TBI and given progesterone which led to better recovery and improved outcomes. Subsequent studies showed similar results in animals. Further studies in humans showed promise but more studies need to be conducted to validate these results.

Effect: mood, stress, energy, memory, sleep, immune system, sex, circulation, bones, joints, weight, and hair.

Progesterone deficiency can lead to: depression, memory problems, swollen and tender breasts before period, irritability, heavy periods, painful periods, bloating of lower abdomen, nervousness, agitation, anxiety, tense muscles, sleep is restless or light, hair loss on top of head in women, dream infrequently, easily worried or excitable, difficulty relaxing.

Estrogen

Translated from ancient Greek, this is the “generator of desire.” Estrogen serves hundreds of functions in the female body. Well known for its function in the reproductive system, it also plays many non-reproductive roles. Let it be known that estrogen is important and needed in men too! Estrogen plays important roles in the brain by blocking a brain enzyme called monoamine oxidase, which allows important mood-simulating neurotransmitters to act longer and stronger. It also creates catecholestrogens which are neurotransmitters that act as mental stimulants. These two functions can aid in the reversal of depression or prevent it in the first place. It improves blood flow and is a powerful antioxidant.

Some research has looked into where a woman was in her menstrual cycle when she sustained a brain injury and how that may play a role in recovery. Estrogen seems to offer a degree of protection to the brain just as progesterone.

Effect: mood, stress, energy, memory, sleep, immune system, sex, circulation, bones, joints, weight, skin and hair.

Estrogen deficiency can lead to: depression, arthritis, irregular menstrual cycle in women, damaged arteries, hot flashes, excess facial hair, fatigue, loss of muscle mass, lack of sexual odors in women, lack of vaginal lubrication, hair loss on top of head, excessively dry skin, pale skin, thin skin, wrinkles at the corners of the eyes, high cholesterol, high blood pressure, difficulty recovering from physical activity, memory problems, dream infrequently, poor sleep, bone loss in the spine. In men specifically – low libido, infertility.

Cortisol

I always associated cortisol with stress but it is so important for reducing stress and has been referred to as the “anti-stress hormone.” The rise of cortisol when under stress actually allows your body to manage and expel the stress. Cortisol not only helps us to quickly respond to stressful situations but also reduces inflammation, influences appetite, increases energy, aids in digestion and even enhances function of the immune system.

Effect: mood, stress, energy, memory, sex, immune system, circulation, bones, joints, weight, skin and hair.

Cortisol deficiency can lead to: weight loss, face looks thinner, allergies, feeling stressed out, digestive issues, arthritis, weak or fast heartbeat, trouble concentrating, being easily confused, salt or sugar cravings, skin issues (eczema, psoriasis, rashes), low blood pressure, light headed in stressful situations, circular patches of hair loss, swollen moon face, feeling wiped out from the least amount of stress, fat hump on upper back, sleep for long periods but do not feel refreshed.

Pregnenolone

Often referred to as the “mother of all hormones,” as it is the first steroid generated from cholesterol and goes on to be the start of two key pathways, ending up as aldosterone/cortisol and testosterone/estrogen. Insufficient levels of pregnenolone can cause a spiral effect down the line. This steroid is found in the brain, and highly concentrated specifically in the hippocampus. It is so important for memory. A fun fact about this one is that with replenishment, it can intensify or enhance the way you see colors.

Effect: memory, joints.

Pregnenolone deficiency can lead to: low blood pressure, craving salty food, memory loss, difficulty handling stress, joint pain, lack of hair in pubic area or under arms, flabby muscles, excessive light-colored urine during the day, feeling drained, not seeing colors as brightly, difficulty trusting your memory.

Thyroid

The pituitary gland produces thyroid stimulating hormone (TSH) which stimulates the thyroid gland to produce triiodothyronine (T3) and thyroxine (T4). Situated at the anterior base of the neck is the thyroid gland. These hormones serve a pivotal role in growth and development, blood circulation, metabolism, the nervous system. The thyroid hormones stimulate the mitochondria of the cells and protects the brain, heart, kidneys, immune system and digestive organs. The effect on blood circulation aids in removing waste from arteries and cells and also dissolving cholesterol.

Effect: mood, stress, energy, memory, sleep, immune system, circulation, bones, joints, weight, skin and hair.

Thyroid deficiency can lead to: cold hands and feet, puffy face and eyelids in morning, sensitivity to cold, easily put on weight, arthritis, constipation, pale skin, feeling more tired at rest than when moving, dry hair, brittle hair, hair loss, slowed thinking, excessively dry skin, stiff joints in the morning, fat hump on upper back, trouble getting up in the morning, high cholesterol, weak heartbeat, high blood pressure, sleep for long periods but do not feel refreshed, trouble concentrating, memory problems, labs showing low immune function.

ACTH

Adrenocorticotropic hormone (ACTH) oversees the production of the anti-stress hormone, cortisol. The effects are not just limited to that; it also plays a role in hair growth, skin color or tan, and is also an important messenger for neurons in the brain. ACTH is important for keeping you cool by building up stress resiliency and helps with mental focus and attentiveness.

Effect: stress, energy, memory, joints, skin and hair.

ACTH deficiency can lead to: feeling stressed out, low blood pressure, weight loss, memory loss, patches of hair loss, hair turning grey, pale complexion, trouble concentrating.

Insulin

Insulin has the primary role of stabilizing and maintaining blood-sugar levels. Not only that, but it plays a role in strengthening arteries and protecting against heart disease. It enhances the immune system and aids in the digestive system. Insulin provides you with energy, strengthens muscles and stores fat as energy reserves.

Effect: mood, energy, sex, circulation, immune system, sleep, weight, skin.

Insulin deficiency can lead to: loss of muscle mass, lack body fat, skinny buttocks and stomach, excess urination in day and night, sugar cravings, excessive thirst, poor healing, lack energy for tiring work.

Vitamin D

I didn’t want to leave this one out. Surprise! Vitamin D is actually a hormone. Many different types of cells have receptors for it throughout the body. It serves such an important role in the immune system, bone health, mental health, a healthy gut microbiome and cardiovascular health.

In several research studies, vitamin D has been shown to protect the neurons of the brain through its powerful immune-boosting and anti-inflammatory capabilities. Deficiency in vitamin D following TBI is common and has been associated with more severe depressive symptoms and worsened cognitive function. Low vitamin D status has been associated with a higher incidence of inflammatory conditions, cancer and chronic disease.

Sources

1. Depression in Men and Women One Year Following Traumatic Brain Injury (TBI): A TBI Model Systems Study, 2017, DOI: 10.3389%2Ffpsyg.2017.00634.
2. Major Depression in Patients with Closed Head Injury, 1987, DOI: 10.1037/h0091773.
3. Neuropsychiatric Complications of Traumatic Brain Injury. 2007, DOI: 10/1176/jnp.2007.19.2.106.
4. Psychiatric illness following traumatic brain injury in an adult health maintenance organization population, 2004, DOI: 10.1001/archpsyc.61.1.53.
5. Traumatic Brain Injury, A Clinical Approach to Diagnosis and Treatment, Gordon, 2016.
6. Prevalence and correlates of vitamin D deficiency in adults after traumatic brain injury. 2016, DOI: 10.1111/cen.13045.
7. The Neuroendocrine Effects of Traumatic Brain Injury, 2007, DOI: 10.1176/jnp. 2007.19.4.363
8. Brain damage, sex hormones and recovery: a new role for progesterone and estrogen? 2001, DOI: 10.1016/s0166-2236(00)01821-x.
9. Estrogen and progesterone as neuroprotective agents in the treatment of acute brain injuries, 2003, DOI: 10.1080/1363849031000095279.
10. Hypopituitarism after traumatic brain injury. 2005, DOI: 10.1530/eje.1.01895.
11. Physiology, Progesterone. 2021, StatPearls.
12. Physiological Action of Progesterone in Target Tissues, 1997, DOI: 10.1210/edrv.18.4.0308.
13. Endocrinology: An Integrated Approach. Whithead, 2001.
14. Physiology, Thyroid Hormone, 2021, StatPearls.
15. Mechanisms in Endocrinology: Insulin and type 1 diabetes: immune connections, 2013, DOI: 10.1530/EJE-12-0693.
16. Normal Physiology of Growth Hormone in Adults, 2019, Endotext.
17. The Hormone Solution, Hertoghe, 2002.
18. Vitamin D and the central nervous system, 2013, DOI: 10.1016/S1734-1140(13)71003-X.
19. Vitamin D and neurocognitive dysfunction: Preventing “D”ecline? 2008, DOI: 10.1016/j.mam.2008.05.001.
20. Physiology, Adrenocorticotropic Hormone (ACTH), 2020, StatPearls.
21. Pregnenolone, Henderson, DOI: 10.1210/jcem-10-4-455.
22. Mechanisms in Endocrinology: Estradiol as a male hormone, 2019, DOI: 10.1530/EJE-18-1000.
23. What Does Estrogen Do? 2014, DOI: 10.1210/jc.2014-v99i4-31A.
24. The Role of Estrogens in Control of Energy Balance and Glucose Homeostasis, 2013, DOI: 10.1210/er.2012-1055.
25. Relationship Between Testosterone Levels, Insulin Sensitivity, and Mitochondrial Function in Men, 2005, DOI: 10.2337/diacare.28.7.1636.
26. Revisiting the role of testosterone: Are we missing something?, 2017, DOI: 10.3909/riu0716.
27. The Biological Actions of Dehydroepiandrosterone Involves Multiple Receptors, 2008, DOI: 10.1080/03602530600569877.
28. Hypopituitarism After Multiple Concussions: A Retrospective Case Study in an Adolescent Male, 2007, PMID: 18060001.
29. Neuropsychology and clinical neuroscience of persistent post-concussive syndrome, 2008, DOI: 10.10170S135561770808017X.
30. Neurobehavioral and quality of life changes associated with growth hormone insufficiency after complicated mild, moderate, or severe traumatic brain injury, 2006, DOI: 10.1089/neu.2006.23.928.
31. Neuroendocrine Dysfunction in a Young Athlete With Concussion A Case Report, 2017, DOI: 10.1097/JSM.0000000000000408.
32. GH deficiency as the most common pituitary defect after TBI: clinical implications, 2005, DOI: 10.1007/s11102-006-6047-z.

Traumatic Brain Injury Treatment Everyone Should Know About: Success at the Regenerative Medicine Center

A few months ago, I started a new treatment protocol for traumatic brain injury (TBI) at the Regenerative Medicine Center in Pittsburgh. I faced many obstacles leading up to this treatment that had prevented me from exploring it much sooner in my recovery. I was told I couldn’t get better, to accept that this is the best I’ll ever get. This is a similar tune heard by many TBI sufferers and it shouldn’t be that way. I hope that my experience can bring some much needed light and perspective to both brain injury sufferers and medical providers alike.

To the medical providers: There is a way to help these patients get better. To the TBI sufferers: There is a light at the end of the tunnel.

In this post, you will learn the medical explanation of this treatment, my flawed experience with conventional medicine for treatment of TBI, my progress and reflection of all that has transpired since starting this new protocol just a few short months ago.

This post is a culmination of months and a huge feat for me as I have spent a lot of time listening, slowly writing, slowly reading, and re-reading in order to gain a deeper understanding of the science behind the treatment. I still have so much to learn! I knew more layers would be revealed as time went on and that there are still many layers to come, but I feel it is important to share this and spread this information. I was initially hesitant because I had this residual feeling from many other treatments in the past that had failed. I thought that maybe this was too good to be true. It turns out, this treatment is good and true! It has been an extremely humbling process.

Flashback to my first post about my initial trip to Pittsburgh, I first learned of the use of neurosteroids to treat TBI while listening to a few podcasts.

After hearing about this treatment in a podcast one year into my recovery, I posed the idea to several of my doctors which was essentially shunned. One doctor said to me, “I’m not sure hormones really play a role in brain injury recovery.” This had led me to suppress the idea that this could help me and was a real option. I brushed it aside as the reaction from my providers led me to feel like this was a crazy idea and one simply out of desperation.

Another year had passed and again, I heard another podcast about neuroendocrinology and this treatment. At that point, I felt so desperate and didn’t care what any of my current doctors thought about seeking this treatment. I discovered Dr. Valerie Donaldson who had completed a certification process in Neuroendocrinology TBI treatment protocols led by Dr. Mark Gordon, who developed them. Dr. Donaldson is also an expert in regenerative medicine and functional medicine so I attribute my success to all of her knowledge in many areas as well as the TBI protocols.

The Neurosteroid TBI Connection

Neuroendocrinology is the study of medicine that relates to the interaction between the endocrine system and nervous system. This focuses on the hormonal activity throughout the body that is regulated by the brain. Neurosteroids are hormones synthesized by the brain, regulating the growth of neurons as well as the connections and communicating system between the neurons. Neurosteroids act in target glands throughout the body such as the thyroid, adrenal glands and gonads (ovaries and testes).

There is primary and secondary injury following brain trauma. The primary injury leads to cellular damages, vascular damages, ischemia (restricted blood flow) and metabolic crisis. The secondary phase is riddled with complex processes, a toxic symphony leading to the fostering of a highly inflammatory state in the brain. The secondary effects from this process can present as symptoms even decades later, and by that point the association between the symptoms and the brain injury may have been lost, resulting in long-term suffering. Without identifying the underlying cause, healing potential is limited and inflammation continues.

The pituitary gland and hypothalamus are both key players in hormonal regulation. These two areas are easily impacted and highly vulnerable to brain injury. The hypothalamus resides between the pituitary gland and the inner brain, connecting the endocrine and nervous systems. Living at the base of the brain is the pituitary gland. It plays such a central role in the endocrine system that it gained the reputation of the “master gland.”

The hypothalamic-pituitary axis is the system that intertwines the central nervous system with the endocrine system. It has been found that TBI can lead to dysfunction of this axis, causing various hormonal abnormalities. In research, it is estimated that about 50-76% of TBI patients show some loss of pituitary neurosteroid function and suggests that 58% of these patients will recover within a year but the other 52% carry on to develop new deficiencies a year after the initial injury.^1-3

Through research and working with thousands of TBI patients, Dr. Gordon found that neurosteroid hormone deficiency or insufficiency (low “normal” range) is often found in brain injury patients and the underlying cause of prolonged symptoms, with growth hormone abnormality being the most common. By properly addressing chronic inflammation, identifying the deficiencies and treating them, there has been great success getting brain trauma patients better with reproducible results. I had wondered if I could be one of those patients.

Neurosteroid deficiencies could mean reductions in any of the following: growth hormone, estrogen, pregnenolone, DHEA, progesterone, testosterone. While all of these play a huge role, growth hormone is of high importance because it is essentially the quarterback of so many functions in the body. If the level declines, the functions of the body start to decline too. Growth hormone is responsible for overseeing these functions: mood, stress, energy, memory, sleep, immune system, sex, circulation, bones, joints, weight, skin and hair.

Interestingly, the symptomatology that is a result of neuroendocrine dysfunction is the same symptomatology of that which is labeled post concussion syndrome. The symptoms include but are not limited to, memory loss, attention difficulties, insomnia, impaired cognition, fatigue, depression, anxiety, mood swings, personality changes. Instead of screening for and identifying such dysfunction, a patient may be labeled with post concussion syndrome and continue to suffer with many debilitating symptoms for years.

Dr. Gordon has had great success helping many veterans who have been diagnosed with PTSD by using these protocols and has found the root of that diagnosis is most often chronic inflammation and this dysfunction secondary to brain trauma. The issue is that these patients, such as myself, are treated with pharmaceutical medications for the symptoms but these pharmaceuticals do not address the underlying cause of inflammation and do not replenish the deficient neurosteroids.

This is not typically taught in medical studies. I wish I had known about this prior to my injury. Suggestions from Dr. Gordon and others about screening for this have come to light. Dr. Gordon recommends screening as soon as possible after TBI as a baseline, followed by hormone panels at 3, 6 and 12 months from the initial testing. Another suggestion is to order a hormone panel at 3 months post-injury if symptoms suggest neuroendocrine dysfunction or if there are delayed symptoms at any point up to 3 years post-injury.^4-5

Despite the thousands of articles available demonstrating the connection between TBI and hormonal dysfunction for more than a decade, this is still a very under-diagnosed consequence of brain injury that is not typically screened for in patients. It’s hard to ignore such research and statistics and say that this would play no role in brain injury recovery.

Conventional Medicine Failures

I want to preface this section by saying, I do believe conventional medicine has a place and I also did have positive experiences with a select few providers in conventional medicine. This is a reflection of my own personal experience and failures of conventional medicine for the treatment of my traumatic brain injury. My frustrations and disappointments are valid and I feel it is important to share them as I felt I didn’t have a voice in this process for so long and I know many others have felt similarly. I am a prime example of a patient with chronic ailments that fell through the cracks of conventional medicine and I hope this can save another from this major fallout.

At some point during my recovery, my treatment started to feel redundant, like the same things were recommended over and over again. The end result was the same – I still felt miserable or even more miserable. It felt as if I were banging my head against a wall. It reminded me of Albert Einstein’s quote about insanity. I feel like that accurately sums up the treatment I received for over two years with the exception of a select few practitioners that provided meaningful benefit.

The definition of insanity is doing the same thing over and over again, and expecting different results.
Albert Einstein

Throughout my recovery, I found that I, as a person, wasn’t being treated but rather my symptoms were being treated and, in the end, this helped foster the identity crisis I was already experiencing.

Unfortunately, I became faceless. The 13-year-old girl who had been seen for a head injury before my appointment was given the same treatment as me, just as the 40-year-old male who was seen after me. We were all the same. I know this after connecting with other TBI sufferers and hearing their experiences. It was as if the “individual” was taken out of the treatment plans.

I had seen dozens of specialists, each dissecting me to only peer inside one system. It reminds me of my days in the cadaver lab, as we dissected each system. Soon after the injury I was seeing 20 different providers for each symptom I was experiencing, none communicating with each other and so instead of a whole being I became this long list of symptoms. They were so zoomed in on one tiny part but never zoomed back out to look at the big picture, to look at how important it is for all of the intricate systems to work together again. The big picture was me as a person, but the big picture was also seeing that an underlying cause led to all of my residual ailments.

In my darkest moments, I was desperate for help. I was desperate to be heard. I was desperate to just be seen.

When I wasn’t making progress and wasn’t getting better, I was usually told a variety of things: “Try this new medication. Just give it more time. It’s all in your head. There is nothing more to offer you.” It felt like I was fending for myself because my providers gave up on me and my healing. This was so detrimental to my mental health to know that the very people who were supposed to help me gave up on me. The very people who were supposed to see me looked past me. I was crying out for help but couldn’t be heard.

I didn’t want to give up but this made me feel like maybe I should.

I’m one of the fortunate ones who did not give up. I thank my friends and family who helped carry me when I couldn’t carry myself. I continued to research more options and continued to present them to my doctors. Unfortunately, almost all of them did not believe the treatment options I was presenting to them were worth exploring. So, not only did it feel like they gave up on me and stopped offering me options, they also told me to stop exploring options too.

My providers who I was supposed to trust stopped problem-solving and advocating for me. They left that to me – the person working with an ineffective and dysfunctional brain, running on almost no energy like a car with its gas light on about to stall. I was fending for myself, working tirelessly with poor vision and depleted energy to get better.

The field of medicine is amazing and astounds me because it is ever-evolving and ever-changing. I became frustrated that my providers closed their minds off and stopped seeking new options and solutions. Aren’t we as medical providers supposed to be detectives of the human body? When did this change?

My treatment plan had been focused on symptomatic relief, and not full healing. This was because the thought process was that there was no room for improvement, no potential for full healing, and the only thing left to offer me was relieving the long list of symptoms I was left with. Unfortunately, most conventional medicine practices involve dishing out more and more medications. This typically leads to more medications being prescribed to combat the side effects from a medication initially prescribed.

Throughout my recovery, I had been on nearly 30 different medications, all with deleterious side effects. How does someone go from being on no medications to this? I was embarrassed to sit down every week to fill up my pill boxes because I couldn’t remember when to take the many pills I was on. These “treatments” only masked the symptoms and caused worsened effects. None of these different medications could have replenished my deficient levels of hormones!

The Start of Getting My Life Back

I did not expect my world to change when I walked into Dr. Donaldson’s office that day in February, but it did. That day is one I will never forget. It was the start of getting my life back.

The positive effects since then have been abundant. This visit started with a comprehensive lab work-up, a detailed history of treatments leading up to that point, my symptoms and my goals. The lab tests assessed how well the hypothalamic-pituitary axis was functioning and how the peripheral glands of the endocrine system were functioning. The treatment is individualized as no person is the same, just as no brain injury is the same.

How refreshing it was and is to be treated like a person and to not be placed in a bucket with every other patient and receive the same exact treatment. I am finally receiving an individualized treatment plan, and one that focuses on me as a whole. How refreshing to know that my doctor believes I can heal.

Dr. Donaldson’s lab work-up showed various significant and impressive hormonal deficiencies, more than I had anticipated. Instead of masking the symptoms with many pharmaceuticals, she works hard to identify the underlying cause and then treats accordingly by addressing inflammation, replenishing deficient hormones and providing additional support with nutraceuticals. Not only does she work hard to identify the underlying issues but works hard to put everything back together, to function in harmony as the body is supposed to.

This treatment protocol is multifaceted and ever-evolving. At each appointment, we go over everything in detail, determining if anything needs to be added or subtracted from the treatment protocol. Dr. Donaldson described it like a game of chess – a well thought out process, determining the next move to healing. I deeply appreciated this thought because where many providers would say there is nothing left that they can do for me or try the same thing on repeat to no avail, I know that Dr. Donaldson will not give up on me and is always thinking of what else can provide further benefit.

Shortly after I started a secretagogue to increase growth hormone production, I had the first glimmer of what quality sleep felt like again. I slept through the night for the first time in years. It felt like I had gone into a coma. I woke up and felt so strange that I had slept through the night that I moved my limbs to ensure I was in fact, alive. While my sleep is still a work in progress, I am deeply grateful for the spontaneous nights of sleep I have experienced since starting treatment.

Similarly, after starting testosterone replacement therapy, I had so much energy that I again felt strange. I felt like I could run a marathon. For the record, I would rather do any other activity than go running so that shows how exceptionally strange I felt. While I still experience fatigue, it has been refreshing to feel moments of energy again. I also noticed an improvement in mental clarity as well as a reduction in my nerve-related head and neck pain as testosterone helps to heal ligaments and joints.

One day recently, I started to develop an all too familiar migraine, one that would typically go on to last seven days straight and would not respond to any medications. It seemed like a miracle that the right dose of progesterone that Dr. Donaldson advised me to take rid the migraine completely within just a couple hours. After that, she said to me, “You are in control!” No provider has ever said that to me and that was one of the best and most empowering things to hear. For so long, I had felt like nothing was in my control.

I recently experienced the Light Portal at my last visit which I am now in love with based on my extremely positive and enlightening experience. This is an apparatus that uses light, color and sound, producing a profound and relaxing energy through the body. It is magical. I describe my full experience here. I look forward to future Light Portal sessions.

During my most recent visit, we also initiated exosome therapy. I am interested to see what benefits I may have. Derived from stem cells, exosomes are extracellular vesicles or tiny bubbles carrying genetic material and proteins. All living cells communicate with other cells and these are the messengers. They are like little envelopes, carrying important information that is released to promote cell repair, regeneration and healing.

Since beginning this treatment a few months ago, I have experienced the most progress I have since my injury, just over 2.5 years ago. Just the other day, I went on my first successful drive after countless failed attempts over the course of my recovery. And since then, I have gone on several more successful drives! Liberated just doesn’t cut it.

While I am still a work in progress, the newfound hope instilled in me brings me to tears. I know my recovery will continue to ebb and flow, but I now have a new perspective on what is possible. And I’m not letting anyone take that from me again.

An Evolution in Mindset

Aside from addressing my hormonal imbalances, chronic inflammation and the physical aspects, Dr. Donaldson has challenged me to change and evolve my perceptions about my limits. I didn’t realize until recently just how many limiting beliefs were instilled in me from this brain injury. It was a culmination of the injury and doctors telling me there wasn’t potential for improvement which then led to my own self-destructive thoughts and beliefs. The result was a lie that I convinced myself was true – an enormous lie that I couldn’t get better, that life as I once knew it was gone, that I would potentially never be able to work in medicine again.

“There is one grand lie – that we are limited. The only limits we have are the limits we believe.”
Wayne Dyer

I was convinced I couldn’t get better because that’s what I was told. I tried so very hard to repel this belief but eventually, after hearing it over and over, I believed it and stored it within me. Even if my conscious mind said I will get better, the subconscious was holding onto that limiting belief, restricting me from my healing potential.

I’ve thought I’m not good enough or I’m not capable. Retaining new information is nearly impossible. The judgment of other people matters. My eyes are stuck like this. I can’t get better, therefore I am a failure. My brain is stuck like this. This is my new normal. This is the best I’ll ever get. These were messages sent to myself, restricting my potential. I hadn’t realized I was really doing this.

This evolution of mindset, in motion with other treatment modalities such as using neurosteroids where I am deficient, regenerative therapies, nutraceuticals and Light Portal has been a power force. While I still have a lot of progress to make, this has been a major kickstart to my healing.

A Reflection in Gratitude

How often do you walk into a doctor’s office and think, this person is going to change my life? How often do you walk into a doctor’s office and think, this person will end up feeling like family? For me, that’s rare. Truthfully, even as a medical provider myself, I had grown to hate going to appointments because they had become filled with despair and negativity. I left the appointments with immense anxiety and hopelessness. All of this changed at the Regenerative Medicine Center.

Throughout my career in the emergency department, I would receive a seemingly random positive experience review from a patient, describing how meaningful I was to them in that moment. It would often come as a surprise that I deeply affected that person and that I had left such a lasting impression. The effect you have on someone is more valuable than you may think.

You never know when someone will alter the course of your life for the better. And a lot of the time, you may not know just how great the impact or lasting impression you left on someone. It’s amazing and miraculous really that one interaction with someone has the power to change the course of your life. Think about how many people you may have touched deeply in your life but don’t ever know about it. Think about all the people who, in one moment or another, you felt so grateful for or still do and they don’t know it. This might have been a cashier at the grocery store, a nurse, someone you simply lost touch with but still think about, or even a stranger you struck up a brief conversation with. A simple, “Hello,” could be the start of an impression of a lifetime.

Sometimes we stop and express our gratitude but often we don’t because we might feel we don’t have time or, for me on various occasions, fear that it may be perceived as creepy to someone you don’t know deeply or just met. During so many moments of reflection about myself, life, love and the world, I think we should proclaim how we feel in those moments. Just that small expression may very well make the person’s day. We never know what burdens someone else may be carrying and that simple message could also be the thing that lifts their spirits and keeps them going.

I recently read a time capsule that I wrote in grade school when I was 9 years old. The time capsule included little prompts with a blank line after each one. We put them in an envelope addressed to ourselves to open five years later. I revisit it from time to time. One prompt read: Before I die, I hope __________. I wrote on the line: I say I love everybody. From a young age, I had this deep desire for everyone to feel love. I think it is so important, now more than ever, to share our gratitude and love and put it out into the world.

As I walked into the Regenerative Medicine Center that cold day in February, I was hopeless and desperate. To be completely honest, I didn’t have many expectations at that point in my recovery. I was desperate for help, to be heard, to be seen. It was in my darkest moment that I needed a lifeline and I got one.

I received help. I was heard. I was seen.

Dr. Donaldson altered the course of my life for the better. She is now associated with hope, light and all that is good. A lifeline. A connection I will never forget. She was a stranger, became my doctor and then became family. It’s amazing to think about how many people we may have touched deeply in our lives but don’t ever fully know about, so I wanted to take a moment to say, Dr. Donaldson has deeply touched mine and left a lasting mark on my heart and soul. She is a bright light, reminding me that healing is in fact, possible.

This is someone you want in your corner. This is someone who can get you your life back.

Someone asked me, “So, Dr. Donaldson is alternative medicine?” I replied, “Dr. Donaldson is an alternative to bad medicine.”

Sources

1. High Risk of Hypopituitarism after Traumatic Brain Injury: A Prospective Investigation of Anterior Pituitary Function in the Acute Phase and 12 Months after Trauma, 2006, DOI: 10.1210/jc.2005-2476

2. Neuroendocrine dysfunction in the acute phase of traumatic brain injury, 2004, DOI: 10.1111/j.1365-2265.2004.02023.x

3. Acute and long-term pituitary insufficiency in traumatic brain injury: a prospective single-centre study, 2007, DOI: 10.1111/j.1365-2265.2007.02931.x

4. Neuroendocrine dysfunction following mild TBI: When to screen for it, 2014.

5. Traumatic Brain Injury, A Clinical Approach to Diagnosis and Treatment, 2016.

6. Neuropsychology and clinical neuroscience of persistent post-concussive syndrome, 2008, DOI: 10.10170S135561770808017X

7. Hypopituitarism After Multiple Concussions: A Retrospective Case Study in an Adolescent Male, 2007, PMID: 18060001

8. Pituitary function in subjects with mild traumatic brain injury: a review of literature and proposal of a screening strategy, 2010, DOI: 10.1007/s11102-009-0215-x

9. Neurobehavioral and quality of life changes associated with growth hormone insufficiency after complicated mild, moderate, or severe traumatic brain injury, 2006, DOI: 10.1089/neu.2006.23.928

10. GH deficiency as the most common pituitary defect after TBI: clinical implications, 2005, DOI: 10.1007/s11102-006-6047-z

11. Neuroendocrine Dysfunction in a Young Athlete With Concussion A Case Report, 2017, DOI: 10.1097/JSM.0000000000000408