Hypopituitarism – A Loss of Identity

As I write this I am sure there may be some other patients that will disagree with me.  One of my challenges throughout this illness has been figuring out who I am now.  I read a description of a person with a chronic illness as forever walking down a dividing line between the past and the future. Looking backward, he can see everything the illness has taken from him or has forced him to relinquish. Looking forward, he can’t see anything quite clearly. There’s no going back to the past, and the future is uncertain.

My story is my own and I accept that some of the things that define me now are not the same as others following their own path.  For me, my life changed a lot during this illness. Being misdiagnosed for many years, as many others have been, we either dealt with the symptoms, or we sought out medical advice to find the answers.  With a non functioning pituitary tumor that took years to grow, the changes in me happened so gradually that for most of my friends and family, they didn’t notice.  It wasn’t until the last couple years that people could say they actually saw the changes in me.  Changes that I didn’t notice myself.

Loss of aggression was one of the first major clues.  Which sounds OK but in the construction business world you need aggression to deal with consultants and contractors on a daily basis.  Loss of sex drive.  This happened really over a couple years on a slow decline until i felt I was no longer functioning as a man or husband.  It was the most difficult thing to admit  and what finally got me to see my doctor.  It was then that I was told at the age of 44 my testosterone was nil.  The good thing was my doctor did not just prescribe me testosterone and leave it at that.  He said to me, yes your testosterone is nil but we need to know why.  Thankfully he sent me to an endocrinologist that completed the testing and found the golf ball tumor on my pituitary gland.  Anyways you can read about all that in some of my previous stories.

For 12 years before being diagnosed I pushed my life to forward my career and provide for my family.  I spent 70% of my working life traveling on the road for many years.  In the last few years, I had worked my way to managing those people that would now spend their days travelling, and I had the chance to slow down and spend time at home.   I had built an addition on the home for my wife to build her own business.  Our future was planned and I had goals and dreams to pursue. We had been married for 22 years when the tumor diagnosis was found.

I wrote this to discuss the loss of identity. During the last, I would guess, two to three years before diagnosis, I made many mental mistakes with my life.  I began to lose who I was.  I can blame my hormone levels for being in the toilet if I choose.  Really I don’t know.  I gave up a career because I was struggling mentally but didn’t know why.  I assumed I needed a change after so many years so I decided to start my own business. My marriage struggled.  The mental challenges continued during this period until being diagnosed six months after giving up my career.  They say everything happens for a reason…I am still trying to figure out the reasons.

Six weeks after surgery to remove the 4 cm tumor from my head, my wife tells me she wants a divorce.  It destroyed me.  I would love to tell everyone that I took it like a man and sucked it up and moved on.  Truth is, being deficient on all hormones, adrenals, thyroid, growth hormone, sex hormones…I was a basket case.  It was at this point that I lost who I was. Along with my identity, many other feelings came across. A loss of comfort, sexual function, career, income, self-efficacy, freedom, cognitive function, intimacy, pride, joy, self-esteem, self-control, independence, mental health, hope, dignity, and certainty. Over the last couple years I have felt these over and over again.  Sorting though the grief alone is a tremendous challenge.

Until you yourself live through a complete hormone deficiency, you will never understand what those effects have on a person.  My endo tried to describe it when replacing all these hormones synthetically that it was like going through a medically induced depression, puberty, menopause, and a mid life crisis  all at the same time.

When you go through a tumor in your brain, many people you thought you were close to will step away.  They don’t mean to be rude or not sympathetic but they don’t understand and it puts them face to face with their own mortality.  They do’t know how to face you or what to say.  Going through this tumor, plus a divorce, seemed to disconnect me even further.  I went from the career guy with family and lots friends to the sick separated guy feeling alone and on my own to deal with this.  I know people going through divorce normally go through some of these feelings.  It was just magnified for me with the illness.

It was something that everyone I knew would never understand.  You tell them it’s hypopituitarism and you get the blank stare.  I was no longer the person that they used to know.

It has been almost three years now, since my original diagnosis.  Tumor was removed in Oct of 2013.  It has been two years of trying to synthetically replace all the hormones that others create on a regular basis but we have to balance and figure out correct dosages regularly.  As much as I have tried to explain to family and friends, they will never truly understand what we work through daily.  Yes…”I am fine”…I tell them.  “All good!”  What else can I say?  I don’t want their pity and I don’t want them to watch me struggle.  It’s written on the inside of my face.  For people who are hypopituitary, our losses are multiple and permanent and therefore difficult to explain. They are infinite losses that will effect our quality of life forever.

Well-meaning individuals, whether friends and family or even doctors can make it more difficult. Some may try to add a helpful perspective by saying, “It could be worse” or “You look fine!” All these statements do are invalidate our physical and emotional challenges.  It is very dismissive of the pain we are experiencing and the type of grief we are trying to manage. Everyone has a right to how they feel, and for us we just say, “It could be better.” There’s also a lot of pride in those of us with chronic illness and it makes us reluctant to ask for help from friends or loved ones.  Sometimes we live in denial about our own limitations.  We often retreat from our social networks, leading to poor social support. Our relationships will often suffer as we become more and more isolated. The depression can worsen to the point where some hypopituitary patients become actively suicidal or passively suicidal or just stop taking care of themselves in any meaningful way.

I gave up a while ago trying to explain the bad days because I really can’t explain them to myself.  I am glad they have become fewer and further between than before.  But how do you even try to explain when hormones are out of whack one day, but good the next?  You can’t explain what its like to have your brain in a fog, pain in your body, emotional disconnect from others, a want to just be alone and a want to just be with someone that understands.

I have forgotten much of the year during diagnosis and have been trying to rebuild since then.  I truly don’t believe all of the pieces are back in place yet. I am doing my best to move forward anyways but have yet to truly define or figure out who I am now.  I know I am no longer the same person mentally that I was before this tumor.  I seem to remind myself on a daily basis of this.  It doesn’t make me less of a person.  I probably help more people now that I ever did before because after going through this we find a connection with others that we never had before. My challenge is finding connection outside the illness itself.

In reviewing the psychology of this illness, I came across Maslow’s hierarchy of Human needs, he used the terms “physiological”, “safety”, “belongingness” and “love”, “esteem”, “self-actualization”, and “self-transcendence” to describe the pattern that human motivations generally move through.

What he says is there may not be any physical indications, but if a person is not meeting the most fundamental “physiological” needs as mentioned above,  and “Safety” we can go through anxiety, tension and depression. The next most basic level of needs, Maslow called “deficiency needs” or “d-needs”: love, belonging, esteem, friendship, and physical needs and finally self actualization.   Maslow’s theory suggests that the most basic level of needs must be met before the individual will strongly desire (or focus motivation upon) the secondary or higher level needs.

When you think about most of us that are diagnosed hypopituitary, we spend a countless amount of time searching and trying to understand our illness.  Trying to find answers to why and what is causing all of our challenges.  This is all part of the physiological state. Our next phase is security.  Whether that be in finally finding a balance with hormones or finding a doctor/endocrinologist that understands or is willing to listen or help.  Or having a partner or family member that is by your side for the duration and willing to love you no matter the challenges.  Or just a feeling of finally understanding our own illness and how to read our own bodies needs.

Finding the next step for me has been difficult.  A “love/belonging” or need.  The belonging or need came through the support groups.  I found peace and understanding with those going through the same as myself.  Helping others going through this illness as I have, became what drove me day in and day out.  But I am not fulfilled.

But I find myself still in this stage.  Somewhere trying to sort out love and passions.  What does it mean? What does it feel like? Why don’t I feel this?  Why is there such a disconnect? Somewhere between here and the next stage, working towards my own self esteem, is where I seem to be stuck.

The human mind and brain are complex and have parallel processes running at the same time.  Maslow said that the different levels of motivation could occur at any time in the human mind, but he focused on identifying the basic types of motivation and the order in which they should be met.  Once we find that level of esteem again, we can move into the Self Actualization stage.  Not everyone moves to this stage.  Some choose to stay at the point that they have great self esteem and that is an amazing place to be.

“What a man can be, he must be. This need we may call self-actualization…It refers to the desire for self-fulfillment, namely, to the tendency for him to become actualized in what he is potentially. This tendency might be phrased as the desire to become more and more what one is, to become everything that one is capable of becoming.”

Self Actualization. To me this relates again back to finding my own identity. It’s no longer about comparing myself to who I used to be and trying to get back there again. I can only hope that one day I will be happy and find that new identity.  I have to learn not to curse the storm but instead to learn to dance in the rain!



Growth Hormone Deficiency and Metabolism

Hypopituitarism and Weight Loss with Growth Hormone Deficiency.

I was asked to write some blogs on Nutrition, our Hormones and how we can find ways to better our health.  There is so much to write on the effects of Hypopituitarism that I am going to break these down by each hormone and work our way through them starting with Growth Hormone.  In my next blog I will address the next deficiency.

Before you read this and follow what I am doing, I always like to say that I am not a doctor and I am only writing on the things I have learned from my endocrinologist, nutritionists and hours of investigating online.  These are things that have worked for me.  Please remember these things may not work for everyone.  This is all based on science that you can look up yourself in reputable journals and medical studies.

Growth hormone is a major body system-wide metabolic hormone that regulates carbohydrate homeostasis (balance), protein and lipids (fat). Carbs, Proteins, and Fats!


Patients with growth hormone deficiency have traditionally been described as having increased insulin sensitivity (resistance).  Being Hypopituitary is close to what’s called having Metabolic Syndrome although ours is hormone related. Insulin Resistance has been studied and proven numerous times.  They have also shown that long-term treatment in GH-deficient adults results in persistent insulin resistance and abnormalities in how we process Insulin…even when on Somatropin.

Insulin is a hormone, just like estrogen, testosterone, cortisol and thyroid hormone. Insulin is secreted into our bloodstream by the pancreas to regulate the amount of glucose in our blood. Insulin allows our body to use sugar (glucose) from carbohydrates in the food that you eat for energy or to store glucose for future use.  Insulin is often described as a “key,” which unlocks the cells to allow sugar to enter the cell and be used for energy.  Insulin acts on many cells in your body, especially those in the liver, muscle and fat tissue. Insulin tells the cells to do the following:

  • Absorb glucose, fatty acids and amino acids
  • Stop breaking down glucose, fatty acids and amino acids; glycogen into glucose; fats into fatty acids and glycerol; and proteins into amino acids
  • Start building glycogen from glucose; fats (triglycerides) from glycerol and fatty acids; and proteins from amino acids

Blood sugar is like a vampire. It needs an invitation to enter our cells. And that invitation is insulin. Insulin is the key that unlocks the door to let the glucose in the blood to enter the muscle cell. When we have insulin resistance, we no longer have the ability to respond to insulin. Normal amounts of insulin are no longer adequate to produce a normal insulin response from fat, muscle and liver cells. In order to compensate, the pancreas produces more insulin. Insulin resistant cells cannot take in glucose, amino acids and fatty acids. Thus, glucose, fatty acids and amino acids ‘leak’ out of the cells. Exess glucose is converted into Glycogen. This then causes fat cells to absorb fatty acids and glycogen and thus expand.

The higher the insulin, the more the fat cells have to expand.  If you have insulin resistance and eat carbohydrates, up to five times the amount of insulin is necessary to bring your blood glucose back down to healthy levels. And some people with insulin resistance produce so much insulin that their blood sugar levels can drop way below normal, forcing us into a hypoglycemic state. When we experience intense cravings for sugary or starchy foods, there’s a good chance it’s due to hypoglycemia. I also believe that because we are not absorbing the glucose into our cells this is causing our lack of fuel for our energy levels.  We also need the glucose in the cells for our brains to function.

When insulin levels spike due to high glucose levels, it creates fat. And the more obese you are, the more insulin resistant you become.  Now the second issue comes into play for us that are Hypopituitary is that Cortisol which would normally be secreted from the adrenal gland is supposed to make fat and muscle cells resistant to the action of insulin.  Cortisol is also supposed to enhance the production of glucose by the liver. Under normal circumstances, cortisol counterbalances the action of insulin. Under stress or if a synthetic cortisol is given as a medication (like many of us), our cortisol gets used up quicker and we remain insulin resistant.  Low cortisol, low blood sugar equals hypoglycemia and possibly Adrenal Crisis.  Sounds like so much fun doesn’t it.  Cortisol and its effects on metabolism I will get into in my next blog.

Most people with insulin resistance don’t know they have it for many years—until they develop type 2 diabetes, a serious, lifelong disease. The good news is that if we find out we are borderline with high triglycerides, higher than normal blood glucose, abnormal (low) levels of good Cholesterol in our blood tests we can address insulin resistance early on.  We can often prevent or delay diabetes by making changes to our lifestyle.

What causes this insulin spike?  Sugars!  When people eat a food containing sugar, the digestive system breaks it down at which point it enters the blood.  Blood glucose levels then shoot up, and our pancreas creates the insulin as mentioned above.  Also Carbohydrates. When people eat a food containing carbohydrates, the digestive system breaks down the digestible ones into sugar, which enters the blood.  Repeat above.

In the past, carbohydrates were commonly classified as being either “simple” or “complex”. However, this does not account for the effect of carbohydrates on blood sugar and chronic diseases. To explain how different kinds of carbohydrate-rich foods directly affect blood sugar, the glycemic index was developed and is considered a better way of categorizing carbohydrates, especially starchy foods.  The University of Sydney has a great searchable index that can be found here http://www.glycemicindex.com/.  Low-glycemic foods have a rating of 55 or less, and foods rated 70-100 are considered high-glycemic foods. Medium-level foods have a glycemic index of 56-69.


One of the other issues with Growth Hormone deficiency is that our Protein synthesis and flux are reduced. Growth hormone is the only hormone to exert its function directly to our cells. Growth hormone increases the rate of protein synthesis within cells by increasing the transport rate of Amino Acids into the cells similar to the method insulin uses.  Replacement GH increases synthesis initially but it’s not sustained long term like we require.  It is also proven that Insulin resistant cells do not uptake amino acids well as mentioned above.

During digestion the proteins we eat are broken down and converted into Amino Acids for our cells.  Twenty percent of the human body is made up of protein. Protein plays a crucial role in almost all biological processes and amino acids are the building blocks of it.

A large proportion of our cells, muscles and tissue is made up of amino acids, meaning they carry out many important bodily functions, such as giving cells their structure. They also play a key role in the transport and the storage of nutrients. Amino acids have an influence on the function of organs, glands, tendons and arteries. They are furthermore essential for healing wounds and repairing tissue, especially in the muscles, bones, skin and hair as well as for the removal of all kinds of waste deposits produced in connection with the metabolism.

Adults produce 9 of the 22 essential amino acids and the remainder come from food. Failure to obtain enough of even 1 of the 9 essential amino acids, those that we cannot make, results in degradation of the body’s proteins (muscle and so forth) to obtain the one amino acid that is needed. Unlike fat and starch, the human body does not store excess amino acids for later use.  Amino acids must be in the food we eat every day.

There are 9 essential amino acids which humans must obtain from their diet in order to prevent protein-energy malnutrition. They are:

  • Phenylalanine
  • Valine
  • Threonine
  • Tryptophan
  • Methionine
  • Leucine
  • Isoleucine
  • Lysine
  • Histidine

Increasing your protein intake and adding quality Amino Acid supplements is a good idea to help us get enough. It’s easy to add protein to your diet with Whey Protein shakes available in most stores.  Just watch for sugar content as they are not created equal.  I use a product from Precision Supplements up here in Canada and I get paid nothing for endorsing their chocolate!  YUM! I am sure there is another brands where you live.

Fats (Lipids)

Growth hormone promotes the use of lipids by promoting the breakdown of triglycerides and oxidation in cells. When people eat less fat, they tend to eat more starch or sugar instead, and this actually increases their levels of dangerous cholesterol, the small, dense cholesterol that causes heart attacks. In fact, studies show that 75% of people who end up in the emergency room with a heart attack have normal overall cholesterol levels.  What they do have is pre-diabetes or type 2 diabetes.

Eating a diet with good quality fat and protein prevents and even can possibly reverse diabetes and pre-diabetes.  Eating sugar and refined carbs is the primary cause of these conditions.  Healthy Fats do not increase insulin.  Dietary fat cannot be converted to blood sugar, and therefore it doesn’t cause serum insulin levels to increase.

It might seem counterintuitive to eat fat if you’re trying to lose weight and use stored fat for energy, but dietary fat does not induce the high levels of insulin secretion seen with a very high-carb meal. Therefore, when the body is relying less on glucose and more on fat for energy, insulin secretion is decreased.  Ultimately, this allows the body to continue efficiently accessing fat stores for energy.


Ok now that the science lesson is over, what do we do about it?  If you are like myself and working towards losing weight, we need to reduce our consumption of sugars and carbohydrates and increase fats and Proteins.  It sounds simple and truly it is.  But you have to be committed to it if you are hypopituitary.  Or at least, give it 30 days and see what happens.  30 days.  That’s all I ask.  See if you feel different.

There are many eating plans you can find online in regards to a Ketogentic way of eating and I highly recommend some of them.  The main benefit of ketosis is that it increases the body’s ability to utilize fats for fuel. Our bodies get very lazy on a high-carbohydrate diet. When on high-carbohydrate diets, the body can usually expect an energy source to keep entering the body. But in the state of ketosis, the body has to become efficient at mobilizing fats as energy.

I don’t follow the Low Carb, High Fat mentality of some keto dieters as I don’t believe it’s a long term plan for us due to other hormone and nutrient deficiencies…which I will explain in a future blog.  I do recommend the Moderate Fat, Moderate Protein, Low Carb way of eating. For fat loss (not muscle loss) we need to keep our fats a bit lower or equal to our proteins per day.  There is a warning I will give.  If you decide to give this a try you may experience what is called the keto flu.  What’s happening is your body transitioning from carb burning to fat burning.  It’s a rough ride and I did have to stress dose my cortisol a few times to make it through some days.  But once through it, you will notice a tremendous difference.  You will want to keep your electrolytes up always.  I also supplemented with Salt, Magnesium and Potassium while on this way of eating mostly through a One a Day Vitamin.

If you can, pickup a book called “The Art and Science of Low Carbohydrate Living” by Doctors Volek and Phinney.  They also have many videos on Youtube and blogs everywhere. Their website is http://www.artandscienceoflowcarb.com/.  There is also a great Facebook group you can join called Ketogenic Dieters.  There are others but I highly recommend this one.  To track my eating and ensure I keep my carbs, proteins and fats where I want them to be, I use My Fitness Pal which is an app or can be used on your computer also.  There is also a list of conditions where you should not try the Keto way of eating.  It can be found here http://www.ketogenic-diet-resource.com/support-files/who-should-not-follow-a-ketogenic-diet.pdf.

Lastly in regarding to nutrients I would like to add that if you are GH deficient you need to be on a quality Vitamin D3.  Even if your levels are normal this will help you.  Vitamin D3 is one of the most useful nutritional tools we have at our disposal for improving our overall health. This vitamin is unique because as a hormone, Calcitriol controls phosphorus, calcium, and bone metabolism and neuromuscular function. Vitamin D3 is the only vitamin the body can manufacture from sunlight. Yet, with today’s indoor living and the extensive use of sunscreens due to concern about skin cancer, we are now mostly deficient.

For more than a century, scientists have recognized that Vitamin D3 is involved in bone health. Research has continued to accumulate, documenting Calcitriol’s role in the reduction of the risk of fractures to a significant degree. The latest research, however, shows that Vitamin D3 deficiency is linked to a surprising number of other health conditions such as depression, back pain, cancer, “insulin resistance”, pre-eclampsia during pregnancy, impaired immunity and macular degeneration.  I recommend 5000 to 8000 IU per day.

I am certainly not saying in any way this is a cure for Hypopituitarism, or replaces the hormones we all need daily.  I have tried Keto myself and lost 25 lbs over three months. I felt stronger and began exercising which helped with my mental attitude and abilities.  I have proven to myself that eating like this is something I could maintain long term.  And I also have proven to myself that when I fall off of this ways of eating and go back to carbs, the weight climbs, I feel less energetic and the brain fog moves in fairly quickly.

Don’t kick yourself for falling off the wagon.  We all do it.  Just choose to climb back on as soon as possible.  We have enough other challenges to deal with daily with our hormones that although weight loss is important for our health, happiness is the most important.  Once you start to feel better hopefully you can start moving again and burn those extra fat cells off even quicker through some exercise.

The fact is, lowering insulin levels will may help you lose weight and make you thinner.  This is my recommendation and I always suggest you do your own research and discuss this with your physician before trying any nutrition and exercise routine.  However, remember too that most classically trained doctors don’t understand the effect of foods on the body, much less ketogenic diets, so if you ask your physician, you may get push back, and a terrifying “danger of ketosis” sermon.  Just remember the doctor is confusing nutritional ketosis with a more dangerous condition called ketoacidosis. These are two different conditions.  Ketoacidosis is a concern for Type 1 diabetics and others whose bodies are unable to make or process insulin correctly.  Educate yourself and be prepared like we have to do with our Hypopituitarism.

I hope this helps someone.  Please feel free to comment as I am always learning myself.  Take care all and live well!