I digested Jeffries work long ago after my first 20-30 patients I’d “freestyled” with hydrocort on. Then over the following years looked at all the so called dogma and experts on such Tx. I have easily given thousands of doses of cortisol analogs (and to be up front, have communicated with Titlebaum and others about all this). Jeffries had a great idea. Like all us humans he thought it was the answer to everything. It is not. That said, I simply could not move some of my sickest patients from illness to the path to wellness without biologically dosed cortisol. You have
to make the determination of dose, timing and length of taper on EACH patient. There is absolutely NO formula at all which is frustrating but also why we are doctors. I’ve seen 2.5 mg work, and I’ve seen people take 40-80 mg to get effect and then ramp down. (recall PO dosed hydrocort can be poorly absorbed.) It is definitely not adrenal suppressive at 20-30 mg, and in some upto 40-80 mg per day (see my pharmacology notes). BUT it is a crutch (a necessary one, but a crutch) which must be tapered by supporting adrenal function over time. I have seen it take as little as 3 months and as long as 3-4 years to fully taper a person off. No side effects if you watch the patient, their electrolytes etc. You all can do any labs you like. I do serum AM cortisol (among others) to check saturation levels, and need for taper. The quicker the adrenal support works the faster you taper. In the “main” you likely need corticoid Tx in 10% of people, in the sickest group it is about 75%. On a screening I do an AM (or corrected) serum cortisol – and many of your sick folks are frankly low. But if AM is not in the upper 25% of the range, I try adrenal support first. If it is below 50% of the norm I add 5-20 mg cort AM with adrenal support. Monitor and taper as needed and tolerated. Thyroid (and the infamous euthyroid need for T3 Tx) are critical or one never can taper the cortisol. my rudimentary thoughts – after thousands of trial and error cases with this powerful therapy.
Don’t fear it, think about it and use it as a physician would and you will be fine – and your sickest patients will be helped.