Second Tier Hormones and Chronic Fatigue By now most of our CMRS family of readers has been exposed to the possibility of deficiency of first tier hormones such as adrenal and thyroid as a major contributing cause of chronic fatigue. I call these hormones first tier because of their direct, classical, and well known connection with fatigue. However there is a second tier of hormones that are often neglected in the workup of chronic fatigue syndrome (CFS) patients. These are human growth hormone, vasopressin, and prolactin. All three of these come from the pituitary gland. Patients who do not respond to typically successful treatments for chronic fatigue may indeed have a problem with these three hormones that derive from the hypothalamus/pituitary axis. Growth hormone (HGH) deficiency is fairly common in the general population, and even more so in patients with CFS and fibromyalgia. HGH is produced mostly during the deep phases of sleep, so the prevalence of sleep disorder in these patients may partly explain the low HGH levels. HGH itself is available for therapeutic use, but it is still quite expensive. There are more reasonably priced nutritionals (like Beulaland’s Meditropin) which increase the release of stored HGH. Increasing HGH levels can reduce fatigue, improve sleep patterns, and indirectly increase DHEA production. Inducing deep sleep with various nutritionals, more exercise, and regular sexual activity also all increase HGH levels. One study done in Scotland found that people who had sex at least 3 times per week looked an average of 10 years younger than those who did not. People who complain of lightheadedness and constant thirst (many CFS patients) may be suffering from vasopressin (also known as ADH or antidiuretic hormone) deficiency. Low blood pressure is also associated with this deficiency. This hormone prevents excess water loss through the kidneys. Increasing salt and water intake may help some, but most will need a prescription for vasopressin nasal spray or fluorinef (a mineral controlling steroid from the adrenal) in low dose with potassium. Since the sympathetic nervous system tone is inadequate in this condition (as evidenced by the low blood pressure), neurotransmitter testing and amino acid therapy directed increasing adrenaline-like neurotransmitters can help. Prolactin levels can also be elevated in CFS patients. This is the hormone that stimulates milk production from the mammary glands after childbirth. Sometimes there is a milky white discharge from the nipples in these patients. Some of these patients have Candida over-growth as the cause. An MRI should be done just to be sure there is not a pituitary tumor causing this problem. Our first thought about hormones in the chronically fatigued is about adrenal, thyroid, and sex hormone depletion. After that, we think about the second tier hormones. But treating stubborn cases of CFS requires a comprehensive approach to the patient, and hormone imbalances may be only one part of the puzzle.