junkcrap50

Why ME/CFS patients should be running DUTCH panels Most ME/CFS research measures cortisol output, how much your adrenals produce. Almost nobody measures cortisol clearance, how fast your tissues break it down and dispose of it. Cortisol breaks down collagen, that's why long-term steroid use thins your skin. If you can't clear cortisol fast enough, it sits in your tissue too long and does that damage slowly, for years, while your blood test looks completely normal. That gives you loose skin, easy bruising, bad healing and hypermobility, which looks like EDS (common in ME/CFS world) Cortisol is inactivated largely by 5α- and 5β-reductase. If that clearance is impaired, a normal stress pulse lands on tissue that can't dispose of it on schedule. Serum cortisol looks fine. Tissue exposure runs high and lasts too long. That would produce: a disproportionate response to ordinary stressors, a delayed crash rather than an immediate one, blunted inflammatory response to infection (can’t feel sick from virus common in ME/CFs) , and poor recovery from exertion. That's post-exertional malaise described in clearance terms. And it explains the delay. ME/CFS needs to run DUTCH panels specifically: a serum cortisol test gives you a snapshot of circulating hormone. DUTCH measures the metabolites a-THF, b-THF, b-THE and gives you a clearance rate, a 5α/5β preference ratio, and the cortisol/cortisone balance. If you have ME/CFS, run a DUTCH Complete. If possible, run one at baseline and one during a crash. The comparison is the thing, if clearance markers shift during PEM while output stays normal, that's a big finding here.