Steroid dynamics in myalgic encephalomyelitis / chronic fatigue syndrome: a case-control study [...], 2025, Thomas, Armstrong, Bergquist et al

Could this 2021 paper be of interest in relation to this study.

Thread : Hypothalamic-Pituitary autoimmunity and related impairment of hormone secretions in chronic fatigue syndrome, 2021, De Bellis, Montoya et al
Paper : LINK

Results: Patients in group 1 showed a high prevalence of AHA (33%) and APA (56%) and significantly lower levels of adrenocorticotropin (ACTH)/cortisol, and growth hormone (GH) peak/insulin-like growth factor-1 (IGF-1) vs controls (all AHA/APA negative). Patients in group 1A (13 patients positive at high titers, ≥ 1:32) showed ACTH/cortisol and GH peak/IGF-1 levels significantly lower and more severe forms of ME/CFS with respect to patients in group 1B (7 positive at middle/low titers, 1:16-1:8) and 1C (10 antibody-negative patients).
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What has fascinated me about hormone levels in general is that they are often higher at waking and then decline during the day. It made me wonder how the body copes with so much variation. At the back of my mind has been the thought that perhaps the body must like to maintain a ratio between certain hormones, so if they both decline as happens later in the day it is not a problem.

Now reading this thread I come back to wondering just how important is it to maintain ratios between certain hormones.........

@MelbME What does the literature or endocrinology experts say about loss of relationships between steroids? Would you expect to see certain symptoms or do any other diseases exhibit this? I guess what I'm asking is if loss of coupling is something completely new, or is a known phenomenon?

Sorry if you answered this in the paper, I'm not able to read much lately.
 
Conclusions
Despite no significant differences in absolute steroid levels, network analysis revealed profound disruptions in steroid-steroid relationships in ME/CFS compared to controls, suggesting disrupted steroid homeostasis.

Collectively the results suggest dysregulation of HPA axis function and progestogen pathways, as demonstrated by altered partial correlations, centrality profiles, and steroid ratios.

These findings illustrate the importance of hormone network dynamics in ME/CFS pathophysiology and underscores the need for more research into steroid metabolism.
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Chris, I'll try to explain what it's like to read those conclusions, when the data is not nearly good enough to support them and the evaluation of the literature expresses bias, as a woman with ME/CFS and the mother of a young man with ME/CFS. Maybe then you can understand why I feel so strongly about this paper and have criticised it so harshly, when equally bad papers from psychosomatic proponents so often just get a few snide posts and a bit of a laugh from us. I write these posts because I think that you can do things better.

People with ME/CFS have been told that all sorts of things are wrong with them, pretty much all of them based on inadequate data and very often poor analysis. We are routinely called neurotic, perfectionist, unwilling to make an effort, militant, fearful, hysterical and overly dramatic, unable to express emotions, overly ambitious, hypochondriacal, overactive to stress, low cortisol due to burnout, cognitively impaired, depressed, anxious, heartsink inducing, many more.... A few of the descriptions may be correct, but we need them to be solidly based in evidence and described very precisely.

Of course there is something wrong with us, we want to find out what it is. But it's a blow when a paper like this comes out, produced by people we respect, people that some of us are actually helping to fund. It can easily be interpreted as definitively saying 'people with ME/CFS have hormones that are out of whack' when there really is not good data to support that claim. The way the abstract is worded, the conclusions can easily become to be seen as an established fact. That can hurt how people with ME/CFS see themselves and how they are seen by others, in quite a number of ways. For example, the mention of progesterone pathways might lead people to think that women with ME/CFS as a whole might have difficulty with fertility. Imbalanced hormones go nicely with accusations of hysteria. Many people are ready to offer self-improvement strategies to tackle "altered HPA axes".

The paper also produces a loss of trust in the people we are relying to find the answers. It makes me feel that we are simply fodder for the advancement of careers, even though I know that that is not how you see it most of the time. I get the feeling that the researchers might think it is worth stretching the truth if it results in funding (I believe truth has been stretched to breaking point here). Ratios of hormones were not found to be significantly different, and yet the abstract says that they were. The data is not clean enough to warrant any conclusions about differences.

I really hope that the study that is following on from this paper will correct the problems of this one. I hope that it will be cautious in its claims, understanding that it is very easy to create harmful myths that can suck scarce research funds into unproductive areas.

Perhaps you can tell us more about the next study and what safeguards you are building into it.
 
jnmaciuch said:
But I do think the main finding about a complete lack of partial correlations in the ME/CFS cohort is striking, and it's a finding that cannot be easily explained by confounders....

The high variability in the ME/CFS group is likely what's driving the breakdown of the network, and that in itself is the interesting finding here. What this indicates is that something is throwing a big sledgehammer into a system that usually has strong internal regulation. Where you'd normally expect two metabolites that are separated by one enzyme to be strongly correlated with each other, suddenly they're not--and this is seen across the whole system. What this strongly suggests to me, coming from a lab that studied transcriptional regulation, is the presence of a transient signal in the ME/CFS group that exerts a stronger regulatory effect on multiple enzymes in this pathway than the normal internal feedback loops.
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Interesting. :nerd:
 
jnmaciuch said:
@Hutan 's concerns are all valid for comparisons of absolute levels and hormone ratios--even if there was a positive finding in that respect, I probably would still be skeptical.

But I do think the main finding about a complete lack of partial correlations in the ME/CFS cohort is striking, and it's a finding that cannot be easily explained by confounders. The reason is that even if different proportions of the groups were on contraceptives or were at different points in their cycle, you would still expect some strong internal correlations.
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But that finding can potentially be explained by confounders. We really can't say that it's not likely, we don't know. We know that there are confounders that can even flip the correlations. One of the issues is daily fluctuations. A lot of hormone correlations change during the day.

Hormone levels fluctuate throughout the day, exhibiting circadian rhythms. For example, testosterone typically peaks in the morning and declines throughout the day, while cortisol, is highest in the morning and lowest at night.​
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If people have different normal wake times, that alone could change the relationships for this point sample. Similarly for a variation in the time the sample was taken - all we know is that the samples were taken in the morning.


jnmaciuch said:
Progesterone, estrogen, etc. are not static within these networks--they're going to get converted into other metabolites, and they're also going to exert regulatory effects on the enzymes that mediate these pathways. So even if [edit: different numbers of people were] taking progesterone, you would expect to see correlations between progesterone and its immediate downstream metabolites, as well as the effects of progesterone suppressing the production of other metabolites in a feedback loop.
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Things are really complicated e.g. this from AI about the progestins in oral contraceptives, I haven't checked the details, but I think it's good enough to get the gist. The various different progestins in different oral contraceptives degrade to different suites of metabolites.
"Oral contraceptives (OCs) containing different progestins lead to varying downstream metabolites due to differences in their chemical structures and metabolic pathways. These variations can affect not only contraceptive efficacy but also influence various metabolic processes, including lipid metabolism, glucose metabolism, and potential effects on the brain.

Key Differences in Progestin Metabolism:
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If a researcher is investigating hormones with the granularity that is used here, they have to be aware of the major impact of oral contraceptives, and even the diversity of oral contraceptives. Really, I think you would have to exclude women on hormonal contraceptives - the disruption to normal hormonal levels is just way too big.
 
Hutan said:
But that finding can potentially be explained by confounders. We really can't say that it's not likely, we don't know. We know that there are confounders that can even flip the correlations. One of the issues is daily fluctuations. A lot of hormone correlations change during the day.

Hormone levels fluctuate throughout the day, exhibiting circadian rhythms. For example, testosterone typically peaks in the morning and declines throughout the day, while cortisol, is highest in the morning and lowest at night.​
​
If people have different normal wake times, that alone could change the relationships for this point sample. Similarly for a variation in the time the sample was taken - all we know is that the samples were taken in the morning.



Things are really complicated e.g. this from AI about the progestins in oral contraceptives, I haven't checked the details, but I think it's good enough to get the gist. The various different progestins in different oral contraceptives degrade to different suites of metabolites.


If a researcher is investigating hormones with the granularity that is used here, they have to be aware of the major impact of oral contraceptives, and even the diversity of oral contraceptives. Really, I think you would have to exclude women on hormonal contraceptives - the disruption to normal hormonal levels is just way too big.
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But the crucial point is that these confounders almost certainly would not produce the maintain finding here, which is that there was a stark lark of network correlations, for the reasons I already outlined. Regardless of what contraceptive you’re taking, you would still expect a partial correlation between [edit: certain closely related] metabolites.

Taking a contraceptive does not break down the regulatory relationships, neither do hormone cycles. If someone had higher progesterone from a contraceptive, they’d also be expected to have higher levels of metabolites derived from progesterone. Unless something biological was happening to interrupt enzyme function on top of that.
 
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We all agree that contraceptives and hormone levels can change absolute levels and ratios. I think what @MelbME and I are both saying is that due to the way the network analysis is done within a highly interdependent biological system, it is largely robust to those confounding factors. Daily variations and contraceptives wouldn’t produce the findings you see here. They might flip the signs on some of the specific correlations if things were skewed enough and cause some correlations to drop out between groups. They would not cause the ME/CFS group to only have 1 significant partial correlation compared to 52 in controls
 
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