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FAQ/Chronic Fatigue Syndrome (CFS)

Extreme fatigue, especially upon waking up in the morning... always LATE to work...
Tue, 22 June 2004
A friend of mine obtained a video tape explaining your practice, and how it works, and am firmly convinced that you can help me. I have had a horrible case of "adrenal burnout" for about 18 years now. I have comtemplated suicide so many times...it was a daily thought for many years. I am probably about 90-100 pounds overweight, and there is just *NOTHING* that works to remedy that. Fortunately, a few years after this began, I ran across a biochemist, whose practice is pretty much devoted to healing the adrenals. That alone helped, because, like your tape, many would say "ah, it's all in your head"...even my dad told me that in the beginning...knowing WHAT the problem was, gave me some peace of mind. Unfortunately, his program didn't work for me...in fact, he claims I was making HIM suicidal!

I have a very stressful job (ah, can't help the adrenals doing that!) in electronics. I haven't had a social life in over 15 years. I have been to many types of "alternative" practitioners, including a world class chinese herbalist in Houston. All to no avail.

As for my symptoms, well, you probably already know...extreme fatigue, especially upon waking up in the morning...always LATE to work...periods of extreme sleepiness throughout the day...eating anything resembling a large meal will flat out put me to sleep faster than any tranquilizer could...all kinds of skin eruptions...many brown "liver spots"...excessively dry skin...periods of "bloating"...mentally *slow*...a very strong aversion to do ANYTHING once I get home from work...a lack of mental motivation...I could probably be a top notch "computer geek" if I had the mental wherewithal I once had before this...also, a mental frustration of being unable to do anything, which leads to apathy, which leads to depression. Could say more, but, I think you get the basic picture...

I am 50 years old (fortunately, still look young for my age! Plan to look younger!), and I have never had *ANY* surgeries...I have taken anti-biotics ONLY twice (that I know of). I am divorced, and have never had children...
Ok...I hope this is enough info. I notice that you are in Austin? If so, I am MORE than willing to drive there, if need be. I also noticed that you have a new San Antonio clinic (I live in SA)...but, if you would rather see me at your main clinic, no problem, cuz, I might be a tough case...hopefully not! Thank you for "hearing me out", and I hope to hear from you soon...

Dr Roby Responds:

O.K., here is the deal. I suspect your adrenals are impaired. At your age you are bound to be low in DHEA, thyroid and testosterone. That will cause you to gain weight, feel tired and use adrenalin for all your daily activity. Adrenalin causes profound fatigue. We get more tired day by day. We can test those things and try to get you back in balance. But, that is the easy part.

The hard part, the part you have to be willing to do, is changing your entire lifestyle. I had the same problem you have. At 38 I was completely burnt out and was wiring up every morning and drinking or drugging every night to get some sleep. The next day I would start the whole thing all over again. I liked being adrenalized. We become adrenalin junkies. Coffee by day, cocktails by night. my case, perhaps, not yours. But, one gets a lot of things done on adrenalin. However, as we age and our hormones change, adrenalin starts to become counter-productive. No balance in our lives. No rest...no fun., no sex.

So, the problem is, can you avoid stimulants, including almost all carbohydrates? Can you begin learning stress reduction techniques such as yoga, or meditation, or prayer? Can you change jobs to something less stressful, if all else fails? Probably most importantly, can you move slowly (as in walking or strolling) for one to three hours a day? The movement...long, slow, distance, is done off the job. I try to get in at least one hour in the morning, on my treadmill, slowly, pulse no higher than 110. I try to do one to two hours when I get home. Same thing. Slowly, just strolling. If you can get in a slow hour each morning and evening, you will be amazed at how much beter you can feel. This allows you to get balanced, to use up excess adrenalin, to generate endorphins and cortisol in a stress-free physiological environment.

If you can do these things and are willing to do whatever it takes to get better, then I think I can help you.

Men with Chronic Fatigue Syndrome... Will dilutions of progesterone work? How about taking cortisol?
Sent: Saturday, December 07, 2002 2:04 AM
Question:
If I had a penny for every physician I have told that "my system races", or that I have asked "is there any way to control the adrenal surges, followed by chronic fatigue" after ingesting certain foods I would be a rich man. I can't begin to tell you how my jaw hit the floor when I read your article. Everything you mentioned fits me to a tee. I would appreciate your insight into these questions:
a) I'm male. Does this make any difference as it pertains to taking homeopathic dilutions of progesterone?
b) If not, how do I go about acquiring the dilution?
c) Is testosterone and/or cortisol something I should consider taking? I apologize for my ignorance, but would be greatful for your advice.
You should know that I have taken both DHEA and thyroid suppliments, but both actually made me feel worse. Thanks for your time. Pierre.
Dr. Roby Answers:
Cortisol helps but that is no solution. Terrible side effects from long-term use. Yes the progesterone works on men. There is a physician sign-in section where licensed docs can have free access to the protocol. I do not want patients to try to treat themselves, no matter how safe the materials are.
Dhea makes some men agitated for a short time. Try using just 25 mg for a month, then 50mg. and so on until you can tolerate 100mg daily without agitation. Testosterone is almost always necessary. We have grown low in these hormones and that is why we use adrenalin for all of our stress, energy and allergy needs. A low carbohydrate diet is essential...the adrenalin must have carbs to fuel it.
Low level exercise (slow walking) is the only way to get rid of stored up adrenalin.
Patient Responds:
I have been doing a bit more research before proceeding. I came across a couple of things that I am wondering about.
Firstly, I found this exerpt from Biogenesis Laboratories. It suggests that taking DHEA will actually lower my cortisol levels...."But DHEA's most over-looked but vital role may be its relationship with cortisol. Research is indicating that DHEA is the counter-balance to cortisol, e.g. when DHEA is low cortisol levels are high and vice-versa. Cortisol is one of the few hormones that increases with age, it is known to induce stress and when allowed to circulate at high levels for long periods may affect many bodily functions... Maintaining healthy levels of DHEA for aging and stressed individuals may be most important, because of DHEA's ability to help lower cortisol levels". I am confused because I thought you had said that DHEA is a necessary precursor in making cortisol, and had recommended I start taking it in low doses. As I mentioned, when I took DHEA it did actually seem to make my system race even more. If you would please clarify that would be great.
The second thing I came across was an article from King's College in the UK. It said researchers have done a study showing that some people with CFS may have their symptoms cease by giving them small (5 to 10mg) doses of hydrocortisone. I know that you had said to stay away from this option because hydrocortisone has bad side effects. Would it be safe at these low dosages? Your input on these 2 things would great. Sorry to take up so much of your time.
Dr. Roby Answers:
My patients have low cortisol, not high. Uniformly. I have seen one patient in the last 30 years with a high cortisol. By high I mean out of range, above the usual 2 to 24 range.
You may, of course, try anything you can get your doctor to prescribe. You would like cortisol. Everyone who tries it likes it. It makes them feel better. However, EVERYONE will get side effects if they take it long enough. I don't do that. It inevitably leads to side effects. Serious side effects. That approach reminds me of the migraine sufferer who insists on morphine because "it makes me feel fine." I try to help people find the cause of the problem and correct that. I am absolutely opposed to treating the symptoms.

Is the natural progesterone cream bad for IC and CFS??
Thursday, October 24, 2002
Question:
I was diagnosed with IC in 1994, but had symptoms since I was 17 right after starting birth control pills, which I took for 13 years. After several therapies failed, I used low dose subcutaneous heparin for one year to treat the IC. Since then, I only need it every 3 months for 2 weeks to rebuild my GAG layer. I've been doing this for the past 8 years and it has allowed me to control the IC and have a fairly normal life. Before the heparin, I was unable to leave my home. I have also had fatigue my whole life, but had chronic fatigue for the past year. I tested positive for Epstein Barr. I also was diagnosed with hypothyroidism by my symptoms such as low basal body tempature in the morning, fatigue, etc....and I've been on 30 mgs. of Armour daily since June. I also began using natural progesterone cream (Phyto brand) several months ago. I use 1/4 teaspoon in the evenings from days 12-26 of cycle.
In May I did a saliva lab test to test my estrogen, progesterone, Dhea and testosterone. I was in the normal range on everything and the low/normal range on estrogen. I've been feeling better on the Armour and progesterone cream, but my basal tempature still varies. I still have a lot of fatigue when I wake up in the early mornings and when I don't get 12 hours of sleep daily. My doctor will be monitoring my temp. chart in early Dec. to determine if I need my Armour dosage increased. My questions are as follows: Is the natural progesterone cream bad for IC and CFS?? I also was given long term antiobiotic therapy over the years before I got my IC diagnosed. Do you think I have an intestional yeast infection and is there a natural medication available for treating that?? Any suggestions will be appreciated.
Dr. Roby Answers:
Wow! You have a bunch of problems. Yes, I think the progesterone cream is bad...really bad. In fact with my IC patients we almost always find elevated levels of Progesterone Antibodies (IgG and IgM). We neutralize the symptoms of IC, instantly, by using dilutions of progesterone under the tonue.
See my section on "Hormone Imbalance" on the website: http://www.onlineallergycenter.com. Many types of allergy have their basis in hormone reactions. This is particularly of ladies who experience increasing symptoms as they undergo hormone changes, usually in their late twenties or after the babies are born.
Check out that section and let me know how those characteristics apply to you and then I can get more specific. You may find some useful areas to explore in your search for medical solutions. Areas such as dietary changes, low level exercise and alternative approaches to solving medical problems. I also outline the lab tests needed.

Fatigue, extreme anxiety, major depression, and fibromyalgia. Try Prometrium?
Tuesday, October 22, 2002
Question:
Help! I am 37 and have been suffering for just over a year now from a multitude of physical, nuerological, psychological and emotional disorders. Once a busy, high energy career professional working toward a doctorate degree, I am now disabled. I have been to see numerous physicians in the last year as well as visiting health food stores for nutritional advise and vitamin and herbal recommendations. What started out as inner-ear vertigo following airtravel with a sinus infection and a bruise on the right eardrum, lead to being diagnosed with extreme anxiety, major depression, and fibromyalgia.
In addition, I feel that perimenapause is a problem. My menstral cycle is all out of wack and I have a cyst on an ovary. I have constant headaches, vertigo, insomnia and memory loss, hair thinning, withering skin, aches in my neck/back/shoulders and constant fatigue and no energy. I feel brain dead and unable to make simple decisions for myself. I have been tried on numerous anti-depressants and tranquiliers which have made matters worse. My ob/gyn wants me to try prometrium. I have seen my G.P., nuerologists (to rule out M.S. - MRI and ENG), psychiatrists, rhematologists, and an ob/gyn, I am now seeing specialists at Stanford in various departments. Right now I am only taking antivan 1 to .5 mil. to try to help sleep at night. Nuerotin (sp.) has been mentioned as a drug that may help with sleep at night as well as daytime anxiety.
Are there any safe vitamin/herbal remedies that you would recommend to try to help get my health back on the road to recovery? It seems that each drug tried has brought on a new set of problems - vertigo, nausea, etc. Thank you for your help to try to get my brain and body back to the land of the living!
Dr. Roby Answers:
Prometrium would be almost the worst drug you could take. The only one worse, in my experience, would be DepoProvera. They are both progesterones and I think you are reacting to that hormone.
Many of your questions relating to fatigue, perimenopause and other symptoms are addressed in my section on "Hormone Imbalance" on my website. Please read that section. Let me know how much of that material applies to you. I can then address your specific questions much more efficiently.
But I urge you, do NOT take any kind of progesterone until you have read this.

Get really fatigued, but bloodwork shows "normal"
Sunday, October 20, 2002
Question:
I am a woman of 63 years and have always had a fatique problem yet my blood work shows ok. I am a driver when it comes to work and have never backed off. I sometimes push myself to the limit. I can't and have never been a couch potato. But as the years come on I get really (sick and tired) fatique. To the point that I am not fit for anything. At this time I am having hot and cold flashes, mid back muscle pain, joint ache,nervousnes, cannot consentrate, forgetful,
I go to bed exhausted, get up exhausted, irritable, IBS, nausea, and I want so bad to feel good and energetic. I had a complete historectomy at age 50 and have been taking premarin ever since. Recently I have tried to get off of it but always go back because I get to feeling really bad and have hot and cold flashes. I have done ok on premarin except for the fatique part, but thought I had come to the age that I could quit taking it. I cannot do my work for feeling the way I do. I am retired but active. Please inform if you can help. I would be glad to arrange and appointment.
Dr. Roby Answers:
Your Doctor probably hasn't explained just how broad the term "normal range" might be. For example, let's look at DHEA. This is the primary precursor for the manufacture of all your hormones. It peaks in women at about ag 22 and then goes down dramatically. The best range is 20 to 30 year old women. That range is 65 to 380. Yet, 65 is also well within the "normal range" for 70 to 80 year old women (32 to 72). So, your hormones may be with the "normal range" and still be miles lower than they used to be.
Why don't we put them HIGHER in the normal range? That is what I do. I think anyone can feel better if they balance their hormones, eat a low carbohydrate diet and walk one hour daily.
Come and see me.
Many of your questions relating to fatigue and other symptoms are addressed in my section on "Hormone Imbalance" on my website. Please read that section. That will give you a clearer picture of what I think is going on and how I try to fix it. Let me know how much of that material applies to you. I can then address your specific questions much more efficiently.

On & off ear blockage, sometimes it occurs all day. Change in energy - severe fatigue.
Saturday, October 12, 2002
Question:
I have been searching the net over and over for help and your site finally seems to have answers! I have read your entire site and my problem is similar to the problem on your FAQ's page except different and that's why I need help!
I am a 26 year old female and have gone to doctor after doctor who has told me that my problem is allergies. I have blockage in my right ear which is on and off, and I can't see a pattern as to why it happens. It is SO bad and SO frustrating that I am miserable. I also work in a field that requires excellent hearing and I do not want this to affect my hearing and affect my job. Everything the doctor's have suggested has failed. I have never had allergies in my life so when the doctor's say it is allergies I believe them but don't understand what possible allergies. They do not know either. This has been occuring for about 2 years but is really bad now. I don't sneeze, I don't have watery eyes or any symptoms like that, I just have blockage in my ear and sometimes it occurs all day!
I went to an Ear, Nose and Throat specialist and he stuck that tube light thing in my ears and said there is no liquid present and that it's nothing big. Nothing big?! I am miserable! He gave me Flonase which isn't helping. When I flip my head upside down the blockage immediately goes away. That's why it makes me think it's not swelling, or could it still be swelling? Why does it go away when I flip my head upside down? Sudafed used to work but doesn't now. When I exercise (run) it gets worse! Every time I run - during the run I get the blockage. I almost don't want to run anymore. I don't want to see another doctor because I'm afraid he'll just say the same thing. It's almost as if something gets knocked out of place and blocks my tube and when I flip upside down it gets out of the way.
Is there anything that will stop this?! Please help! I know you have tons of mail and questions but I don't know what else to do. Thank you so much.
Dr. Roby Answers:
Ear blockage that comes and goes is, by definition...allergy. If you had a tumor or some anatomical defect the problem would never change. It is indeed caused by soft-tissue swelling.
Now, as to why you have and what you can do about it. You have it because your hormones are changing. The one hormone you are no longer making enough of is cortisol...your allergy hormone. See my section on "Hormone Imbalance" for the appropriate tests. In the meantime, try a very low carbohydrate diet. Take over-the-counter antihistamines like Tavist-D (it has a decongestant that is very useful in stopping the swelling).
Many of your questions relating to allergy swelling, ear blockage and other symptoms are addressed in my section on "Hormone Imbalance" on my website. Please read that section again. Let me know how much of that material applies to you, in particular the menstrual history (how old were you when you began periods? have there been any changes in periods? weight? energy? fatigue? loss of short-term memory? skin problems? diminished sex drive?). I can then address your specific questions much more efficiently.
Patient Responds:
Hi Dr. R, Thank you so much for responding. It is nice to have someone that knows! If I were near Austin I would definitely go and see you. I just re-read your hormone imbalance page. To answer your questions, yes, I was under 15-16 when I started having my periods. I was 13. There hasn't been any change in periods, however there has definitely been a change in energy. There are days when I can sleep the entire day if I do not get up and go to work. It's not like I'm just tired though, it's like I'm exhausted! It is more like fatigue. Like I can't get up! I don't mention it anymore because people just say, "yeah right!". There is definitely a loss of short term memory. It was so bad a few months ago that I started to get scared but it is better now. I would forget everything. I would forget if I locked the door, what I drank that morning, what I ate the day before, etc. For some reason right now it is a little better. Maybe because I started taking vitamins on a daily basis. I did have skin problems (acne) until I started Ortho-Tricyclen. The entire time I've had the blockage I was on Ortho-tricyclen, and then I got that skin condition associated with birth control pills with dark spots on my face. That really bothered me so I got off the pill and took the depo-provera shot 3 weeks ago. The spots went away almost immediately but by the second week, I went nuts! I tried to attack my boyfriend (which is not like me!!!) I yelled at him and cried all the time. It was so bad that I started to take vitamin B-6 and now I feel better but I do not plan on taking the shot again. The diminished sex drive occurred after taking the shot. I haven't gained any weight or anything. Could the shot be making it worse? IT's mostly the ear blockage and fatigue that bother me right now. I will do what you said. Thank you for your help and I will definitely spread the word about your site.
Dr Roby Answers: This the worst thing that could have happened to you. They have injected the very hormone, progesterone, that causes soft-tissue swelling in women. It will affect you for about one year. I have seen some go on longer. I would try to "neutralize" the impact of the progesterone with homeopthic dilutions of the hormone itself. When we find the right strength, it makes the syptoms go away within seconds.

Daughter diagnosed with CFS at age 13, suffers from headaches, neck pain, fatigue, insomnia, and body aches.
Tuesday, October 08, 2002
Question:
My daughter was diagnosed with CFS at age 13.She developed symtoms at age 9. She is now 17. She suffers from headaches, neck pain, fatigue, insomnia and just overall body aches. She has been to pain clinics headache clinics, a mile long line of doctors and even an acupuncturist. Her hormones are postmenopausal with an FSH of 98.8 and an LH of 58.7. I have believed for a long time that this is all related but I haven't found any one who knows how to help her. Can you please shed some light on this childs dilema?
Dr, Roby Answers:
This is certainly connected to hormones. She began changing hormones about 9 when the symptoms began. Now, all her symptoms will be worse the week before her period begins. Check out that section on my site and see what you think. Also be sure to try the "food allergy" avoidance list as carbs always play a role in this.
Many of your questions relating to allergy and other symptoms are addressed in my section on "Hormone Imbalance" on my website. Please read that section again. Let me know how much of that material applies to you. I can then address your specific questions much more efficiently.

Chronic allergies, headaches, fatigue.
Tuesday, October 08, 2002
Question:
Help! I live in Memphis, TN...also a well-known allergy capital in the US. I am 38 years old, started my periods at age 12, gave birth to my two children when I was 20, then again at 22.
I have experienced headaches, scratchy eyes, runny nose, sore throat, absolutely no energy, irritable bowel, mitral valve prolapse and had exploratory surgery last November for endometriosis (which a D&C seemed to clear up those pelvic cramping symptoms). I have been prescribed all types of medicines for these conditions over the years, am on a daily allergy serum, nose spray, Allegra. No one, even my gynocologist has ever tested my hormones to see if I have an imbalance in this area. I have been told that maybe I'm depressed ( I have a wonderful husband, wonderful teenagers and a great job that I LOVE). No one has been able to help me. What type doctor can I see that can successfully take a look at the BIG PICTURE and try to connect the dots? Seeing a separage allergist, gynocologist, cardio doctor is not working for me! Help!
Dr. Roby Answers:
Many of your questions relating to allergy and other symptoms are addressed in my section on "Hormone Imbalance" on my website. Please read that section again. Let me know how much of that material applies to you. I can then address your specific questions much more efficiently.
Patient Responds:
I have read this section again on Hormone Imbalance. These are the areas that have affected me over the last couple of years...
Headaches, stomach pain, pelvic pain, interstitial cystitis, oily skin from the neck up, very dry skin below the neck, spot breakouts (not severe) of almost cyst-like acne on my chin, airborne allergies, extreme fatigue, water retention, visual disturbances (blurry vision), a case of vertigo approximately every 6 months (in some cases I have not been able to drive for a couple of weeks; I have been thoroughly tested for Meniere's), numbness in the fingers on my right hand.
The hair growth that you mention - I have had thinning hair from my usually thick mane, hairy legs, a line of hair that grows from the pubic bone to the naval, and a few stray hairs around my breast. The pubic hair is quite thick.
I am 38 years old, weighing 120 lbs. Also, my gynecologist put me on continuous birth control pills - Loestin - taking the pill packs 3 months straight then taking the 1 week of blank pills. This has cured the cramping symptoms I was experiencing prior to the endoscopy and d & c I had last November. My last checkup revealed I am a bit anemic, to which he put me on an iron supplement 3 times a week.
Dr. Roby Answers:
That certainly puts you squarely in my profile of hormone imbalance, I outline the tests needed to deal with this in the section on hormone imbalance. In addition to estrogen, testosterone, cortisol, thyroid and DHEA, I would get Progesterone Antibodies (IgG and IgM) from Immunosiciences Labs in LA. Most commercial labs use them and I'm sure your's knows about this. If your doctor won't order these let me know and I will fax a lab requisition to you.
Once you have that information you can begin to nudge things back into balance. Some of your hormones may be "within the normal raqnge", but that range is enormous. The protocol I use to treat the reaction to progesterone is available to licensed physicians, at no charge, on my website.

Fibromyalgia flared up after move, weight gain, chronic fatigue, sinusitis...
Saturday, August 24, 2002
Question:
I spoke with a lady in my church tonight that just got back from seeing you. She and I have the same symptoms. She is raving about your treatment. I am 32 yrs old and was diagnosed with fibromyalgia at 22 but the symptoms seemed to go away while I lived on the East Coast. When I moved to Idaho and got pregnant my health went down hill fast. I gained 50lbs and wasn't eating hardly anything. I was very ill and had a rough pregnancy. Nothing has changed since I had my baby. My symptoms are as follows: chronic fatigue, dry mouth, chronic sinus with sinutitus, confusion, problems with temperature, pain all over my body, stomach problems, irratable bowel, depression, ADD and a few more. I feel like I'm falling apart and I'm only 32! I feel like no one can understand what I'm going through. My daughter is 5 months old and I struggle to hold her because of my pain and lack of energy. I'm scared sometimes because of my absent mindedness. Can you help me?
Dr. Roby Answers:
Come and see me. You will be 80% better when you return home the next day. All of your problems are a result of "Hormone Allergy". Read this section on Hormone Imbalance carefully. You need to study the problem. Up until now you have been frustrated because all the doctors tell you that you are just fine. You know you are not "fine." What they should say is... "there is nothing medically wrong with you...you do not have any kind of illness or disease." And, you don't have a disease. You have an "imbalance" in your hormones. You periods probably started before you were sixteen (that is still the average age worldwide) and so Nature is treating you like a little old lady...you are suffering postmenopausal just like a 50 or 60 year old lady...all the fatigue, weight gain, loss of short-term memory and diminished sex drive that you would expect to see in a grandmother in her late fifties or sixties.
All this can be changed at once. Ultil you can get here you might start Dr. Atkin's Diet and begin walking at least 30 minutes every day.
For appointments: 1-800-767-0141 - Airline and hotel information is on the website.

40 year old male experiencing increasing CFS intensity (Zoloft)
Wednesday, September 11, 2002 7:28 PM
Question:
Dr. Roby, I am a 40 year old male living in Austin, Minnesota. The information on your website concerning CFS closely describes what I have experienced increasing intensity last fall and again this fall. Last fall my doctor put me on 100 grams of Zoloft per day to handle the anxiety I was experiencing. My questions for you are;

1. Is it plausible that the intensity of CFS would be higher in the fall and spring than during winter and summer?
2. Can CFS or allergies be a cause of digestive system problems, like excessive mucus in my fecal matter?
3. Would Zoloft be merely treating the sympton(anxiety), rather than the problem?
4. Can you recommend a specialist in the Minnesota area?
Any help you can provide me would be greatly appreciated. Thank You.

Dr. Roby Replies:
See my section on hormone allergy. when your hormones begin to change, the first hormone that gets low is cortisol. that is you stress, allergy and energy hormone. in its absence you have an increase in allergy, a decrease in energy and less ability to deal with stress. in the absence of cortisol you have to use your emergency, back-up hormone...adrenalin for all those needs. You become more allergic, profoundly tired, and you gain weight and lose short-term memory. the seasonal aspects relate to your sensitivity to airborne pollen (ragweed for your seasons). The Zoloft is an anti-depressant. It solves nothing and contributes to further fatigue, weight gain and diminished sex drive. Ergo, you feel even worse! No one in your area. Oklahoma (Ardmore) is the farthest north from here. Many of your questions relating to allergy and other symptoms are addressed in my section on "Hormone Allergy" on my website. Please read that section carefully and let me know how much of that material applies to you. I can then address your specific questions much more efficiently.

 


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