How fasting after workouts can cause high testosterone, acne, and PCOS

How fasting after workouts can cause high testosterone, acne, and PCOS

This morning one of my most dear friends posted to Facebook that she was so happy after an interview she just conducted with Mark Sisson.

The reason she was so happy, at least in part, was that Mark helped her understand better how to re-fuel after a work out. Most fitness gurus know that muscle building is the most efficient when you refuel with carbohydrate and protein. This is a precise science that people talk about all the time.

What we forget to often talk about are the hormonal effects that occur at this time, too.

This is especially important for women.

When I was diagnosed with PCOS, I searched high and low for a link between muscles and testosterone. I thought maybe my high muscle mass was causing my PCOS. Exercise junkies on internet forums often hypothesized that this was the case…. that increased muscle mass causes women’s testosterone levels to go up. That made intuitive sense to these people. Men have muscles, and lots of testosterone.

So, QED?

But I couldn’t find any good science to back it up.

Today, still, women with high testosterone levels ask me all the time if their exercise habits have anything to do with it. Just last week I had to shrug my shoulders as a fellow blogger and say ‘hm sorry I don’t have a good answer for you?’

kthanxbai?

(By the way, I did write a book on PCOS, its causes, and how to support your body with it.  See it here.)

Then Stacy and Mark gave me the idea to look into the science of post-workout meals.

(THIS is my favorite post-workout snack.)

Because what’s important for the relationship between exercise and testosterone levels is not muscle mass, nor even the intensity of the workout.

It is, instead, whether or not you eat afterwards.

What happens when you workout and afterward

During the course of any kind of strenuous activity — whether more in the vein of endurance / cardio or in high intensity weight lifting — the body burns through its glycogen stores. Glycogen, in essence, is a form of sugar. It’s stored in the muscles. It’s one of the body’s favorite fuel sources for exercise. Athletes almost always start a demanding workout with full glycogen stores. Otherwise, they will have less fuel for their efforts and will perform less than optimally.

Fitness specialists recomment that after a workout that depletes muscle glycogen (so after about one hour of higher intensity), you eat a meal composed of 3:1 carbohydrate:protein. When you do so, insulin and growth hormone levels rise, and testosterone levels fall.  This boosts muscle building while at the same time maintaining healthy hormone balance. Cortisol levels appear to stay the same after you eat. For women, luteneizing hormone levels also stay the same . This demonstrates that it is not hormone levels in general that fall when you eat post-workout, but testosterone levels specifically.

Moreover, it seems as though post-work-out feeding reduces muscle soreness, too.

Testosterone is important for a lot of functions in the female body. Excess testosterone, however, is not. Excess testosterone causes infertility, poly cystic ovarian syndrome, acne, male pattern hair growth on the face and body, hair loss on the top of the head, and diminished libido.

Here are some summaries of papers I recenty read to demonstrate these effects:

Kramer, Volek et al 1998 compared the hormonal responses to consecutive days of resistance training with and without nutritional supplementation.  Subjects drank either a carbohydrate‐protein supplement 2 hours before and immediately after their workout or a placebo.  Blood was taken before and 0,15,30,45 and 60 minutes after the workout.  Lactate, growth hormone, and testosterone were significantly elevated immediately postexercise in all subjects.  Growth hormone and prolactin responses on day 1 were significantly higher for supplementing subjects, then leveled out.  After exercise, testosterone declined below resting levels for supplementing subjects during all three days.  Glucose and insulin remained stable for placebo subjects and were significantly elevated by 30 minutes during supplementation.  Insulin‐like growth factor‐I was higher during supplementation on days 2 and 3, indicating long-term increases in IGF1.

Chandler, Byrne, et al 1994 examined the effect of carbohydrate and/or protein supplements on the hormonal state of the body after weight training exercise.  Subjects consumed either a control (water), protein, carbohydrate, or carbohydrate‐protein drink immediately and 2 hours after a resistance training workout.  Blood samples were drawn before and immediately after exercise and during 8 hours of recovery.  Exercise induced elevations in lactate, glucose, testosterone, and growth hormone in all groups. Carbohydrate and carbohydrate-protein stimulating insulin levels.  Carbohydrate‐protein led to an increase in growth hormone 6 hours post exercise which was greater than protein and control.  Supplements had no effect on insulin‐like growth factor‐I but caused a significant decline in testosterone.  Testosterone levels fell below resting levels 30 minutes postexercise during all supplement treatments compared to the control.

 

The takeaway

Many people deliberately fast after a workout in order to burn as much fat as possible.

While this is a reasonable approach for people who are significantly overweight or who do only this only occasionally, women who repeatedly fast after workouts can experience significant long-term testosterone elevations.

I used to be one of these women. My testosterone levels were through the roof…. but I was completely insulin sensitive. Conventional wisdom says that insulin is the primary means by which testosterone becomes elevated in the body (it directly stimulates testosterone production in the ovaries). Clearly, insulin wasn’t my problem.

I can’t say that my daily high intensity workouts and limited fueling were the only cause of my high testosterone levels. Most definitely they were not.

But it seems that they were a culprit. And I can honestly say that deliberately refueling after every workout (like with awesomeness that is Tanka bars!) and dance class, along with being sure to include plentiful carbohydrates in my diet, relax as much as possible, and gain a few body fat percentage points, has drastically improved my sex drive and the quality of my skin.

The healthiest athletes I know – and some incredibly beautiful female fitness competitors, to boot – always, always, always refuel after a workout.

Julia Ladewski of Bella Forza fitness.

My body building friend Julia Ladewski of Bella Forza fitness. Image credit: Eva Cowan Fitness.

 

Re: how to refuel. THIS is my favorite post-workout snack, rich in protein and carbs with a little bit of fat… from grass-fed buffalos! I also really like this Wild Alaskan Salmon from Vital Choice with some Extra Virgin Olive Oil and some fruit.

Check out more awesome snacks like smoked salmon, protein bars, and powerhouse paleo granola here.

Even if you are on a low carbohydrate diet, I — and low-carbohydrate gurus, too — recommend consuming some carbohydrates after your workout. Make it at least 30 grams of carbohydrate — so about two apples, or a half cup of rice — and 10 grams of protein, so 1-2 eggs, or half a can of tuna. Fasting after a workout very occasionally is okay. And it varies by individual. Nonetheless science doesn’t lie – a fasted workout decreases muscle growth, increases soreness, and elevates testosterone levels in women.

And, of course, for more on how to fast, and how many carbs and fat grams and the like to eat…

you can learn all about that in my book on weight loss for women Weight Loss UnlockedTo get a jump start on it, you can dowload a free chapter of the book HERE, and sign up for updates on more free weight loss tips and info!

And if you happen to suffer from acne as a result of your workouts or hormone balance, you may be interested in my brand new, right now 50% off program for overcoming acne, Clear Skin Unlocked: The Ultimate Guide to Acne Freedom and Flawless Skin.

Clear Skin Unlocked was written specifically for women like you in mind. It’s for when you’re frustrated, looking for answers, and tired of falling through the cracks. In Clear Skin Unlocked I discuss everything I did in this blogpost here at much greater depth, as well as provide a Four  Week Jumpstart to Acne Freedom to get you on your way to robustly healthy and radiant skin, for good.

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How Fasting After Workouts Can Cause High Testosterone, Acne, and PCOS.

There is a right way and a wrong way to do fitness

There is a right way and a wrong way to do fitness

 

The majority of my fellow bloggers went to AHS in Berkeley, California the weekend of August 7. A big part of my heart desperately wanted to, too. Berkeley is one of my favorite places in the world, and that weekend it was filled with some of my favorite people in the world. Nonetheless I chose to expand my horizons differently this August weekend.

Instead of  flying across the country to AHS, I drove a few hundred miles up the Atlantic coast to Auburn, Maine. There’s not a whole lot up there in the middle of Maine – aside from rivers and trout and good people and grass and serenity – but what is there, is astounding.

I am talking about Wolfpack FitnessYou may have heard me singing Wolfpack’s praises on Facebook before. This past weekend, however, was my first opportunity to actually see what this awesome community of women, men, and children has going on in real life.

August 7-9 marked Wolfpack’s second annual Strong is Beautiful celebration.

At Sib2 I got to witness, finally, a real life gym that does fitness right.

 

sib2

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Here is what I got to witness while I was there:

-Scalable workouts that are possible for anyone of any skill level.

-Short bursts of high intensity exercise that never leaves anyone over-drained.

-1-3 intense workouts a week, and no more.

-Workouts that focus on abilities rather than on numbers on a scale.

There are no tens, twenties, or fifties at Wolfpack Fitness. There are, instead, cinderblocks, iron chains, buckets full of bricks, and tractor tires. There are no treadmills, but instead bear crawls. The Wolfpack leader, extraordinary energizer bunny Luke Robinson, celebrates being fit enough to keep up with toddlers, push a stalled car, or help friends move from one side of town to the other.

-A focus on strength rather than appearance

All body types are welcome and celebrated at wolfpack fitness. No one applauds anyones physique, nor denigrates anyone’s rolls.

-Community support

Members of Wolfpack fitness – at least so far as I can tell! – do not compete or try to tear each other down. They cheer for each other, chant each other’s names, and hug each other out of exultation and pride.

-Family

Members of Wolfpack fitness treat each other like their own.

-Fun Workouts are accompanied by fun outfits, pop music, and – admittedly bad, but appreciated nonetheless – jokes by leader Luke.

-Seriousness about health.

People at Wolfpack fitness focus on health first and foremost. While so much of what they do is about having fun, it is fun focused on healing the body and the spirit. This community is 100 % about empowerment. Nothing like a number on a scale.

-Community involvement and outreach

Wolfpack fitness won Robb Wolf’s farm-to-gym challenge for good reason. They are loyal customers of and advocates for Nezinscot farm, an organic farm with grass-fed, pasture-raised cattle, pigs, goats, and poultry. (If you’re in Maine, a visit to Nezinscot farm is a must!)

-Sustainability

Wolfpack fitness runs it’s own garden, completely directed and sustained by its members.

-Inclusivity

All with a positive attitude are welcome as one of their own at Wolfpack fitness – an incredible feeling I can personally attest to.

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At Wolfpack fitness, there was no:

-Body shaming

-Food shaming

-Putting each other down

-Injury-prone exercising

-Obsessive fitness mentality

-Competition

-Hopelessness

-Calorie counting

—–

Before I drove up to Auburn, I suspected the Shevoles of Wolfpack fitness would show me that all the good fitness stuff I’ve always dreamed of is possible. Boy, oh boy did they ever deliver. I am so glad I went, even though it meant I had to miss AHS. And while I have moved work outs out of my own life to help me minimize body image issues, the Wolfpack had me charmed. I knew that if I lived in Auburn, my life would be enriched by joining, no questions asked. I wouldn’t be drawn into body image issues. I’d be held as a member of loving community.

So at the very least, I returned home with a warm, grateful feeling in my heart.

Wolfpack is a community focused on strength — which includes physical, mental and spiritual strength — that delights in each other’s spirits and capabilities of their physical bodies. This is how fitness should be done. If you are a fitness instructor, junkie, or participant, read through this list again. Check out Wolfpack’s Facebook page. Maybe you’ll be inspired them. I sure as hell was.

sib21

All photo credits go to Luke Robinson of Wolfpack Fitness.

 

Finding Strength After the Stage, a guest post by former fitness competitor and rabid body lover Madelyn Moon

Finding Strength After the Stage, a guest post by former fitness competitor and rabid body lover Madelyn Moon

 

The following post is written by a lovely and powerful new voice in the body love scene. Her name is Madelyn, and she used to be a body builder.

I first came across Madelyn’s work I believe at some point in 2013. To be honest, I wasn’t a fan. I was perhaps even appalled. A bit horrified, maybe. Sad. Angry. I mean – it was okay. But what she was selling on her website, more or less, was herself as a muscle-glorified sex object.

madelyn 2

Yep.

Madelyn-Moon-Fitness-Bikini

Mmhmm.

madelyn 3

Honestly, that’s got to be a hell of a body to let go of. I can’t even imagine what it’s like to step ‘down’ from so high a pedestal.

madelyn 4

Now this is the kind of photo I used to look at and weep tears of envy.

 

 If you go to her site today, you’ll see a lot of the same photos.  These kinds of photos sell appearances more than health, which isn’t my favorite way to inspire people.

Yet with a keen eye, you’ll see, too, a woman on a hell of a journey of change, and a set of photos that tell a story.

Because while so many of the photos are the same, the language is different. Madelyn talks about “health” and “inner strength” and “acceptance.” Those photos are old, and she and doesn’t compete any more.  Her invitation to join her mailing list reads like this:

“Ready to love your body? Sign up for the FREE eCourse “Mind Body Satisfaction, Sacrifice-Free” and learn how to fall in love with yourself exactly how you are. “

but anyway. It’s so powerful to witness someone coming through these changes and rocking them out. Madelyn now loves her body because of the way it feels far more than the way it looks.

Madelyn is over body building. And in love.

She recorded a hell of a youtube video about her journey –

– and if you’ve got ten minutes it’s definitely worth the watch.

Here she is, in her own words. You can find more of Madelyn (and her kickass podcast, which I was just recorded for last night) @ MaddyMoon.com.

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The following story generally rings true for many people, which is why I’m such an open book in regards to my food and body issues growing up. Nobody is alone in this battle and there is most definitely a solution just waiting to be discovered. I am so glad I can now share my discovery of that solution.

 

I started my food obsession, body shaming, and negative self-worth at a really young age. When I was about 15 years old I watched a television show that warned against the dangers of anorexia, bulimia and the likes. Even though it warned against the tragic habit, it was the first time I had really heard about eating disorders and it stuck in my head as something to try out later and see what happened.

 

I wouldn’t say that I suffered from one specific eating “disorder” but I’ve had disordered eating most of my life. My relationship with food always depended on my relationship with my weight. And my relationship with weight depended on how “in control” I was of everything else. It was a terrible cycle that I seemed to never get out of.

 

I started the cycle as a vegetarian, mostly for animal rights, but it eventually turned into a weight control practice. I then realized I wanted the body of a fitness model and physique competitor, so I switched over to the meat eating clan and began to eat like a bodybuilder AKA six meals a day, every three hours, no salt, no fruit, everything had to be weighed and measured and eaten out of Tupperware. Soon enough, getting my body fat pinched every weekend was a typical activity, as well as my hour-long cardio sessions in the morning paired with lifting sessions in the evening. Amidst this loveless, foodless, deprived life, I was starting to become addicted to seeing my body transform. As the body fat melted off, my self-esteem skyrocketed. As my butt got rounder, my smile got larger.

 

After hitting the stage for my first and even second fitness competition, I gained a little weight back and returned to my average size. In fact, I was much stronger, healthier, happier, and fuller (physically and emotionally) but less toned. Womp, womp. The psychological struggles continued. I loathed my lack of leanness, I hated my distorted body image and I still measured and weighed my food in attempt to create that perfect body again.

 

Soon enough I discovered paleo after receiving a book to review for my blog, and then again, when a friend told me how awesome the “diet” had been for him. I became really interested and really involved in the community, where I met many people who taught me to love myself no matter what. Though this is easier said than done, after extreme commitment, positive affirmation, journaling, getting a dog, and moving states (not necessarily because of my body image struggles but it certainly didn’t hurt), I finally found something deep inside of me that was dying to come out.

 

Strength.

 

Not just physical strength but emotional strength. I developed the strength to challenge social norms and to decide for myself what I think “beautiful” really means. In the end, I decided beautiful means life. It means coffee in bed on a Sunday morning. It means an extra spoonful of peanut butter just because. It means going four wheeling or boating whenever I want, because I no longer have to worry about bringing Tupperware meals. Last but not least, it means being able to tell myself “it’s okay” to not work out when I don’t feel like it. It’s okay to put family and friends FIRST before the gym and bulk cooking. It’s okay. Why? Because I’m already beautiful.

As many people say, paleo is not just a diet. It’s a lifestyle. It means to live organically, stress-free, happy and healthy. Healthy can be subjective but for most people, it means to live a life that promotes your version of optimal health. It means to live in a way that promotes mind-body satisfaction, without the sacrifices.

When I first discovered paleo, I went the strictest route. I basically did a Whole30 but for four months. I became too rigid and decided that wasn’t the healthiest for me, personally. I even discovered I have no allergies to gluten, dairy, beans or grains. While that’s kind of cool, I didn’t go crazy on eating them because as I listened to my body, I discovered those foods don’t necessarily make me feel optimal energy.

Truthfully, I rarely eat gluten or legumes by choice because they don’t make me the best version of myself. Dairy on the other hand makes me feel like a rock star.

So I make it work for me. Paleo has allowed me to find the best version of myself by helping me realize what makes me feel best, inside and out.

There are no meal plans, no food scales, no body fat pinchers, no tiny swimsuits hanging on my “inspiration wall” and certainly no sports-bra and spandex clad photo shoots in my near future.

I’m so excited to now have the “Madelyn Moon Diet” and nothing else. And more than just the diet aspect, I now live a much more minimalistic life. I try to keep my household minimalistic, as well as my face (less is more, ladies) and even my workouts!

The people I have met in the paleo community have literally changed my life in every aspect. I could name you ten people right now that have impacted me in some way or another and have brought me to tears from their support and generosity.

I am in no way exactly where I want to be in terms of body image and my relationship with food, but I am much farther in my journey than where I started. I have come incredibly far in all actuality, and as long as I remember to keep up the self-love and acceptance, I will be in the best “shape” of my life (possibly literally, but that one is more metaphorically).

 

Because I wanted to share how I’ve learned to retrain my brain into loving my body just the way it is, as well as block out all of the lean body fitness fluff, I created an eCourse that guides readers step by step on how to do exactly that.  My goal with the course is to give you small, easily implemented changes you can make every day that will eventually lead you into non-negotiable self-love and body acceptance.

 

Lastly, I wanted to further share my passion for the ever-so-important mind body relationship by creating a podcast, called Mind Body Musings. The podcast features various guests that are well-known in the fitness industry who share their stories, theories, research and knowledge with us so that we can all better understand our bodies and brains. The podcast can be found on iTunes here, or you can go to my website here for the direct download links.

I also provide a free audioguide 4 Pillars of Femininity for Perfections, here.

A big thank you to Stefani for letting me share my story with you today. Stay tuned for this story to be published in The Paleo Miracle 2 as well, along with many other inspirational mind body strengthening stories.

 

I hope you enjoy any newfound insight you learn from these two tools and further develop your own strength, beauty and self-love.

 

With love,

Madelyn Moon

:)

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Overcoming hypothalamic amenorrhea

Overcoming hypothalamic amenorrhea

 

Far back in the very beginning weeks of this blog, I wrote a long series of articles on the sources of infertility.    In terms of the kinds of infertility caused by diet and lifestyle, there are two primary categories: PCOS and Hypothalamic Amenorrhea.  Long time readers of this blog know that I believe the relationship between these two disorders is much more complicated than regular doctors and medicine would have us believe.  Nonetheless, while I was writing about PCOS and HA (read more about HA here and here and here), I promised to write a post on how to overcome HA.

I never did.

The reason I didn’t write it is because the answer is both way too complex and way too simple.  I couldn’t come up with anything coherent to say.

Hypothalamic Amenhorrhea is the fancy way of saying “stress-induced loss of menstruation.”  The hypothalamus is the part of the brain that determines if you are in a safe enough environment to bear children.  If your body receives signals that you are not “safe” enough, then your hormone production will decrease and you will stop menstruating.  You may also suffer symptoms of low libido, depression, anxiety, insomnia, acne, and fatigue.

“Safe” means both physiologically and psychologically.  Mental stress can hurt your fertility just as much as physical stress.  Unfortunately, these two stressors commonly occur in women today, and commonly in paleo dieters.  Mental stress comes from pressure and ambition and work and life as well as body image issues, low-self-esteem, and disordered eating.  Physical stress comes from low body fat levels, rapid fat loss, excessive fat loss, fasting, over-exercising, under-sleeping, and under-eating.   It’s no wonder that so many women struggle with this.

 

 

Estrogen, progesterone, LH and FSH — all female hormones — decrease with hypothalamic stress.  LH and FSH come directly from the pituitary and fall off the wagon, and then estrogen and progesterone, which take their cues largely from LH and FSH, fall off of it, too.

Can it be overcome?

Sure.

Is it easy?

Not always.

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The thing about HA is that its severity and “cure” are different for each woman.  The trick is to address all of the kinds of stress that play a role in HA, and to focus on the type of stress that caused your problem in the first place.

For example: say you recently dropped from 130 to 110 pounds.  The primary problem — the thing that if it looks like a duck and quacks like a duck, it’s a duck, so stop fighting the reality of your weight loss — is that you lost too much weight too fast.  Your body couldn’t keep up with your changing leptin levels.  And you likely underate calories and gave your body starvation signals while you were losing.  So that needs to take precedence.  You also, however, exercise a fair bit and have a fairly stressful life.  To that end, you should also reduce your exercise, work on your priorities and your stress level, and be sure to eat as much as you need to.  Address all of the ways in which you can increase your body’s detection of “safety.”  Focus on perhaps gaining a little bit of weight back, however, since that was your primary “problem.”  The faster you can convince your body you are no longer starving, the faster you’ll regain hormone balance and fertility.

Other women, on the other hand, might have to focus on stress, or might have to give up marathoning for a while.

HA is all about convincing your body that it’s no longer in danger.  It doesn’t need to stress.  It doesn’t need to shut down hormone production to prevent a poorly timed pregnancy.  So you have got to nourish it as best you can.  Err on the side of over versus under eating.    Dial down your exercise — particularly the sprint based kind — and do only what feels comfortable.   Stop pushing through being so tired.  Don’t wake up in the morning to an alarm after a short night’s sleep to go for a run.  Be sure to eat plenty of carbohydrates — at very minimum 100 grams of carbohydrate a day — and make sure to eat even more if you are an athlete.   Learn to move more slowly, to eat more gently, to be less hard on yourself.   Relax, eat, relax, eat, relax, eat, repeat.   Don’t eat garbage– no way!  Some women do, and find that their fertility comes back.  But go wild with your diet, and eat as much as you are craving.  Your body has been starved, and it’s important to respond to hunger signals when you have them.  That is, if you want your fertility back.

To that end, there’s a simple answer to HA:

-Eat more.  Relax more.  Repeat.

On top of that, we can get more specific:

-Focus on nutrient-rich foods that support healthy hormone production.  Liver, egg yolks, other organ meats, bone broth, leafy greens, fruits, and vegetables are all great.

-Make sure to eat plenty of fat.   At minimum 40 grams a day.  This amounts to approximately three tablespoons of your favorite paleo oil (such as coconut oil) — one for each meal.   Including saturated fat is particularly helpful since it is the backbone of hormone production.

-Make sure to eat plenty of carbohydrates.  Your body can think it’s starving if it doesn’t get enough for a significant period of time.  Eat at least one piece of fruit or serving of starchy carbs with every meal.  Make sure to do more on active days.

-Eat when you are hungry.  Do not go hungry.  Ever.

-Only exercise when you feel energetic and excited to do so, and refuel appropriately afterward.

-Do not sprint more than a couple of times a week.

-Consider eating a fuck ton of calories.  Many women have spent ages on different forums learning about what works, and debating how many calories should be eaten at any given point in time.    Some argue you need as many as 3000 calories a day to recover.  Others assert 2000.  I wouldn’t go crazy, but consider the fact that there’s a good chance you are undereating relative to your needs.

-Consider weight gain.  Anywhere from 1 pound to 10 might be necessary, or 30, depending on where you are.   How much did you weigh when you stopped menstruating?  Is it much more than where you are now?  How much more?  What else was going on in your life?  You may need to close the gap a bit between where you are now and where you stopped menstruating in order to do so again.  Each woman’s body is different and requires a different level of fat to feel safe and be fertile.

-Sleep as much as possible.  9 hours a night!

-Consider supplementation.  Magnesium supports hormone production.  Calcium is helpful with the magneisum.   Take the magnesium and calcium in a 1:1 or 1:2 (at most) ratio.  Vitamin D can support functions with magnesium and calcium.  Fermented cod liver oil will never hurt.

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Which is all that I’ve got.  I know it’s a lot and also a little at the same time.  Hypothalamic amenorrhea is all about you and your body and your own particular needs.  You’ve got to think deeply about the kinds of stress you might be dealing with, and then go ahead and rectify it.

And then give it time.

It takes time to recover from this sort of thing.  Hormones don’t leap ahead of us, they follow behind, peaking around all of the corners, making sure it’s safe before they come out and play.   I can say, however, that your recovery will be faster the more you nourish yourself, the more you eat, and the more you relax.   You can go more slowly if you are fearful of the process.  This is what I did.   And it’s good — the body learns to adjust to new leptin levels over itme.  But know that it takes longer the more slowly and cautiously you move forward with your hypothalamus.

I highly recommend checking out the Fertile Thoughts forum on hypothalamic amenorrhea.   It contains 108,000 posts and counting.  Women all across the world come to this forum to share their experiences with HA and infertility.  Definitely worth the read if you’re interested in HA at all.