Victor,
I'm really glad you raised this. Non-classical 21-hydroxylase deficiency (NC-CAH) can affect more than the androgenic changes you've welcomed in transition, and it's wise to think beyond "preventing masculinization." Lori's suggestion is exactly right: an endocrinologist who understands both CAH and trans/intersex care can sort out what genuinely needs attention without undermining your testosterone regimen. (Sharing peer experience here—not medical advice.)
In NC-CAH, resting cortisol is often adequate, but some people have a blunted stress response. In real life that can feel like fatigue that spikes during illness or intense emotional/physical stress, slower recovery after being sick, feeling wrung out by things you used to shrug off, or occasional lightheadedness. Salt cravings or mild electrolyte quirks can occur, though frank salt-wasting is much more a classical-CAH issue. Your concern about "creating stress hormones correctly" is therefore reasonable and testable.
A good work-up typically starts with early-morning cortisol and ACTH, plus 17-hydroxyprogesterone; if there's doubt about reserve, an ACTH stimulation test clarifies how your adrenals respond under stress. The goal isn't to suppress androgens you want—it's to confirm that your stress-hormone system can cover you when life gets rough. Many adults with NC-CAH don't need daily glucocorticoids. Some do well with an individualized "sick-day" plan: short, low-dose hydrocortisone only for significant illness, surgery, or major physiological stress. That approach can protect adrenal function without fighting your masculinization. If you ever use steroids for more than a few days, tapering under medical guidance matters; long-term daily dosing can affect bone and metabolism—another reason to keep treatment as light and targeted as possible. Your exogenous testosterone should continue to drive masculinization even if adrenal androgens are briefly suppressed during stress-dose windows.
Between now and your appointment, it helps to note patterns—times you were unusually wiped out under stress, difficulty bouncing back after infections, dizziness when ill, or symptoms that cluster around high-stress periods. That context makes the visit more productive and helps your endo tailor testing—and, if needed, a simple plan that supports your health while honoring your transition.
You're asking exactly the right questions. Please keep us posted on what you learn; your experience will help others navigating the same intersection of CAH and transition.
Here's wishing you clarity and good answers soon.
— Susan
