Making the appropriate changes to your diet and lifestyle, along with taking some good herbal supplements, can go a long way to reversing Adrenal Fatigue and restoring energy levels. However, for those of us in Stage 3 or 4 Adrenal Fatigue, some hormone replacement may also be necessary.
Hormone replacement has come a long way in the last 15 years, and there are now bioidentical hormones of excellent quality on the market. These will need to be prescribed by your doctor, and this page contains details on the most important of them. As you will read below, Adrenal Fatigue sufferers can also use adrenal glandular extract, a more natural option that also comes with its own advantages and disadvantages.
Bioidentical Hormones
You might remember that in 2002 hormone replacement was linked to the development of certain cancers in women. It is important to note that the hormones that those women were taking were synthetic hormones and quite different from the natural hormones produced by our own bodies. Many of the hormones available today are termed ‘bioidentical’. Although they are not natural (they still undergo chemical processes during their manufacture), they are extremely close in molecular structure to our own hormones.
Hormone replacement is one of the most powerful tools available to Adrenal Fatigue specialists today. And using bioidentical hormones enables us to replicate the action of our own hormones. Bioidentical hormones are almost identical, at a molecular level, to the hormones that we produce. They are synthesized from chemicals extracted from natural substances like yam, soy or horse urine.
Before you get a prescription for hormone replacement from your doctor, he or she should establish a baseline for your hormone levels. This involves taking a blood test before you start your treatment. Your doctor will then establish the areas in which you are deficient, and establish a plan to return your readings to optimal levels. Hormone treatment should also involve ongoing blood tests to measure the effect of the hormones replacement and make suitable adjustment to your regimen.
When you speak to an integrative doctor or naturopath, they will also be conscious of the need to support your adrenals and endocrine system throughout this treatment. Starting hormone replacement treatment without addressing adrenal weakness can be counterproductive and put undue stress on both the adrenal glands and your liver. Starting with low doses and testing regularly is usually the smart way to go.
What are bioidentical hormones? (Harvard Women’s Health Watch)
Bioidentical Hormones (Dr. Karla Dionne)
Cortisol
Bioidentical cortisol is available on prescription and has been used for decades as treatment for Addison’s and adrenal insufficiency. However, there are drawbacks to its use. The side effects, even from bioidentical cortisol, can be significant. In fact this kind of synthetic cortisol tends to produce more side effects than adrenal glandular extract (see below).
Another drawback with bioidentical cortisol is that it prevents the adrenals from producing cortisol themselves. Adrenal Fatigue treatment is usually designed to get the adrenals working again, so this treatment can be counter-productive. However, in more stubborn or severe cases of Adrenal Fatigue it can be a good option to discuss with your health care professional.
DHEA
Saliva testing is the most reliable way to determine the optimal dose of DHEA. This hormone is the precursor to testosterone and other sex hormones. As pregnenolone is diverted away from the sex hormones and towards the stress hormones, it is easy for Adrenal Fatigue sufferers to experience a shortage of DHEA. Replacing this DHEA can lead to a return of sex drive and some of the other general markers of vitality that are disrupted during Adrenal Fatigue.
DHEA replacement should always be accompanied by regular testing. It converts easily into testosterone, so this is especially important for women. As with the other hormones in this list, starting with small doses is always advisable.
Pregnenolone
The process of creating hormones begins in your body with cholesterol, but the next step along the production line is a hormone named pregnenolone. For these with reduced levels of either sex or stress hormones, supplementing pregnenolone can ameliorate many of their symptoms.
Pregnenolone is often administered in oral capsules. As with the other hormones on this list, beginning with a small dose is best, particularly for those suffering from Stage 3 or 4 Adrenal Fatigue.
Testosterone
Many people don’t realize that both men and women need testosterone. Although women produce only a fraction of the amount needed by men, it is still extremely important for several markers of vitality like libido, endurance and mood. For those suffering from Adrenal Fatigue, restoring testosterone to optimal levels can result in a greatly improved quality of life.
Progesterone
Once progesterone begins to fall (as it often does in the late 30s for women), the result can be lower energy levels, irritability, weight gain and more. For those of us experiencing Adrenal Fatigue, the ‘pregnenolone steal’ means that progesterone levels can trend even lower.
Progesterone supplementation can be achieved through capsules, lozenges or topical creams. Be sure to discuss the best option for you with your health care professional. As with the other hormones listed here, the optimal dose should be determined (by blood test) before treatment begins.
Estrogen
Estrogen deficiency can also occur with Adrenal Fatigue, but it tends to happen much later in the progression of the condition. Typically, progesterone will start to drop long before estrogen levels change. So for those women who are in the later stages of Adrenal Fatigue, oestrogen supplementation can be useful. For men the picture is sometimes more complicated, as falling testosterone levels are often associated with rising estrogen. Your health care professional will be able to accurately test your estrogen levels and determine an optimal range that you should be aiming for.
Adrenal Extract
This method of hormone replacement is sometimes controversial among the medical community. Adrenal glandular extracts have been sold commercially for almost 100 years, but the fact is that they would be unlikely to get FDA approval today. When the FDA began giving approval for new drugs in 1938, most drugs and extracts that were already being sold were given automatic approval (or ‘grandfathered’). Luckily for many Adrenal Fatigue sufferers today, adrenal glandular extract was one of those given approval.
Why is this a controversial treatment? Many doctors prefer to treat with synthetic cortisol. The advantage of synthetic cortisol over adrenal extract is that it is much easier to standardize dosage. Adrenal extracts (even the highest quality ones) have some inherent variation in the strength of each dose, simply because they are a natural product. And synthetic cortisol is much cheaper to produce than adrenal extract, which goes a long way to explain why the pharmaceutical companies stopped producing the natural variant in the 1960s.
Of course, being a natural product confers some real advantages too. Adrenal extract tends to come with fewer side effects than synthetic cortisol. Obtaining a natural source intuitively seems a smarter choice (see synthetic vitamin C vs natural vitamin C). And there is 90 years of research into adrenal extracts to back up and support their use.
When you take adrenal glandular extract, be sure that it comes from a good, organic source. Quality control can vary, as with any medicine. The best extracts tend to come from animals raised in New Zealand and Switzerland. The extract will typically come in a powder or liquid form. Follow the guidance of the manufacturer or your health care professional in deciding your dosage.
Are adrenal extracts suitable for every Adrenal Fatigue sufferer? It really depends case by case. Those with Stage 1,2 or 3 Adrenal Fatigue find that adrenal extract tends to raise their energy levels when they are low, and prevent them from getting that ‘wired-tired’ feeling when they are stressed. However those with Stage 4 Adrenal Fatigue should be careful to start with a very low dose, as their sensitivity to these supplements will be dramatically heightened.
Adrenal Fatigue Glandular and Herbal Therapy (Dr. Michael Lam)
Adrenal Extract (WebMD)
Further Experiments on Cortico-Adrenal Extract: Its Efficacy by Mouth (Britton et al, 1939)
