To diagnose Adrenal Fatigue correctly requires using a combination of lab testing and feedback from the patient (questionnaires can also play a useful role). On this page I will give a brief summary of the major tests that can be used in an Adrenal Fatigue diagnosis. Dr Wood and I discuss these tests in more detail in The Adrenal Fatigue Solution, along with some revealing tests used by integrative doctors.
Symptoms can be very similar to the ones experienced by fibromyalgia sufferers and up to 70 percent of the patients actually suffer from both conditions. Symptoms include: fatigue that doesn’t go away with sleep, difficulty getting restful sleep, pain, stiffness, tender spots in muscles and/or joints, headaches, sore throat, flu-like feeling, weight gain, digestive problems, mental fog, and poor concentration.
I think adrenal fatigue is real and could be the symptom of other illnesses. When your cortisol level is low for whatever reasons your blood pressure is bound to be low resulting in lethargy and general weakness. People who complain of tiredness should be checked thoroughly by endocrinologists to ensure that they are not suffering from serious illnesses such as Addison ‘s disease for example.
Adrenal fatigue can be caused by a one-time extreme stress such as a bereavement, or by a prolonged situation such as stress in the workplace. Other factors can also play a role in adrenal fatigue and these include poor diet, insufficient sleep, substance abuse and prolonged situations that leave a person feeling trapped – such as a bad relationship, lack of financial resources and so on. Chronic illness can also reduce the function of the adrenal glands.
I think adrenal fatigue is real and could be the symptom of other illnesses. When your cortisol level is low for whatever reasons your blood pressure is bound to be low resulting in lethargy and general weakness. People who complain of tiredness should be checked thoroughly by endocrinologists to ensure that they are not suffering from serious illnesses such as Addison ‘s disease for example.

She begins with a central issue: the nature of stress. As she explains it, stress is not people, places, things, or events. Stress is not any external factor that somehow does things to you. Those are stressors. Stress, however, is nothing more than your mind and body’s reaction to those outside stimuli. Moreover, stress is not inherently bad for you either. Some stress reactions can save your life – such as the fight or flight response that provides your body with the burst of energy you might need to escape from momentary danger. Exercise is another example of a type of stress that can have positive impact on your life.
He also spends a great deal of time targeting the root causes of this fatigue, linking these causes to one common factor: stress. His central premise is one that has been taken up by other authors in other forums, which is just one indication of how influential he has been in this area of health. That premise is simple: adrenal fatigue is the result of massive amounts of stress overwhelming the adrenal glands’ ability to manage and then recover from the effects of the stress response.
This is an excellent introduction to hormone imbalances of all kinds. All hormones are interrelated, and this book will help you sort out your symptoms so that you can determine which symptoms are adrenal, which are thyroid, and which are sex hormone related (estrogen, progesterone, testosterone). They have great diagnostic quizzes, and then outline treatment strategies for each hormone group. This is an easy read, and a great starting place if you're new to learning about health related topics.
I have been working in a very high stress environment for the last several months. Within a month of starting this job I started having what felt like heart attacks but which the ER docs told me were panic attacks. I ended up having to take a leave of absence to recover and finally resigned when I realized that I literally dreaded going back to work to that point that every time I thought about returning I felt the anxiety attacks starting. It’s been a month now since I quit and I still feel physically exhausted and unhealthy with frequent heart palpitations and dizzy spells. Drs including cardio can’t find anything physically wrong with me. Does this sound like adrenal fatigue to you? If so, How do I get my health back to normal? FYI I’ve been in perimenopause for about 3 years now I still get my period about once every 3-4 months and they are generally very heavy and last for about 3-5 days.
What type of specialist (i.e., doctor, naturopath, etc.) is the most effective to help with this treatment? I have had thyroid issues since my 20s (I’m now in my 50s), including the periodic loss of hair in large spots on my head, weight gain (now to include the lovely layer of fat around my midsection), exhaustion after workouts, and on and on. I have also been told I have adrenal exhaustion. I would really appreciate some guidance.

Adrenal glands that are in balance produce adequate amounts of hormones to power us through the day. These hormones impact just about every process in the body, from energy production and immune activity to cellular maintenance and repair. They are key regulators of glucose, insulin and inflammation, and play a major role in bone and muscle building, mood and mental focus, stamina, sex drive and sleep cycles.
Congenital Weak adrenals. Many children today are born with weak adrenals due to their parents’ nutritional deficiencies. This is not a genetic problem. Instead, it is due to the nutritional imbalances of the mother, in particular. These are passed through the placenta to the unborn child. For example, if the mother is zinc-deficient, as most are, the baby is born low in zinc and often high in copper, cadmium or other minerals that substitute for zinc to a degree. Fortunately, this means the problem can be corrected, though it is better to prevent it, of course. By age three or four, these children are in burnout. They are often sick, depressed and have difficulty in school. Some of these children react to the situation by becoming hyperactive, compulsive, obsessive or by developing various other behavior problems. On their hair mineral analyses, these children are often in a state of burnout at this early age, a relatively new phenomenon, in my experience. By gently rebuilding their body chemistry, however, their behavioral and other disorders generally vanish in a few months to a few years.

I now try to avoid caffeine in the afternoon. This is difficult, as I am a self-admitted tea addict, but I opt for the caffeine-free chamomile or rooibos instead if it’s after lunch. Other ways to promote quality sleep include turning off the TV, computer, and smartphone a few hours before bed (those screens and artificial light can overstimulate the brain, block melatonin production, and negatively impact sleep quality), and eating an ounce or two of clean protein like organic turkey, along with 2 tablespoons of coconut oil right before bed. This has a balancing effect on blood sugar throughout the night.
Well that explains it Dr. Northrup! After a difficult winter I was on my way to rejuvination and ran into a road hazard without warning. I have been freaking out ever since. Very concerned someone else will hit it and not be so lucky. I have withdrawn from my usual uplifting activities and feel as if I will emerg reborn. Living by a motto of “Eat right, get plenty of rest and exercise” has worked for decades, menopause is a trip! I will be preparing delicious meals to savor and add Licorice and Ginseng to replace caffine. Practice having more fun while “Celebrating peace and love always”. I was shaken hard enough in the accident that my pinky and ring fingers are numb, it was spreding to my palm and wrist but numbness has receeded to fingers. I was restless and having nightmares too. My hump on the back of my neck flattened. I am doing PT to keep it away. Sleeping with arms straight and down seems to help too. Driving can be stressful as it requires we be more alert. I had taken a side road to get away from a driver who was swerving and driving at inconsistant speeds and a tailgater who had been behind me for sometime on a dangerous two lane road know for head ons and off road accidents. Hummm, getting back to focusing on love and having more fun. . .Now!!!

I’ve spoken exclusively about hormones so far, but neurotransmitters are another important part of our endocrine system. These chemical messengers transmit messages between our cells and, just like cortisol, they can become depleted after long periods of stress. With recent developments in testing procedures it is now possible to compare a patient’s neurotransmitter levels to a reference range for healthy patients. This test is usually conducted first thing in the morning and is best accomplished via a urine test. It is only available from a small number of labs.

Not included in the above piece by Dr Northrup about adrenal exhaustion is information about the affects of sustained stress on the adrenals leading to elevated aldosterone production. With work/life stress, extreme exercise and chronic dehydration (many people don’t get enough fluids) the adrenals will produce elevated levels of the hormone aldosterone in order to try to maintain a type of homeostasis. Aldosterone will push potassium, zinc and magnesium out of the body resulting in impaired immune function, poor digestion, compromised liver function, poorer iron absorption, and increased risks for oxidative stress.
One of the most commonly overlooked causes of Adrenal Fatigue is intestinal infections that gives rise to an inflammatory response. Such infection can occur sub-clinically with no obvious signs at all. Infections in the gut, including giardia, SIBO (small intestinal bacterial overgrowth), fungal dysbiosis, and h. pylori infection are just a few that may contribute to adrenal dysfunction.
I find it curious that suboptimal health status (SHS) has many of the same tenets as what we refer to as adrenal fatigue. Actually, people classified as having SHS have “significantly higher levels of plasma cortisol,” and confirm the correlation between stress and suboptimal health. This has led those studying SHS to realize that reducing the stress in work environments may help to prevent chronic diseases in the future. (16)
Unfortunately, many individuals and physicians continue to deny that this syndrome is a legitimate disease. The medical literature is, however, very clear in proving the opposite; individuals with this disorder have measurable hypothalamic, pituitary, immune and coagulation dysfunction. These abnormalities then result in a cascade of further abnormalities, in which stress plays a role by suppressing immunity and hypothalamic-pituitary function.

Diagnosis is an important part of the book as well. Because Wilson recognizes that most doctors know little about this syndrome, he provides everything that any fatigue sufferer needs to self-diagnose: a detailed questionnaire to help gauge the level of fatigue and potential causes, advice on the best tests to perform – both at home and in a laboratory setting, a health history timeline that can help you to pinpoint the various stressors that have led to your current condition, and many chapters meticulously detailing his best treatment advice for nursing yourself back to health. An entire section is also devoted to explaining what the patient can expect as he or she slowly recovers from this ailment.


Particular emphasis is given to chronic stress, and its long-term, cyclical effect on fatigue. Oxygen, free radical damage to cells, and cortisol’s importance are also examined. And all of that is before the serious discussion about adrenal fatigue begins! That discussion involves a close look at adrenal fatigue, its causes, symptoms, and diagnosis.
Adrenal fatigue can be caused by a one-time extreme stress such as a bereavement, or by a prolonged situation such as stress in the workplace. Other factors can also play a role in adrenal fatigue and these include poor diet, insufficient sleep, substance abuse and prolonged situations that leave a person feeling trapped – such as a bad relationship, lack of financial resources and so on. Chronic illness can also reduce the function of the adrenal glands.
I’m hoping maybe you can unconfuse me. I recently had an adrenal stress index done as well as a full thyroid panel because I’ve experienced all the symptoms you’ve mentioned above and more (headaches, inability to lose baby weight despite trying, etc). I’ve even taken the questionnaire you linked ( and a few others) and they all come back indicating some amount of adrenal fatigue.
I find it curious that suboptimal health status (SHS) has many of the same tenets as what we refer to as adrenal fatigue. Actually, people classified as having SHS have “significantly higher levels of plasma cortisol,” and confirm the correlation between stress and suboptimal health. This has led those studying SHS to realize that reducing the stress in work environments may help to prevent chronic diseases in the future. (16)
So how widespread is Adrenal Fatigue Syndrome? Some practitioners believe as many as two-thirds of Americans have suffered from some degree of adrenal exhaustion. But while some of us can bounce back relatively quickly from a period of stress or trauma, others find it more difficult. Left untreated, Adrenal Fatigue can gradually worsen until simple everyday tasks become a challenge. That's why it is important to address the cause of your Adrenal Fatigue early, and begin a restorative treatment to rebuild your health, vitality and energy levels.

Doctors urge you not to waste precious time accepting an unproven diagnosis such as “adrenal fatigue” if you feel tired, weak, or depressed. If you have these symptoms, you may have adrenal insufficiency, depression, obstructive sleep apnea, or other health problems. Getting a real diagnosis is very important to help you feel better and overcome your health problem.
Do you feel that your energy levels are just at a permanently lower level than they used to be? Aging is often a factor in this, but chronic stress can be a major contributor to exhaustion too. If you’re one of those people who find themselves drinking more and more coffee just to get through the day, it might be time to look at the underlying cause behind your tiredness.
When Adrenal Fatigue was first diagnosed many of these tests did not even exist. To help provide a diagnosis, doctors developed a series of more physical tests that can be conducted quickly in a doctor’s clinic or at home. These tests are clearly much less accurate than the blood, saliva and urine tests mentioned above, and positive results may reflect other health problems besides Adrenal Fatigue. However they can be a useful diagnostic tool in combination with all the other evidence provided.
Some people call the time when the "camel's back" finally breaks a "nervous breakdown." However, nerves really don't break down; adrenal glands do. A "nervous breakdown" is actually adrenal fatigue, or when the adrenal glands can't deal with the amount of stress they're given. Adrenal fatigue used to be rare, but is now all too common because of our lack of relaxation and other lifestyle factors, such as smoking, sleep deprivation, poor eating habits and excessive caffeine intake, as well as allergies.
Hello, It all started about 8 months ago when my symptoms first started appearing. My first symptom was unexplained paresthesia through my body, usually around the neck area and extremities. After a while, it got the point where my legs would start hurting (burning sensation) on the inside after standing up for a while. After driving home from work at night, I felt wired, as if I had consumed 2-3 cups of black coffee in one sitting. I had to leave my job because of this. There was a period in where these symptoms were beginning to subside but gradually came back so I also stopped exercising and lifting. In the past 5-6 months I have changed my diet drastically, experimenting with different things such as gluten-free paleo, vegan, and even raw foodist at some point. My symptoms remain the same. I constantly battle with fatigue, I have trouble waking up in the morning(cold hands and feet and shivers upon waking up), extremely low libido, loose stool, and brain fog. I have an appointment tomorrow with an endocrinologist but would like to hear from you first. What can I do in the meanwhile to alleviate these symptoms? What might be the root cause of all this? Thank you!

Located near the top of each kidney, your adrenal glands release hormones (such as adrenaline and cortisol) that help your body respond to stressful situations (by briefly pumping up your energy levels, for instance). Research suggests that when you're constantly suffering physical, mental, or emotional stress, your stress-hormone system may become "worn out" and actually produce fewer stress hormones. This state of exhaustion — commonly known as adrenal fatigue — is associated with chronic tiredness, food cravings, mood swings, and weight gain.
i have been on entocort steroids for a year now 9mg and recently down to 6 mg – I want to get off but have been told to go slowly due to adrenals. Can you explain why to me and how I should go about this. I did the eye test and mine pulsed as well. I sleep great but also take ketotifen which is a mast cell stabilizer and makes me very sleepy. Can you also tell us what do to for adrenal support thx
A relatively new area of understanding, there are some who make the connection between adrenal fatigue and osteoporosis. It’s well-known that osteoporosis is often a result of imbalanced hormones. However, the sex hormones that are often named as the transgressors aren’t the only problem. Abnormally high or low cortisol levels are also associated with bone loss and osteoporosis risk. (36, 37, 38)
Prior to having my left Adrenal Gland surgically removed last month after the recommendation of an endocrinologists, I struggled from moderate adrenal fatigue, high blood pressure, low potassium, etc. The removal of the gland was to eliminate the need for blood pressure medicines all together. It didn’t seem to work. I have sever adrenal fatigue, sever high blood pressure, continued weight gain of my mid section, and now depression. Any advice?
Carmen there is hope, I was on prednisone for more that 5 years straight, it was a long, awful, painful, and slow withdrawal from it. this was about a year and a half ago, i’ve had to do short bursts about 4 times since then, I like to breathe. At that time I also got off of high doses of morphine another withdrawal that was not pretty, I was put on methadone as i have chronic pain issues. After this time I started investigating herbs that might help me, and i have found a wealth of information on not just herbs, but on many other natural ways to heal, and I’m actually starting to feel better than I can ever remember and I’m 53, with 6 children, 7 grandchildren 3 of which I have been Mom to for the last year and a half.
Patients with diabetes symptoms might be at increased risk for adrenal fatigue. Research from the University of Delhi found that diabetes patients “display significantly higher chronic stress and stress responses when compared to subjects with [normal glucose tolerance].” (14) This suggests that impaired glucose tolerance might have a connection with taxing of the adrenal glands.
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If you tend to be dehydrated and don’t get thirsty, know that your body is demonstrating stressed adrenals. Try to rehydrate using an electrolyte solution containing targeted nutrients which will trigger the Sodium-Glucose Cotransport System allowing your body to absorb fluids more readily from the small intestine (water otherwise is reabsorbed in the large intestine). I’m using CellFood, Essential Minerals, sea salt, sodium bicarbonate, and table sugar in water and I have noticed a big difference in how my body is using water. You can also look into an over-the-counter product such as DripDrop.
Depending on his or her preference, your doctor may order a saliva, blood or urine test to measure your cortisol. These days it is generally accepted that saliva cortisol testing is the most accurate, as it gives a better estimate of the cortisol levels within your cells, where the hormone reactions are actually taking place. Remember that it is important to be well-hydrated before you do your saliva test – dehydration can skew the results.

Treatments for adrenal fatigue vary from using certain botanical medicines - which certainly will always play a major role, to using intravenous vitamin therapy. Usually this combination very quickly delivers results that both address the symptoms and nourish your adrenals back to optimal function. Additionally, patients usually need some blood sugar support and dietary changes to support stabilizing and decreasing insulin resistance while healing the adrenal glands.
When Adrenal Fatigue was first diagnosed many of these tests did not even exist. To help provide a diagnosis, doctors developed a series of more physical tests that can be conducted quickly in a doctor’s clinic or at home. These tests are clearly much less accurate than the blood, saliva and urine tests mentioned above, and positive results may reflect other health problems besides Adrenal Fatigue. However they can be a useful diagnostic tool in combination with all the other evidence provided.
One of the hallmarks of alternative medicine is the “fake disease”. Fake diseases don’t actually exist – they are invented without any objective evidence showing that they are real. Fake diseases tend to emerge from vague symptoms which can’t be attributed to a specific medical diagnosis. This is not to say what patients are experiencing isn’t real – the issue is the diagnosis, and the practitioner making the call. As has been pointed out by other SBM contributors, it’s understandable to want reasons and answers when you have debilitating symptoms. But symptoms need to be studied in rational and objective ways in order to understand the underlying illness – call it the “root cause” if you prefer. The diagnosis guides the treatment plan, so getting a diagnosis right is essential. While a group of vague symptoms might lead a medical doctor to run tests to rule out serious illness, alternative medicine providers seem to jump to the diagnosis and techniques they prefer, even if they’re completely unvalidated, or made up out of thin air. It’s your Chi. Your energy fields. It’s wifi. It’s gluten. In this case, it’s your adrenals. Rather than offer a guide to proper care, a fake disease is a distraction from the truth.

Hello, at Age 51, 5’6″, Nothing has changed, i am still 165 to 170 depending on the Decision of GOD knows what, i went down to 163 last June after climbing to 170 and was ecstatic, no change in diet, i cannot exercise due to the Fibromyalgia (long story) but i am the busiest person i know, i hardly EVER sit down. My period was 2 months late in June of 2015, then it started, and my weight dropped 7 pounds in 5 days ! (from 170 to 163 in June 2015) i did nothing diff, then it climbed back up , doing nothing different, only my period was late again, for another 2 months.
Or, if you cannot afford the book, go to the author's website StopTheThyroidMadness.com and click on the tab "What We've Learned." Pay close attention to the section "Ducks In a Row," which I found particularly helpful. This will help you (1) Identify a physician who is best to treat you, and (2) explain what you need to know going into the appointment. If I would have had this book at the beginning of my health crisis, I would have shaved a year and half off of healing.
Adrenal Fatigue for Dummies is a book written by Dr. Richard Snyder and nutritionist Wendy Jo Peterson. As the title suggests, this is another in that series of “Dummies” books that are not really written for “dummies” at all. Like others of its kind, this book is written for those who currently have little understanding about the nature of adrenal fatigue – which would include most patients suffering from exhaustion, as well as their attending physicians!
However, at LifeWorks Wellness Center, when a patient presents with symptoms of unexplained tiredness, a functional evaluation will be performed by the practitioner, to help to determine whether adrenal fatigue is the cause. It is very common for adrenal fatigue to be a component of many issues since one of the adrenals “jobs” is to respond to stress factors, including other diseases.
There are a number of different tests for thyroid function, all blood tests. Here I’m going to give a brief summary of the most important ones. As with the cortisol test, your doctor should be looking beyond the reference ranges provided by the lab. In fact, these days it’s very common for someone to be diagnosed with mild hypothyroidism even if all their results are within the range.
Within the book’s more than 360 pages, the author covers virtually aspect of this dread ailment. He explains in great detail how the adrenals work in combination with other key systems in the body to maintain homeostasis and ensure sound health. He examines the symptoms that accompany this disorder, as well as how to differentiate normal momentary tiredness from the type of chronic exhaustion these patients must endure.
I also promote quality sleep by turning off the TV, computer, and smartphone a few hours before bed (they can overstimulate the brain, block melatonin production, and hurt your quality of sleep). And I often eat an ounce or two of clean protein like organic turkey and 2 tablespoons of coconut oil before bed to balance out my blood sugar throughout the night.
Adrenals are the stress-response organ so if they are dysfunctional, I recommend looking for root cause – subclinical infection, toxic exposure (mold, chemicals, glyphosate), gut dysbiosis, etc. I recommend a nearly grain-free paleo diet with high healthy fats like avocado, coconut, olive oils and moderate protein (fish, chicken, eggs) and low carbohydrate with your carb intake being in the evening. For adrenals best to consume fat/protein in AM and minimal carbs. You may do ok on some cooked rice/quinoa but otherwise grain-free. It is clear that your current diet is not working if you are feeling poorly and gaining weight…
Eating right for one’s type of metabolism will help to ensure the proper amounts of sodium and potassium levels as well as raw materials for one’s unique biochemistry. In addition to this, understanding the regulatory effects that the sympathetic and parasympathetic nervous system has with the endocrine system is also a very important part of the picture.
Although a concept that is sometimes uncomfortable and foreign to traditional medical styles of thinking, the need for multiple interventions is required for effective treatment of such complex illnesses like CFS and adrenal fatigue. The HPA axis works as the body’s energy and hormone regulator. An imbalance between any part of the axis can affect the entire body system and treatment for such disorders requires a well-rounded approach to restore function. Therefore, adrenal and pituitary dysfunction often require treatment with several hormones. When treatment is received, individuals with devastating syndromes like CFS, adrenal fatigue and fibromylagia can “get their lives back” despite the fact that they were previously told, “there is nothing that can be done.”

This extends to more than just lifestyle and dietary choices. Patients also need to identify and eliminate the sources of stress in their lives. This can often be difficult, but it is a necessary part of restoring their health. Unhealthy relationships, stressful jobs, family quarrels, money worries – these all need to be eliminated somehow. Often a patient will feel as though a huge weight has been lifted off their shoulders when these issues are fixed. As you would expect, that feeling also signifies a great deal of stress being taken off their adrenal glands and HPA axis too.
For anyone who has ever wondered why his or her doctor seems to know nothing about this syndrome, Dr. Wilson offers an answer. He does this by explaining the reasons why adrenal fatigue is so readily dismissed by most in the medical community. As he points out, there is always money involved in these considerations, and in the case of adrenal fatigue the money trail leads right to the pharmaceutical companies. At one time, adrenal fatigue was a well-known diagnosis, and patients actually received treatment for it. As the pharmaceutical industry grew larger and more politically connected, however, that diagnosis became rarer and rarer. Today, only the most severe forms of adrenal dysregulation – such as Addison’s disease – receive any serious recognition by doctors.
Patients can conduct a saliva cortisol test or a urine cortisol test to assess adrenal hormones. This involves collecting four non-invasive samples over the course of one day, from which ZRT is able to generate results with a diurnal cortisol curve. This four-point graph reveals cortisol levels throughout the day and allows health care providers to pinpoint issues with adrenal gland function.
For those of us deep into Stage 4, where levels of both the sex hormones and stress hormones have dropped substantially, treatment will take even longer. You should expect a treatment period of at least 12 months, possibly involving bio-identical hormone replacement as well as the dietary changes, lifestyle changes and supplementation mentioned above.

You might wonder what the point of a thyroid test is, when we are looking to diagnose Adrenal Fatigue? The complexity of the human body means that one part of the endocrine system (the HPA axis) cannot exist independently of another part (the thyroid). In reality, there are connections and relationships that exist between every system in the body, and a weakness in one area can easily translate into changes in another.
After determining that adrenal fatigue is a widely misdiagnosed syndrome, Dr. Zodkoy goes on to discuss the nature of adrenal fatigue, its symptoms, and the most effective exams and lab tests for detecting problems with the adrenals. He also gives insight into his own thought process regarding why so many adrenal fatigue patients fail to produce lab results confirming their condition.

I’m here to share my story of healing with you. I know what it’s like to suffer and not know what’s going on with your body. I’ve been there. I was lost, searching for answers and alone for 10 years until I learned how to get my body working for me, not against me—to address the underlying symptoms instead of using a Band-aid approach to reclaim my vitality. I want to show you that eating and living clean feels incredible. Once you see life this way, you’ll never go back. Ever. Come play along with me on Instagram, Pinterest, Facebook and Twitter. I’m here for you. xo

The DUTCH testing is the only one I use because with other salivary testing you will not see the true picture (more here https://dutchtest.com/2016/07/05/adrenal-fatigue-is-all-in-your-head-sort-of/) About 30% of people with low free cortisol overall, have elevated levels of metabolized cortisol. Think about the implications of that. When you see low overall free cortisol in saliva (or in urine) you THINK cortisol production is low. In almost one out of three patients, they are actually making more cortisol than 80% of their peers. They make lots of cortisol! You just can’t see it in the free cortisol.
But if you’re overwhelmed by chronic stress, your adrenals can get burnt out from constantly producing cortisol. The result is adrenal fatigue. Your natural cortisol rhythm becomes irregular — sometimes you produce too much cortisol, sometimes not enough — and you can struggle to make other hormones, like androstenedione (the precursor to testosterone).
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