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Using Replacement Hormone Treatment with Adrenal Fatigue

Posted Jul 16, 2018

Using Exogenous Cortisol with Severe Adrenal Fatigue

In some cases of severe adrenal fatigue a short therapeutic course of natural cortisol may be needed. Although the administration of cortisol will produce fast, almost immediate relief, it should not be used except in the most severe cases because the exogenous cortisol suppresses adrenal function and as such, may not be substantially therapeutic in the long run.

However, if you think this therapy is necessary, confirm it with tests such as the combined 24-Hour Urinary Cortisol & ACTH tests and the 24-Hour Salivary Cortisol test. It is important to remember that corticosteroids suppress adrenal function in proportion to the dosage. For this reason it is critical that treatment is commensurate with the patient’s need and withdrawn slowly, never abruptly.

There are many types of corticosteroids on the market but the natural form of hydrocortisone is the only one to use. Note that commercially available hydrocortisone, although essentially the same as physiological cortisol, also contains unnecessary ingredients some patients react to. To make certain you are getting pure cortisol without additives, it is best to have a compounding pharmacist prepare your prescriptions.

Most therapeutic regimens for natural hydrocortisone conform to the normal physiologic 24-hour cortisol secretion totaling approximately 20 mg. Some alternative physicians use an initial dose of 12, 5, 2, and 1 mg. at 8:00 AM, 12:00, 3:00 and 6:00 PM respectively. If sleep disturbances are part of the syndrome, 1 mg. before bedtime may be helpful.

After approximately 6 months, try to gradually decrease the dosage. If the adrenal glands have recovered sufficiently, they will pick progressively up the slack as the exogenous cortisol decreases and begin to respond normally. If not, the patient may need to be maintained at the same or a reduced dose for a while longer. Most adrenal fatigue patients on hydrocortisone therapy will only need it for a relatively short time and that time will be minimized with the proper HPA axis and adrenal support, such as is provided by Dr. Wilson’s Adrenal Fatigue Protocol®. Blood, saliva and urine tests should be completed regularly to monitor progress.

Exogenous Cortisol Combined with Glandulars and Supplement Support

Natural exogenous cortisol can be taken simultaneously with an HPA axis glandular supplement, like Dr. Wilson’s Adrenal Rebuilder®. This regimen for severe adrenal fatigue often allows the adrenals to rest and rebuild much faster than with either therapy alone. After 2-3 months on both cortisol and the glandulars, the daily dose of cortisol is slowly withdrawn while the glandulars are increased and the following supplements added: an antioxidant vitamin C complex, like Dr. Wilson’s Adrenal C Formula®; a nutrient complex that specifically supports adrenal function, like Dr. Wilson’s Super Adrenal Stress Formula®; and adaptogens that promote optimal HPA axis function, like Dr. Wilson’s Herbal Adrenal Support Formula®.

This allows the adrenal glands to recover more quickly and to strengthen enough that when the cortisol is discontinued, the adrenals can function adequately on their own. For people with severe adrenal fatigue, this can be a very satisfactory combination therapy.


DHEA is one of the androgen hormones secreted by the adrenal glands and is the precursor to several other sex hormones. DHEA levels often become depressed during adrenal fatigue. Even though DHEA is a hormone, it is considered a dietary supplement in the United States and can be purchased at a reasonable cost in health food stores and other supplement outlets. A saliva test will determine whether DHEA levels are below normal. When it is low in males, it is a good idea to supplement with DHEA. Approximately 25 mg. to 200 mg. is the accepted and normal dosage range for men.

Typically older men need more than younger men, although this varies with the individual. People often see improvement within 2-3 weeks of beginning DHEA. Be careful of overdosing with DHEA; more than 200 mg. for men can create hostility, aggression and make the person unpleasant to be around. There are also some minor concerns in some alternative medical circles about the possibility that DHEA may represent a threat to health because it can be converted into dihydro-testosterone, which has been linked to prostate cancer.

However, there are other studies that show that men with higher DHEA levels are actually protected against prostate cancer, so the jury is still out. If a patient takes DHEA for more than three months, it is also good to have PSA (prostate serum androgen) levels checked every six months, as a precaution. If it begins to rise, decrease or eliminate the use of DHEA until the cause of the rise is found.

Women often do not do well on DHEA unless their adrenals are very fatigued. Levels as low as 10-25 mg. have produced symptoms of excess DHEA such as facial hair and acne. A safer and more successful way of raising DHEA levels in women is to have them take either progesterone or pregnenolone, although some studies of women with chronic fatigue syndrome or lupus have found benefit from using 200 mg. of DHEA/day.

Progesterone and Pregnenolone

Progesterone and pregnenolone are hormones that are manufactured in the adrenal cascade, as well as in the ovaries and testicles, before they are metabolized into DHEA. In the adrenal cascade, pregnenolone is the first hormone to be made from cholesterol and progesterone is the second. Both can be converted into several other adrenal hormones besides DHEA, including the sex hormones aldosterone and cortisol.

Thus, taking exogenous hormones like pregnenolone and progesterone that occur early in the adrenal cascade lets the body’s wisdom choose which other hormones it will make from them, according to its needs.

With adrenal fatigue, the sex hormone levels often fall because the adrenal glands are not able to manufacture adequate levels of hormones. One function that sex hormones serve is to act as antioxidants that help prevent the oxidative damage caused by cortisol. So the lower the sex hormones, the more damage there is to tissues, especially when the patient is under stress. This oxidative damage is one of the key factors in rapid aging.

Either pregnenolone or progesterone can better be used to raise the hormonal levels in both men and women, and decrease some aspects of adrenal fatigue. By bypassing the very complex and energy consuming steps required of the adrenals to make pregnenolone or progesterone from cholesterol, the adrenals do not have to work nearly so hard to keep your hormone levels adequate.

Besides helping fatigued adrenals, both these hormones have been used very successfully to diminish premenstrual syndrome (PMS). This is not surprising considering that the most common cause of PMS seems to be too little progesterone and/or too little magnesium.

Progesterone is made in both the ovaries and the adrenal glands. Women suffering from adrenal fatigue often have lower saliva progesterone levels and increased PMS. The addition of oral pregnenolone or natural progesterone cream is often needed for relief of PMS and female complaints common in adrenal fatigue. 10-40 mg. per day of pregnenolone, taken orally, and 20-30mg. (1/4 – ½ tsp.) of progesterone applied as a cream to the the areas of thinner skin (swimsuit areas plus the inside thighs and arms) morning and evening is usually sufficient. Premenopausal women should apply progesterone cream from the 12th day of the menstrual cycle to the 26th day (the first day of bleeding is counted as the 1st day). Post-menopausal women can use it for 21 days each month.

Both pregnenolone tablets and progesterone cream are available from many health food stores and some pharmacies. It is important to note that we are speaking of the natural progesterone and not the synthetic progestins in tablet form usually prescribed for hormone replacement therapy. The synthetic progestins can have many side effects and should be avoided. The various progestins exist because drug companies need forms of progesterone different enough from their competition to be patented and controlled by the company.

The reason all progestins have side effects is that none of them are exactly like the natural progesterone the body makes. Because the large drug companies do not produce natural progesterone creams, many doctors are not knowledgeable about them and are unaware of the difference in safety between the synthetic progestins and the natural progesterones.

Pharmaceutical companies further complicate the issue by referring to the synthetics as progesterone, when they should be called progestins. Progestins are the synthetic altered forms of progesterone that are responsible for most of the negative side effects experienced by women taking them.

The progesterone contained in progesterone cream, however, is usually a natural plant progesterone (phytoprogesterone) that has been converted into exactly the same molecule as physiological progesterone. It can be used safely by most women. An excellent book that covers this topic is What Your Doctor May Not Tell You About Menopause by Dr. John Lee.