Adrenal Fatigue Testing
STEP 4. There has been a great increase in what I would call "Testosterone Awareness."
Thanks to all the recent testosterone advertisements, most men now know that
they need to examine this critical hormone if they have certain symptoms such as
lowered libido and loss of their edge at work thanks. Unfortunately,
testosterone is not always the silver bullet that many men hope it would be and
a significant percentage find that it does absolutely nothing. Frequently men in the
Peak Testosterone Forum will
post, "When am I going to feel anything?"
The reason for this can relate to other hormones. Often it's not
just testosterone levels that have plummeted but the
thyroid hormones, which I discussed on my page covering Testosterone and the Thyroid,
the adrenal hormones. On this page I'll cover Adrenal Fatigue, another fairly common condition that can affect our mood, energy and life in the bedroom.
First, let's cover classic "Adrenal Fatigue Theory" and what happens to three of your three
Stage I. (High Cortisol, Normal Pregnenalone, Lowered DHEA) During this stage, you experience stress of some sort (job, marriage, financial, illness, death of a loved one, etc.)
and your adrenal begins to pump out extra cortisol. The elevated cortisol has many negative effects, including lowering cortisol and potentially killing brain cells.
Stage II. (Normal Cortisol, Lowered Pregnenalone, Even More Lowered DHEA) This is the beginning of the "fatigue" or "exhausion" phase. The theory is that
the adrenals can no longer handle the excess load and begin to decrease their output of all the key hormones.
Stage III. (Low Cortisol, Lowered Pregnenalone, Very Low DHEA) This end result of the "fatigue" or "exhausion" is lowered output of all the key adrenal hormones. At this point
the adrenals are depleted and can no longer function normally.
Need to boost your Nitric Oxide naturally through food, drink and supplements? Check out Lee Myer's book here:
The Peak Erectile Strength Diet
Or do you need the most comprehensive testosterone book in Amazon? Here it is:
Natural Versus Testosterone Therapy
Now I want to point out that adrenal fatigue is widely accepted in the
alternative health community, but largely unaccepted by most endocrinologists.
Keep in mind, though, that there is evidence in adrenal fatigue from
athletes who have overtrained and followed similar patterns
to the above-mentioned stages. And, practically speaking, many
individuals fall into low DHEA and low/high cortisol. So, whether or not
you accept adrenal fatigue, adrenal hormones do seem to be out of alignment
The Adrenal Fatigue sites can be very confusing in my opinion. Below I will
try to summarize some of the very practical and easy adrenal methods that I
have seen work for the some of the men in
the Peak Testosterone Forum
Adrenal Fatigue Evaluation
a) Assess Your Symptoms.
How do you test for adrenal fatigue? This is actually an involved
question that is complicated by the fact that the adrenal is composed of two parts: the medulla (inner
core) and the cortex (outer shell). On this page I am not going to go
into the medulla hormones. These should not
necessarily be ignored, but tend to be more transient and involve hormones such as
epinephrine/adrenaline. It is the cortex that I am going to focus on,
because it secretes more long-lasting hormones, cortisol in particular, that can
wreak havoc with multiple systems and cause symptoms that are very common.
Take a quick look at the following standard adrenal fatigue
symptoms. How many of them apply to you?
- Fatigue (often just at one time of the morning or day)
- Low libido
- Easily Stressed
- Body and muscle aches
- Dizziness upon standing
- Intense cravings
- Hypoglycemia (blood sugar crashes)
- Constitipation or diarrhea (depending on the adrenal stage)
- Mental fog
- Frequent urination (from low aldosterone)
- Unexplained low blood pressure
- Poor memory
- Insomnia (high cortisol)
- Increased belly fat (high cortisol)
- Nausea, heartburn or diarrhea (high cortisol)
CAUTION: Of course, always get checked out by your physician if you have
any of the above symptoms as they can also be signs of completely unrelated
Notice that a lot of these symptoms are very similar to hypothyroidism
and/or hypogonadism (low testosterone). Again, this is why you cannot
necessarily always assume that testosterone will cure things like low libido,
erectile dysfunction, fatigue and mental fog: it could by hypothyroidism
or adrenal fatigue.
Assuming that you have some of the above symptoms, it would be prudent in my
opinion to find a good medical practitioner and get some basic testing done.
This may be a forward-thinking M.D., a naturopath or perhaps an anti-aging
physician. However, if all else fails, you should be able to use one of these
labs to the answers that you need:
Testosterone and Hormone Testing Labs.
Most of these symptoms can be explained by low or high cortisol readings and
so you'll probably find that testing focuses on it.
Keep in mind that high cortisol will generally lower testosterone as well.
The adrenals also control and are heavily involved in body functions such as a)
blood sugar regulation, b) fluid retention/loss, c) immunity and d) blood
pressure. If you've had inexplicable low/high readings in blood pressure
and/or blood sugar, it could adrenal-related.
b) Pull Your Numbers. The good news is that you can usually gain considerable useful information by just pulling two hormones
in order to keep cost and confusion to a minimum.
i) DHEA. DHEA is produced in several tissues including the adrenals and is considered the complement or "adversary" of cortisol. When
one is up, the other is usually down and vice versa. As you might guess, there are a number of medical conditions that are tied to a high
cortisol-to-DHEA ration, such as treatment resistant depression.  Getting your DHEA measured can help diagnose which stage of Adrenal Fatigue you lie in.
ii) 3+ Point Cortisol Read. As I mentioned, cortisol affects mood, libido
and other adrenal fatigue symptoms profoundly and so it is most often
recommended to get a reading first thing in the morning around 8 a.m., at noon
and then at 4 or 5 p.m. The reason is simple: men can be low in
cortisol at different times, something I will diccuss below.
Salivary, Blood or Urine? There are actually 3 different ways to pull your
cortisol and DHEA. Most of the men on the Peak Testosterone Forum that have looked into adrenal function have used
a saliva test. It is usually inexpensive and you can do it from home. Furthermore, many of the experts actually prefer saliva testing and feel it is more
accurate. However, if you want a blood draw,
Life Extension Foundation has a 2 point cortisol read along with DHEA,
insulin/glucose and a couple of other markers of adrenal function.
This may be advisable is you want to take your results to show to a physician.
Now how do you diagnose adrenal fatigue? Here are some of the general rules
that I see applied:
Stage II. If your DHEA is below the lab's midrange and your cortisol is
high, then you are considered in stage II adrenal fatigue.
Stage III. If you DHEA is below the lab's midrange and your cortisol is
near the lowest part of the lab's range or lower, then you are in stage III
Adrenal Fatigue Solutions (High
Cortisol or Stage II)
If you are high cortisol during part of the day - again, always talk to your
doctor first - most of the gurus recommend three basic steps to pull the
1. Stress Management. Instead of just running off and taking a bunch of
supplements, one should first examine root causes: there is
probably an underlying reason that your cortisol is high and it's probably
stress. There are a dozen different forms of stress, but that's generally
where adrenal fatigue starts and ends - stress. And all the medications
and supplements in the world aren't going to help unless practical
ways are learned to manage it.
As you probably know, stress managment is a whole field. However, I have many
practical and easy-to-learn suggestions that I discuss
in my Summary Page on Stress and Cortisol. I want to
highlight two important ones: Secular Mindfulness Meditation and
Progessive Muscle Relaxation. Both of these are non-religious body-mind
disciplines and are proven cortisol-busters in the research. Furthermore,
they are very easy to learn and do.
15 minutes a couple of times per day and you're done. But there are many other proven ways to lower cortisol, including
yoga, Tai Chi, walking (in a relaxing environment), massage and on and on. Pick a couple and get good at them and give your poor
adrenals a break!
2. Sleep Management. I would guess that half of all Adrenal Fatigue cases
could be eliminated by simply getting more sleep.
A recent study clearly showed that we need (at least) 7.5 hours of sleep.  If
subjects got any less, their inflammation and immunity and stress reactivity
went down the toilet. Many studies have shown elevated cortisol levels
with lowered sleep time. If you need help going to sleep, then see my Sleep Aid Page for many research-backed ideas.
Also, many men have sleep disorders such as apnea, restless leg syndrome, loud
snoring and on and on. Most of these will benefit significantly from
dropping the pounds and some sort of medical therapy. (For more
information, see my page on The Incredible Benefits of Sleep (Including Testosterone).
3. Phosphatidylserine (PS or S-PS). If a man has high cortisol, one common solution is phosphatidylserine,
and a number of prominent alternative practitioners state that it can lower cortisol levels.
Typically it is taken at the same time as your high cortisol reading. In other words, if you have high cortisol in the
afternoon, then the PS is taken at that time. Unfortunately, it is a fairly expensive supplement. One should probably try a
smaller dosage, such as 50 mg, and see if that is effective. However, I often see men taking larger
dosages in the 100, 200 or even higher range. CAUTION: Long term
safety is poorly understood.
4. Vitamin C. Linus Pauling noted that humans are one of the few mammals that cannot manufacture their own Vitamin C. His theory was that this
was a bad mutation that we have somewhat adapted to live with but that we actually do better with megadoses of Vitamin C. Whether or not you buy into this
theory, one thing that does seem to be true for many men is that they do better in the stress/cortisol department with megadoses of Vitamin C. Vitamin C may
or may not actually lower baseline levels of cortisol, but what has been shown in a number of studies is that Vitamin C lowers the increase in cortisol that
comes from a variety of stressors. I have some coverage of this here in my page on Why Take Vitamin C? and
C and Phosphatidylserine. CAUTION: Vitamin C should be taken in
the "Ester-C" form on an empty stomach as it can increase iron absorption.
5. Anti-Stress Herbs. There are several herbs that have been used successfully by literally millions of people over the years to overcome
stress, anxiety and so on. Some of the more well-known ones are ashwagandha, rhodiola and Korean Ginseng.
It requires some experimentation to find out which one of these will help.
In my opinion, these are good short or perhaps medium term solutions to help you get past a particularly
stressful period in your life. (If you have any medical conditions or are on any
medications, talk to your doctor first.)
Adrenal Fatigue Solutions (Low
Cortisol or Stage III)
1. Overtraining. Many men end up with adrenal fatigue from
overtraining. It is hard for many men to not ignore pain and just keep
pushing themselves. If there is any chance you are overtraining, then it's
time to stop. I had to do this myself for a time and bought a book by Phil
Maffetone, who discusses the use of monitoring pulse to force yourself not to go
2. Pregnenalone. One adrenal-related supplement that has grown in popularity is pregnenalone. Pregnenalone is the "Mother of All Hormones", because it is
essentially right below cholesterol in the Hormone Pyramid. The theory is that if a man take pregnenalone, then the body can utilize it downstream (for testosterone, cortisol, progesterone, DHEA, etc.) however it needs. "The body knows best" is the kind of naturopathic philosophy that has arisen.
And what is nice is that pregnenalone seems to have few side effects and very few
downsides, unlike some of the other adrenal hormones such as DHEA. (Excess
DHEA has been found accumulated in the brains of Alzheimer patients. It
may not be causative, but some concern is warranted.)
If you have any medical conditions or are on any
medications, talk to your doctor first. Occasionally, pregnenalone can have a
Practically speaking, pregnenalone really seems to help some low cortisol men
with Adrenal Fatigue symptoms. In addition, it does often raise cortisol.
Common dosages 50 mg a few times per day. Some men have taken more in
order to raise their cortisol. CAUTION: Even though side effects are
minimal, long term safety is poorly understood.
Hyrdrocortisone (HC). This is just the chemical, pharmaceutical way to
say cortisol. Some alternative practitioners will give their male patients HC in
small dosages of between 5 and 40 mg/day. Again, the theory is that adding some
cortisol exogenously "gives your adrenals a rest" and lets them recover.
This is usually done for a few months only at a time.
I am cautious about cortisol, because elevated amounts do so many negative
things: increase visceral fat, kill neurons, lower testosterone, etc.
Admittedly, if you are low cortisol, that is likely an entirely different thing.
However, HC (20 mg) has also been shown to decrease REM sleep.  It may also
increase anxiety in some men according to one study.  So you can try it, but
it would seem prudent to use it as low dose and as short term as possible.
5. CAUTION: Licorice Extract. Many alternative practitioners recommend licorice extract to raise cortisol levels. I am very cautious about
this one as well, because it has been shown in several studies in animals and women to lower
testosterone.  Yes, raising cortisol but licorice's action seem to go
beyond this, and I don't see the need to lower your T in order to improve your
1) Psychoneuroendocrinology, 2009 Jan, 34(1):19-26, "The ratio of cortisol/DHEA in treatment resistant depression"
3) Endocrinologia Japonica, 1988, 35(2):333-342, "Inhibitory effect of
glycyrrhetinic acid on testosterone production in rat gonads."
4) Steroids. 2004 Oct-Nov, 69(11-12):763-6, "Licorice reduces serum testosterone
in healthy women"
5) Journal of Affective Disorders, Oct 1994, 32(2):139–146, "Effects of
hydrocortisone on brain 5-HT function and sleep"
6) Biological Psychiatry, Mar 2011, 69(6):549–555"Acute Hydrocortisone Treatment
Increases Anxiety but Not Fear in Healthy Volunteers: A Fear-Potentiated Startle