How Hormones Can Help Address What Causes Fatigue

By: Michael Lam, MD, MPH; Dorine Lam, RDN, MS, MPH

Hormone replacement therapy can be a consideration in What Causes FatigueAdrenal hormones are essential for life. Too much of them or too little, however, can be dangerous. An imbalance of these crucial hormones can oftentimes be the source of what causes fatigue. How can we find a solution to what causes fatigue? Hormone replacement is commonly prescribed by physicians when presented with a patient’s symptoms suggestive of adrenal insufficiency. In the early days of adrenal hormone replacement, researchers had little clue of the proper dosage or the complications resulting from toxicity. Misled by improvement in their patients’ symptoms, they gave patients many times more adrenal hormones than the normal amount to fix what causes fatigue. Cortisol was the drug of choice. Many patients suffered toxic effects as a result of this and died. Long term and excessive use of cortisol has many negative side effects as well, to the extent that its use as a performance enhancer in competitive sports has now been universally banned. As a result of these bad experiences, many researchers became frightened and avoided prescribing adrenal hormones such as cortisol whenever possible to fix what causes fatigue.

In addition to adrenal hormones, the use of thyroid replacement to fix what causes fatigue brought on by Adrenal Fatigue is a common practice. In fact, many people with Adrenal Fatigue with symptoms of low thyroid function are prescribed thyroid medications as if they suffer from primary hypothyroidism. Many continue to suffer. In the early days of thyroid hormone replacement, patients received up to many times the usual dose of thyroid hormone as well and as a result, the toxic effects could be severe.

Clearly, hormone replacement therapy in a setting of Adrenal Fatigue requires careful attention and the use of adrenal hormones needs to be put into perspective. In the right situation and using the right dose, hormone replacement can be of great benefit alleviating what causes fatigue.

Medical science is just beginning to realize that a person can feel horrible and function poorly even with a minimal to moderate hormone deficiency that is not clinically detectable by routine blood tests for a solution to what causes fatigue. This is evident in the case of Adrenal Fatigue. Adrenal hormones are under the control of the hypothalamus-pituitary-adrenal axis where over 50 hormones are involved, and dysregulation of any one of these can produce unpleasant symptoms and be a factor in what causes fatigue. For example, low aldosterone level can lead to blood pressure irregularities and fatigue, high estrogen can trigger PMS and anxiety, and low cortisol output can lead to sugar dysregulation, hypoglycemia and sluggishness. Those in the advanced stages of Adrenal Fatigue are especially vulnerable to what causes fatigue. Unfortunately, laboratory tests and other investigative tools are not very helpful when it comes to Adrenal Fatigue and what causes fatigue due to inconsistent clinical correlation. However, good qualitative challenges can be helpful. Paying close attention to the signs and symptoms of Adrenal Fatigue and what causes fatigue is perhaps the most effective way to assess whether or not there is the need for hormone replacement. The ultimate decision as to whether or not use hormone replacement as an Adrenal Fatigue recovery tool or for what causes fatigue is best left to the professional. Due to poorly understood patho-physiological mechanisms, some trial and error in administering hormone replacement will be inevitable even in the best of hands.

What Causes Fatigue? – Adrenal Glands 101

The adrenal glands are two small glands; each about the size of a large grape and their role in producing hormones required for optimal living is crucial. The outer adrenal cortex comprises eighty percent of the adrenal gland and is responsible for producing over 50 different types of hormones in three major classes-glucocorticoids, mineral corticoids and androgens. Without proper hormonal production and balance, it is impossible for anyone to feel good and what causes fatigue.

You can check your hormone levels to see What Causes Fatigue

When the adrenals are weak, production of any or all of these hormones will be affected. Hormones can be over-produced or under produced, depending on the state of fatigue of the adrenals, and also on each person’s intrinsic body constitution. For example, cortisol output in the body usually rises in Stages 1 and 2 but will subsequently fall when a person enters into Stage 3 and beyond. DHEA level tends to fall gradually as Adrenal Fatigue progresses from Stages 1 to 4. DHEA output can also be high temporarily during onset of Adrenal Fatigue. Pregnenolone output also tends to rise in early stages of Adrenal Fatigue just like cortisol before it starts to fall due to a phenomenon known as pregnenolone steal.

In addition to output considerations, we need to pay attention to how these hormones are broken down and metabolized to help understand what causes fatigue. All steroidal hormones are metabolized to a great degree by the liver. The more advanced the Adrenal Fatigue and signs of what causes fatigue, the more compromised the liver function generally. Hormones required for recovery from Adrenal Fatigue and from what causes fatigue need to be considered not only their absolute quantity. Just as important is consideration of the overall clearance state of the body to get rid of metabolic byproducts of the various hormones. Hormone replacement therapy for people suffering from Adrenal Fatigue, whether it is in synthetic or bio-identical form, is therefore difficult and challenging especially when factoring in what causes fatigue. It should be undertaken only under the close supervision of an experienced health care provider after more gentle first line recovery tools have been exhausted. In other words, adrenal hormone replacement should not be considered as a first line remedy for what causes fatigue until better and gentler compounds that can get the job done without the risk of side effects, has failed. Premature use of adrenal hormonal replacement is common in most self-navigation programs, is a common mistake, and can be a major cause of recovery delay or failure. Improper use of adrenal hormonal replacement in fact can be what causes fatigue and makes the condition worse due to toxicity, paradoxical effects, addiction, and withdrawal complications. Worst of all, it may also trigger adrenal crashes.

Steroidal Hormone Synthesis Pathway

A steroid is a chemical substance with four carbon ring structures attached to each other in a very specific and unique fashion. Cortisol, DHEA, testosterone, pregnenolone, progesterone, and estrogen are all steroid-based hormones that chemically look very similar to each other in terms of their basic molecular structures. They are all made in the adrenals with cholesterol being the raw material. However, their actions differ markedly, with enormous differences in how they function and in the roles they play in the various chemical factories of our bodies.

The following is a simplified diagram of how the key adrenal hormones are made:
To discover What Causes Fatigue, look at the adrenal pathway

Each hormone produced acts as part of an overall orchestra of hormones where proper balance is essential for optimal adrenal function. Each hormone has an important role to play in the overall scheme of things inside the body. In addition to recognizing the sequential cascade of hormonal synthesis, it is very important to understand that pro-hormones such as pregnenolone and DHEA, which are placed naturally at the top of the cascade, are gentler as compared to down-stream hormones such as testosterone and cortisol. The more gentle the hormone, the more nurturing it is for the adrenal to make its own down-stream hormone and the less will be the side effects. Pro-hormones are less potent but contrast this with the cortisol, which is the most potent, and has the greatest potential side effects especially in what causes fatigue.

This article will examine some of the most common steroidal hormone replacements and their clinical ramification in the Adrenal Fatigue setting and these hormones are: Pregnenolone, DHEA, cortisol, melatonin, testosterone, estrogen, progesterone, and also DHEA. Thyroid replacement will be covered separately due to its importance.


Pregnenolone is called the mother of all steroid hormones for a good reason. It is a steroid hormone at the top of the hormonal production cascade. It is also the precursor in the synthesis of female hormones such as estrogen and progesterone, mineralocorticoids such as aldosterone that is responsible for sodium regulation, glucocorticoids such as cortisol that suppresses inflammation and helps to reduce stress, and androgens such as testosterone. Pregnenolone is therefore aptly called a pro-hormone.

Back in the 1940’s, when researchers started experimenting with the use of pregnenolone, they realized that it could be helpful for people who were under stress and that it could also increase energy in those who were fatigued. However, at about the same time, cortisol, another closely related hormone, was discovered and it stole the limelight, as it was far more potent. When cortisol was given to individuals with rheumatoid arthritis or other inflammatory conditions, there were outstanding short-term improvements.

During periods of stress, the output of adrenal steroids such as cortisol will increase, which will put a great demand on pregnenolone production. This may lead to pregnenolone deficiency, which in turn may lead to reduction of both glucocorticosteroids and mineralocorticoids such as cortisol and aldosterone respectively.

Numerous studies have shown the effects of pregnenolone on the body and brain. In normal people, pregnenolone will boost energy, elevate mood and improve memory and mental performance. Pregnenolone will also create a sense of well being while improving the ability to tolerate stress. Furthermore, pregnenolone has a host of other benefits, which include the ability to influence cerebral function, the female reproductive cycle, immune defenses, inflammation, mood, skin health, sleep patterns, stress tolerance, and wound healing. As an anti-aging tool, taking pregnenolone will therefore rejuvenate the entire adrenal cascade. However, in the case of Adrenal Fatigue, replacement tends to be more complex.

Pregnenolone and what causes fatigueSome with Adrenal Fatigue find pregnenolone replacement improves their energy, vision, memory, clarity of thinking, well being, and often sexual enjoyment or libido. Some women report lessening of hot flashes or premenstrual symptoms and this is likely due to the rise of progesterone (the biological daughter of pregnenolone) reduction in estrogen dominance. Others, however, may find pregnenolone worsen existing fatigue and may even trigger adrenal crashes. Such paradoxical reactions are common. The more advanced the adrenal weakness, the more likely such experiences are common.

Part of the reason can be explained by pregnenolone’s unusual response curve. Many studies have found a U-shaped distribution in the therapeutic response to pregnenolone therapy. The U-shaped distribution describes a benefit associated with low dose pregnenolone, a loss of effect with increasing dose of pregnenolone, and a second peak of benefit with higher doses of the steroid. It is unknown what dosage range is represented in either part of the U-shaped curve for humans and whether or not this curve is altered by disease.

The cells of the adrenal glands, as well as the central nervous system, synthesize pregnenolone. In Adrenal Fatigue, pregnenolone level usually stays high in early stages, but tends to be low as adrenal weakness progresses due to a phenomena known as “pregnenolone steal” as the pregnenolone level drops because the body bypasses pregnenolone production in favor of producing more down-stream hormones such as DHEA and cortisol.

Taking pregnenolone for adrenal fatigue can therefore be challenging for multiple reasons as paradoxical reaction is a major concern. In addition, one can take what appears to be an adequate dosage but will not benefit from this if the body is shunting it towards cortisol production. On the other hand, overdose is possible if too much is taken over time.

The normal starting dose is 15 mg, increasing up to 100 mg for men or women. Pregnenolone should be derived from a pharmacologically pure product and not a yam-derived “precursor.” Oral pregnenolone pills work well. Sublingual administration is an excellent option by bypassing the initial liver metabolism that occurs after swallowing an oral pill but it tends to be “spiky” and not well tolerated by those who are sensitive or in advanced s adrenal fatigue state.

Pregnenolone is converted in the body to progesterone and these two hormones have some overlapping similarities. Pregnenolone is also converted into DHEA, which, in turn may convert into androstenedione, testosterone, and estrogens. Pregnenolone supplementation may increase progesterone levels and consequently other hormones in the body (testosterone and estradiol).

Side effects of pregnenolone include:

  • Overstimulation and insomnia – low doses can be helpful for sleep when taken in the morning. This is especially prominent in those with advanced adrenal fatigue.
  • Irritability, anger or anxiety – low doses can actually ease a person into a relaxed feeling, while higher amounts may lead to irritability. The exact reason for this is not known.
  • Acne can occur due to the probable conversion of this hormone into androgens.

What causes fatigue could be connected to headaches

  • Headaches are possible with high dosages – possible scalp hair loss if used daily for prolonged periods. Pregnenolone converts into DHEA, which in turn converts into testosterone and possibly onto DHT. Pregnenolone can also be converted into progesterone.
  • Irregular heart rhythm, heart palpitations, even when the dose is as low as 10 mg. This side effect can be serious in the elderly or in those with heart rhythm disturbances.
  • Pregnenolone may cause disturbances in the endocrine system, including changes in the menstrual cycle and problems associated with hormone sensitive diseases, or it may interact with hormone therapy such as oral contraceptives.

Due to the possible side effects, pregnenolone should be taken under the supervision of a health care professional. Do not rely on blood or saliva tests alone to determine how much pregnenolone should be taken as the clinical correlation is unreliable in Adrenal Fatigue.

Due to its antagonistic effects on the GABA receptor in the central nervous system, pregnenolone therapy may be contraindicated in some people with a history of seizures. Pregnenolone may inhibit drugs used to increase GABA activity (i.e. Neurontin); these drugs are frequently used in the treatment of epilepsy and depression.

Both pregnenolone and DHEA can be taken together for Adrenal Fatigue. Since some pregnenolone is converted into DHEA, the intake amount of DHEA can be lowered if both are taken together.

DHEA (Dehydroepiandrosterone)

DHEA is the biological daughter of pregnenolone. It is a weak androgenic hormone made in large amounts in the adrenal glands of both sexes. DHEA is a precursor of testosterone, estrogen, and corticosteroids. Their actions are similar, but generally, DHEA is more potent than pregnenolone. Energy generation appears to be more intense.

DHEA is commonly used as a hormone replacement therapy for energy enhancement and anti-aging. Supplementation with DHEA can improve well-being, energy levels, moods, and libido for normal healthy people. Dosages of 15 to 25 mg of pregnenolone and 25 to 50 mg DHEA seem to do the trick in many women as it can bring them a renewed sense of well-being. Men are less hormone sensitive and the results may not be as evident. For men, direct testosterone precursors such as androstenedione (and its metabolite androstenediol) may be more effective. These protocols, however, only apply to healthy individuals and not to those who are afflicted with Adrenal Fatigue.

DHEA is also widely used in Adrenal Fatigue. Their actions tend to mimic pregnenolone, but amplified, both in terms of desired results and side effects. Therefore, DHEA use should be judicious, as different doses appear to do different things. DHEA does not convert into progesterone; rather it converts into estrogen and testosterone. High dosages (100 to 200 mg or more) can lead to a repartitioning of body mass as a result of the conversion of the DHEA into more androgenic steroid hormones. Significant side effects are similar to those of pregnenolone, only more severe. Hair loss and acne are particularly common.

What causes fatigue and hair loss explainedEven low dose DHEA can be problematic, as it tends to be quite stimulatory for those people with advanced adrenal weakness. In particular, those in Stage 3 (Adrenal Exhaustion) tend to react strongly even at minute dosage. Additional side effects such as severe anxiety, feeling jittery, and PMS are common and they seem to be more prevalent in women.

Since DHEA is a slight mood elevator, it can potentially clash with anti-depressants. Theoretically, the dosage of anti-depressants can be lowered if DHEA is taken. People on cholesterol lowering drugs as well as blood thinning medications, such as Coumadin, may need to watch their medications, as well as their requirements, because the amounts required to be taken may well be reduced since DHEA has both a cholesterol lowering and blood thinning effect. Studies have shown that DHEA also reduces appetite and this means that those who want to lose weight may benefit from DHEA, and those who are already on weight reduction pills may need less.

One interesting thing about DHEA is that it is not regulated by a negative feedback loop in the body. In other words, taking DHEA supplements will not suppress the production of these hormones or cause the adrenals to rest and result in atrophy from disuse. Theoretically, no “resting period” is required, although it may be a good practice to have a resting cycle of a few weeks for every few months of therapy.

Commercial DHEA products are made from diosgenin, an extract from the Mexican wild yam of the Dioscorea family. Biochemists can convert diosgenin to DHEA by engineering a series of chemical conversions, but such conversion will only happen in the laboratory and not in the human body. Therefore, ingestion of Dioscorea plant extracts cannot possibly lead to the formation of DHEA inside the body. DHEA should be used under professional guidance in the Adrenal Fatigue setting. Dosage determination can be tricky as it is not straightforward. Special attention needs to be paid to the many possible side effects similar to those of pregnenolone.

Depending on the stage of Adrenal Fatigue and on each person’s constitution, the blood or saliva DHEA level can increase while Adrenal Fatigue is in progression instead of going into gradual decline. Serum absolute levels are generally not very helpful due to inconsistent clinical correlation. From the Adrenal Fatigue perspective, DHEA should be viewed in conjunction with total cortisol. DHEA is an anabolic hormone (a building up hormone) while cortisol is a catabolic hormone (for breaking down tissues). The absolute DHEA level by itself in the Adrenal Fatigue context has little meaning. If the total cortisol to DHEA ratio is high, then there will be excessive cortisol relative to DHEA. That points to a body in a catabolic state.


The most important anti-stress hormone in the body is cortisol and it is produced in the adrenal cortex. Cortisol protects the body from excessive Adrenal Fatigue by:

Control your blood sugar to understand what causes fatigue

  • Normalizing blood sugar level: Cortisol increases the blood sugar level in the body, thus providing the energy needed by the body to physically escape the threat of injury in order to survive. Cortisol works in tandem with insulin, which is released from the pancreas, to provide adequate glucose to the cells for energy. More energy from any source is required when the body is under stress, and cortisol is the hormone that makes this happens. In Adrenal Fatigue, more cortisol is secreted during the early stages but in the later stages of Adrenal Fatigue (when the adrenal glands become exhausted), cortisol output is reduced.
  • Anti-inflammation Response: Cortisol is a powerful anti-inflammatory agent. When we have a minor injury or a muscle strain, our body’s inflammatory cascade is initiated, leading to swelling and redness commonly seen when an ankle is sprained or when there is an insect bite. Cortisol is secreted by the body as part of its anti-inflammatory response and its objective is to remove and prevent swelling and redness in nearly all tissues. These anti-inflammatory responses will prevent mosquito bites from getting bigger, bronchial stress, and eyes from swelling shut due to allergies and Adrenal Fatigue.
  • Immune System Suppression: People with high cortisol levels are very much weaker from the immunological point of view. Cortisol influences most cells that participate in the body’s immune reaction, especially white blood cells. In particular, cortisol suppresses white blood cells, natural killer cells, monocytes, macrophages, and mast cells. Finally, cortisol also suppresses Adrenal Fatigue.
  • Vaso-constriction: Cortisol contracts mid-size arteries. People with low cortisol levels (as in advanced stages of Adrenal Fatigue) have low blood pressure and reduced reactivity to other body agents that will constrict blood vessels. Cortisol tends to increase blood pressure that is moderated.
  • Physiology of Stress: People with Adrenal Fatigue cannot tolerate stress and will then succumb when faced with severe stress. As the stress level increases, progressively higher levels of cortisol will be required by the body. When the cortisol level cannot rise in response to stress, it is impossible to maintain the body in its optimum stress response condition and in this respect, we can conclude that stress does kill.

In short, cortisol sustains life via two opposite, but related, kinds of regulatory actions: releasing and activating the existing defense mechanisms of the body, while shutting down and modifying the same mechanisms to prevent them.

Cortisol production from the adrenal glands is controlled via the hypothalamic-pituitary-adrenal (HPA) axis. There is an existing negative feedback loop that governs the amount of adrenal hormones that are being secreted under normal circumstances in normal people. For example, the HPA axis adjusts cortisol levels according to the body’s need via a hormone called Adrenal Corticotropic Hormone (ACTH) that is secreted by the pituitary gland in response to signals from the hypothalamus. When the ACTH binds to the walls of the adrenal gland cells, a chain reaction occurs within the cells, leading to the release of cholesterol where it is manufactured into pregnenolone, the first hormone in the adrenal cascade. After this, cortisol is released into the blood stream where it travels in the circulatory system to all parts of the body and back to the hypothalamus.

Cortisol levels can show What Causes Fatigue

Cortisol and ACTH are not secreted uniformly throughout the day. They follow a diurnal pattern, with the highest level secreted at around 8:00 a.m., after which there is a gradual decline throughout the day. Episodic spikes during the day can also occur when the body is stressed or when certain foods are eaten. The cortisol level is at its lowest between midnight and 4:00 a.m. Morning cortisol is indicative of peak cortisol output. Noon cortisol is indicative of cortisol adaptability and usage. Afternoon cortisol is associated more with sugar regulation than adrenal cortex function, while evening cortisol level points to adrenal baseline function.

Cortisol level, especially in the morning, is characteristically high for those in Stages 1 and 2 Adrenal Fatigue as the adrenals are put on overdrive to produce more cortisol in order to neutralize stress. As Adrenal Fatigue progresses, cortisol output will eventually peak and then start to decline. Those people who are in Stage 3 Adrenal Fatigue invariably face a low cortisol level in the morning. After this time, the body’s cortisol output for the rest of the day will remain low. A 24-hour saliva cortisol curve is commonly flat throughout the day in Adrenal Exhaustion (Stage 3 Adrenal Fatigue). There are many exceptions to the above generalization and this is why relying on a test result to determine the body’s cortisol level, as the sole clinical yardstick can be very misleading. For example, some patients who are Stage 2 Adrenal Fatigue can present themselves with high evening cortisol but low or normal morning cortisol. These people tend to have low energy in the morning, with alertness returning around evening time. Despite high evening cortisol, they may be able to sleep well without sleep onset insomnia that commonly plagues those with high evening cortisol. As if this is not confusing enough, some people in Stage 3 Adrenal Fatigue clinically can present with a typical Stage 1 Adrenal Fatigue cortisol curve for reasons not well understood.

Conventional physicians have been using cortisol, also known as hydrocortisone, to combat Addison’s disease for decades. The drug is widely available under the trade name Cortef. Some have advocated the use of cortisol for treating Adrenal Fatigue as well. Some physicians, notably, Dr. Jefferies in the mid 1980s, have advocated low dose cortisol as safe for long-term use. Dr. Jefferies found that as long as the adrenal hormone level is kept within the normal range, the main toxicity that a patient might experience was a slight upset stomach, due to the body not being used to having the hormone come in through the stomach. Advances in nutritional therapeutics over the years have now greatly reduced the need of using this medication in most Adrenal Fatigue situations other than in the most serious cases. Many, however, continue to use cortisol as a first line recovery medication for Adrenal Fatigue. Over-use of cortisol as an Adrenal Fatigue recovery tool is a serious concern.

There is little question of the great benefits of cortisol for those who need it; cortisol can be a lifesaver for someone in a severe stage of Adrenal Fatigue. The gentler natural compounds such as vitamin C, vitamin B, DHEA, and pregnenolone, when dosed and delivered properly, will greatly support adrenal health. In such cases, external cortisol administration may be delayed or avoided. However, the clinical picture is anything but straight-forward.

Adrenal issues can be linked to what causes fatigueThe use of cortisol must be considered with great care. This is because the more advanced the Adrenal Fatigue the more prevalent the symptoms of intolerance. A good portion of people suffering from advanced Adrenal Fatigue actually cannot tolerate cortisol and in fact, their condition can become worse, even at low dose. Adrenal crashes may be triggered. The exact etiology is not known. Many will require a few weeks to get used to the medication, and the beneficial effect may not be immediately evident. Still worse is the issue of addiction and withdrawal symptoms, as anyone who has gone through those problems will tell you what a nightmare things can be.

Fortunately, as mentioned earlier, modern advances in nutritional therapeutics have rendered the use of cortisol unnecessary in most cases. Cortisol can be considered as a last resort. In fact, one of the key goals in Adrenal Fatigue recovery is to let the body heal itself naturally and wean off from cortisol dependency for those who have been on it long term.

Most patients find that 5 to 10 mg of Cortef in the morning, 0 to 7 1/2 mg at noon and 0 to 2 1/2 mg at 4 p.m. often work best. The actual dosage used needs to be adjusted to match the body’s need. Those who are on cortisol should slowly decrease their dosage after a few months if possible, eventually discontinuing the treatment entirely. The key to this is to rebuild the adrenal reserve first with natural compounds before titrating down cortisol dosage to avoid negative and unpleasant rebound withdrawal side effects and adrenal crashes.

There are many side effects when using cortisol. If the dose is too high, one may feel shaky and the dosage should then be lowered. If cortisol causes upset stomach, the patients should take it with meals or lower the dose. If taken too late in the day, Cortef can disrupt sleep. At a dose of over 20 mg a day, one will begin to see the more toxic side effects of cortisol. Clearly higher doses are not recommended unless the benefits do clearly outweigh the risks.

Another important function of the adrenal glands is to maintain blood volume and pressure. Low blood pressure, low blood volume, electrolyte imbalance, and dehydration are common in people suffering from Adrenal Fatigue Stage 3. In such cases, the prescription adrenal hormone, fludrocortisones (sold under the brand name Florinef) may be indicated and can be a lifesaver.

Read Part 2 Now!

© Copyright 2012 Michael Lam, M.D. All Rights Reserved.

Dr. Lam’s Key Questions

People with AFS tend to have weak immune system, where candida thrives.

For a disease to be an official diagnosis, it has to go through many clinical trials. This is a slow process that can take upwards of 50 years.

When your body is stronger and able to sustain itself, the level of steroid can be reduced. Letting your doctor know is the key as well as following your doctor’s instructions.

It may, depending on the purpose and timing. Often in a setting of AFS, allowing the body to self-regulate is much better because the body can then have the automatic mechanisms to activate the feedback loop and fine tune what it needs.

What causes fatigue
5 -
I find it incredulous that you are the only professional aware of the OAT axis. I struggled for years.. And it finally all made sense when I understood the relationship between ovaries, adrenal gland and thyroid. I am now thriving after years of anxiety, depression, etc. Hormones balanced with natural progesterone, adrenals and thyroid with iodine/iodide, gluten-free, healthy diet, pure water, abundant exercise and mind set, and vitamins and a few supplements. Doctors need to dump the pharmaceuticals and learn how to truly heal their trusting patients like you! With much admiration and respect,
Wendy Hildmann


  • Sarah R says:

    Hi DR Lam

    Just curious do you know what High DHEA means but normal cortisol. I also have low SHBG and High Free Testosterone. DHEA is at the highest so far 17, SHBG is 16, and free testosterone is 46 (I don’t have Polycystic overies) I am quite fatigued all the time and do have some weight on 85KGs but the problem is I’ve been experiencing heart palpitations every time I exercises and since the birth of my son. (all tests rule out heart problem, normal heart etc). So I feel limited with exercising because I don’t want my PVCs to come back and the heavy exhaustion that I do get after a few days of exercise (on the bed for a week before I feel energy to get up and move around a lot). My doctor said that it’s basically all weight related but I am 7 kgs less than what I have been, I eat as healthy as can be and I’m gluten free. No junk food at all (I’m deadly serious here) just meat and vegetables/salad.

    I don’t add additional salt to my food because my PVC’s rev up yet eating a decent amount of banana slows them down. My electrolyte levels are ok as per blood test. This also came on bad since the birth of my son 2 years ago when the symptoms and heart palpitations started. It’s not anxiety. Before my son I used to help run a dairy farm and that was long hours and hard work but it didn’t faze me. I was also probably 3-5kG less so I don’t feel it’s completely weight related. I am working on getting it down though. My bili (liver) blood test is a little in the red 18 as well but the doctors aren’t concerned nor have they followed up with it.

    Do you know whether elevated DHEA would cause fatigue or is a stage of adrenal fatigue even if the cortisol is normal.

    Is there any other tests that could be done to determine this?

    Do you know whether it would drop the SHBG because it is high, or whether naturally high DHEA levels could cause heart palpitations.

    I’m following up with my doctor about the DHEA levels but just curious on your take.

    Thanks for your time.

    • Dr.Lam says:

      High DHEA with normal cortisol points to a body on adrenal overdrive. There are many reasons, and a detailed history will put the puzzle together. There are many pathways that have to be considered. It is person specific.

      Dr. Lam

  • Shelby says:

    This was a great informational article– The video was interesting too!

  • Katie says:

    Would the hormonal changes that happen during pregnancy assist with adrenal fatigue? Even though fatigue is also a factor in being pregnant?

  • Heather says:

    Dr. Lam,
    My main concern when I was first diagnosed with Hashimoto’s about 2 years ago was the weight I was gaining and there was no reason for as I eat very healthy and exercise very regularly. My doctor just recently put me on a small dose of hydrocortisone for adrenal fatigue. I have felt a world of difference in just the few days of taking it. Is it possible taking the hydrocortisone will help me lose these stubborn 10-12 pounds I have been trying to get off for about 2 years now or could there possibly be yet another underlying reason why I am not able to lose any weight? Thank you!

  • Sara says:

    How powerful are xenoestrogens? Can they cause pregnancy complications?

    • Dr.Lam says:

      They are not very powerful on their own but can have a significant cumulative effect on people who are already marginal to start.

      Dr. Lam

  • Dana Evans says:

    Can discontinuing bioidentical progesterone cream 40mg a day cause a temporary state of adrenal insufficiency? I had all the symptoms of excess levels. I lost all the water weight and all was well until six weeks later when I had low BS/cortisol symptoms, very low mental and phys. Energy, cold intolerance, and low body temp. Basal and midday. I also have hashimotos so maybe the sudden fluctuation threw my thyroid off, too? Will my receptors likely become resensatized after the excess? Would it be best to begin again, if indicated by the saliva test, at 20mg./day?

  • Donny says:

    can electrolyte issues cause hormone problems?

  • Armando says:

    My MD just started me on hormone replacement without really giving me an explanation. Im happy to have found this article. I will call the number if I have any additional questions. Thx

  • L. says:

    I recently had my pregnenolone tested, and it is <6 ng/dl (range: 7-188 ng/dl). Thyroid is low, too: FT4: 0.97 (range: 0.80-1.80 ng/dl) and FT3: 2.9 (2.0-4.4 pg/ml). DHEA is 107 (range: 35-256 mcg/dl). Historically, I've had adrenal issues (mostly low in the a.m. and then high-ish at night). I've also got elevated liver enzymes (GGT, AST, ALT). Would supplementing pregenolone be indicated? Thanks so much for any response!

  • sharon says:

    addition to previous email from sharon
    He rejected the saliva tests done through neuroscience and my natural dr.
    sorry I forgot to add this to my previous email. sharon

  • sharon says:

    Dr. Lam: my endo ( who does not believe in adrenal fatigue) wants to test me using dexamethasone. I would take it at bed time and then go in for blood work at 8:00 a.m.
    I have had many saliva tests done but he doesn’t believe they are valid.
    I am concerned, I do not want to put dexamethasone in my body, and told him so in his office. I have stage 3d adrenal fatigue, will dexamethasone hurt my adrenals? I have loved your books. thanks sharon 3/13/2017

  • Anna says:

    Dear Dr. Lam, is it possible with adrenal fatigue to not only have high cortisol, but also have high ACTH? Or should the pituitary regulate ACTH to be at lower levels if cortisol levels are too high? I am asking because the doctors have found a pituitary microadenoma, and because of the increased ACTH and cortisol together, they think it’s a mild case of Cushing’s syndrome. We’ve done a 24-hour urine cortisol test, ACTH test (taking Dexamethasone), etc. But I am uncomfortable assuming that it is due to a pituitary tumor, if it is possible that ACTH could also be too high in a certain stage of adrenal fatigue. Thank you!

    • Dr.Lam says:

      When The ACTH is high in cases like yours and with your type of history, you have to think more towards the pituitary.


  • Adrienn says:

    Dear Dr Lam. I am a Hungarian girl, I can not speak English, it helps me to google translator. I hope you understand what I write. I have adrenal fatigue for years. Salivary cortisol testing demonstrates morning 2.2 nmol / L, during the day is over 1.5, very few. not menstruating for 3 months. All the symptoms fit me, estrogen dominance is likely to be for me. Slow weight gain, sleep disorders, PMS. I tried to cure recommended vitamins and licorice capsules, but it did not help. 2 months ago I use progesterone cream, 14 days to 26 days.
    After two months in the morning cortisol 3.4 nmol / L, but the rest is still 1.5 nmol / L below. Apply pregnenolone supplement about one week, starting 10 mg orally morning. Now the 60 mg dose, DHEA supplement no. What do you suggest? How long the dose may be increased? Should you use licorice? I think not, because it disturbs the natural balance. Thank you very much for taking the time to my problem, I look forward to your reply. I welcome you!

  • Chad says:

    Wow, I can across this article because I was told I might have to get on hormone replacement (testosterone). This is a heavy article but a good read as well. Thanks.

  • Sandra S says:

    Thank you Dr Lam for your detailed explanations of our hormones. There is so much to read, I can’t take it all in.
    I have been unwell . for years, with chronic fatigue, hypothyroid, severe adrenal problems; unable to handle any stress, without getting episodes of heart symptoms – tachycardia, palpitations, arrhythmia &/or fibrillation; I have no real life. Finding a doctor in UK with any knowledge of adrenals, thyroid or chronic fatigue is next to impossible.
    I recently did a saliva, adrenal stress test and am now worried sick I have Addisons, as two results have no reading.
    Sample 1. 38.27 H Range [7.45 – 32.5]
    2 . 6.09 [2.76 – 11.3]
    3. <dl L [1.38 – 7.45]
    4. <dl L [0.83 – 3.86]
    DHEA . Sample am. 0.6 [0.25 – 2.22]
    Sample pm. 0.14 [0.25 – 2.22]
    Mean . 0.37; Ratio 0.016 ]0.015 – 0.150]

    • Dr.Lam says:

      You need special tests to diagnosis Addison’s Disease. No reading is not uncommon. Click Laboratory Testing for more information. Be careful not to interpret lab results yourself when you dont know what you are doing.

      Dr Lam

  • Jake says:

    What are natural ways to control cortisol without the use of steroids?

  • Denise Chilton says:

    I have primary addisons for 26 years , am now 53 and have been on 25mg hydrocortisone and 200mcg fludtocortisone for that long. I have added dhea 25mg daily for the last few years, exercise daily and eat a healthy high protein diet. Despite this I find my energy levels & particularly ability to handle stress compromised. My weight remains very low at 47 kg( height 5 foot 4 inches)I would be interested to learn more about wether adding pregnenalone may be helpful ? I was using bioidentical progesterone and estrodial for about 3 years , with good results initially but over time gained a lot of weight in like celllulite deposits around abdomen thighs and upper arms indicative of excess hormone, so stopped. Am currently still having mostly regular monthly cycle. I have blood tests and see the endocrinologist annually but cannot seem to get any advice re: the dhea or pregnenalone.. I have done a lot of my own research but would very much value your opinion.

    • Dr.Lam says:

      Pregnenolone is the chemical mother of DHEA and generally less potent but more gentle. Whether it is fitting for you depends on the clinical situation. To be accurate, a detailed history is needed. You would be wise to support your adrenals naturally as steroid use, while is needed for life in cases like yours, should still be kept to a minimal if possible especially as you grow older with many events coming your way. Think long term, not just short term energy support.

      Dr Lam

  • Blue says:

    What if you have been on hormone replacement for years. Would it be impossible to wean off?

  • Sue Smith says:

    My 16 year old daughter has suffered longterm stress and has been unable to attend school for 3 years because of fatigue. The saliva test has shown she has raised cortisol and very low DHEA which also causes her to have hypos after eating. I would estimate around Stage 2. We are waiting to see a consultant which may take some time. Is it safe to give her 10mg of DHEA to see if it gives her any relief and rebalances the ratio with cortisol? After such a long time, I’m desperate to help her in some way. Many thanks

    • Dr.Lam says:

      Raised cortisol and low DHEA does not necessarily lead to reactive hypoglycemia. Be careful on how you interpret the test. What seems obvious may not be so simple in young adults because there are multiple hormonal changes going on.
      Click Laboratory Testing for more information.

      Dr Lam

  • Maggie says:

    I have been on and off hormones but do not feel a difference either way what does this indicate?

  • Richard says:

    I had a test done on my hormones everything tested in range or good. Except my estradiol(3) level it tested 13 pg/ml below normal levels for a male 37 years old. Would supplementing with estrogen be a good idea? Thanks!

  • kate says:

    I have been struggling with insomnia nightly for 18 months and awake each morning between 1-3am hungry and sweating and then alternating between sweating and being chilled and cannot return to sleep, if at all, until about 6am, no trouble falling asleep at 10pm. All my hormone tests TSH oestrogen etc were normal except 9am cortisol which was on the low side 284nmol/l (range 138-635), synacthen was normal. Could my insomnia & constant fatigue be due to my cortisol levels being very low at 3am so I am unable to regulate blood sugar levels? I do struggle with hypoglycemia symptoms some days although blood glucose levels are always normal. would a low dose of hydrocortisone help with the nightime hunger / sleep?

    • Dr.Lam says:

      It is possible, but it could due to other causes as well including hormonal, metabolic, and neurotransmitter imbalances etc.

      Dr Lam

  • Daniel says:

    Can meditation make AFS worse? I am trying to calm myself down at night but I seem to get more agitated instead of relaxed. Is this a hormone problem?

    • Dr.Lam says:

      Generally speaking, meditation is helpful, but if you are in very advanced stages, mediation can be too much for the system if the body is not used to it.

      Dr Lam

  • Sandy says:

    Great information Dr. Lam! I just started HRT with progesterone capsules, estrogen and testosterone creams made in compounding pharm as prescribed after 24 hr. urine hormone testing. Also blood tests. these hormone levels are all low; DHEA is “normal”, 5a-THF is high, pregnanediol low, cortisol is 48. So she wants me to also take pregnenolone but I am worried it may compound the other HRT supplements? I am also taking melatonin,iodine (my sodium is low), and Beta-TCP supplement. Is the pregnenolone beneficial? (I am 60,post menopausal and general good health and want to stay that way!) Thank you! 🙂

    • Dr.Lam says:

      Be careful of having too many hormones on board. Treating numbers is easy. Whether you actually feel better is a different story.

      Dr Lam

  • Yvette says:

    I have recently been diagnosed with 1st stage of Adrenal fatigue, this was established from a 24 hr Saliva test where my Cortisol levels were high, especially on wakening (off the top of the scale) and still high in the evening prior to bed. In relation to this my DHEA levels were low in the evening and ratio was low. Besides vitamin D, C, B etc I am also on 25 mg of DHEA. In addition to this I am also diagnosed as hypothyroid (results are low-normal levels, fully symptomatic). Not currently being treated for the thyroid at the moment just the adrenals, but have noticed my ‘turns’ of hormone release are becoming more frequent, and hypo symptoms stronger e.g. emotional, anxiety etc. Pulse rate at rest can jump from 49/55 – 85 in a min. Is this a sign my adrenals are improving ? or do I need to start now treating the thyroid ?

    • Dr.Lam says:

      A fragile pulse is a sign of body being stimulated. It can be due to a variety of factors including DHEA. Secondary thyroid issues usually resolve if adrenals are properly healed.

      Dr Lam

      • Yvette says:

        Hi Dr Lam,
        Thanks for the reply, am I on the correct medication for healing the adrenals or should I be taking anything additional e.g. progesterone etc ?
        Many thanks

  • Allen says:

    Is it true that vitamin D is a hormone?

  • Annette Venet says:

    Dear Doctor Lam
    I totally agree with you : hydrocortisone is not the best choice for me at this time. You WERE RIGHT. After 5 weeks I stopped it. Although I was in paradise in the day, at night it was hell : I had terrible adrénaline flashes. I read on other sites and books it was because of to low dosage, and I should go on higher dosage such as 25 or 30 mg. But I’m so afraid to be worse that I did’nt try it of course. So for the moment my body does’nt tolerate weather HC nor thyroid hormon. I stopped both despite of my thyroid hormons déficiency and all symptoms of both AFS and hypothyroïd. My thyroid bas become as large as a hazelnut. Because of what exactly ? I had a lot of dental fillings (mercury), fluor intake during my pregnancies and one year lithium ! And then Tchernobyl accident, I live in the east of France and we were deep affected.
    You write in your book that when patients With AFS recover, their thyroid issue improves too. But do you mean it could be the case for me ? Or one day I must anyway re add thyroid hormones…? So after how many time ?
    Do you mean dhea could be ok for me ? I noticed it helps my damaged skin and my mood (a little).
    I take only 25mg three times weekly.
    And I ordered progesteron cream and it helps me to fall asleep in the evening together with melatonin. What do you mean ?
    Thank you so much for your helpful answers every time. My doctor is very open minded but she knows nothing about AFS, but I can’t be annoyed because here in France almost nobody knows the existence of AFS or completely denies it. And nobody knows either the relationship between the different glands, they give consistently thyroid hormones and nothing all !
    I’m so thankful for all !


    • Dr.Lam says:

      The body reacts logically. Understanding the physiology will help to put the whole picture together. Hormonal replacement, whether it be DHEA or anything else, need to be carefully considered as there are pros and cons. Click Adrenal Fatigue & Hormone Therapy for more information.

      Dr Lam

  • Annette Venet says:

    Dear doctor Lam,
    Now I received your book in France and I’m reading it and practice your breathing exercices.
    As you wrote me 14 days ago, one can take hydrocortisone but with small doses and only for a short time. So, I’m taking some, as already said and it works very well. But I need some doses, you surely won’t agree with…
    I did trials and the best to me is 5mg at 8, 5mg at 12, 5mg at 4pm, and 5mg before bedtime, which especially great works ni order to sleep in. In the middle of the night I wake up, and can fall asleep again only after one or two Hours. Maybe a little dose at this time would be necessary to fall easy asleep again, but I did’nt try !
    In this way I could stop my sleep aid medication I had to take years along very quickly, i take just melatonin. Likewise with my antidepressant I have been taken for long long years to ! I simply stopped to take it. And I feel astonished well.
    I am a woman, now 59. But i am, according to your book, on stage 3D and was these last years a living dead, lying a good part of the day (I was a teacher) and can no more do my job. Everybody thought I was just depressed of course. But for me I was in hell…
    So excuse me pour this long post, but is HC not very necessary in my case ??
    I can eat and sleep again ! Live comes back to me. And at my age, is it so harmfull if I must take HC for six months or even two Years ?? Would adrenal cortex be sufficient in my case ? And you know here in France we can’t get such products. May be they are even prohibited, I don’t even know. I should order them somewhere…
    My life quality is in stake. Perhaps after some time I’ll can take my T4 T3 again and wean hc. I’ve a very atrophied thyroid (not hashimoto). At least I hope.

    Thank you so much for your answer.

    • Dr.Lam says:

      HCTC is a prescription medication and you need to consult your treating doctor and follow his advise. Please do not self navigate as this drug is powerful and have long term consequences. Very sorry I cannot give you more suggestion specifically as this forum is for educational purposes only as everyone is different.

      Dr Lam

      • Annette Venet says:

        I understand… unfortunately, my doctor doesn’t know how to manage…but she prescribes me hc…
        But I am so thankful for your answers. I hope I learn a lot reading your book !

  • Maria says:

    Why are hormones so complicated !? Maybe it’s just me trying to interpret them? Anyways, thanks for the info, it was a great read.

  • Luke says:

    Dear dr. Lam,
    I am a 52 year old male, 1m78 tall, weigh 71 kg, and have been suffering since mid June from severe fatigue due to overtraining. I take medication for high blood pressure (as did my parents), have trouble sleeping, have been constipated, etc. Meanwhile, I increased my protein intake, and try to avoid foods rich in simple sugars or soy. I also consume more healthy fats (like salmon and avocados) and replaced cow milk with goat milk, rice milk etc.
    The blood tests showed slightly elevated total cholesterol (197 mg/dL), and low vitamin D (25-OH-vD.: 15.4 ng/mL ref range 30/100). The rest was quite normal (eg. TSH: 1.51 mU/L vs 0.27-4.20).
    I also had a 24H urine test done:
    Magnesium: 1.90 mmol/L (ref range 3-5)
    T3: 285 pmol/24H (250-1250)
    T4: 477 pmol/24H (400-1600)
    Cortisol: 43 ug/24H (36-137)
    Androsteron was OK, but Pregnaantriol, all the 11-Keto’s and especially DHEA (0.02 mg/24H vs 0.06-0.86) were below the ref. ranges.
    My doctor proposed 1 high dosage magnesium baxter per month for 3 months. I also asked for a DHEA supplement, but he does not agree. However, I have been doing a lot of reading on Adrenal Fatigue and suspect I might be somewhere between Stage 2 and 3 (given the very low DHEA and borderline cortisol), so I recently starting taking 25mg DHEA daily.
    What’s your view on the matter?
    Many thanks

    • Dr.Lam says:

      If you are concern with magnesium, get a RBC magnesium which will tell you the true picture. urine and serum sample is not very indicative. Low Pregnenolone and possibly DHEA in AFS is common and reflect a “steal” phenomena describe in my book which you read so you understand how to better understand laboratory values and how to interpret because it can be very confusing and convoluted. The use of hormones should be carefully considered. Click Adrenal Fatigue & Hormone Therapy for more information.

      Dr Lam

  • Venet annette says:

    Dear dr Lam, i surfer of chronic fatigue since about 10 years and have been placed under thyroïde médication t4 only for 8 years without success. Then thist year I went to a doctor in Belgium and he gaves me t4-t3. Unfortnately I am worse. I am on stage 4 of adrenal fatigue without a lot of insomniaque, l’ost of appetite, great l’ost of wheight I went to my physicien and asked for hydrocortisone. Only one tablet 10mg and I felt immediately better. Since 14 days i am continuing to take it. 10 mg in the Early morning and 10 at lunch Time. I feel great better In body and mental. I have decreased intake of t3-t4. (1/2 euthyral) But i read on you site hydrocortisone can worsen adrénal fatigue !
    So What Must I do ?? give up every Kind of treatment, both for adrenals and
    Thyroide ? What do you mean ? Please help me ! I live in France and have just bought you book by Amazon hopening to find some possibilities of relief. If you have any advice it would be great for me. I’m totally exhausted and can’t work any more.
    Thank you very very much !

    • Dr.Lam says:

      Steroid can be considered as last resort, and temporary if possible. YOu need to read my book and understand more the pros and cons. When you are in this stage, any advise cannot be easily dispense without a great knowledge and detail of your body. This is especially true when your body appear to reject thyroid meds and now need steroids to stabilize. Having said that, nothing you are telling me is unusual. Call my office and make an appointment by telephone to talk. I will take a more detailed history and tell you on the spot your options, both naturally and conventionally.

      Dr Lam

      • Venet annette says:

        Thank you very much for your quick answer. First I’ll read your book and try to understand und see…

      • Venet annette says:

        And I’m afraid I don’t speak and understand English so easily for a telephone appointment… I read first your book.
        And I thank you so much for all the time you dedicate to answer on this site.

  • James says:

    Can you quit Pregnenolne cold turkey after starting it. I have been taking 5mg a day for 3 days with adrenal fatigue stage 3A or 3B.

    • Dr.Lam says:

      It all depends on the person. Three days is not a long time and generally should be ok if your body is relatively strong.

      Dr Lam

  • Jennifer says:

    My Testosterone levels are very high and I am not sure what to do I do not want to be on any medications for this.

    • Dr.Lam says:

      High testosterone is a symptom and your focus should be on the source of the increase output. See an endocrinologist for work up.

      Dr Lam

  • Matt says:

    Dr Lam, regarding your above statement ‘Pregnenolone should be derived from a pharmacologically pure product and not a yam-derived “precursor.” ‘, do you mean that pregnenolone supplements should not be derived from yam, or do you mean that pregnenolone itself should not be derived (created in our body) by taking yam extract supplements (diosgenin)?
    I just want to verify if the pregnenolone supplements that are derived from yams and converted into pregnenolone in laboratories are ok or not.

  • Shannon Belland says:

    Dr Lam…I am experiencing low adrenals and my doc has ordered Cortef but I am not sure he’s well versed in the dosing of it…wants to start me at a low dose of 7.5mg….5mg am and 2.5 mg at 4…what is your thoughts on this?

    • Dr.Lam says:

      The use of Cortef should be one of last resort. We tend to stay away from that unless absolutely needed because of side effects and long term issues, but it dose have its place short term. Fortunately we have found no shortage of natural compounds, if done right, that can support adreanals wihtout the use of steroid. But each person is different. Dosage can be as low as 2.5 mg and ranges much much higher. Every practitioner have their own comfort zone, so to say. Talk to your doctor more is key and you should be comfortable with the pros and cons. Click Adrenal Fatigue & Hormone Therapy for more information.

      Dr Lam

  • Maureen Kirby says:

    Hello Dr. Lam,

    Do you advise the use of DHEA in capsule form, trans-dermally or sublingually? Should we be bypassing the liver when we are using this?

    • Dr.Lam says:

      they all have different properties and different uses, depending on the person. sublingual is fast delivery but can be too excitatory for some people., for example.

      Dr Lam.

  • Robert says:

    Just wanted to thank you as well for putting together this information. I have found the subject of adrenal hormones so confusing, and a lot of websites do a poor job of explaining it. Finally, a site that cuts through it all in a straightforward way!

    In the past year I have taken high dose prednisone (50mg and 60mg) on two occasions, spanning several months. I was then able to titrate down and eventually stop. However, this year I find I am caught in the cycle of adrenal recovery where my original health condition is susceptible to flaring. I have Inflammatory Bowel Disease and prednisone helps control it until the gut lining can heal. But this year I’m finding the lack of adrenal strength is allowing the gut inflammation to creep back in — perhaps a cortisol deficiency? Also have low BP, electrolyte and blood volume issues, etc. So I’m caught in a catch-22 where I need cortisol to control inflammation but might not have enough and they want to put me back on prednisone.

    I just finished my prednisone taper a month ago so it’s too soon for an official adrenal fatigue diagnosis. They may recover. I just don’t know what to do in the mean time to support them. My doctors here are useless, they aren’t willing to do adequate investigation, even simple blood testing. Seeing an endocrinologist will take 5 months.

    I experimented with DHEA at 25mg/day, but I found it too strong. I do feel that my testosterone levels are currently decreased, so my entire adrenal cascade is weak or imbalanced. But the DHEA did not seem to solve the problems I’m describing, it just made made libido higher and made me more irritable, but it didn’t seem to quench inflammatory problems (which are admittedly complicated, but there is definitely an adrenal relationship).

    The other thing I’m not clear on is if taking adrenal pro-hormones and other nourishment aspects can undo adrenal atrophy, or if it’s basically just damage control and maintenance? I’m 30 and it would be sad to find out that prednisone has destroyed my adrenals. My MD has said that reduced adrenal function is “forever”, but they say that about everything.

    I may look into trying pregnenolone at low doses as a supportive measure. I know I should be doing it under a doctor’s advice but I don’t have medical resources right now to help me with fine tuning, and I’m kind of desperate.

    Thank you!

    • Dr.Lam says:

      Prednisone is a drug of almost last resort, and repeated use can lead to withdrawal, resistence, and tolerance. I can sense your plight and your effort to titrate using pro-hormones. You do have to be careful as they may not be indicated. Click Adrenal Fatigue & Hormone Therapy for more information.

      Dr Lam

  • Helen P. says:

    I just wanted to stop by and thank you for your time and this website 🙂 only takes 1minute of my day to thank you for the millions of minutes you dedicated to this so I suggest others do the same

    • Dr.Lam says:

      Thanks for taking the time to write. The encouragement from many like you is what keeps us going.

      Dr Lam

  • Stephanie says:

    Thank you for the information, i have been suffering with symptoms for a while and through reading this i now how a better understanding of what i am going through. Wasn’t aware how much hormones were so closely correlated with fatigue.

  • Savannah Jane says:

    I love the fact I can get lost on this site and not feel guilty about it. I feel like I have used my time to benefit my life tenfold by gaining the knowledge shared with each article. I can’t thank you Dr Lam enough for your knowledge

    • Dr.Lam says:

      thanks for your kind words. The more you know, the better for you to navigate through this condition.

      Dr Lam

  • Elena says:

    Can you provide more information about the use of DHEA/Pregnenolone when you have uterine fibroids? I’m reading mix reviews about it. I know uterine fibroids can cause nausea but after being on DHEA and pregnenolone (for stage 3 AFS) for a month my nausea has worsen.

  • Eva Corral says:


    I have battled fatigue my entire life, insomnia, muscle spasms, back and hip pain; diagnosed with Fibromyalgia. Had a partial hysterectomy 5 yrs ago (ovaries and cervix intact. I’ve recently came across an article on on Adreal Fatigue and ordered a saliva test. My results came in yesterday and before running to different doctors I would like your advice on what questions to ask. I have an appt with an naturopathic/accupuncture/ Md next week. I am so confused with all the content found online….
    Test taken: 06/15/2016
    Results: 24 hour saliva test
    Estradiol 0.7
    Progesterone 127
    Ratio Pg/E2 181
    Testosterone 14
    DHEAs 2.6
    Morning 3.5
    Noon 5.1
    Evening 1.9
    Night 0.8

    I would appreciate any and all advice.

    Thank you,


    Medications taken: ambien 5mg, 3 Benadryl each night. I No longer take anti depressants, lyrica anti inflammatory etc prescribed for fibromyalgia…too many side affects.

    • Dr.Lam says:

      Proper interpretation of lab must include close correlation with clinical situation. Wrong intepretation can be common. Click Laboratory Testing for more information. The same results can have different meaning depending on the history and current condition. Be very careful not to overread into the lab as it is easy to treat numbers while underlying root issue get worse.

      Dr Lam

  • Nicole says:

    Thank you for giving us the opportunity to understand all this valuable info. I’ve been dealing with Adrenal symptoms so long and I’m so happy that I have finally have a resource to look to.

  • stephanie allen says:

    Thank you for these articles. I have been in a severe adrenal crises for about a year. I went to a naturopathic doctor which helped a lot, but everyday is still a challenge and I feel worse in some ways, and very congested. All activities except for work have ceased. Where can I get a consultation to go on a full recovery plan?

    • Dr.Lam says:

      Some roller coaster type ride is part of the recovery process, but the overall trend should be up, and most people do better in a matter of weeks or months. Congestion points to underlying unresolved issues that can deter the recovery process. We have a telephone coaching service which deals with retarded recovery. You can call for an initial telephone appointment at no charge if you are in the US or Canada.

      Dr Lam

  • Amaya says:

    Dr. Lam – I was diagnosed with autoimmune thyroiditis three years ago and ever since I have been on T3/T4 medication and taking 100mg Pregnenolone daily to support adrenals. I have been feeling WONDERFUL during three years with the thyroid medication and the Pregnenolone however:
    my periods stopped half a year ago and my gynaecologist prescribed a bi-gest cream containing Oestradiol and Progesterone to treat menopausal symptoms. A month after I started the cream, my hair started falling out in clumps, it is very severe hairloss. I am told the cream is supposed to have the opposite effect, allegedly Progesterone blocks DHT conversion… Could it be that it is not the cream but the Pregnenolone causing the hairloss (prolonged use?), or an interaction between the cream and the Pregnenolone? Could the addition of Progesterone to Pregnenolone have caused an excess of androgens in some way? The hairloss is dramatic, so I have stopped both the cream and the Pregnenolone. I would welcome insight into this. What is the mechanism by which Pregnenolone is linked to hairloss, is it the possibility of it converting into DHT?

    • Dr.Lam says:

      The DHT pathway is just one of many pathways that regulate hair health. When the adrenals are weak, we do see this type of clinical picture that you referred to . The exact mechanism is not known, but we suspect it is due to the dysregulation trigger by selected hormones that lead to paradoxical behavior. Fortunately, this can be stopped as far as reamining hair, but it usually takes some time to first resolve the underlying issue and rebuilt the system with proper balance and the hair loss slows. Remember that if you have unattended AFS underlying, the thryoid and pregnenolone may have made you feel great at first, but the price you pay is the masking the root problem, and the bio identical hormone can act as a negative trigger.

  • Leyla Salvo says:

    Dr. Lam- I was diagnosed four years ago with hypothyroidism with symptoms being heavy menses with resulting anemia/fatigue and constipation. I was placed on levothyroxine 25 mcg and my hair started falling out horribly. Two pregnancies ensued and all hairloss stopped three months into the pregnancies and again four months post partum..levothyroxine never fixed my initial symptoms and adding t3 did resolve constipation and heavy menses but the hairloss is still excessive and I am more exhausted than I should be..especially after a long day.

    • Dr.Lam says:

      When thyroid support fail to give you the solution, you have to start looking outside the box. Low thyroid function that is persistent can indicate adrenal issues and resistance issues. Hair loss is quite typical . Until these root issues are resolved, often more thyroid support only is temporary at best and many become overstimulated and “wired and tired” is possible. Hormones such as thryoid therefore can be helpful shortterm but you have to be alert when it fails. Click Adrenal Fatigue & Hormone Therapy for more information.

      Dr Lam

  • Neil says:

    Would taking pregnenolone decrease the body’s natural production of pregnenelone?

  • Mark says:

    Thank you, Dr. Lam, for making your research public. It has greatly contributed to my understanding of my unique situation (loss of ACTH from radiological damage to pituitary).
    My symptoms are therefore similar, but not identical to those from Adrenal Fatigue. I suffer from early morning adrenal crashes (even with a maintenance level cortef), and have an acute intolerance to sharp temperature drops. Any suggestions?

    • Dr.Lam says:

      Your situation is complex. Morning cortisol can be adjusted by titrating your meds according to your doc. If that does not work, then you have to start thinking outside the box. There are various other pathways that may be involved that may be deterring the normal function, including resistance that tend to be associated with people on long term steroid use. Sharp temperature drop intolerance is very significant as it points to underlying metabolic dysregulation and loss of proper regulation which is usually autonomically driven. This goes along with the resistance picture as one possibility. A detailed history will tell the big picture. Laboratory test are not very good and can even be misleading

      Dr Lam

  • Holly says:

    I read that in another Dr. Site that the body cannot convert Pregnenalone supplement into other hormones. Are there studies to demonstrate either way?

    • Dr.Lam says:

      Pregnenolone is called the mother of all steriodal hormones because it converts to DHEA and many other hormones step by step in a complex cascade. If you want to learn more, read my book and its detailed there. Click Book – Adrenal Fatigue Syndrome – Reclaim Your Energy and Vitality with Clinically Proven Natural Programs for more information.

      Dr Lam

      • Nathalie says:

        Hi Dr Lam. I tried taking 25mg of oral DHEA recently and had to stop immediately. My had a bad reaction and heart palpitations became worse. I have been diagnosed with marginally low cortisol from a blood test done in the morning, but not dure how accurate this is. I feel like i have advanced adrenal fatigue along with impaired liver function. I have irregular heart beats/rhythm and doctors are not pointing me in the right direction. The worst of my symptoms are the palpitations. Due to impaired liver and digestion function, I am reluctant to take supplements. Please help!

        • Dr.Lam says:

          When the body is intolerant to DHEA there are multiple reasons, from dosage issues to sensitivities that usually point to underlying unresolved issues, or advanced AFS. None of these are good senerios, especially with the other accompanying symptoms you mentioned such as liver congestion and heart rate problem. Fortunately, they all fit into a picture if you understand the underlying issue and how AFS can affect the body in numerous ways. Nothing you mentioned are unusual. We deal with them daily in our telephone coaching service. I know it can be scary. You should go back to your doctor and ask for help, and as last resort, you can call my office and I will explain to you.

          Dr Lam

  • Sarah Z says:

    Dr Lam,
    I have been to several doctors, none of whom have any idea how to help me. Most of my blood work is “in normal range.” Hormonal saliva testing came back with extremely low cortisol levels (my evening level was 0.48 nmol/L) but my DHEA levels are sky high, causing high testosterone and estrogen dominance. My hair falls out all day long, even my eyelashes are falling out. I am so tired I’m afraid that I will lose my job, and I’m not even thirty yet. I can’t find anything online about high DHEA levels combined with low cortisol. I also take a lot of sublingual vitamin b, but have no energy. It’s like my body cannot utilize the hormones and nutrition that are available. Have you ever seen anyone with the high DHEA/low cortisol paradox? If so, what helped them?

    • Dr.Lam says:

      A high or low DHEA has little relevance to the cortisol clinically because of various mechanism in place in addition to the straight physiological pathways which does not apply to everyone. Nothing unusual. We deal with this in our telephone coaching program frequently. Loss of hair is often in a case like this trigger by AFS resulting in loss of protective conversion from testosterone to DHT in non AFS people , resulting in more DHT and thus hair loss. The exact reason is unknown but the good news is that this often resolve itself when adrenals improve. Excessive Vitmain B is not reocmmended as it will only make things worse over time. Your situation cannot be resolved by someone who tries to “go by the book” because the book does not recognize AFS and thus miss the many connection when AFS is in place. Only a detailed history can put the puzzle together. The more lab you , the more likely you are going to be more confused. The more you stimulate the adrenal including with Vitamin B , herbs and glandulars, the worse it gets. However, if you are already on these, you should not stop abruptly or without an alternative safety net in place that is right for you as you risk withdrawal and crashes. We take great care in crafting a program for people like you to avoid the many issues you bought up.

      Dr Lam

  • Emma S says:

    Dear Dr.Lam,
    i have read your site with much interest, such information proving a rare find on the internet. I had an ASI done several months ago, the results showing extremely low levels of DHEA and cortisol peaking slightly in the morning, though not as high as it should be. Brief medical history – type 1 diabetes for 21yrs, double transplant (kidney/pancreas) in 2003, prednisolone treatment for 3yrs finishing 3yrs ago. Prior to taking the ASI was experiencing hypoglycaemia, fatigue, intolerance to stress, symptoms of hypothyroidism,etc. I have been taking a Nutri supplement (adrenal glandular) and have also addressed my diet, removing all sugars and any possible gut inflammatory triggers. The results, I feel a lot better, no more low blood sugars, mood is more level, energy levels increased. However, I know there is still a way to go, I am still experiencing symptoms of low thyroid, there is still an intolerance to stress, and so my question is, will pregnenolone and/or DHEA supplementation benefit me? I would greatly appreciate any guidance, many thanks.

    • Dr.Lam says:

      Your situation is quite complex because of your history. low thyroid function often goes with low adrenal. The use of hormones and glandular of any king needs to be carefully evaluated because it can often mask the underlying problem, giving you a false sense of improvement and only lead to dependency and withdrawal issues. On top of that many hormones do normalize itself and external hormones can potentially lead to dysregulation of feedback loops. you need to talk to your doctor prior to embarking on such a program. They do have their place under proper situation. Click Adrenal Fatigue & Hormone Therapy for more information. Also click Adrenal Fatigue Glandular & Herbal Therapy for more information.

      Dr Lam

  • Heather Bradley says:

    Dear Dr Lam

    I recently discpvered your website and it’s FAB!

    What a pity you don’t work in Britain. Do you have any pals from Med School working in Britain who are as intelligent about adrenals as you? If so, please give me their practice details.

    You see I’ve been going through the Menopause from Hell for 8 years now, yes, that’s right EIGHT years! Also, I’ve got ME or Chronic Fatigue as it’s also called. And since puberty I’ve had hypoglycaemia and oh, if that’s all not fabtastic enough… I’ve also had Adrenal Exhaustion (cortisol saliva tests proven) too, since 2003 (caused by severe financial stress) and so in 2009 when I was second year into the menopause a bomb basically went off in my body, which meant that what causes palpitations in a woman somehow has also caused me to experience INCREDIBLE, OFF THE SCALE hunger when under stress.

    Anyhow, so I’ve taken Isocort, Adrenal Glandulars, vitamins, maca herb – you name it I’ve tried it. Oh, and what I forgot to tell you is that I’ve spent 90% of the last 8 years in bed with the most profound and disabling exhaustion known to man. And woman!

    Because of the reduction in the oestrogen on my brain and as the brain in the control of the body, whenever I need to use my brain… such as typing this, talking, listening and reading… I tend to find that I get very,very hungery. Indeed, all stress makes me hungry.

    Since 2009 when the palpitaitons started I had to eat before I slept and then about 6 hours later I would get woken for food, with shocking palps. THen it would take me about 90 mins to 3 hours to get back to sleeps. And I forgot, my adrenals are my dominant hormone.

    Basically, my food isn’t working for me in the sense that I don’t get energy from food like I used to. I used to be so lovely and slim. Slim my entire life until (8.5 stone from 21 to 43) I got stressed and noticed getting fatter round tum but not eating any more food. With the AE and the Menopause and all the hunger of both… I have gone from 8 to 18 and its been a VERY painful time for me.

    I could not ignore the hunger before bed/in the night otherwise I would not get to sleep and if I did not get up in night I would wake next day and feel TERRIBLE and need to eat every 2 hours.

    It seems to me that m y food is not converting into energy properly, Is that one of the symptoms of AE, only I looked on your list and could not see that? It seems to me that my brain is tired because its not getting food properly. When I have to talk early in the morning (I am most awake in the evenings, naturally), if I eat something with sugar in it my brain does not feel SHATTERED and I do not feel hungry. But I don’t usually eat sugar. I tend to eat nuts in between my meals/protein.

    How I wish you practised in London. I would pay whatever you charged to come and see you and get better. I’m desperate!!

    I am thinking of trying a private doctor (I’ve taken supps and herbs for 5 years now but still not recovered) who can give me Plenadren (do you have that in USA), but I’ve just read one of your excellent articles on your website and it’s made me feel a bit worried about side effects of drugs.

    The menopause has been a MONSTER sized 24/7 stress on my body. Every day when I wake up I feel like there’s a 10″ slab of concrete pressing down on me. If you do prizes for endurance, resilience, fortitude and courage – I deserve one!

    How much is it to speak to yourself or one of your experts as all I want is to get better. Quickly. Or do you think that when my ovaries stop partying I wll naturally improve?

    Sorry this is so damn long Dr Lam but you are the only expert that I have been able to find.

    All I want is ENERGY, good sleeps, normal appetite and to be a size 10.

    THank you for reading this. I appreciate it. I’m also wondering if you have ever heard of other women suffering like I have/and still am?

    PS: American Docs are light years ahead of the Brits in many ways.
    When I had my first saliva/cortisol test (6.8 whole day, 2010) I got an apt with an endocrinoligst in Lancaster, a teaching hospital. He did a synacethen test and said everything was normal. I tried to tell him it wasn’t but he would not listen.

    I found out about saliva tests in a book written by an American Dr called, Feeling Fat, Fuzzy or Frazzled.


    • Dr.Lam says:

      your problem is quite typical of those that we handle. the body can often heal itself with the right tools. read my book if not already done so. call my office my staff will give you instructions on how to arrange a telephone appointment to see if you qualify for our telephone coaching program.

      Dr Lam

  • Anne W. says:

    How will I know when using Pregnenolone if my body is shunting it towards cortisol production? Also, I checked with two compounding pharmcies about Pregnenolone and they both use wild yam. Is this product still more beneficial than purchasing it over the counter?

    Thank you very much for your help.

    • Dr.Lam says:

      Your body automatically shunts when needed and is self regulated. you do not have control of that. As long as it is natural pregnenolone, they are the same. the difference is on dosage and route of delivery.

      Dr Lam

  • Amy M says:

    I tried for 10months to combat my stage 3-4 AF & hypothyroidism with the proper supplements and Cytomel, under a Integrative dr’s guidance but after a stressful event caused severe shakes, nausea, dizziness & weakness Hydrocortisone was finally necessary. Now I’m on HC & Florinef and dealing with major deficiencies in the following according to blood work: Pregnenoleone, DHEA, Progesterone, Testosterone & Iodine.
    I was put on DHEA & Progesterone, and have continued to suffer with DAILY HEADACHES, Irritability, Depression, weakness , terrible neck pain and fatigue I’m also Hypothyroid again.
    Why have I not made a full recovery with the help of Hydrocortisone?
    What are your thoughts regarding the use of Iodine when dealing with Adrenal Insufficiency? Any chance you can explain the headaches and why I haven’t improved more?

    • Dr.Lam says:

      Steriod is not necessary the solution. Not everyone can tolerate it, and in advance cases, they can actually trigger adrenal crashes. We see that in bodies that have already been overstimulated with other hormones such as thyroid, DHEA, etc. No surprise given your history. When you get to this stage, recovery is very challenging, but it can be done with proper guidance. Make sure you first find a doctor who knows what this is going on and not just keep increasing doses which can worsen the situation. We deal with many such cases in our telephone coaching service but the recovery process is slow and cannot be hurried but it can be done naturally.

      Dr Lam

  • Gerad says:

    I recently had a hair test which showed very high mercury levels and my doctor gave me an infusion of Dmps. Almost immediately I experienced a severe adrenal crash which has left me with arthritic type symptoms adrenal pain and fatigue. A naturopath has since put me on NAC, chlorophyll vitamin C, b5, however The NAC and chlorophyll appear to make me more fatigued. I tried hydrocortisone and pregnenelone briefly but found they made my condition more unstable although had some positives. I’m reluctant to use them and would rather recover in a more natural way if possible. Should I cease taking the NAC? How else can I lower the Mercury burden safely?

    • Dr.Lam says:

      What you experienced is common. Your body is weak already and the best intentioned approach of trying to help you by your doc actually backfired. You need to alert your doc that you have internal issues and your level of sensitivity so they dont put you on more well intentioned supplement that will only make you worse. When you body is this kind of fragile state, nothing will work well. You need to consider support the adrenals first. It is very delicate and no regular rules work because the system internally is not ready. You should not fight a battle until your body is ready. Mercury can be in the body for your lifetime and not cause problem. Just because you have high level does NOT mean that you have to aggressively get rid of it aggressively. Remember that until your adrenals are stable and strong, chances of you being successful with any program is very limited. The right thing done at the wrong time will hurt you more than help you. You should go back to your doctor and sit down and go over what happened and have a comprehensive plan before proceeding further with more potential damage coming. We take a long time to know the body, often weeks and months, and formulate a personalized plan to avoid the problem exactly what you have described and that is an important reason for our success.

      Dr Lam

  • Sonia says:

    Can pregnenolone supplementation cause the adrenals to shut down and atrophy or can pregnenolone supplementation take the load off the adrenals and help them to heal?

    • Dr.Lam says:

      The adrenal glands have a feedback loop where the signal to make more is turned off when there is sufficient. When you put external pregnenolone into the body over a long period of time and in high doses, such feedback loop may be involved. We have found that while in theory this pre-hormone seems to make sense for some, most people dont need it. Women, in particular ,should be careful due to hair loss and other issues. Read Adrenal Fatigue & Hormone Therapy for more information.

      Dr Lam

  • Rachel says:

    Hi Dr Lam. Thank you very much for the information, I’ve really enjoyed reading through your website and have found it extremely helpful. I just have a few questions. I recently completed a salivary adrenal test with the following results;
    Cortisol Morning: 6.0 nmol/L
    Cortisol Midday: 4.4 nmol/L
    Cortisol Afternoon: 3.5 nmol/L
    Cortisol Evening: 1.9 nmol/L
    Do these results suggest I am in stage 3 Adrenal Fatigue? My blood serum cortisol level, however, is very high.
    My other question is about DHEA. Both my DHEA results were high (DHEAS 33.8 nmol/L DHEAS/CORTISOL ratio 5.63). Do you know why that would be? It seems as though DHEA is often much lower with adrenal fatigue. I have Chronic Fatigue Syndrome also. Thanks very much.

    • Dr.Lam says:

      Dhea high can happen in early stages of AFS, and it generally goes lower as AFS advances. The cortisol curve needs to be correlated with clinical picture to make good sense. When you have CFS, the numbers can be very skewed . Try not to intepret the numbers on their as you can get very confused. Read Laboratory Testing for more information.

      Dr Lam

  • Kristy says:

    Hello Dr, THANK YOU soooo MUCH for offering us the opportunity to learn all these valuable info. I have had the Mirena IUD and I really felt that I had come back to life after so many years of suffering from extreme exhaustion and depression. Until then, I thought I had lost it and had become num and stupid. After I searched and found out about the dangers of synthetic hormones and got informed about the existence of the biohormons, I tried the cream (which by the way I find it to act like a very potent drug and that it dangerously boosts people’s ego and selfishness) and have also tried the pregnenelone and DHEA combination which led me into a terrible crash and heart arrythmias (low potassium) at the ER. I am 36, I feel that I haven’t really lived my life ever sinse I was a teen, and I am about to have the Intra- Uterus- Device placed once again, but I am afraid sinse the first time I had it removed, my immune system came down completely and I became seriously ill with infection and left with constant joint pain.some of my children are exhibiting signs of the same condition as I went through, while other members of my family are also struggling likewise. Please dear Dr, if you have any recommendations to give me, It would be greatly appreciated. Once again thank u so much…

    • Dr.Lam says:

      Your body is obviously very unique and anything you do should be done carefully with your doctor in full understanding. Do not be surprised with paradoxical and hypersensitivity type reactions based on the history you presented. I have a feeling something deep inside may be the root issue and that is not resolved, but I cannot do much more than alert you as this forum is for educational purposes only. you can call my office if you are at your wits end and I will talk to you and try to figure out what are the stones unturned so you can talk to your doctor further.

      Dr Lam

      Dr Lam

  • Bennet says:

    I go to bed at 9 by the latest every night, and get up at around 7 am, but no matter what I do, I don’t feel rested. Can you please point me in the right direction for understanding what’s going on?

    • Dr.Lam says:

      There are many reasons for waking up unrefreshed. they can range from structural problem like tongue obstructions, brain issues such as apnea, metabolic issue such as sugar imbalance, to adrenal issue such as having palpitations and waking up throughout the night. Each needs to be explored and investigated. Assuming that conventional medicine has nothing to offer, do look into adrenal fatigue as a possible cause of sleep issues. this article may help.

      Dr Lam.

      • Maggie says:


        Is it okay to take pregnenolone tablets during my menstrual cycle? How long does it usually take for low DHEA levels to normalize if i’m taking pregnenolone at 5mg to start?


        • Dr.Lam says:

          Pregnenolone is a powerful pro-hormone that can affact your menstrual cycle. you should seek your doctor’s advise prior to taking because everyone’s behavior can be different in the setting of AFS. If you have low DHEA, the first thing you should do is to find out why. In AFS, DHEA can be low and is part of the clinical picture. Trying to correct lab values without focusing on the underlying issue is a common recovery error. Do be careful. Click 7 Adrenal Fatigue Recovery Mistakes for more information.

          Dr Lam