TikTok is obsessed with reducing cortisol, but what if you're not making enough?

Let’s be honest, we’re pretty lucky living where we do, with a quality of life that outranks most. We even topped the World Happiness Index for Asia and Oceania in 2023 – fair dinkum! 

But this modern Aussie life still comes with its challenges. Between the all-hours work emails, sky-high interest rates and the rush of helplessness that comes from tuning into the news, it sometimes feels like our beautiful bodies just weren’t designed to thrive in these conditions. And when our systems start to exhibit signs of burnout, chronic stress or general malaise, it’s only natural to go looking for an explanation. 

Enter, adrenal fatigue. 

Referring to a theory whereby the adrenal glands become so overworked they stop functioning properly, it’s a term that gets thrown around to explain away a whole host of symptoms related to chronic stress. There’s just one problem – ‘adrenal fatigue’ is not a recognised medical condition. In fact, the whole concept of adrenal fatigue has been broadly critiqued by the medical community, and without an evidence base to support its existence, a ‘diagnosis’ of adrenal fatigue may well be distracting you from the real issue.  

What do the adrenals do?

Living with Addison’s disease, a rare autoimmune illness that essentially renders my adrenals ornamental, has given me a crash course on the importance of those little walnut-sized glands camping out above our kidneys. But don’t just take my word for it. Dr Warrick Inder is a practising endocrinologist at Princess Alexandra Hospital, and an Associate Professor at the University of Queensland Medical School, and he knows a thing or two about our complicated hormonal system. 

“So, the adrenals do lots of jobs, but they basically help people cope with stress of all kinds and maintain a normal blood pressure, salt and sugar balance, and vitality,” he explains, suggesting an easy way to remember their vital functions as “the four S’s – salt, sugar, sex and stress!” 

Dr Inder says the main hormones the adrenals produce that run the show are:

Cortisol – “which is essential for life. Biological clocks regulate the level of cortisol which follows a ‘diurnal rhythm’ which means the levels change across the day. The highest level is shortly after waking and the lowest is generally around midnight. Cortisol goes up normally in various forms of acute and chronic stress including psychological, physical (such as acute exercise) and trauma/illness.”

Adrenaline – “The inner part of the adrenal is called the adrenal medulla and this makes adrenaline (which everyone has heard of). This results in the ‘fight or flight’ response, and again is a stress hormone.”

Aldosterone – “which is very important for salt and water balance. Too much leads to high blood pressure,” and too little has the opposite effect. 

Adrenal androgens – which are “stepping stones to testosterone formation.”

According to Hormones Australia, these hormones help to control:

• Blood pressure regulation
• Salt and water balance
• Control blood sugar levels
• Energy production
• Sex organ development
• Stress response
• Heart rate
• Attention
• Inflammation
• Fetal development

So, they’re no small fish when it comes to our daily function, wellbeing and survival. 

The good news here is that much like our other essential organs, “Adrenal gland function is preserved throughout life in healthy people,” says Dr Inder. So, most people (myself unfortunately excluded) don’t need to worry too much about these little guys burning out. Phew! 

Can they really get… tired?

“No, the adrenal glands do not get fatigued!” confirms Dr Inder, although they do adapt based on past experience. “During repeated acute stress, the hypothalamus-pituitary unit works out that we have already been there and done that, so the signal to the adrenals is reduced, and cortisol does not rise to the same extent with repeated stress,” he explains. 

Remember the first time you had to get up in front of a group of people and speak? Heart racing, sweat pouring, senses so sharp you could catch a passing fly between your fingers? Now think about the tenth time. You might still feel that morning’s breakfast sitting uncomfortably in your gut, but your stress response may well have been muted, because your system knows you’ve been there, done that and survived to tell the tale. This is all part of a normal, functioning system, learning and adapting to its complex environment. 

Melbourne-based endocrinologist, Dr Aditi Nevgi, agrees “the adrenals should not get ‘fatigued’ from overuse; if they are truly not working well (in making cortisol or otherwise), it is possible for us to assess this with various pathology tests.”

Image: Pexels

So, what is ‘adrenal fatigue’?

The definition varies depending on the source, which is a red flag in the medical science world but, essentially, the idea is that your adrenals become so overworked and overwhelmed by the chronic stress of our modern lifestyle, they can no longer produce enough cortisol to meet the demand.

However, as we hinted at above, “adrenal fatigue is not recognised as a real condition by specialist endocrinologists,” confirms Dr Inder. Despite sounding pretty legit when you read about it on social media, the term ‘adrenal fatigue’ is not an official medical diagnosis but rather a theory, often touted by non-medical sources to explain very real symptoms that can be a result of chronic stress.

Okay, so what about chronic stress?

While our adrenal system adapts to respond to our lifestyle and experiences, there are times when we experience chronic stress, particularly where there is a long-term threat, that requires a constant cortisol response. “Great examples of this include severe depression, alcohol withdrawal and malnutrition (often seen in eating disorders),” explains Dr Inder, “where the cortisol levels can be chronically higher than normal until the stressor is addressed and treated.”

He continues, “This is a natural response to help the person recover from the stress. But sometimes elevated cortisol in chronic stress can be a maladaptive response – the key is to treat the underlying stress (e.g. anorexia nervosa, severe depression) and then the cortisol will normalise.”

Of course, life doesn’t always hand you the space to deal with chronic stressors as they arise, and the hormonal system is, in a word – complicated. Researchers have dubbed this the ‘allostatic load’ and it can be thought of as the amount of chronic stress our bodies can manage before something goes haywire, often manifesting as chronic disease. 

When things go wrong, (adrenally speaking) 

Dr Inder lays out some ways the adrenals can malfunction and what happens when they do.

Adrenal insufficiency – a very serious issue requiring treatment with medication that replaces the missing hormones, with Addison’s disease as a rare but primary example.

“Certain conditions may cause adrenal insufficiency which can be primary (arising from a problem in the adrenal glands themselves) or secondary (arising from a problem in the pituitary or hypothalamus which is a part of the brain that controls pituitary gland function,” Dr Inder Explains. 

Another cause of low cortisol levels comes from the use of steroids containing preparations that switch off the body’s ability to produce the hormone. “These are dangerous and often found in ‘natural’ supplements imported from overseas,” warns Dr Inder, noting that when testing for this, “It is also normal for cortisol levels to be lowish in the afternoon/evening so blood tests should be done in the early morning before 9 am at the latest.”

Cushing’s Syndrome – High levels of unregulated cortisol production can cause a condition called Cushing syndrome.

“This can be tricky to diagnose and sometimes it takes months or even years to confirm a diagnosis,” says Dr Inder, “It is important though, as this can lead to significant complications including diabetes, high blood pressure, osteoporosis and higher risk of blood clots, and well as weight gain, bruising and muscle weakness.”

Why is there so much confusion?

At the top of a quick Google search for ‘adrenal fatigue’, I was met with ads for various herbal supplements claiming to support adrenal function ranging in cost from $25 to $140. The reality is, there is a lot to be gained by selling a product that promises to help ease such common and unpleasant symptoms.

“Sometimes people feel like doctors are being dismissive if we don't accept the diagnosis of adrenal fatigue,” says Dr Nevgi, “It's important for both patients and doctors to know that the symptoms they are feeling (tiredness, headaches, mood changes, etc..) are real, even if we're not going to put a label of ‘adrenal fatigue’ on it.

“We know that chronic stress does lead to health impacts. We know it can affect cardiovascular risk, mood, the gastrointestinal system, and more. It just doesn't mean your adrenal glands are necessarily ‘wiped out’,” she explains. 

Both of our specialists are among the many medical professionals growing concerned by people getting their medical information from non-medical sources. 

“Adrenal fatigue seems to be becoming a more popular discussion point on social media,” says Dr Nevgi, “I'd much rather patients get their health information from a trusted health professional like their GP. It's important that we don’t misdiagnose adrenal issues, as adrenal diseases can be serious and life-threatening - we don't want to put a label on something that it's not!”

What to do if you’re worried about unexplained symptoms

Dr Inder recommends a visit to the Hormones Australia website as a first step to understanding the complex hormonal system operating underneath our proverbial hood. There are many disorders and deficiencies that can cause symptoms including fatigue, weakness and problems with sleep, and they should be taken seriously and investigated.

And when it comes to diagnosing problems within the endocrine system, Dr Inder suggests your best bet is to see your GP for a referral to an endocrinologist. “There are enough things to worry about in life without a fictional condition! Get advice from the experts who have done years of training in their chosen specialty!”