Do You Have Adrenal Fatigue?

Everything You Need to Know to Save Your Adrenals

by Christiane Northrup, M.D.

One of the most common complaints I hear from women is that they have too much to do and not enough time to get it all done. When this is a temporary situation and if you are healthy, your adrenal glands provide a burst of cortisol and epinephrine to give you the energy you need to cope with your immediate crisis.

But, if you are constantly in “crisis mode” and the demands placed on you are excessive and ongoing, eventually the adrenals become overtaxed and can’t keep up with the burden. This can lead to adrenal fatigue.

How Your Adrenals Work

Your adrenals are thumb-sized glands that sit on top of your kidneys. They help during times of fight or flight by producing hormones that give you energy to respond to the conditions of your daily life in healthy and flexible ways, both physically and emotionally.

The hormones produced by your adrenals include norepinephrine, cortisol, and DHEA.

Norepinephrine (also called adrenaline) is commonly thought of as the fight-or-flight hormone. It’s produced when something is (or you think it is) threatening. Norepinephrine makes your heart pound, your blood rush to your heart and large muscle groups, your pupils widen, your brain sharpen, and your tolerance for pain increase—basically, it prepares you for battle. Modern-day battles include pushing your body to keep going when it’s fatigued, working a stressful job, and reacting with quick reflexes to avoid a traffic accident.

However, every adrenaline surge is a withdrawal from your adrenal bank account. If you are in the habit of withdrawing too often, you’ll eventually be overdrawn and will have too little adrenaline when you actually need it.

Cortisol increases your appetite and energy level while toning down your immune system’s allergic and inflammatory responses. It stimulates the storage and release of energy in the body; helps the body resist the stressful effects of infections, trauma, and temperature extremes; and helps you maintain stable emotions. Synthetic versions of cortisol including prednisone and cortisone are often prescribed to help people perk up and feel better so they will eat, drink, and move around more and are better able to fight off illness or heal from an injury.

Ideally, cortisol is released into the system only on an occasional basis. If cortisol levels become too high for too long, as in cases of chronic stress, you can experience undesirable side effects, including loss of bone density; muscle wasting; thinning of the skin; decreased ability to build protein; kidney damage; fluid retention; insulin resistance; weight gain; and increased vulnerability to bacteria, viruses, fungi, yeasts, allergies, parasites, and even cancer.

Dehydroepiandrosterone (DHEA) is an androgen that is produced by both the adrenal glands and the ovaries. DHEA helps to neutralize cortisol’s immune-suppressant effect, thereby improving resistance to disease. (Cortisol and DHEA are inversely proportional to each other. When one is up, the other goes down.) DHEA also protects and increases bone density, guards cardiovascular health by keeping “bad” cholesterol (LDL) levels under control, provides vitality and energy, sharpens the mind, and helps maintain normal sleep patterns.

Like norepinephrine and cortisol, DHEA also improves your ability to recover from episodes of stress and trauma, overwork, temperature extremes, and more.

How the Adrenal Fatigue Spiral Happens

Women with adrenal fatigue often complain of too much to do and too little time. Yet, they continue at this pace without changing their lifestyle. The problem is your body is not meant to be in a constant state of high alert. You also need deep rest and restoration. Unfortunately, many women’s adrenals are tasked with constantly producing the hormones that keep them amped up. When this happens, adrenaline and cortisol levels become imbalanced, which can lead to mood disorders, sleep disturbances, reduced immunity, and changes in vital circulation.

Because these side effects are not always uncomfortable enough to be intolerable, many women continue a self-destructive, adrenal-depleting lifestyle. The problem is if the intensity and frequency of the stresses in your life—whether internally driven (i.e., your perceptions) or externally driven (i.e., having surgery or working a demanding job)—become too great, over time your adrenal glands will become exhausted. And, a woman in a state of adrenal fatigue is likely to find herself at a distinct disadvantage when entering perimenopause, which is an additional form of stress.

6 Hallmark Symptoms of Adrenal Fatigue

Exhaustion that is relentless is the primary symptom of adrenal fatigue. If you have true adrenal fatigue, you will typically have difficulty dragging yourself out of bed. You can’t get going without that first cup or two of coffee. You rely on sugary snacks and caffeine to get through the day, particularly in the late morning or afternoon. At night, though exhausted, you have difficulty falling asleep as the worries of the day keep replaying in your mind. You sometimes wonder what happened to your interest in sex.

While sometimes feeling tired, making poor food choices, or not getting adequate sleep can simply be part of life if this pattern continues unabated for long periods of time, your adrenals eventually give out.

So, how do you know if your adrenals are shot? Here are 6 hallmark symptoms of adrenal fatigue:

  1. Relentless and debilitating fatigue
  2. Depressed mood
  3. Irritability
  4. Loss of interest in life
  5. Low energy
  6. Inability to carry out your normal day-to-day activities

If you have these 6 symptoms (or a majority of them), you may have suboptimal adrenal function. Now, if you have hypothyroidism or low-level depression, you may have similar health complaints as someone with adrenal exhaustion. It’s always a good idea to see your health care provider to determine if you have adrenal fatigue and to rule out other causes of your symptoms.

Diagnosing Adrenal Fatigue

Conventional blood tests might indicate that your adrenals are normal. However, adrenal fatigue is characterized by cortisol levels that are too high at night and not high enough in the morning. So, a better diagnostic approach will test your levels at different times of the day, which is much more likely to reveal an out-of-whack pattern of cortisol or DHEA secretion.

One thing I recommend is that you have your doctor prescribe the DUTCH test, which is short for dried urine test for comprehensive hormones. This test offers the most complete assessment of sex and adrenal hormones, along with their metabolites, in one easy-to-administer test. It’s great for baseline measurements of women with hormonal imbalances and for hormone replacement therapy (HRT) monitoring.

After utilizing the DUTCH test, you will be able to work with your medical provider to continue to track and evaluate hormone levels, ensuring they are at their optimum balance.

Should You Take Hormones to Treat Adrenal Fatigue?

If an adrenal test shows that you are producing inadequate levels of adrenal hormones, you have several options for increasing either DHEA, cortisol, or both.

First, you can take the hormone directly. If you take DHEA, opt for small doses of pharmaceutical-grade DHEA (5–10 mg/day, but possibly up to 25 mg once or twice a day). Have your levels retested every three months, and when levels return to the normal range, the dose should be gradually tapered until you’re off the hormone completely.

Some individuals require very small doses of hydrocortisone, which can be used safely and effectively if prescribed by a health care provider knowledgeable about how and when to use it.

Be aware that if you supplement your adrenal hormones in dosages that are too high or if you take supplements for too long, the result can be permanent depression of adrenal function.

7 Natural Ways to Heal from Adrenal Fatigue

If you suffer from adrenal fatigue, the good news is that, with lifestyle changes, you can restore your adrenal health and function so your adrenals can eventually produce the hormones you need on their own.

Here are some of the ways you can nurse your adrenals back to health naturally:

  1. Eat whole foods. Follow a healthy, whole foods diet with minimal sugar and adequate protein. Avoid caffeine. Also avoid fasting or detox regimens because they can weaken you further. (However, a digital detox is always a good idea!)
  2. Take a multivitamin. Nutritional supplements are a great way to support long-term health. Be sure to take a pharmaceutical-grade multivitamin and mineral supplement. Be sure it contains vitamins A and C, along with the minerals zinc and selenium and the amino acid L-carnitine. In addition, be sure to get enough vitamin D and magnesium. You may also want to add glutathione for liver support and an adaptogen, such as ashwagandha, to help when you are under stress.
  3. Try herbal support. Some herbs mimic adrenal hormones and may help ease your symptoms and restore adrenal function. For example, licorice root contains plant hormones that mimic the effects of cortisol. Start with a small amount and gradually work up to ¼ teaspoon solid licorice root extract three times per day. Make sure to monitor your blood pressure. Also, Siberian ginseng can act as a precursor for DHEA and cortisol. Try one 100 mg capsule two times a day. It can have a stimulating effect, though, so if it interferes with your sleep, take it before 3 PM.
  4. Get plenty of sleep. Try to go to bed by 10 PM. Getting to sleep on the earlier side of midnight can help restore your adrenals—much more so than sleep that begins later in the night, even if you sleep late the next morning to get in your full amount of sleep. And remember, many women require 8 to 10 hours of sleep to function optimally.
  5. Exercise regularly. Light-to-moderate exercise can help restore your adrenal function. But, don’t exercise so much that you feel depleted afterward. Pushing yourself beyond your limits weakens your adrenals even further. Start slowly—even if it’s only walking down your street and back.
  6. Get out in the sun. Natural sunlight helps to reset your circadian rhythm, which can help you achieve better, more restorative sleep. Sunbathe only in the early morning or later afternoon. Be sure not to burn or even redden your skin. Work up to 10 to 15 minutes of exposure three to four times per week.
  7. Learn to prioritize. Make a list of your most important activities and commitments, and then let everything else go. Don’t agree to a new task or commitment unless it’s something that will recharge your batteries.

How Low Self-Esteem Contributes to Adrenal Fatigue

Adrenal insufficiency usually suggests that there are long-standing life problems in need of resolution. Remember that true healing of any kind comes when you address the circumstances in your life that are the ultimate cause of your physical condition.

The adrenal glands are part of your third chakra. If you are experiencing adrenal fatigue (or health problems in the abdomen, upper intestines, liver, gall bladder, lower esophagus, stomach, kidney, pancreas, spleen, or middle spine), chances are you have emotional or psychological issues associated with the third chakra, especially feelings of low self-esteem and lack of personal power.

Ongoing negative thoughts about your self-worth, including negative self-esteem, and lack of self-confidence or self-respect can lead to adrenal fatigue. Although there’s no physical emergency, self-talk loaded with shame and insults, such as “I’m too fat,” “I’m too old,” or “I’m too dumb,” causes stress. So, your adrenal glands release cortisol and epinephrine to help you fight (or flee) from it.

Here are 11 common emotional stressors that put relentless demands on your adrenals:

  1. Worry
  2. Anger
  3. Guilt
  4. Anxiety
  5. Fear
  6. Depression
  7. Lack of pleasurable experiences
  8. Chronic pain
  9. Chronic illness
  10. Feelings of lack
  11. Feelings of shame

I encourage you to look objectively at whether you have these feelings, and then do something about it.

Here are 5 easy exercises you can try today:

  1. Allow yourself to accept nurturing. Start by asking for and accepting help. This can be the first step toward loving yourself more. If you didn’t learn how to do this as a child, you may need to practice it. Every morning before you get up, spend a minute or two reveling in a memory of a time you felt loved. Do the same at night. Imagine your heart being filled with this love. If help isn’t forthcoming, practice nurturing yourself.
  2. Nourish your body. This includes eating healthy food and getting enough rest. And if you think you don’t have enough time, make time. Remember that going without rest and good nutrition will leave you feeling more depleted and stressed.
  3. Say affirmations. Affirmations don’t make things happen, but they make things possible. Affirmations also help you look at life more optimistically. Try Louise Hay’s daily affirmations.
  4. Focus on loving thoughts. Thoughts that bring you pleasure, such as thinking about people you love, favorite pets, a delicious meal, or even a sweet memory, help short-circuit the harm done by the body’s physiological reaction to stress. You can also try practicing loving-kindness meditation. Soon, you will be better able to pay attention to areas of your life that bring you joy and fulfillment. This will evoke biochemical changes in your body that, over time, will recharge your adrenal batteries.
  5. Engage in pleasurable activities. Make time to do more things that bring you pleasure and make you laugh, and spend less time on activities that feel like obligations. Spend more time with people who make you feel good and less time with energy vampires.

Why Men Should Support Their Adrenals Too!

Like women, men can experience hormonal imbalance at mid-life and more specifically a decline in androgens, including testosterone. In fact, many men are living with a testosterone deficiency. And over time this can contribute to serious health problems.

Low testosterone in men has typically been attributed to andropause, or male menopause. The symptoms include fatigue, low energy, low sex drive, muscle loss, fat/weight gain, change in mental acuity, urinary problems, erectile dysfunction and more.

While supplementing with testosterone can be beneficial for some men under the right circumstances, I don’t recommend that men supplement with testosterone unless it is indicated for restoring hormone balance and he is under the care of a knowledgeable health care practitioner. This is because testosterone supplementation can cause unwanted side-effects such as fluid retention, acne, decreased sperm count, and even elevated red blood cell count.

In addition, when a man supplements with testosterone, there is a good chance his body will stop producing testosterone on its own. This is why I recommend men with low testosterone try supporting their adrenal glands first.  There are many adrenal support formulas on the market. Look for ones that contain adaptogenic herbs such as astragalus, schisandra, ginseng, rhodiola, and others.

It may also be a good idea for men with low testosterone to add more zinc to their diets and/or through supplementation. Studies show that zinc supplementation increases serum testosterone in men. B-vitamins and magnesium are also beneficial in that they help with energy production and to reduce cortisol. Men can try supplementing for 4- weeks and then see how they feel.

Do you suffer from adrenal fatigue? What have you done to heal? Please leave your comments below.


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Last Updated: January 24, 2024

Christiane Northrup, M.D.

Christiane Northrup, M.D., is a visionary pioneer and a leading authority in the field of women’s health and wellness. Recognizing the unity of body, mind, and spirit, she empowers women to trust their inner wisdom, their connection with Source, and their ability to truly flourish.


Add comment
  1. Angela
    3 years ago

    I was waking up every morning feeling like was dying. I was extremely weak and exhausted which lasted for several hours. I had gotten better a few weeks ago after starting the supplement Cortisol Manager and received Myers Cocktail IV’s and B shots twice a week. This past week I regressed and am miserable as I am waking up the same. It’s a nightmare!

  2. Ora
    4 years ago

    For so long this problem was brushed aside as so much “little ladies hog wash.”
    You know, the female thing!
    Our lives were being destroyed …
    some never to be recovered.

  3. Flora
    4 years ago

    I have had two broken vertebrae in eight months. I eat right, love the exercise, spend tons of time in the trees and take the gold standard in bone supplements. These were spontaneous breaks and my naturopath says I need the allopathic drugs for osteoporosis. I really don’t want to take them. My body is very sensitive to drugs yet I really don’t want to suffer the two plus months in bed with severe pain that comes with a broken back. Advice?

  4. pei
    4 years ago

    as I have low self esteem, it is true that I also have adrenal fatigue when my health issues seem to come from liver and kidney area) with jaundice and dehydration cause by sjogrens. recently I am practising meditation and gentle exercises to help with getting rid of negativity in the mind and body. it is important that if one has many problems in life whether past or present, first thing is to look at each of them separately and make a list of solutions for them. if there are things that cannot be controlled by oneself, then it is best to let go of them, especially when we are going through these unprecedented times around the world.

  5. Cindy V
    7 years ago

    I have been so exhausted, with shortness of breath, and feels like someone is rocking my body back & forth, leaving me housebound for 9 months now. I’ve been to many doctors to check my lungs, heart, trips to ER, all with no answers and no diagnosis. I live alone and am isolated..feel like I’m dying. I’m trying to get into an Internist but don’t know if they’ll see me or help me. My body is severely sleep deprived due to nite sweats from nemopause. Any slight exertion makes me feel weak and faint. Should I go to a holistic doctor, or naturopath? I suspect my thyroid is off. Doctors tell me its “normal” but its not my normal. Beside cortisol test, is there any other tests I should have? I’m recovering from Ovarian Cancer (2yrs remission) so I don’t know if I can take DHEA, if its safe? Desperate. thank you for this website and I don’t feel so alone knowing that others are going through similar symptoms. Thank you

    1. Anita
      6 years ago

      Hi Cindy! I too have Adrenal Fatigue. I was diagnosed by my Naturapath. I stopped going because they do not take insurance and all they do are saliva tests which aren’t very accurate. If you can’t take DHEA which a lot of people can’t take magnesium. Magnesium turns into DHEA. I feel your pain. People look at me and I look fine! I’m not fine I’m in a lot of pain! Good Luck! Anita

  6. Kath Bradbury
    8 years ago

    Good to find this site as this health issue is so confusing and you can feel so alone with it as not recognised by medical profession generally. I am being advised to take anti depressants but don’t which one would have least detrimental effect on adrenals.

  7. Gwen
    12 years ago

    Dr. Northrup, u are amazing! I’m 52. Was experiencing all symptoms of adrenal exhaustion. Felt like I was dying. A male co-worker (!) told me about Women to Women. I started the “workhorse” program 2 months ago. I felt better in 7 days! Two months in, and I’m close to 100%. I was relaxing a few nights ago, & remembered that Dr. Northrup was the co-founder of Women to Women with Marcelle Pick. (Brain fog lifting!) I am GRATEFUL that 2 powerful women came together. I have my life back!

  8. Tanya
    12 years ago

    Wow thank you Heather for this site. I can’t believe how sytcironichny works in this universe. While I have been aware of depression effecting me for sometime, I did not know how poorly I thought of myself, or treated myself it surely has been obvious to others, but I did not know. I just had an insight about this today, and then tonight I find your site and your comment about sitting on that darned wicker chair with the hole in it !

  9. Stephanie
    12 years ago

    Amelia, I smiled when u read your post. You said it best ‘being tired of being tired’. Is it nit us that knows our own bodies the best. Sending you light and positive energy.

  10. Amelia
    12 years ago

    ive been diagnosed with adrenal fatigue by my naturopath but my obgyn thinks my fatigue is from perimenopause symptoms like heavy bleeding. she put me on seasonique and after a month I feel more exhausted. my naturopath had me on progesterone but the obgyn didn’t agree with her treatment. I’m so confused. I’m just tired of feeling tired. how do you know who to believe??

    and thank you for all your books and wisdom.

  11. Lea
    12 years ago

    …complete healing is not my goal, but I’d like not to develop more organ-specific autoimmune diseases, and also to try to listen to and work with what was given me.

  12. Lea
    12 years ago

    I’ve been deeply touched by your work, and I wonder how this applies to Addison’s disease (and premature ovarian insufficiency). Is it the organ-symbolism or the autoimmune reaction that needs to be healed?

  13. Martine
    12 years ago

    I especially like today’s quote on finance and energy. We all need a team to come back to vibrant health. I have enjoyed “following” you since I listened to you in New Orleans at a wellness conference years back. Thanks for connecting with me last month. Merci.

  14. Randi Destefano
    12 years ago

    It’s encouraging to hear another doctor talking about adrenal fatigue. I’m finding this to be a discouraging and confusing journey, and don’t know who to believe. I’ve discovered that mainstream doctors don’t believe in adrenal fatigue and become angry when I tell them I’ve been to a doctor who has given this diagnosis. They even question their credentials. Wondering if anyone else has had this experience.

  15. Pati Chandler
    12 years ago

    Excellent article – most helpful! Knowing that all the hormones work together synchronicistically, one should be aware that the 7 other endorcine glands are also affected. When one is “wonky” the others are nearly always affected, such as adrenal, thyroid, pineal (mealtonin/sleep), etc. Thanks so much for this article! *:)

  16. Debbie Phillips
    12 years ago

    Thank you so much for your knowledge, insight and wisdom … you’ve been a constant source of support in my life for more than 30 years.

  17. Ej
    12 years ago

    I have low thyroid, adrenal exhaustion and a demanding job. This is part of the economic situation that no one talks about. There are countless people who kept their jobs, took on the work of their layed-off coworkers and are now suffering the health consequences. Medical leaves and disability ont the rise. Why is no one addressing this?

  18. Joline P
    12 years ago

    Thank you so much for your insights and willingness to share this great information monthly….although this particular one does not refer to me…..I do enjoy your healthy suggestions and holistic techniques and healings views

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