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Using Replacement Hormone Treatment for Adrenal Fatigue


May 12, 2017 | Published by

Cortisol as a Treatment Option

In some cases of severe adrenal fatigue a short therapeutic course of natural cortisol may be needed. Briefly, if this therapy is necessary, it should be confirmed by special tests such as the combined 24-Hour Urinary Cortisol & ACTH tests. In addition, it is important to remember that corticosteroids suppress adrenal function in proportion to the dosage. For this reason it is important that treatment should be withdrawn slowly, never abruptly.

There are many types of corticosteroids on the market but the only type that should be used is the natural form of hydrocortisone. The commercially available hydrocortisone, although essentially the same as the cortisol your body produces, also contains unnecessary ingredients some patients react to. To make certain you are getting pure cortisol without additives, it is best to have a compounding pharmacist prepare your prescription.

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

After approximately 6 months most doctors try to gradually decrease the dosage. If the adrenal glands have recovered sufficiently, they will pick up the slack and begin to respond normally. If not, they may need the same or a reduced dose for awhile longer. Most patients will only need hydrocortisone therapy for a temporary time. It is seldom necessary to go beyond 2 years.

It goes without saying that if steroid replacement therapy is needed, blood and urine tests should be completed regularly to monitor progress. Although the administration of cortisol will produce fast, almost immediate relief, it should not be used except in the most severe cases. Again, this is because the cortisol shuts down the adrenals and as such, may not be substantially therapeutic in the long run.

Cortisol Combined with Adrenal Cell Extracts

In many cases, natural cortisol has been taken simultaneously with adrenal cell extracts. This regimen for severe adrenal fatigue often allows the adrenals to rest and rebuild much faster than with either therapy alone. After 2-3 months on both cortisol and adrenal extracts, the daily dose of cortisol is slowly withdrawn while a vitamin C complex, the adrenal cell extracts and other supplements are increased.

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

Naturally, if you are going to use cortisol, you will need the help of a physician because it is by prescription only. The physician needs to have an in depth knowledge of adrenal function and how to use adrenal extracts and cortisol together for optimum benefit. If you consult a physician, do not be afraid to ask what experience and training she or he has had in restoring adrenal function.


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

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

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

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

Progesterone and Pregnenolone

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

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

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

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

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

Progesterone is made in both the ovaries and the adrenal glands. Women suffering from adrenal fatigue often have lower saliva progesterone levels and increased PMS. The addition of oral pregnenolone or natural progesterone cream is often needed for relief of PMS and female complaints common in adrenal fatigue. With pregnenolone 10-40 mg. per day is usually sufficient, taken orally, and 20-30mg. (1/4 – ½ tsp.) per day of progesterone when applied as a cream to the skin. More specific instructions are given below.

Both pregnenolone tablets and progesterone cream are available from many health food stores and some pharmacies. If you cannot find them or want immediate sources, check our website for a list of suppliers. It is important to note that we are speaking of the natural progesterone and not the synthetic progestins in tablet form usually prescribed by your doctor for hormone replacement therapy. The synthetic progestins can have many side effects and should be avoided. The various progestins exist because drug companies need forms of progesterone different enough from their competition to be patented and controlled by the company.

The reason all progestins have side effects is that none of them are exactly like the natural progesterone your body makes. Unfortunately, most doctors only know about products made by pharmaceutical companies, and the bulk of their information about therapeutic substances comes from these same companies. Because the large drug companies do not produce natural progesterone creams, many doctors are not knowledgeable about them and are unaware of the difference in safety between the synthetic progestins and the natural progesterones.

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

The progesterone contained in progesterone cream, however, is usually a natural plant progesterone (phytoprogesterone) that has been converted into exactly the same molecule as the progesterone in your body. It can be used safely by most women. You do not need a prescription for it and it is available from many health food stores and on the internet. Rub 1/4 to 1/2 teaspoon cream into the tender areas of your skin (swimsuit areas plus the inside of thighs and arms) each morning and evening.

Premenopausal women should apply it from the 12th day of the menstrual cycle to the 26th day (the first day of bleeding is counted as the 1st day). Post-menopausal women can use it for 21 days each month. An excellent book that covers this topic is What Your Doctor May Not Tell You About Menopause by Dr. John Lee.

Using hormone replacement therapy for adrenal fatigue is an area that requires skill. Although some of the hormones mentioned can be purchased without a prescription, I highly recommend using a physician familiar with hormone replacement in cases of adrenal fatigue. If you cannot find one in your area, check our website for physicians within driving distance or who do telephone consults. Hormones work together in symphony to perform in the concert of life.

To throw in a hormone here and another there in a haphazard way is like having a heavy metal band thrown in with an orchestra. Hormones are powerful engineers of body processes and balancing them calls for delicate precision. The timing, the quantity and the form of hormone used are all critical. It is best to work with an expert who will monitor your progress using laboratory tests. If you do embark upon this yourself, use caution: start low and go slow.

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  • Leanne Fierstein says:

    Hi Dr. Wilson,
    I have moderate adrenal fatigue. I’m going through peri-menopause and feel I could really benefit from progesterone. I’ve tried using natural progesterone cream and had a bad reaction. I felt really great for about 30 minutes and had the desire to interact with others, had energy, etc. After about 30 min, I felt more stimulated and wired. That night, I woke up anxious and had bad insomnia. I decided not to try this again. I read that when people have low adrenal functioning, their body turns the progesterone into cortisol (hence, the anxious feeling). Will it be possible to improve my adrenal glands to the point that I can take natural progesterone? Thank you.

    • Adrenal Fatigue Team says:

      Hi Leanne,

      That’s a good question. It is possible but we would not be able to say for sure. Are you currently working with a healthcare practitioner? If not we may be able to provide you with a referral in your area.

      • Leanne Fierstein says:

        Hi there,
        Yes, I would appreciate a referral to a healthcare practitioner here in the Phoenix area. It would be great to work with someone who understands adrenal fatigue.

        • Adrenal Fatigue Team says:

          Hi Leanne,

          We have sent you an email including practitioners in the Phoenix area from our database. Let us know if you did not receive the email. Thanks for writing!

          • Ashley Sharland says:

            Hi my name is Ashley and I’ve been suffering from severe adrenal fatigue for about 9 months now to the point of being bed ridden and I really really need someone who knows about adrenal fatigue to help me if u could give me some advice that would be so helpful!

          • Adrenal Fatigue Team says:

            Hi Ashley,

            Thank you for writing. We may be able to offer you referrals to healthcare practitioners who can help you. If you’re interested send us an email with your zip code to

  • Maureen Rogleff says:

    Dear Dr Wilson
    I recently purchased your book as I have severe adrenal insufficiency. Unfortunately I live in Sydney Australia and cannot find a health professional that even knows what I have or how to treat it. I know this is asking the impossible but how do I locate a doctor who is aware of your treatment protocols in this country as I’m desperately ill for three years and can no longer function. Thanking you so much for any help you can suggest or offer. Greatly appreciate your help. Kindest Regards Maureen

    • Adrenal Fatigue Team says:

      Hi Maureen,

      You may have luck contacting Nutrisearch, our distributor who services our customers in Australia and New Zealand. You can contact them by phone at 1 800 177 959 or email at I hope this helps. Thank you for writing!

  • Bethinee says:

    Dear Dr Wilson,
    I’m a 57 year old dealing with menopause and adrenal fatigue. I have insomnia, anxious, hot flashes, extremely tired, and racing heart. I’m hanging on by a thread. My naturopathic started me on a natural hormone- ( progesterone) I have become worse! Which of your supplements you feel would give me relief? I have had saliva testing etc. low cortisol especially in a.m.

    • Adrenal Fatigue Team says:

      Hi Bethinee,

      For adrenal fatigue we recommend Dr. Wilson’s Adrenal Fatigue Quartet, which includes all 4 of Dr. Wilson’s supplements for adrenal fatigue and chronic stress (Adrenal Rebuilder, Adrenal C Formula, Herbal Adrenal Support Formula, and Super Adrenal Stress Formula). If you were to start with 1 or 2 at first we’d recommend the Adrenal Rebuilder (cornerstone product of Dr. Wilson’s program) and Super Adrenal StressFormula. I hope this helps. If you have further questions about the supplements feel free to contact our customer service team at 800-357-5027 or Thank you for writing!

  • Michelle Edwards says:

    Help, I have severe adrenal fatigue along with depression Ptsd, anxiety and going through menopause. I’m currently not on any medication for my mental also bipolar. I’m 49 and am trying to use natural methods of boosting my serotonin level and dopamine as well as trying to figure out how to put together this plan for adrenal fatigue. Please please help me sort this all out and how to try all of these methods without over doing it. Thank You. Michelle

  • chereena McArthur says:

    Dear Dr Wilson

    I am very confused and stressed with all the info out there and would really appreciate your help! I am based in South Africa and after years after suffering with CFS, depression, ODC and ADHD I have just been to see an immunologist who is now testing me for adrenal fatigue and malabsorption at the age of 34.

    My two concerns after finding your site is that he mentioned he might put me on covocort for a month to kick start my adrenals, I am concerned about this after reading your site and the side effects of weight gain etc. seen on other sites.

    I am also worried about as crazy as this sounds how one manages their weight once this all comes right as I am not overweight now, I don’t need more issues than I already have. Sorry just tired of years of issues:-)

    Could the ADHD all just be caused by the adrenals and malabsorption?

    Many Thanks

    • Adrenal Fatigue Team says:

      Hi Chereena,

      We can’t say for certain if the ADHD is caused by the adrenal glands/malabsorption. We wouldn’t be able to offer any advice on the covocort, though we can say short-term, low dose hormonal treatments are sometimes used for those with adrenal fatigue.

  • Kim says:

    I have only 1 adrenal gland. But I have all the symptoms of age??

  • Lana Comer says:

    Im hypothyroid on T3 and have adrenal fatigue, diagnosed by saliva test only. I was convinced to start hydrocortisone 8/6/17. I regret starting HC for many reasons:-(. Effectively, Ive been on HC for 9 weeks now. Im not sure what I should do. I think I’d like to go ahead and wean off of it. But I dont know if its the correct thing to do. Im on 25mg total. I take 10, 7.5, 5 and 2.5 at bedtime. I didnt make an informed decision when agreeing to start on HC. I asked the correct questions, but was never told about withdraw syndrome and other side effects of the HC. Now that Im on it and already had to stress dose, I’ve also gained 25 lbs, I just dont like how I feel so out of control on it. Now I’m reading all the horror stories of people trying to wean off of it unsuccessfully. The longer you stay on it the harder it will be to wean off of it. I regret starting it:-( Is it a terrible idea to try to wean off now? Am I already down the rabbit hole? Do I just need to stick it out for 6 months then try to wean off?

    • Adrenal Fatigue Team says:

      Hi Lana,

      We don’t recommend quitting or weaning off hormones without the guidance of a healthcare practitioner. If you’re looking for a practitioner to work with on this, we may be able to offer you some referrals. If so, respond with your area or write to us as Thanks for writing, and I hope this helps.

  • Suzie Duncan says:

    Dear Dr. Wilson,
    My practitioner diagnosed me with stage 3 adrenal fatigue around 8 weeks ago through a silica test. She put me on 10mg cortisone in the morning and progesterone cream. My cortisol levels are low throughout the day and tend to average out in the evening. My progesterone levels are pretty much non-existent. I am feeling better, but my biggest issue is trying to control blood sugar irregularities and anxiety. I take a multivitamin, but no additional vitamin C. Do you recommend that? And any recommendations on blood sugar control? To complicate matters I have well controlled epilepsy. I’m quite a science project!

  • Rich Tillman says:

    Dear Dr. Wilson,
    I’ve been dealing with intermittent adrenal insufficiency/fatigue for the last 5 years, which has been verified by multiple saliva tests over the last couple of years. I’m currently dealing with my 3rd major “episode” and I’m afraid I may lose my job. I live in Los Angeles and I’m having a very hard time finding a specialist in adrenal fatigue who isn’t trying to up-sell chelation therapies and IV treatments.

    My GP prescribed cortef, but I’m hesitant to take it, so have been scraping by on high doses of pregnenolone, DHEA and moderate doses of adrenal cortex. I feel like winging it on my own is unwise, but I’m quite desperate.

    Can you provide me with reputable practitioners in the LA area?

    Thanks so much,

    • Adrenal Fatigue Team says:

      Hi Rich,

      We’ve sent you an email including some referrals in that area. Let us know if you didn’t get it. Thanks for writing!

  • Louise says:

    Hi, is it possible for people who have been on longterm cortisol to wean down and/or replace it with other products? Thanks!

  • Chris Snow says:

    Hello, I have bilateral hyperaldosteronism. I am suffering from adrenal fatigue.

    I have two questions.

    Can you program help me even though I have hyperaldosteronism?

    Do you have any doctors you can recommend in the UK who are familiar with your work?

    Thank you

  • Dana Leo says:

    Looking for a good hormone dr in The Woodlands/Spring area of Houston! I have Hashimoto and suffering from adrenal fatigue

    Thank you!

    • Adrenal Fatigue Team says:

      Hi Dana,

      We’ve sent you an email including referrals. Please let us know if you did not receive it. Thank you for writing!

    • Selena says:

      Hey I would recommend checking out medical medium on youtube and his website for Hashimoto’s and adrenal fatigue

      Best wishes

  • Mari Johnson says:

    How is adrenal fatigue different from Addisons? I am currently on my 3rd year of taking 20 ml of cortisone after being diagnose with Addisons.
    Is there any hope for my adrenals once I gotten to this point.
    Your articles are so informative, I really appreciate all the information.

    • Adrenal Fatigue Team says:

      Hi Mari,

      There’s quite a difference between adrenal fatigue and Addison’s disease. For one, Addison’s is not curable. Addison’s is much more severe and is typically caused by an autoimmune reaction in the body. People with Addison’s disease will need to be on some sort of hormonal treatment for life, whereas with adrenal fatigue hormonal treatments aren’t always needed and are given over a shot-term time period. That said, with proper treatment, those with Addison’s can still lead a happy productive life.

  • Jake Dalyanci says:

    Recently purchased Dr. Wilson’s book, really amazed by this book.
    I am located in the London, UK. And wonder if there are any doctors familiar with Dr. Wilson’s work in England, I have Hashimotos, leaky gut and adrenal fatigue.
    Thank you so much

    • Adrenal Fatigue Team says:

      Hi Jake,

      Thank you for writing. Unfortunately we do not have any English practitioners in our database. We do encourage you to contact Nutri-Link, our U.K.-based distributor. They may be able to help you locate a practitioner. You can contact them by email at and phone at 08450 760 402.

  • Belinda Trimarchi says:

    Dear Dr. Wilson,

    I could never thank you enough for explaining what my problem was until I read your book and purchased a saliva test.

    Before I found out why I lost the ability to sleep for 34 years and going to Doctors and Pysyitrist that would only give me anti-depressents when I explained I wasn’t depressed. just exhausted. I have gone 18-30 days without sleep so many times.

    I went to an Oncologist with my saliva test, that horriic doctor only took an 8:00 a.m. Cortisol test which shows I have no Cortisol in the a.m. I’m tired all day until my Cortisol levels begin rising around 7:00 p.m., and I have to force myself to take the medications that allow me to sleep. It wasn’t until 31 years later that a doctor finally gave me meds to help me sleep. All I needed was Trazadone & Diazepam.

    One Dr. that I offered my book to actually took it, and I hope your advice helps him helps others.

    I’ve tried almost everything in your book except for purchasing one from you that I read about today. I’d prefer to be healed overtaking my medications.

    Any advice that you could give me would be appreciated.

    Warmest regards,

    • Adrenal Fatigue Team says:

      Hi Belinda,

      Thank you for writing. We’re sorry to hear about your long and frustrating journey to better health. A good place to start as far as Dr. Wilson’s programs go is this blog:
      It includes a video featuring Dr. Wilson as well as links to food, lifestyle, and supplementation recommendations. We work with a network of practitioners nationwide and may be able to offer you a referral. If interested, write us at with your area or zip code. In the meantime, please let us know if you have any other questions for us.

  • Louise Robertson says:


    I have taken the saliva test and my doctor has told me that I have adrenal fatigue (as well as previously being told I have fibromyalgia and rheumatoid arthritis) . I feel exhausted and it’s affecting my quality of life. Two months ago I started taking Dr Wilson’s formulations (Adrenal c, super adrenal stress formular, adrenal rebuilder and herbal HPA).

    My question is that because I am over 50 (ie52) my doctor has switched my birth control pill to a progesterone pill (norethisterone) which is a synthetic progestogen only pill. I’ve read that synthetic progestogen is bad for your adrenal glands when they are fatigued. Will this stop or slow their recovery and should I be looking to come off this type of pill?

    Many thanks

    • Adrenal Fatigue Team says:

      Hi Louise,

      Thank you for writing. We can’t say for certain if that type of birth control will negatively affect your adrenal function or not. It could depend on your adrenal hormone output. Your healthcare practitioner would best be able to make that call.

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