The Myth of Adrenal Fatigue

Are you constantly tired but struggle to fall (and stay) asleep when it’s time for bed? Have you gained weight that you can’t seem to lose? Are you grouchy and exhausted all the time? If you consult Dr. Google, he might tell you that you have adrenal fatigue.

The theory is this: The adrenals, two triangular glands that sit atop the kidneys and produce cortisol (the hormone that regulates many of your bodily functions, including metabolism, stress responses, blood pressure, and the immune system), can be exhausted by exposure to constant stress. As a result, they stop producing enough cortisol and bodily chaos ensues. Sounds like something that “makes sense,” no? Wellness culture constantly bombards us with messages that we’re stressed, that we don’t take proper care of ourselves, that we need to meditate, take baths, and detoxify from modern life and all its evils. Stress is making us sick, and this explains it all, right?

The concept of adrenal fatigue was first suggested by James L. Wilson, a chiropractor, who wrote a book called Adrenal Fatigue: The 21st Century Stress Syndrome in 2001. Wilson has a thriving supplement business where he sells formulations for immune and gut health as well as adrenal fatigue supplements. A protocol of 150 pills each of three different adrenal support supplements plus two ounces of a tincture costs $234.33 per month or so if you follow his most aggressive treatment plan.

Thing is, mainstream medicine actually rejects the idea of adrenal fatigue. (A 2016 systematic review found that there is no hard science that backs the theory.) The wellness community, however, doesn’t — many alternative practitioners, ranging from naturopaths to functional medicine doctors to chiropractors, diagnose patients with adrenal fatigue despite the mainstream consensus that it’s not an actual condition. Goop has a resident expert, Dr. Alejandro Junger, a functional doctor, on adrenal fatigue who recommends supplements and an “adrenal reset.” (All of the endocrinologists I spoke with told me that some of the supplements alternative practitioners prescribe for adrenal fatigue are made from ground-up adrenal glands from pigs or cows, which contain hormones that can interfere with and damage adrenal function.) It has made its way into British Vogue, MindBodyGreen, Mpls St. Paul Magazine, and the Seattle Times. The Medical Medium, the wellness guru who brought us the celery-juice trend, goes as far as to call adrenal fatigue “an epidemic.”

Instagram thinks I have adrenal fatigue — or at least the algorithm that decides what ads I see. I’m in my 40s and have a very full life — two little kids, a complicated arrangement of freelance jobs, and a busy volunteer schedule. I’m the sole income source for my family. Some would call it stressful. So it makes sense that I would be targeted for such ads. For several months last year, adrenal fatigue was the seemingly reasonable explanation for my steadily deteriorating health. I had “the symptoms”: I grew a goddamned beard (not my regular middle-aged lady beard but a full-on teen-boy beard), gained 30 pounds, never slept but always felt wired. My periods stopped, my hair thinned, and my blood pressure soared. I had acne like I’d never had before.

But when I brought up my uncharacteristic weight gain in the face and upper abdomen — “If my ass was suddenly two sizes bigger, I wouldn’t be distressed, but this is just weird,” I told one doctor — the message I got was that it was just lady hormones doing mysterious lady-hormone things. Among the various theories that the internet suggested to me (perimenopause, polycystic ovary syndrome) was adrenal fatigue. The internet didn’t help. The more I Googled, the more supplements — for sleep, for inflammation, for hormonal balance — I started taking.

After six months of not getting my period, blood pressure so high that it gave me headaches, and realizing my chin hair had migrated down my neck, I saw a nurse practitioner who listened to me carefully, ordered a series of tests, and then diagnosed me. It wasn’t adrenal fatigue; it was adrenal cancer. She may have saved my life.

In December, I had my left adrenal gland removed. I’ve done chemo; I take medication daily to help minimize recurrence. This fall, I will have a second surgery to remove some small nodes that have popped up where the tumor was. It’s a terrifying and uncertain cancer to have because it is exceedingly rare (in the U.S., between 400 and 600 people a year are diagnosed with it). I refuse to be anything other than aggressive and optimistic. My surgeon told me that my job is to make sure I take good care of myself through sleep, diet, and exercise and to be hopeful.

While this is my very personal and very, very rare experience, it’s emblematic of a larger problem. People of all genders and ages get diagnosed with and treated for adrenal fatigue, but the wellness culture in which it’s embedded is largely directed at women in their 30s and 40s. There’s a certain kvetching, conspiratorial tone to adrenal-fatigue sites that catalogue the multitude of factors, including children, marriage, work, caring for older parents — the experience of moving through the world in a female body. We do tend to treat all middle-aged-lady bodies as faulty by definition — saggy, graying, tired, and prone to hormonal fluctuations. And sometimes symptoms like brain fog, fatigue, and weight gain are just a normal part of perimenopause. The popularity of the idea of adrenal fatigue speaks to this; it’s a desire to find something wrong and fixable rather than just the inevitability of aging in a youth-obsessed culture.

When I saw yet another Instagram ad for an adrenal-fatigue supplement a few weeks ago, I was reminded of my own search for a diagnosis and how the promise that I just needed to take the right supplements and change my habits to fix everything that was wrong almost stood in the way of getting a diagnosis of a very real condition. I knew there was something wrong with my body, but I didn’t want to believe it, and the adrenal-fatigue diagnosis tapped into my anti-authoritarian streak. One of the challenges with adrenal cancer is diagnosis. There is no screening for it, and for many patients, there are no symptoms. By the time they realize something is wrong, it has spread and their treatment options are very limited. I had a functional tumor, meaning it was producing excess hormones, cortisol and testosterone, mostly. So basically, I got luckily unlucky.

Still, the what-ifs — What if she hadn’t ordered the tests? What if I’d just ordered adrenal-fatigue supplements instead and waited to feel better? What if I had taken mainstream meds designed to deal with chin hair, acne, and high blood pressure, covering up my symptoms and ending up waiting until my tumor was inoperable? — haunted me. So I set out to ask endocrinologists who didn’t know me, plus some alternative practitioners, about the adrenal-fatigue diagnosis and whether there’s anything to it.

There are indeed conditions that can affect adrenal function, like adrenal insufficiency, also called Addison’s disease. This is usually the result of a problem with the pituitary gland, which sends signals to the adrenals to produce cortisol, a hormone that rises and falls during the day in a delicate balance and in relation to our body clock and situation (cortisol production can be a stress response). Tumors, both benign and malignant, trauma, and infections can also affect the adrenals.

But the idea that they can become tired out and stop working is not backed by science. Physiologically speaking, the adrenal glands are tough. “We only need about a third to half of a single adrenal gland to do all the work,” Dr. Lucinda Gruber, an endocrinologist at the Mayo Clinic, told me. (Which is why I can get by with just the one.) “But we’re actually built with two, so in some ways, there’s a lot of redundant tissue there. Also, the adrenal glands are quite resilient. They can put up with a lot of insults before they become affected.”

Adrenal fatigue is strongly marketed toward middle-aged women, and there’s an unspoken promise in the wellness industry that if you eat the right combination of things, take the right supplements, meditate, and do Pilates, you’ll never age. It’s very hard to know whether the very real fatigue you feel is because of a medical condition or simply because you had kids at a later age than previous generations and you haven’t slept well in seven years, between breastfeeding and middle-of-the-night toddler interruptions, or because you’re caring for aging parents, or because your work keeps you on screens until 11 p.m. — or all of the above and then some.

In the course of reporting this story, I reached out to several alternative practitioners and only one would speak with me, particularly once I explained that I wanted to talk to both mainstream endocrinologists and providers outside of that world. One told me that these sorts of stories always end up being hit pieces, not just on the concept of adrenal fatigue but on the industry as a whole.

Listen, I do a lot of yoga and go to acupuncture regularly. I’m going to see a healing shaman after my next surgery. I understand wanting a diagnosis when you feel strongly that something is wrong with your body and you’re not finding the answer in a doctor’s office. Add to this the fact that mainstream medicine has a long history of dismissing women’s pain. And while openly discussing menopause is becoming more normalized thanks to celebrities like Gillian Anderson, Michelle Obama, and yes, Goop herself, Gwyneth Paltrow, we still don’t have a robust conversation around it that would support women questioning whether their brain fog and fatigue are temporary symptoms of perimenopause.

“Chronic fatigue often coincides with or is a symptom of another health problem,” Dr. Will Cole, a functional medicine doctor and the author of Intuitive Fasting, told me over email. “Even if you don’t want to call it adrenal fatigue or chronic fatigue, if you have an imbalance in your cortisol rhythm that is affecting your energy levels, it is something that needs to be addressed. Mainstream medicine doesn’t always like when you can’t match a diagnosis to a corresponding drug, which is often the case with people struggling with chronic fatigue.”

Every mainstream endocrinologist I spoke with actually echoed this sentiment in some way. While they universally cautioned against expensive, unregulated tests and supplements, they were all supportive of lifestyle changes like diet, exercise, and good sleep hygiene to help address symptoms, even if they can’t make a specific diagnosis, and recognized that the symptoms are very real.

“As doctors, we like to give things labels, and we like to make things better, and I think that’s where the adrenal-fatigue phenomenon has come from. It’s come from a good place,” Dr. Marie Freel, an endocrinologist at the University of Glasgow, told me. “It’s come from, I think, genuinely trying to help people and give them a diagnosis, which they want, and give them something that helps them. But certainly there’s no evidence, not physiological evidence, that adrenals fatigue when under chronic stress.”

While there is no physiological evidence that chronic stress can exhaust the adrenals, there is evidence that chronic stress, or allostatic load, can have a complicated, deleterious effect on the body. When I asked Dr. Annice Mukherjee, an endocrinologist in the U.K. and the author of The Complete Guide to Menopause, whether adrenal fatigue was a condition like chronic fatigue, fibromyalgia, or long COVID that took a long time to be accepted by mainstream medicine, she did not mince words. “I think people who are given the diagnosis of adrenal fatigue are being fobbed off by practitioners who want their money, that’s my view,” she told me. “But in my patients who come to me who’ve spent loads of money on quack tests, and I take the history, what I find is that they’ve often got effects of chronic stress. So the adrenal is more the outcome than the cause.”

What she’s saying is that chronic stress has a complex effect on the body — it doesn’t simply wear out the adrenals. It can interfere with the interrelated system of hormone production as well as other parts of the body. It’s a systemic problem, not a localized one.

The answer is pretty straightforward, and you won’t find it in a bottle of ground-up animal adrenal glands: Find a doctor who takes your symptoms seriously. You’ll probably want to start with your primary-care provider or gynecologist, who then may refer you to an endocrinologist. Even though the endocrinologists I spoke with said that the adrenals just don’t work the way that adrenal fatigue posits, they all emphasized that they know that the symptoms that people come to them with are real and they understand the desire for a diagnosis. And don’t let my illness freak you out — it’s exceedingly rare, and it’s likely you are just experiencing perimenopause or have a hormonal imbalance that can be addressed with medication. Or maybe you need to holistically deal with your stress levels through diet, exercise, sleep, and leaning harder on some of the other people in your life to help you out.

Of course, a holistic approach requires a certain amount of privilege. It’s not cheap to take yoga classes, eat a diet of whole foods, and maintain a healthy work-life balance. But at the very least, we can all avoid sketchy supplements that are untested by the U.S. Food and Drug Administration with unproven ingredients. Small lifestyle changes like moving your body (it doesn’t have to be HIIT cardio, it can be a daily walk), eating fewer processed foods, and getting enough sleep — though what this actually means can vary widely — can help, too.

“With Google and with Instagram, they make everything look simple,” said Dr. Mukherjee. “Patients come in and they go, ‘Well, if I feel really tired, and I’m 45, it must be medical. So I’ll go on estrogen, and I’ll be fine.’ But then they go on estrogen, they’re not fine because there’s loads of other things going on in their lives like a breakup, or they’ve got an elderly mother to look after, or a challenging job, or other stresses. We can’t look at any one symptom in isolation.”

For me, one of the most frustrating things about wellness is that it makes the idea of listening to your own body sound like woo-woo garbage when really it’s a real, potentially life-saving skill. I knew something was wrong but it took overcoming the idea that I could treat it with supplements and lifestyle changes alone, as well as my own internalized fatphobia — I was embarrassed to admit to a doctor that I had gained 30 pounds instead of seeing that as a sign that something was going on in my own body — to find answers. (Again, I don’t want to freak you out, my surgeon told me that by having the disease I do I’m one in a million.) So yes, move your body in a way that feels good. Get enough sleep. But also go see a doctor if you don’t feel any better. There could be something going on that you can, and should, get help with.