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6 Adrenal Myths: Why “Adrenal Fatigue” Isn’t Real and What Actually Matters · Clearly Hormonal

• 0:01
  Dr. Komal Patil-Sisodia: Welcome to Clearly Hormonal, the podcast where we stop googling our symptoms at midnight and actually start understanding what's going on in our bodies.
• 0:09
  Dr. Komal Patil-Sisodia: I'm Dr.
• 0:10
  Dr. Komal Patil-Sisodia: Komal Patil-Sisodia, an endocrinologist, internist, obesity medicine specialist, and a Menopause Society certified practitioner, which is really just a whole lot of words to say hormones are kind of my jam.
• 0:21
  Dr. Komal Patil-Sisodia: I've spent 17 years watching women try to navigate their hormonal health without ever having been taught the language for what's happening in their own bodies, and then meeting clinicians who want nothing more than to help them figure it out, but are up against 10-minute appointments and a system that just wasn't built for it.
• 0:37
  Dr. Komal Patil-Sisodia: This podcast is my answer to that gap.
• 0:40
  Dr. Komal Patil-Sisodia: We'll cover menopause, metabolism, hormones, and everything in between with real evidence, not trends, and without the overwhelm.
• 0:48
  Dr. Komal Patil-Sisodia: A quick disclaimer: I'm a physician, but this is education, not personalized medical advice.
• 0:53
  Dr. Komal Patil-Sisodia: Take what resonates and discuss it with your own healthcare team.
• 0:56
  Dr. Komal Patil-Sisodia: Now, let's get into it and talk about what's clearly hormonal and what's not.
• 1:04
  Dr. Komal Patil-Sisodia: My adrenals are shot.
• 1:06
  Dr. Komal Patil-Sisodia: I'm in adrenal fatigue.
• 1:09
  Dr. Komal Patil-Sisodia: I need to support my adrenals before they completely burn out.
• 1:14
  Dr. Komal Patil-Sisodia: If you've said any version of that sentence in the last year, first, I believe you that you feel terrible.
• 1:22
  Dr. Komal Patil-Sisodia: Second, I need you to know something that might genuinely change how you think about your own body.
• 1:29
  Dr. Komal Patil-Sisodia: There is no such thing as adrenal fatigue, not as a diagnosis, not as a lab value, not as a thing your adrenal glands can do.
• 1:39
  Dr. Komal Patil-Sisodia: Today, we're going to do a full myth bust on the adrenal glands, six things almost everyone gets wrong, including, in some cases, well-meaning clinicians.
• 1:49
  Dr. Komal Patil-Sisodia: Stick around because myth number six is the one that actually keeps me up at night because it's the one that delays real diagnoses for years Welcome back to Clearly Hormonal.
• 1:59
  Dr. Komal Patil-Sisodia: I'm your host, Dr.
• 2:00
  Dr. Komal Patil-Sisodia: Komal Patil-Sisodia.
• 2:02
  Dr. Komal Patil-Sisodia: This episode is part of the myth-busting series, and this is the adrenal installment.
• 2:07
  Dr. Komal Patil-Sisodia: I take claims everyone has heard, I tell you what the actual evidence is and what the guidelines say, and I tell you why the myth persists anyways.
• 2:16
  Dr. Komal Patil-Sisodia: So let's get into it.
• 2:17
  Dr. Komal Patil-Sisodia: Myth number one, adrenal fatigue is a real medical diagnosis.
• 2:23
  Dr. Komal Patil-Sisodia: This is the myth that built an entire wellness industry.
• 2:27
  Dr. Komal Patil-Sisodia: So let's take it apart carefully.
• 2:30
  Dr. Komal Patil-Sisodia: The idea is that chronic stress eventually, quote,"exhausts your adrenals." They stop making enough cortisol, and that's why you're tired, wired, and running on fumes.
• 2:41
  Dr. Komal Patil-Sisodia: It sounds plausible, but it's not really how the adrenal gland or the hypothalamic pituitary adrenal axis actually works.
• 2:51
  Dr. Komal Patil-Sisodia: A few things that you need to know.
• 2:53
  Dr. Komal Patil-Sisodia: No major endocrinology society recognizes adrenal fatigue as a diagnosis.
• 2:58
  Dr. Komal Patil-Sisodia: The American Association of Clinical Endocrinologists has a position statement that's very clear.
• 3:04
  Dr. Komal Patil-Sisodia: It's a condition not recognized by endocrinology specialists, and the tests that are marketed to, quote,"diagnose" it have never been validated against a real reference standard.
• 3:15
  Dr. Komal Patil-Sisodia: There's no real reproducible mechanism showing chronic stress can cause adrenal glands to physically wear out.
• 3:23
  Dr. Komal Patil-Sisodia: That's not really how cortisol regulation works.
• 3:26
  Dr. Komal Patil-Sisodia: The adrenal gland doesn't just run out because it's tired.
• 3:29
  Dr. Komal Patil-Sisodia: There are other reasons why an adrenal gland can shut down, but that is not the same thing as adrenal fatigue.
• 3:35
  Dr. Komal Patil-Sisodia: And this isn't just an argument over words.
• 3:38
  Dr. Komal Patil-Sisodia: Treating imaginary adrenal fatigue can actually mask a real diagnosis.
• 3:43
  Dr. Komal Patil-Sisodia: True adrenal insufficiency, thyroid disease, depression, sleep apnea, anemia, all of which have a similar I'm exhausted and nothing really helps feeling.
• 3:55
  Dr. Komal Patil-Sisodia: And when adrenal fatigue protocols include hydrocortisone, there's trial data in chronic fatigue syndrome showing it does not meaningfully improve energy.
• 4:06
  Dr. Komal Patil-Sisodia: So even the treatment people reach for doesn't deliver on its own premise.
• 4:10
  Dr. Komal Patil-Sisodia: What I want you to walk away with, there's no test, no scan, no lab value that diagnoses adrenal fatigue because it isn't a diagnosis.
• 4:21
  Dr. Komal Patil-Sisodia: It is a description of a feeling wearing a lab coat.
• 4:25
  Dr. Komal Patil-Sisodia: To be clear, I'm not telling you that your exhaustion isn't real or that your nervous system can't be in a chronically dysregulated state from stress.
• 4:33
  Dr. Komal Patil-Sisodia: What I'm telling you is that the adrenal gland isn't the broken part, and calling it adrenal fatigue often stops people from finding what the actual problem is.
• 4:45
  Dr. Komal Patil-Sisodia: Let's move on to myth number two.
• 4:47
  Dr. Komal Patil-Sisodia: Adrenal support supplements are effective and safe.
• 4:52
  Dr. Komal Patil-Sisodia: If myth number one is a diagnosis that doesn't exist, myth number two is the industry that sells you the cure for it.
• 5:00
  Dr. Komal Patil-Sisodia: These adrenal support supplements that you often see on social media or on your webpage are frequently marketed as hormone-free, and yet the testing has found that some actually contain real thyroid and steroid hormone, but it's undeclared on the label.
• 5:18
  Dr. Komal Patil-Sisodia: In people without confirmed adrenal insufficiency, supplementing with things like pregnenolone or DHEA doesn't improve how people feel.
• 5:26
  Dr. Komal Patil-Sisodia: It mostly causes acne, hair changes, and other side effects that you can get from taking things that are androgenic or similar to testosterone.
• 5:37
  Dr. Komal Patil-Sisodia: So that can be hugely problematic.
• 5:40
  Dr. Komal Patil-Sisodia: DHEA does actually have a real evidence-based role, but only in women with confirmed adrenal insufficiency who have specific symptoms like low libido, fatigue, depression.
• 5:53
  Dr. Komal Patil-Sisodia: And even there, the benefit is minimal, like modest.
• 5:56
  Dr. Komal Patil-Sisodia: It's not a dramatic transformation like the bottle will promise you.
• 6:01
  Dr. Komal Patil-Sisodia: So if you don't have a diagnosed adrenal problem, an adrenal supplement isn't really supporting anything.
• 6:06
  Dr. Komal Patil-Sisodia: It's just an unregulated hormone that you didn't ask for, or an unregulated bunch of herbs that are not proven to do anything, especially for a condition that doesn't exist Now let's move on to myth number three: every adrenal tumor needs surgery.
• 6:24
  Dr. Komal Patil-Sisodia: This is one that I constantly see in my clinic.
• 6:26
  Dr. Komal Patil-Sisodia: Somebody gets a CT scan for something totally unrelated, and the radiologist notes adrenal nodule.
• 6:32
  Dr. Komal Patil-Sisodia: And the patient spends, like, the next three weeks convinced that they need surgery.
• 6:38
  Dr. Komal Patil-Sisodia: Adrenal incidentalomas, which are incidental findings or adenomas that we see on other scans, show up in about one to five percent of CT scans.
• 6:48
  Dr. Komal Patil-Sisodia: And the overwhelming majority of those adrenal tumors are benign, non-functional adenomas, meaning not cancer and not overproducing any hormones.
• 6:59
  Dr. Komal Patil-Sisodia: Now, the current guidelines are pretty consistent.
• 7:02
  Dr. Komal Patil-Sisodia: When we have a benign-appearing non-functional adenoma, they don't need surgery.
• 7:08
  Dr. Komal Patil-Sisodia: They need monitoring, not an operating room.
• 7:10
  Dr. Komal Patil-Sisodia: So we'll generally monitor those over a period of time.
• 7:13
  Dr. Komal Patil-Sisodia: If they're continuing to grow or they are larger in size, like four centimeters or bigger, then we'll talk about actually going and sending people for surgery.
• 7:24
  Dr. Komal Patil-Sisodia: We will also operate on patients who have tumors that are overproducing hormones that can cause issues like high blood pressure or Cushing syndrome, or when you have an excess of those adrenaline-like hormones, that's called a pheochromocytoma.
• 7:40
  Dr. Komal Patil-Sisodia: There are true conditions where hormones are being overproduced that you do need to remove the adrenal to help manage those symptoms.
• 7:48
  Dr. Komal Patil-Sisodia: But in people who have no symptoms and the tumor is less than four centimeters in size, that's actually something you can watch pretty safely.
• 7:57
  Dr. Komal Patil-Sisodia: Now let's move on to myth number four, which is that everyone with obesity or diabetes should be screened for Cushing syndrome.
• 8:04
  Dr. Komal Patil-Sisodia: Cushing syndrome gets a lot of attention because when you look it up and you Google it, the presentation is really dramatic, right?
• 8:11
  Dr. Komal Patil-Sisodia: People will gain weight around their middle.
• 8:13
  Dr. Komal Patil-Sisodia: They'll lose muscle mass in their arms or legs.
• 8:16
  Dr. Komal Patil-Sisodia: If they have a pituitary gland tumor that's overproducing the hormone that stimulates the adrenal glands, people can get very dark stretch marks along their abdomen.
• 8:26
  Dr. Komal Patil-Sisodia: They can have hair loss and acne, and they get a round appearance of their face, and they get kind of a hunched over appearance of their back.
• 8:35
  Dr. Komal Patil-Sisodia: So those types of symptoms are concerning for Cushing syndrome, but just because you have obesity and diabetes does not mean that you have Cushing syndrome, right?
• 8:46
  Dr. Komal Patil-Sisodia: People are often told your cortisol is the reason you can't lose weight, but in reality, it's a rare cause of obesity and diabetes, not a common one.
• 8:54
  Dr. Komal Patil-Sisodia: So screening every person with obesity or diabetes for Cushing syndrome isn't recommended by any guidelines.
• 9:00
  Dr. Komal Patil-Sisodia: It would actually create a flood of false diagnoses without actually finding more real disease.
• 9:06
  Dr. Komal Patil-Sisodia: There's no single symptom that points to or is a definitive thing that Cushing's syndrome presents with.
• 9:13
  Dr. Komal Patil-Sisodia: And a high cortisol level by itself isn't actually diagnostic because your cortisol levels naturally fluctuate up and down throughout the day with something called diurnal variation, which is the way our body is supposed to produce and use up cortisol and then kind of recharge it overnight.
• 9:28
  Dr. Komal Patil-Sisodia: Your cortisol level will naturally fluctuate throughout the day, and those fluctuations get worse when you have stress or illness as well.
• 9:36
  Dr. Komal Patil-Sisodia: And so testing should really be reserved for people who have a very specific clinical pattern that will make you suspicious for Cushing's.
• 9:45
  Dr. Komal Patil-Sisodia: So dark purple colored stretch marks, muscle weakness because you've lost muscle tone in your arms or legs, and then unexplained osteoporosis in someone who's young.
• 9:57
  Dr. Komal Patil-Sisodia: I've had a few patients in my practice where their diabetes is something that we can't control no matter what we put them on, and they are following their diet.
• 10:08
  Dr. Komal Patil-Sisodia: And it's unfortunate, a lot of times these patients will get told,"Well, you must not be doing the diet part" or"You must not be exercising enough." But what I've seen in these patients who end up having Cushing's syndrome is that no matter what we do, no matter what diet they follow, because the cortisol is high, it's driving up the sugars, and insulin and other medications don't treat it appropriately.
• 10:33
  Dr. Komal Patil-Sisodia: So that's something to keep in mind if you have symptoms like that and nothing is working.
• 10:38
  Dr. Komal Patil-Sisodia: In that case, it kind of makes sense.
• 10:40
  Dr. Komal Patil-Sisodia: You should probably get screened for Cushing's.
• 10:42
  Dr. Komal Patil-Sisodia: But for the overwhelming majority of people, it's actually not super helpful.
• 10:47
  Dr. Komal Patil-Sisodia: So it's important to know that cortisol is not the villain for most obesity or diabetes.
• 10:53
  Dr. Komal Patil-Sisodia: When it's actually Cushing syndrome, the body tells a much more specific story than weight gain.
• 11:00
  Dr. Komal Patil-Sisodia: Myth number five, everyone on chronic steroids needs maximal stress dose steroids for any procedure This is more of an inside medicine myth, but it matters if you or someone you love is on long-term steroids heading into surgery for a procedure.
• 11:18
  Dr. Komal Patil-Sisodia: The old rule was that we gave everyone steroid, on steroids a huge stress dose before any procedure, and we've actually replaced it with what's called a tiered approach based on how stressful the procedure actually is.
• 11:31
  Dr. Komal Patil-Sisodia: So for if someone you love has adrenal insufficiency, for minor procedures or minor stress, like you're having something done under a local anesthesia and you're already on a reasonable steroid dose, some people actually don't need an increase at all unless they start having their blood pressure drop or other crazy things happen.
• 11:53
  Dr. Komal Patil-Sisodia: For people who are undergoing major surgery, like general anesthesia, then in that case, we will usually give a hundred milligrams of a steroid called hydrocortisone at the start of the procedure, and then they get a continuous infusion and then additional doses after that we then taper down to their home dose.
• 12:11
  Dr. Komal Patil-Sisodia: And giving everyone the highest dose of steroids, just in case, isn't protective.
• 12:17
  Dr. Komal Patil-Sisodia: It actually exposes people to real risks of taking too much steroid, which are gonna be high blood sugars, poor wound healing, infection, mood changes.
• 12:27
  Dr. Komal Patil-Sisodia: And so more steroids are not automatically safer.
• 12:29
  Dr. Komal Patil-Sisodia: The goal is really to match what's happening in the body and not just flood the system with steroids in the name of keeping people safe.
• 12:38
  Dr. Komal Patil-Sisodia: Now, myth number six is that adrenal insufficiency is easy to diagnose clinically.
• 12:44
  Dr. Komal Patil-Sisodia: Of everything in this episode, this is the myth I want you to walk away with remembering because the cost of it isn't a wasted supplement purchase.
• 12:52
  Dr. Komal Patil-Sisodia: It's years of suffering and sometimes a medical emergency.
• 12:56
  Dr. Komal Patil-Sisodia: But a quick reset before we go any further.
• 12:58
  Dr. Komal Patil-Sisodia: This myth is not about adrenal fatigue.
• 13:01
  Dr. Komal Patil-Sisodia: That's the fake one from myth one.
• 13:04
  Dr. Komal Patil-Sisodia: This is about adrenal insufficiency, which is a real diagnosable disease where the adrenal glands genuinely don't make enough cortisol, and it's life-threatening.
• 13:13
  Dr. Komal Patil-Sisodia: The same gland, completely different framework, and the myth is that it's obvious when someone has it, and it isn't obvious when somebody has adrenal insufficiency, at least not initially.
• 13:27
  Dr. Komal Patil-Sisodia: True adrenal insufficiency is frequently missed for months to years because the symptoms mimic the symptoms of other conditions.
• 13:35
  Dr. Komal Patil-Sisodia: A lot of patients will present with fatigue, nausea, weight loss, joint pain, and that overlaps with, like, a dozen other common conditions.
• 13:44
  Dr. Komal Patil-Sisodia: And in one cross-sectional study that was done, It was noted that twenty percent of patients had symptoms for more than five years before they were diagnosed with adrenal insufficiency.
• 13:54
  Dr. Komal Patil-Sisodia: Fewer than thirty percent of women were diagnosed within six months of when the symptoms actually started.
• 13:59
  Dr. Komal Patil-Sisodia: And up to half of the patients diagnosed with adrenal insufficiency experienced a life-threatening adrenal crisis either right before or shortly after they were finally diagnosed, meaning the delay itself is dangerous and not just frustrating.
• 14:14
  Dr. Komal Patil-Sisodia: Adrenal crisis is really scary.
• 14:17
  Dr. Komal Patil-Sisodia: I've admitted patients in adrenal crisis.
• 14:20
  Dr. Komal Patil-Sisodia: Their blood pressure is tanking.
• 14:21
  Dr. Komal Patil-Sisodia: They're having nausea and vomiting.
• 14:23
  Dr. Komal Patil-Sisodia: They're not able to maintain their blood pressure.
• 14:25
  Dr. Komal Patil-Sisodia: They are passing out.
• 14:27
  Dr. Komal Patil-Sisodia: It can be very, very scary.
• 14:30
  Dr. Komal Patil-Sisodia: And a lot of times what happens is they will be going along, and then they have some major stressor happen, like an illness or a surgery or, they get into a car accident, and their adrenal glands are not able to make enough steroid to get them through that crisis.
• 14:46
  Dr. Komal Patil-Sisodia: And so it puts the body itself into crisis.
• 14:49
  Dr. Komal Patil-Sisodia: Here's the connection back to where we started, adrenal fatigue, which was the first myth, and a true diagnosis of adrenal insufficiency are not the same condition, even though they kind of sound like they would be cousins.
• 15:01
  Dr. Komal Patil-Sisodia: One is a wellness industry myth that has no test, no mechanism, and no diagnosis behind it, and the other one is a real measurable and sometimes life-threatening disease of the adrenal gland itself, And it's the one unfortunately that we are worse at catching in time.
• 15:18
  Dr. Komal Patil-Sisodia: And here's the part that should actually bother you.
• 15:20
  Dr. Komal Patil-Sisodia: The noise around the fake diagnosis may be making it harder to catch the real one.
• 15:27
  Dr. Komal Patil-Sisodia: The phrase,"I think it's my adrenals," has been the battle cry of the supplement industry that make both patients and clinicians mentally file it under like wellness chatter instead of running the actual tests that would tell you and give you a diagnosis.
• 15:45
  Dr. Komal Patil-Sisodia: So if you've been told to support your adrenal glands for a few years and nothing's changed, that's not a sign that you need a stronger supplement.
• 15:55
  Dr. Komal Patil-Sisodia: It's a sign you need a better workup.
• 15:58
  Dr. Komal Patil-Sisodia: As we close out this episode of the six myths, let's run it back real fast.
• 16:03
  Dr. Komal Patil-Sisodia: Number one, adrenal fatigue isn't a diagnosis.
• 16:06
  Dr. Komal Patil-Sisodia: Number two, adrenal support supplements are not harmless.
• 16:10
  Dr. Komal Patil-Sisodia: Number three, most incidentally found adrenal tumors, otherwise known as adrenal incidentalomas, don't need surgery.
• 16:18
  Dr. Komal Patil-Sisodia: Number four most people with obesity and diabetes don't need Cushing screening.
• 16:23
  Dr. Komal Patil-Sisodia: Number five, most people on chronic steroids don't need to be put on huge stress doses for every procedure they have.
• 16:31
  Dr. Komal Patil-Sisodia: And number six, real adrenal insufficiency is dangerously underdiagnosed, partly because the fake diagnosis of adrenal fatigue takes up all the attention, and it's so much louder than the real one.
• 16:43
  Dr. Komal Patil-Sisodia: If this episode made you rethink something about your own health or something you were told by a wellness account with very good lighting, that's exactly the point of this series.
• 16:54
  Dr. Komal Patil-Sisodia: If you know someone who's been told to, quote,"heal their adrenals" with a$90 supplement bundle, send them this episode instead.
• 17:02
  Dr. Komal Patil-Sisodia: Follow the show, leave a rating, and find me on socials,@drpatilsisodia, And if you've got 30 seconds, pop over to my website, clearlyhormonal.com, where you can find the full reference list from today's episode on the show notes, and let me know if you have more questions.
• 17:17
  Dr. Komal Patil-Sisodia: My next episode in this series is going to focus on how you test for true adrenal insufficiency and what fake tests are out there that are really just taking money out of patients' pockets.
• 17:30
  Dr. Komal Patil-Sisodia: Thank you so much for tuning in, and I will see you on the next episode.