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There are two hormones typically used as markers of adrenal fatigue or adrenal dysfunction. The two hormones commonly measured are cortisol and DHEA.  The best way to test your adrenal health is to measure your level of free key adrenal hormones, such as, cortisol and DHEA. The free form is important because it actually measures the available hormone. Saliva testing is preferred as it measures the amount of free and circulating hormones instead of the bound hormone commonly measured in blood tests. DHEA can be measured any time during the day. Cortisol on the other hand is the highest in the morning and the lowest in the evening before bedtime. Taking four samples of cortisol at 8 a.m., noon, 5 p.m., and before bedtime is the most accurate. With multiple samples taken throughout the day, we are able to map diurnal curve of free cortisol in the body relative to DHEA level. This will give us a much clear picture of adrenal function. This also gives us a better picture as to adrenal stress loads. Stress can also affect the levels of adrenal hormones. Your cortisol level tested after a quiet and relaxing morning will be different from that taken when you are under tremendous stress.


The adrenal glands contribute about 35% female hormones premenopausally and almost 50% postmenopausally.  Without proper functioning adrenal glands, pregnancy cannot occur.  Women often have exhausted adrenal glands by the time they reach their mid 30s or early 40s due to a stressful lifestyle.  Stress is regulated by our adrenal glands primarily.  In the early stages of adrenal fatigue, the cortisol output is high as the body attempts to neutralize the stress by producing more of it.  When too much cortisol is produced, you will have multiple undesirable effects.  For example, cortisol blocks progesterone receptors making them less responsive to progesterone.  Progesterone, which is normally produced by the adrenal glands, comes to a halt in favor of cortisol.  Insufficient progesterone production leads an imbalance of estrogen to progesterone.  The result is estrogen dominance.  With reduced progesterone to offset estrogen, the body may experience estrogen dominance and a host of undesirable side effects associated with excessive estrogen occur.  Again, the condition is known as estrogen dominance.  It is not a coincidental finding that we see multiple conditions associated with excessive estrogen such as //PMS, fibroids, premenstrual syndrome in women who reach their mid 30s and early 40s.  Adrenal normalization should precede hormone modulation.  In other words, the adrenals need to be addressed and treated properly before taking hormone replacement therapy.  The adrenals do deal with daily stressors of life.  A woman must normalize her adrenal glands in order to have a total body hormone balance.  Replacement of the deficient hormones alone without addressing the overall health of the adrenal gland is a Band-Aid approach and is often ineffective in the long run.  The normalization process can begin with investigating and eliminating stressors.  Stressors are often chronic in nature and can be really related to lifestyle, dietary, mental, and inflammatory causes. Women with heavy menstrual bleeding and adrenal exhaustion can normalize their adrenal functions with natural cortisol, adequate sleep, proper diet, and nutritional supplementation. This should be considered before considering hormonal progesterone therapy. Oftentimes progesterone makes the bleeding even heavier.  This usually only temporarily occurs in the beginning when the estrogen sites are being resensitized.  Women under stress can paradoxically have high cortisol and adrenal insufficiency. At the same time, before they get to adrenal fatigue stage, where//5:45// the cortisol level eventually drops. Most postmenopausal women who are experiencing hair loss have an adrenal function problem. Hair loss is a sight of excessive androgen. Some women tend to produce too much androstenedione, which then gets converted into estrone and testosterone. Estriol can be given to off set the testosterone effects as estrogen balances testosterone in the body. Cortisol is also very helpful and can be used as a first line natural medicine.  It keeps the adrenal glands from getting stuck in the androgen part of the stress cycle.  Cortisol also complements the use of progesterone as well.

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