Is Adrenal Fatigue Real?

If there are two words Dr. James Findling, an endocrinologist at the Medical College of Wisconsin, dreads hearing, they’re probably “adrenal fatigue.” Some of his patients recite claims they’ve read on social media: that adrenal fatigue happens when the adrenal glands, which produce the stress hormone cortisol, can’t keep up with the amount of stress they’re facing and underperform, leading to a long list of symptoms. But the mainstream medical community disagrees. “Adrenal fatigue is an illogical and illegitimate diagnosis that has no scientific basis,” Findling says, and endocrinologists are “fed up” that the idea hasn’t gone away. The Endocrine Society, of which Findling is a member, agrees that adrenal fatigue is not a legitimate medical diagnosis, and researchers have debunked the concept in studies. But the term persists on social media and among some alternative-medicine practitioners, so people continue to think they have it. “It takes a lot of time and a lot of explanation…to prove their adrenals are fine,” says Dr. Anat Ben-Shlomo, an endocrinologist at Cedars-Sinai in Los Angeles.

How the adrenal glands work

It’s hard to blame patients for thinking they have adrenal fatigue, as the symptoms attributed to the condition are extremely common. They include struggling to wake in the morning and then feeling tired for much of the day, relying on caffeine for energy, craving salt or sugar, experiencing brain fog, feeling hopeless or in despair, and reporting a low sex drive. And that’s the short list. “It’s pretty much every symptom,” says Dr. Rashmi Mullur, an endocrinologist and integrative-medicine specialist at UCLA Health. These symptoms are real, Mullur says, and they may indeed be linked to chronic stress—but they aren’t happening because your adrenal glands are giving out. “While you may emotionally and mentally feel burned out, your adrenals can’t actually burn out,” she says. “They will continue to function even in chronic stress.” Read More: Why Zero Stress Shouldn’t Be Your Goal The adrenal glands, which sit atop the kidneys, produce and release multiple hormones, including cortisol and adrenaline. During stressful situations, a domino effect beginning in the brain eventually signals to the adrenals that it’s time to start pumping out these hormones, which trigger a range of physiological effects meant to help the body respond to the stressor. When there’s enough cortisol in the bloodstream, the brain gets the message and regulates production accordingly. The adrenals’ ability to carry out that process “appears to be limitless,” Ben-Shlomo says, unless someone has true adrenal dysfunction. There are rare conditions that lead the adrenal glands to either under- or over-produce hormones—Addison’s disease and Cushing’s syndrome, respectively—but they’re usually caused by autoimmune conditions, tumors, infections, prolonged medication usage, or other medical problems, not routine stress. (Damage to the pituitary gland, which is located at the base of the brain, may also disrupt the hormone-production process.) And, unlike for adrenal fatigue, there are validated tests that doctors use to diagnose Addison’s disease and Cushing’s syndrome, Ben-Shlomo says.

The myth of adrenal fatigue

If it’s not an accepted diagnosis, where did the idea of adrenal fatigue come from, anyway? It’s often attributed to James Wilson, a chiropractor and naturopath who in 2001 published the book Adrenal Fatigue: The 21st Century Stress Syndrome. In an interview with TIME, Wilson says he coined the term in the late 1990s after seeing many clients who had the same energy and mood problems, which he attributed to problems with their adrenal glands. Though he says it’s “doubtful” that mainstream medicine will accept adrenal fatigue, Wilson maintains that there is a state between adrenal failure and regular functioning, and that physicians are missing it because they’re not using the right diagnostic tests. For one, Wilson thinks saliva tests are more precise than blood tests for measuring cortisol levels. The U.S. National Institutes of Health says blood tests are the gold standard for diagnosing adrenal insufficiency, but a 2023 study from researchers in the U.K. found that saliva tests are not drastically less accurate. The medical system isn’t motivated to take adrenal fatigue seriously, Wilson says, because “there’s no money in it” without drugs that can be prescribed to treat it. (Wilson sells a range of supplements that claim to improve adrenal health.) Read More: You Don’t Need to Balance Your Hormones The problem with people believing they have adrenal fatigue, Ben-Shlomo says, is they may self-diagnose themselves and seek out unproven and potentially dangerous treatments. She once saw a patient who took so many supplements containing steroids that they actually damaged his adrenal glands—the exact opposite of what they promised to do. Plus, people who think they have adrenal fatigue may in fact have another medical issue that’s causing their symptoms, which could also be missed if patients diagnose themselves.

Treating stress, not symptoms

Where does that leave people who are experiencing all the symptoms attributed to adrenal fatigue, but are testing normal in the doctor’s office? Mullur can empathize. As the parent of a child with disabilities, she has faced extreme stress and experienced many of the alleged symptoms of adrenal fatigue herself, which inspired her to do more for patients in the same boat. “I knew my adrenals were functioning, but I had all the symptoms: can’t sleep, eating too much, fatigued all day, weight gain, hair loss, irritability, all of it,” she says. For other people dealing with these issues, she says the solution often comes down to managing chronic stress—because, although it won’t fry the adrenal glands, chronic stress can have a profound impact on overall health, Mullur says. Read More: Can Food Really Change Your Hormones? In the short-term, the body’s stress response can be lifesaving and health-boosting. But when people live with unrelenting stress, they can experience a cascade of effects that contribute to health problems ranging from cardiovascular issues to immune- and nervous-system dysfunction. Research also suggests chronic stress can disrupt circadian rhythms, which may have trickle-down effects on everything from sleep to digestion. Mullur says people should focus on managing their stress through “back to basics” approaches like movement, nutrition, mindfulness practices, and social connection. Seeing a mental-health clinician or other health care practitioner may also help, if possible. Over time, Mullur says, these practices should improve the symptoms people are experiencing, which are legitimate and worthy of treatment—even if they’re not linked to an adrenal problem. “We need a different name,” Mullur says. “It’s about treating the chronic stress. That’s the main issue.”