As I mentioned in the previous chapter, in a few cases of severe hypoadrenia that border on actual Addison’s disease, a short therapeutic course of natural cortisol may be needed. Jeffries gives an excellent account of how to use the natural hydrocortisone in therapy in his book, “Safe Uses of Cortisol”, (Jeffries, 1998). He also does a nice job of covering the historical aspects of the development of the synthetic corticosteroids and the disadvantages of using them. Briefly, if this therapy is necessary, it should be confirmed by special tests such as the combined 24-Hour Urinary Cortisol & ACTH tests mentioned in Chapter 11. 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 For this reason it is important that treatment should be withdrawn slowly, never abruptly.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. Jeffries recommends 5 or 7.5 mg. orally before each meal and at bedtime (Jeffries, ’98, pg. 43). 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 several cases, natural cortisol has been taken simultaneously with adrenal cell extracts. This regimen for severe hypoadrenia 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 (as described in Chapter 15) 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, and even some cases of Addison’s disease, 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 (see section on Saliva Testing). 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 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 to1/2 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 by Dr. John Lee, What Your Doctor May Not Tell You About Menopause.
Using hormone replacement therapy for adrenal fatigue is an area that requires skill. Although some of the hormones mentioned in this chapter 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.