Adrenal Thread

[marianco]

Propecia and Adrenal Fatigue

i have fatique, lack of morning erections, weak erections, inability to orgasm, absolutely no libido. lack of emotions, my problems appear to be from the use propecia like a few others here, i have not taken any other medications. my urologist has also said i have also have an enlarged prostate, i assume its from the high estrogens in my system. i'm in my early 30's height 5feet 7" weigh 160. i have been off propecia for 2 yrs yet the symptoms still persist, having taken it for 8 months.

gonadal:
testosterone = 465 range 250-850
free testosterone = 14 range 9.3-26.5
estradiol = 45 range <54
dht = 36 range 30-85

adrenal:
progesterone = 2.6 range <4.0
cortisol = 399 range < 175 - 685 (done in the morning)
dhea-s = 6.8 range 5.2 - 14.2

thyroid:
tsh = 1.3 range 0.47 - 4.2
free t3 = 4.3 range 4.0 - 6.8

pancreatic:
glucose fasting = 4.7 range 3.3 - 6.0

liver panel:
albumin = 46 range 35 - 50

lipids:
cholesterol = 4.67 range 2.0 - 4.59

I wish the units were included to help translate them into units commonly used in the U.S.

Often I wonder how men who previously used Propecia developed seemingly permanent problems from it despite stopping it. Unless Propecia causes some genetic damage (and there is no evidence of this), it is very unlikely that Propecia is the cause. I would look to other persistent problems instead that may have been overlooked.

One possible scenario: a man who is living a stressful life realizes he is losing hair. Hair loss is a possible consequence of stress alone - for example, by causing a loss of zinc. The man takes Propecia to try to help reduce the hair loss. Along the way, he developes fatigue, loss of libido, erectile disturbance, depression or other mood problems. The problem is blamed on Propecia. Propecia is stopped. The problems persist. What happened? A possible answer is that the stressful life, which caused the hair loss, also caused adrenal fatigue - which can cause all of the symptoms described.

Diagnosising adrenal fatigue via blood tests is difficult because it is based on looking at small deviations from the mean. The diagnosis is helped by history and physical exam. On physical exam, often the blood pressure is low - or blood pressure drops between the sitting and standing measurements. There may be sensitivity to sunlight, weakness of pupillary constriction to light. Other historical clues include sugar or salt cravings, craving for chocolate, fatigue and sleepiness in the afternoon, difficulty in falling asleep at night, a desire to sleep most of the time, increased energy at night, etc.

Blood test clues include:
1. Low normal cortisol
2. Low normal DHEA-s
3. Low normal progesterone
4. Low normal blood sugar
5. Low sodium
6. Low potassium
7. high normal to high albumin
8. high cholesterol

The best test for adrenal fatigue is a saliva test with cortisol at four times in a day, and DHEA-s at least twice in a day.

James Wilson's book "Adrenal Fatigue" is a good place to start for information.

One mistake I see many people make when doing hormone balancing is to treat thyroid deficiency simultaneously with adrenal fatigue. The problem is that thyroid hormone forces the adrenal glands to increase output. Increasing output is exactly what the adrenal glands have a problem doing. The result is a worsening of adrenal fatigue and the patient does not get better.

Interestingly, in some people, treating adrenal fatigue (such as with progesterone and hydrocortisone), often results in a return of morning erections even when testosterone is as low as 170 (300-850).

 

[SPE]

"Interestingly, in some people, treating adrenal fatigue (such as with progesterone and hydrocortisone), often results in a return of morning erections even when testosterone is as low as 170 (300-850)."

I found this to be very true for myself. Even after T therapy and being in the upper quartile of the range, my libido didn't completely return 'till I addressed my adrenals.

In the results above, it looks like your problem could very well be adrenal. Your DHEA, TSH, and cortisol are all fairly low. Your FT3 is also in the gutter. If you had normal adrenal function, your TSH would be much higher, revealing your thyroid issues to most docs.

 

[Legenden1999]

Re: Propecia and Adrenal Fatigue

Often I wonder how men who previously used Propecia developed seemingly permanent problems from it despite stopping it. Unless Propecia causes some genetic damage (and there is no evidence of this), it is very unlikely that Propecia is the cause. I would look to other persistent problems instead that may have been overlooked.

Most of us guys with "permanent propecia damage" has low-normal T and/or high estrogens. Of the ones who had bloodtests for adrenal fatigue, I often see low-normal DHEA, and low morning cortisol.

I'm not saying propecia causes permanent damage by altering genes, but I think propecia causes hypogonadism and adrenal fatigue in some of the users who are genetic disposed for it. And once you are in it, it seems like we are stuck.

I know for a fact that Testosterone replacement has helped my fysical symptoms such as libido, sencitivity in the penis, mucsle wasting, and I even have my scalp itzy-ness back, so Im pretty sure my Testosterone levels has been higher before propecia.

I don't know if I have adrenal fatigue or not, but many things points in that direction. I just started to take isocort 20mg/day, but its still to soon to tell if it will help.

Just because there is no evidence, that does not mean thats its unlikely that propecia caused the symptoms. I would rather say, if everything was fine before propecia and no other drug was taken, its likely propecia that are the cause of these symptoms.

JH

 

[marianco]

Lab tests for adrenal fatigue

I am trying to get a right to the point answer about what tests my doc should run for my adrenals. Than I need to know where these levels should be for optimum adrenal functioning. The adrenal thread is very hard to follow. Can anyone post this info??? She told me if I get the info she will run them. She just wanted a TSH and I told her we needed more. So she said ok get me the info.

Blood Tests:
1. Cortisol AM and PM
2. DHEA-s AM and PM
3. Progesterone
4. Comprehensive Metabolic Panel - to obtain the following:
a) Sodium
b) Potassium
c) Albumin
d) Fasting Glucose
5. Hemoglobin A1c with calculated mean blood glucose
6. Lipid Panel

Saliva Tests (highly sensitive test for adrenal fatigue):
1. Cortisol - at least 4 times in a day, approximately 3-4 hours apart.
2. DHEA-s - at least 2 times in a day.

Urine Tests:
1. 24-hour urine Cortisol (Some practitioners prefer using this. I don't think it is sensitive enough for early stages of adrenal fatigue.)

ACTH Stimulation Test:
This test is useful for primarily Addison's Disease rather than adrenal fatigue. In adrenal fatigue (particularly the early and mid-stages), the adrenal glands may be able to produce cortisol but they have difficulty sustaining the production, creating a "sputtering" pattern of production - where cortisol is normal one moment, then low the next. The ACTH test may show up normal then depending on when it is administered - yet adrenal fatigue is present.

Note that the extreme presentations of low adrenal function (where cortisol production is consistently below the reference range) are cases of Addison's Disease, not Adrenal fatigue.

Adrenal fatigue is a condition where cortisol (and other adrenal hormones)production is impaired (often has non-sustained levels where there are normal levels and low levels or high levels depending on the response to stresss) but is not consistently below the reference range.

 

[Legenden1999]

Re: Lab tests for adrenal fatigue

Marianco, how much do you weight temperature messurements when diagnosing adrenal fatigue ?

JH

 

[love_en]

Re: Adrenal Thread and over-the-counter treatments.

What is interesting is that almost everything needed to treat adrenal fatigue can be obtained over-the-counter, even Cortisol (Hydrocortisone) as a 10 mg per gram (approximately a flat 1/4 teaspoon) skin cream (1% cream for use on rashes and hemorrhoids), and progesterone (as a menopausal skin cream).

For the past week, I have been rubbing in the equivalent of 25 mg, little over 1/2 teaspoon. of hydrocortisone before going to bed. The first day after, felt a little stimulated, as if I had too much coffee. The following days, I have been arising on time morning errection included. Prior to this experiment, I hated mornings, did not want to get out of bed. Orthostatic hypotension is no longer a problem. I think my problem before was that I was not using enough. I should squeeze out a line of HC cream on my digital scale to determine what 2.5 grams lools like.

 

[oki]

i feel very shaky under stress and in the mornings i feel terrible....shaky, weak and tight.... i think this my adrenals... any thoughts ? i found this site from Legenden.... i am on propeciasideeffects site for nearly 3 years.... my hormones seem ok.... had saliva test a while ago that showed VERY low cortisol but very high dhea.... then more recently my blood test showed dhea-s was normal.....what does all this mean ....any ideas ? i have recently started dr wilsons adrenal rebuilder... its been 2 weeks so cannot say if it has helped or not... it doesnt contain hormones... dhea in low doses seems to help for first few days then makes thinsg worse... im really confused... i feel like i have too much cortisol... i really over react to minor stress...is this sign of low cortisol or not ???? im confused as u may be able to tell

 

[SPE]

i feel very shaky under stress and in the mornings i feel terrible....shaky, weak and tight.... i think this my adrenals... any thoughts ? i found this site from Legenden.... i am on propeciasideeffects site for nearly 3 years.... my hormones seem ok.... had saliva test a while ago that showed VERY low cortisol but very high dhea.... then more recently my blood test showed dhea-s was normal.....what does all this mean ....any ideas ? i have recently started dr wilsons adrenal rebuilder... its been 2 weeks so cannot say if it has helped or not... it doesnt contain hormones... dhea in low doses seems to help for first few days then makes thinsg worse... im really confused... i feel like i have too much cortisol... i really over react to minor stress...is this sign of low cortisol or not ???? im confused as u may be able to tell

If you react poorly to stress, it can be the result of low cortisol.

 

[Matt Muscle]

Re: Adrenal Thread and over-the-counter treatments.

For the past week, I have been rubbing in the equivalent of 25 mg, little over 1/2 teaspoon. of hydrocortisone before going to bed. The first day after, felt a little stimulated, as if I had too much coffee. The following days, I have been arising on time morning errection included. Prior to this experiment, I hated mornings, did not want to get out of bed. Orthostatic hypotension is no longer a problem. I think my problem before was that I was not using enough. I should squeeze out a line of HC cream on my digital scale to determine what 2.5 grams lools like.

Hey Mate,
does taking hydrocortisone further shut down your adrenals because you are supplementing it?
I read somewhere that once you do shut them down for a period of time its very hard to get them working again, is this correct?
Glad to hear your feeling better though!

 

[T Man]

I took my cortisol Saliva Tests to a a teaching and research endocrinology University clinic a few days ago. They told me SALIVA tests for cortisol are absolutely worthless. There is no correlation between the actual blood levels of cortisol and the saliva test. Its BS period. Cortisol needs either Blood or urine testing period. They said if they worked they would be using them. They said the alternative labs that do these cortisol saliva tests are providing misleading information and doing a diservice. They told me if anyone here believes otherwise. Tell them we want to see the documented research studies validating saliva corisol testing to actual blood levels. Interesting? Did I waste my money on my saliva cortsol test?

 

[love_en]

Re: Adrenal Thread and over-the-counter treatments.

Hey Mate,
does taking hydrocortisone further shut down your adrenals because you are supplementing it?
I read somewhere that once you do shut them down for a period of time its very hard to get them working again, is this correct?
Glad to hear your feeling better though!

Because my adrenal glands are unable to do what they are supposed to be doing, shutdown is irrelevant. Same as my natural testosterone production, it is not enough to maintain my physical health, so shutdown does not matter. I have been shutdown hormone wise all of my life. The strawman of adrenal shutdown is broadcast by doctors who routinely prescribe prednisone in doses over and above what is produced by the body. 25 mg of hydrocortisone, some of which is not absorbed, is not an overdose. Dr Jeffries has had cases where partial adrenal insufficient patients were able to discontinue hydrocortisone replacement and the adrenal glands output was higher than when the patient started treatment.

 

[Matt Muscle]

Re: Adrenal Thread and over-the-counter treatments.

Because my adrenal glands are unable to do what they are supposed to be doing, shutdown is irrelevant. Same as my natural testosterone production, it is not enough to maintain my physical health, so shutdown does not matter. I have been shutdown hormone wise all of my life. The strawman of adrenal shutdown is broadcast by doctors who routinely prescribe prednisone in doses over and above what is produced by the body. 25 mg of hydrocortisone, some of which is not absorbed, is not an overdose. Dr Jeffries has had cases where partial adrenal insufficient patients were able to discontinue hydrocortisone replacement and the adrenal glands output was higher than when the patient started treatment.

Well keep me posted on how your doing with supplementing it. Is there any advantage to using the cream rather than oral preparations?
Perhaps the partial adrenal insufficient patients gave thier adrenal glands a rest whilst they were on the hydrocortisone?

 

[oki]

i will get my blood tests back for cortisol... then will post results BUT it seems that other who took propecia are now in simialr situation... the longer i stand up the worse i feel but my blood pressure is normal !! i just feel weak and dizzy and my balls go v tight !! its mystery ... propecia fukked me good
any advice....in the eveings after 3pm i basically feel much better unless i get v stressed or take strenuos aerobic exercise....any advice amigos

 

[marianco]

Re: This is for Marcieo (thread) and Adrenal Fatigue

Whatever the problem is, diet probably has little to do with it. If I had numbers like yours, I'd be MUCH more concerned about your adrenal function. Your cortisol level is the lowest I've ever seen. You are at the bottom of the range for adrenal INSUFICCIENCY. Someone correct me if I'm wrong, but below the range indicates Addison's Disease, correct? Not that you are below, but pretty close.

Adrenal fatigue, from what I see now, is too often missed or minimized in treatment of sexual dysfunction.

A probable cause is that all the blood lab values are usually within the reference range. It is the pattern that has to be understood, if only using blood tests, in order to recognize adrenal fatigue.

Occasionally, one gets lucky. For example, the potassium may be actually low. Interestingly enough, often, primary care providers don't do anything despite the obviously abnormal lab value - probably because it does not match up with the usual illness patterns they have learned. One of the rules of thumb of medicine is that a serious metabolic disturbance has to occur in order to derange the sodium or potassium values. Yet, I often see little done when potassium is low.

One case example: a non-steroid user (past or present), without pituitary tumor, patient has a testosterone which is usually around 200 ng/dl. He has sexual dysfunction - no libido, no erections, fatigue, stress, a feeling of "burnout", depression, impaired concentration and memory.

His morning cortisol was 12, DHEA-s was low. He had insulin resistance, high cholesterol, high blood pressure - metabolic syndrome despite being slim - with body fat less than 12 %. Urine neurotransmitters showed a low dopamine level. Saliva cortisol and DHEA-s numbers are low across the board. He has adrenal fatigue and low testosterone level as probable contributors for the other health problems.

Initial treatment to address adrenal fatigue using hydrocortisone, DHEA and progesterone have gradually increased his energy level, reduced the feeling of "burnout" and stress over the course of two weeks. Interestingly, he started developing strong morning erections and an increase in libido to the point he could make love with his wife about once or twice a week. The libido is not at the point it was 10 years ago, but it is markedly improved compared to having no libido at all.

He has had difficulty with transdermal testosterone creams. Possibly because of skin type (perhaps having good skin hydration), the initial use of a high potency, 10% PLO-based testosterone cream (which is essentially oil-based), actually reduced testosterone levels, even at high doses (2-4) grams a day. In analyzing the results, it seemed that only a small amount of testosterone was absorbed and was disproportionally transformed to DHT. The DHT gave negative feedback to the hypothalamus and reduced his native testicular testosterone production, resulting in an overall reduction in testosterone level. His libido, as expected, was worse on the cream.

Notably, libido returned the day after the testosterone cream was stopped, while treatment for adrenal fatigue continued.

Since we are aiming for reducing problems with depression, stress, impaired concentrationand memory, sexual function (to more than what a testosterone around 200 will give), and the metabolic syndrome symptoms, next in line is an alcohol-based testosterone gel - compounded 5% - which is a lot less expensive than using the 1% Androgel, and needs a smaller area of application (which helps control DHT). Androgel, in the majority of people, is a fabulous product. At gives steady state testosterone levels of around 700 through 24 hours at 10 grams of gel a day. The problems are the large application area and the cost - close to $450/month for 10 grams a day - shockingly high for a generic product with simple formulation.

 

[love_en]

Re: Adrenal Thread and over-the-counter treatments.

Well keep me posted on how your doing with supplementing it. Is there any advantage to using the cream rather than oral preparations?
Perhaps the partial adrenal insufficient patients gave thier adrenal glands a rest whilst they were on the hydrocortisone?

That is one of the theories proposed by progressive doctors. Physiological doses of hydrocortisone rest the adrenal glands so they do not burn out and fail completely later on. As in hypogonadism, there is primary and secondary adrenal insufficiency. Primary is marked my high ACTH output and adrenals that cannot produce enough cortisol. Secondary is a lack of ACTH signaling to the adrenals.

It has been said that resting the adrenals helps those that are on their way to becoming primary. But does not work for people who are secondary. In addition to shutting them down hard. That is a chance I am willing to take. I cannot plan my life to accomodate my hormones or lack thereof. It would not work if I had to tell people: "I cannot start my day before 10AM, I cannot do any physical work, do not pressure me about time or deadlines and I can only work a few hours per day, no more than 3 days a week." The people who push themselves without addressing the root of their problem pay with their health, sanity, and life in the end. That price is too high for me. To answer your question about hydrocortisone cream VS tablets. The only difference I can think of is HC cream is sustained in action like Androgel. Cortef tablets must be taken 2-4 times a day.

 

[Matt Muscle]

Thanks, very interesting. Yes, that would make sense regarding the cream.

 

[1cc]

Re: Adrenal Thread and over-the-counter treatments.

To answer your question about hydrocortisone cream VS tablets. The only difference I can think of is HC cream is sustained in action like Androgel. Cortef tablets must be taken 2-4 times a day.

Where are you applying the HC cream, and how much and how often. I am interested to see how well the "sustained" action works.

 

[marianco]

Adrenal Fatigue vs. Adrenal Insufficiency

If someone finally determines that they are suffering from partial adrenal insufficiency. Would the use of low dose hydrocortisone further shut down the adrenals so that it would be difficult to get them working again if the HC therapy was discontinued? Should the use of hydrocortisone only be considered if all natural therapies to repair the adrenals has not worked? In other words once you start using it, you could be on it for life? Where as with TRT, most can stop the therapy and just return to baseline levels in time.

The best initial sources of information which is also fairly easy to read are the books: "Adrenal Fatigue" by James Wilson, and "Safe Uses of Cortisol" by William Jeffries.

It is important to distinguish the terms "Adrenal Fatigue" vs. "Adrenal Insufficiency".

Adrenal insufficiency is an illness. It is recognized by endocrinologists. In many cases, it indicates the long-term need, if not life-time need to use hydrocortisone.

In adrenal insufficiency, either the brain cannot release enough ACTH or the adrenals cannot produce enough cortisol and other hormones to sustain life if under stress. In primary adrenal insufficiency, there is destruction of the adrenal glands to the point it cannot work, does not respond to ACTH. Secondary adrenal insuffiency has many causes. One is failure of the pituitary, due to a tumor, to produce ACTH. Another is the excessive use of hydrocortisone or prednisone - glucocorticoid steroids - which shuts the adrenal glands down either permanently or potentially for years. Adrenal insufficiency is life-threatening without treatment. In adrenal insufficiency, since the body cannot make adequate cortisol (e.g. the adrenals are shut down), a person could die without hydrocortisone treatment.

In adrenal insufficiency, only in cases where the adrenals can rehabilitate (e.g. excessive glucocorticoid use) can hydrocortisone be gradually withdrawn. That is iffy because it can be difficult if not impossible to restart the adrenal glands once it has been shut down. Thus excessive use hydrocortisone or prednisone or other glucocorticoid use runs the risk of developing a permanent disability and life-threatening illness.

There is no "partial" adrenal insufficiency. A person either has it or doesn't.

On the other hand, adrenal fatigue is not technically an illness. It is the condition associated with adrenal fatigue (e.g. depression, chronic fatigue syndrome, anxiety disorders, etc.) that recognized as the "official" illness.

In Adrenal fatigue, there is no destruction of the adrenal glands. The adrenal glands are not shut down. The brain works. The parts of the brain - called the hypothalamus and pituitary - work. Blood tests of cortisol and DHEA-s are usually within the normal range. Adrenal fatigue is a deviation from the mean which still usually remains within the normal range.

In normal function, the brain determines how much cortisol is needed to respond to stress and signals the hypothalamus to signal the pituitary to send out ACTH to tell the adrenal glands to make cortisol. The cortisol level is then monitored by the hypothalamus. The amount of ACTH is then lowered or increased to control cortisol production to the amount desired by the brain. ACTH also stimulates adrenal growth.

Adrenal fatigue is analogous to an overtrained muscle. The muscle still can work. However, it is weaker and may lose muscle mass because the owner of the muscle has not had adequate rest or nutrition to build the muscle either in strength or endurance. This is a principal known to bodybuilding. Any stress, positive or negative, results in stimulation of the adrenal glands to produce its hormones and to grow. Without adequate rest and nutrition, the adrenals (like a muscle) wears down and has more difficulty in producing its hormones.

When given a short period of rest (such as some sleep or lack of activity for a few hours), the adrenals can rally and produce enough hormones so that blood tests of cortisol, for example, are normal or even high (when stressed). But ultimately, the adrenals can be shown to have periods when it has difficulty producing cortisol and the other hormones. I liken this to the adrenals sputtering - as a car engine sputters when the electrical system (analogous to the adrenal glands) is not working well. The amount produced is usually not below the reference range of the blood test. If below the reference range, the adrenals have failed and you have adrenal insufficiency, which is life threatening. In adrenal fatigue, a person still makes enough cortisol to live - though their life is suboptimal (e.g. chronically bedridden, depressed, fatigued, etc.).

Adrenal fatigue can be thought of as a mental-physical illness since the brain is what is first affected by stress and is overwhelmed in controlling the stress to the point the brain sends excessive stress signals to the adrenal glands which causes adrenal fatigue. Without the brain, there is no stress felt by the body, there is no adrenal fatigue.

Mental disorders which I've found are associated with adrenal fatigue include: mood disorders, anxiety disorders, attention deficit/hyperactivity disorders, psychotic disorders, adjustment disorders, personality disorders - practically any mental illness where stress is a factor. The word "stress" itself implies tension, anxiety, irritability, anger, etc., which are symptoms of adrenal fatigue. As such, mental illnesses are also physical illnesses - the mind and body cannot be separated in function - both are intertwined.

In adrenal fatigue, the use of low dose hydrocortisone (determined by the physician) does not shut down the adrenals. The adrenals still function fully, though are fatigued. If hydrocortisone is withdrawn, the person still has the original functional state of the adrenals, or the improved state with time of treatment.

In adrenal fatigue, when hydrocortisone is added to treatment, the brain (hypothalamus, pituitary) senses the additional cortisol and sends less ACTH to the adrenal glands. This then reduces the activity of the adrenal glands. The total cortisol in the body thus remains the same with or without hydrocortisone. The main change with treatment of adrenal fatigue is that the adrenal glands do not have to work so hard. Over time, they get rest even when working, to the point they can be not fatigued and fully healthy. This assumes that the original source of stressed is reduced (i.e. the brain acts to reduce the stress that led to adrenal fatigue).

If stress is reduced significantly, treatment of adrenal fatigue may last usually two years or less. It is not a permanent treatment - unless one has severe, overwhelming, chronic, inescapable stress, which cannot be addressed behaviorally or socially.

There are numerous treatments for adrenal fatigue aside from hydrocortisone.

The first treatment for adrenal fatigue is enough rest (e.g. taking a vacation from muscle building exercise - a strong neuroendocrine stress). Years ago, before managed care came in, psychiatrists could hospitalize patients with severe depressions and other mental illnsses for up to two years. The patient would then be in a state of nearly complete reduction in stress - no responsibilities, not chores, no societal stresses, etc. The patient would be given intensive psychological therapy, support by numerous staff (in essence, a new family). That patient would often come out completely well. In retrospect, those 2 years of complete rest, therapy and support essentially also fully rehabilitated the adrenal glands, which is one reason the patient did so well. Of course, this is impossible in the real world and with managed care, today.

I am hesitant to give hydrocortisone to my young child patients with adrenal fatigue, given the politics and medico-legal aspects of treatment. In this case, I prefer treatment which helps the parents with parenting skills to help reduce patient stress, psychotherapy which helps the patient adapt to stress, possible medications to reduce perceived stress, and nutritional interventions to help address adrenal fatigue.

Which of the numerous treatments for adrenal fatigue to choose depends on the individuals condition and situation. The treatment is individualized, customized, in conjunction with discussion with the patient. It does not always include hydrocortisone. A lot will depend on what the patient desires in treatment, e.g. some patients prefer natural therapies first.

 

[love_en]

Re: Adrenal Thread and over-the-counter treatments.

Where are you applying the HC cream, and how much and how often. I am interested to see how well the "sustained" action works.

I put on 2.5 g. right before bedtime. That way I start the day with elevated cortisol. Because the HC cream is not a transdermal base, I doubt that it is absorbed that quickly. It would be interesting to do a 4x a day saliva test after putting on HC the night before.

 

[love_en]

I do not like to use the word fatigue. The medical community becomes dismissive and condescending. They think your problems are all psychological. So out comes the SSRI's and nonbenzodiazepine sleep aids. To me, insufficiency is a better description. The adrenals are not keeping up.