The greatest deception men suffer is from their own opinions.                              ~ Leonardo da Vinci

“Opinions” are like flies–they are everywhere!!

Do this: don’t do that! This causes this: this causes that. 

“Who do I believe? What do I follow?”

The following represent common misconceptions about adrenal treatment. Why do we know they are misconceptions? Because they counter years of consistent patient reports about their experiences, observations, and wisdom gained from successful cortisol use.

MISCONCEPTION #1: It’s okay to guess that one may have low cortisol without doing saliva testing, or to treat based on blood testing.

We discovered years ago that some symptoms of high cortisol can be similar to symptoms of low cortisol. That also happened to me, Janie Bowthorpe. I was sure that I was having symptoms of low cortisol. I did saliva testing. But before my results came back, I got on cortisol via adrenal cortex for a little over a week. And when my results came back, I was beyond shocked. I had very high cortisol at all four times!! I was giving myself MORE cortisol on top of the already high cortisol. I immediately got off the supplementation, and worked to treat the seriously high cortisol.

As far as blood cortisol testing, patients also discovered blood testing frequently does not give accurate results. In other words, there were many times blood would show high cortisol, but saliva cortisol pointed to low…and our symptoms outright corresponded to the low cortisol. Or blood said high low cortisol, yet saliva was showing high!

Turns out that blood testing is measuring mostly bound and unuseable cortisol…90% or more is unuseable and bound to proteins.

Second, patients have learned repeatedly that they need to see what’s going on at four key times in a 24-hour period, which saliva gives. Those four results reveal what treatment might be best. Here’s a good one you can order.

And we learned the hard way that treating based on NO testing whatsoever can be problematic, because we might be treating the wrong problem!! Some symptoms of high cortisol can be similar to symptoms of low!

MISCONCEPTION #2: With my extremely low in the range saliva cortisol results, I can successfully use over-the-counter adrenal cortex.

Over-the-counter adrenal cortex (ACE) has a much lower level of cortisol. Some facilities who make ACE even state they remove the cortisol.

And though years of thyroid patient experiences with ACE show we are getting some cortisol, and can work for minor to moderately low cortisol, it’s been proven to be inadequate when saliva testing shows low-in-the-range cortisol. We can experience rising adrenaline on ACE if our cortisol is quite low in the range. And raising the ACE hasn’t helped–we just keep going higher and higher and still feel the tension of the low cortisol.

Additionally, those who tried ACE (when their saliva cortisol showed low in the range cortisol levels), but then switched to prescription HC, reported far better results: a better sense of calm (probably due to adrenaline not being released in excess anymore from too low amounts of cortisol) and an easy move of thyroid to the cells (thyroid hormones need the right amount of cortisol to shuttle into the cells).

Bottom line, those whose saliva cortisol results were quite low seemed to repeatedly need the strength of prescription hydrocortisone. not the weaker adrenal cortex (ACE).

Study chapters chapters 5 and 6 in the updated revision Stop the Thyroid Madness book. We have successfully learned how to use ACE, vs how to use HC. This may be an area you’ll have to teach your doctor.

MISCONCEPTION #3: Adaptogens work for low cortisol

This is another area where patient experiences have been gold: herbal adaptogens may have made some patients feel a little better, but they have done little to nothing for those whose saliva cortisol results proved low cortisol three or more times in a day. i.e. even after several months of adaptogen use, patients who had low cortisol…still had low cortisol.

Instead, adaptogen use has been the most helpful for those with healthy adrenal function, but where one’s life is going through repeated, chronic stress. Saliva cortisol results for people with healthy adrenal function but under stress is often a see-saw pattern: low, high, low, high and vice versa. And taking adaptogens 3-4 times a day evens out the stress pattern.

Also, some “adaptogens” seem more targeted to lower “high cortisol”, such as Holy Basil or PS.

MISCONCEPTION #4:  Hydrocortisone (HC) use can cause Addison’s

In the majority of cases, Addison’s disease, or Primary adrenal insufficiency, is an autoimmune issue, not an “HC use issue”. And Addison’s is very rare. The damage caused by the autoimmune attack, specifically to the adrenal cortex, causes insufficient amounts of cortisol (and could also negatively affect the release of aldosterone and certain sex hormones).  US President John F. Kennedy had Addison’s, as may have the English writer Charles Dickens.

Other causes of damage to your adrenals, and even more rare than the autoimmune issue, include:

  • Excessive blood loss (after a difficult childbirth, for example)
  • Tuberculosis infection
  • Certain fungal infections
  • AID’s complications
  • Amyloidosis (excessive buildup of protein)
  • Certain genetic defects

Sometimes, literature will propose that if a person used high pharmacological doses, such as prednisone for extended periods of time for asthma or bowel disease, that could theoretically cause an “Addison’s-like crisis”, but it’s quite rare, as well. Thyroid patients with proven low cortisol don’t use high pharmacological doses of HC, and most don’t use prednisone, either. That’s why Daily Average Temps are used—to find the physiological doses (those which simply meet the daily needs of one’s body), not high pharmacological doses. See Chapter 5 in the revised STTM book about DATS.

MISCONCEPTION #5: The use of hydrocortisone (HC) will permanently suppress one’s adrenals for life.

Hasn’t happened.

As mentioned above, informed thyroid patients with saliva-tested proven low cortisol don’t attempt to use high “pharmacological” cortisol meds or amounts. They use “physiological” amounts (the amount which meets the daily needs of one’s body functioning) found by doing Daily Average Temp taking (see Chapter 5 and 6 in the updated revision STTM book) and comparing those averages to find stability in temps, as explained by Dr. Rind. As a result, the feedback loop is still intact to some degree and the adrenals do not shut down or atrophy.

MISCONCEPTION #6: Low dose HC, such as 20 mgs or less, is perfectly adequate for most low cortisol patients. 

To the contrary, if saliva cortisol testing proves one has some fairly low cortisol results (especially three or more times in a day), 20 mg and less has backfired and resulted in worsening problems like excess adrenaline and more. Why? When we give ourselves cortisol (and we think this starts by 10 mg and higher), the body decides to tone down the messaging feedback to the adrenals. So now your adrenals produce even less, and you are giving yourself a small amount on top of the suppression of the feedback loop. i.e. it’s “suppressing” more than “replacing” what your body needs, causing the body to be alarmed, and excessive adrenaline symptoms are the result.

Most studies show that low dose HC use is only meant for short-term use, and we know it’s only meant for issues much less problematic than we tend get.

To see what we’ve learned as far as starting and raising HC, study chapter 6 in the revised STTM book. With OTC adrenal cortex, we have to guess how much to start on, since the cortisol within the product is not measured.

MISCONCEPTION #7: If you just “start on” HC, you will have to be on it for life

Very false, reveal the experiences of many low cortisol patients. Several patients who used HC correctly, and who are now adequately treating their low cortisol, low B12, low iron and more, are now off and have stayed off.

Those who haven’t been able to get off may have other issues continuing to stress their adrenal function, such as certain genetics, Lyme disease, chronic inflammatory issues, inadequate treatment of one’s hypothyroidism, etc. i.e. it’s not HC use which results in people not getting off; it’s the continuation of other issues.

More reading:

Effects of long term glucocorticoid use on pituitary-adrenal responses use http://www.nejm.org/doi/pdf/10.1056/NEJM199201233260403

Click on the graphic to order your own saliva cortisol test. ZRT’s saliva test is excellent!

Important note: STTM is an information-only site based on what many patients worldwide have reported in their treatment and wisdom over the years. This is not to be taken as personal medical advice, nor to replace a relationship with your doctor. By reading this information-only website, you take full responsibility for what you choose to do with this website's information or outcomes. See the Disclaimer and Terms of Use.