Why can adrenal insufficiency make nausea feel so unpredictable?

In this episode, Chloe and Alex explore a My Adrenal Life article on gut motility, nausea, and cortisol, and why digestive symptoms in adrenal insufficiency are not always caused by a stomach bug or food poisoning.

The discussion explains that nausea in adrenal insufficiency is often tied to gut motility, meaning how quickly or slowly food moves through the digestive tract. When cortisol signaling is disrupted, that rhythm can become unstable.

Some people experience slow gut, where food sits in the stomach too long. This can cause:
• fullness after only a small amount of food
• pressure or queasiness after meals
• bloating
• reduced appetite
• the feeling that food is just “stuck”

Others experience fast gut, where food moves too quickly through the digestive system. This may show up as:
• sudden nausea with urgency
• cramping
• loose stools
• feeling shaky or weak after eating

A key point in the episode is that nausea is not always a primary gastrointestinal illness. In adrenal insufficiency, nausea can also be driven by:
• blood sugar fluctuations
• low blood pressure
• stress-response signaling
• unstable brain-gut communication
• cortisol dips during the day

That helps explain why nausea may seem to appear “out of nowhere,” or why the same meal can feel fine one day and awful the next.

Chloe and Alex explain that cortisol does more than regulate stress. It also helps support:
• digestive rhythm
• blood sugar stability
• blood pressure
• the signaling between the brain and the gut

When cortisol is too low, fluctuating, or not well timed, digestion may become more sensitive and less predictable.

The episode also breaks down how this can look across different forms of adrenal insufficiency:
• Primary adrenal insufficiency (Addison’s disease)
• Secondary adrenal insufficiency (SAI)
• Tertiary adrenal insufficiency (TAI)
• Steroid-induced adrenal insufficiency

While the causes differ, all can affect digestive stability, nausea patterns, and gut motility.

The conversation also expands on practical ways people may be able to support themselves, depending on their pattern:

For slow gut:
• smaller meals instead of large meals
• softer, easier-to-digest foods
• paying attention to whether fat or fiber worsen symptoms
• considering liquids or gentle foods during flares

For fast gut:
• noticing whether symptoms follow stress, meals, or cortisol dips
• choosing foods that feel more stabilizing
• staying hydrated
• watching for blood sugar-related weakness after eating

They also discuss the importance of salt and fluids in some people with primary adrenal insufficiency, especially when nausea is tied to low blood pressure or feeling shaky and depleted.

Another major theme is pattern recognition. Many people with adrenal insufficiency notice symptoms at similar times of day, especially:
• early morning
• late afternoon
• during stress
• around medication dips
• when they need to eat but feel too nauseated to do so

The episode stresses that these symptoms are real, even when testing looks “fine,” and that nausea in adrenal insufficiency often requires a broader explanation than “just a GI issue.”

Most importantly, Chloe and Alex emphasize that people are not doing anything wrong if their nausea does not fit typical digestive explanations. The body systems involved in adrenal insufficiency are deeply connected, and symptoms can be complex.

If your nausea feels unpredictable, lingering, or tied to fatigue, dizziness, weakness, or appetite changes, you are not alone—and your experience makes sense.

Visit us at www.MyAdrenalLife.com and our Facebook Group.

Why do so many people with adrenal insufficiency wake up at 2, 3, or 4 a.m. feeling alert, restless, or suddenly unable to fall back asleep—even when they were exhausted at bedtime?

In this episode, Chloe and Alex explore a My Adrenal Life article on cortisol and sleep architecture, and why sleep in adrenal insufficiency often does not follow the usual rules.

Sleep is not one continuous state. The brain moves through repeating cycles of lighter sleep, deeper restorative sleep, and REM sleep. In people with typical adrenal function, cortisol is part of that rhythm. Levels stay low during the early part of the night, then gradually rise in the later part of sleep. That early-morning rise helps prepare the body for waking and supports the transition from deep sleep into lighter sleep before morning.

For people with adrenal insufficiency, that natural rhythm cannot be fully recreated. Cortisol must be replaced through medication, and standard replacement does not perfectly match the body’s natural overnight timing. This can help explain why many people experience:

• waking in the early morning hours
• feeling “wired and exhausted” at the same time
• restless sleep despite deep fatigue
• poor recovery after a bad night
• brain fog, low stress tolerance, and reduced reserve the next day

The episode explains that one possible reason for early waking is the mismatch between normal circadian signaling and replacement timing. A healthy body naturally begins increasing cortisol in the early morning hours. In adrenal insufficiency, those hours may instead be a period of very low cortisol, especially if the last medication dose was many hours earlier.

This can create a situation where the body is trying to transition toward waking without the hormone support it would normally use to keep blood sugar, inflammation, and energy stable.

Chloe and Alex also discuss two additional factors that may contribute:

• Overnight blood sugar instability: low cortisol can make it harder to maintain glucose during the long overnight fast
• Inflammatory and stress signaling: when cortisol is low, the body may have a harder time keeping overnight physiology calm and stable

That helps explain why some people wake feeling suddenly alert, shaky, sweaty, or internally “on,” even though they are physically exhausted.

The episode also makes an important point: traditional sleep advice is usually built around people with typical hormone rhythms. Things like perfect sleep hygiene, darker rooms, and less screen time may help some, but they do not always address the underlying hormone-timing issue in adrenal insufficiency.

The discussion covers practical ideas people may want to explore with their healthcare team, including:

• paying attention to the timing of overnight waking
• watching for patterns linked to medication timing
• noticing whether symptoms feel connected to early-morning weakness, shakiness, or restlessness
• using symptom tracking to identify repeat sleep patterns
• understanding that sleep disruption may be physiologic, not a personal failure

A key message throughout the episode is that sleep problems in adrenal insufficiency are often not just about “bad habits.” They may reflect real differences in hormone rhythm, circadian biology, and the body’s transition from sleep to wakefulness.

The larger takeaway is reassuring: if you live with adrenal insufficiency and your nights feel different from what standard sleep advice describes, your experience is real. Early waking, restless nights, and feeling strangely alert in the early morning hours are patterns many others with adrenal insufficiency recognize too.

Understanding the connection between cortisol and sleep architecture does not solve every problem, but it can make those patterns feel less mysterious—and a lot less lonely.

Visit us at www.MyAdrenalLife.com and our Facebook Group.

Why do people with adrenal insufficiency sometimes feel inflamed, achy, or slow to recover even when “stress” doesn’t seem like the issue?

In this episode, Chloe and Alex explore a My Adrenal Life article that reframes cortisol as far more than a “stress hormone.” Cortisol is one of the body’s key regulatory hormones. It helps control inflammation, guide immune activity, and bring the body back to balance after illness, injury, or stress.

That matters because inflammation is not just about starting an immune response. The body also has to know when to stop.

Cortisol helps do that by:

• limiting inflammatory signaling
• helping prevent excessive tissue damage
• supporting the body’s shift out of an active inflammatory state
• helping keep immune responses proportionate rather than prolonged

Without enough cortisol, the body may have a harder time shutting down inflammatory and immune activity efficiently. This can help explain why many people with adrenal insufficiency describe:

• feeling more inflamed than before
• body aches that linger
• slower recovery from illness or stress
• feeling physically “overreactive”
• difficulty getting back to baseline after a challenge

The episode explains that cortisol does not simply “turn off” the immune system. Instead, it acts more like a built-in brake or reset button. It helps prevent immune responses from escalating too far or lasting too long.

Chloe and Alex also discuss the biology behind this, including how cortisol interacts with inflammatory signaling pathways such as NF-kB and helps regulate cytokine activity. In plain language, cortisol helps the body say, “That’s enough. We can calm this down now.”

The conversation also clarifies how this applies across all forms of adrenal insufficiency:

• Primary adrenal insufficiency (PAI / Addison’s disease): the adrenal glands cannot produce enough cortisol
• Secondary adrenal insufficiency (SAI): the pituitary does not produce enough ACTH to stimulate cortisol production
• Tertiary adrenal insufficiency (TAI): the hypothalamus does not signal properly
• Iatrogenic or steroid-induced adrenal insufficiency: external steroids suppress the HPA axis, often overlapping with SAI or TAI patterns

Although the causes differ, the central issue is the same: the body no longer has normal, real-time cortisol regulation.

The episode also explains an important limitation of treatment. Cortisol replacement is life-saving, but it cannot perfectly copy the body’s natural moment-to-moment cortisol rhythm. That helps explain why some people may still feel less steady, less resilient, or slower to recover even when treatment is appropriate.

A key clarification in this episode is that cortisol deficiency does not directly cause autoimmune disease. However, cortisol does play a role in regulating immune balance, which is why its absence can change how illness, inflammation, and recovery are experienced.

The broader message is simple but important: calling cortisol only a “stress hormone” leaves out much of what it really does.

Cortisol also helps regulate:

• inflammation
• immune system activity
• illness recovery
• internal balance after stress or challenge

For people living with adrenal insufficiency, that missing regulation can make everyday life feel more physically intense, more reactive, and harder to recover from.

Visit us at www.MyAdrenalLife.com and our Facebook Group.

What happens when everything is done right—and the system still fails?

In this episode, Jake and Rachel take a deep dive into a powerful real-life story shared in the My Adrenal Life community by Christin Disler. Her experience during a total hip replacement highlights a critical truth: advocacy and preparation can be life-saving in adrenal insufficiency.

Christin did everything right. She met with her endocrinologist, confirmed a detailed perioperative stress-dose plan, brought written documentation, called ahead to verify coordination, wore medical alert bracelets, and even brought her emergency medications.

But just before surgery, the anesthesiologist refused to follow her endocrinologist’s instructions. He insisted that his standard steroid protocol was sufficient and declined her documented plan.

This moment highlights a key issue: not all steroids are interchangeable.

The anesthesiologist was likely referring to dexamethasone, a potent anti-inflammatory medication commonly used in surgery. However, dexamethasone does not provide the same physiologic support as hydrocortisone (Solu-Cortef), which is specifically needed to replace the body’s natural cortisol response during surgical stress.

For someone with secondary adrenal insufficiency (SAI), the body cannot produce adequate cortisol during stress. Without proper coverage, this can lead to hemodynamic instability, low blood pressure, and adrenal crisis.

Despite resistance, Christin calmly advocated for herself and took her own oral stress dose as a backup.

After surgery, her condition began to decline. She became lethargic and nearly unable to sit upright—classic warning signs of inadequate cortisol coverage. At that point, her husband and son stepped in to advocate for her when she could no longer advocate for herself.

Eventually, she was given 50 mg IV Solu-Cortef, and within 20 minutes, her condition improved significantly.

This outcome reinforces a critical lesson: timely, appropriate cortisol replacement is not optional—it is life-sustaining.

The episode also highlights the difference between types of adrenal insufficiency:

• Primary adrenal insufficiency (Addison’s disease): both cortisol and aldosterone are affected
• Secondary and tertiary adrenal insufficiency: cortisol signaling is impaired, even if adrenal glands are structurally intact
• Steroid-induced adrenal insufficiency: suppression of the HPA axis can also impair stress responses

Across all types, the ability to mount a normal stress response is compromised—especially during surgery.

Christin’s story also underscores the importance of a backup plan, including:

• written medical documentation
• visible medical alerts
• carrying emergency medication
• taking a preemptive dose if needed
• having a trusted advocate present

Perhaps the most powerful takeaway is this: being informed and speaking up is not being difficult—it is being safe.

This episode is not about fear. It is about preparation, awareness, and understanding that even in well-planned situations, advocacy may still be necessary.

Visit us at www.MyAdrenalLife.com and our Facebook Group.

Why can blood sugar feel so unpredictable with adrenal insufficiency, even when you are eating regularly and taking your medication as prescribed?

In this episode, Jake and Rachel explore a My Adrenal Life topic many people recognize but rarely see explained clearly: the connection between cortisol and blood sugar instability.

Cortisol is often called a “stress hormone,” but it also plays a major role in keeping blood sugar steady. It helps the body release stored glucose from the liver, supports blood sugar between meals and during sleep, and works as part of the body’s counter-regulatory system to help prevent glucose from dropping too low.

When cortisol is reduced, poorly timed, or inconsistent, blood sugar regulation can become much harder.

Jake and Rachel explain why people with adrenal insufficiency may experience:

• shakiness, weakness, or sudden fatigue after meals
• waking in the night feeling sweaty or unsettled
• significant weakness in the morning before medication kicks in
• midday or afternoon crashes
• symptoms that feel like anxiety but may actually reflect adrenaline compensation

One key point in the episode is that insulin lowers blood sugar after eating, while cortisol helps prevent that drop from going too far. In adrenal insufficiency, that cortisol “buffer” is weaker or missing, so some people may experience post-meal crashes that feel sudden and intense.

The conversation also explains why these episodes can feel so dramatic. When cortisol is low, the body may rely more heavily on adrenaline to compensate. That can create symptoms like:

• trembling
• sweating
• racing heart
• irritability
• a sense of panic or internal alarm

This is one reason blood sugar instability in adrenal insufficiency can sometimes be mistaken for anxiety.

The episode also looks at overnight blood sugar instability. During sleep, the body depends on cortisol to help maintain glucose while fasting. If cortisol levels are low overnight, the body may struggle to keep blood sugar stable, which can trigger nighttime waking, sweating, poor sleep, and feeling depleted in the morning.

Another major theme is the timing gap created by cortisol replacement. The body naturally releases cortisol in small changing amounts across the day, but oral medications are absorbed in larger doses that rise and fall more abruptly. Even when the total daily dose is appropriate, there may still be periods when cortisol levels dip below what the body needs. That can contribute to early morning weakness, post-meal symptoms, and afternoon crashes.

Jake and Rachel also touch on how this can look different across types of adrenal insufficiency:

• Primary adrenal insufficiency (Addison’s disease): cortisol and aldosterone are both affected, increasing vulnerability during illness, dehydration, or physical stress
• Secondary and tertiary adrenal insufficiency: aldosterone is usually preserved, but cortisol instability can still cause major blood sugar symptoms
• Steroid-induced adrenal insufficiency: patterns may be shaped by both cortisol deficiency and the metabolic effects of prior steroid exposure

The episode emphasizes that these symptoms are real, even when they are hard to capture on a single lab test. Blood sugar and cortisol both change throughout the day, so a normal result does not always reflect what someone experiences hour to hour.

The core message: these patterns are not imagined, and noticing them is not overthinking. It is part of learning how a complex condition affects the body in daily life.

Visit us at www.MyAdrenalLife.com and our Facebook Group.

Why do some people with adrenal insufficiency still feel flat, unmotivated, or “hollow” even when their labs look stable and they are taking their replacement steroids correctly?

In this episode, Chloe and Alex explore a My Adrenal Life topic that many patients recognize but rarely hear explained clearly: the role of DHEA and adrenal androgens in adrenal insufficiency.

Standard treatment for adrenal insufficiency usually focuses on replacing the hormones most essential for survival: cortisol and, in Primary Adrenal Insufficiency (Addison’s disease), aldosterone. But the adrenal glands also produce another important group of hormones from the zona reticularis: adrenal androgens, especially DHEA and DHEA-S.

These hormones are usually not routinely replaced.

The episode explains why that gap may matter.

DHEA is often thought of as simply a weak androgen or a hormone precursor, but it also acts as a neurosteroid, meaning it influences brain function directly. It crosses the blood-brain barrier and interacts with systems involved in mood, motivation, resilience, and reward signaling.

For some people with adrenal insufficiency, especially women, the loss of DHEA may contribute to symptoms such as:

• low libido
• reduced motivation or “spark”
• emotional flatness
• muscle weakness
• slower physical recovery
• feeling “stable” but not truly well

This may be especially noticeable in Primary Adrenal Insufficiency, where the adrenal cortex is damaged and DHEA production can drop very low. But it can also occur in Secondary, Tertiary, and steroid-induced adrenal insufficiency, because ACTH signaling also helps stimulate DHEA production.

Chloe and Alex also explain why women may be affected more strongly. In men, the testes provide a major source of androgens, so the loss of adrenal DHEA may be less dramatic. In women, the adrenal glands contribute a much larger share of androgen production, so the drop can feel much more significant.

The episode also explores why DHEA replacement is not yet standard for everyone. Research has shown mixed results. Some studies found improvements in mood, libido, and quality of life, particularly in women with adrenal insufficiency. Other studies showed less consistent benefit. DHEA can also cause side effects such as acne, oily skin, or increased facial hair if dosing is too high.

Because of that, current endocrine guidelines do not recommend DHEA universally. However, it may be considered in carefully selected patients—especially women with Primary Adrenal Insufficiency who continue to have low libido or reduced well-being despite otherwise optimized treatment.

This episode emphasizes an important point: “normal” lab ranges do not always reflect a person’s individual baseline or fully explain how they feel. A patient can be medically stable and still feel like something important is missing.

The conversation encourages patients to optimize their basic replacement first, then speak with a qualified endocrinologist if symptoms like flat mood, low drive, or persistent reduced well-being continue.

Visit us at www.MyAdrenalLife.com and our Facebook Group.

Why do many people with adrenal insufficiency experience dizziness, racing heartbeats, or unstable blood pressure—even when heart tests appear normal?

In this episode, Jake and Rachel explore a new My Adrenal Life mini-series book by Rick Disler titled The Cardiovascular System in Adrenal Insufficiency: Understanding Circulation, Orthostatic Instability, Stress Physiology, and Early Warning Patterns.

Many patients with adrenal insufficiency experience symptoms such as dizziness when standing, rapid heart rate, internal tremors, or fluctuating blood pressure. Yet cardiac testing often shows the heart itself is structurally normal. This episode explains why those two things can both be true.

Rick Disler highlights an important concept: in adrenal insufficiency, most cardiovascular symptoms are regulatory rather than structural. The heart muscle is usually healthy, but the systems that control blood pressure, vascular tone, fluid balance, and autonomic responses can become unstable when cortisol—and in some cases aldosterone—are not functioning normally.

Cortisol plays a key role in helping blood vessels respond to stress hormones like epinephrine and norepinephrine. When cortisol levels are insufficient or poorly timed, blood vessels may not respond properly to changes in posture, heat, illness, or stress. This can lead to dizziness, poor circulation, or exaggerated heart rate responses.

The episode also explains how adrenal insufficiency affects blood pressure differently depending on the type. In Primary Adrenal Insufficiency (Addison’s disease), both cortisol and aldosterone may be low, which can lead to sodium loss, dehydration, and low blood pressure. In Secondary, Tertiary, or steroid-induced adrenal insufficiency, aldosterone is usually preserved, meaning blood pressure may remain normal or even elevated despite cortisol deficiency.

Jake and Rachel also discuss why symptoms can appear before major blood pressure changes occur. Even small reductions in blood flow to the brain can cause brain fog, dizziness, head pressure, or cognitive slowing.

Orthostatic instability—symptoms triggered when standing—is another common experience. Normally the body quickly adjusts blood flow when posture changes, but cortisol deficiency can make that adjustment slower or less effective.

Rick Disler also describes early warning patterns that may signal increasing cardiovascular strain, including unexplained fatigue, internal tremor, head pressure, or narrowing pulse pressure before more serious symptoms appear.

Understanding that adrenal insufficiency affects circulatory regulation rather than heart structure can help patients, caregivers, and clinicians better recognize symptoms and respond earlier.

Visit us at www.MyAdrenalLife.com and our Facebook Group.

Can the adrenal glands “wake up” again after long-term steroid use?

In this episode, Noah and Eloise explore a My Adrenal Life topic that many people living with adrenal insufficiency wrestle with: steroid tapering, HPA-axis suppression, and the uncertain path of adrenal recovery.

For many patients, steroid treatment begins as something lifesaving. Medications such as prednisone, prednisolone, hydrocortisone, and dexamethasone can reduce inflammation and replace missing cortisol. But over time, those same medications can also suppress the body’s natural cortisol signaling system.

This episode explains how the hypothalamic-pituitary-adrenal (HPA) axis normally works and why long-term glucocorticoid use can cause the brain to reduce ACTH signaling, leaving the adrenal glands less active over time.

Noah and Eloise break down:

• how steroid medications suppress the HPA axis

• why steroid-induced adrenal insufficiency often overlaps with secondary or tertiary adrenal insufficiency

• the difference between primary adrenal insufficiency (Addison’s disease) and forms of adrenal insufficiency that may sometimes recover

• why tapering steroids must happen gradually

• why recovery can feel inconsistent, stalled, or up-and-down

• how withdrawal symptoms and true cortisol deficiency can overlap

The episode also explains why recovery does not always follow a straight line. Some people notice improvement, then setbacks. Others feel worse as doses get closer to physiologic levels. In many cases, the brain’s signaling may begin recovering before the adrenal glands are fully responsive, which can create confusing periods of instability.

Noah and Eloise also discuss the difference between:

• glucocorticoid withdrawal symptoms, such as body aches, headaches, sleep changes, mood shifts, and flu-like feelings

• true adrenal insufficiency symptoms, such as severe fatigue, weakness, nausea, dizziness, low blood pressure, and reduced tolerance for stress

Because these experiences can overlap, tapering can feel physically and emotionally confusing even when it is medically appropriate.

The conversation also highlights an important truth: not all adrenal insufficiency is the same. This topic is often most relevant for people with:

• Secondary adrenal insufficiency (SAI)

• Tertiary adrenal insufficiency (TAI)

• Iatrogenic or steroid-induced adrenal insufficiency

It may be less applicable to people with primary adrenal insufficiency (Addison’s disease), where the adrenal glands themselves are usually damaged and do not typically recover.

Beyond the physiology, this episode also speaks to the emotional reality of tapering. Many patients feel caught between hope and uncertainty, wondering whether recovery is possible, why symptoms fluctuate so much, and whether what they are feeling is “normal.” The episode offers reassuring context for that uncertainty and reminds listeners that recovery timelines vary widely.

It also mentions that the My Adrenal Life community has a worldwide audience, anchored by its Facebook support group and www.myadrenallife.com, where people can learn more and find tools, trackers, and support for managing adrenal insufficiency.

At its core, this episode is about understanding that tapering is not simply lowering a number on a pill bottle. It is the gradual process of testing whether the body can safely restart one of its most important hormone systems.

Visit www.myadrenallife.com and join the My Adrenal Life Facebook community.

Why do some people feel worse after starting thyroid medication instead of better?

In this episode, Chloe and Alex explore a My Adrenal Life topic that many patients recognize but rarely see explained clearly: the two-way relationship between cortisol and thyroid hormones.

Most people are taught to think of thyroid and adrenal problems as separate issues. But biologically, these systems are closely connected. Thyroid hormone helps drive metabolism, while cortisol helps support blood pressure, blood sugar stability, and the body’s ability to tolerate that metabolic demand.

This episode explains why thyroid medication can sometimes make a person feel more shaky, anxious, nauseous, or exhausted when underlying adrenal insufficiency has not been recognized first.

Chloe and Alex break down the difference between the:

• HPA axis (hypothalamus-pituitary-adrenal)

• HPT axis (hypothalamus-pituitary-thyroid)

and explain why these systems must work together.

Using a simple analogy, the episode describes thyroid hormone as the gas pedal and cortisol as the oil and coolant. Thyroid medication can increase the body’s metabolic demand, but if cortisol is too low, the body may not be able to support that shift safely.

Topics covered in this episode include:

• why thyroid medication can worsen symptoms in someone with low cortisol

• how thyroid hormone can increase cortisol clearance

• why this can create a dangerous mismatch in patients with adrenal insufficiency

• how cortisol affects conversion of T4 into active T3

• how low cortisol may contribute to higher reverse T3

• the difference between primary and central thyroid and adrenal disorders

• why a “normal” TSH does not always rule out a serious endocrine problem

• how Secondary and Tertiary adrenal insufficiency can be missed

• why treating thyroid issues without evaluating cortisol first can sometimes trigger adrenal crisis

The episode also explores the history of Schmidt’s syndrome and Autoimmune Polyglandular Syndrome Type 2, conditions that remind us autoimmune endocrine disorders often do not happen in isolation.

Beyond the lab work, Chloe and Alex also talk about the lived experience of this mismatch. Many people describe feeling “wired but tired,” with racing heart, shakiness, brain fog, low blood sugar symptoms, and a sense that their body cannot tolerate even normal stress. The episode explains why those reactions are not imagined and may reflect a real hormone imbalance rather than simple anxiety.

This conversation is especially relevant for people with:

• Primary adrenal insufficiency (Addison’s disease)

• Secondary adrenal insufficiency

• Tertiary adrenal insufficiency

• steroid-induced / iatrogenic adrenal suppression

• central hypothyroidism

• unexplained worsening after starting thyroid replacement

At its core, this episode is about understanding that the endocrine system works as a network, not as isolated glands. When one part is under strain, treating another part without looking at the full picture can make symptoms worse.

If thyroid medication has ever made you feel more unstable instead of more energized, this episode offers important context for that experience.

Visit us at www.MyAdrenalLife.com and join our Facebook group.

What happens when someone with Addison’s disease is told they are “stable,” but still does not feel truly well?

In this episode, Jake and Rachel explore a My Adrenal Life topic that many people with Primary adrenal insufficiency (Addison’s disease) quietly struggle with: the difference between surviving and thriving.

Standard treatment for Addison’s focuses on replacing the two hormones considered most essential for survival: cortisoland aldosterone. These replacements are lifesaving and remain the foundation of care. But this conversation looks at an important question many patients ask: if the labs look good and the medication is correct, why do so many people still feel flat, tired, or unlike themselves?

Jake and Rachel unpack the idea that the adrenal glands do more than produce cortisol and aldosterone alone. They discuss two areas that may help explain why some patients continue to struggle even when they are considered medically stable:

1. Adrenal androgens, especially DHEA
The episode explores how DHEA, an adrenal androgen precursor, drops to very low levels in primary adrenal insufficiency. This may matter especially for women, since the adrenal glands are an important source of androgen production. The discussion looks at how low DHEA may contribute to symptoms some patients describe, including:

• low drive or “loss of spark”

• reduced libido

• low motivation

• difficulty building or maintaining strength

• a sense of emotional flatness

Jake and Rachel also review why DHEA remains a debated topic in endocrinology. Some studies have shown meaningful benefits in mood, energy, and sexual well-being, while others have shown more mixed results. The episode explains why DHEA is not routine for every patient, but may still be worth discussing with a knowledgeable endocrinologist in the right context.

2. The overlooked cortisol-adrenaline connection
The episode also explores a lesser-known physiologic issue: the relationship between cortisol production in the adrenal cortex and adrenaline production in the adrenal medulla.

Because blood flows through the adrenal gland in a very specific way, the inner adrenaline-producing cells are normally exposed to very high local concentrations of cortisol. In Addison’s disease, that internal environment is lost. Even when oral hydrocortisone is replaced through medication, it cannot fully recreate the same local adrenal chemistry.

Jake and Rachel explain how this may help account for symptoms patients describe such as:

• feeling easily overwhelmed by minor stress

• delayed or blunted recovery after stress

• reduced resilience

• “flat” stress response

• feeling like the body has less reserve than it used to

The episode also discusses why this can be so psychologically confusing. Many people with Addison’s are told they are doing well because their treatment is keeping them out of adrenal crisis. But being medically stable does not always mean feeling fully restored.

At its core, this conversation is about the gap between life-saving hormone replacement and full physiologic replacement. Modern treatment has transformed Addison’s from a fatal illness into a manageable one. But some patients still experience a quieter kind of loss — not always dramatic enough to show up clearly on labs, but significant enough to affect quality of life.

This episode offers language for that experience, along with a compassionate reminder that feeling “off” despite good lab work is not a personal failure.

Visit us at www.MyAdrenalLife.com and join our Facebook group.