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Stages of Adrenal Fatigue - where are you on the spectrum?

Updated: Dec 9, 2023


Kimberley wright Health - stages of adrenal fatigue

This is the second post in my Adrenal Fatigue series. In the first post, Is Adrenal Fatigue real, or am I just a mad woman?, we explored the signs and symptoms of adrenal fatigue and how you might be experiencing them.

In this post, I delve into each of the four stages a little further, so you can learn where you sit on the spectrum of the condition’s intensity.

It’s a little bit tech-y, but if you’ve clicked over to here, I’m guessing you’re the kind of person who likes a little more knowledge.

So here we go:

Stage one of adrenal fatigue – FIGHT OR FLIGHT

This is your body’s immediate reaction to a perceived threat – your ‘fight or flight’ reaction, and is regulated by the Hypothalamic –Pituitary – Adrenal Axis (HPA axis).

During this phase, the adrenals produce mass amounts of adrenaline, cortisol, DHEA and insulin. During the initial stress response:

- Adrenaline increases the heart rate, blood pressure, expanding the air passages in the lungs, and pumping this additional oxygenated blood to the muscles.

- Cortisol raises blood sugar (which is important for fuelling muscles during a fight or flight response).

- DHEA is required to produce both male and female sex hormones, and may be increased during acute stress due to it’s neuroprotective / anti-inflammatory properties.

- Insulin signals to the cells to take up glucose from the blood. When both cortisol and insulin are high – this leads to a vicious cycle.

Characteristic of this phase are heightened levels of anxiety, an inability to sleep and overwhelming feelings of stress.

Stage two of adrenal fatigue - WIRED BUT TIRED

We often talk about ‘cavemen’ and their fight or flight response, in relation to evading a predator. Let’s face it – you either escaped, or were eaten. This fight or flight response did not need to extend beyond a few minutes. Case closed.

Now, we can find ourselves in an ‘alarm’ state for an extended period. In our modern life – this can be days to weeks.

This period can be referred to as a time of stress maladaptation. Cortisol levels remain high, but DHEA and other sex hormone levels begin to drop (resources needed go to produce cortisol instead).

It’s generally around this time that sufferers will start to feel the effects of exertion of the adrenal glands – commonly clients report feeling ‘wired but tired’ - somehow making it through the day (usually with caffeine for a little help), but falling into bed as soon as they get home from work.

Stage three of adrenal fatigue – RESISTANCE

During this phase, substantial drops in sex hormones occurs – as the hormone precursors for both sex hormones and cortisol is pregnenelone. Pregnenelone is diverted to cortisol creation.

It’s at this time a client will report fatigue and a lack of sex drive. This phase can last anywhere between a few months to years.

Stage four of adrenal fatigue – BURNOUT

This is the point at which the body just goes ‘oh, hell no’ and packs it in. The body has run out of ways to continue to produce cortisol optimally. However it’s not just cortisol that is no longer being produced as it should– the whole HPA axis is down-regulated.


Cortisol, DHEA, testosterone, adrenaline are all low, as are neurotransmitters – which leads to anxiety / depression and apathy, as well as a lack of sex drive, & inability to fight infection.

Once in stage four adrenal fatigue, almost every body system has been effected, and as such, recovery can be slow and arduous.

I hope you’ve enjoyed learning a little more about Adrenal Fatigue. Or maybe you’re panicking? It’s OK, don’t panic, because in the next post I’m going to show you exactly how you can recover from adrenal fatigue, even from stage four.

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