What is HPA Axis Suppression?

Feb 22, 2026

Woman wearing a gray stripped shirt and jeans sitting on a gray couch looking stressed

Your body has a built-in stress management system called the hypothalamic-pituitary-adrenal (HPA) axis. You can think of it as your body's command center for handling stress, regulating energy, and keeping your immune system in check. When it's working well, you barely notice it. But when this system gets suppressed, often from steroid medications or chronic stress, the effects can be significant.

Let's break down what HPA axis suppression actually means, why it happens, and what you can do about it.

How Your HPA Axis Normally Works

Your HPA axis is a communication loop between three players: your hypothalamus (in your brain), your pituitary gland (also in your brain), and your adrenal glands (sitting on top of your kidneys).

When you encounter stress, your hypothalamus releases a hormone called CRH (corticotropin-releasing hormone). This signals your pituitary gland to release ACTH (adrenocorticotropic hormone). ACTH then travels to your adrenal glands and tells them to make cortisol, your primary stress hormone.

Cortisol helps you manage blood sugar, blood pressure, inflammation, and energy. It's essential for getting through your day and responding to stressful situations. When everything's working properly, this system turns on when you need it and turns off when you don't.

But sometimes, this communication loop can get disrupted.

How Steroids Disrupt the Hypothalamic Pituitary Adrenal (HPA) Axis

One of the most common causes of HPA axis suppression is steroid medications (also called glucocorticoids or corticosteroids). These are frequently prescribed for conditions like asthma, rheumatoid arthritis, lupus, eczema, and other inflammatory or autoimmune conditions.

When you take steroids, your body senses high levels of cortisol-like hormones circulating in your blood. It thinks, we have plenty of cortisol already, so we don't need to make more. This triggers what's called negative feedback. Your hypothalamus and pituitary gland stop sending signals to your adrenal glands. Over time, your adrenal glands are essentially not receiving the message to produce cortisol.

The longer you're on steroids and the higher the dose, the more suppressed your HPA axis becomes.

This becomes dangerous if you suddenly stop taking steroids or if you get sick, have surgery, or experience significant stress. Your body can't produce enough cortisol on its own to meet the demand, which can lead to a life-threatening condition called adrenal crisis.

This is one of the reasons why doctors need to be careful about tapering steroids slowly rather than stopping them abruptly. Your body needs time to restart its cortisol production.

Chronic Stress and the HPA Axis

Steroid medications aren't the only thing that can suppress your HPA axis. Chronic stress, whether physical, emotional, or environmental, can also throw this system off balance.

Initially, when you're under ongoing stress, your HPA axis ramps up cortisol production to help you cope. But if that stress continues month after month, year after year, your system can start to falter.

Instead of producing adequate cortisol, your system becomes less responsive. You might have heard this referred to as adrenal fatigue (though that's not a medically recognized term). What's actually happening is that your HPA axis communication loop is impaired.

Research shows that chronic stress causes changes in brain regions responsible for emotion and behavior regulation, contributing to symptoms like anxiety, depression, and irritability. It also disrupts the natural rhythm of cortisol secretion, which should be highest in the morning and lowest at night.

When chronic stress combines with steroid use, the risk of HPA axis suppression becomes even greater.

The Link Between Autoimmune Disease and HPA Suppression

If you have an autoimmune disease, there's another layer to this story.

In autoimmune conditions, your immune system is overactive and causes chronic inflammation. This inflammation triggers your body to produce more cortisol as part of its natural response to calm things down. One key inflammatory signal called IL-6 (interleukin-6) can directly activate your HPA axis.

When you start taking steroids for your autoimmune condition, two things happen:

First, the steroids suppress your HPA axis. Second, the steroids reduce inflammation, which lowers IL-6 levels. This removes the natural stimulus that was driving your cortisol production.

This is why people with autoimmune diseases are at higher risk for adrenal suppression and why their recovery after stopping steroids can take longer.

What Are the Symptoms of HPA Axis Suppression?

The symptoms of HPA axis suppression can be subtle at first, and many people attribute them to their underlying condition rather than recognizing them as a separate issue.

Common symptoms include:

Persistent fatigue and weakness
Low energy and poor exercise tolerance
Nausea, vomiting, or loss of appetite
Mood changes like depression or irritability
Difficulty concentrating or brain fog
Muscle aches and joint pain
Dizziness or lightheadedness

Unlike primary adrenal insufficiency (where your adrenal glands themselves are damaged), HPA axis suppression from steroids doesn't typically cause skin darkening because your ACTH levels stay low.

The most serious complication is adrenal crisis, a medical emergency that can occur if you stop steroids suddenly, get a serious infection, have surgery, or experience major physical stress. Signs include very low blood pressure, severe dehydration, confusion, and potentially shock. This is why it's critical to never stop steroid medications abruptly without medical supervision.

How Doctors Diagnose HPA Axis Suppression

Doctors usually begin testing with a morning blood cortisol level since cortisol is naturally highest between 8–9 a.m. A level above 15 µg/dL usually rules out adrenal insufficiency, while levels below 5 µg/dL strongly suggest it. Anything in between usually requires more testing.

The most common confirmatory test is the ACTH stimulation test. Your doctor gives you synthetic ACTH and measures whether your cortisol rises appropriately. If your adrenal glands respond well, your HPA axis is likely intact. If they don't respond, it indicates suppression.

Some practitioners also use saliva cortisol tests to measure free cortisol throughout the day and assess your natural cortisol rhythm.

Recovery and Monitoring After Steroid Use

Recovery from HPA axis suppression varies widely from person to person. Some people's systems bounce back within a few weeks, while others may take months or even over a year to fully recover.

Several factors influence recovery time:

How long you were on steroids
What dose you were taking
Your individual physiology
Whether you have an autoimmune condition
Your age (children often take longer to recover)
Your overall stress levels

During recovery, doctors typically check cortisol levels about four weeks after stopping steroids and repeat testing every month or two until your HPA axis function normalizes.

The key is gradual tapering. Instead of stopping steroids all at once, your doctor will slowly lower your dose over time, giving your HPA axis a chance to wake up and start producing cortisol again. If withdrawal symptoms or signs of adrenal insufficiency appear, the taper may be slowed down.

The Big Picture: Stress, Immunity, and Balance

Your HPA axis doesn't exist in isolation. It's intimately connected to your immune system, your nervous system, your metabolism, and your overall stress response.

The goal isn't just to avoid HPA axis suppression. It's to support your body's natural ability to handle stress, regulate inflammation, and maintain balance. This means:

Managing chronic stress through nervous system support
Working with practitioners who understand the delicate balance of steroid therapy
Tapering medications slowly and carefully when it's time to stop
Supporting your body's recovery with nutrition, sleep, and stress management
Being patient with the recovery process

Your body is resilient, but it needs time and support to heal.

Working With Your Healthcare Provider

Your provider should be a partner in protecting your HPA axis function while managing your underlying condition effectively.

If you're navigating steroid use, recovering from HPA axis suppression, or dealing with the complex intersection of autoimmune disease and hormonal health, know that support is available. At Naturopathic by Design, we work with patients to support their body's natural healing capacity while carefully managing necessary medications.

Book a discovery call to explore how we can support your recovery, or join our email list for more insights on hormone health and whole-body wellness.