Social media has become the most far-reaching means of mass communication in today's digital age. However, with little to no regulation over the validity of information, it has turned into a cesspool of misinformation. 

When patients are battling constant fatigue or have trouble losing weight, they may go to the Internet. Social media influencers are wont to suggest these symptoms are the result of a hormonal imbalance, before providing instructions on how to self-diagnose and treat these imbalances using diets and supplements. 

 

Cortisol and adrenal glands

 

Cortisol is the drama magnet of hormones—always at the centre of attention and often blamed for causing trouble. Yet, it's the most misunderstood hormone of all time. Produced by the adrenal glands in response to stress, cortisol follows a diurnal pattern, rising in the morning to help us wake up and feel alert. Despite the body's efficient cortisol regulation, the internet is rife with advice on diagnosing and treating “cortisol imbalance.” 

A 2018 letter from endocrinologists titled “We are tired of 'adrenal fatigue’” firmly states, “Current evidence does not support the existence of adrenal fatigue or the usefulness of supplements to support adrenal function.”

Ross IL, Jones J, Blockman M. We are tired of 'adrenal fatigue'. S Afr Med J. 2018;108(9):724-725.

Furthermore, while Cushing’s syndrome and adrenal insufficiency are legitimate medical conditions, their incidence is very low. 

 

Nevertheless, there has been an alarming rise in the use of supposedly all-natural cortisol-boosting supplements. Unfortunately, many of these supplements contain undisclosed steroids, for instance:

• A study published in Mayo Clinic Proceedings analyzed 12 different adrenal support supplements and found that most had at least one steroid hormone—pregnenolone in 42%; budesonide in 25%; androstenedione in 17%; and 17-OH progesterone, cortisone, and cortisol each in 8%.

  Akturk HK, Chindris AM, et al. Over-the-Counter “Adrenal Support” Supplements Contain Thyroid and Steroid-Based Adrenal Hormones. Mayo Clinic Proceedings. 2018;93(3):284-290.

   

• A 2022 report from AACE Clinical Case Reports detailed cases of Cushing's Syndrome caused by the OTC herbal supplement Artri King, containing hidden glucocorticoids.

  Patel R, Sherf S, Lai NB, Yu R. Exogenous Cushing Syndrome Caused by a "Herbal" Supplement. AACE Clin Case Rep. 2022;8(6):239-242.

   

 

Supplements for 'low T'

 

Testosterone replacement therapy (TRT) is a well-established therapy reserved for patients with hypogonadism and clinical symptoms of low testosterone. In the T trials involving nearly 800 older men with unequivocal hypogonadism, short-term transdermal testosterone demonstrated good improvements in vitality, sexual function, anaemia, and bone density, no improvement in cognitive function, and a negative impact on cardiovascular health.

Swerdloff R, Wang C. Reflections on the T Trials. Andrology. 2020;8(6):1512-1518.

 

A 2022 study found that only 24.8% of “T-boosting” supplements claiming to improve testosterone levels naturally had research backing their claims, with 10.1% actually containing testosterone-lowering ingredients.

Clemesha CG, Thaker H, Samplaski MK. 'Testosterone Boosting' Supplements Composition and Claims Are not Supported by the Academic Literature. World J Mens Health. 2020;38(1):115-122.

 

 

Factitious thyrotoxicosis

 

As evident from a 2023 Annales endocrinologic report, some dietary supplements sold online contain significant amounts of T4 and T3.

Persani L, dell'Acqua M, Ioakim S, Campi I. Factitious thyrotoxicosis and thyroid hormone misuse or abuse. Ann Endocrinol (Paris). 2023;84(3):367-369.

The aforementioned study from Mayo Clinic Proceedings on adrenal support supplements also found that all contained triiodothyronine (T3).

Akturk HK, Chindris AM, et al. Over-the-Counter “Adrenal Support” Supplements Contain Thyroid and Steroid-Based Adrenal Hormones. Mayo Clinic Proceedings. 2018;93(3):284-290.

Such unregulated supplementation runs the risk of iatrogenic thyrotoxicosis. 

 

Alternatively, in an attempt to alter their body composition, reducing body fat and weight while appearing fit, patients might covertly and voluntarily ingest excessive thyroid hormone, giving rise to factitious thyrotoxicosis.  

 

A physician's guide to 'de-influencing'

 

Social media algorithms often amplify controversial or popular posts, leading to misinformation. This polarization can prompt risky behaviors, especially in closed groups on platforms like Facebook, where experts cannot intervene unless they become group members. 

 

Explain to them the diagnosis of any endocrine disorder should only come from a physician or endocrinologist. Symptoms attributed to “hormone imbalance” can also stem from issues like anemia, autoimmune disorders, mental health problems, cardiac or pulmonary conditions, dietary deficiencies, and hepatic or renal impairments—requiring thorough patient history, counseling, and lab investigations.

Lastly, it’s difficult to determine if a patient is taking supplements spiked with hormonal preparations, as many patients believe these supplements are harmless wellness aids. Consider a diagnosis when typical features of hormonal disorders like Cushing's disease, adrenal suppression, hyperthyroidism, or endogenous thyrotoxicosis appear in patients without an apparent cause.