What are the adrenal glands?
The adrenal glands are glands located above the kidneys. They secrete hormones that affect blood pressure, energy, sugar levels, salt levels, and immune response. Each adrenal gland is made up of two main parts, which produce different hormones. These are the adrenal cortex and the adrenal medulla.
What hormones are produced by the adrenal glands?
- Cortisol: Produced by the adrenal cortex, it is involved in maintaining blood pressure, regulating sugar and fat metabolism, and regulating energy expenditure.
- Aldosterone: Produced by the adrenal cortex, it is involved in maintaining sodium and potassium levels by acting on the kidneys.
- Dehydroepiandrosterone: Produced by the adrenal cortex, it is a weak androgen and is converted in the ovaries into oestrogen and in the testes into testosterone. Oestrogen and testosterone are produced in much larger amounts by the ovaries and testes directly.
- Adrenaline: Produced by the adrenal medulla, it increases energy expenditure, heart rate, and blood pressure in stressful situations.
- Noradrenaline: Produced by the adrenal medulla, it increases energy expenditure, heart rate, and blood pressure in stressful situations.
What are adrenal disorders?
Adrenal glands cause health problems by producing too little or too much of certain hormones.
- Adrenal insufficiency: When the adrenal glands are underactive, they produce too little of certain hormones. This can be due to a disease of the adrenal glands themselves (Addison’s disease) or by a disease of the hypothalamus or pituitary gland (secondary adrenal insufficiency). This can lead to low sodium levels, high potassium levels, low blood sugar, low blood pressure, fatigue, weight loss, and nausea.
- Adrenal overactivity: When the adrenal glands are overactive, they produce too many of certain hormones. Too much cortisol (Cushing’s syndrome) can cause high blood pressure, weight gain, diabetes, fatigue, muscle weakness, and easily bruised skin. Too much aldosterone (Conn’s syndrome) can cause high blood pressure, high sodium levels, and low sodium levels.
- Phaeochromocytoma: This is a rare tumour of the adrenal medulla that results in increased production of adrenaline and noradrenaline. This causes high blood pressure, rapid heartbeat, tremors, sweating, and headaches.
- Congenital adrenal hyperplasia: This is a congenital condition where the adrenal glands produce too many androgens, which can cause ambiguous genitalia, masculinization in people born with ovaries, and precocious puberty in people born with testes.
Do adrenal disorders affect gender affirming treatment?
Spironolactone shouldn't be prescribed to people who have adrenal disorders. Spironolactone can affect blood pressure and sodium and potassium levels. If you have an adrenal disorder and want to start feminising hormone treatment, we recommend using a different antiandrogen.
Otherwise, having an adrenal disorder shouldn't affect your gender affirming hormone treatment. Oestrogen and testosterone levels will be monitored as usual and your doses of oestrogen or testosterone can be adjusted accordingly.
Reference
National Institute for Health and Care Excellence (2023). “Spironolactone: Cautions and Contraindications”. https://cks.nice.org.uk/topics/hypertension/prescribing-information/spironolactone/