Why Does Chronic Fatigue Happen in TSW?
One of the most debilitating symptoms of Topical Steroid Withdrawal (TSW) is the deep, unrelenting fatigue that many people experience. This is not just everyday tiredness—it is a bone-deep exhaustion that makes even simple tasks feel overwhelming. Understanding why this happens can help guide effective recovery strategies.
1. HPA Axis Dysfunction & Adrenal Fatigue
Topical corticosteroids suppress the body's natural production of cortisol by disrupting the Hypothalamic-Pituitary-Adrenal (HPA) axis. When steroids are used over a prolonged period, the adrenal glands reduce their natural cortisol output in response to external steroid use. Once the steroids are stopped, the body struggles to regulate cortisol levels, leading to adrenal insufficiency or dysfunction. Symptoms include:
- Extreme fatigue
- Low blood pressure & dizziness
- Difficulty handling stress
- Brain fog & difficulty concentrating
- Salt cravings
- Increased sensitivity to cold
Since cortisol plays a key role in energy production, inflammation regulation, and stress response, a sudden drop leads to intense fatigue.
2. Mitochondrial Dysfunction & Energy Deficiency
Cortisol is also critical for mitochondrial function, the powerhouses of our cells that generate ATP (energy). During TSW, mitochondrial function is impaired due to high levels of oxidative stress, inflammation, and nutrient depletion. This can lead to:
- Physical exhaustion that doesn’t improve with rest
- Muscle weakness
- Brain fog & cognitive fatigue
- Poor exercise tolerance
- Increased recovery time after activity
3. Inflammation & Immune Dysregulation
TSW triggers a pro-inflammatory state, with high levels of cytokines and histamine flooding the system. This inflammation places a heavy burden on the body, further contributing to exhaustion. Chronic inflammation has been shown to:
- Disrupt energy metabolism
- Impair sleep quality
- Trigger nervous system dysregulation (leading to anxiety, restlessness, and insomnia)
- Increase oxidative stress, which damages mitochondria
4. Blood Sugar Dysregulation
Cortisol also helps regulate blood sugar levels. When levels are low due to adrenal dysfunction, people in TSW often experience blood sugar crashes, leading to:
- Dizziness, shakiness, and irritability
- Cravings for sugar & carbohydrates
- Energy crashes after eating
- Difficulty concentrating
- Increased hunger and appetite fluctuations
Stabilising blood sugar is critical in reducing fatigue and promoting recovery.
5. Disrupted Sleep Patterns
Many individuals experiencing TSW-related fatigue also suffer from poor sleep quality due to:
- Cortisol dysregulation (waking up exhausted despite sleeping long hours)
- Nighttime itching & discomfort
- Increased nervous system activation (leading to anxiety & insomnia)
Even if someone is sleeping eight or more hours, their body may not be achieving deep, restorative sleep, which further exacerbates fatigue.
How Long Does TSW Fatigue Last?
Fatigue during TSW is highly individual and depends on:
- The duration & strength of steroid use
- Overall adrenal & mitochondrial health prior to withdrawal
- Stress levels & lifestyle factors
- Nutritional status
Some people experience severe fatigue for several months, while others take over a year to feel normal again. However, targeted naturopathic support can help significantly reduce symptoms and speed up recovery.
Naturopathic Support for TSW-Related Fatigue
1. Support the Adrenal Glands
- Adaptogenic Herbs: Help regulate the HPA axis and support energy production.
- Vitamin C & B Vitamins: The adrenals require high amounts of Vitamin C and B5 to produce cortisol naturally.
- Electrolyte Balance: Salt cravings during TSW indicate a need for sodium, potassium, and magnesium to support adrenal function.
2. Reduce Oxidative Stress & Inflammation
- Antioxidants: Vitamin C, glutathione, and N-acetylcysteine (NAC) help combat inflammation and protect mitochondria.
- Omega-3 Fatty Acids: Found in wild-caught fish, flaxseeds, and walnuts, omega-3s help reduce inflammation and support brain function.
- Turmeric & Ginger: Natural anti-inflammatory compounds that can help manage systemic inflammation.
- Resveratrol & Quercetin: Additional plant compounds that help lower oxidative stress.
3. Support Mitochondrial Energy Production
- Coenzyme Q10 (CoQ10): Critical for ATP production and reducing fatigue.
- Magnesium: Helps with muscle function, energy production, and nervous system support.
- L-Carnitine: Supports mitochondrial function and energy metabolism.
- Alpha-Lipoic Acid (ALA): A potent antioxidant that improves mitochondrial efficiency.
4. Balance Blood Sugar
- Protein-Rich Breakfasts: Prevents blood sugar crashes throughout the day.
- Healthy Fats & Fiber: Supports slow, steady energy release (e.g., avocado, nuts, and seeds).
- Cinnamon & Chromium: Natural compounds that improve blood sugar stability.
- Frequent Small Meals: Helps avoid blood sugar dips and maintains consistent energy levels.
5. Improve Sleep Quality
- Magnesium Glycinate: Helps relax the nervous system and improve deep sleep.
- Chamomile & Passionflower Tea: Natural sedatives that can support restful sleep.
- Blue Light Blocking & Sleep Hygiene: Reducing screen time before bed can help regulate melatonin production.
- GABA & L-Theanine: Amino acids that help calm the nervous system and promote deep sleep.
6. Manage Stress & Nervous System Regulation
- Mindfulness & Meditation: Helps regulate the nervous system and reduce overactive stress responses.
- Gentle Movement: Activities like yoga, stretching, and slow walks can support lymphatic drainage and energy production without over-exertion.
- Deep Breathing Techniques: Helps regulate the vagus nerve, which plays a key role in the stress response.
Final Thoughts & Next Steps
Chronic fatigue in TSW is a real and challenging symptom that requires a multi-faceted approach. While it may feel like an uphill battle, supporting adrenal function, mitochondrial health, inflammation, and blood sugar balance can make a huge difference in energy levels over time.
If you're struggling with TSW-related fatigue, we offer personalised naturopathic support to help guide your recovery with tailored herbal and nutritional strategies. Book a consultation today to create a plan that works for your unique needs or check out our TSW eBook Bundle.
