The Slow‑Burn Signs of PPID (Cushings) Every Owner Should Know
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PPID (Cushings) is one of the most common hormonal issues we see in older horses, but Australian data shows many cases are still slipping past owners. With around one in five horses over 15 affected, it’s far more widespread than most people realise. The challenge is that PPID doesn’t show up all at once, you need to keep a close eye on symptoms of problems with insulin and metabolic health to catch it early and keep these horses safe.
(the prevalence data is here, but you need a subscription to access it: McGowan, T. W., Pinchbeck, G. P., McGowan, C. M. (2016). Prevalence, risk factors and clinical signs predictive for equine pituitary pars intermedia dysfunction in aged horses. Animal Production Science, 56(12), 2005–2014. doi:10.1071/AN15225.)
This isn’t a battle between “natural” and “pharmaceutical” approaches, it’s about understanding what’s actually happening inside your horse’s hormone system, why the changes are so slow and sneaky, and how each tool on the table plays a different role. It's important to know the signs of PPID / Cushings. When you know what each option can and can’t do, it becomes much easier to make decisions that keep your horse comfortable, safe, and thriving for as long as possible.
What is PPID / Cushings?
Pituitary Pars Intermediary Dysfunction (PPID - also sometimes called ‘pituitary pars intermediary syndrome’ or 'Cushings') develops when part of the pituitary gland becomes overactive and starts releasing too much ACTH.
ACTH is a hormone—its full name is adrenocorticotropic hormone. ACTH’s normal job is to signal the adrenal glands to adjust the horse’s stress‑related hormones. In a healthy horse, ACTH rises and falls in tight, seasonal patterns. In a PPID horse, the pituitary gland loses its normal dopamine control and starts releasing too much ACTH, which then drives many of the changes owners notice: coat abnormalities, muscle loss, immune weakness, and a higher risk of laminitis.
The earliest signs are subtle: a horse that sheds a little later, loses topline despite eating well, seems a bit flat, grows odd fat pads, or tends towards laminitis seasonally. Because these changes look like “normal ageing,” many horses go years before anyone realises something deeper is happening.
As PPID progresses, the coat becomes thicker or patchy, shedding becomes unreliable, infections linger, and laminitis risk rises. By the time the classic long, curly coat appears, the disease has usually been present for a long time.
The Pharmaceutical Approach to Managing PPID / Cushings
A medication called Pergolide helps regulate the hormonal imbalance that PPID creates. The goal is to bring ACTH back toward a more stable range so the horse’s system isn’t constantly under pressure. Some horses adjust quickly; others need a slower introduction or dose changes.
Pergolide can cause appetite loss or dullness, but it doesn’t happen in every horse, and it doesn’t always look like the classic “pergolide veil” owners frequently report when the horse is first introduced to the treatment. Some horses sail through treatment with no issues at all. Others react strongly. Others react only at certain doses or certain times of year. That variability is normal.
The medication doesn’t stop PPID, but it helps manage the hormonal consequences that lead to complications like laminitis, muscle loss, and immune decline.
The Natural Management Approach to Managing PPID / Cushings
Many owners prefer to support their PPID horses with a strong management foundation.
This includes:
low‑sugar, forage‑based diets
correct mineral balance, especially zinc
consistent turnout and movement
regular hoof care
body‑condition monitoring
clipping when shedding becomes unreliable
These management practices reduce metabolic strain and help the horse cope with the disease more comfortably.
Chaste tree berry fits into this approach as a supportive herb. It influences dopamine‑related pathways in a gentle way, which can improve shedding, mood, and day‑to‑day comfort. Horses are often brighter and more settled on it, especially when the rest of their management is already optimised.
Chaste tree berry is generally well‑tolerated, and most horses show no obvious adverse effects. It doesn’t regulate ACTH as strongly as Pergolide, but it can make a meaningful difference in how a horse feels. It's a great option for horses showing early signs to help delay progression.
We sell CTB as whole seeds, but we also include chaste tree berry powder with magnesium in our 'Moody Mare Mix' (3kgs).
Chaste tree berry regulates all hormones - not just insulin and ACTH, so it's a good option for adding CTB for our owners who are already feeding Calm Mix - our magnesium supplement.
To be clear - if you already feed Calm Mix and want to add Chaste Tree Berry, it might be easier to buy 'Moody Mare' instead of feeding the two separately, as it combines both in one scoop, or you can buy them separately. Whichever suits you best.
Why outcomes differ so much between horses
Horses that move straight on to medication are often diagnosed late, already laminitic, or living with years of unmanaged PPID. In our experience, horses on Pergolide with no other changes to management generally have shorter life spans.
Horses on natural programs are often the ones whose owners are already feeding low‑sugar forage, balancing minerals, providing turnout, and watching for early signs. Those management differences alone can change lifespan and quality of life. Introducing Chaste Tree Berry as a natural option early can stave off pharmaceuticals longer.
The real pattern is that management determines the trajectory, and both pharmaceutical and natural tools sit inside that bigger picture. There is no "cure" for PPID. Even horses that have great natural interventions may eventually need pharmaceutical intervention as the condition progresses. This will vary from horse-to-horse.
Here at Sound Advice we encourage owners to document feeds, take frequent photographs, and track small changes because PPID, and many other chronic conditions, rarely announce themselves all at once.
Horses can stay sound, bright, and working well into their twenties, so when a horse in its early or mid‑teens starts to shift in ways that feel “a bit off,” those details matter.
Photos make coat changes or fat deposits obvious. Feed logs reveal creeping sugar intake or mineral gaps. Regular notes help owners spot patterns that would otherwise blend into the background of daily care.
Early PPID signs are subtle, and the horses who thrive longest are the ones whose owners notice the small shifts before they become big ones.
We’ve cared for many PPID horses over the years, and the hardest cases are always the ones where small changes were missed for too long. This condition moves slowly, but it does move, and when owners stay alert and respond early, the outcomes are dramatically better.
Looking to dig deeper into Cushings?
Below are links to other articles about metabolic dysfunction.
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