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What You Should Know About Cortisol Testing and Detecting Adrenal Fatigue

Finding answers to adrenal fatigue through cortisol testingToday, people live in a world where stress is prevalent. Stress can affect you constantly, to the point that you begin to struggle with your health. When this happens, you may develop adrenal fatigue. This is a little known disorder that can be difficult to identify and detect. One of the ways that you can tell if you have adrenal fatigue is with cortisol testing. However, you need to be aware that having periodic tests is more accurate than only getting tested once. It’s always better to trend the cortisol curves over time to see the overall picture.

Why Test for Cortisol?

Cortisol is often called the stress hormone, and it’s produced by the adrenal glands. Cortisol levels can be used to identify adrenal gland disorders such as Addison disease and Cushing’s syndrome. They can also give you a good indication of your general stress levels.

Cortisol is released in response to stress and assists in the fight or flight response. It speeds up your heartbeat, your breathing rate, and other processes in your body so that you’re ready to face a threat. However, in the modern world, it isn’t often that you need to run from a physical threat. Stressors are more likely to be emotional or mental in the modern world. Unfortunately, these stressors still prompt the same response in the body, just on an ongoing basis. This can be very dangerous as high cortisol levels can suppress your immune system, digestion, growth, and reproductive systems. So, if you’re chronically stressed, the results can be very problematic and lead to issues like Adrenal Fatigue Syndrome (AFS).

Cortisol and Adrenal Fatigue

Cortisol is one of the hormones that the adrenal glands produce in response to stress. The adrenals, along with several other organs and systems, play a critical role in the body’s NeuroEndoMetabolic (NEM) stress response system.

The NEM stress response system is composed of six circuits, each of which includes three main components. The adrenal glands are part of the Hormonal Circuit and they work separately and together with the reproductive system and the thyroid to handle stress. The primary task of the adrenals is to produce hormones such as epinephrine and cortisol.

Cortisol is the body’s primary stress hormone. Once stress is detected, cortisol triggers actions in the body that allow it to move into a state of fight or flight. To prompt this state, it floods the body with glucose, giving your body an immediate energy source. Meanwhile, it inhibits insulin production so excess glucose is available for immediate use and not put into storage in the body.

Cortisol also triggers an increase in heart rate, making you more alert and preparing you for a burst of energy and activity.

Once the stressful episode has passed, the adrenals’ production of cortisol would normally return to normal. The other 2 components of the Hormonal Circuit and the rest of the NEM stress system circuits would also resume normal function. This protects the body against the damage that can be inflicted by stress and the unnatural state it creates.

In the case of chronic stress, however, the adrenal glands must keep producing cortisol. Over time, the adrenals become overworked and can no longer produce enough cortisol. At the same time, all the organs and systems involved in the NEM stress response system become overworked and the entire NEM stress response is dysregulated.

Hormonal Circuit Deregulation

cortisol testing and adrenal fatigueIf your severe stress levels aren’t corrected, they can severely impact the health and functioning of the Hormonal Circuit. The three components of this circuit, the adrenal glands, the sexual organs, and the thyroid, are tightly interconnected and reliant on each other for good functioning. So, as the adrenals decline in health, the other two components will also start to struggle.

Thyroid function will drop, causing fatigue and problems with temperature regulation and your overall stress response speed. This will cause additional stress and cause your body to demand more cortisol from your adrenals, worsening their workload.

When you’re stressed and your body’s functions are slowed because of thyroid dysfunction, your body markedly slows your reproductive system. After all, when you’re under threat, reproducing is of little importance. This will result in a low libido as well as disruptions in the ovarian-adrenal-thyroid (OAT) axis, which determines hormone levels in your body. This can often result in hormonal imbalances and symptoms that can be confusing, frightening, and very stressful.

The kinds of problems associated with Hormonal Circuit imbalances and AFS can be difficult to identify and correct. That’s why cortisol testing is so important. It’s a good way to get an overall view of your overall stress levels and what that might be doing inside of your body.

The Basics of Cortisol Testing

There are two main types of cortisol tests:

Blood Test

During cortisol testing, your doctor will draw blood in the usual way. The site, which is usually the inside of the elbow or back of the hand, will be cleaned and a band placed around the arm to apply pressure. The vein will fill with blood and a needle is used to puncture the vein. The blood is collected in a vial and when enough blood has been collected, the needle is removed and the site is covered. This process is basically the same for children and adults.

A cortisol blood test is often performed outpatient just once a day in the morning because patients find it hard to get poked twice in a day unless in the hospital.

Saliva Test

The second type of cortisol testing is the saliva test. This has been shown to be a far more accurate measurement of the body’s cortisol levels as it tests to the cellular level. In contrast, the blood test only measures hormone levels in the bloodstream. The saliva test can also be performed with a kit at home, which allows for multiple measurements and more comprehensive results. It’s important to see the overall curve, so multiple measurements throughout the day is a much better look at how your adrenals are producing cortisol.

The Risks of Cortisol Testing

There are very few risks involved in cortisol testing. The saliva test is non-invasive and has no side effects. However, there are some possible side effects of a blood test, though they’re fairly rare. They include:

  • Fainting
  • Feeling lightheaded
  • Excessive bleeding
  • Infection
  • Hematoma or an accumulation of blood under the skin around the testing site.
  • Difficulty locating a vein, resulting in multiple punctures.

Important Things to Note About Cortisol Testing

Now that you have a better idea about how cortisol testing works, it’s important to do everything you can to ensure accurate results. This includes the following:

Fast Before the Test

You will need to fast before cortisol testing. For saliva tests, you mustn’t eat or drink for at least 15 minutes prior to specimen collection. Meanwhile, for blood tests, you should not eat or drink for 15 to 30 minutes prior to the test.

Ask your Doctor About Medications

Certain medications such as estrogen, prednisone, and prednisolone can increase cortisol measurements. On the other hand, androgens and phenytoin can decrease cortisol measurements. So, make sure you talk to your doctor before your test if you’re taking any of these medications.


If you’re stressed during your cortisol testing, it will change your results. So, try to relax before and during your test to get more accurate results.

Prepare for Multiple Specimens

Proper cortisol testing must be conducted more than once during the day because a single snapshot of one point in time is often inadequate for long term understanding of how the body works. In fact, your cortisol levels should be measured four times in a day to allow a clinician to correctly map your cortisol daily curve. This will reveal your adrenal function more clearly. The shape of the curve may even be correlated with symptoms you are experiencing. So, be prepared for multiple tests and even for regular testing every 3 to 6 months.

The Results

Cortisol testing and Adrenal Fatigue SyndromeNormal cortisol levels are generally from 6 to 23 mcg/dl at 8 am (mcg/dl is the abbreviation for micrograms per deciliter). Abnormally low cortisol levels can be linked to:

  • Hypopituitarism, which means that your pituitary gland isn’t sending the proper signals to prompt the release of normal cortisol levels.
  • Addison’s disease

Abnormally high cortisol tests can indicate:

  • A tumor in the adrenal glands
  • A tumor in another part of the body that’s involved with cortisol production
  • Pituitary gland problems such as a tumor, which is resulting in the release of too much of the hormone that controls cortisol production.

Abnormal cortisol levels, both high and low, can also be linked to AFS. So, if your doctor is struggling to find a reason for your abnormal cortisol levels, make sure that you consult with a medical practitioner who’s aware of AFS and the best strategies for recovery.

Can Cortisol Testing Identify AFS?

Today, adrenal fatigue sufferers face a lot of challenges when it comes to getting help for the condition. This is mainly because AFS has yet to become a recognized medical condition. Hence, there are no diagnostic protocols available that a clinician can use to definitively identify AFS. Instead, many medical professionals rely on cortisol testing to help understand what’s happening in the body and why.

Adrenal fatigue causes many effects in the body, cortisol testing may be able to help diagnosisIf adrenal fatigue is suspected, the health practitioner must rely on their own knowledge and experience to help you find a way to reduce your stress levels and find the path to recovery. As a result, your doctor should ask a lot of questions about your health history and stress levels during your consultation. This will help them to identify areas that may be problematic.

Another aid that health practitioners can turn to is cortisol testing. Unfortunately, cortisol tests are not as straightforward as they appear to be for these reasons:

Varying Results

Different types of cortisol tests produce varying results. Saliva cortisol tests check for bioavailable free cortisol while blood cortisol test measures both bioavailable and binded cortisol. Hence, results from a blood cortisol test would be less specific. In this regard, the saliva cortisol test is seen as a better option for testing hormone levels.

Individual Differences

Everyone’s body is different. Normal cortisol levels for you may be abnormally high for someone else. These individual differences can make it difficult for your doctor to identify both your body’s normal range and when there might be a problem.

However, this doesn’t mean that cortisol testing is pointless. Actually, this type of testing can help indicate your adrenal fatigue stage, which will help determine your recovery path. Adrenal test kits are usually best for identifying adrenal fatigue. They measure several samples over the day, which is ideal for catching dysregulated cortisol patterns. Your doctor may also recommend other tests to get a clearer idea of your body’s overall condition. This may include:

  • DHEA tests
  • ACTH tests
  • Thyroid testing
  • Glucocorticoid stimulation or suppression tests.
  • Neurotransmitter tests


If you suspect that you are suffering from adrenal fatigue or other cortisol related disorders, you need to see a physician as soon as possible for cortisol testing. This will give you the best chance of correcting the issue and avoiding long term problems associated with it. Here’s what to do:

  1. Talk to your doctor about your cortisol levels and whether you need testing.
  2. Try to reduce your overall stress levels and see if that has any effect on the symptoms you’re experiencing.

If you’re concerned about your cortisol levels or other problems related to stress, the team at Dr. Lam Coaching can help. We offer a free** no-obligation phone consultation at +1-626-571-1234 where we will privately discuss your symptoms and various options. You can also send us a question through our Ask The Doctor system by clicking here.

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Dr. Lam’s Key Question

Having cortisol testing done only once would lead to inaccurate results as cortisol levels vary throughout the day. Hence, it is important to conduct tests throughout the day to allow the clinician to plot your daily curve of cortisol. This would provide a better state of your adrenal function.

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