Cortisol Testing: How to Diagnose and Treat Adrenal Issues

Cortisol Testing: How to Diagnose and Treat Adrenal Issues

Weight gain, crushing fatigue, the inability to sleep…

These are only some of the symptoms associated with adrenal problems and yet this condition is ignored by so many physicians and Doctors. 

In addition, there is much confusion regarding which is the best way to actually evaluate your cortisol levels and which is the best cortisol test. 

This post will walk you through why testing your cortisol level is important, how to determine if you need testing, the best way to actually test your cortisol, and how to treat yourself once you find out.

Let’s dive in:  

What is Cortisol & Why do we care about your levels so much?

Cortisol is a hormone involved in many different functions in the body (many we will go over today). 

The problem with this hormone is two-fold:


High levels of cortisol cause problems by themselves and may lead to the signs and symptoms of adrenal fatigue.


Dysregulation of cortisol levels also may cause problems with other hormones (1) in your body leading to weight gain, difficulty with concentration, and many other symptoms.

study headline describing the connection between prolactin, thyroid hormones, and cortisol and the influence of exercise on each.

This gives you more than just 1 good reason to not only understand your cortisol levels but to treat them if necessary.

​The problem with cortisol testing today

This problem extends beyond what we’ve already discussed.

Like other hormones in the body (think thyroid, testosterone, estrogen, progesterone, etc.) doctors and physicians don’t have a really good understanding of what these hormones do, how to test for them and how to treat them. 

This leads to a lot of confusion – especially on the side of the patient, and frustration on the side of the physician.

​This problem may explain why so many patients step out on their own to ask for tests or purchase their own cortisol tests. 

To add to the confusion there are many different ways to actually test for cortisol levels (some certainly better than others) that may give conflicting or confusing results. 

To complicate problems further most physicians don’t know how to interpret or understand cortisol testing which leaves patients on their own for treatment and management. 

Sound confusing?

It can be, but let’s shed some light: ​

What defines normal cortisol vs high cortisol vs low cortisol

a figure which shows the impact of the hypothalamus and pituitary gland on the adrenal gland.

​Part of the problem with understanding changes in cortisol levels stems from a lack of consistency and branding/naming conditions. 

Most doctors are intimately familiar with the conditions known as Addison’s disease and Cushing’s disease

These conditions range from zero cortisol to extremely high levels of cortisol (both outside of the reference range that doctors love): ​

Addison’s disease is basically a complete lack of cortisol in the body due to autoimmune (or other damage) resulting in almost zero cortisol – this is a life-threatening condition and requires cortisol or steroid replacement. 

On the other hand, Cushing’s disease is a syndrome that causes an incredible amount of cortisol in the body leading to many serious and potentially life-threatening conditions. 

​When you talk to your doctor about your cortisol levels they are going to be looking at your cortisol levels with these conditions in mind. 

When they check your cortisol and find that you are decidedly in the “normal” range you will be branded as completely normal and fine. 

But does this make sense?

​Surely there are conditions in between the two extremes of absolutely zero cortisol and total excess of cortisol in the body, right?

Of course – just like other hormones can become dysregulated and sub-optimal, so too can cortisol. 

Like other hormones in the body, small changes to concentrations of these hormones can lead to big symptoms that are felt throughout the body. 

Symptoms that fall in this range are frequently lumped into the category of “adrenal fatigue” and that’s what we are going to be discussing in this post today:

The difference between “normal” and “optimal” levels of cortisol. 

We will not be focusing on Addisonian or Cushingoid levels of cortisol, but instead, we will focus on the mid and “gray” range of cortisol testing. 

Testing for Cortisol levels

So how do you find out if your cortisol tests are abnormal? 

Surely, some tests are better than others for determining this…

There are several ways to test for cortisol in your body but I’m only going to focus on the best ways.

The first place to start is always with your serum (blood levels). 

I know what you’re thinking…

Serum levels of cortisol are the worst! They don’t tell you anything!

That’s generally true if you have cortisol receptor issues, but these levels can be very useful to start with because they are easy to get and much cheaper than the alternative forms of testing (which we will detail below). 

​Serum cortisol levels are especially helpful if they are low normal or high normal, but not much if they are simply “normal”. 

What defines low normal and high normal?

  • Low normal cortisol range: 8 am Serum cortisol levels ranging from 4.0 to 10.0
  • Normal cortisol range: 8 am Serum cortisol levels range from 11-18
  • High normal cortisol range: 8 am Serum cortisol levels greater than 20 

You can see an example of a low-normal patient below:

lab test from a patient with a low normal serum cortisol level.

In this example, the 8 am serum cortisol level is 6.5 with a range of 4.0-22.0. 

Obviously, this is in the “normal” range, but certainly, it is suboptimal when you consider that cortisol levels should peak at 8 am (2).

​This peak should represent the highest your cortisol levels should be throughout the day and low levels are often consistent with symptoms of fatigue. 

As mentioned previously serum testing is really only useful if your cortisol levels are either high normal or low normal, they are largely unhelpful if your cortisol level is in the standard “normal” range.

In addition to this, serum levels change at least 8 times throughout the day and may peak due to various substances (like caffeine) or changes to stress.

For this reason, serum levels are not often considered the “best” test, but they are certainly an easy test and the first place you should start.

But what is the best test? ​

Testing your Cortisol pattern with DUTCH

In order to get a full evaluation of your cortisol levels, it may be necessary to evaluate the “rhythm” of your cortisol throughout the day. 

By checking your cortisol several times per day you can accurately see how your body is responding to various situations.

This allows for more detailed information which can then be used for treatment.

The most accurate form of testing is through urinary measurements which are taken several times throughout the day (compared to a 24-hour urine test). 

This is even more accurate than salivary levels.

You can learn more about DUTCH testing in the video below or at this link. ​

​You can see an example of my test, taken several times throughout the day which tracks both urinary cortisone and urinary cortisol levels. 

You can see the benefit you get from this evaluation because my 8 am serum cortisol levels were in the “normal” range, and yet in this example, you can see that my 10 am cortisol levels spike very high. 

This pattern that you see above is seen in people who are reliant upon stimulants for energy each morning (as I was at the time). 

Does this mean that everyone needs their urinary cortisol levels tested?


Instead, start with your serum 8 am cortisol levels to see what kind of information you can get, and then move to the DUTCH test if necessary.

It’s also worth a trial of treatment if you are simply symptomatic with “normal” cortisol levels, because even though these tests are helpful there is no test that is 100% accurate.

Many patients stand to benefit from treatment due to the other benefits that adrenal adaptogens and adrenal glandulars provide. ​

​Symptoms of Adrenal problems

The problem with many hormone imbalances is that they tend to share many of the same symptoms as one another. 

For this reason (and to ensure proper treatment) it is usually wise to test prior to any treatment you undergo.

Having said​ that, the value of assessing your symptoms is also very helpful because it gives you a starting point prior to treatment. 

Because of this, it’s a good idea to understand some of the symptoms you may be experiencing if you have adrenal-related problems. 

Common symptoms of cortisol dysregulation:

  • Constant fatigue throughout the day classically with a 2-3 pm “crash”
  • The sensation of being “wired but tired”, especially at night
  • The feeling of getting a “second wind” at night, especially around 9-10 pm
  • Weight gain and/or weight loss resistance
  • Other hormonal problems in the body, especially hypothyroidism
  • Changes in mood including depression, anxiety, and/or irritability
  • Intense carbohydrate or sugar cravings
  • Reliance upon stimulants (like caffeine) with frequent use throughout the day for “energy”
  • The sensation of more energy after eating a carbohydrate-rich (or sugar-rich) meal
  • Cravings for salty foods

This isn’t an exhaustive list but it really hits the highlights that many patients with adrenal problems experience.

You can see that some of these symptoms are highly specific and you will relate to them if you’ve ever experienced them before.

Classically these symptoms build up over time and continue to get worse and worse unless treatment occurs.

But why do patients experience them?

A huge part of this problem has to do with constant everyday stress.

As you may know, cortisol is a stress hormone that your body releases when it’s under some influence that it perceives as stress.

The problem is not that this response is necessary, but the fact that this response tends to get triggered day in and day out.

“Stressors” to the body may include any or all of the following:

  • Frustration or changes in emotion from job/work/social life
  • Over-exercising or exercising too much for what your body can tolerate
  • Anything physically stressful on the body(including exercise, manual labor, etc.)
  • Lack of sleep(especially if prolonged over months to years)
  • Pressure from school work/workload/etc. 
  • Poor diet or nutritional deficiencies(especially diets lacking in fruits and vegetables)
  • Constant use of stimulants like caffeine(energy drinks, coffee, soda, etc.)
  • Complete lack of exercise or a sedentary lifestyle
  • Known chronic medical conditions(high blood pressure, insulin resistance, metabolic syndrome, cholesterol problems, etc.)
  • Recent illness or sickness
  • And anything else that may cause you frustration, annoyance, or “stress”

​This is not an exhaustive list, but it’s easy to see how these little things from day-to-day activities stack up over time. 

Each time your body undergoes one of these stressors your body will instinctively release cortisol as a way to “cope” with this stress. 

The cortisol allows your body to deal with stress by liberating sugar stores and increasing epinephrine and adrenaline. 

This is what you want to have happened, and this isn’t necessarily the problem.

The problem comes when this system is constantly activated day after day.

This causes hormonal changes like an increase in insulin resistance, changes to your autonomic nervous system, weight gain, and all of the other symptoms we mentioned above.

This constellation of symptoms has been documented in business executives (3) and even in the military after deployments and other stressful situations

The point is this:

As humans, we weren’t meant to experience this constant level of stress day in and day out and it really leaves a toll on the body that is actually measurable. 

The problem isn’t in diagnosing the disease (that’s actually the easy part) but in getting the proper treatment from conventional doctors. ​

It’s not also uncommon for kids (children) to experience these symptoms, the only difference is that they tend to respond differently than adults. 

Children may have changes in their behaviors, extreme fatigue, and poor grades.

One of the best ways to catch this condition in children is by checking reverse T3 levels which will usually be elevated in children under extreme stress. 

Treatment based on your test results:

Treatment for adrenal-related issues is actually quite complex but can be simplified. 

Treatment should be based on a combination of your symptoms plus your lab results. 

For instance:

Even though high normal cortisol levels and low cortisol levels may present with similar symptoms the treatment of both may vary. 

For this reason, it is helpful to understand your levels.

Herbs and supplements that INCREASE cortisol levels wouldn’t necessarily be helpful if your levels were already elevated.

Make sense?

With that in mind let’s talk about how to evaluate and treat these conditions.

For the purpose of this article, we will focus primarily on herbal and adaptogenic intervention but realize that lifestyle changes are ALWAYS required for optimal results.

Treatment for low cortisol

With low cortisol levels, you will want to focus on supplements and herbs that are designed to provide your body with the precursors necessary for the production and creation of cortisol. 

Cortisol is a hormone, much like other hormones in the body, that requires several different nutrients to function properly. 

With that in mind there are several that can help the cortisol in your body function more efficiently: 

  • Adrenal glandulars: These tend to work best for patients with very low cortisol levels, they also tend to provide an immediate boost to energy levels. Using glandulars in combination with other supplements listed below is very effective for low cortisol levels. Should be used for 6 + months
  • Adrenal adaptogens: Adaptogens can actually help to lower cortisol levels as well (4), but should at least be considered in the treatment. There are many types of adaptogens but I find that blends of multiple adaptogens tend to work best. These adaptogens can be combined with glandulars as well for more benefit. Should be used for 3+ months at least. 
  • CoQ10: This coenzyme is involved in proper mitochondrial energy production (5) and can help increase energy levels. Because energy levels are often low in adrenal-related issues, mitochondrial boosters are particularly effective. Use 2 capsules (240mg) per day for several months. 
  • Alpha Lipoic acid: ALA helps increase mitochondrial energy production, and acts as a powerful antioxidant and an anti-inflammatory agent (6). ALA can also help with weight loss due to its effects on insulin. 
  • Vitamin B6: Vitamin B6 is used in several pathways in the creation of adrenal hormones and is a nutrient that many patients are deficient in (7). Taking higher doses of B6 during the acute phase of treatment may be necessary for short periods of time. 
  • DHEA: DHEA is the precursor to testosterone and other estrogen metabolites. With low cortisol and low adrenal hormone production, supplementing with hormone precursors may be of benefit. Start with a low dose every 2-3 days and increase to daily as tolerated. Be careful because DHEA can turn into androgens or estrogens (8) in high doses. 
  • Pregnenolone: Pregnenolone is another hormone precursor and can be helpful (9) if used along with DHEA. Watch out for acne as a side effect and like DHEA, start low and go slow. The use of these hormones may be necessary for 3+ months. 

Taking 3+ of the supplements listed above may be necessary for a minimum of 6 months in order to see continued results and an increase in cortisol levels. 

Most patients experience an improvement in their symptoms within 4 weeks of treatment. ​

Be careful when using DHEA and/or pregnenolone as these are actual hormones that have influence and make changes in the body. ​

Treatment for high cortisol
  • Phosphatidylserine: Phosphatidylserine has been shown to reduce cortisol levels (10) if taken in doses up to 600mg per day. Use 4-6 capsules at night (each capsule is 100mg) and recheck cortisol levels in 2-3 months. 
  • Ashwagandha: Ashwagandha is an adaptogen that can actually help to lower cortisol levels, boost libido, and may help with weight loss. You can read more about ashwagandha in this comprehensive post
  • Melatonin: Melatonin has been shown to reduce cortisol levels (11) and may actually help improve your sleep at night. Even if you are sleeping well, melatonin can still help reduce cortisol levels and should be considered. Dosages vary from 1-3mg, but starting with 3mg is generally tolerated unless you are very sensitive. 

Because fewer supplements lower cortisol, it’s helpful to use several supplements listed above and combine them with the lifestyle changes listed below. 

​Lifestyle interventions

Lifestyle changes create the backbone of treating adrenal problems and should not be ignored. 

Most people have problems in at least 2 of the areas listed below, make sure you focus on your “weak” areas… 


You should be getting at least 8 hours of quality sleep per night. Failure to address a lack of sleep may result in weight gain (12) and persistent fatigue. 


With adrenal-related problems, it’s important to get adequate servings of carbohydrates (healthy carbohydrates like fruits and vegetables).

Make sure you are also eating a real, whole-food diet.

A diet like whole 30 is a great place to start. ​


​You need to be actively taking steps to reduce the impact of stress on your life. 

If possible the complete elimination of stress from your life is ideal (but this isn’t always possible).

Instead, if you know will be under stress then you need to take steps to help reduce the impact that it plays on your body.

You can do that through regular meditation, the practice of yoga, the practice of religion, or the practice of mindfulness.

Each of these has been shown to help reduce the impact that stress plays on your life. 


While exercise can be difficult with the crushing fatigue that accompanies adrenal-related problems it is still quite important.

Instead of focusing on going to the gym to sit on a treadmill for an hour, you should focus on staying active each and every day.

Simple changes like walking for 1 hour per day, taking regular breaks throughout your work day, and making time to do outdoor activities that are fun can make a huge difference.

If you have the energy to work out, make sure you don’t over-exercise and try to stick to 10-30 minute bouts of exercise at medium intensity. ​

Recap & Final Thoughts

Understanding your cortisol levels is critical if you are suffering from the symptoms of adrenal-related problems. 

By understanding the difference between “optimal” and “normal” cortisol you can then determine how to treat your cortisol levels. 

Start by testing your 8 am serum cortisol level and then move to DUTCH urine testing (4x urinary tests throughout the day) for optimal results but only if absolutely necessary. ​

Remember that the combination of supplements plus lifestyle interventions will be necessary for long-term success and a reduction in your symptoms. 

Also, remember that treating your adrenals takes time!

I’m talking 6 plus months of active work may be necessary before you restore your adrenals back to optimal health. 

Now it’s your turn:

Are your cortisol levels off?

Have you been able to improve your symptoms?

Why or why not?

Leave your questions or comments below! 













which cortisol test is the most accurate? pinterest image.

picture of westin childs D.O. standing

About Dr. Westin Childs

Hey! I'm Westin Childs D.O. (former Osteopathic Physician). I don't practice medicine anymore and instead specialize in helping people like YOU who have thyroid problems, hormone imbalances, and weight loss resistance. I love to write and share what I've learned over the years. I also happen to formulate the best supplements on the market (well, at least in my opinion!) and I'm proud to say that over 80,000+ people have used them over the last 7 years. You can read more about my own personal health journey and why I am so passionate about what I do.

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49 thoughts on “Cortisol Testing: How to Diagnose and Treat Adrenal Issues”

  1. Dr. Childs,
    Great info.
    My serum cortisol was taken at 10 am. I know I have adrenal problems but docs keep telling me all is normal.

    Cortisol AM 9.5 ug/dL (3.9 – 19.4 ug/dL)

    What can you tell from this number? I will be doing the DUTCH test in the near future. Thanks!

    • Hey M.J.

      I outlined the “optimal” ranges for cortisol (assuming it’s an 8am sample) above. I hope the DUTCH test helps you out!

  2. Hey Dr Childs,

    I really like your article. Very informative reading so thank you very much for posting this. If you see low DHEA in a saliva test would you say taking DHEA is a good idea or is it better to target specific hormones like progesterone using a cream?


  3. Dear Dr. Childs,
    Thank you for the perfect publication. This is to kindly ask for your advice with the therapy based on following results:

    Cortisol saliva test:
    Morning, 7.30 AM: 9.36 nmol/l (ref 0-19.10)
    Lunch time, 12 AM: 7.30 nmol/l (ref 0-11.90)
    Afternoon, 5 PM: 3.70 nmol/l (ref 0-11.90)
    Bed time, 11.30 PM: 2.31 nmol/l (ref 0-14.20)

    Testosterone in Serum 1.11 nmol/l (ref 0.10 – 1.42)
    DHEA-s in Serum 5,44 mmol/l (ref 0.96 – 6.95)

    I am with hypofunction of the TG and Hashimoto, currently with 100 mg T4 & 25 mg T3 medication. Based on this TSH – optimal, low ranges of fT3 and fT4.
    Following AIP since July 2016.
    Thank you in advance for your support!

    • Where did you text for cortisol saliva? Testosterone in serum, is that what was given to you based on your saliva? DHE in serum was that also due to your results? and what is AIP? I have the DUTCH test now and will be doing it 19 days after my period.

  4. Hi Dr.Childs
    I have severe adrenal fatigue diagnosed with a saliva cortisol test, My cortisol levels are very low across all 4 points tested and DHEAS is also very low. Is saliva testing accurate? What are your thoughts on using physiologic doses of hydrocortisone to treat adrenal fatigue? My symptoms are severe and the diet and lifestyle changes I have made over the last year ( and addition of supplements) have only reduced the severity, I am still severely restricted by the fatigue etc and a normal life is not possible. I am reluctant to use hydrocortisone but am desperate to reclaim my health. Is recovery from severe adrenal fatigue possible?

    • Hey Lynda,

      I will occasionally use hydrocortisone for very low cortisol levels that fail to increase with standard treatment, but these are still sub physiologic doses to prevent HPA suppression. I wouldn’t use it until you confirm that your fatigue isn’t due to some other cause and not until you’ve done the DUTCH test which is superior to salivary testing in terms of accuracy.

  5. Thanks for all your useful information, Dr. Childs. I have, for the last 8 years, been following a LCHF-diet.(low carb, high fat) But now, beeing somewhat stressed and waking up every night. Could my low carb diet be too low in carbs? (under 50gram a day) My carbs comes from vegetables (little fruits and no sodas, cookies,candy asf) . Regards from Margretha

    • Hey Margretha,

      Yes, it’s possible that your diet may not be sufficient in carbohydrates. However, your symptoms may also be related to other issues as well (or perhaps a combination of both).

  6. I have been taking a supplement entitled: CALM CP to help lower my high cortisol levels. Have you ever heard of the supplement? And if so, what do you think of it?

    -Erin Sands

  7. I had Dutch test done and I have low metabolized cortisol and high free cortisol. I have read that this indicative of a thyroid problem so my doctor recently put me on thyroid meds. Do my adrenals also need addressed or will treating thyroid alone do the trick? I’ve been on paleo diet for 5 years. My main symptoms are intense stomach pain/bloating.

  8. I am feeling better on my thyroid meds but my issue is sleeping. I take a low dose xanax .5 to sleep every nite.. I would like to get off of this and treat another way. I am thin and feel better and can only sleep when i take my .5 xanax. I wake up and feel good after i take my thyroid meds.

  9. I have all the symptoms of Adrenal/Cortisol issues but my 24hr urine test came back at 25ug. My Endo says the results are normal, and rules out Cushing or Addison’s. Why do I feel so bad?

    • Hi Amee,

      Your endocrinologist is only interested in cushing’s or addison’s, both representing extreme sides of the spectrum. You can consider a spectrum where cortisol exists ranging from high to low and everything in between. It doesn’t really make sense from a logical standpoint to suggest that you only become symptomatic once you reach either of the defined states above, the idea of adrenal fatigue is that symptoms exists somewhere in the middle. This concept will be lost to endocrinologists, so it’s not even worth discussing it with them. You might find more luck with an integrative or functional physician.

      • My Integrative Dr that I had been seeing since 2014 did do a blood test and was 7.9 at initial draw and them 30 minutes later after injection it was 28 in January 2016. I was told at that time I had adrenal issues and was put on Cortef, with no change, so I was taken off of Cortef and nothing more was done.

  10. My 20 year old son has been unwell for over 7 years. Eight months ago we had testing done and found a great team of doctors who are now dealing with his pituitary and thyroid issues. But doctors still believe there is more to solve.

    He has severe growth hormone deficiency (confirmed with a stim test), severe hypogonadism and an atrophied thyroid. Two very good endocrine doctors also believe that his cortisol is disregulated.

    He is on growth hormone injections, clomid (to stim his testoterone), anastrozole (to lower estrogen) and levothyroxine for his thyroid. Vit D, B12 and iron are also supplemented because of deficiencies.

    It’s the cortisol that presents the mystery.

    Two recent 8am serum tests show high ACTH at 99.6 and 64.7 (7.2-63.3 range) and cortisol 23.03 and 22.35 (6.02-18.4 range).

    Two recent 11pm salivas were both low normal at <.01 and .02 (<.01-.09 range)

    Once recent 24hr urine was also low normal at 8 (range 0-50). We will be doing three more urines this month as there are still questions lingering about possible Cushings (MRI shows some oddities but no clear pit tumor).

    Months ago we also did saliva and urine cortisol testing that showed normal or low normal results. Years ago, before testing he had very classic high cortisol symptoms, many have resolved but he still has a distinctively pronounced cushingoid appearance.

    I've looked at some DUTCH test videos and see that obese patients can have high serum (total) cortisol with low free cortisol (urine& saliva). I've not seen studies to back this up though.

    All cortisol tests mentioned here were done during a time of health and low life stress.

    I'm interested in you thoughts and any specific opinions about DUTCH testing with a case like this. Thank you so much for you time!

    • Anne,

      I am 28 years old and also experience many of the symptoms as your son. I, however, am experiencing these as a result of damage to my pituitary gland after a brain tumor resection.

      I am struggling to find a good endocrinologist and was wondering who he sees??

  11. Recent blood test shows
    Serum TSH 0.07 (range 0.27-4.20)
    Serum Free T4 <3 (range 12-22)
    Serum Free T3 11.7 (range 3.1-6.8)

    I only Take T3 and was on 100mg but reduced it to 50Mg due to high T3 readings. However my symptoms are now worse again and back putting on weight. Do I need to increase my T3 again back to 100mg? I am back feeling miserable and foggy again.

  12. I had a total thyroidectomy (Graves) in May 2017. Recently, my ability to cope with stress has changed significantly (along with other symptoms). My thyroid levels are “normal” w/TSH slightly suppressed. I asked my endo to check my Cortisol and it was 7.2 at an 8am blood test. It was 15.7 in January 2017. I would like to get further testing throughout the day to see the cycle & figured out if I am truly low all day. In the meantime, I am interested in a SAFE adrenal support supplement. I looked at yours and am wondering if the gladular ingredients are safe for autoimmune sensitivity or have been known to cause any issues with antibodies? Is it a product you’d recommend to a patient after a recent TT (w/ Graves and Hashi) with a low AM Cortisol of 7.2? I appreciate your work, this site, and recommend it often. Thank you!!

  13. Hello,

    I can’t seem to find much info online about abnormally high cortisol first thing in the morning (5:30am) and normal levels the rest of the day and normal before bed. I had urine testing done and showed extremely high levels in the morning and then back to a normal range 2 hours later at 7:30am.

    I often wake up at 3:00am or sometimes at 4:00am and not able to tall back to sleep. Is this due to abnormal cortisol surges? What’s the best supplement to control? PS100 before bed? Ashwangda in the evening? I have neither high or low cortisol… since it’s normal the entire day. I only have that ONE abnormal reading and it affects my sleep. Thanks for any advise!

  14. Good Morning Dr. Childs,
    Thank you so very much for the informative article. I am on a journey to figure out why I have Granuloma Annulare and I had a saliva test done on Cortisol and Dhea.
    06:00-08:00AM 12
    11:00-1:00PM 3
    04:00-05:00PM 3
    10:00-Midnight 2
    DHEA 2
    I was considered depressed morning cortisol and depressed Dhea. Could you please clarify for me? I seem to fall in the normal range. I am confused.

  15. What does it mean when one’s *serum* cortisol is always high (like 2-3x the upper normal limit), but ACTH and salivary / urine cortisol always come back low? I’m already seeing an endocrinologist and they’ve run a bunch of other tests; some of my lab values fluctuate wildly but the 3 cortisol measures are always as I described above. I’ve known for years that *something* is up, but none of the doctors I’ve seen (including my current endo, who thinks I’m just a depressed hypochondriac) seem to want to figure it out. I feel sure that my results, especially the conflicting cortisol levels between blood & the others, must mean something, but no one seems to have an answer. Any ideas? Thanks 🙂

    • Hi Laura,

      There isn’t much variability in cortisol supplements, you really only have adaptogens, glandulars, B Vitamins and then some supplements designed to help lower cortisol. This is why testing is really only helpful to identify high/low cortisol.

  16. Hi,

    I’m currently in the process of being tested for Cushing’s.
    My AM blood cortisol level yesterday was 20.3 and my PM was 8.0. According to the “normal range” they provided, I’m in that “normal” range for both.
    They’re also testing my ACTH from yesterday (haven’t gotten back yet), I’m doing a 24-hour urine sample now, and a midnight salivary test tonight.
    If multiple of these tests come back in that “normal high” area, do you think that’s enough for my endocrinologist to pursue a diagnosis of Cushing’s? I feel like every doctor I’ve talked to so far doesn’t believe me and I have to convince them to at least test me.

  17. Dr Childs, In your experience, have you seen children with Asthma on Inhalers , come back with ACTH stim tests showing Adrenal Insufficiency? I have an 8 year old that has been on an Asthma inhaler for 7 years of his life. Presents with extreme fatigue and his AM ACTH is only 0.5. I am positive his GI Microbiome is in very bad shape and a player for sure. I found this on NCBI:

    Wondering of possibly the Cortisol is bound up (to Cortisone) and thus possibly a reason he is only showing 0.5 in response to ACTH Test, or it has been totally suppressed by medication? Thanks much!

    • Hi Anthony,

      It’s possible if the inhalers are steroid based that they are being absorbed and suppressing the HPA axis. This is rare but it certainly can happen.

  18. Good Afternoon, Dr. Childs.

    I had quintuple bypass surgery 1 1/2 yrs ago and since then have been having problems with taste and smell. Cardiologist sees no reason for this, pulmonologist cannot find reason for this. One day I was talking to my endocrinologist who suggested I may have a cortisol problem. He was supposed to check into that and get back to me but I haven’t heard from him.
    Also, I have had respiratory problems and was put on prednisone for a short period of time to help. At the time when I was taking prednisone, my taste and sense of smell came back!
    I came across your website and am wondering if loss of these two very important senses could also be attributed to cortisol loss?
    I am interested in taking the Dutch test to possibly diagnose my symptoms. I am so frustrated with this.
    Any ideas, Dr. Childs?

  19. Hi Dr.Childs,

    I’m symptomatic, and recent cortisol levels are 7.7 ug/dL 9am, other testing was normal. My endo suggested a ACTH stim test. What’s your feeling on that test? And does this test generally cause a lot of side effects?


    • Hi Mitch,

      The ACTH stim test is a good way to see how well your adrenals can respond to a set demand. It’s a reasonable test to perform if you feel that your adrenals are under-functioning. I don’t think it’s always necessary but if your physician wants to take that route it’s not an unreasonable approach.

  20. Hi Dr. Childs,

    Great article. I just had the DUTCH test and have low free cortisol and very low metabolized cortisol paired with extreme fatigue. My question is how to approach my carb intake when I seem to also have insulin resistance? You said carbs are necessary, but what if my adrenal dysfunction is due to IR? Is that possible? I have been mostly eating a ketogenic diet for the last couple months. I was also wondering if doing 24-36hr fasts would be helpful considering both issues. I would very much appreciate your opinion. Thank you for all that you do!


    On armour 120, elevated cortisol in my labs, low dhea, low testosterone, tsh low, free t4 low, t3 mid range. One dr says cortisol is causing the thyroid prob. The other dr lowered my armour. I am an RN so I am familiar with and am well read on the subject, but don’t know where to go from here. I feel terrible, tired, all the time! Can’t get through the day without caffeine. I eat relatively healthy, I workout, don’t know which way to go. Any advice would be amazing.

  22. Good Afternoon Dr. Childs,

    I’m currently awaiting the arrival of your Adrenal Reset Complex however after scanning your many blog articles I’m not sure where to go next or even if I started in the right place. A recent morning blood test showed a huge, above normal spike in Cortisol at 34.7 as well as my Free T3 at 9.6. I’m 44 yrs old, hypo & have been on NDT for years. My Free T4 was 1.71 with a Reverse T3 of 10.7. My TSH was suppressed as usual. I’ve recently gained a stubborn & solid 10-15 lbs with many of the estrogen dominance symptoms you describe. My doc was of course alarmed at the Free T3 level & immediately lowered my dose of NDT but can’t Cortisol alone be the reason for the surge of T3 and not necessarily the thyroid med or am I completely backwards on my understanding of that? I just hate to lower my dose and make everything worse than it already is.

    Any insight on this would be greatly appreciated!!
    Warmest Regards from NE,

    • Hi Angie,

      The thyroid adrenal reset complex is ideal for alterations in cortisol, so you don’t need to worry about that. And your T3 level was probably related to your medication (not your cortisol) but that doesn’t mean the high T3 is necessarily a problem.

  23. Hello,
    I did the DUTCH test and show low cortisol for all 4 times. However I show above range metabolized cortisol and while my DHEA-S is at the low end of the range my total DHEA is over and has been elevated for several years. I am thinking of treating with adaptogens, glandulars and ALA per your article. Am I am the right path?

  24. Hello Dr Childes I have a TPO ab of 89.5kiU/L and a TG ab of 247.5 kIU/L have been on the AIP diet and supplementing iodine 6mg per day for three months (with Zinc, Selenium, Vit E and NAC).These results are are slightly worse that when I started the AIP diet and supplementing. My TSH has gone from 2.72mIU/L to 4.99mlU/L. (Rest of thyroid results continue to be normal) In one of your articles I think you said that that this might be ok and to stick with it as it will settle. I also have high Ferritin and just found out I have high Cortisol. I have lost about 16 pounds over the last year so no weight gain for me. I am not sure in I should pull back on the iodine Any thoughts?

  25. Hi Dr. Childs, I’ve been dealing with many adrenal fatigue symptoms listed above for about a year and recently had my cortisol, estrogen and progesterone tested after being brushed off by my endocrinologist. My cortisol was:

    I shared these results with my endo and he said that my numbers are fine even though they’re low and outside of normal range and then prescribed phentermine to help with my weight loss.

    For reference-I am a 33yo female and workout 6X/week and follow a mostly Whole30 diet and have gained 20 pounds in the last year with no change to my lifestyle.


  26. Thou I am taking your thyroid adrenal as I believe I have adrenal
    Insufficiency, I just did the Genova AdrenCortex stress test. Thou haven’t spoken to my Dr. yet, it was stated that it appeared I did not follow the directions! Not a chance.! Followed it to a T. Just seeing the graph told me “ not good “ and I don’t know a thing abt Genova testing results. I am below the bottom of their range for dhea/dhea cortisol range. Therefore reading your explanation
    Re cortisol testing didn’t help me under my circumstance. Something tells me I will need to return your product, wait a week an re-do this test even thou I followed the directions. Your adrenal reset has 25 mg of adrenal bovine wh is a hormone. I think this is what has caused this Genova test to be a bust. I am doing very purely with no thyr hormones for over2.5 years an now adrenal insufficiency so losing all this time iis putting me thru the ringer as I feel destroyed everyday, 24/7.

  27. Hi Dr. Childs,

    I took a Genova Lab 24 hr cortisol saliva test requiring 4 saliva samples given at 4 specific times starting at 8am through 9-10 pm. The results showed my cortisol peaks and valleys were opposite of the normal circadian rhythm.
    In addition to that, my cortisol levels were so high, the Genova chart could not accommodate such high values. Because the results were so high, the laboratory actually suggested that I did not follow the correct guidelines given the extraordinarily high numbers.
    I will say I followed the directions to a T because I was desperate to find answers as to why I am severely lethargic, low brain function, unable to make complete sentences and have absolutely no vitality or physical strength.
    Is there such a syndrome as “Reverse Circadian Rhythm” ?
    If so, are there ways to correct this?
    Thank You Dr. Childs!
    You’re knowledge is such a blessing.

    • Hi Colleen,

      I would recommend getting a serum cortisol to see if your results were in fact an anomaly or if they were accurate. It would be nice to compare your results to another source to verify if the original test was accurate or not.

  28. Six years ago, I received the diagnosis of Secondary Adrenal Insufficiency. My natural capability to generate Cortisol is all but gone. It was detected as part of a lab test of my Testosterone. My first value was 1 which is very low T. I was referred to an endocrinologist. I also have Type 2 Diabetes.

    I am on Cortef therapy which I now have to take each and every day to survive. The prevailing narrative in Endocrinology and Gastroenterology is that there is a nervous system located within both our GI and Endocrine systems. That it’s significant and barely understood.

    It’s my experience that this inexperience within medicine has resulted in a series of anecdotal information points throughout a day to signal the requirement of Cortef and how much? Patients like myself are expected to exercise personal judgement in assessing how much Cortef is needed.

    Dosage of Cortef is a reoccurring challenge for patients.

    I recently added the Freestyle Libre 2 Glucose monitoring system. A wearable sensor, inserted in your arm provides real-time BS data, 24/7. It is linked to my smart phone which can and has woken me up with low sugar alarms.

    Such a wearable, instant result lab that could measure cortisol would be a game changer for the millions of Adrenal Insufficiency patients. It could help correct dosage errors and optimize medication schedules based upon actual data and not anecdotal theories.

    So I hope that another ambitious tech company or Abbott takes on this opportunity.

    • Hi Col. Stuart W. Ross,

      I agree, if such a monitoring advice existed it would be great for patients with adrenal insufficiency.


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