Is Cortisol Testing Accurate?

hormone health open access Aug 12, 2024

Testing cortisol on a single day doesn’t accurately reflect your true cortisol levels, even with the DUTCH test. Cortisol fluctuates significantly and is influenced more by situational factors than by long-term traits. Some common factors that affect cortisol include:

Time of awakening, time of day
Thyroid status
Illness & inflammation

Sleep duration and quality

Ambient light levels

Seasons

Weekdays vs. weekends

Prior day experiences and anticipation of the day ahead (prospective memory load)

Eating habits and macronutrient distribution

Smoking, alcohol, exercise, and caffeine

Gender, socioeconomic status, race, and age

To get a precise picture, ideally, you’d need to test five times, spaced three months apart, with each visit involving three days of sampling and six collections per day (PMID: 24119668). Since this approach is impractical, a more feasible method is to take 4-6 samples over 1-2 weeks, including both workdays and days off, at the same time each day. While this won't assess your diurnal rhythm or cortisol awakening response (CAR), it will give you a better sense of whether your cortisol levels are generally high or low.

In addition to testing, consider these symptoms of cortisol imbalance:

Low Cortisol Symptoms:

Lack of appetite

Stomach pain

Body aches

Muscle cramps

Dizziness

Salt cravings

Orthostatic hypotension

Low blood pressure

Hypoglycemic symptoms (low blood sugar)

Low-normal sodium and high-normal potassium on blood work

High Cortisol Symptoms:

Easy bruising

High blood pressure

Poor wound healing

Acne

Muscle weakness

Weight gain

Elevated glucose despite healthy habits

Elevated HbA1c despite healthy habits

Many of my women clients have imbalanced cortisol levels. Using both testing and symptom assessment is a reliable way to determine your cortisol status

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