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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