How to Test Cortisol Levels

Ever feel totally drained, wired but tired, or like stress is running the show? You may need to check your cortisol levels. Cortisol, known as the “stress hormone,” plays a big role in how your body responds to everything from anxiety and poor sleep to that third cup of coffee. When it’s too high or too low, you can feel completely out of sync.

In this guide, we’ll break down cortisol tests (including discussing at-home options). We’ll also explain when to test, what your results mean, and how to naturally support healthy levels. If you’re feeling burnt out, curious, or just want answers, we've got you covered without the medical jargon.

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What Is Cortisol and Why It Matters

Many people misunderstand cortisol. We often associate it with high stress levels or have a negative perception of it. However, cortisol is an important hormone that, when well-regulated, helps your body in numerous ways.

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Understanding the ‘Stress Hormone’

Dubbed the “stress hormone,” cortisol is produced in the adrenal glands (a pair of small glands located on the top of each kidney) and has several functions. The hormone helps regulate energy, immune response, sleep, mood, and yes, stress. 

Normally, cortisol follows a daily cycle, peaking in the early morning and dropping at night. That rhythm, known as the diurnal (AKA ‘daily’) cortisol rhythm, is essential for feeling alert when you wake up and winding down at bedtime.

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What Happens When Cortisol Levels Are Off

Cortisol dysregulation is sometimes linked to conditions like PCOS (polycystic ovarian syndrome), chronic anxiety, poor sleep, burnout, and mood swings. The dysregulation and hormone disruption can alter your metabolism, resulting in extra fat storage, skin issues, and immune function.

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Why You Might Want to Test Your Cortisol Levels

We don’t usually start with cortisol testing unless there are clear signs of a serious imbalance. Cortisol shifts can stem from chronic stress or an underlying condition, but testing isn’t the first step. Since hormonal imbalances often show up through physical, mental, and emotional symptoms, it’s more effective to begin with a complete picture of your health and then decide if you need testing.

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Symptoms of High Cortisol Levels

High cortisol can sneak into your daily life with signs like:

• Trouble losing weight or maintaining a healthy weight
• Thinning skin that bruises easily or takes ages to heal
• Skin issues like acne
• Mood swings and chronic anxiety
• Irregular cycles, low libido, or fertility issues

• Difficulty sleeping

Low cortisol also has symptoms, like low appetite and blood pressure, loss of libido, and fatigue.

Both low and high cortisol levels are associated with cognitive and mood symptoms such as brain fog, fatigue, or depression. These are classic signs of cortisol dysregulation or even Cushing’s syndrome in severe cases.

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Health Conditions Linked to Cortisol Imbalance

A cortisol imbalance can lead to other conditions or be a sign of an underlying issue. These include:

• Cushing’s Syndrome: A rare condition caused by prolonged exposure to high cortisol levels, leading to symptoms like weight gain, fatigue, high blood pressure, and mood changes.
• Addison’s Disease: A rare disorder where the adrenal glands don’t produce enough cortisol and sometimes aldosterone (a hormone produced by the adrenal glands), resulting in fatigue, low blood pressure, weight loss, and salt cravings

PCOS and Chronic Stress

PCOS and chronic stress share several similar symptoms like fatigue, weight management problems, and skin and hair issues. In some studies, women with PCOS had higher perceived levels of stress, though serum cortisol levels were found to be similar to those of women without PCOS. However, it’s not a given that you’ll have PCOS and chronic stress. The best approach is to test and work with a specialist.

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Types of Cortisol Tests Explained

If you're curious about what a cortisol test shows, or wondering about the difference between a cortisol blood and saliva test, here’s an overview of each type of test.

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Blood Test

The serum cortisol test is a blood test usually administered early in the morning (when cortisol levels are at their peak) that measures the level of cortisol in your blood. Doctors primarily use this test to diagnose adrenal conditions, like Addison’s disease.

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Saliva Test

Saliva testing measures the free, bioactive cortisol, the form your body actually uses. The test can be done in-clinic or at home, and you may have to provide multiple samples to gauge cortisol levels throughout the day (based on the diurnal cortisol rhythm).

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Urine Test

A urine test (sometimes done as part of the Dutch Test, AKA a Dried Urine Test for Comprehensive Hormones or for a definitive Cushing’s Syndrome diagnosis) requires you to collect and deliver all urine you expel in a 24-hour period to your doctor. The urine test is less commonly done as it may not be accurate, and the DUTCH test isn’t FDA-approved.

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ACTH Stimulation and Dexamethasone Suppression Tests

When basic tests are inconclusive or adrenal/pituitary issues are suspected, doctors may use:

• Adrenocorticotropic hormone (ACTH) stimulation test: Measures cortisol response to the injection of a synthetic version of ACTH, a hormone produced in the pituitary gland that signals the release of cortisol.
• Overnight dexamethasone suppression test: In this test, you’re given a dose of a cortisone-like medicine called dexamethasone in the evening. The next morning, you’ll return to the doctor so they can measure your cortisol levels.
  
  

These are specialized and reserved for diagnosing conditions like Addison's or Cushing’s, not to check daily fluctuations.

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How to Prepare for a Cortisol Test

Accurate, meaningful results are based on proper test preparation. Whether you're planning an at-home saliva kit or a clinic-based blood draw, skipping or ignoring prep rules can lead to contaminated or misrepresentative samples. Listen to your provider, read all written instructions carefully, and follow the tips below for the best chance of success.

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Preparing for a Cortisol Blood Test

For in-lab or clinical tests, a lot of the preparations are surprisingly similar to the at-home test:

• Schedule it for early morning (usually before 9 a.m.), ideally within three hours of waking, to catch your peak cortisol level.
• Avoid intense physical activity the day before and rest quietly for ~30 minutes before your blood draw; physical and emotional stress can increase cortisol levels and skew results. 
• Don't consume food or liquids (except water) at least 30–60 minutes before, depending on your lab’s instructions. Unless your provider advises otherwise, water is generally fine as a small amount helps keep your veins hydrated. 
• Let your provider know about medications like steroids or oral contraceptives, which can affect cortisol levels for hours or even days.

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24-Hour Urine Test​ Preparation

The 24-hour cortisol urine test is a bit more involved, so you’ll likely need to set aside a full day for the test:

• Consider taking the day off from work or limiting activity the day of your test.
• Ensure you collect every sample; your lab will typically ask for 24 consecutive hours of urine, starting and ending at the same time.
• Keep the container refrigerated between collections, and return it quickly to the lab.

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Understanding Test Results

Once you receive your results, there may be some confusion, but we’ve got you covered. Below, we have a general overview of what’s considered normal ranges. Disclaimer: always consult with your healthcare provider to interpret test results.

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Normal Cortisol Ranges

Due to the diurnal cortisol rhythm, your cortisol levels throughout the day​ fluctuate, so the normal range is slightly different in AM vs PM. For women over the age of 18:

• Serum and salivary cortisol levels are measured in micrograms per deciliter (µg/dL) or nanomoles per liter (nmol/L) :
  
  • AM: 10–20 µg/dL (≈ 140–550 nmol/L)
  • PM: 3–10 µg/dL (≈ 82.8-276 nmol/L)
• 24-hour urine test levels: Less than 45 µg/dL in 24 hours (124 nmol/L in 24 hours)

Normal ranges can vary slightly by lab, so always compare your results against your lab’s reference values and consult your healthcare provider for any questions regarding results. 

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What Do The Results Mean?

High cortisol may be linked to chronic stress, Cushing’s syndrome, or certain meds like birth control or steroids. If levels stay high at night, your doctor might order a dexamethasone suppression test.

Low cortisol could signal adrenal issues like Addison’s disease. Symptoms often include fatigue, dizziness, or low blood pressure, and may require an ACTH stimulation test to confirm.

If your rhythm looks “flat”, no morning peak or evening dip, it could reflect burnout or HPA-axis dysregulation, a condition that can cause issues with your body’s ability to fight off infections. 

The best next step? Talk to a professional. One of our Allara specialists can help you understand your results and guide you toward achieving a more balanced hormonal state.

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Natural Ways to Support Cortisol Balance

If you’re looking for natural ways to manage cortisol dysregulation, a holistic approach can support your hormonal and overall well-being. Consider the following lifestyle changes:

• Keep a consistent sleep schedule, as even slight shifts can disrupt cortisol.
• Eat balanced meals to steady blood sugar and avoid cortisol spikes.
• Use stress-reducing habits like breathwork or walks to calm your system.
• Move regularly—exercise supports hormone balance and stress relief.

Also consider supplements to lower and balance cortisol levels. Allara’s Hormone Equilibrium supplement blends choline (450 mg) and CoQ10 (100 mg) with additional supportive nutrients. In studies, CoQ10 may help reduce the stress and damage linked to adrenal hormone imbalances.

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Take the Reins of Your Hormonal Health & Wellness

Testing your cortisol levels isn’t about chasing perfection; it’s about understanding your body, spotting patterns, and making informed choices that support your hormonal health.

If you’re feeling off, speak with your current healthcare provider about diagnostic testing, such as cortisol levels. If you are looking for an empathetic, knowledgeable provider, consider working with an Allara specialist. 

Why? Because we offer clinically informed solutions that go beyond surface-level care. Your hormones aren’t the enemy; they’re messengers. When you listen, test, and support them thoughtfully, you take back control.

Discover the Allara care model and learn how to achieve your best self.

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Cortisol Testing FAQs

Can I test cortisol during my period?

Yes, you can, but hormone fluctuations during your cycle may slightly affect results. If you’re tracking patterns over time, it’s best to test during the same cycle phase each time.

What is a normal cortisol level for a woman​?

Morning blood cortisol levels are typically 10–20 µg/dL. Saliva levels in the morning range from 10.2–27.3 ng/mL. Levels drop naturally throughout the day.

What are the symptoms of high cortisol levels​?

Common signs include weight gain (especially around the belly or face), acne, fatigue, mood swings, sleep issues, and irregular periods.

What is considered high cortisol​?

Blood levels consistently above 20 µg/dL in the morning or elevated late-night saliva levels (≥ 5 µg/dL) may be considered above the normal range.

Can birth control affect cortisol levels?

Yes. Oral contraceptives can increase total cortisol levels due to higher cortisol-binding globulin levels, although free (active) cortisol may remain unchanged.

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