Who Should Take an Adrenal Test?

We consider an adrenal test when people have these symptoms and conditions, which are all linked with adrenal dysregulation:

  • PMS, perimenopause symptoms, PCOS, infertility
  • Unexplained abdominal weight gain (apple-shaped body)
  • IBS – irritable bowel
  • Muscle pain or rapid muscle/joint breakdown and degeneration
  • Intestinal permeability (leaky gut)
  • Headaches including migraine
  • Heart disease and high blood pressure
  • Difficulty regulating blood sugar
  • Cold hands and feet
  • TMJ
  • Anxiety and depression
  • Fatigue, especially in the morning, as well as afternoon slumps
  • Insomnia, including difficulty falling asleep at night and waking too early in the morning
  • Difficulty recovering from exercise
  • Need caffeine in the morning to wake up, or throughout the day to function
  • Injuries that are slow to heal
  • Frequent colds and flus
  • Past trauma or current significant stress
  • Hypothyroid symptoms or diagnosis
  • Inflammation or infections that aren’t resolving

Any of these may have adrenal dysfunction part of the picture. Adrenal dysfunction is called HPA-D, which you can learn about here. Wonder if this applies to you? Take this self-assessment:

Laura Paris, adrenals, perimenopause, menopause, hormones, functional medicine, Monterey California, acupuncture

What do we test for?

To check for HPA-D, we check free cortisol. You cannot test for free cortisol in serum (blood draw). Free cortisol is measured in saliva or urine. Saliva has the most historical use and data behind it, and urine is the new kid on the block. It’s best to take samples (saliva or urine) over 24 hours so you can see the cortisol curve over that time. Here’s an example of a healthy cortisol curve:

circadian, functional medicine, Dr Laura Paris, sleep, insomnia, adrenal

Our favorite adrenal test kits

You can order an adrenal test kit yourself to do at home in our functional lab shop. Your results will end the guesswork about whether or not the root cause of your symptoms is due to adrenal fatigue (HPA-D). Here we compare and contrast our four adrenal tests:

4-Point Salivary Cortisol (Diurnal Cortisol Cx4) – $175

This is the most affordable test. You take four saliva samples over 24 hours, which maps your diurnal cortisol. You’ll get a chart of the results as well as a graph that looks like the picture above -of course with your own results.

Adrenal Stress Profile – $190

For an additional $15 you can add DHEA to your 4-Point Salivary Cortisol test. This is another hormone the adrenals make that can give more information about your diagnosis. DHEA tends to be affected (low) in a more advanced case of HPA-D.

Cortisol Awakening Response – $215

This combines the two tests above, plus two extra cortisol samples in the first hour you’re awake to test your “cortisol awakening response.” This is when your cortisol should rise the most. If your morning is disrupted (waking too early, feeling exhausted or groggy, or unrested when you wake up), honing in on the cortisol awaking response can be helpful. Order this test here.

DUTCH Adrenal Test – $280

This test uses urine dips (4 or 5 over 24 hours) to look at metabolized cortisol. This allows you to look at both free cortisol and metabolized cortisol, which offers a wealth of information. It includes DHEA. The lab also provides an extensive written report which is quite educational. Order this test here. We tend to choose this when:

  1. Someone prefers dipping test strips into urine over taking a saliva sample
  2. A woman also wants to test reproductive hormones and melatonin, in which case we recommend choosing the DUTCH Complete Hormone Test, because it includes these plus adrenal.

Why not just take an adrenal supplement instead of testing?

You may have thought you have “adrenal fatigue” and tried various things to help. Unfortunately, with guessing rather than testing, what you do or take may not be on target with your specific HPA-D pattern. You may be wasting your money or you may be treating yourself inappropriately. For example:

  • You may be taking something that lowers cortisol when you need more.
  • You may need more or less cortisol during certain times of day, and not be gearing your treatment in the right direction, at the right time of day.
  • Herbs that work on the HPA axis have different properties according to the herb. You don’t know if the herb matches your presentation. It may be too stimulating or too sedating.
  • It’s possible you don’t have HPA-D at all, and your symptoms have a different root cause! I see this on a regular basis.

In essence, why do this test? If your HPA axis is dsyfunctional, it will affect all of your neuroendocrine systems: thyroid, insulin, sex hormones, energy production, and your brain. With the specific results of this test, you can fine-tune your treatment. You can find out what interventions to use for sleep, stress, and energy.

How can you get help with your results?

Functional and integrative practitioners interpret adrenal tests and treat the nuances of HPA-D (hint: lifestyle approaches always come first)! You can book an appointment with us after your test results come back, and we can get right down to the business of assessing your results and coming up with an individualized health action plan for you. F

or those who don’t have access to individual appointments, we created a DIY course just for you, called Fix Your Adrenals. This course is designed for people who don’t have access to testing as well! You can skip the testing, take the course, and assess and treat yourself successfully! This multimedia course is accessible to the hearing-impaired population. Watch a sneak preview:

Questions about this? Please ask below.

paris healing arts, doctor laura paris, dr. laura paris, dr laura paris, stress, adrenal, functional medicine, acupuncture, HPA

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  1. I would like to learn if Dutch test applied in Paris, do you analyse it in Paris or or do you send it to USA?

    1. Yes, the Dutch test is available in Paris – you pay to have it shipped there, then you are responsible for shipping samples back to the U.S., because the lab is only in the U.S. But absolutely you can do it from France as well as most countries.

  2. How much is fee for the:


    and is it the same or different from the:

    Free Cortisol Pattern – Cortisol Metabolites – Estrogen
    Estrogen Metabolites – Progesterone – Testosterone
    Androgen Metabolites – Melatonin – Organic Acids
    Neurotransmitter Metabolites

    Thank you, I’m very interested.

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