Who Should Take an Adrenal Test?

We consider an adrenal test when people have symptoms and conditions that can be linked to adrenal dysregulation, such as these:

  • PMS, perimenopause symptoms, PCOS, infertility
  • Unexplained abdominal weight gain (apple-shaped body)
  • IBS – irritable bowel syndrome
  • Muscle pain or rapid muscle/joint breakdown and degeneration
  • Intestinal permeability (leaky gut)
  • Headaches or migraines
  • Heart disease and high blood pressure
  • Difficulty regulating blood sugar
  • Cold hands and feet
  • TMJ (jaw pain/mobility issues)
  • 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(s) or current significant stress
  • Hypothyroid symptoms or diagnosis
  • Inflammation or infections that aren’t resolving

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

Adrenal fatigue, falling asleep drinking coffee, lab tests

What do we test for?

To test for HPA-D, we check free cortisol in saliva or urine. (You can’t use a serum test/blood draw for free cortisol.) Saliva has the most historical use and data behind it, while urine testing is the new kid on the block. It’s best to take multiple samples (saliva or urine) within a 24 hour period 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)

This is the most affordable test. You take four saliva samples over 24 hours, which map 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

This is the 4-point salivary cortisol test with DHEA added. DHEA is another hormone the adrenals make, and testing can give more information about your diagnosis. Low levels of DHEA can be seen in more advanced cases of HPA-D.

Cortisol Awakening Response

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

DUTCH Adrenal Test

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. Testing includes DHEA. Along with your results, the lab also provides an extensive written report which is quite educational. 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, as it includes these plus adrenal hormones

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 actually need more.
  • You may need more or less cortisol depending on the time of day, and not be gearing your treatment in the right direction timing-wise.
  • Herbs that work on the HPA axis have different properties. You would need to know if the herb matches your presentation, and the right dosage, as 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 we take these tests? If your HPA axis is dsyfunctional, it will affect all of your neuroendocrine systems—thyroid, insulin, sex hormones, energy production— and your brain. By obtaining your specific results, you can find out what interventions to use for sleep, stress, and energy, and fine-tune your treatment.

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 action plan for your health. 

For those who don’t have access to individual appointments and/or access to testing, we created a DIY course just for you, called Fix Your Adrenals. You can skip the testing, take the course, and learn how to assess and treat yourself successfully! This multimedia course has been made accessible for the hearing-impaired population as well. Click to 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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