Can Tracking Your Cortisol Help Your Health?

Cortisol is a hormone that plays an active role in metabolic health, blood pressure control and immune response. But, perhaps what cortisol is most known for is its handling of stress.

Appropriately dubbed the stress hormone, cortisol is released in response to various forms of stress, including acute stress (which is temporary, short-term stress), chronic stress (which is longer-term stress) and traumatic stress. The body may also temporarily release cortisol in response to physical stress, like exercise — even though regular exercise can help you regulate your cortisol levels over time.

But cortisol is not manipulated by stress alone, and your levels fluctuate throughout the day independently of stressful events too.

Testing or tracking your cortisol levels may alert you if your cortisol levels are too high or too low, which — if results are interpreted by a professional — could help you understand if your body’s cortisol response is healthy and normal.

Tests to track cortisol aren’t doctor-recommended for every patient, but a blood cortisol test may be prescribed to people who show cortisol imbalance symptoms, are nervous about cortisol-related tumors, are trying to determine if they have a diagnosis for Cushing’s syndrome or Addison’s disease, or are undergoing a work-up for another health condition. Those without a doctor’s prescription — the healthy-but-curious, per se — can still purchase blood or saliva cortisol tests from many online retailers. However, the health benefits of an online test may depend on the validity of the retailer and the information you are hoping to gather.

[SEE: DNA Testing Kits: Are They Worth It?]

What Is a Cortisol Test?

A cortisol test is a test that measures your cortisol levels. Some cortisol tests measure your cortisol levels using samples of blood, whereas others make their calculations based on saliva or urine.

Doctors can test cortisol levels in all three of these areas due to how cortisol is made — and where it is found — in your body. Notably, cortisol is produced by the adrenal glands, which are located at the top of your kidneys. The adrenal glands release cortisol into the bloodstream — allowing for the blood test to be conducted — which is later filtered by the kidneys and into the urine through a process called glomerular filtration — hence the urine test. Cortisol is believed to enter the saliva from the bloodstream through passive diffusion, allowing for the spit test.

How to test your cortisol levels

— Blood Tests are an invasive form of test, as they involve drawing blood. Blood draws are typically taken in the morning and late afternoon.

— Saliva Tests, or spit tests, are non-invasive tests that can be relatively easy to perform on your own. You can take multiple saliva tests throughout the day to assess your levels at different times.

— Urine Tests, such as 24-hour urine collection, can offer insights into cortisol excretion over an extended period.

— Wearable Devices: While not exactly a test, wearable technological devices are emerging to allow people to monitor cortisol levels in real time by monitoring cortisol through sweat.

Dr. Victoria Finn, an endocrinologist with Medical Offices of Manhattan in New York City, explains that “cortisol testing is beneficial when trying to rule out or confirm specific hormonal disorders, such as adrenal insufficiency or Cushing syndrome.”

Your doctor may order one of these types of cortisol tests for you if they have reason to believe you are at risk for high or low cortisol levels or if your test results can help them understand other facets of your health and treatment. You can also purchase a test from online sites like Rx Home Test or Verisana.

[READ: Signs of a Hormonal Imbalance.]

Understanding Cortisol Levels

While cortisol tests can reveal if you are experiencing dangerously high or low cortisol levels, it is unclear whether they provide health benefits for people who are not at risk for cortisol-related conditions.

Finn discourages patients from randomly testing their cortisol levels, as this may lead to “misdiagnosis and unnecessary anxiety and overuse of supplements,” she says. Additionally, because cortisol levels naturally fluctuate throughout the day, the same number could be seen as “high” or “low” depending on what time of day the test was conducted.

“Cortisol levels naturally rise early in the morning and decline throughout the day,” Finn explains. “Therefore, a single measurement is insufficient to accurately assess cortisol status, as this hormone fluctuates multiple times daily due to various stressors we encounter.”

According to the University of Florida Health, a normal cortisol value on a blood sample, when taken at 8 a.m., is 5 to 25 mcg/dL or 140 to 690 nmol/L. After that, cortisol levels should gradually decline throughout the day, reaching their lowest point at night.

Because cortisol levels tend to be highest in the morning, tests for Addison’s disease or low cortisol levels can be more accurate at this time. On the other end of things, because cortisol levels tend to be lowest at night, tests for Cushing syndrome or high cortisol levels can be more accurate at this time. It is important to note that if you work a night shift or have irregular sleeping hours, your cortisol levels will likely follow a different schedule. That’s because fluctuations are less influenced by the clock on the wall than they are by the clock in our body, that sets our sleeping and waking schedules.

Symptoms and Conditions That May Warrant Cortisol Testing

If you are experiencing signs and symptoms of adrenal insufficiency or Cushing’s syndrome, you’ll want to discuss these with your doctor. If they do not find another reason for your symptoms, they may want you to get your cortisol levels tested.

Finn adds that unexplained symptoms that may necessitate cortisol testing for adrenal insufficiency include:

— Unexplained weight loss

— Low blood pressure

— Low blood sugar

— Fatigue

— Occasional salt cravings

— Skin darkening

Unexplained symptoms that may necessitate cortisol testing for Cushing syndrome include:

— Weight gain, particularly weight gain on the face or trunk of the body

— High blood sugar

— High blood pressure levels

— Facial redness

— Stretch marks

— Easy bruising

— Muscle weakness

[Vitamins for Stress: Do They Work?]

Who Should Test Their Cortisol Levels?

Adrenal insufficiency, also known as Addison’s disease, is a condition related to low cortisol levels, whereas Cushing syndrome is related to elevated or too-high cortisol levels.

“In general, routine testing for cortisol levels as part of a general screening to evaluate ‘stress levels’ is not recommended unless there are specific suspicious features pointing towards adrenal insufficiency or Cushing’s syndrome,” Finn adds.

Cortisol testing can also be important for people with a long history of steroid use — cortisol is a steroid hormone — or who have had brain surgery involving the pituitary gland, Finn says.

Weight management and cortisol testing

Cortisol testing may also be recommended for people who experience weight-related medical conditions, particularly if they are about to be referred to a specialist or receive more intensive treatment for weight gain.

“Cortisol is one of those hormones that can contribute to significant weight gain and other medical conditions,” says Dr. Mir Ali, a board-certified bariatric surgeon and the medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, California.

Ali adds that his patients often undergo several types of hormonal testing including cortisol testing, before coming to him.

“It’s kind of a beginning place to check for things,” Ali says. “When we see a patient that’s coming to us for weight loss surgery or weight loss in general who hasn’t had any evaluation by their primary doctor for other conditions that could contribute to weight gain, then we ask them to do that — get some hormone levels and other factors checked.”

Doing so can help detect or rule out any other factors that may be involved in the patient’s weight gain, so that doctors can most appropriately individualize their treatment plan.

[SEE: Mindfulness Exercises to Reduce Stress or Anxiety.]

How Tracking Cortisol Can Benefit Your Health

When medically recommended, cortisol tests may provide health benefits. For instance, a test that reveals abnormal cortisol levels could alert you that you are at risk for certain cortisol-related health conditions, like Cushing’s syndrome, Adrenal insufficiency or a tumor. Abnormal cortisol levels could also infer that you are experiencing another, potentially more discrete health issue that requires more testing or medical evaluations to diagnose.

Not all abnormal results indicate a health issue, either. Sometimes, your doctor may interpret your test result to show that other factors are impacting your cortisol levels.

Perhaps you are over-stressed, or not getting enough high quality sleep. In circumstances like these, your test results could indirectly benefit your health by opening up a dialogue — to be had with your medical provider — about how to make actional lifestyle changes to support this important hormone. Potential changes could include practicing stress-reduction techniques or prioritizing your sleep.

It’s worth noting that abnormal results could also be nothing to worry about at all. These could be due to the natural fluctuations of your individual levels or a faulty test.

[See: 10 Unexpected Signs That You’re Stressed]

How to Prevent Cortisol Imbalances

Despite its nickname as the stress hormone, it’s important to remember that cortisol isn’t typically trying to make you stressed out — it’s acting in response to already-active stress in your life. With that in mind, and for the otherwise healthy individual, preventing cortisol imbalances may have less to do with tracking your cortisol levels and more to do with managing controllable sources of stress.

“Often misunderstood as an enemy, cortisol becomes a concern only when conditions like Cushing’s syndrome or adrenal insufficiency arise,” Finn says. “In other cases, stress from various life triggers, sleep deprivation, depression, or poorly controlled diseases can stimulate cortisol levels.”

To reduce your stress and support healthy cortisol levels, she advises people to form healthy habits to help manage various sources of stress in their lives. These may include:

— Practicing stress reduction techniques such as meditation, yoga and deep breathing exercises

— Establishing regular sleep habits to support adequate sleep

— Performing regular physical activity such as engaging in moderate cardiovascular exercise multiple times a week, and strength training a couple of times a week as well

— Optimize your diet by consuming balanced meals, prioritizing whole foods and limiting your intake of alcohol, caffeine and processed foods

— Staying on top of your doctor’s visits to make sure you are getting recommended vaccinations, medical check-ins and doctor-recommended testing, which may include cortisol testing, if you are at risk

“These measures can help curb cortisol spikes and maintain a balanced hormone level,” Finn says.

Is Tracking Cortisol Right for You?

Tracking your cortisol could be a good idea if you are at risk for Cushing’s syndrome or adrenal insufficiency. It’s also worth considering if you currently have a cortisol-related condition or if you used to in the past. It is also a good idea if your doctor recommends this as part of a screening for another condition. Tracking your cortisol could be a bad idea if you are otherwise healthy, are easily alarmed by medical findings and are not working with a trusted medical professional to interpret results.

Before taking a cortisol test, you may want to talk to your doctor about whether or not doing so is a good idea for you. You may also want to ask yourself a few questions to determine your own interest and investment in the test.

Some questions you may consider asking yourself include:

1. Why do you want to test or track your cortisol?

2. What are you hoping to get out of a cortisol test?

3. Are you at risk for too-high cortisol levels or Cushing’s syndrome?

4. Are you at risk for too-low cortisol levels or adrenal insufficiency?

5. Do you have Cushing’s syndrome or adrenal insufficiency, or have you had either of these conditions in the past?

6. Does your doctor recommend you track your cortisol?

7. Will you work with a doctor to interpret your results?

8. Do you trust the company or pharmacy from which you are getting your test from?

9. Is tracking your cortisol part of a larger integrative health approach you are purposing? If so, how does this fit in?

10. How will you respond if your results appear abnormal?

More from U.S. News