Testing · Adrenal health
How to test cortisol levels: saliva, blood, urine, and hair
Cortisol is a 24-hour rhythm, not a single number. A random blood draw at 2pm tells you almost nothing about how your stress response is actually behaving. The right test depends on the question you're asking.
Why a single blood test is not enough
Cortisol should peak within 30 minutes of waking (the CAR — Cortisol Awakening Response) and decline throughout the day. A flat curve, an inverted curve, or a blunted CAR each imply different problems — none of which show on a single 10 AM draw.
The four main testing methods
- 4-point salivary cortisol — best for HPA rhythm and everyday stress patterns
- DUTCH complete — cortisol + metabolites + sex hormones in one panel
- 24-hour urine free cortisol — gold standard for suspected Cushing's
- Morning serum cortisol + ACTH — when Addison's or pituitary problems are suspected
What to do before you test
No caffeine 12 hours before, no strenuous exercise the day of, no oral steroids for at least 24 hours, and no biotin supplements (they interfere with immunoassays). Test on a typical day — not a vacation or a crisis.
Frequently asked questions
What is the best cortisol test?
For rhythm and adrenal function: 4-point salivary cortisol or DUTCH (Dried Urine Test for Comprehensive Hormones). For suspected Cushing/Addison: 24-hour urine free cortisol or morning serum cortisol plus ACTH.
What time should cortisol be tested?
Peak cortisol is 30 minutes after waking. Morning serum tests should be drawn between 7–9 AM. Salivary rhythms require 4 collections: waking, +30 min, midday, evening.
Can you test cortisol at home?
Yes. Salivary and dried-urine kits are validated for consumer use when processed by a CLIA-certified lab.
What is a normal cortisol level?
Serum: 7–25 mcg/dL in the morning, dropping to <10 by evening. Values depend on the assay, time, and stressors that day.
Should menopausal women test cortisol?
If you have belly weight resistant to diet, chronic insomnia, or persistent fatigue, a 4-point saliva or DUTCH is the highest-yield first test.
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Medically reviewed by Kindr Health Clinical Team · Last reviewed 2026-06-19. Compounded medications are prepared by FDA-registered 503A pharmacies and are not FDA-approved drug products.