What is Cortisol? High and low values | Lab results explained

What is Cortisol?

what is cortisol high low meaning symptoms treatment steroid HPA axis

Cortisol is a steroid produced and secreted by the adrenal glands. Cortisol affects many different body systems, including: bone growth, blood pressure control, immune system function, metabolism of fats, carbohydrates, and protein, and nervous system function. Additionally, our brain releases a chemical called adrenocorticotropic hormone in response to threatening stimuli. This triggers your adrenal glands to release cortisol and adrenaline, giving you a burst of new energy and strength.

Let’s take a closer look at cortisol levels:

Cortisol levels follow a pattern called “diurnal variation,” peaking in the early morning then declining throughout the day and reaching the lowest level at night.

Why are cortisol tests performed?

Cortisol tests are done to check for increased or decreased cortisol production, which is an indication of how well the pituitary and adrenal glands are working. Tests may also be ordered when women have irregular menstrual periods and increased facial hair or when children have delayed development and short stature.

More details on the fight or flight response – a modern take:

The fight or flight response which triggers a release of cortisol is a natural and necessary tool for our survival. However, in our modern world threatening situations usually take the form of bills and deadlines not bears and tigers. Our bodies have a limiting response when a threat passes that brings cortisol levels back to baseline; however, when stressors are always present cortisol levels remain elevated. This long-term activation and subsequent overexposure to cortisol and other stress hormones can disrupt almost all of our body’s processes. This puts us at risk for a number of serious health problems, including:

– Anxiety

– Depression

– Digestive problems

– Heart disease

– Weight gain

– Sleep problems

  • Normally, cortisol levels rise within 10 to 30 minutes of waking to help boost energy levels and then drop throughout the day. This is known as the cortisol awakening response (CAR)
  • In the DUTCH test the 24hr Free Cortisol biomarker is the sum of the Waking, Morning, Afternoon and Night cortisol levels.
  • Cortisol levels are a good indication of baseline HPA axis function since they represent the lowest level during the circadian rhythm.
  • Cortisol is often reflective of glycemic control due to the post-prandial timing of collection.
  • Cortisol measurement reflects peak ACTH-mediated adrenal gland response.

Lower levels

A low level of cortisol may indicate Addison’s disease, a disorder in which the adrenal glands do not produce sufficient steroid hormones. Symptoms include:

  • weight loss
  • Fatigue
  • low blood pressure
  • abdominal pain
  • dark patches of skin

You may also have hypopituitarism, which occurs when cortisol production by the adrenal glands is low because the pituitary gland is not sending proper signals.

Possible reasons associated with low cortisol awakening response (CAR):

Normally, cortisol levels rise within 10 to 30 minutes of waking to help boost energy levels and then drop throughout the day. This is known as the cortisol awakening response (CAR)

– Underactive HPA axis

– Chronic stress, including psychological stress (L)

– Seasonal affective disorder (L)

– Type 2 diabetes and insulin resistance (L, L)

– Insomnia or other sleep issues, including sleeping in late (L, L) PTSD (L, L, L, L)

– Chronic fatigue syndrome (L)

– Chronic pain (L)

– High blood pressure (L)

– IBS and dyspepsia (L)

– Fibromyalgia (L)

Possible reasons associated with low cortisol throughout the day:

– Addison’s disease (where the adrenal glands are not responding to the ACTH released by the pituitary gland and are not producing enough cortisol) [L]

– Hypothyroidism [L]

– Medications – opioids, corticosteroids, Accutane [L, L, L]

– HPA-axis dysfunction

– Head trauma affecting the HPA axis [L]

Lower evening cortisol:

Saliva evening cortisol levels should be lower than the mean of the range. If all 4 readings in the adrenal stress profile are low, suspect adrenal fatigue, otherwise maladaption.

Cortisol (3PM-5PM) lower:

– Low levels can reflect underlying HPA axis dysfunction.

– Late afternoon cortisol level is below mean range and suggestive of adrenal insufficiency.

This suggests suboptimal adrenal functioning, and if accompanied by low evening cortisol and low DHEA, suspect adrenal fatigue. Suggest supplementation with DHEA and standard adrenal support.

Higher levels:

Possible reasons for a high cortisol awakening response (CAR):

– Overactive HPA axis

– Short-term stress about a future event [L]

– Shoulder and neck pain [L]

– Anticipating having to wake up at a certain time [L]

– Visceral adiposity in men (=Excess weight that develops over time around the center of the body). Likely caused by elevated cortisol, not vice versa. [L, L, L, L]

– Upper respiratory infection / a cold [L]

Possible reasons for high cortisol throughout the day:

– Cushing’s disease (where the pituitary gland releases too much ACTH, stimulating the adrenals to release too much cortisol) [L]

– High levels of stress (including mental stress)

– Insulin resistance [L, L]

– Hyperthyroidism [L]

– HPA axis dysfunction

– A high blood cortisol level at night may indicate a problem with the adrenal glands; however, individuals who work at night and sleep during the day will have an inverted pattern.

– A tumor in the adrenal gland or somewhere in the body involved in cortisol production can also cause higher-than-normal cortisol levels.

– Pregnancy or birth control pills are also known to cause a high blood cortisol level.

Suggestions for lowering cortisol levels:

– Evaluate lab results correctly to help pinpoint and address the root cause

– Reduce stress levels [L]

– Improve sleep quality (and quantity if needed) [L]

– Meditation [L, L]

– Massage [L]

– Support the HPA axis [L, L]

Higher evening cortisol levels:

– Elevated levels may be due to stress, exercise, alcohol, and specific lifestyle stressors.

– Elevated evening salivary cortisol is linked to insomnia

– High evening cortisol levels are also associated with various diseases such as diabetes, cardiovascular disease, hormonally driven cancers, and osteoporosis.

Treatment of elevated cortisol should be directed at the root cause of the stressor. Lifestyle modification with relaxation methods, dietary changes, pain management, and overall HPA axis support with nutrition and/or adaptogens can be helpful. Glandulars may be added if additional support is necessary.



Test results may vary depending on your age, gender, health history, the method used for the test, and other things. Your test results may not mean you have a problem. Ask your healthcare provider what your test results mean for you.

The information on is NOT intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice.

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