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Adrenal fatigue testing: Which test is best? (urinary vs salivary vs serum)

The Dr. Westin Childs Podcast
The Dr. Westin Childs Podcast
Episode • Nov 5, 2019 • 7m
Download my free thyroid resources here (including hypothyroid symptoms checklist, the complete list of thyroid lab tests + optimal ranges, foods you should avoid if you have thyroid disease, and more): https://www.restartmed.com/start-here/

Is adrenal fatigue a real condition? The answer is most assuredly yes. But that's not what we are going to be focusing on today. Instead, we are going to focus on how to TEST for adrenal fatigue including all of the current problems with modern testing.

Adrenal fatigue tends to impact your CORTISOL level. Most people believe that the more stress you are under the higher your cortisol levels will become.

Eventually, with enough stress, you may "poop" out your adrenal glands and end up with adrenal fatigue.

There's only one problem with this idea:

It doesn't seem to work as nicely as it sounds in theory. There are a number of people who can have adrenal fatigue with so-called NORMAL cortisol levels.

This has lead many people to order such as tests as urinary cortisol and salivary cortisol thinking these are better than serum cortisol.

They are somewhat more accurate but all lab tests have their pros and cons.

Your options for testing cortisol include:

Urinary cortisol - You can get either a 24 hour urinary cortisol or 4 spot urinary cortisols throughout the day.
Salivary cortisol - You can get 4 spot salivary cortisols throughout the day.
Serum cortisol - Serum cortisol should be taken at 8am to get the best results.

Only serum cortisol is "accepted" among conventional doctors such as endocrinologists and PCP's but that doesn't mean the other tests are completely useless.

There is some data to suggest that urinary cortisol tests may be more accurate than salivary and serum tests but does it actually matter?

We really only care about your cortisol status if it impacts how we manage the condition.

But the truth is that MOST therapies for adrenal fatigue don't depend on your cortisol.

For instance, do we care if you have low or high cortisol if you should eat healthy anyway? Do we care if you have low or high cortisol if you should be sleeping more? Do we care if you have low or high cortisol if you are using adaptogens?

The answer is no because you should be doing those things ANYWAYS.

My recommendation is to start with a serum cortisol which is often the cheapest cortisol test and should be covered by insurance. And, regardless of the results, you should start treating yourself for adrenal fatigue if you have adrenal fatigue symptoms.

There are some therapies that are specific to high/low cortisol but these are the exceptions rather than the rule. And in these cases, it may be a good idea to get the urinary/salivary cortisol tests run.

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I'm Dr. Westin Childs and I focus on thyroid health, hormone balance, and weight loss. I write about thyroid disorders, weight loss, insulin resistance, estrogen/progesterone balance on my blog. I truly believe that hormone balance is the key to managing your weight, your mood and your quality of life which is why I'm so passionate about it.

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