How to Measure Urinary and Salivary Cortisol Levels to Monitor Your Adrenal Health - dummies

How to Measure Urinary and Salivary Cortisol Levels to Monitor Your Adrenal Health

By Richard Snyder, Wendy Jo Peterson

Healthcare practitioners test for adrenal fatigue by focusing on hormones produced by the adrenal glands and other parts of the body. Different practitioners have different approaches to evaluating the condition. You need to be aware of the various modes of testing — including blood, urine, and salivary testing — and the advantages of each.

Be sure that you get copies of all your lab work and keep a file for yourself. That way, you have a copy of your medical record and can bring the results with you when you visit your healthcare practitioner. If you have a medical emergency, having all your medical information with you can provide the doctors with all the info they need to give you the best care possible.

How to measure urinary levels of cortisol

Some healthcare practitioners order urinary cortisol levels. This test is usually done as part of a 24-hour urinary collection (you void into a jug). In most cases, in the setting of adrenal fatigue, the urinary levels of cortisol are lower than one would expect.

A normal urinary level of cortisol is 50 micrograms. Levels less than 10 micrograms are considered suggestive of adrenal fatigue. Unfortunately, like blood tests, urinary tests don’t accurately depict the variation of cortisol secretion that occurs over a 24-hour period. This is why salivary testing is so useful.

How to test for salivary cortisol

Blood and urinary tests give you an average of what the adrenal glands are doing over a 24-hour period. Salivary cortisol measurements are better because they give you a sense of the cortisol levels at different times in a 24-hour period.

For the salivary cortisol test, you collect saliva samples at home and send them to a lab for analysis. Your healthcare practitioner will likely recommend a lab where you can get the salivary testing kit.

You take saliva samples several times a day, including in the morning, at lunch, at dinner, and before you go to bed. You should also consider collecting a sample when you’re experiencing symptoms of adrenal fatigue.

Each time you obtain a sample for the salivary cortisol test, you should document how you feel. Your healthcare practitioner’s interpretation of many of these levels will be based on how you felt at the time of each sample. The test is very personalized.

You can actually buy a home testing kit on However, some states have rules about mailing lab tests and medical samples. In California, for example, you have to send in “a written order from a health care professional licensed in California to order laboratory tests.”

After collecting samples, you send the saliva to the company that sold you the kit and wait for the results. A normal range for salivary cortisol levels is 20 to 25 nanomoles per liter (nmol/L) in the morning. The salivary cortisol levels decrease throughout the day.

Many labs offer interpretation of the salivary cortisol lab results, but it’s imperative that you discuss the results with your healthcare practitioner. Not only are the absolute values of the cortisol levels important, but so is correlating the cortisol levels with how you felt when you collected the samples.