Tegan Philp | 11 Jan 2021 | Adrenal

Adrenal Fatigue Testing – The Complete Guide (2021)

If you’re always tired, stressed, and feel like you have no energy, your adrenals could be struggling.

Read on to find out what your adrenals do and if you might benefit from adrenal fatigue testing.

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What are your adrenals?

Your adrenals (also known as adrenal glands) are two small glands that sit on top of your kidneys. They produce a stress hormone called cortisol. They play many roles in your endocrine system.

Your endocrine system is the collection of glands that produce hormones to regulate your metabolism, growth and development, tissue function, sexual function, reproduction, sleep, and mood, among other things.

Your adrenal glands are regulated by a number of complex feedback mechanisms, known as the hypothalamic-pituitary-adrenal axis (or HPA axis for short). Your adrenal hormones work in harmony with other hormones and body systems to keep you feeling energised and alert.

Adrenals and stress

A little stress is normal and OK. For example, it’s normal for your cortisol levels to spike in the morning to help you get up. But problems can occur when your HPA axis is stimulated too much and too frequently. This can lead to imbalances in your adrenal hormones. This leaves you feeling tired, wired and exhausted.

It’s important to note that while there’s no doubt that adrenal disease is real, the actual term ‘adrenal fatigue’ isn’t a recognised medical condition [Source: PubMed]. Researchers at NICHD—a leading US research institute—say on their website that adrenal gland disorders occur when the adrenal glands produce too much or too little hormone.

But ‘adrenal fatigue’ is the name given to a group of non-specific symptoms, including:

  • Brain fog
  • Low energy
  • Depressive mood
  • Light-headedness

These usually come on after prolonged exposure to stress. A more accurate term would be ‘HPA-axis dysfunction’ or ‘adrenal imbalance’, but for the purpose of this guide, the terms will be used interchangeably.

For an at-a-glance rundown of the symptoms of adrenal fatigue, take a look at our conditions page.

What tests are done to check adrenal function?

You can gain insight into your adrenal function through taking a salivary cortisol test. But—because adrenal fatigue has become a popular talking point online—it’s also very easy to presume you have it.

The problem is that assessing adrenal health from symptoms alone is very difficult. For the most accurate diagnosis, you’d need to look at your symptoms and adrenal fatigue test results together. This often requires the knowledge of an experienced Functional Medicine Practitioner or Registered Nutritional Therapist. They are trained to understand the complexity of hormones and how they can influence your unique biochemistry.

Adrenal fatigue test at home

Cortisol is the main marker for adrenal health. This can be tested through blood, urine, or saliva, and there are a variety of testing options.

You can buy adrenal fatigue home test kits online. These are designed to assess cortisol imbalances and are simple and effective. Cortisol can also be tested using dry urine samples. This is also considered an accurate way to assess your stress response, although there is less research to confirm its validity in clinical practice.

Before you purchase an adrenal fatigue test kit, it’s important that you find one that takes four or five cortisol samples over a 24-hour period, as this will give you more insight into how your body responds to stress throughout the day.

The first morning cortisol sample, known as the ‘cortisol awakening response’ (CAR) is the most important test for adrenal function and has become a diagnostic marker of HPA activity. The best tests on the market will take a few CAR samples to really pinpoint your morning surge in cortisol.

The Healthpath Adrenal Cortisol/DHEA Profile offers a comprehensive snapshot of your stress-response system. The measured biomarkers include:

  • CAR cortisol (3 samples for improved accuracy)
  • 4 further time-point measures of cortisol
  • 2 DHEA samples in the morning and afternoon
  • cortisol: DHEA ratio

These biomarkers provide a comprehensive measurement of your overall stress response. The test results also come with a practitioner-reviewed interpretation and personalised recommendations.

What are the signs of an adrenal fatigue problem?

Adrenal fatigue is a cortisol production problem.

Cortisol is the primary stress hormone that fine-tunes your response to the challenges of everyday living. It’s important for many bodily processes, including growth, immune function, cognition, behaviour, and reproduction. The correct balance of cortisol levels is important, as too little or too much can result in poor health.

Symptoms of high cortisol can include:

  • Insomnia
  • Anxiety
  • Sugar cravings
  • Feeling tired but wired
  • Increased belly fat
  • Bone loss [Source: PubMed]

High cortisol is usually the first sign of an adrenal imbalance. But if stress persists, this can deplete our physiological resilience and metabolic reserve—eventually leading to low cortisol production.

Low cortisol has a bigger impact because of prolonged wear and tear on the body. Sign of low cortisol can be:

  • Chronic fatigue
  • Poor exercise tolerance or recovery
  • Lowered immunity [Source: PubMed]

DHEA is another hormone produced in the adrenal glands, as well as other areas in the body. It follows a similar daily pattern to cortisol.

Low DHEA can mean your adrenals are out of balance. Both high and low cortisol can result in low DHEA. DHEA levels may also be linked to other conditions, including thyroid disorders, cardiovascular disease, obesity and rheumatologic diseases [Source: PubMed].

How do you find out if you have adrenal fatigue?

You can buy an adrenal fatigue test online and test your adrenal function by collecting saliva samples in the comfort of your own home.

To understand how your adrenal glands function throughout the day, you need to collect and measure more than one cortisol and DHEA sample and track how these change over a 24-hour window.

Usually, you’ll need to collect your first sample immediately on waking, and then at least three further samples at different times throughout the day. This helps you to see your circadian rhythm of cortisol.

The Healthpath adrenal function report is based on an assessment of both your test results and symptom picture. It comes with an easy-to-follow health plan, and gives you personalised recommendations too.


How to test for adrenal fatigue infographic

NHS adrenal fatigue test

There isn’t a specific medical test for adrenal fatigue.

If your GP suspects you have an underlying condition or Addison’s disease—a medical condition in which your adrenal glands are unable to produce the necessary hormones—they may refer you to an endocrinologist.

An endocrinologist will run additional blood tests and an adrenocorticotropic stimulation test to measure adrenal hormone function [Source: PubMed]. If you’re diagnosed with Addison’s disease, the treatment will require synthetic hormonal drugs to replace what the adrenal hormones would make under normal circumstances.

Thankfully, Addison’s disease is rare. If you are experiencing symptoms of burn-out and exhaustion, it’s more likely you have a hormone imbalance due to adrenal dysfunction [Source: PubMed].

Unfortunately, symptoms of dysfunction are not yet recognised by traditional GPs—but that’s where Functional Medicine Practitioners come in. They will use adrenal testing to evaluate your stress response, recommend targeted nutritional supplements and address the root of your symptoms.

What test do doctors do to determine adrenal fatigue?

Conventional doctors won’t run tests specifically for adrenal function, but they will ask questions about your medical history, request blood tests or do a physical examination.

But because fatigue is a common symptom across many illnesses, often their findings don’t explain why you feel tired. This can be frustrating. There’s nothing worse than being told: “There is nothing wrong with you.”

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How to get a saliva test for adrenal fatigue

The adrenal fatigue test can be purchased online and, as it is non-invasive, you can complete this on the comfort of your own home.

You will need to take five saliva samples at set times, as this will reveal how your cortisol levels change throughout the day.

The Healthpath Adrenal Cortisol/DHEA Profile comes with a straightforward report that turns your test results into actionable recommendations. A tailored supplement plan and an expertly designed food list are also included to support your health journey.

How to produce saliva for adrenal fatigue saliva test instructions

Adrenal fatigue test kits usually come with a collection device and clear instructions on how to take samples and label each specimen. It’s important to follow the instructions carefully as there are several saliva collection techniques and their testing methods vary in reliability and sensitivity [Source: PubMed].

People don’t normally have issues with producing the saliva needed for testing, but some companies will advise that staying hydrated or looking at food can help.

How to treat adrenal fatigue

To diagnose any adrenal imbalances, correct testing must be used alongside your symptoms and health history.

There is no one magic tablet or solution to restore adrenal health. Treatment will vary, and will usually consist of dietary tweaks, lifestyle advice and targeted supplements.

Let’s look at each in more detail:

It’s important to maintain steady blood-sugar levels. High blood sugar raises insulin—and insulin triggers the release of cortisol. Blood-glucose levels that are too low are also a problem as this can put extra stress on the body.

What you drink is important too. Adequate hydration from filtered water can boost energy, whilst reducing caffeine intake can help to reduce your stress response.

Sleep is critical because it gives your adrenal glands time to rest and repair. Head over to our article on stress and the sleep-wake cycle to learn more.

Intense physical activity can further weaken your adrenal function. Taking some time out to meditate, practise yoga or socialise with friends can also help slow down an over-hyped nervous system.

Specific vitamins and minerals can be a useful tool for adrenal imbalances. Adaptogens, which are a group of herbs that support the body’s resistance to stress, are also helpful [Source: PubMed]. It’s best to speak to a practitioner first, as they can tell you which supplements are best suited for your needs.

For more suggestions on how to tackle adrenal fatigue, check out our blog How to treat adrenal fatigue.


Adrenal imbalance (or HPA-dysfunction) occurs when both real and perceived stress becomes too much for your body to handle. It has several causes, and each of us will have a different way of responding to what the body considers as internal and external ‘stress’. The only way to really know how your body is responding to stress is to test your adrenal function.

Remember that once adrenal dysfunction has been found, the true cause must be identified. It’s all very well knowing whether you have high or low cortisol, but an important part of this process is understanding why it’s happening—and what you can do about it.

Tegan Philp BA PgDip MSc is a Registered Nutritional Therapist. Passionate about all things gut-related, her master’s dissertation was on the role of the microbiome in cardiovascular outcomes. Tegan has over eight years’ experience working for leading nutrition colleges in both Australia and the UK. You can learn more about Tegan on her practitioner page or connect with her via LinkedIn.


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