Tegan Philp | 11 Jan 2021 | Adrenal

Adrenal Fatigue Testing – The Complete Guide (2021)

Are you wondering why you are always tired? Perhaps you’re feeling a little stressed, low in energy or maybe even ‘burnt out’.

Stress and fatigue have many causes: work, relationships, money, chronic illness, injury…the list goes on. But how do you know when your habitual stress is negatively impacting your health?

The only way to really know how your body is responding to stress is to test it. This guide will help you navigate adrenal fatigue, discuss the available testing options and show what to do if you suspect you’re suffering from burn out.

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How to test for adrenal fatigue
How to test for adrenal fatigue at home
How reliable is the light test for adrenal fatigue
What blood test is best for adrenal fatigue
What to test for adrenal fatigue
How do I test myself for low adrenal fatigue?
What are the most important tests for adrenal fatigue?
Which cortisol test for adrenal fatigue?
How to test for anaemia or adrenal fatigue
What medical test can diagnose adrenal fatigue?
What test do doctors do to determine adrenal fatigue?
How to get a saliva test for adrenal fatigue
How to produce saliva for adrenal fatigue saliva test instructions
Does adrenal fatigue exist, how to test for it?
How to tell if adrenal fatigue by 4 tube cortisol test?
How to test and treat adrenal fatigue


How to test for adrenal fatigue

Stress in the body can be measured by looking at cortisol. This is a hormone that’s produced by the adrenals—the two small glands that sit on top of your kidneys.

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.

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 depletes your physiological resilience and metabolic reserve, and can lead to imbalances in your adrenal hormones. This leaves you feeling tired, wired and exhausted.

It’s important to note that the actual term ‘adrenal fatigue’ isn’t a recognised medical condition.1 Rather, it’s 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.

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.

How to test for adrenal fatigue 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.

How reliable is the light test for adrenal fatigue?

There is no clinical evidence to suggest a light test is an accurate way to assess adrenal function.

This test is also known as the ‘Iris Contraction Test’, as it measures your pupil’s response to light stimulation. The idea is that you sit in a dark room, shine a light on the pupils and track how your pupils contract or change. It’s believed that in those who have adrenal dysfunction, the pupil may not contract and stay dilated, or it might just contract and then quickly dilate.

While this might be a fun experiment to carry out at home, it’s not a reliable diagnostic and should not replace gold-standard salivary cortisol testing.

The scratch test and accessing blood pressure on standing are similar anecdotal experiments, but they should not replace proper adrenal testing carried out under the supervision of a trained Functional Medicine Practitioner or Registered Nutritional Therapist.

What blood test is best for adrenal fatigue?

Cortisol can be measured in blood but—as cortisol levels change throughout the day—a blood test may not be convenient if you need to have more than one sample taken.

What’s more, research shows that salivary cortisol tests are more accurate than blood serum tests because saliva measures cortisol within your cells, where the hormone is most active.2,3 It’s important to keep that in mind when deciding what method to use.4

What to test for adrenal fatigue

By measuring levels of cortisol and DHEA, it’s possible to see how your body responds to stress.

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 loss5

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 immunity6

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.7

How do I test myself for low 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.

What are the most important tests for adrenal fatigue?

Assessing hormones and behaviour can be a challenge for even the most experienced health professionals.

Each of your hormones is intertwined with other complex hormonal systems and works alongside several body functions. Recent research on cortisol testing found that test results were vulnerable to individual variation, meaning the way we respond and process stress from both perceived and real stressors is unique to the individual and the circumstance.8 You could have no problem with something one day, but find it quite stressful the next time it comes up.

If you are concerned about your adrenal function, the most valuable test is the 5-point salivary cortisol and DHEA test. A Functional Medicine Practitioner or Registered Nutritional Therapist may also recommend a gut health test, plus testing for other hormone imbalances.

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Which cortisol test for adrenal fatigue?

The most accurate adrenal fatigue tests will measure both cortisol and DHEA production, and the ratio between these two hormones. Adrenal test kits which measure several cortisol samples over the course of the day are preferred as they check if you have a dysregulated cortisol pattern.

The cortisol: DHEA ratio may also be more useful than individual cortisol or DHEA figures. Taken together, all of these measurements will give you a comprehensive evaluation of your stress response.9

As you’ve learnt, to really pull together a meaningful picture of your unique health status, it’s best to discuss your test results, health history and symptoms with an experienced practitioner.

By delving deeper into why you have these particular results, a practitioner will look to address the true cause of your fatigue. And lots of things can contribute to adrenal fatigue or HPA axis dysfunction. These include:

  • Leaky gut
  • Poor diet
  • Food sensitivities
  • Chronic infections
  • Chronic stress
  • Over-exercising

Your practitioner can offer dietary, lifestyle and supplement recommendations that are tailored to you and your circumstances.

How to test for anaemia or adrenal fatigue

Low energy, tiredness and fatigue are common symptoms that drive people to the doctor’s surgery.

But the confusing thing is that fatigue can be a symptom of several different conditions. You may think you have adrenal fatigue, but anaemia due to low consumption of iron-rich foods—or anaemia due to other reasons—could possibly be the true cause of your fatigue.

Adrenal fatigue and anaemia are very different, and therefore and therefore require distinct treatment approaches. It’s essential to have the right assessment to avoid the wrong diagnosis.


How to test for adrenal fatigue infographic

What medical test can diagnose adrenal fatigue?

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.10 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.11

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.12

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.

Does adrenal fatigue exist, how to test for it?

Whilst there is no scientific evidence to support adrenal fatigue as an actual medical condition, there is lots of evidence confirming the symptoms experienced by those who have adrenal hormone imbalances.13

Symptoms of poor adrenal function have also been linked to several conditions, including chronic fatigue, thyroid disorders and infections.14

Says Functional Medicine Practitioner, Alex Manos, “Whether it’s physical, chemical or psycho-emotional, chronic stress is one of the most common contributors to poor health. That’s why a non-invasive, at-home saliva test to assess adrenal function is so valuable. It can help us understand your overall physiological state, enabling us to tailor recommendations accordingly. ”

So, while our adrenal glands cannot actually get ‘tired’ and ‘fatigued’ or stop working, the hormones they produce can be out of balance—which causes very real and unwanted symptoms. The first step to assess imbalance is to take a five-point salivary cortisol and DHEA test.

How to tell if adrenal fatigue by 4 tube cortisol test?

Cortisol and other hormone levels fluctuate based on time of the day and month. This is why taking one single cortisol sample is not enough to give you meaningful information about your adrenal health status.

The best adrenal function tests will take four or five saliva samples at different times in a 24-hour period. Your results will be mapped against what a normal cortisol pattern, and how this corresponds with normal DHEA levels.

A normal cortisol pattern is higher in the morning, referred to as our ‘cortisol awakening response’, and then peaks 30-45 minutes after waking. Cortisol will then decrease throughout the day, reaching its lowest in the evening.15A dysregulated cortisol pattern might be too high or too low on waking, which can indicate different stages of fatigue and burn out. Your practitioner will then investigate your test results in light of your symptoms to understand the underlying causes of this dysregulated pattern.

How to test and 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.16 It’s best to speak to a practitioner first, as they can tell you which supplements are best suited for your needs.


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.


1. https://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-016-0128-4
2. https://www.ncbi.nlm.nih.gov/pubmed/6316831
3. https://www.ncbi.nlm.nih.gov/pubmed/28375882
4. https://www.ncbi.nlm.nih.gov/pubmed/6316831
5. https://www.sciencedirect.com/science/article/pii/S0306453011001855
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4437603/
7. https://www.ncbi.nlm.nih.gov/pubmed/15248817
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5673546/
9. https://www.ncbi.nlm.nih.gov/pubmed/26779782
10. https://www.nhs.uk/conditions/addisons-disease/
11. https://www.ncbi.nlm.nih.gov/pubmed/27129928
12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1579286
13 https://www.ncbi.nlm.nih.gov/pubmed/6316831
14 https://www.ncbi.nlm.nih.gov/pubmed/28375882
15 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5673546/
16 https://www.sciencedirect.com/science/article/pii/S2212962614000054

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