Stressed And Running On Empty? What Cortisol And DHEA-S Tests Can Show
When you feel wired and worn out at the same time, it is natural to wonder whether your stress hormones are off. Cortisol and DHEA-S are real, useful tests. They are also easy to over-read, so it helps to know what a result can and cannot tell you before you order.
Cortisol Follows A Daily Rhythm
Cortisol is made by your adrenal glands, and it is not a steady number. It normally peaks in the early morning and falls to its lowest point around midnight. A blood test captures one moment of that curve, which is why the time of your draw matters and why results are compared with a reference range for that time of day. A morning draw is the usual standard.
What A Single Cortisol Result Is Good For
A low early-morning cortisol can be a clue to adrenal insufficiency, a real and treatable condition, but it is confirmed with follow-up testing such as a stimulation test, as described in the Endocrine Society's guideline on adrenal insufficiency. A high random cortisol does not diagnose Cushing's syndrome. The Endocrine Society's guideline on Cushing's recommends specific tests instead, such as late-night saliva cortisol, a 24-hour urine collection, or an overnight dexamethasone suppression test.
Things That Can Throw Cortisol Off
Estrogen, including birth control pills and oral estrogen, raises the protein that carries cortisol in the blood, so total cortisol can read high even when the adrenal glands are working normally. Steroid medicines, including some creams, inhalers, and joint injections, can affect the result too. So can acute illness, a short night, or shift work. Tell whoever reviews your results about all of these.
What About Adrenal Fatigue?
Adrenal fatigue, the idea that long-term stress wears out the adrenal glands, is not a recognized medical diagnosis. The Endocrine Society has said there is no scientific proof it exists, and a 2016 systematic review in BMC Endocrine Disorders found the research did not support it. Your exhaustion is still real. It just deserves a look at causes that can be measured, like thyroid function, iron, sleep, and mood.
DHEA-S: An Adrenal Marker That Falls With Age
DHEA-S is a hormone made mostly by the adrenal glands. Levels drop steadily as you get older, so a result only means something next to an age-specific range. A high DHEA-S alongside signs like new facial hair growth, acne, or irregular periods is something a provider would look into further. A low one is not, on its own, a reason to start DHEA supplements; the Endocrine Society's 2014 guideline on androgen therapy in women recommends against routine DHEA use.
Where To Start
If stress and fatigue are what brought you here, the Stress & Recovery Panel checks cortisol, DHEA-S, thyroid, and inflammation in one draw. It pairs well with a closer look at thyroid tests and iron and ferritin, two common, measurable causes of fatigue. Book a morning draw if you can, and have a licensed provider review your results.
This guide explains general information and is not medical advice. It doesn't replace a licensed provider reviewing your own history.