How to Test Cortisol Levels at Home or in a Lab

Stop us if this sounds familiar: Your stress system sounds the alarm multiple times during the day. There are emails. Deadlines. Navigating kids’ big feelings. Family drama. Oh, and the hormonal changes your body’s going through in perimenopause and menopause. These struggles aren’t unique. That’s why so many women are concerned that all this stuff of life is messing with our body’s main stress hormone, cortisol. 

To get some insight into your internal workings, you can get a cortisol test, available as an at-home version or done in a lab. But getting your cortisol number is just the start—one piece in the larger puzzle of your overall health. We’ll address how to check cortisol levels, testing options, must-know test prep, what your results suggest about cortisol’s daily rhythms in your body, and when to see a healthcare professional, like a Midi clinician, for support. 

Why Take a Cortisol Test, and What You’ll Learn

During this life stage,  it can be tough to nail down exactly what’s happening in your body. Are the hormonal fluctuations of menopause causing your symptoms? Is it a problem with your cortisol levels? Could it be something else entirely? 

Cortisol issues can have vague symptoms. And those symptoms—persistent fatigue, sleep difficulties, anxiety, irritability, weight changes—are often blamed on several different causes, including general life stuff. Adrenal gland disorders can also be the underlying reason for some symptoms (cortisol is produced in that gland). 

But when you have mysterious symptoms or generally feel run-down, that’s reason enough to ask a healthcare professional whether it makes sense for you to get your cortisol levels tested. 

A single cortisol test measures the level of cortisol in your blood, urine, or saliva. It’s one snapshot in time that tells you whether— on that day, at that time—you have high, normal, or low levels of cortisol. 

But it won’t tell you why your cortisol levels are off. Abnormal cortisol can be a sign of a medical condition, but it can also be the result of, say, taking a steroid medication or going for an intensely long run or having a string of high-stress days at work. 

In other words, a cortisol test is one step in this process. Once you identify whether your levels are off, you can start to make an action plan to feel better.

How to Test Cortisol Levels: At Home vs. in a Lab

Several tests can analyze your cortisol levels. The three most common:

Saliva Cortisol Test

This is an at-home cortisol test that’s often used for people who want to focus on reducing their stress levels. Midi’s clinicians  use a four-point test, meaning you collect your saliva in a tube four times over the course of one day–the first right after you wake up. This gives a thorough picture of your cortisol rhythm—how it rises and falls during the day. 

Cortisol Blood Test

These tests, done in a lab, are generally used to help diagnose adrenal disorders, like Cushing’s or Addison’s disease. 

Urine Test

A urinary cortisol test is also used to help diagnose an adrenal disorder. For this test, a person has to collect all of their urine over 24 hours.  

At Midi, we don't order blood or urine cortisol tests when assessing a patient’s stress levels, since the main purpose of those tests is to diagnose adrenal disorders. If your clinician suspects you may have an adrenal disorder, she can refer you to an endocrinologist for further support.

How to Test Cortisol Levels at Home

The saliva cortisol test is convenient and non-invasive. Follow the instructions closely to get results that are as accurate as possible. A few things to keep in mind:

• Ask your clinician the exact times you should collect saliva samples—and stick to it. The first saliva sample should be taken immediately after you wake up, ideally within 5 minutes.
• Avoid eating, drinking, or brushing/flossing your teeth for 30 minutes before testing.
• Wash your hands, but don’t touch the swab itself. Soak the swab in your spit, then deposit it into the test container once it's fully saturated. Then send it off to the lab.

It’s also a good idea to keep a record of factors that may affect your cortisol levels that day, such as the time you wake up, your sleep quality, how much caffeine and alcohol you have, what you do for exercise, mental stressors you experience, and medications or supplements you take. This will provide some context for your cortisol readings.

Timing Matters for Meaningful Results

Allow us to get a little technical here. Our cortisol levels follow a diurnal rhythm, meaning they have a similar pattern throughout the day and night. 

They largely follow our sleep-wake cycle, with the highest cortisol levels in the morning as we’re waking up (ever wonder what prompts you to get out of bed?). Cortisol gradually decreases as the day progresses, hitting its lowest point in the late evening or early nighttime as you slip into sleep. 

Beyond that, cortisol fluctuates during the day—it can spike, say, when you get a passive-aggressive email from a colleague or take an intense workout class—but that’s all part of a general, healthy pattern. Little spikes and dips are normal and something we're all accustomed to.

All that means: The times you take your saliva samples are key to getting a result that makes sense and provides info for the next best steps. Some helpful guidance:

• Morning testing: Avoid heavy caffeine or vigorous exercise before early samples, unless instructed otherwise.
• If you do shift work or are jet lagged: Plan timing closely with your clinician, making adjustments for your personal sleep cycle as needed.
• Late-night salivary samples: Collect late at night (around 11 p.m. or midnight), as instructed. 

Medications, Hormones, and Habits That May Skew Results

False positive or false negative results, both of which can happen with a cortisol test, can send you on a wild goose chase to figure out what’s going on. So it’s important to know that certain medications and habits can affect the results: 

• Corticosteroids
• Antiseizure medications
• Hormones, including estrogen and androgens
• Birth control pills
• Certain supplements, like high-dose biotin
• Exercise, especially vigorous exercise
• Pregnancy
• Time spent in hot or cold temperatures, like in a sauna (hot) or out in the snow (cold)
• Sleep disturbances
• Stress 

Next Steps if Cortisol Levels are High 

Throughout the day, cortisol levels are expected to trend up and down. Experts expect to see cortisol levels peaking in the morning and decreasing  in the evening. If your cortisol test shows low cortisol levels throughout the day, or the levels don’t rise and fall normally, it may be an indication of chronic stress, disrupted sleep, or emotional exhaustion or burnout.  

If one test shows that your values are out of whack, you may need more info before you start a treatment plan. Talk with your healthcare provider about next steps, and whether it’s worth retesting or seeing a specialist, especially if the results don’t seem to make sense with your symptoms.

It’s also key to discuss how your lifestyle might influence your body’s stress response. Cortisol levels can be affected  by a number of things, including:

• eating an unhealthy diet, with cortisol-triggering foods
• not having adequate calm-down strategies for runaway stress
• drinking too much caffeine or alcohol
• skimping on sleep, exercise, or social relationships 

You may need support in one or more of these areas. After all, the stresses of everyday life add up, and it can be tough to take care of yourself. A clinician you trust will listen and understand—and help you get on track and back to normal cortisol levels.

If your lab results and symptoms need to be evaluated further, you may be referred to an endocrinologist, a physician who specializes in the endocrine system (the network of glands responsible for making hormones).

Midi's Cortisol Care Stack

High cortisol is a signal that your body is stuck in overdrive. Left unchecked, it can wreak havoc on everything from your metabolism to your mood to your immune system. When cortisol is well regulated, you experience steadier energy, better sleep, improved mood, easier weight management, and lower inflammation throughout the body. At Midi, we see cortisol support as a multi-pronged approach, and leverage a range of strategies to help you bring cortisol back into balance.

Solutions can include:

• Hormone Replacement Therapy (HRT): For patients whose hormonal changes are driving elevated cortisol, HRT can help lower cortisol indirectly by helping to reduce anxiety, stress, and potentially inflammation, while also improving sleep.
• Supplements: Midi's Daily Cortisol Support has been shown to help regulate the body's stress response, and improve sleep.
• Lifestyle Changes: Sleep hygiene, strength training, stress management support all play a role in bringing down chronically high cortisol levels.
• Other meds: Once lifestyle, HRT, and other factors have been optimized, we may consider low-dose naltrexone (LDN) or a microdosed GLP-1 to reduce inflammation.

Key Takeaways

• The most accurate way to test cortisol levels for stress is a multi-point saliva test. Unlike blood or urine tests used to diagnose adrenal disorders, saliva testing captures your cortisol rhythm across the day, showing how levels rise in the morning and fall at night.
• You can test cortisol levels at home using a saliva test, but timing is critical. Samples must be collected at specific times—starting within minutes of waking—to reflect your body’s natural cortisol pattern.
• Blood and 24-hour urine cortisol tests are primarily used to diagnose adrenal conditions, such as Cushing’s or Addison’s disease, and are not ideal for evaluating everyday stress or burnout.
• Medications, hormones, supplements, exercise, sleep, and stress can skew cortisol test results. Factors like birth control, corticosteroids, high-dose biotin, intense workouts, poor sleep, or acute stress should be documented to help interpret results accurately.
• Abnormal cortisol results don’t automatically mean a medical disorder. Irregular patterns may reflect chronic stress, sleep disruption, or burnout—and often require repeat testing, lifestyle assessment, or clinician guidance before treatment decisions are made

Frequently Asked Questions (FAQs)

How can I check my cortisol level at home?

There are a couple of ways to test cortisol levels at home. The options include saliva testing and a 24-hour urine test. Midi clinicians use a four-point saliva test, meaning you take saliva samples four times over the course of one day.

How do I tell if my cortisol levels are high?

You need a cortisol test to determine this. Talk with your clinician about your symptoms, and ask whether they would recommend cortisol testing. 

How do you get your cortisol levels checked?

Several tests can check your cortisol levels. Some are done at home and some in a lab. Options include saliva testing, a cortisol blood test, or a 24-hour urine test. When stress is the concern, Midi clinicians recommend saliva testing.

How do I fix my high cortisol levels?

If you have a medical condition that’s affecting your cortisol levels, such as an adrenal gland disorder, you will need medical treatment. Lifestyle factors also influence your body’s stress response, so making time to exercise, taking steps to support your mental health, eating a balanced diet, and getting adequate sleep are all moves that can make a big difference.