Although we, the doctors of feminology, are always talking about evaluating the endocrine system as a whole, there are benefits to testing for adrenal health–be be aware not all tests are created equal!
Healthy adrenal glands are secreting cortisol and other hormones in what is called the circadian rhythm. This means that optimal levels of hormones should be very different depending on the time of day. Our 24 hour day/night cycle is the circadian rhythm that the adrenal glands follow. Your cortisol levels should be highest in the morning just after you wake up, and lowest in the late evening in preparation for sleep. This is why it’s called the “sleep-wake cycle.”
Throughout the course of the day your cortisol levels should gradually decrease, this is why testing cortisol levels should be done at different times of the day. Several samples during one 24-hour period is necessary to get a good idea of adrenal function. For many years we used salivary testing which is a decent option, certainly easier than getting 4 or 5 blood draws performed at various times of the day, but now we recommend dried urine testing. This is the easiest and most accurate way to evaluate cortisol output and bypasses problems with elevated levels of cortisol for those that are stressed by needles!
Your blood levels of cortisol are very tightly regulated (like most substances in the blood) and it’s tricky to get an accurate assessment. With the urine test we use, the DUTCH test, we can evaluate how the body is making cortisol, and more importantly, how it is utilizing cortisol as well. In addition, the DUTCH test will evaluate inactive levels of cortisone (not cortisol, different thing) that the body may or may not be using effectively. Problems with cortisone/cortisol can result in weight gain around the organs (not good) and suggest a reason for some stressed out women why they are gaining weight when they are exercising and eating healthily. It’s not all about the thyroid when it comes to weight struggles and hormones.
Comprehensive hormone testing is best because it allows us to assess some of the relationships between different parts of the endocrine system; the pituitary, the adrenals and the hypothalamus. (They don’t call it the HPA Axis for nothin’!) In addition, urinary metabolites for various neurotransmitters play a role in adrenal health as well. Organic acid testing (OAT) for dopamine, norepinephrine/epinephrine and serotonin are also important factors to consider when looking at adrenal health and function.
To learn more about the DUTCH test, please go to their website www.dutchtest.com.
What we often see is that the circadian rhythm is off-balance, there is so much stress in our lives today! Read more about our approach to adrenal health here. (INSERT LINK TO ADRENAL POST IN WOMEN’S HEALTH AND CULTURE)