---
title: "Cortisol test: what it measures, normal morning levels, and the symptoms of high or low cortisol"
type: biomarker
url: "https://www.test-well.com/biomarkers/cortisol-am"
also_known_as:
  - cortisol
  - cortisol, am
  - cortisol am
  - morning cortisol
category: Hormones
units:
  - mcg/dL
  - ug/dL
order_price_usd: 26.99
order_item: Cortisol (AM)
order_url: "https://www.test-well.com/tests/cortisol-am"
reviewed_at: 2026-09-20
---

# Cortisol test: what it measures, normal morning levels, and the symptoms of high or low cortisol

> Cortisol AM is measured with a standard blood draw; no fasting is needed. A typical reference range is 6.20 – 19.4 mcg/dL. At TestWell it's $26.99 all-in as Cortisol (AM), results in 2–4 business days, drawn at Quest or Labcorp. An out-of-range result is a prompt to look closer, not a diagnosis.

Cortisol is the body's main stress hormone, made by the adrenal glands on a daily rhythm that peaks shortly after waking. The morning cortisol blood test measures that peak. It is the standard first test when adrenal insufficiency is suspected, and a useful — but not definitive — first look when someone has the weight gain, high blood pressure, poor sleep and bruising that raise the question of high cortisol.

Also known as: cortisol, cortisol, am, cortisol am, morning cortisol.

## Key facts

| Fact | Value |
| --- | --- |
| Units | mcg/dL / ug/dL |
| Sample | Blood draw |
| Fasting | Not required |
| Results | 2–4 business days |
| Price | $26.99 |
| Labs | Quest or Labcorp · BioReference in NY/NJ |

## What does a cortisol test measure?

The test measures total cortisol in the blood — the hormone the adrenal cortex releases in response to ACTH from the pituitary gland. Cortisol raises blood sugar, tempers inflammation, maintains blood pressure and helps the body respond to illness and stress. About 90% of it travels bound to cortisol-binding globulin (CBG) and albumin; the serum test counts the bound and free fractions together, which matters when a medication changes the amount of binding protein.

Cortisol follows a strong circadian rhythm: it is highest in the hour or two after waking, falls through the afternoon and reaches its lowest point around midnight. A result only means something when the draw time is known, which is why TestWell's cortisol test is a morning draw and the reference range is written for 6–10 a.m. The same number at 4 p.m. would be read very differently.

A morning serum cortisol is not the same as a cortisol saliva test, a 24-hour urine free cortisol or a dexamethasone suppression test. Those measure the free hormone, the day's total output, or the adrenal glands' response to suppression, and they are the tests endocrinologists use to confirm excess cortisol. The blood test is the screening tool for too little cortisol and a starting point for too much.

## Who should get a cortisol test?

The strongest reason to test is suspected adrenal insufficiency: unexplained profound fatigue, weight loss, poor appetite, nausea, dizziness on standing, salt craving, low blood pressure or darkening of skin creases and scars. Anyone who has taken glucocorticoid medication for weeks — prednisone tablets, but also high-dose inhaled steroids for asthma, potent topical steroids, or repeated joint injections — can suppress their own cortisol production and is a candidate for testing when those symptoms appear, especially after stopping or tapering the drug.

People also test for the opposite picture: weight gain concentrated in the trunk, face and upper back, purple stretch marks wider than a centimeter, skin that bruises and tears easily, muscle weakness climbing stairs or rising from a chair, new or worsening high blood pressure or blood sugar, insomnia, low mood or irritability, acne and excess facial hair in women, and irregular periods. Together these are the features of Cushing's syndrome, and a morning cortisol is a reasonable first step even though it cannot rule the condition in or out on its own.

Athletes, people under sustained stress and people tracking recovery from burnout sometimes test cortisol as a baseline. A single morning value is a blunt instrument for that purpose — it varies day to day with sleep, illness and the stress of the draw itself — so trends over several draws at the same time of day are more informative than any one result.

## How to get a cortisol test and prepare for it

Book the draw for 7–9 a.m., ideally within about two hours of waking, and keep your usual sleep schedule the night before. Night-shift workers should tell the reviewing physician, because their peak shifts with their sleep and a 7 a.m. draw may catch the trough instead. No fasting is required for cortisol itself, but avoid intense exercise that morning and try to arrive a few minutes early so the stress of rushing does not inflate the result.

Medications matter more than food. Any glucocorticoid — oral, inhaled, nasal, topical, injected — can lower the body's own cortisol, and prednisone and prednisolone also cross-react in many cortisol immunoassays, producing a falsely high reading. Estrogen-containing birth control and pregnancy roughly double cortisol-binding globulin, which raises total cortisol without changing the free, active hormone; a normal-to-high result on the pill is expected, not alarming. List every steroid-containing product and any hormonal contraception when you order.

You can order the morning cortisol test online through TestWell: a physician reviews and approves the order, you visit a Quest or Labcorp patient service center (BioReference in New York and New Jersey) first thing in the morning, and the result appears in your portal within a few business days with the 6–10 a.m. reference range printed alongside it.

## What is the normal range for Cortisol AM?

| Population | Reference range |
| --- | --- |
| age 18+, drawn 6–10 AM | 6.20 – 19.4 mcg/dL |

Reference intervals differ slightly between labs; the range printed on your report is the one to interpret against. Ranges are usually set so 95% of healthy people fall inside them.

## Normal cortisol levels: what a morning result means

For a draw between 6 and 10 a.m., the reference range TestWell's catalog uses is 6.2–19.4 mcg/dL (about 170–535 nmol/L). Ranges differ slightly between laboratories and assay methods, so read your result against the range printed on your own report. Afternoon values run roughly half the morning value, and a healthy midnight level is very low.

Interpretation is asymmetric. At the low end, the Endocrine Society's adrenal-insufficiency guideline treats a morning cortisol below about 3 mcg/dL as strongly suggestive of adrenal insufficiency and a value above about 15 mcg/dL as making it unlikely; results in between need an ACTH stimulation test to settle the question. At the high end, there is no single blood value that diagnoses Cushing's syndrome — because the normal morning range is wide and stress, illness and estrogen push results upward, a high morning cortisol is common in perfectly healthy people and the confirmatory tests measure cortisol differently.

| Morning cortisol (mcg/dL) | Usual interpretation |
| --- | --- |
| below 3 | Adrenal insufficiency likely — prompt clinical follow-up, ACTH stimulation test |
| 3–10 | Indeterminate — ACTH stimulation test decides; review steroid medications |
| 10–20 | Typical for a 6–10 a.m. draw in most healthy adults |
| above 20 | Raised — repeat under calm conditions; if Cushing's features are present, move to salivary, urinary or dexamethasone testing |

_Thresholds from the Endocrine Society adrenal-insufficiency (2016) and Cushing's syndrome (2008) guidelines; assay ranges vary, so your report's printed range governs._

## High cortisol symptoms and what causes them

The signs of sustained high cortisol build slowly. The most recognisable are weight gain around the abdomen, face and the back of the neck while arms and legs stay thin; a rounded, reddened face; wide purple stretch marks on the abdomen, thighs or arms; thin skin that bruises with minor knocks and heals slowly; weakness in the shoulder and hip muscles; and high blood pressure or high blood sugar that appears or worsens without an obvious reason. Less visible are insomnia, anxiety, depression or irritability, poor concentration, frequent infections, and in women acne, extra facial hair and irregular or absent periods. In children the first sign is often slowed growth alongside weight gain.

Most high cortisol results do not have Cushing's syndrome behind them. Acute stress, a poor night's sleep, an infection, pain, intense exercise, alcohol, depression and obesity all raise cortisol, as does the stress of the blood draw. Estrogen-containing contraceptives and pregnancy raise the total level by increasing binding protein. Glucocorticoid medication is the most common cause of genuine cortisol-excess symptoms — the body is receiving cortisol-like hormone from the drug — and it paradoxically suppresses the body's own production, so the blood level can read low, high or normal depending on the drug and the assay.

Endogenous Cushing's syndrome — the body making too much cortisol on its own — is rare, on the order of a few cases per million people per year. It is caused by a cortisol-producing adrenal tumor, an ACTH-producing pituitary tumor (Cushing's disease), or, rarely, ACTH from a tumor elsewhere. Because it is rare and the morning blood test is a poor discriminator, the Endocrine Society recommends screening people with suggestive features using late-night salivary cortisol, the 1 mg overnight dexamethasone suppression test or 24-hour urinary free cortisol — usually two of them, repeated — rather than a serum cortisol alone.

## Low cortisol: the result that should not be ignored

A low morning cortisol is the more urgent finding. Adrenal insufficiency means the adrenal glands cannot make enough cortisol, either because the glands themselves are damaged (primary adrenal insufficiency, or Addison's disease — usually autoimmune) or because the pituitary is not sending enough ACTH (secondary). The most common cause overall is suppression of the pituitary–adrenal axis by glucocorticoid medication, which can persist for weeks to months after the drug is stopped.

Symptoms are non-specific and easy to attribute to stress or a virus: deep fatigue, weakness, nausea, poor appetite and weight loss, abdominal pain, dizziness on standing, salt craving, low blood pressure and, in primary disease, darkened skin over knuckles, creases and scars. Blood tests may also show low sodium, high potassium and low glucose. Untreated, an intercurrent illness can tip adrenal insufficiency into adrenal crisis — vomiting, confusion, collapse — which is a medical emergency.

A morning cortisol below about 3 mcg/dL, or a low-normal value with these symptoms, is followed by an ACTH level and an ACTH (cosyntropin) stimulation test, which shows whether the glands can respond. Anyone with a low result who feels unwell should be seen promptly rather than waiting for a routine appointment.

## What happens after an abnormal cortisol result

A single high morning cortisol without any features of Cushing's is usually repeated under calmer conditions — after a normal night's sleep, off oral estrogen if that is practical, with the draw taken within two hours of waking. If it stays high or the physical signs are present, the next step is one of the screening tests above, ordered and interpreted by a clinician, followed by ACTH and imaging only if excess is confirmed. Glucose, potassium and blood pressure are checked along the way because they are where cortisol excess does its damage.

A low result is confirmed and localised with ACTH and a stimulation test, plus sodium, potassium and glucose, and every steroid-containing medication is reviewed. Confirmed adrenal insufficiency is treated with replacement hydrocortisone, with sick-day rules and an emergency injection kit; it is a lifelong, manageable condition once recognised. Either way, cortisol is one number in a rhythm — the pattern across the day and the response to stimulation or suppression are what clinicians act on, and a morning draw is the first data point rather than the last word.

## What does a high Cortisol AM mean?

A high morning cortisol is most often stress, poor sleep, illness, pain, or a draw at the peak of the daily rhythm — not Cushing's syndrome. Oral contraceptives and pregnancy raise total cortisol by increasing its binding protein. A single high value is rarely diagnostic; if Cushing's is a concern, clinicians use late-night salivary cortisol, a dexamethasone suppression test or 24-hour urine cortisol.

### Common causes of high Cortisol AM

1. Acute stress, anxiety, poor sleep, illness, intense exercise
2. Estrogen-containing contraceptives or pregnancy (raise binding protein)
3. Alcohol use, depression, obesity
4. Glucocorticoid medications (prednisone, hydrocortisone) cross-reacting in some assays
5. Cushing's syndrome — adrenal, pituitary or ectopic ACTH (rare)

### Symptoms that go with high Cortisol AM

- Often none
- Weight gain around the trunk and face, purple stretch marks, easy bruising, muscle weakness, high blood pressure, high glucose when Cushing's is present

### What clinicians usually check next

- Repeat under calm conditions, off oral estrogen if possible
- If Cushing's is suspected: late-night salivary cortisol, 1 mg overnight dexamethasone suppression test, or 24-hour urine free cortisol
- Glucose, potassium and blood pressure review

Follow-up tests at TestWell: [Glucose](https://www.test-well.com/tests/glucose-basic) ($14.99).

**Does a high morning cortisol mean Cushing's?** Rarely. A morning serum cortisol is a poor screening test for Cushing's because the normal range is wide and stress raises it. The screening tests are the late-night salivary cortisol, the dexamethasone suppression test and 24-hour urine cortisol.

## What does a low Cortisol AM mean?

A low morning cortisol (especially below about 3–5 mcg/dL at 8 a.m.) can indicate adrenal insufficiency — Addison's disease, pituitary disease, or suppression of the adrenal axis by glucocorticoid medication, including inhaled and topical steroids. It is the one cortisol result that should not be ignored. Values between about 5 and 15 mcg/dL are indeterminate and usually prompt an ACTH stimulation test.

### Common causes of low Cortisol AM

1. Glucocorticoid use — prednisone, inhaled or high-potency topical steroids, joint injections — suppressing the body's own production
2. Primary adrenal insufficiency (Addison's disease, usually autoimmune)
3. Secondary adrenal insufficiency from pituitary disease or after stopping long-term steroids
4. Late-afternoon draw mistaken for a morning value

### Symptoms that go with low Cortisol AM

- Profound fatigue, weakness
- Nausea, poor appetite, weight loss
- Dizziness on standing, salt craving
- Darkened skin creases (primary adrenal insufficiency)

### What clinicians usually check next

- Confirm the draw time; repeat at 8 a.m. if unclear
- ACTH level and an ACTH (cosyntropin) stimulation test
- Sodium, potassium and glucose
- Review all steroid-containing medications

Follow-up tests at TestWell: [Glucose](https://www.test-well.com/tests/glucose-basic) ($14.99).

### Seek care promptly if

- Low cortisol with vomiting, confusion, low blood pressure or collapse — emergency care (possible adrenal crisis)

**My morning cortisol was 4. What now?** That's low enough to need prompt clinical follow-up — typically an ACTH stimulation test — and a review of any steroid medications. Don't wait for a routine appointment if you feel unwell.

## How do you get tested for Cortisol AM?

| Order | Type | Price | Includes |
| --- | --- | --- | --- |
| [Cortisol (AM)](https://www.test-well.com/tests/cortisol-am) | Single test | $26.99 | This marker |
| [Metabolism & Weight Loss Panel](https://www.test-well.com/tests/metabolism-panel) | Panel | $119.99 | 8 tests |
| [Fitness & Performance Panel](https://www.test-well.com/tests/fitness-performance-panel) | Panel | $119.99 | 8 tests |
| [Sleep Health Panel](https://www.test-well.com/tests/sleep-health-panel) | Panel | $129.99 | 8 tests |
| [Chronic Fatigue Panel](https://www.test-well.com/tests/chronic-fatigue-panel) | Panel | $169.99 | 9 tests |

## Quest vs Labcorp vs BioReference

| Lab | Available | Price | Notes |
| --- | --- | --- | --- |
| Quest Diagnostics | Yes | $26.99 | Choose Quest at checkout; walk-in patient service centers in every state TestWell serves outside NY and NJ. |
| Labcorp | Yes | $27.99 | Choose Labcorp at checkout; walk-in patient service centers in every state TestWell serves outside NY and NJ. |
| BioReference (NY & NJ) | Yes | $31.99 | New York and New Jersey orders route here automatically — state rules keep Quest and Labcorp from accepting self-ordered draws. |

## Common questions about Cortisol AM

### What are the symptoms of high cortisol?

Weight gain around the trunk, face and upper back; a rounded face; wide purple stretch marks; skin that bruises and tears easily; weakness in the hip and shoulder muscles; high blood pressure or blood sugar; insomnia, anxiety or low mood; frequent infections; and in women acne, extra facial hair and irregular periods. Occasional stress-related cortisol spikes cause none of these — the physical signs come from months of sustained excess.

### What causes high cortisol levels?

Most often stress, poor sleep, illness, pain, intense exercise, alcohol, depression or obesity, and — for total cortisol — estrogen-containing contraception or pregnancy, which raise the binding protein. Glucocorticoid medications cause cortisol-excess symptoms directly. Cushing's syndrome from an adrenal, pituitary or other tumor is rare and is confirmed with salivary, urinary or dexamethasone-suppression testing, not a blood level alone.

### Can a cortisol blood test diagnose Cushing's syndrome?

No. The morning serum range is wide and stress pushes results up, so healthy people often test high and some people with Cushing's test normal. Endocrine Society guidance screens with late-night salivary cortisol, a 1 mg overnight dexamethasone suppression test or 24-hour urinary free cortisol — usually two tests, repeated — and a morning blood cortisol is at most a first look.

### What time of day should cortisol be tested?

Between 6 and 10 a.m., ideally 7–9 a.m. and within about two hours of waking, because that is when cortisol peaks and when the reference range applies. Night-shift workers should tell the reviewing physician so the timing can be adjusted to their sleep schedule.

### Does birth control affect a cortisol test?

Yes. Estrogen-containing pills, patches and rings raise cortisol-binding globulin, which can roughly double total serum cortisol while the free, active hormone stays normal. A high result on the pill is expected; if the level matters for a diagnosis, clinicians either use a salivary or urinary test or repeat the blood test after a period off oral estrogen.

### What is a dangerously low cortisol level?

A morning cortisol below about 3 mcg/dL strongly suggests adrenal insufficiency and needs prompt follow-up with an ACTH stimulation test and a review of any steroid medications. If a low result comes with vomiting, confusion, very low blood pressure or collapse, that is a possible adrenal crisis and an emergency.

### Do I need to fast for a cortisol test?

No. Timing is what matters: a morning draw shortly after waking, on a normal night's sleep, without hard exercise beforehand. Bring a list of every steroid-containing medication — including inhalers, creams and joint injections — and any hormonal contraception.

### Do I need a doctor's order to test my cortisol am?

No. TestWell's licensed physician network reviews and approves your order — usually within minutes. You can place an order online without an in-person visit or a referral from your own doctor.

### How long does it take to get Cortisol AM results?

Most Cortisol AM results are available in 1–3 business days after your specimen arrives at the lab. You'll get an email the moment your results are ready, with everything viewable in your TestWell portal.

### How much does a Cortisol AM test cost?

Our Cortisol (AM) starts at $26.99. That's the all-in price — no copays, no insurance hoops, no surprise bills. HSA and FSA cards are accepted.

### Do I need to fast before my Cortisol AM test?

Fasting is not required for the Cortisol AM test. You can have your blood drawn any time of day.

### Which lab will process my Cortisol AM test?

Your test will be processed by Quest Diagnostics, Labcorp, or BioReference depending on which is closest to you and which lab carries the test. All three are CLIA-certified and trusted by hospitals nationwide. You'll choose your lab during checkout from 4,000+ locations.

## Keep reading

- [How to Read Your Blood Test Results](https://www.test-well.com/guides/how-to-read-your-blood-test-results)
- [Blood Tests for Athletes](https://www.test-well.com/guides/blood-tests-for-athletes)
- [Fatigue: which blood tests?](https://www.test-well.com/symptoms/fatigue)
- [Unexplained weight gain: which blood tests?](https://www.test-well.com/symptoms/weight-gain)
- [Insomnia and poor sleep: which blood tests?](https://www.test-well.com/symptoms/insomnia)
- [Anxiety: which blood tests?](https://www.test-well.com/symptoms/anxiety)
- [Brain fog: which blood tests?](https://www.test-well.com/symptoms/brain-fog)
- [Before your test: Time of day](https://www.test-well.com/prep/time-of-day)
- [Before your test: Sleep deprivation](https://www.test-well.com/prep/sleep-deprivation)
- [Before your test: Oral contraceptives and estrogen](https://www.test-well.com/prep/oral-contraceptives)
- [Before your test: Common medications](https://www.test-well.com/prep/medications)
- [Before your test: Recent illness](https://www.test-well.com/prep/recent-illness)

## Sources

- [Mayo Clinic Labs](https://www.mayocliniclabs.com/test-catalog/overview/8545)
- [MedlinePlus (NIH) — Cortisol Test](https://medlineplus.gov/lab-tests/cortisol-test/)
- [Endocrine Society — Diagnosis and Treatment of Primary Adrenal Insufficiency: Clinical Practice Guideline (2016)](https://doi.org/10.1210/jc.2015-1710)
- [Endocrine Society — The Diagnosis of Cushing's Syndrome: Clinical Practice Guideline (2008)](https://doi.org/10.1210/jc.2008-0125)
- [NIDDK (NIH) — Cushing's Syndrome](https://www.niddk.nih.gov/health-information/endocrine-diseases/cushings-syndrome)

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---

Medically reviewed by Youmna DiStefano, MD (Medical Reviewer, TestWell); last reviewed 2026-09-20. Review policy: https://www.test-well.com/reviewers/youmna-distefano-md

Canonical page: https://www.test-well.com/biomarkers/cortisol-am
Machine-readable catalog: https://www.test-well.com/api/catalog.json · MCP server: https://www.test-well.com/mcp · Overview for agents: https://www.test-well.com/llms.txt

Prices are cash-pay, in USD, and include physician authorization; every order adds one flat $6 lab processing fee. Educational content is not a diagnosis — discuss results with a clinician.