Cortisol PM levels: what's normal, high and low
Afternoon cortisol — should be considerably lower than morning levels in a normal diurnal pattern.
Medically reviewed by Youmna DiStefano, MD · Last reviewed September 2026
The short answer
Cortisol PM is measured with a standard blood draw; no fasting is needed. A typical reference range is 2.30 – 11.9 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.
- 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
Cortisol PM Reference Range
These are the typical adult reference ranges used by major US labs. Your report will include the specific range used by the lab that processed your sample.
| Population | Range |
|---|---|
| age 18+, drawn 4–6 PM | 2.30 – 11.9 mcg/dL |
Reference ranges are educational. Always interpret your result with the specific range printed on your lab report and discuss anything outside the range with a clinician.
Have a result in hand? analyze it with your AI assistant using these reviewed ranges, or run it through our explainer. Tools: look up another marker's range · convert lab units
What does a high Cortisol PM mean?
Cortisol should be at its lowest late in the evening, so a PM value that fails to fall raises the question of Cushing's syndrome, where the daily rhythm is lost. Far more often it is high because of shift work, stress, illness, poor sleep, alcohol, oral estrogens, or a draw taken too early. Late-night salivary cortisol and a dexamethasone suppression test confirm or exclude it.
Common causes of a high Cortisol PM
- Acute stress, illness, pain, poor sleep or recent night shifts (rhythm shifted, not lost)
- Oral estrogens or pregnancy (raised binding protein, total cortisol high, free normal)
- Alcohol, depression, obesity, uncontrolled diabetes (pseudo-Cushing's)
- Cushing's syndrome: pituitary adenoma, adrenal tumor, ectopic ACTH, or high-dose steroid medication
- Draw before ~10 pm or after caffeine or exercise
Ordered from most to least common.
Symptoms that can go with it
- Weight gain around the trunk and face, thin skin and easy bruising, purple stretch marks, muscle weakness, high blood pressure and glucose (Cushing's)
- Often none when the cause is stress or timing
What clinicians usually check next
- Repeat properly: seated, rested, 11 pm–midnight; or a late-night salivary cortisol on two nights
- 1 mg overnight dexamethasone suppression test or 24-hour urine free cortisol
- Medication review for steroid exposure (creams, inhalers, injections count)
- Endocrinology referral if two screening tests are abnormal
What's a normal cortisol at night?
Well under half the morning value — typically below ~7 mcg/dL by late evening, and salivary cortisol near the detection limit at midnight. Loss of that drop, confirmed twice, is what prompts a Cushing's work-up.
I work nights — is my evening cortisol meaningful?
Only against your own rhythm. Cortisol peaks after waking whenever that is; for shift workers the 'evening' sample should be timed to your bedtime and interpreted accordingly.
Educational only — not a diagnosis. A single result outside the range is a prompt to look closer with a clinician.
What does a low Cortisol PM mean?
A low late-afternoon or evening cortisol is usually normal — that is when cortisol is supposed to be lowest — so a low PM value on its own rarely means anything. It becomes relevant only alongside a low morning cortisol (adrenal insufficiency), in someone taking steroid medication that suppresses their own production, or in a night-shift worker whose peak has moved. The morning value, and an ACTH stimulation test if needed, are what answer the adrenal question.
Common causes of a low Cortisol PM
- Normal circadian low point
- Corticosteroid medication (prednisone, inhaled or topical steroids, injections) suppressing the adrenal axis
- Adrenal insufficiency (primary or from pituitary disease) — only if the morning value is also low
- Shift work (rhythm shifted)
- Hypothyroidism, opioids (mild)
Ordered from most to least common.
Symptoms that can go with it
- None when it's a normal evening low
- Fatigue, weight loss, dizziness on standing, nausea and salt craving with true insufficiency
What clinicians usually check next
- Morning (7–9 am) cortisol on a rested day; ACTH stimulation test if that is also low
- Review all steroid-containing medications
- Sodium, potassium, glucose, TSH
Follow-up tests at TestWell: TSH (Thyroid Stimulating Hormone) ($26.99), TSH + Free T4 ($27.99), Glucose ($14.99).
Seek care promptly if
- Low cortisol with vomiting, confusion, very low blood pressure or severe weakness — emergency care (possible adrenal crisis)
Does a low evening cortisol mean adrenal fatigue?
'Adrenal fatigue' is not a recognized diagnosis, and a low evening value is the expected rhythm. Real adrenal insufficiency shows a low morning cortisol and a failed stimulation test.
Educational only — not a diagnosis. A single result outside the range is a prompt to look closer with a clinician.
How do you get a Cortisol PM test?
Order online, a licensed physician reviews the requisition, and you walk into a nearby lab for the draw. Cortisol PM is available on its own or inside these panels — panels cost less per marker when you want the fuller picture.
| Option | Includes | Price |
|---|---|---|
| Cortisol (AM) | This marker only | $26.99 |
| Metabolism & Weight Loss Panel | 8 tests | $119.99 |
| Fitness & Performance Panel | 8 tests | $119.99 |
| Sleep Health Panel | 8 tests | $129.99 |
| Chronic Fatigue Panel | 9 tests | $169.99 |
Quest vs. Labcorp for Cortisol PM: which lab should you pick?
Both are CLIA-certified national labs and the result is clinically equivalent, so pick whichever location is closer. Your report will print that lab's own reference range, which can differ slightly from the table above.
| Lab | Available | Price |
|---|---|---|
| Quest Diagnostics | Yes | $26.99 |
| Labcorp | Yes | $27.99 |
| BioReference (NY & NJ) | Yes | $31.99 |
Need help choosing a location? Use the lab finder to see draw sites near your ZIP.
Related Hormones biomarkers
Markers commonly tested alongside Cortisol PM.
Frequently asked
What does a high Cortisol PM mean?
Cortisol should be at its lowest late in the evening, so a PM value that fails to fall raises the question of Cushing's syndrome, where the daily rhythm is lost. Far more often it is high because of shift work, stress, illness, poor sleep, alcohol, oral estrogens, or a draw taken too early. Late-night salivary cortisol and a dexamethasone suppression test confirm or exclude it.
What's a normal cortisol at night?
Well under half the morning value — typically below ~7 mcg/dL by late evening, and salivary cortisol near the detection limit at midnight. Loss of that drop, confirmed twice, is what prompts a Cushing's work-up.
I work nights — is my evening cortisol meaningful?
Only against your own rhythm. Cortisol peaks after waking whenever that is; for shift workers the 'evening' sample should be timed to your bedtime and interpreted accordingly.
What does a low Cortisol PM mean?
A low late-afternoon or evening cortisol is usually normal — that is when cortisol is supposed to be lowest — so a low PM value on its own rarely means anything. It becomes relevant only alongside a low morning cortisol (adrenal insufficiency), in someone taking steroid medication that suppresses their own production, or in a night-shift worker whose peak has moved. The morning value, and an ACTH stimulation test if needed, are what answer the adrenal question.
Does a low evening cortisol mean adrenal fatigue?
'Adrenal fatigue' is not a recognized diagnosis, and a low evening value is the expected rhythm. Real adrenal insufficiency shows a low morning cortisol and a failed stimulation test.
Do I need a doctor's order to test my cortisol pm?
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 PM results?
Most Cortisol PM 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 PM 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 PM test?
Fasting is not required for the Cortisol PM test. You can have your blood drawn any time of day.
Which lab will process my Cortisol PM 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.
What can throw off a Cortisol PM result?
Time of day, common medications and caffeine can change a Cortisol PM result without anything being wrong. Time of day can shift Cortisol PM — A.M. cortisol at 7–9 a.m.; P.M. cortisol as the lab specifies. Common medications can lower Cortisol PM — cortisol testing needs prescriber guidance. Caffeine can raise Cortisol PM — no caffeine the morning of a cortisol draw. Each is explained on our physician-reviewed "Before your test" pages; when one applies, remove it and retest.
Ready to test your cortisol pm?
Order in two minutes, get physician-approved, and visit a lab the same day. Starts at $26.99.