Optimal Result:
65 - 200 ug.
Cortisol is a steroid produced and secreted by the adrenal glands.
A very small percentage of cortisol is free and unbound, while the remaining is in transition. The human body produces cortisol first, and then different glands have the ability to keep it as cortisol or convert it into cortisone, which is biologically inactive.
The biomarker 24hr Free Cortisol is the sum of your free cortisol measurements throughout one day. In the DUTCH test those individual measurements are labeled as:
- Cortisol (Waking)
- Cortisol B (Morning)
- Cortisol C (Afternoon)
- Cortisol D (Night)
If you add those four readings together you get your 24hr Free Cortisol reading.
Free cortisol results tell us how much cortisol is free to bind to receptors and allows for assessment of the circadian rhythm.
In the DUTCH test it is important to compare the 24hr Free Cortisol with the Metabolized Cortisol (a different marker in the DUTCH test), as the metabolized cortisol number is a good indication of how much cortisol was produced in total. It essentially reflects how much cortisol was made in the body and has been processed out through the liver, into the kidney, and onto the DUTCH Test
The amount of cortisol produced (=metabolized cortisol is a good indication for that) and the amount of free cortisol available can be very different in some scenarios. Measuring both allows for insight into the rate of cortisol clearance/metabolism. The metabolized cortisol and free cortisol markers are important to use both together and separately in order to tell a more detailed story.
Example: Increased cortisol clearance
For example, higher levels of metabolized cortisol (compared to free cortisol) are often seen in obesity where adipose tissue (=fat) is likely pulling cortisol from its binding protein and allowing for metabolism and clearance. The adrenal gland has to keep up with this cortisol sequestering and excretion, so cortisol production is often quite high (as seen in the levels of metabolized cortisol) even though free cortisol does not correlate positively with adipose tissue or BMI. This insight is quite helpful for those looking to lose belly fat and suspect cortisol/stress is a major factor. These patients are often misdiagnosed as having low cortisol production when only free cortisol is measured. Increased cortisol clearance may also be seen in hyperthyroidism and is suspected to be part of the chronic fatigue story as well.
Example: High Free Cortisol, but decreased Metabolized cortisol (=total levels)
In people with low thyroid, the opposite pattern is often seen. When the thyroid slows down or if there is peripheral hypothyroidism where free T3 cannot get into the cells, the clearance (or metabolism) of cortisol through the liver slows down. As a result, free cortisol starts to increase and may show up elevated on the DUTCH Test. The literature is more definitive for lower metabolized vs. higher “free”.
In the DUTCH test it is important to compare the 24hr Free Cortisol with the Metabolized Cortisol (a different marker in the DUTCH test), as the metabolized cortisol number is a good indication of how much cortisol was produced in total.
The amount of cortisol produced (=metabolized cortisol is a good indication for that) and the amount of free cortisol available can be very different in some scenarios. Measuring both allows for insight into the rate of cortisol clearance/metabolism. The metabolized cortisol and free cortisol markers are important to use both together and separately in order to tell a more detailed story.
Cortisol is then metabolized into 5-alpha-Tetrahydrocortisol (5a-THF) and 5-beta-Tetrahydrocortisol (5b-THF) and cortisone is metabolized into 5-beta-Tetrahydrocortisone (5b-THE). Since all production and output originally started as cortisol, the cortisone metabolites are added to the cortisol metabolites when evaluating the “total metabolized cortisol”.
Here are a few different scenarios:
Possible reasons for high cortisol throughout the day:
- Cushing’s disease (where the pituitary gland releases too much ACTH, stimulating the adrenals to release too much cortisol) [L]
- High levels of stress (including mental stress)
- Hyperthyroidism [L]
- HPA axis dysfunction
- A tumor in the adrenal gland or somewhere in the body involved in cortisol production can also cause higher-than-normal cortisol levels.
- Pregnancy or birth control pills are also known to cause a high blood cortisol level.
Suggestions for lowering cortisol levels:
- Evaluate lab results correctly to help pinpoint and address the root cause
- Reduce stress levels [L]
- Improve sleep quality (and quantity if needed) [L]
- Massage [L]
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If cortisol is going back down at the end of the day [Cortisol D (Night)] where it is supposed to be, scenarios like Cushing’s disease or potential tumors are not likely the case. In a case like this it seems that the HPA axis (stress response system) is really turned on ‘high’. The total of 24hr Free Cortisol would be very high, especially when you wake up [Cortisol (Waking)] and in the early parts of the day [Cortisol B (Morning)]. Metabolized Cortisol would confirm the story as they would be really high as well.
It doesn't really help to look at CAR here as the CAR might seem normal, but overall cortisol levels are really high.
Possible treatment:
Treatment of elevated cortisol should be directed at the root cause of the stressor. Lifestyle modification with relaxation methods, dietary changes, pain management, and overall HPA axis support with nutrition and/or adaptogens can be helpful. Glandulars may be added if additional support is necessary.
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In people with low thyroid, this pattern is often seen. When the thyroid slows down or if there is peripheral hypothyroidism where free T3 cannot get into the cells, the clearance (or metabolism) of cortisol through the liver slows down [Metabolized Cortisol → Relatively lower]. As a result, free cortisol starts to increase [24hr Free Cortisol → Relatively higher] and may show up elevated on the DUTCH Test. The literature is more definitive for lower metabolized vs. higher “free”.
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Possible reasons for a relatively higher cortisol compared to cortisone: hypothyroid, licorice, grapefruit, inflammation, visceral obesity, high insulin, excess sodium
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In the DUTCH test it is important to compare the 24hr Free Cortisol with the Metabolized Cortisol (a different marker in the DUTCH test), as the metabolized cortisol number is a good indication of how much cortisol was produced in total.
The amount of cortisol produced (=metabolized cortisol is a good indication for that) and the amount of free cortisol available can be very different in some scenarios. Measuring both allows for insight into the rate of cortisol clearance/metabolism. The metabolized cortisol and free cortisol markers are important to use both together and separately in order to tell a more detailed story.
Here are a two different scenarios:
Free cortisol → Low
Metabolized Cortisol → Low
This is a good indication for overall low production of cortisol.
A low level of cortisol may indicate Addison’s disease, a disorder in which the adrenal glands do not produce sufficient steroid hormones.
Symptoms include: weight loss, fatigue, low blood pressure, abdominal pain, dark patches of skin.
You may also have hypopituitarism, which occurs when cortisol production by the adrenal glands is low because the pituitary gland is not sending proper signals.
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Free cortisol → Low
Metabolized Cortisol → Relatively High
This implies increased cortisol clearance. This can be due to obesity, or hyperthyroidism.
Higher levels of metabolized cortisol (compared to free cortisol) are often seen in obesity where adipose tissue (=fat) is likely pulling cortisol from its binding protein and allowing for metabolism and clearance. The adrenal gland has to keep up with this cortisol sequestering and excretion, so cortisol production is often quite high (as seen in the levels of metabolized cortisol) even though free cortisol does not correlate positively with adipose tissue or BMI. This insight is quite helpful for those looking to lose belly fat and suspect cortisol/stress is a major factor. These patients are often misdiagnosed as having low cortisol production when only free cortisol is measured. Increased cortisol clearance may also be seen in hyperthyroidism and is suspected to be part of the chronic fatigue story as well.
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Add your results anytime with our easy entry form. It's quick, guided, and helps you stay organized — free for all members.
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See your lab reports in clear graphs and tables. Spot patterns, track changes, and compare results over time — all in one place.
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After collecting lab results from different providers, you can download your entire history combined into a single file.
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Our inclusive service handles the data entry for your lab reports. Just submit your information and we'll take care of the rest. Complete plan members receive one report entered for free, then $15 per report after that. Unlimited plan members receive ten report entries for free, then $15 per report after that.
Our inclusive service handles the data entry for your lab reports. Just submit your information and we'll take care of the rest.
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Whether you're working with a doctor, nutritionist, caregiver, or wellness coach, you can securely share your complete lab history by sending an invite link to anyone you trust. You have full control over who sees your information and for how long, ensuring your privacy and peace of mind at every step.
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Healthmatters is a personal health dashboard that helps you organize and understand your lab results. It collects and displays your medical test data from any lab in one secure, easy-to-use platform.
With a Healthmatters account, you can:
Professionals can also analyze client data more efficiently and save time managing lab reports.
Healthmatters.io personal account provides in-depth research on 4000+ biomarkers, including information and suggestions for test panels such as, but not limited to:
You can combine all test reports inside your Healthmatters account and keep them in one place. It gives you an excellent overview of all your health data. Once you retest, you can add new results and compare them.
If you are still determining whether Healthmatters support your lab results, the rule is that if you can test it, you can upload it to Healthmatters.
While we work with many popular labs, we welcome reports from lots of other places too.
It's as simple as this: if you can get a test done, you can upload it to Healthmatters and we can interpret results from any lab out there. If laboratories can analyze it, we can interpret it.
If you're on the hunt for a specific biomarker, contact us and we'll add it to our database. Anything from blood, urine, saliva, or stool can be uploaded, understood, and tracked with your Healthmatters account.
The Complete Plan ($15/month) is perfect for individuals who want ongoing access to their health data. It includes unlimited lab imports, visual tracking, custom ranges, result explanations, full account exports, and secure sharing — all with a simple monthly subscription. You can cancel anytime and restart your plan whenever you're ready — your data will still be there waiting for you. You can also upgrade to the Unlimited Plan at any time, with the cost prorated based on what you've already paid.
The Unlimited Plan ($250 one-time) is also designed for individuals but offers lifetime access with no ongoing subscription. You'll get all the same features as the Complete Plan, plus a larger initial data entry allowance (10 reports), making it a great choice if you prefer a one-time payment and long-term use without monthly fees.
In short:
There are two ways to add your test reports to your Healthmatters account. One option is to input the data using the data entry forms. The other method is to utilize our "Data entry service."
Our data entry forms offer an easy, fast, and free way for you to input the reports yourself. Self-entry allows you to add an unlimited number of reports at no cost. We make the self-entry process user-friendly, providing dozens of templates that pre-populate the most popular laboratory panels and offering instant feedback on entered values.
For those who prefer assistance, we offer a "Data entry service" to help you input your data. Simply attach an image or file of your lab test results, and a qualified team member from our data entry team will add the results for you.
We support various file types, including PDFs, JPGs, or Excel. This service is particularly useful if you have many reports to upload or if you're too busy to handle the data entry yourself.
Our Data Entry Service is for when you don't want to manually type in your lab results yourself. You simply upload your report (PDF, image, or screenshot), and our trained team enters the information into your Healthmatters account for you — accurately and neatly organized, ready to view in graphs, tables, and timelines.
The $15 per report covers the time and care it takes for a real person to review your file, make sure each result is entered correctly, and double-check for accuracy. This ensures your health data is precise and easy to work with — without you having to spend the time doing it yourself.
Prefer to do it yourself? You can always use our free self-entry tool to add results manually — it just takes a bit more time and attention.
For users on the Complete monthly plan, the first report is entered free of charge, and each additional report incurs a fee of $15.
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All professional accounts allow you to import and onboard an unlimited number of clients and their lab results. The distinction between professional plans lies solely in the data entry service.
The Pro Monthly Plus plan is priced at $75 per month and includes a data entry service for five reports each month. Additional reports can be self-entered at no extra cost or, if preferred, you can use our data entry service for an additional fee of $15 per report.
The Pro Monthly plan is priced at $45 per month and does not include a data entry service. Self-entry is free for an unlimited number of reports, and you can opt for the data entry service at a fee of $15 per report.
You also have the option to upgrade to higher monthly or to annual plans, which come with substantial discounts. All upgrades can be done directly from your account.
Simply log in and navigate to your account settings to cancel your subscription. Scroll down to locate the 'Cancel' button at the bottom of the page. Ensure you cancel at least one day before the renewal date to prevent any charges. Once cancellation is requested, the subscription remains active until the conclusion of the current billing cycle.
Our goal has been to make your Healthmatters account as intuitive as possible.
We've crafted multiple ways for you to navigate your data, whether you're glancing at a single report or delving into your historical test reports.
1. Graph View:Dive into a visual journey with our biomarker graphs, showcasing over 40 data points. Combining years of results unveils trends, empowering you to make informed decisions. Our visualization tools make it a breeze to compare and understand changes over time, even if your results are from different labs. A search function and filters simplify the exploration of extensive data, allowing you to focus on what needs attention.
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3. Table View:For a holistic view of all biomarkers side by side, our table view is your go-to. Results are neatly displayed in a categorized and dated table, ideal for those with an extensive test history. Utilize sorting, filters, and color-coding to enhance your analysis and gain extra insights.
Yes, you can download your information anytime. We offer two easy ways to export your lab data:
This makes it simple to save, back up, or share your health data whenever you need.
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Yes, you can! We highly recommend activating Two-Factor Authentication (2FA) for your account. To do so, please navigate to the "Profile and Security" section of your account, where you will find instructions for activating 2FA.
Yes, you can. When entering values for the biomarker, you will see an "Edit Range" button. Click this button, and you'll have the option to enter a custom range.
A personal account is all about keeping your own lab test results in check. It's just for you and your personal use.
The professional account is designed for health professionals who wish to track and organize their clients' laboratory results.
To learn more about Healthmatters Pro, please refer to the professional page.
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