Acne on back & stomach - E2 problem?

Cortisol levels fluctuate wildly. A urine test reveals the total amount produced in a day and a blood draw reveals the level at a single point in time.

When looking at adrenal insufficiency you have to see the whole picture, multiple data points throughout the day. Then correlate that with DHEA - S levels.

We are now using what we think is the best test available in the world for adrenal insufficiency, it is a urine and saliva sample the accurately measures metabolites.

Just FYI we are also using the same test for females, since their HPA fluctuates so much.

The truth is adrenal insufficiency is most accurately diagnosed by symptoms, the lab work just confirms.
Last edited:
Did you end up getting a sensitive E2 test?

About saliva cortisol and urine cortisol. Saliva is the gold standard for cortisol testing. ZRT uses LC/MS to test, and its only for free cortisol. Urine metabolites is second. The standard clinic test for Urine Cortisol is a 24hr total cortisol, which is helpful. Percision Analytical makes 3 versions of its Dutch Test, which you get the AM, Noon, Dinner and Bedtime cortisl via urine metabolites. So the short of it, clinic 24 urine testing is helpful but it doesnt tell the highs and the lows like the 4part saliva or the 4 part dutch test. For women the Dutch Test is great because it really breaks down their sex hormones and shows the metabolic pathways and how each step is being handled by the body but its quite a bit more expensive. The saliva 4 part test measures free cortisol, while the blood test measures bound and unbound. The most important cortisol readings are the morning and bedtime. High bedtime cortisol will fuck up your sleep, and sleep is the most important thing in recovering from adrenal fatigue/insufficiency. Low morning cortisol will mess up the bodys response to inflammation and healing, plus without enough cortisol t3 and glucose cant work together to stimulate mitochondria.

The other thing I have to add is ACTH. That blood test should be included to make sure its not a pituitary issue where the the cortex is not receiving enough ACTH, thus it wont make enough cortisol and aldosterone.
Last edited: