Dr. Amy Nett: This depends a lot, I think, on the severity of the symptoms and what the underlying issue is. If I’m working with a patient who is a little more complex and has a lot of layers that we need to work on in terms of decreasing inflammation and bringing her body back into balance, she might be on adrenal support for quite a long time. I don’t always retest because if we’ve treated all of the other factors, if I feel like someone is doing a really good job in terms of diet, lifestyle, and stress management, and I feel like if they have all those pieces together and they say, “My energy is great. My sleep is great. I’m doing okay,” I don’t know that a repeat test showing an abnormal cortisol is necessarily going to influence my decision.
I would repeat the test if someone has been on supplements for maybe six months. I feel like we’ve otherwise done a lot of treatment and are on the right track with how they are doing, but then they are still having symptoms. Then I might think, huh, what are we missing? There is some variability in the cortisol test. Patients will sometimes tell me, “Oh, no. Like I took it. I was stressed, so I didn’t sleep as well the night I took it,” and that sort of thing. There is going to be some lack of reliability just because of normal life getting in the way, normal variations. If things seem like they are doing—the patient is doing better, doing well, doesn’t have complaints, then what I would probably do is suggest that she starts weaning off the supplements that we have her on for her particular treatment protocol and see how she does. If she feels like she is doing well without the supplements, she can stay off them. If she starts noticing she either gets into a rut where she has increased stress, not eating well, traveling, not sleeping as well or something like that, she can potentially rely on the supplements to get her through those periods, but she can often kind of wean off them on more of a regular basis. I think it’s just kind of checking in with the patient. Often patients will get to a point with me where they say, “Okay. I’m feeling pretty good. Can we see what supplements we can minimize and get me off?” I think that’s a good time to say, “Great. Let’s wean you off these.” These tests add up, right? At this point, this patient has already invested in stool testing, breath testing, hormone testing, maybe metals, or other things. I don’t necessarily—if a person doesn’t have complaints, I’m not sure you absolutely need to retest, but it depends a little bit. When you retest, it depends on their symptoms and their other treatments.