What should I consider if a patient has low total cortisol but normal free cortisol? So her levels are 2,226 for the total range, and the lower limit of normal total cortisol is 2,750. And for free, 105 for free cortisol, with the range being 80 to 185. So she has high-normal cortisone, symptoms of fatigue in the morning, but her diurnal rhythm is essentially normal. Melatonin is low normal, DHEA was high, let’s see, and then she goes and lists the hormone values. Periods are irregular, 37 and she’s been off birth control the past six months.

Dr. Amy Nett:  So, I mean, the big question is, I think, what are her symptoms? So what are you trying to treat? So you’re saying she has symptoms of fatigue in the morning, but her daily rhythm is otherwise normal. So she has low total cortisol, normal free cortisol and some fatigue. You could think about something like adrenal glandulars, given that she has normal free cortisol, you could also do Vital Adapt. And again, all of this needs to be done in the context of why is there low total cortisol? Is there something else that might be causing inflammation? So in terms of looking at all of these things that affect the HPA axis, so working in the context of just the overall HPA axis in terms of supplements, you’re saying she has a little bit of fatigue, low total cortisol, think about adrenal glandulars, maybe Vital Adapt. And it sounds like diurnal rhythm is essentially normal. So try starting with those two things, and as we always do, look at what else might be causing inflammation or could otherwise be just sort of putting an additional strain on her HPA axis.