How to find doctors who will listen to your concerns and not tell you to stop checking Dr. Google... it's a fair question and the one I hear most. A few things that have worked for readers: at Marcus Institute of Integrative Health at Thomas Jefferson University (where I work), all practitioners check and track cortisol. You can also look for functional/integrative MDs through the IFM "Find a Practitioner" directory. Last option is to search for a board-certified endocrinologist who lists adrenal disorders specifically (not just thyroid and diabetes). NPs and PAs in women's health and menopause practices are often more willing to run a 4-point salivary cortisol or DUTCH test than a traditional primary care office. I'm going to dig deeper into how to vet a practitioner in the next essay and in the meantime, it would be great to hear how other readers have found collaborative clinicians. Thanks for your question, Megan.
good point. You could always just forward this article to your current doctor, to gauge their reaction to the information contained within. That would be a good start, methinks
That's actually a great low-stakes first move. Their reaction tells you a lot. If they wave it off, you have your answer. If they engage with it even skeptically you might be able to work with them. Thanks for adding this.
How do we find a reasonably priced doctor to help us figure this out?
And what groups are out there trying to get the medical system changed? I can talk to my doctor, etc. But I think we need a combined voice/body of people to get changes in care made. The information is out there, but we need doctors to come up to speed in order for us to feel safe and know we are getting proper treatment.
The medical system encourages conformity all through medical school and you get punished not rewarded for asking questions the system doesn't like.
And insurance companies, medical schools, hospital systems, medical boards and regulatory agencies are all entwined.
I'm not in the system but have had these conversations with people who are and it's so hard to know how to solve. Because groups of doctors who have the courage to think outside the box are a threat to the pocketbooks of those who made and control big medicine in the first place.
I would love to see a good solution to your question! Perhaps courage and steady refusal to accept the routine dismissals that are inherently part of the current standard of care?
Agree! We need advocacy. Note, I think it was largely due to doctor "influencers" (women gynecologists and urologists who researched, wrote books, and used social media) that lobbied to change the "black box" warning on HRT. There is a precedent.
Totally agree there are many female doctors (and even some male) advocating for change. I love that and am grateful.
I often wonder how can I make a meaningful difference here too? I agree I can push my own doctor, talk about this with friends…but I also want to do more - make a bigger impact. But how? I’m open to ideas. 🙂
Wow. I have never felt so seen with this article. I’ve had my cortisol checked before and they noted that throughout the day, it remained high and didn’t naturally decline as it should at night. I don’t think I’ve had anything done since then and it’s so incredibly frustrating. I would love to know what you would use to treat it to help if nothing is working? My doctor simply said to do less and to try not to stress out, which is impossible as a wife, mother and entrepreneur.
Elevated nighttime cortisol that doesn’t drop is exactly what disrupts sleep, memory consolidation, and weight regulation. I see it a lot in my patients. Being told to "do less” is not a treatment plan, it is dismissive and uninformed. I wrote a lot about what to do in my first book, The Hormone Cure. Real options include adaptogens (ashwagandha and rhodiola have the most evidence), phosphatidylserine specifically for evening cortisol, magnesium glycinate at night, and addressing blood sugar swings that spike cortisol. I often start with a nighttime ritual like a hot bath with Epsom salt and a breathing exercise to activate the parasympathetic. And a supplement called Cortisol Manager. Consider looking at my essay on what to say to yourself in the 30 minutes before sleeping (here is the link: https://saraszalmd.substack.com/p/10-sentences-that-retrain-your-brain). A practitioner needs to look at YOUR numbers before recommending a stack. The next essay will go deep on this — what actually moves the needle versus what’s just marketing.
I would love for a doctor to check into this further for me. I have struggled with this my entire life and it’s only thru therapy that we figured out that this is probably what caused my issues. But do I ask my primary doctor to order it or is there a specific specialist that deals in cortisol issues?
On whom should order a cortisol test for you… either your primary care clinician or a specialist can order the test, but the issue is how collaborative and open-minded they are. I struggled with high cortisol that I discovered in my 30s, and that made me look at the scientific literature for the first time even though I wasn’t taught to order cortisol tests in my medical training. The two routes most readers have luck with: (1) ask your primary to order a 4-point salivary cortisol test or a DUTCH Complete (the latter is more comprehensive since it captures cortisol patterns plus metabolites and sex hormones), or (2) skip ahead to an endocrinologist or a functional medicine practitioner who works with HPA-axis dysfunction. You can also order it yourself through a direct-to-consumer test like Superpower, Peak Health, or Function Health. Would love to hear from others if they've tested their cortisol, who ordered it, and what they learned. Therapy figuring it out is huge and that context will help whoever you see next.
My endocrinologist looked at me blankly when I used the term "HPA Axis dysfunction". Despite three cortisol tests and the DUTCH complete, a supposed expert in "subclinical adrenal excess" at the Mayo refuses to see me. Where do I find these "HPA Axis dysfunction" providers?
My PCP has managed my BHRT since 2017 and checks my hormones and cortisol levels (4 point) with a salivary test that she sends home twice a year, called ZRT Laboratory
The elephant in the living room is how to find a functional physician who will listen and then order the testing that you recommend for just about anything. I have been on bioidenticals for 30 years and life has been so very good. But even my NP balks and argues if I request additional blood work such as freeT3, diurnal cortisol, TIBC, or even APOe4. She shared with me that she had to quit being a Medicare provider because they began visiting her office and going thru patient files, discarding her blood work orders, as "not indicated." How in the world do we get over that huge hump of ignorance, dismissal, and ego????
Bumping for attention. You named two key problems--scarcity of knowledgeable providers AND lack of coverage for this in the current conceptual medical model.
I appreciate your work so much. Thank you for this information! I am 55 pushing my way through doctor visits and lab requests trying to solve my decade+ of symptoms (with the help of AI). Cortisol is certainly a culprit and scary to see the connection to memory loss.
Thank you for being here, and for being your own advocate. That’s exactly what this work is for. The memory connection is the part that scared me into writing this! Keep learning, growing, and being cognitively flexible. Less pushing, more attracting and finding the like-minded people. And keep us updated on your progress.
I just had the morning cortisol test but will get the one that measures throughout the day. Is there a test to measure plaque build up in the brain? Are there any tests to determine build up and any supplements etc that you can take to prevent further damage
Several tests can look at plaque in the brain. Amyloid PET scans can detect plaque directly but are expensive and not always covered. Blood biomarker tests are newer and more accessible, including the PrecivityAD2 and Quest’s blood-based amyloid tests are available now. MRI can show brain volume changes. For prevention, the strongest evidence is around the boring basics: exercise, sleep (especially deep sleep, when the glymphatic system clears amyloid), reducing inflammaging, and keeping cortisol regulated — which closes the loop on why this matters.
I am completing my next post about the "what next." I hope to post it tomorrow morning. Appreciate your question!
I have been so fatigued. I am seeing a direct care DO and just did the saliva test for the 24 hour cortisol and the estrogen and DHEA. I was so low on most all of the tests. Finally validated for feeling like I was dying. I came across the article. So excellent.
I'm spinning my wheels educating my GP, my endocrinologist, my gynecologist, a PT, and being denied prior authorizations to see specialists (it's a wild guess if those specialists can help). Functional/Integrative Medicine doctors are private pay and still don't get it, and have caused iatrogenic harm so I'm reluctant to spend thousands more with them. I've bought all the supplements and HRT doesn't move the needle.
I've done all the cortisol tests, the DUTCH, sequenced my full genome. Yes, your writing resonates. What's the solution? Where are the helpers?
This resonates with me very much. I'm in the early stages of questioning why I am feeling everything you described in your article. Eager for some next steps direction!
Is it just me or have any of you been handed it’s your thyroid, you have “hypothyroidism”Every doctor uses that as the excuse for all the symptoms that could just as well be adrenal fatigue also. Can you suffer from both?
Wow. Thank you. I am almost 56. I have Hashimoto’s. I had adenomyosis and eventually had a radical hysterectomy two years ago. I am on HRT (estrodial patch - no progesterone anymore) and levothyroxine. I, too, would love to know how to find practitioner(s) in my area that see these connections and the science. My current ND has provided an “adrenal supplement” when she’s thought it prudent (no testing), but I never noticed any difference or understood the science of why. Your article has opened my eyes. Do you know if the recent women’s health providers, like Midi, look at, understand, or treat patients for what you discuss here?
Thank you for the info. It is all very scary, especially the memory connection. I would like to know a list of doctors per state and a list of herbs/ vitamins that would be beneficial.
How do we find doctors who will actually listen to these concerns and not just tell us to get off the internet?
How to find doctors who will listen to your concerns and not tell you to stop checking Dr. Google... it's a fair question and the one I hear most. A few things that have worked for readers: at Marcus Institute of Integrative Health at Thomas Jefferson University (where I work), all practitioners check and track cortisol. You can also look for functional/integrative MDs through the IFM "Find a Practitioner" directory. Last option is to search for a board-certified endocrinologist who lists adrenal disorders specifically (not just thyroid and diabetes). NPs and PAs in women's health and menopause practices are often more willing to run a 4-point salivary cortisol or DUTCH test than a traditional primary care office. I'm going to dig deeper into how to vet a practitioner in the next essay and in the meantime, it would be great to hear how other readers have found collaborative clinicians. Thanks for your question, Megan.
good point. You could always just forward this article to your current doctor, to gauge their reaction to the information contained within. That would be a good start, methinks
That's actually a great low-stakes first move. Their reaction tells you a lot. If they wave it off, you have your answer. If they engage with it even skeptically you might be able to work with them. Thanks for adding this.
How do we find a reasonably priced doctor to help us figure this out?
And what groups are out there trying to get the medical system changed? I can talk to my doctor, etc. But I think we need a combined voice/body of people to get changes in care made. The information is out there, but we need doctors to come up to speed in order for us to feel safe and know we are getting proper treatment.
The medical system encourages conformity all through medical school and you get punished not rewarded for asking questions the system doesn't like.
And insurance companies, medical schools, hospital systems, medical boards and regulatory agencies are all entwined.
I'm not in the system but have had these conversations with people who are and it's so hard to know how to solve. Because groups of doctors who have the courage to think outside the box are a threat to the pocketbooks of those who made and control big medicine in the first place.
I would love to see a good solution to your question! Perhaps courage and steady refusal to accept the routine dismissals that are inherently part of the current standard of care?
Agree! We need advocacy. Note, I think it was largely due to doctor "influencers" (women gynecologists and urologists who researched, wrote books, and used social media) that lobbied to change the "black box" warning on HRT. There is a precedent.
Totally agree there are many female doctors (and even some male) advocating for change. I love that and am grateful.
I often wonder how can I make a meaningful difference here too? I agree I can push my own doctor, talk about this with friends…but I also want to do more - make a bigger impact. But how? I’m open to ideas. 🙂
Wow. I have never felt so seen with this article. I’ve had my cortisol checked before and they noted that throughout the day, it remained high and didn’t naturally decline as it should at night. I don’t think I’ve had anything done since then and it’s so incredibly frustrating. I would love to know what you would use to treat it to help if nothing is working? My doctor simply said to do less and to try not to stress out, which is impossible as a wife, mother and entrepreneur.
Elevated nighttime cortisol that doesn’t drop is exactly what disrupts sleep, memory consolidation, and weight regulation. I see it a lot in my patients. Being told to "do less” is not a treatment plan, it is dismissive and uninformed. I wrote a lot about what to do in my first book, The Hormone Cure. Real options include adaptogens (ashwagandha and rhodiola have the most evidence), phosphatidylserine specifically for evening cortisol, magnesium glycinate at night, and addressing blood sugar swings that spike cortisol. I often start with a nighttime ritual like a hot bath with Epsom salt and a breathing exercise to activate the parasympathetic. And a supplement called Cortisol Manager. Consider looking at my essay on what to say to yourself in the 30 minutes before sleeping (here is the link: https://saraszalmd.substack.com/p/10-sentences-that-retrain-your-brain). A practitioner needs to look at YOUR numbers before recommending a stack. The next essay will go deep on this — what actually moves the needle versus what’s just marketing.
I would love for a doctor to check into this further for me. I have struggled with this my entire life and it’s only thru therapy that we figured out that this is probably what caused my issues. But do I ask my primary doctor to order it or is there a specific specialist that deals in cortisol issues?
On whom should order a cortisol test for you… either your primary care clinician or a specialist can order the test, but the issue is how collaborative and open-minded they are. I struggled with high cortisol that I discovered in my 30s, and that made me look at the scientific literature for the first time even though I wasn’t taught to order cortisol tests in my medical training. The two routes most readers have luck with: (1) ask your primary to order a 4-point salivary cortisol test or a DUTCH Complete (the latter is more comprehensive since it captures cortisol patterns plus metabolites and sex hormones), or (2) skip ahead to an endocrinologist or a functional medicine practitioner who works with HPA-axis dysfunction. You can also order it yourself through a direct-to-consumer test like Superpower, Peak Health, or Function Health. Would love to hear from others if they've tested their cortisol, who ordered it, and what they learned. Therapy figuring it out is huge and that context will help whoever you see next.
My endocrinologist looked at me blankly when I used the term "HPA Axis dysfunction". Despite three cortisol tests and the DUTCH complete, a supposed expert in "subclinical adrenal excess" at the Mayo refuses to see me. Where do I find these "HPA Axis dysfunction" providers?
My PCP has managed my BHRT since 2017 and checks my hormones and cortisol levels (4 point) with a salivary test that she sends home twice a year, called ZRT Laboratory
The elephant in the living room is how to find a functional physician who will listen and then order the testing that you recommend for just about anything. I have been on bioidenticals for 30 years and life has been so very good. But even my NP balks and argues if I request additional blood work such as freeT3, diurnal cortisol, TIBC, or even APOe4. She shared with me that she had to quit being a Medicare provider because they began visiting her office and going thru patient files, discarding her blood work orders, as "not indicated." How in the world do we get over that huge hump of ignorance, dismissal, and ego????
Bumping for attention. You named two key problems--scarcity of knowledgeable providers AND lack of coverage for this in the current conceptual medical model.
I appreciate your work so much. Thank you for this information! I am 55 pushing my way through doctor visits and lab requests trying to solve my decade+ of symptoms (with the help of AI). Cortisol is certainly a culprit and scary to see the connection to memory loss.
Thank you for being here, and for being your own advocate. That’s exactly what this work is for. The memory connection is the part that scared me into writing this! Keep learning, growing, and being cognitively flexible. Less pushing, more attracting and finding the like-minded people. And keep us updated on your progress.
This is both enlightening and terrifying at the same time. What are the treatment and/or lifestyle options to address this?
Coming next! And I've written a few books about what to do, including my first book and NYT bestseller, The Hormone Cure :)
ok, great thank you! I will check them out.
I just had the morning cortisol test but will get the one that measures throughout the day. Is there a test to measure plaque build up in the brain? Are there any tests to determine build up and any supplements etc that you can take to prevent further damage
Several tests can look at plaque in the brain. Amyloid PET scans can detect plaque directly but are expensive and not always covered. Blood biomarker tests are newer and more accessible, including the PrecivityAD2 and Quest’s blood-based amyloid tests are available now. MRI can show brain volume changes. For prevention, the strongest evidence is around the boring basics: exercise, sleep (especially deep sleep, when the glymphatic system clears amyloid), reducing inflammaging, and keeping cortisol regulated — which closes the loop on why this matters.
I am completing my next post about the "what next." I hope to post it tomorrow morning. Appreciate your question!
I have been so fatigued. I am seeing a direct care DO and just did the saliva test for the 24 hour cortisol and the estrogen and DHEA. I was so low on most all of the tests. Finally validated for feeling like I was dying. I came across the article. So excellent.
Is there actually a solution?
I'm spinning my wheels educating my GP, my endocrinologist, my gynecologist, a PT, and being denied prior authorizations to see specialists (it's a wild guess if those specialists can help). Functional/Integrative Medicine doctors are private pay and still don't get it, and have caused iatrogenic harm so I'm reluctant to spend thousands more with them. I've bought all the supplements and HRT doesn't move the needle.
I've done all the cortisol tests, the DUTCH, sequenced my full genome. Yes, your writing resonates. What's the solution? Where are the helpers?
What test do you suggest running?
And there are many great supplements to support HPA axis, adrenals and brain. What to you suggest?
This resonates with me very much. I'm in the early stages of questioning why I am feeling everything you described in your article. Eager for some next steps direction!
Is it just me or have any of you been handed it’s your thyroid, you have “hypothyroidism”Every doctor uses that as the excuse for all the symptoms that could just as well be adrenal fatigue also. Can you suffer from both?
Wow. Thank you. I am almost 56. I have Hashimoto’s. I had adenomyosis and eventually had a radical hysterectomy two years ago. I am on HRT (estrodial patch - no progesterone anymore) and levothyroxine. I, too, would love to know how to find practitioner(s) in my area that see these connections and the science. My current ND has provided an “adrenal supplement” when she’s thought it prudent (no testing), but I never noticed any difference or understood the science of why. Your article has opened my eyes. Do you know if the recent women’s health providers, like Midi, look at, understand, or treat patients for what you discuss here?
Thank you for the info. It is all very scary, especially the memory connection. I would like to know a list of doctors per state and a list of herbs/ vitamins that would be beneficial.
This is extremely valuable information — thank you for sharing it! I’m wondering what the treatment for adrenal fatigue would look like.