Low cortisol in women and men: what differs and what does not

Low cortisol is the same condition in women and men. The core symptoms are the same, and so are the tests. A few things do differ: who is diagnosed more often, some symptoms and causes tied to sex hormones, and how estrogen and pregnancy change a blood result. This page covers those differences and sends you to the main pages for the rest.

If you have an adrenal condition or take a steroid medicine and you have repeated vomiting, severe weakness or fainting, call 911 or go to the emergency room. See adrenal crisis.

Cortisol AM and PM

A morning result and a later one, because cortisol changes through the day. Follow the times on your lab order.

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Not for emergencies. If you have repeated vomiting, severe weakness or fainting, get urgent care instead of ordering a test. If you take a steroid medicine or an estrogen-containing medicine, ask your prescriber how it affects results.

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Who is diagnosed

More women than men. In a 2014 study of hospital admissions in New South Wales, Australia, 62.5% of 824 adults treated for an adrenal crisis were women. The authors say this may reflect how common adrenal insufficiency is in the population rather than a difference in risk of crisis between the sexes. In a Polish clinic’s group of 60 people with primary adrenal insufficiency, 48 were women. A 2025 paper says primary adrenal insufficiency is more common in females, with its peak in the reproductive years. The 2014 paper gives the likely reason: autoimmune disease is the most common cause, and autoimmune disease is more common in women.

In men the evidence is thinner. A 2026 study of 435 adults with pituitary disorders (236 of them men) looked at who had central adrenal insufficiency, where the pituitary doesn’t send enough signal. Male sex was associated with it, but the result did not reach statistical significance, and the authors say it needs confirming in a study built to test it. Treat that as a hint, not a finding.

Symptoms in women

The common symptoms are long-lasting fatigue, muscle weakness, loss of appetite, weight loss and abdominal pain. NIDDK adds irregular or absent menstrual periods and loss of interest in sex to the list.

A 2023 review links low energy and a lack of libido in women to a shortage of adrenal androgens, a group of adrenal hormones. It also says primary ovarian insufficiency, meaning menopause before age 40, is more common in women with primary adrenal insufficiency than in people without autoimmune disease. The review cites a Norwegian group of women with primary adrenal insufficiency in which 10.2% had been diagnosed with it. Missed periods in a woman with adrenal symptoms therefore have more than one possible source, and a clinician has to sort them out. See low cortisol symptoms for the full list.

Symptoms in men

Men share the core symptoms. NIDDK lists loss of interest in sex. The 2023 review says erectile dysfunction in men is associated with a shortage of adrenal androgens. Libido and erections have many other causes, so they are weak clues on their own. For the testosterone side, see cortisol and testosterone.

In men, one genetic cause deserves a mention. The review lists X-linked adrenoleukodystrophy among the inherited causes of primary adrenal insufficiency. It says that in men whose antibody test for autoimmune disease is negative, doctors check a blood marker to rule it out. See causes of low cortisol.

Does normal cortisol differ by sex?

A little. A 2024 review says:

• Men have higher cortisol output, with a higher mean peak, nadir and morning rise than women before menopause.
• In women the peak rises gradually with age, but not in men, so after menopause the difference is gone.
• Studies across the menstrual cycle disagree. Some find no difference in saliva cortisol. Others find higher circulating levels in the follicular phase, the first half of the cycle.
• Sex-specific normal responses to cortisol testing are not yet defined.

Because sex-specific normal responses are not defined, the range printed on your own lab report is the one to use. Published ranges by sex and time of day are on normal cortisol levels for women and men.

How estrogen and pregnancy change a blood result

This difference only affects women. Most cortisol in blood is attached to a carrier protein. The 2024 review says oral estrogens, and the high estrogen of pregnancy, raise that protein and so give a falsely high total cortisol. A 2024 study of 41 healthy women on combined oral contraceptives and 46 healthy women not using exogenous estrogens found that after a stimulation test, plasma cortisol was higher in the pill group, and the authors warn that women with adrenal insufficiency on the pill are at risk of an apparently normal result. Saliva cortisol and cortisone were much less affected.

Do not change a pill or hormone treatment because of a test. Ask your prescriber. See birth control and cortisol results and cortisol in pregnancy.

Common questions

What are the effects of low cortisol in women?

The same as in men (fatigue, weakness, poor appetite, weight loss, belly pain, low blood pressure on standing), plus possible period changes and lower interest in sex. Pregnancy can add risk if adrenal insufficiency is already present, as the pregnancy page explains.

Is low cortisol more dangerous for one sex?

We found no approved source showing a difference in risk. The 2014 hospital study suggests the larger share of women reflects how many women have the condition. What matters more is whether the condition is known and treated, and whether warning signs are acted on.

Can men and women use the same tests?

Yes. Clinicians use a blood cortisol, often with ACTH, then a stimulation test if the result isn’t clear. A single cortisol result can’t diagnose adrenal insufficiency or rule it out. See low cortisol.

If you are thinking about ordering a test

A morning cortisol with a later sample can give you a number to bring to a clinician, if you have no emergency signs. It is a first look and not a work-up. The seller’s page for its AM and PM test is unclear about when the second sample is taken and doesn’t say whether it is one visit or two, so follow the timing on your lab order and check it before you order. Tell your prescriber about any steroid or estrogen-containing medicine before you test, and don’t stop or change a medicine for a test.