How HPA Axis Testing Illuminates Mental Health
In recent years, there has been growing interest in how our hormones—especially stress hormones—shape our mental and emotional wellbeing. At the center of this conversation is the hypothalamic-pituitary-adrenal (HPA) axis, the body’s central stress response system. Functional medicine approaches, such as the DUTCH test (Dried Urine Test for Comprehensive Hormones), offer detailed insights into how this system is functioning over time. Understanding the HPA axis can provide valuable context for a wide range of psychiatric symptoms, from anxiety and depression to burnout and insomnia.
Understanding the HPA Axis.
The HPA axis connects three key players:
The hypothalamus, which senses stress and signals the pituitary gland
The pituitary gland, which signals the adrenal glands
The adrenal glands, which release cortisol, our primary stress hormone
Cortisol follows a daily rhythm—rising sharply in the morning to help us wake and engage with the day, then gradually falling to its lowest levels at night to allow for rest and recovery. This is known as the cortisol curve or diurnal rhythm.
When the HPA axis is dysregulated—due to chronic stress, trauma, inflammation, or other factors—it can lead to a flattened or blunted cortisol curve, or abnormal peaks and valleys that disrupt both physical and psychological equilibrium.
Why Functional Testing Matters.
Conventional labs may provide a one-time snapshot of cortisol (usually in the morning), but this often misses the nuance of how cortisol fluctuates throughout the day. Functional medicine tools like the DUTCH test or salivary cortisol panels assess cortisol at multiple points across a 24-hour period. This provides a more complete picture of stress adaptation over time.
Key patterns identified might include:
Elevated morning cortisol (associated with anxiety, agitation, insomnia)
Blunted cortisol awakening response (linked to burnout, depression, fatigue)
High evening cortisol (associated with sleep disruption and overactivation)
Low total cortisol (suggesting adrenal fatigue or exhaustion phase of stress)
Psychiatric Implications of HPA Axis Dysfunction.
Numerous studies link HPA axis dysregulation to common psychiatric conditions:
Depression: Often associated with a blunted diurnal cortisol rhythm or elevated evening cortisol
Anxiety disorders: May show elevated cortisol throughout the day or in response to minor stressors
PTSD and trauma: Frequently marked by a disrupted cortisol awakening response and increased sensitivity to stress
Chronic fatigue and burnout: Typically exhibit low total cortisol output or flattened curves
ADHD and insomnia: Sometimes related to circadian misalignment or abnormal peaks of cortisol at night
These dysfunctions don’t just mirror psychiatric symptoms—they often amplify them by impairing sleep, mood regulation, focus, and energy metabolism.
Treatment Considerations.
Addressing HPA axis dysfunction is not about “fixing” cortisol with a pill. Instead, it's about supporting the body's natural rhythm and stress adaptability. Common functional medicine approaches include:
Lifestyle and Behavioral Interventions
Prioritize sleep hygiene, especially winding down in the evening to reduce nighttime cortisol
Incorporate stress-reduction practices like meditation, breathwork, nature exposure, and trauma-informed therapies
Use consistent routines to re-entrain the circadian rhythm
Targeted Nutraceuticals
Phosphatidylserine: May help reduce nighttime cortisol
Ashwagandha and Rhodiola: Adaptogens that modulate stress responses
B vitamins, magnesium, and vitamin C: Support adrenal function and nervous system resilience
L-theanine and GABA: Promote calmness and mitigate excitatory stress responses
Nutritional Support
Focus on stable blood sugar through regular, balanced meals
Minimize caffeine and alcohol, which can disrupt cortisol regulation
Include anti-inflammatory and nutrient-dense foods to reduce physiological stress
Psychotherapy and Somatic Practices
Address unresolved trauma and chronic stress through trauma-informed care
Consider modalities like IFS, somatic experiencing, or EMDR, which help regulate nervous system patterns linked to HPA axis function
Conclusion.
The HPA axis acts as a bridge between the mind and body. Through functional testing like the DUTCH test, we can better understand how stress physiology may be silently influencing psychological symptoms. This opens the door to more personalized, root-cause approaches that move beyond symptom suppression toward true regulation and resilience.
Whether you're a clinician or an individual seeking answers, exploring the HPA axis can be a powerful step in restoring balance across the entire human system—physically, emotionally, and mentally.
