Metabolized Cortisol (THF+THE)

Optimal Result: 2750 - 6500 ng/mg.

Metabolized Cortisol is the sum of a-THF, b-THF and b-THE (the most abundant cortisol metabolites).

While free cortisol is the best assessment for tissue levels of cortisol, it only represents 1-3% of the total produced. The majority of cortisol results in a urine metabolite and the total of these metabolites best represents the total glandular output (=from glands) of cortisol for the day.

Cortisol is metabolized into 5-alpha-Tetrahydrocortisol (5a-THF) and 5-beta-Tetrahydrocortisol (5b-THF) and cortisone is metabolized into 5-beta-Tetrahydrocortisone (5b-THE).

Since all production and output originally started as cortisol, the cortisone metabolites are added to the cortisol metabolites when evaluating the “total metabolized cortisol”. It essentially reflects how much cortisol was made in the body and has been processed out through the liver, into the kidney, and onto the DUTCH Test.

The amount of cortisol produced and the amount of free cortisol available can be very different in some scenarios. Measuring both allows for insight into the rate of cortisol clearance/metabolism. For example, higher levels of metabolized cortisol (compared to free cortisol) are often seen in obesity where adipose (=fat) tissue is likely pulling cortisol from its binding protein and allowing for metabolism and clearance. The adrenal gland has to keep up with this cortisol sequestering and excretion, so cortisol production is often quite high (as seen in the levels of metabolized cortisol) even though free cortisol does not correlate positively with adipose tissue or BMI.

The metabolized cortisol and free cortisol markers are important to use both together and separately in order to tell a more detailed story about the patient. Metabolized cortisol answers the question of how much cortisol is being made in total and clearing through the liver. Whereas free-cortisol results tell us how much cortisol is free to bind to receptors and allows for assessment of the circadian rhythm.

-------------------------------------------------------------------------------------------

Correlating it with other markers:

-------------------------------------------------------------------------------------------

Metabolized cortisol → elevated

24hr Free cortisol → relatively low

This implies increased cortisol clearance. You see this a lot in people with obesity, people with too much thyroid medication (as it upregulates cortisol metabolism).  

-------------------------------------------------------------------------------------------

Metabolized cortisol → elevated

24hr Free cortisol → elevated

Cortisol throughout the day → elevated

Cortisol at night → elevated 

If cortisol is elevated all day, you have to start thinking about Cushing’s disease or potentially adrenal/pituitary tumors that are pushing out all that cortisol. 

-------------------------------------------------------------------------------------------

Metabolized cortisol → elevated

24hr Free cortisol → elevated

Cortisol throughout the day → elevated

Cortisol at night → normal (going back down)

If cortisol is going back down at the end of the day where it is supposed to be the above (Cushing’s disease, etc)  is not likely the case. In a case like this it seems that the HPA axis is really turned on ‘high’. The total of free cortisol would be very high, especially when they wake up and in the early parts of the day. The metabolites would confirm the story as they would be really high as well. 

-------------------------------------------------------------------------------------------

Metabolic preference:

Cortisol, which is the active hormone, can convert into cortisone, the inactive form. The Dutch report shows you which one you make more of by looking at whether cortisol metabolites (aTHF, bTHF) or cortisone metabolites (bTHE) are made more (compared to what is normal). Balance between the two is usually preferred, but making more cortisol than cortisone is sometimes good to help give you enough cortisol if your levels are low. In some cases this index is important for overall understanding of why symptoms of high or low cortisol may be predominating. In other cases this index is not critically important.

Is cortisol being broken down to its active form (cortisol metabolites) or to its inactive form (cortisone metabolites)?

- If cortisol is low, ideally its leaning towards cortisol metabolites: THF

- If cortisol is high, ideally it's not leaning against cortisol as it could exacerbate a high cortisol situation potentially.

- A preference for cortisone metabolites might be preferable as it is keeping cortisol levels from becoming even higher.

What does it mean if your Metabolized Cortisol (THF+THE) result is too high?

High free cortisol (and high free cortisone) and high metabolized cortisol:

In this situation there is an abundance of cortisol.

General signs and symptoms of too much cortisol include:

- weight gain, mostly around the midsection and upper back

- weight gain and rounding of the face

- acne

- thinning skin

- easy bruising

- flushed face

- slowed healing

- muscle weakness

- severe fatigue

- irritability

- difficulty concentrating

- high blood pressure

- headache

Low free cortisol and high metabolized cortisol:

This is a picture of elevated cortisol metabolism and low circulating cortisol.

This can be seen in people with:

- High thyroid

- Obesity (high insulin)

- Long-term stress (high cortisol over long periods of time)

- Long-term glucocorticoid use

Higher levels of metabolized cortisol (compared to free cortisol) are often seen in obesity where adipose tissue is likely pulling cortisol from its binding protein and allowing for metabolism and clearance. The adrenal gland has to keep up with this cortisol sequestering and excretion, so cortisol production is often quite high (as seen in the levels of metabolized cortisol) even though free cortisol does not correlate positively with adipose tissue or BMI. These people are often misdiagnosed as having low cortisol production when only free cortisol is measured.

Increased cortisol clearance may also be seen in hyperthyroidism and is suspected to be part of the chronic fatigue story as well.

What does it mean if your Metabolized Cortisol (THF+THE) result is too low?

High free cortisol and low metabolized cortisol:

==> Slow cortisol clearance

Possible due to hypothyroidism:

Lower Thyroid (free T4) leads to lower metabolized cortisol (THF, THE).

When the thyroid slows down the clearance (or metabolism) of cortisol through the liver slows down. As a result, free cortisol starts to increase and may show up elevated.

Low free cortisol and low metabolized cortisol:

Not a lot of cortisol is being produced.

Some of the possible symptoms might include:

- Extreme fatigue

- Weight loss and decreased appetite

- Darkening of your skin (hyperpigmentation)

- Low blood pressure, even fainting

- Salt craving

- Low blood sugar (hypoglycemia)

- Nausea, diarrhea or vomiting (gastrointestinal symptoms)

- Abdominal pain

- Muscle or joint pains

- Irritability

- Depression or other behavioral symptoms

- Body hair loss or sexual dysfunction in women

Frequently asked questions

Unlock Your Health Journey with Healthmatters.io! Ever wished for a one-stop digital health haven for all your lab tests? Look no further! Healthmatters.io is your personalized health dashboard, bringing together test reports from any lab. Say goodbye to scattered results—organize and centralize your lab data effortlessly. Dive into the details of each biomarker and gain insights into the meaning behind your medical test data.

Join the community of thousands who've transformed the way they understand their lab results. Experience the joy of having all your lab data neatly organized, regardless of where or when the tests were done.

For our professional users, Healthmatters.io is a game-changer. Revel in the intuitive tools that not only streamline analysis but also save valuable time when delving into your client's lab report history. It's not just a dashboard; it's your gateway to a smarter, more informed health journey!

Healthmatters.io personal account provides in-depth research on 4000+ biomarkers, including information and suggestions for test panels such as, but not limited to:

  • The GI Effects® Comprehensive Stool Profile,
  • GI-MAP,
  • The NutrEval FMV®,
  • The ION Profile,
  • Amino Acids Profile,
  • Dried Urine Test for Comprehensive Hormones (DUTCH),
  • Organic Acids Test,
  • Organix Comprehensive Profile,
  • Toxic Metals,
  • Complete Blood Count (CBC),
  • Metabolic panel,
  • Thyroid panel,
  • Lipid Panel,
  • Urinalysis,
  • And many, many more.

You can combine all test reports inside your Healthmatters account and keep them in one place. It gives you an excellent overview of all your health data. Once you retest, you can add new results and compare them.

If you are still determining whether Healthmatters support your lab results, the rule is that if you can test it, you can upload it to Healthmatters.

While we do talk about popular labs, we welcome reports from lots of other places too. It's as simple as this: if you can get a test done, you can upload it to Healthmatters. We can interpret results from any lab out there. If laboratories can analyze it, we can interpret it.

Still on the hunt for a specific biomarker? Just tell us, and we'll add it to our database. Anything from blood, urine, saliva, or stool can be uploaded, understood, and tracked with your Healthmatters account!

There are two ways to add your test reports to your healthmatters.io account. One option is to input the data using the data entry forms. The other method is to utilize our "Data entry service."

Our data entry forms offer an easy, fast, and free way for you to input the reports yourself. Self-entry allows you to add an unlimited number of reports at no cost. We make the self-entry process user-friendly, providing dozens of templates that pre-populate the most popular laboratory panels and offering instant feedback on entered values.

For those who prefer assistance, we offer a "Data entry service" to help you input your data. Simply attach an image or file of your lab test results, and a qualified team member from our data entry team will add the results for you. We support various file types, including PDFs, JPGs, or Excel. This service is particularly useful if you have many reports to upload or if you're too busy to handle the data entry yourself.

Our special data entry service makes it easy to add your results to your private dashboard. Just attach an image or a file of your lab test results, and our skilled data entry team will do the work for you. It's all done by humans, ensuring that your data is entered accurately and with personal care for each client.

Depending on your account, the data entry service can be included for free or come at an additional cost of $15 per report.

For users on the Complete monthly plan, the first report is entered free of charge, and each additional report incurs a fee of $15.

Unlimited account holders enjoy the entry of ten reports without charge. Subsequent reports are subject to a $15 fee per report.

Additionally, users on the Complete plan can upgrade to a yearly subscription from the account settings. The annual subscription includes a data entry service for five reports.

The Unlimited plan is a one-time purchase for $250, and it covers your account for a lifetime with no additional payments.

For the Complete plan, the cost is $15 per month. You have the flexibility to cancel it anytime through your account settings, ensuring no further payments. To avoid charges, remember to cancel at least a day before the renewal date. Once canceled, the subscription remains active until the end of the current billing cycle.

Additionally, you can upgrade to the yearly Advanced plan from within your account. The annual cost is $79, and it comes with a data entry service for five reports.

You can always upgrade to a lifetime version with a prorated price from a monthly or yearly subscription.

Simply log in and navigate to your account settings to cancel your subscription. Scroll down to locate the 'Cancel' button at the bottom of the page. Ensure you cancel at least one day before the renewal date to prevent any charges. Once cancellation is requested, the subscription remains active until the conclusion of the current billing cycle.

Unlocking the insights from your lab tests has never been this intuitive! We've crafted multiple ways for you to navigate your data, whether you're glancing at a single report or delving into a treasure trove of testing data.

1. Graph View:

Dive into a visual journey with our biomarker graphs, showcasing over 40 data points. Combining years of results unveils trends, empowering you to make informed decisions. Our visualization tools make it a breeze to compare and understand changes over time, even if your results are from different labs. A search function and filters simplify the exploration of extensive data, allowing you to focus on what needs attention.

2. All Tests View

Get a quick grasp of your test reports in minutes! Explore neatly organized reports on a timeline, highlighting crucial details like dates, critical results, and lab/panel names. Each report opens up to reveal in-depth descriptions and additional recommendations for each biomarker. The history of previous results is just a click away, and you can download a comprehensive report for deeper insights. Color-coded and user-friendly, it's designed for easy reading, understanding, and navigation.

3. Table View:

For a holistic view of all biomarkers side by side, our table view is your go-to. Results are neatly displayed in a categorized and dated table, ideal for those with an extensive test history. Utilize sorting, filters, and color-coding to enhance your analysis and gain extra insights.

Experience the power of clear, organized data visualization with Healthmatters.io — your key to understanding and taking charge of your health journey!

Yes, you can download information from your account. We can compile your labs into a CSV file. To download all your labs, you can go to Account Settings, and at the bottom of the page, you will find a link to download your information.

Yes, you can print your report. To do so, navigate to "All tests" and open the report you wish to print. You'll find a print button in the right corner of the report. Click on it, and your browser's print window will open. If you prefer to print in a bigger typeface, adjust the scale using the print window settings.

A personal account is all about keeping your own lab test results in check. It's just for you and your personal use.

The professional or business account is designed for health professionals who wish to track and organize their clients' laboratory results.

Use promo code to save 10% off any plan.


We implement proven measures to keep your data safe.

At HealthMatters, we're committed to maintaining the security and confidentiality of your personal information. We've put industry-leading security standards in place to help protect against the loss, misuse, or alteration of the information under our control. We use procedural, physical, and electronic security methods designed to prevent unauthorized people from getting access to this information. Our internal code of conduct adds additional privacy protection. All data is backed up multiple times a day and encrypted using SSL certificates. See our Privacy Policy for more details.