Tetrahydrocortisol (THF)

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What is Tetrahydrocortisol (THF)?

Tetrahydrocortisol (THF) is a metabolite of cortisol, the body’s main stress hormone produced by the adrenal glands. After cortisol circulates through your body and performs its functions—regulating energy, blood sugar, and the stress response—it is broken down in the liver into several metabolites, including THF and tetrahydrocortisone (THE).

Measuring THF in urine provides insight into how efficiently your body is metabolizing and clearing cortisol, offering a more complete picture of adrenal activity and stress hormone balance over time.


Why is THF important?

Cortisol metabolism doesn’t end when cortisol is released—its downstream metabolites like THF reflect how your body processes stress hormones through the liver and kidneys.

Evaluating THF helps identify:

  • The overall cortisol load over a 24-hour period

  • Whether the adrenal glands are producing too much or too little cortisol

  • How well the liver enzymes (5b-reductase, 11b-HSD) are converting cortisol into its inactive and excreted forms

When interpreted alongside tetrahydrocortisone (THE) and cortisone (E), THF provides a deeper view of adrenal and metabolic health.


Key takeaway

Tetrahydrocortisol (THF) is a key urinary marker of cortisol metabolism and adrenal activity. Elevated levels can point to chronic stress or adrenal overactivation, while low levels may reflect adrenal fatigue or reduced cortisol output.

Interpreting THF alongside tetrahydrocortisone (THE), cortisol, and cortisone (E) helps provide a more complete understanding of how your body produces, uses, and clears stress hormones—offering valuable insight into your overall stress resilience and adrenal health.

What does it mean if your Tetrahydrocortisol (THF) result is too high?

When Tetrahydrocortisol is elevated

High THF levels typically indicate increased cortisol turnover—the body is producing and metabolizing more cortisol than usual. This is often a marker of an overactive stress response or elevated adrenal output.

Possible causes:

  • Chronic physical or emotional stress

  • Early stages of adrenal overactivation (“wired but tired”)

  • Inflammation or infection

  • Excessive exercise or sleep deprivation

  • High caffeine or stimulant use

  • Corticosteroid medication use

Possible symptoms:

  • Anxiety, irritability, or restlessness

  • Weight gain (especially around the abdomen)

  • Trouble sleeping or staying asleep

  • Fatigue despite feeling “wired”

  • Sugar cravings or high blood pressure

Supportive measures:

  • Prioritize adequate rest and relaxation

  • Reduce caffeine and late-day screen time

  • Include magnesium, B-vitamins, and adaptogenic herbs (ashwagandha, rhodiola)

  • Focus on balanced nutrition and blood sugar control

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What does it mean if your Tetrahydrocortisol (THF) result is too low?

When Tetrahydrocortisol is low

Low THF levels may suggest reduced cortisol production, adrenal exhaustion, or slowed metabolism of cortisol in the liver. This pattern is often seen after prolonged stress or in individuals experiencing adrenal fatigue or chronic burnout.

Possible causes:

  • Late-stage adrenal dysfunction or fatigue

  • Hypopituitarism (low ACTH stimulation)

  • Chronic illness or inflammation

  • Nutrient deficiencies (B-vitamins, zinc, magnesium)

  • Long-term corticosteroid use suppressing adrenal function

Possible symptoms:

  • Persistent fatigue or low energy

  • Difficulty handling stress

  • Low mood, apathy, or brain fog

  • Low blood pressure or dizziness

  • Cravings for salt or stimulants

Supportive measures:

  • Ensure consistent sleep and recovery time

  • Eat balanced meals with adequate protein and complex carbs

  • Support adrenal recovery with vitamin C, electrolytes, and gentle movement

  • Work with your healthcare provider to assess full adrenal function

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