May 20, 2026

Normal Cortisol Levels by Age and Sex: What Your Numbers Should Be

Reference ranges for serum, salivary, and 24-hour urinary cortisol broken down by age decade and sex. Includes pediatric ranges, adult ranges by life stage, pregnancy adjustments, and how lab variability changes what counts as normal for you.

Quick Summary

Cortisol reference ranges are wide because the hormone follows a daily rhythm, varies by age and sex, and differs depending on whether your lab measures it in blood, saliva, or urine. For a healthy adult, morning serum cortisol typically falls between 5 and 25 micrograms per deciliter, evening serum cortisol drops to under 10, and 24-hour urinary free cortisol stays under 100 micrograms per day. Children, pregnant women, and adults over 70 have meaningfully different ranges, and your result needs to be compared to the reference interval your specific lab uses.

You got your cortisol result back. Your number says 14, or 22, or 4.8, and you have no idea whether that is normal for someone your age or sex. The lab report shows a range, but you have read that women run higher than men, that levels drop with age, that postmenopausal women are different, and that the morning peak makes the time you tested matter more than the number itself.

Here is the problem with the standard reference range. Most labs report a single adult interval for cortisol, usually built from a small reference population in their region. That single range often spans more than a five-fold difference between the low and high end, treats a 22-year-old and an 80-year-old the same, and rarely distinguishes between pre and postmenopausal women. Studies show meaningful age- and sex-related shifts that the single number on your lab slip cannot capture.

This guide breaks down what a normal cortisol level looks like for your specific situation: by age decade, by sex, in pregnancy, and across the three sample types labs commonly use. It is a reference page, not a treatment plan. Use it to read your result correctly, then act on the right next step.

Why Reference Ranges Vary So Much Between Labs

Before any numbers, it helps to understand why the cortisol range on your lab report may differ from what you read here.

Cortisol assays do not all measure the same thing. Older immunoassays cross-react with other steroid metabolites and tend to read higher than modern liquid chromatography mass spectrometry (LC-MS/MS) methods. A 2017 review in Annals of Clinical Biochemistry showed that bias between assay methods can exceed 30 percent at clinically relevant cortisol concentrations [1].

Reference populations are local. A reference interval established in a Chinese hospital using IMMULITE 2000 [2] will not match a U.S. reference built from LC-MS/MS testing, even though both are technically correct for their setting.

Sample handling changes the number. Salivary cortisol stays stable at room temperature for several days, but serum cortisol can drift if not centrifuged and frozen quickly. Late-night samples are particularly sensitive to collection error.

The practical implication: always read your number against the reference range printed on your own lab report, then use age- and sex-aware ranges (like the ones in this guide) to refine the interpretation.

Adult Cortisol Reference Ranges by Time of Day

For comparison context, here are the time-of-day adult reference ranges that apply across most healthy 18- to 65-year-olds. These are the baseline against which the age and sex breakdowns are applied.

These ranges are broadly stable across healthy adults aged 18 to 65 [3]. The age and sex adjustments below sit on top of this scaffold.

Normal Cortisol Levels by Age

Cortisol does not stay constant across the lifespan. Pediatric ranges differ from adult ranges, and the elderly show characteristic shifts that change what counts as normal.

Newborns and Infants (0 to 12 Months)

Cortisol levels in newborns are highly variable in the first days of life. Cord blood cortisol can range from 30 to over 100 mcg/dL, then drops sharply over the first week.

By 1 month, salivary cortisol settles into a measurable diurnal pattern. A 2020 study established reference values for healthy infants aged 0 to 12 months using LC-MS/MS, with morning salivary cortisol ranging roughly 5 to 25 nmol/L by 6 months of age [4].

The cortisol awakening response, the spike in cortisol within 30 minutes of waking, does not fully develop until later in childhood.

Children (2 to 12 Years)

Pediatric reference intervals show morning serum cortisol typically running 5 to 23 mcg/dL in children 4 to 10 years old, similar to adult ranges [2]. Salivary morning cortisol in healthy children clusters around 5 to 20 nmol/L [5].

The diurnal rhythm is clearly established by age 3 and looks adult-like by age 6. Children with disrupted sleep, chronic stress, or pituitary disorders can show flattened rhythms even at otherwise normal absolute levels.

Adolescents (13 to 17 Years)

Puberty briefly raises cortisol output. Morning serum cortisol can run slightly higher in this group, often 7 to 25 mcg/dL, with steeper diurnal decline.

Cortisol awakening response peaks in late adolescence and is most pronounced in girls.

Adults (18 to 49 Years)

This is the population that defines most lab reference ranges. Morning serum cortisol of 5 to 25 mcg/dL, salivary morning cortisol of 5 to 24 nmol/L, and 24-hour urinary free cortisol of 10 to 100 mcg/24h apply.

Within this age band, levels are remarkably stable. A 35-year-old and a 25-year-old should have nearly identical reference intervals.

Older Adults (50 to 70 Years)

Total cortisol exposure across the day, measured as area under the curve, tends to increase modestly with age. The diurnal rhythm begins to flatten: the morning peak is slightly lower, but the evening low is somewhat higher [6].

Practical implication: a bedtime salivary cortisol of 4 to 5 nmol/L might be borderline-high in a 30-year-old and within range for a 65-year-old.

Adults Over 70

The flattening of the diurnal curve becomes more pronounced. Late-night salivary cortisol rises further, and a sex- and age-stratified study published in 2024 in Clinical Chimica Acta documented measurable age-related shifts in cortisol and 16 other steroid metabolites in this group [7].

The cortisol awakening response is blunted, and HPA-axis recovery from a stressor is slower. These shifts are physiologic, not pathologic, but they make the “normal” range broader in this age group.

Normal Cortisol Levels by Sex

Most labs do not sex-stratify cortisol reference intervals. Research suggests they should, particularly across reproductive life stages in women.

Men (Adult, Non-Elderly)

Adult men show stable cortisol patterns from age 18 to about 60. Morning serum cortisol typically falls between 5 and 25 mcg/dL. Diurnal slope is well-preserved.

Acute psychological or physical stress raises cortisol acutely in men, often with a sharper peak and faster return to baseline than women.

Premenopausal Women (18 to 50, Non-Pregnant, Non-Postmenopausal)

Premenopausal women show cortisol levels broadly similar to men, though small differences in the cortisol awakening response are commonly reported. Morning serum cortisol of 5 to 25 mcg/dL applies.

The menstrual cycle modulates cortisol modestly. The luteal phase (the second half of the cycle, after ovulation) tends to show slightly higher overall cortisol exposure than the follicular phase. The difference is usually within the reference range and does not require testing-time adjustment.

Pregnant Women

Pregnancy dramatically alters total cortisol because cortisol-binding globulin (CBG) rises substantially under estrogen influence. By the third trimester, total serum cortisol can be 2 to 3 times pre-pregnancy values, with reference morning serum cortisol of 25 to 50 mcg/dL or higher.

Free cortisol (the biologically active fraction) rises less, roughly 1.5 to 2 fold by late pregnancy.

Diagnostic cortisol testing during pregnancy requires pregnancy-specific reference intervals, ideally measuring salivary cortisol (which reflects free, not bound, cortisol) or 24-hour urinary free cortisol.

Postmenopausal Women

Postmenopausal women show a flatter diurnal cortisol curve, modestly higher evening cortisol, and a blunted cortisol awakening response compared with premenopausal women [6]. A 2019 study in the Journal of Clinical Endocrinology and Metabolism linked elevated cortisol patterns in this group to higher rates of hypertension and metabolic dysfunction [8].

Practical takeaway: a 60-year-old postmenopausal woman with a late-night salivary cortisol of 3 to 4 nmol/L may be in her normal physiologic range. The same number in a 35-year-old would warrant further investigation.

Elderly (Both Sexes, Over 70)

Sex differences in cortisol narrow in the elderly. Both men and women show flattened diurnal patterns and increased total cortisol exposure. The Chinese Clinica Chimica Acta study tracked these shifts using LC-MS/MS quantification of 16 steroid metabolites and found measurable age effects without strong sex divergence in this band [7].

Reference Ranges by Sample Type

Cortisol can be measured four ways, and the right sample depends on the question you are trying to answer.

Serum Cortisol

Measured in a blood draw. Best for morning peak quantification and for confirming abnormal results from other sample types.

Standard adult morning range: 5 to 25 mcg/dL (140 to 690 nmol/L). Standard adult evening range: under 10 mcg/dL (under 275 nmol/L).

Limitation: reflects total cortisol (free plus bound to cortisol-binding globulin), which can read falsely high in pregnancy or with estrogen therapy.

Salivary Cortisol

Measured from saliva collected via a swab or passive drool sample. Reflects free, biologically active cortisol.

Standard adult morning range: 5 to 24 nmol/L. Standard adult bedtime range: under 4 nmol/L.

Best use: detecting late-night cortisol elevation (Cushing screening) or measuring the cortisol awakening response. The CIRCORT database is the most comprehensive published reference for salivary cortisol across populations [9].

24-Hour Urinary Free Cortisol

Measured from a complete 24-hour urine collection. Reflects total free cortisol excretion across the day.

Standard adult range: 10 to 100 mcg/24h (28 to 276 nmol/24h).

Best use: integrating total cortisol exposure across a full day, particularly when screening for Cushing syndrome. Limitation: collection error (missed samples) commonly invalidates the result [10].

Late-Night Salivary Cortisol

A targeted variant of salivary testing, used specifically as a Cushing syndrome screen.

Standard adult bedtime range: under 4 nmol/L (under 145 ng/dL).

Elevated late-night salivary cortisol is one of the most sensitive screens for endogenous hypercortisolism.

When Your Numbers Are Outside the Reference Range

A single out-of-range result rarely settles a diagnosis. Cortisol is exquisitely sensitive to time of day, acute stress, recent caffeine, recent meals, illness, sleep deprivation, and medications.

Morning Cortisol Below 3 mcg/dL (Serum)

Strongly suggestive of adrenal insufficiency. Requires confirmatory testing, typically an ACTH stimulation test. Consult an endocrinologist.

Morning Cortisol Above 25 mcg/dL (Serum)

May reflect acute stress (recent illness, surgery, severe psychological stress), or sustained hypercortisolism. Pregnancy or estrogen therapy can elevate total but not free cortisol. Confirm with a late-night salivary cortisol and 24-hour urinary free cortisol before further workup.

Elevated Late-Night Salivary Cortisol

Suggests loss of the normal nocturnal cortisol nadir. Confirm with a repeat measurement or a 24-hour urinary free cortisol. If persistent, refer for Cushing syndrome evaluation.

Flattened Diurnal Slope

A morning-to-evening cortisol difference smaller than expected, without absolute values outside reference range, can reflect chronic stress, sleep disruption, or aging. Not a stand-alone diagnosis, but worth tracking longitudinally.

How to Test Cortisol Properly

Timing and preparation are as important as the sample type.

For morning serum cortisol: schedule between 6 and 10 AM, fasted, before any caffeine. Recent shift work or jet lag will distort the result.

For salivary cortisol: avoid eating, brushing teeth, or vigorous exercise for 30 minutes before sampling. Multiple-sample protocols (4-point salivary curve) are more informative than single samples.

For 24-hour urinary free cortisol: refrigerate the collection container, void the first morning urine into the toilet to start the clock, and include every void for the next 24 hours. Missed samples invalidate the result.

For diagnostic accuracy, lab choice matters. LC-MS/MS-based assays give more accurate readings than older immunoassays, particularly at the high end and during pregnancy.

The Bottom Line

Normal cortisol depends on three variables that the printed reference range on a single lab slip rarely captures: time of day, age, and sex. A morning serum cortisol of 18 mcg/dL is unremarkable in a 30-year-old man and would be the same in a 70-year-old woman, but the diurnal pattern, response to stress, and clinical interpretation around that number can differ significantly.

Read your result against the reference printed on your own lab report first. Then refine the interpretation using the age- and sex-stratified ranges in this guide. If you are pregnant, postmenopausal, over 70, or under 18, the standard adult range likely does not apply to you cleanly. Re-test before treating anything, ideally using two sample types (a morning serum plus a late-night salivary cortisol is a strong screening combination), and discuss patterns rather than single numbers with your care team.

Test This with Mito

Cortisol is most informative when measured alongside DHEA-S, fasting insulin, thyroid markers, and inflammation markers in a single panel that captures the full HPA-axis and metabolic picture. Mito Health offers several testing options with physician-guided interpretation:

• Mito Core Panel: 100+ biomarkers including 4-point salivary cortisol, DHEA-S, thyroid panel, fasting insulin, glucose, inflammatory markers, and lipid markers in a single comprehensive baseline. Individual testing starts at $349, duo testing at $668.
• Build Your Own panel: select cortisol plus the specific markers you want to track over time. Pricing starts at $39 per marker, useful when you have a recent comprehensive panel and want to re-test specific markers.
• How Mito testing works: walks through sample collection, turnaround time, and how the physician-guided interpretation report is delivered.

For most readers tracking stress, sleep quality, energy issues, or HPA-axis questions, the Mito Core Panel provides the strongest single starting point because cortisol patterns are most readable when paired with DHEA-S, thyroid, and metabolic markers in the same draw. If you already have a recent comprehensive panel and want to follow cortisol over time, Build Your Own targets that gap without re-running everything.

Key Takeaways

• Healthy adult morning serum cortisol falls between 5 and 25 mcg/dL, evening serum drops under 10, and 24-hour urinary free cortisol stays under 100 mcg/day.
• Children, pregnant women, and adults over 70 have meaningfully different reference ranges. The standard adult range does not apply to them.
• Pregnancy raises total cortisol 2 to 3 fold due to cortisol-binding globulin. Free cortisol rises less. Pregnancy-specific ranges are required for diagnosis.
• Postmenopausal women show flatter diurnal patterns and slightly elevated evening cortisol, which is physiologic, not pathologic.
• Salivary, serum, and 24-hour urinary cortisol measure different things. Choose the sample type that matches your clinical question.
• LC-MS/MS-based assays are more accurate than older immunoassays, particularly at the extremes and during pregnancy.
• A single out-of-range result rarely settles a diagnosis. Confirm with repeat testing and pattern analysis before acting.

Medical Disclaimer

This guide is for educational purposes and does not replace evaluation by a qualified healthcare professional. Cortisol abnormalities can reflect serious endocrine conditions including adrenal insufficiency, Cushing syndrome, and pituitary disorders. If your cortisol is outside the reference range, work with an endocrinologist or your primary care team before making any treatment decisions.

Track Your Progress

Cortisol is most useful when measured in context. Pair your cortisol result with related markers to see the full HPA-axis and stress-response picture:

• Cortisol biomarker page for biomarker-specific reference details
• DHEA-S to assess adrenal output beyond cortisol alone
• Cortisol/DHEA-S ratio for stress-resilience tracking
• Fasting insulin and glucose for metabolic context
• TSH to differentiate adrenal versus thyroid contributors to fatigue

Related Content

• How to Raise Cortisol Naturally if your morning levels are low
• Low Cortisol Symptoms and Causes for symptom-driven decision-making
• High Cortisol Dangers and Management for elevated-cortisol patterns
• Adrenal Dysfunction and Insufficiency for clinical context
• Understanding the Stress Hormone for mechanism review

References

1. Hawley JM, Keevil BG. Endogenous glucocorticoid analysis by liquid chromatography-tandem mass spectrometry in routine clinical laboratories. Ann Clin Biochem. 2017. PMID 28068807.
2. Chinese Pediatric Reference Intervals for Serum Cortisol on IMMULITE 2000. Ann Lab Med. 2018. PMID 29071821.
3. El-Farhan N et al. Salivary cortisol monitoring: determination of reference values in healthy children and applications. Allergy Asthma Proc. 2012. PMID 22856637.
4. Reference values for salivary cortisol in healthy young infants by liquid chromatography-tandem mass spectrometry. Pediatr Int. 2020. PMID 31976606.
5. Determination of reference values for salivary cortisol in healthy infants aged 0-12 months. Arch Argent Pediatr. 2020. PMID 31984691.
6. Ice GH et al. Diurnal cycles of salivary cortisol in older adults. Psychoneuroendocrinology. 2004. PMID 14644066.
7. Sex- and age-specific reference intervals of 16 steroid metabolites quantified simultaneously by LC-MS/MS. Clin Chim Acta. 2024. PMID 38977173.
8. Cortisol Secretion, Sensitivity, and Activity Are Associated With Hypertension in Postmenopausal Women. J Clin Endocrinol Metab. 2019. PMID 31112276.
9. Miller R et al. The CIRCORT database: Reference ranges and seasonal changes in diurnal salivary cortisol. Psychoneuroendocrinology. 2016. PMID 27448524.
10. Relationship of 24-hour urinary free cortisol to 4-hour salivary morning and afternoon cortisol. J Endocrinol Invest. 1995. PMID 7594227.