Cortisone (S2) - +30 Min.

This sample measures cortisone in your saliva 30 minutes after waking, the time when cortisol should be peaking. In a healthy pattern, cortisone should also rise alongside cortisol, since more circulating cortisol means more raw material for the 11b-HSD2 enzyme to convert into cortisone in the salivary glands.

There is currently no published literature specifically assessing cortisone in place of cortisol for evaluating the cortisol awakening response (CAR). However, the DUTCH guide notes it is not unreasonable to take the cortisone waking sample (S1) and the +30 minute sample (S2) into consideration when determining the best overall treatment plan. If your cortisol CAR appears blunted but your cortisone shows a healthy rise, your true cortisol response may be better than the cortisol reading alone suggests.

When Cortisol and Cortisone Diverge at +30 Minutes

If your cortisol at +30 minutes is low but cortisone is within range or elevated, it may mean cortisol is being deactivated more actively in the salivary glands. This does not necessarily mean your blood cortisol is low. Conversely, if cortisol is elevated but cortisone is not, it could indicate a transient spike (from acute stress, low blood sugar, or hydrocortisone cream contamination) that has not been fully converted. Hydrocortisone cream on the skin is bioidentical cortisol. If it contacts the sample, it raises cortisol but not cortisone, since cortisol must enter the body to be deactivated.

Questions This Biomarker Can Answer

• Does my cortisone pattern at +30 minutes confirm my cortisol awakening response?
• Is cortisol being rapidly deactivated in my salivary glands, making the cortisol peak look lower than it truly is?
• Should I factor in cortisone when interpreting an apparently blunted morning cortisol surge?