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A summed measure of your body's active stress hormone across all salivary time points, reflecting your total daily cortisol exposure as seen through saliva.
This value is the sum of all your salivary free cortisol readings across the day (five time points on a DUTCH Plus panel). It is the saliva-based equivalent of 24-hour free cortisol measured in urine and is considered the best marker for assessing overall tissue exposure to cortisol.
While the individual time points show you the shape of your cortisol curve throughout the day, the total tells you the overall volume. You could have a normal-looking curve with uniformly low values at each point, producing a low total despite a healthy pattern shape. Or you could have a few exaggerated spikes that inflate the total even if most of the day looks normal. Both the shape and the total matter.
Low total salivary cortisol may be associated with fatigue, burnout, low mood, low motivation, low libido, dizziness, weakness, fainting, sleep apnea, and orthostatic hypotension. It can also be seen with long-term stress, poor sleep, pituitary or hypothalamic dysfunction, traumatic brain injuries, concussions, PTSD, and certain medications that suppress HPA axis activity.
High total salivary cortisol may be associated with stress, anxiety, panic attacks, depression, insomnia, weight gain (particularly belly fat), brain fog, blood sugar dysregulation, inflammation, pain, high blood pressure, hair loss, and immune suppression. Cortisol can be acutely elevated by low blood sugar, anticipatory stress, stressful events, acute inflammation, intense exercise, and caffeine.
Total salivary cortisol and metabolized cortisol (from urine) do not always agree. This discrepancy is explained by the cortisol clearance rate (CCR). If you have fast clearance, your salivary cortisol may look low while your metabolized cortisol is above range, because cortisol is being broken down rapidly. Keep in mind that free cortisol represents only about 5% of total circulating cortisol; the other 95% is bound to carrier proteins in the blood.
Always compare your total salivary cortisol with your total salivary cortisone. If the cortisone total points higher than the cortisol total relative to their respective reference ranges, your true circulating cortisol may be higher than the cortisol value alone implies. This happens when the 11b-HSD2 enzyme in the salivary glands is particularly active, converting more cortisol into cortisone before it is captured in your sample.
For low total cortisol, support may include adaptogenic herbs (ashwagandha, rhodiola, Korean ginseng, cordyceps, schizandra, bacopa), B vitamins, vitamin C, blood sugar regulation, sleep hygiene improvement, and licorice root (with caution regarding blood pressure). Addressing underlying causes such as chronic stress, poor sleep, or medication-induced HPA suppression is essential.
For high total cortisol, calming herbs (ashwagandha, skullcap, holy basil, cordyceps, jujube, mimosa, chamomile, lemon balm, passionflower, valerian, magnolia, California poppy), parasympathetic nervous system support (meditation, breath work, vagal nerve stimulation), GABA support, stress reduction, blood sugar regulation, and addressing inflammation or pain may help.