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A summed measure of your body's inactive stress hormone across all salivary time points, providing the strongest salivary confirmation of your true total daily cortisol exposure.
This value is the sum of all salivary free cortisone readings across the day. Cortisone is the inactive form of cortisol, produced when the enzyme 11b-HSD2 deactivates cortisol in the salivary glands and kidneys. Because cortisone in your saliva comes directly from cortisol that was recently active, total salivary cortisone is a powerful secondary marker for estimating your true daily cortisol exposure.
Research has found that salivary cortisone correlates with blood (serum) free cortisol better than salivary cortisol does. This may seem counterintuitive since cortisone is the inactive form, but it makes sense biologically. The 11b-HSD2 enzyme in the salivary glands is highly active, meaning cortisone effectively captures what cortisol was doing in the blood just moments before deactivation. Salivary and urinary cortisone both reflect systemic free cortisol.
The most important use of this value is in comparison with your total salivary cortisol. When both totals point in the same direction relative to their reference ranges (both low, both normal, or both high), they confirm each other. This gives you high confidence that the cortisol picture is an accurate reflection of your true circulating cortisol throughout the day.
When the cortisone total is relatively higher than the cortisol total (each compared to its own reference range), it suggests your free cortisol in circulation may be higher than the cortisol number alone implies. If only cortisol had been tested, you might be incorrectly assessed for very low cortisol when your actual levels are adequate or even higher. This is one of the key reasons the DUTCH test measures both.
Conversely, when cortisol is elevated but cortisone is not, it may suggest an acute stressor during testing or possible contamination from topical hydrocortisone cream. Hydrocortisone is bioidentical to active cortisol. If it contacts the sample paper or skin near the mouth, it raises cortisol levels but not cortisone, because cortisol must enter the body in order to be deactivated to cortisone.
Because salivary cortisone is derived from cortisol, the same interventions that move total salivary cortisol will move total salivary cortisone. Additionally, the 11b-HSD enzyme system itself can be influenced. Factors that push the balance toward cortisone (deactivation) include EGCG, curcumin, progesterone, coffee, holy basil, hyperthyroidism, high estrogen levels, and glucocorticoid medications. Factors that push the balance toward active cortisol include insulin resistance, obesity, inflammation, hypothyroidism, licorice root, phthalates, and certain environmental chemicals.