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You know whether your patient has high cortisol, normal cortisol, or low cortisol—so what?

Cortisol and DHEA can be high, low or within range and be perfectly appropriate depending on the patient’s physiologic condition. How do these markers change your medical decision-making?

Of course, every lab test must be interpreted only in correlation with the patient’s signs and symptoms, health history, and exam findings. For example, if a patient has a low B12 measurement, is it low because the patient does not intake sufficient B12, or because they cannot absorb sufficient B12? Perhaps they are fighting an illness and have a higher need for B12? Even if the therapy decision includes injectable B12, is there more testing or therapy that should be considered?

In the case of a four-point salivary cortisol test, even before the test is administered, the most important concept to understand is seemingly contradictory: We are not looking at adrenal function in this test. Rather, we are evaluating and observing the patient’s stress response as a system. That system consists of the hypothalamus, pituitary gland, and adrenal gland as a functional unit. It also consists of numerous neurotransmitters that act as messengers to accentuate or attenuate the signals between each. Additionally, the salivary cortisol test must be understood as a method of identifying stress inducers to determine how the hormones measured are produced, as well as the metabolism of the body and how this reduces the measured levels of hormones. In other words, what causes the hormones to rise, and what causes them to fall? Both sides of the equation must be considered when interpreting any test properly, including the salivary hormone profile.

With a better, more comprehensive understanding of the HPA axis, its inducers, and the metabolic pathways of steroid hormones, we can be far more precise in designing our interventions and will see significantly better outcomes.

For example, as you review a four-point salivary cortisol test, you can see the effects of your patient’s poor blood sugar habits. You can determine which of the three most common causes for insomnia are affecting your patient. You can even see altered patterns of steroid homone metabolism that may be related to genetic defects or intestinal bacterial overgrowth. As you look at the cortisol patterns and even the individual samples, you will see your patient’s response to stress and begin the detective work of identifying the stress inducer and how to modulate it. In addition, you will see how that stress is changing function in your patient and how to help them adapt. And you will even begin to make associations with other physiologic problems your patient may be experiencing, such as COMT mutations or beta-glucuronidase elevations.

Please note, a four-point salivary cortisol test is an abbreviated test, and I do not suggest running this panel without also including the sex hormones, especially progesterone, and melatonin. As an example of the necessity of a comprehensive test, let’s take the case of a patient with insomnia. Three factors can be identified with the full test panel. You can see elevated bedtime cortisol which gives a patient a “second wind” near bedtime and prevents sleep initiation or even maintenance. You can also see low progesterone, which inhibits the proper release of GABA and leaves the sleep patient with a racing mind that will not allow them to power down and sleep. In addition, you can assess melatonin levels to help you understand if the issue pertains to timing or output.

There is tremendous utility in the salivary hormone panel to manage cases of all degrees: fatigue, depression, pain, menopause/HRT, insomnia, and thyroid. For each of these, a salivary hormone test, properly interpreted, can be the difference between an average outcome and an outstanding one.

About Christopher Mote, DO, DC, IFMCP


Christopher Mote, DO, DC, IFMCP, earned his doctorate in osteopathy from the Chicago College of Osteopathic Medicine at Midwestern University. He earned his doctorate in chiropractic and Bachelor of Science in human biology from the National University of Health Sciences (NUHS) in Lombard, Illinois, and is certified in Functional Diagnostic Medicine. With a focus on addressing the root cause of health concerns, Dr. Mote specializes in the diagnosis and treatment of chronic health disorders.

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