I use the saliva hormone test to confirm the other signs and symptoms of adrenal fatigue. I start with a saliva cortisol screening test that measures cortisol levels at four different times during the day: between 6-8AM (within one hour after waking) when cortisol levels are highest; between 11AM-12PM; between 4-6PM; and between 10-12PM. This shows how your cortisol levels vary during the day – something you cannot easily do with blood or urine tests.
Another way I like to use the saliva test, when possible, is to compare samples taken when a patient is experiencing an energy high or low with samples taken during a regular day when the patient is feeling relatively normal (baseline samples). After we have a baseline, these patients carry around some spare vials to take saliva samples at times when they are feeling especially good or especially bad. Again, they record the symptoms(s) they were experiencing, as well as the date and time. They also record the date and time on each vial and send them off to the lab. This is an excellent way to determine whether the lows and highs you experience correspond to relatively low and high cortisol levels.
I also usually measure DHEA-S levels with the saliva test, as well, because the adrenals are the primary source of DHEA-S (but not necessarily of DHEA). Adrenal fatigue syndrome often involves decreased DHEA-S. The DHEA-S level is a direct indicator of the functioning of the area within the adrenal glands that produces sex hormones (the zona reticularis). Saliva tests for testosterone, the estrogens, progesterone and other hormones can also be done, if needed, and may be of value in working with adrenal fatigue. Testosterone and DHEA-S levels are two of the most reliable indicators of biological age. Testosterone and DHEA-S levels below the reference range for the person’s age may be indicators of increased aging. If the cortisol levels are also decreased, the three tests together further indicate chronically decreased adrenal function.
If a doctor does not use the saliva hormone tests, piecing together a correct diagnosis of adrenal fatigue from other laboratory tests is more difficult. Most laboratory tests are designed to look for “disease” states in the human body and adrenal fatigue is not a disease. In addition, there has never been a reliable urine or blood test that checks for, and can definitively diagnose, mild forms of hypoadrenia.
The main reason I prefer the saliva test is that it gives clearer and more direct indications of hormone levels at the actual site where they are utilized – inside the cell. None of the blood or urine tests typically give you as much useful information about your adrenal function as you will get from the combined use of the adrenal fatigue questionnaire from page 61 in the my book, Adrenal Fatigue: The 21st Century Stress Syndrome, clinical self-tests, and saliva hormone tests.