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Cortisol, Free, Salivary

Published: August 9, 2026Updated: August 16, 2026

This test measures the amount of free cortisol present in your saliva, which reflects your body’s natural cortisol levels over time. Free cortisol is the active form of the hormone cortisol, which helps regulate stress responses and metabolism.

Quick summary

["Salivary cortisol helps assess your body’s stress response and hormone balance."]

Medically reviewed by WellAlly Editorial TeamLast reviewed August 16, 2026Editorial policy

Key facts at a glance

LOINC
58668-5
Short code
Cortis 4 PM Sal-mCnc
Synonyms
Cortis 4 PM Sal-mCnc
Category
hormone
Sample
serum
Container
Red-top tube (SST)
Units
N/A
Fasting
false
Population
adult
Sex
all
Age range
18–65 years
Specimen volume
5 mL
Stability
Room temperature: 4h, Refrigerated: 24h, Frozen: 7d
Hemolysis max
500
Lipemia max
1000
Icterus max
500
TAT
4–24 hours
Order
routine

Why This Test Is Done

Salivary cortisol testing is often used to evaluate chronic stress, adrenal function, or conditions like Cushing’s syndrome or Addison’s disease. It may also be part of a broader evaluation for hormonal imbalances or sleep disorders. Your doctor may recommend this test if they suspect your cortisol levels are too high or too low over time.

How the Test Works

A small sample of saliva is collected, usually in the morning when cortisol levels are naturally highest. The sample is then analyzed to measure free cortisol concentration. Unlike blood tests, this method avoids fluctuations caused by stress during blood draws.

What to Expect Before the Test

No special preparation is needed, but you may be asked to avoid caffeine, nicotine, or eating/drinking immediately before collection. Follow your doctor’s instructions for timing—morning samples are most common for accurate results.

What the Results Mean

Results are compared to reference ranges for healthy adults, though individual ranges can vary. Elevated levels may indicate overproduction of cortisol (e.g., from stress or Cushing’s syndrome), while low levels could signal adrenal insufficiency or other hormonal issues.

Clinical interpretation

How abnormal results are interpreted and what conditions they suggest.

Clinical Significance

Short name

Free Cortisol in Saliva

Frequently asked questions

What might cause elevated cortisol levels?
Chronic stress, certain medications (e.g., steroids), or conditions like Cushing’s syndrome (hypercortisolism) can lead to higher-than-normal cortisol. Repeated stress or sleep disturbances may also contribute.
What might cause low cortisol levels?
Conditions such as Addison’s disease (adrenal insufficiency), autoimmune disorders, or long-term steroid withdrawal can result in lower cortisol. Rarely, genetic factors or certain medications may also play a role.
How often is this test repeated?
Your doctor may recommend multiple saliva samples (e.g., morning and evening) to assess daily cortisol patterns. Follow-up tests may be needed if initial results are abnormal or to monitor treatment progress.
  1. 1
    MedlinePlus — Laboratory TestsSource
  2. 2
    Lab Tests OnlineSource
  3. 3
    Mayo Clinic — Tests & ProceduresSource

Click any link to access the full source. PubMed Central (PMC) links provide free full-text access.

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.

Medical Disclaimer

This content is for general informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider with any questions you have about a medical condition, and never disregard professional medical advice or delay seeking it because of something you read here.

If you think you may have a medical emergency, call your local emergency number or go to the nearest emergency department immediately.

Medically reviewed by WellAlly Editorial Team Last reviewed August 16, 2026. · Read our editorial policy