Besides cortisol, the other adrenal hormones to test for are DHEA, aldosterone, estrogen, pregnenolone, and progesterone. They can be measured in the blood, but some people prefer salivary tests because they show how the hormone levels change throughout the day.
For these tests, most healthcare practitioners order a salivary hormonal profile; in addition to cortisol, they're ordering levels of DHEA-S (dehydro-epiandrosterone sulfate), estradiol, progesterone, and testosterone. These levels can be tested together.
The interpretation of the hormone testing doesn't just depend on the hormonal levels as measured in the saliva. Hormonal analysis and treatment is much more than simply replacing levels that are low. Your holistic healthcare practitioner will look at your particular hormonal pattern. For example, in many cases of adrenal fatigue, cortisol levels tend to be high and DHEA levels tend to be low.
The levels of the other hormones (estradiol and progesterone) are important as well. Estradiol and progesterone, if needed, have to be prescribed to be in a specific ratio to one another to maintain hormonal balance. Some people may have more of a propensity to convert testosterone to estradiol than others; in these people, for example, testosterone supplementation may not be warranted.
Everyone with adrenal fatigue can have different hormonal patterns and can have different hormonal needs for supplementation. Your healthcare practitioner will review the results of your salivary hormonal analysis in detail.
To provide you with some basis for reference, here are average salivary hormonal levels for a typical young man or young woman:
DHEA-S: A normal DHEA-S range is approximately 7 to 10 nanograms per milliliter (ng/mL) for a man and 3 to 5 ng/mL for a woman.
Estradiol: A normal estradiol range for a woman is usually around 2 to 2.5 picograms per milliliter (pg/mL). For a man, the normal level is about 0.5 to 1.2 pg/mL.
Testosterone: A normal level of testosterone is 150 to 200 pg /mL for a man and 25 to 50 pg/mL for a woman.
Progesterone: A normal range of progesterone is 20 to 50 pg/mL for a man and 70 to 150 pg/mL for a woman.
When you're being tested for adrenal fatigue, other testing needs to be done in addition to the hormone testing. Specifically, you need to have your thyroid, liver, and kidney function assessed. Here are some tests that do just that:
AM cortisol with an ACTH level: This blood test can provide information on the status of your pituitary gland. It measures both cortisol and ACTH (adrenocorticotropin hormone) levels. Note that this test differs from the cosyntropin stimulation test.
A TSH with a free T4 (thyroxine) level and free T3 (triiodothyronine) level: Because the thyroid affects your adrenal glands, your healthcare practitioner should evaluate your thyroid function. The TSH, free T4, and free T3 test helps evaluate the thyroid and pituitary gland.
A serum creatinine level and blood urea nitrogen (BUN) level: This test evaluates kidney function. Abnormal kidney function can increase the stress and workload on the adrenal glands. Kidney function is often associated with worsening acidosis, which is a direct cause of adrenal stress.
Liver function tests: These tests help assess liver function. The presence of liver disease can affect the ability of the adrenal glands to produce cortisol.