Salivary cortisol tests measure free cortisol in saliva collected at home at set times, usually on waking or between 6 and 8am, at noon, at 4pm and at 8pm. The cortisol awakening response (CAR) kit adds samples 30 and 60 minutes after waking to capture the morning rise. The tests describe rhythm. They do not diagnose adrenal disease, and suspected Cushing’s or Addison’s disease needs a GP. Verified practitioners can order Nutripath’s saliva kits through Vively.
| Test type | Measured in saliva collected at set times |
|---|---|
| Nutripath code | 1003, 1012, 1001, 1002 |
| Sample and collection | Saliva kit collected at home over one day (4 or 6 tubes) and posted to Nutripath |
| Preparation | Collect on a normal day, at the exact times in the kit. Nothing to eat, drink or brush teeth for 30 minutes before each sample, and no steroid creams or liquorice beforehand. |
| Turnaround | 3 to 5 business days (Nutripath estimate, from when the lab receives the sample). Allow extra days for postage. |
| Available through | Nutripath test ordered through Vively. You need to be a verified practitioner to refer it. |
| Pricing | Pricing in your practitioner account |
| Results | PDF report from Nutripath, filed in your client’s record and app beside their blood results |
Only practitioners can order this test. Ask your naturopath, nutritionist or dietitian whether they use Vively.
What do the saliva cortisol kits measure?
Saliva carries the free, active fraction of cortisol, and clients can collect it at home without a needle. That makes it the practical way to see several points across one day.
Free cortisol between 6 and 8am, at noon, at 4pm and at 8pm, measured by LC-MS. It shows whether the expected morning high and evening low are there.
Cortisol immediately on waking, at 30 minutes and at 60 minutes, plus noon, 4pm and 8pm, with DHEA-S. Cortisol normally rises sharply in the first 30 to 45 minutes after waking.
The 4 point cortisol curve with a morning DHEA-S. The Extensive profile adds salivary secretory IgA.
Each time point is reported in nmol/L against the reference interval printed on the report for that time of day.
| Nutripath test | Code | Sample | Turnaround |
|---|---|---|---|
| Cortisol Profile | 1003 | Saliva | 3 to 5 business days |
| Cortisol Awakening Response (CAR) | 1012 | Saliva | 3 to 5 business days |
| Adrenocortex Stress Profile, Basic | 1001 | Saliva | 3 to 5 business days |
| Adrenocortex Stress Profile, Extensive | 1002 | Saliva | 3 to 5 business days |
How do you order salivary cortisol testing through Vively?
- Get verified. You need to be a verified practitioner to refer tests. Practitioners with a recognised qualification or membership (ATMS, NHAA, ANTA, Dietitians Australia, NSA, CMA or Ahpra registration) can request free practitioner access.
- Build the order. Log in to the practitioner platform, choose the Nutripath test and add any blood tests or the $99 Baseline Health Check to the same order. Pricing shows in your account, and either your client or your practice can pay.
- Client collects at home. Nutripath sends your client the collection kit once the order is placed. Your client follows the kit instructions (spitting into labelled tubes at each set time, then refrigerating them until posting) and posts the sample back to Nutripath in the packaging provided.
- Review the report. Nutripath’s PDF report is filed in your client’s record and app, next to their blood results, ready for the follow-up consult.
See every Nutripath test you can order on the Nutripath tests page.
Order salivary cortisol testing with your client’s blood tests
Free access for verified naturopaths, nutritionists and dietitians. Order Nutripath tests and blood pathology in one place, and see every result in your client’s record.
What can salivary cortisol tell you, and what can it not?
Saliva is good for questions about rhythm and timing. It is weak evidence for labels that endocrinology does not recognise.
A flat curve, a missing morning peak or high evening cortisol can fit with poor sleep, shift work, chronic stress or depression, and give you a baseline to retest after changes.
A systematic review of 58 studies found no evidence for adrenal fatigue as a condition, and endocrinology societies do not recognise it (Cadegiani and Kater, 2016). Describe results as rhythm patterns, not adrenal failure.
Expert guidelines say the first sample should be taken immediately on waking, and treat samples more than 5 minutes off schedule as inaccurate, because even short delays distort the CAR. Clients should keep the tubes by the bed and note their real waking time (Stalder et al., 2016).
Suspected cortisol excess or deficiency needs a GP and an endocrinologist. They use standardised tests such as late night salivary cortisol, dexamethasone suppression and morning serum cortisol with ACTH.
How does salivary cortisol fit with blood work?
A cortisol curve rarely stands alone. Blood markers help explain tiredness and rule out causes that need medical care.
- ContextFlat or low curve with tiredness
Check iron, thyroid and blood glucose first, since these are common, treatable causes of fatigue.
- ContextHigh evening cortisol with poor sleep
Fits with stress or a late body clock. Check metabolic markers, as long term high cortisol affects glucose and weight.
- ContextLow DHEA-S on the Adrenocortex profile
Compare with serum DHEA-S, which is the more established measure, and with age expected levels.
- ReferVery high or very low cortisol at every time point
Outside the usual stress patterns. Refer to the GP before any further testing.
What can affect a salivary cortisol result?
- Collection times that drift, or a first CAR sample taken more than a few minutes after waking
- Oral, inhaled or topical corticosteroids, including hydrocortisone creams
- Liquorice, oral contraceptives and pregnancy
- Shift work, jet lag, a poor night’s sleep or a big night out before the collection day
- Food, coffee, exercise or brushing teeth (which can cause bleeding gums) in the 30 minutes before a sample
When should you refer the client to their GP?
- Unexplained weight loss, low blood pressure, dizziness on standing, salt craving or darkening skin
- Weight gain around the trunk with purple stretch marks, easy bruising, muscle weakness or new high blood pressure
- Very high or very low cortisol across every time point
- A client on long term steroids who wants to stop or change them
- Low mood, anxiety or poor sleep that is severe or getting worse
How should a client prepare for a salivary cortisol or CAR test?
Copy or print this to send to your client. Follow the instructions in the Nutripath kit if they differ.
Preparing for your saliva cortisol test
- Pick a normal day. Avoid a day after a late night, travel across time zones or a night shift.
- Put the kit and a pen next to your bed the night before.
- For the CAR test, collect the first tube as soon as you wake, before you get up, then at 30 and 60 minutes. Write down your real waking time.
- Collect the other tubes at the times in the kit, as close to the time as you can.
- For 30 minutes before each sample, don’t eat, drink anything but water, brush your teeth or exercise.
- Don’t use liquorice or steroid creams on the day. Keep taking prescribed medicines unless your doctor says otherwise, and tell your practitioner what you take.
- Keep the tubes in the fridge and post them back the next business day, early in the week.
What does the salivary cortisol report look like?
Nutripath publishes sample reports on its website. They open in a new tab.
How do practitioners use salivary cortisol with clients?
It works best for a specific question: is the morning rise there, is evening cortisol too high for sleep, or did a change in routine shift the curve? Choose the CAR kit when mornings are the problem and the client can collect within minutes of waking. Order iron, thyroid and glucose markers alongside so you are not attributing fatigue to cortisol when the cause is elsewhere. Retest after 8 to 12 weeks of changes, on a similar day of the week. For clients, the consumer saliva cortisol page explains the test in plain language.
Salivary cortisol and CAR FAQs
Can a naturopath, nutritionist or dietitian order salivary cortisol testing through Vively?
Yes. You need to be a verified practitioner to refer it. Add a Nutripath cortisol profile, CAR or Adrenocortex profile to an order in the Vively practitioner platform. Pricing shows in your account. No account yet? Request free access.
What is the cortisol awakening response?
The rise in cortisol over the first 30 to 45 minutes after waking, on average about 50% above the waking level. The CAR kit measures it with samples on waking, at 30 minutes and at 60 minutes.
Is saliva or blood better for cortisol?
Blood gives one total cortisol reading at the time of the draw and is what doctors use for diagnosis. Saliva measures free cortisol and lets a client collect several samples across a day at home, which suits questions about rhythm.
Can salivary cortisol diagnose adrenal fatigue?
No. Adrenal fatigue is not a recognised medical diagnosis. Describe results as rhythm patterns, and refer suspected adrenal disease to the GP.
How long do salivary cortisol results take?
Nutripath estimates 3 to 5 business days from when the lab receives the samples. Allow extra time for postage.
References
- Stalder T, Kirschbaum C, Kudielka BM, Adam EK, Pruessner JC, Wüst S, Dockray S, Smyth N, Evans P, Hellhammer DH, Miller R, Wetherell MA, Lupien SJ, Clow A. Assessment of the cortisol awakening response: expert consensus guidelines. Psychoneuroendocrinology. 2016;63:414-432.
- Cadegiani FA, Kater CE. Adrenal fatigue does not exist: a systematic review. BMC Endocrine Disorders. 2016.
- Nieman LK, Biller BMK, Findling JW, et al. The diagnosis of Cushing’s syndrome: an Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism. 2008.
- Fries E, Dettenborn L, Kirschbaum C. The cortisol awakening response (CAR): facts and future directions. International Journal of Psychophysiology. 2009.
- Nutripath. Cortisol Profile (1003), Cortisol Awakening Response (1012) and Adrenocortex Stress Profiles (1001, 1002). nutripath.com.au, checked 1 October 2026.