What is Cortisol / Cortisone Ratio And Why Does the Hormone Zoomer Test for It?

Adrenal hormone conversion marker

The cortisol/cortisone ratio compares active cortisol with its inactive form, cortisone, reflecting local enzymatic conversion. Measuring this ratio offers insight into how much active cortisol tissues are exposed to and can flag shifts in stress signaling and metabolism when interpreted with other hormones.

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Cortisol / Cortisone Ratio

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About Cortisol / Cortisone Ratio

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About Cortisol / Cortisone Ratio

Overview and History

Biochemical category: a steroid hormone conversion ratio governed by 11β-hydroxysteroid dehydrogenase enzymes (11β-HSD1 and 11β-HSD2). Cortisol is the biologically active glucocorticoid; cortisone is its inactive ketone form. The ratio is derived from measured concentrations in saliva or urine and represents local balance between activation and inactivation processes. Clinical relevance: discovery of 11β-HSD activity clarified how tissues control local cortisol exposure independent of circulating adrenal output. Core biological functions tied to this ratio include modulation of metabolic signaling, stress-response timing, and tissue-level glucocorticoid effects that influence energy, inflammation signaling, and daily rhythm coordination.

Interpreting Highs and Lows

A relatively high cortisol/cortisone ratio usually reflects greater conversion toward active cortisol or reduced inactivation, which can indicate increased tissue cortisol exposure. A relatively low ratio suggests greater conversion to cortisone or reduced activation, implying lower local cortisol signaling. Interpretation depends on the full Hormone Zoomer profile — adrenal output, diurnal saliva cortisol, DHEA, metabolite patterns, medications, sampling timing, kidney function, and environmental factors all influence the ratio, so isolated values are best read in context.

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Included in the Hormone Zoomer because it reveals how much active cortisol tissues encounter versus how much is inactivated. This ratio complements diurnal saliva cortisol, urinary metabolites, and adrenal markers to clarify stress rhythm, tissue-level signaling, and metabolic impact, supporting providers in identifying which physiological patterns may warrant focused investigation.

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Cortisol / Cortisone Ratio FAQs

What is Cortisol / Cortisone Ratio and why is it important?

The cortisol/cortisone ratio compares active cortisol to inactive cortisone to show how tissues regulate cortisol exposure. It matters because tissue-level cortisol signaling affects energy, sleep, mood, and metabolic processes. The ratio helps providers understand whether local activation or inactivation of cortisol is contributing to a broader hormonal pattern.

What does it mean if my Cortisol / Cortisone Ratio levels are low?

A low ratio suggests relatively more conversion to cortisone and less active cortisol at the tissue level, which can be associated with reduced local glucocorticoid signaling. It may occur alongside low adrenal output, increased 11β-HSD2 activity, or other factors like timing and medications. Full panel context is needed to interpret whether the pattern relates to stress rhythm, metabolism, or other influences.

What does it mean if my Cortisol / Cortisone Ratio levels are high?

A high ratio indicates relatively more active cortisol versus cortisone, pointing to greater tissue exposure to cortisol. This pattern can be linked to increased 11β-HSD1 activity, reduced inactivation, or shifts in adrenal output or timing. Clinical interpretation requires correlation with diurnal cortisol profiles, urinary metabolites, and other Hormone Zoomer markers.

Why is the Cortisol / Cortisone Ratio included in the Hormone Zoomer?

Measuring this ratio helps providers assess local cortisol activation versus inactivation, adding a tissue-level perspective to saliva and urinary hormone measures. It refines understanding of stress signaling, metabolic impact, and timing disturbances, improving the precision of pattern recognition across the full panel.

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