Why Use Saliva?  

Saliva testing is an easy and noninvasive way of assessing your patient’s hormone status and balancing needs and is proving to be the most reliable medium for measuring hormone levels.  

Appreciating the reliability of saliva testing is based on understanding the difference between steroid hormones in saliva and serum. This difference is based on whether or not the hormones are bound to proteins in the medium used for testing. The majority of hormones exist in one of two forms: free (5%) or protein bound (95%). It is only the free hormones that are biologically active, or bio-available, and available for delivery to receptors in the body. Those which are protein bound do not fit those receptors and are considered non-bioavailable. When blood is filtered through the salivary glands, the bound hormone components are too large to pass through the cell membranes. Only the unbound hormones pass through and into the saliva. What is measured in the saliva is the bioavailable hormone, the clinically relevant portion which will be delivered to the receptors in the tissues of the body. 

Salivary hormone levels are expected to be much lower than serum levels, as only the unbound hormones are being measured. When health care providers measure serum hormone levels and prescribe hormone replacement therapy based on those results, patients are often overdosed. If the patients are then tested using saliva, the results are extraordinarily high, and confusion results from a lack of correlation between the two methods. 

This discrepancy becomes especially important when monitoring topical, or transdermal, hormone therapy. Studies show that this method of delivery results in increased tissue hormone levels (thus measurable in saliva), but no parallel increase in serum levels. Therefore, serum testing cannot be used to monitor topical hormone therapy. 

Why Test Hormone Levels? 

Hormones are powerful molecules essential for maintaining physical and mental health. We frequently think of estrogen as being a female hormone, and testosterone as being a male hormone. But men AND women make both, plus several more that need to be in balance for optimum health. An imbalance of any one hormone can throw your physical and mental health out of balance, causing aggravating and even serious health problems. 

One size does not fit all when it comes to hormones! For decades western medicine has prescribed Hormone Replacement Therapy as if everyone needed the same thing and the same amount. Nothing could be further from the truth. Your hormones are like your fingerprints and in order to achieve optimal health, you need to know what your specific imbalances are. 

There are several ways to test for hormones(saliva, serum and urine), but the state-of-the-art method is through saliva. This is because only the active portions of hormones are measured and it is these portions that determine how individuals feel. So if your patient is seeking bio-identical hormone replacement (BHRT), you’ll need to know active hormone levels. In addition, if using a topical (transdermal) hormone preparation for treatment, saliva testing is the most accurate tool to measure and monitor hormone status. 

Who Should Be Tested? 

Men and women concerned with decreasing hormone levels as a result of age. Cycling women experiencing PMS symptoms, perhaps related to a hormonal imbalance. Peri and postmenopausal women concerned with their estradiol and progesterone levels for replacement considerations. Those wishing to monitor their hormone levels following replacement therapy (oral, sublingual or topical), and subsequently regulate their supplement levels. Anyone with symptoms involving fatigue, insomnia, stress, immunity problems, blood sugar problems, and overweight should be tested for cortisol levels as well as “sex" hormones. 

Men and women of any age who are having symptoms of hormone imbalances should test for all hormones that may be associated with their symptoms. 

Men and women over the age of forty may want to do a baseline test. Frequently imbalances will be detectable for a time period before symptoms gain attention. 

Which Hormones Need Testing? 

The major sex hormones to assess are estradiol, progesterone and testosterone. The main adrenal hormones are DHEA and cortisol. These five hormones will provide crucial information about deficiencies, excesses and daily patterns, which then result in a specifically tailored treatment approach and one far more beneficial than the old “shotgun" approach. Below is a brief description of each of these five hormones: 

Estrogen: there are three forms made by the body: estrone, estradiol and estriol. The form used in past hormone replacement therapies is estradiol, often in the form of concentrated pregnant mare’s urine (premarin). It is a proliferative (causes growth) hormone that grows the lining of the uterus. It is also a known cancer-causing hormone: breast and endometrial (uterine) in women and prostate gland in men. It will treat menopausal symptoms like hot flashes, insomnia and memory-loss. With the bio-identical formulas estriol is matched with estradiol (biest) to provide protective effects and additional estrogenic benefits. The other major protector in keeping estradiol from running amok is progesterone. 

Progesterone is called the anti-estrogen because it balances estradiol’s proliferative effects. It is considered preventive for breast and prostate cancers as well as osteoporosis. In addition too little progesterone promotes depression, irritability, increased inflammation, irregular menses, breast tenderness, urinary frequency and prostate gland enlargement (BPH). 

Testosterone is an anabolic hormone (builds tissue) that is essential for men and women. The proper level of testosterone is necessary for bone health, muscle strength, stamina, sex drive and performance, heart function and mental focus. 

DHEA is an important adrenal gland hormone, which is essential for energy production and blood sugar balance. DHEA is a precursor to other hormones, mainly testosterone. 

Cortisol is your waking day hormone (highest in the morning and lowest at night). It is necessary for energy production, blood sugar metabolism, anti-inflammatory effects and stress response. 

Some of the common imbalances identified through testing include estrogen dominance, estrogen deficiency, progesterone deficiency, androgen (testosterone and DHEA) excess or deficiencies, adrenal dysfunction and adrenal fatigue. 

Where Should I Start? 

We believe the bare minimum for assessing hormonal status and endocrine function is the five hormone panel; Estrogen, Progesterone, Testosterone, DHEA and AM cortisol. When there are any sleep disruptions or high cancer risk profiles we also recommend the night cortisol level. But as a basic guideline, an excellent starting place for men and women is the five hormone panel. 

As clinicians with over twenty five years of experience in working with natural hormone balancing and bio-identical hormone replacement we believe the reasons for this are well-established and prove out clinically…the intricate balance and direct relationship between adrenal gland function and sex hormone balance. It will frequently be seen that when the estrogen, progesterone and testosterone are showing deficiencies and excesses, the adrenals have already been working overtime to attempt to compensate for the strain to reproductive systems…and other functional roles. 

AM cortisol levels represent the maximum output of cortisol for the entire 24 hour period and initiates and maintains waking day activity and function. DHEA has equally important duties and is often referred to as the “anti-aging hormone" because it is central in its role for disease prevention and health optimization. Measuring DHEA and AM cortisol is your first glimpse into the status of the endorcrine balance and function. As we age and our production of sex hormones is changing, the adrenals will maintain a central role in sustaining optimal health and function. Aging is often first noticed when our sexual function diminishes and menopause or andropause have begun. While it is obvious that we want to test the estrogen, progesterone and testosterone at this stage, it is not so apparent but equally important to look at the foundation for this endocrine balance: cortisols and DHEA.