Why Use Saliva Instead of Blood for Hormone Testing?

Learn more about Saliva Collection Instructions here

Saliva testing is an easy and noninvasive way of assessing 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.

Saliva Measures the “Unbound" Biologically Active or Free Hormone Levels in the Body:

When blood is filtered through the salivary glands, the bound hormone components are too large to pass through the cell membranes of the salivary glands. Only the unbound hormones pass through and into the saliva. What is measured in the saliva is considered the “free", or bioavailable hormone, that which will be delivered to the receptors in the tissues of the body.

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 (Horse/Equine) 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. 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
  • Testerone  excess or deficiency
  • Cortisol  excess or deficiencies (Adrenal dysfunction & Adrenal Fatigue Syndrome)
  • DHEA excess or deficiency