Hormones are responsible for crucial bodily functions as well as major changes that occur over your lifetime. They are essential for fertility, libido, muscle tone, skin tone, bone health, energy levels, and weight management, among other functions. Additionally, hormone levels shift at various points to induce life stages such as puberty, reproduction, pregnancy, and menopause. Imbalanced hormone levels are part of the reason why young people going through puberty often develop facial acne and why women going through menopause typically experience hot flashes just to point out a few issues.
Hormones are chemical messengers that manage many bodily functions. Balanced hormones help you maintain good health, but shifting or unbalanced hormones can negatively affect your health. Hormone testing can identify hormonal imbalances to provide insight as to whether hormone therapy to balance your hormone levels could improve your health, vitality, and quality of life.
Saliva Hormone tests have proven to be a common way to test hormones with medical practitioners, especially if they are alternative practitioners like chiropractors or are in states where they are not not licensed to order blood tests. It is up to each individual to understand the pros and cons of the saliva hormone test.
Saliva Hormone Test Pros
- Obtaining a saliva sample for a saliva hormone test does not require highly trained personnel. Testing for hormones in a saliva sample is stress free, non-invasive, easy to collect, store and transport as well as convenient because you are able to do it at home.
- Many compounds found in saliva, including hormones, can provide useful clinical information. Because saliva is a “real-time” fluid from glands, it produces profiles indicative of an individual’s health and well-being status at the moment of collection. Hormones secreted at different times during the day, such as free cortisol and melatonin, can be measured using multiple samples collected throughout the day and night, allowing for a representation of the normal (or deviation from) cyclical pattern in real time.
- Another advantage of salivary testing is that it measures the free hormone levels, or bio-available hormone fractions of the total amount of hormone. ‘Free’ means that the hormone is unbound by binding proteins in the blood such as sex hormone binding globulin and can give an approximation of how much hormone is available to enter the tissues.
- In the past decade and a half, saliva testing has gained in popularity among practitioners of functional medicine. Saliva has the advantage of being noninvasive as well as being accessible to practitioners such as naturopathic physicians, chiropractors, and acupuncturists who may be practicing in states where they are not licensed to order blood tests or draw blood. Saliva collection also allows for multiple collections over a period of a day or month, which can help elucidate abnormal hormonal patterns, such as a shortened luteal phase. While this can theoretically be done with a serum test, it would be logistically cumbersome.
Saliva for Estrogen, Progesterone, Testosterone and Cortisol Hormone Tests
- Saliva hormone tests can be beneficial for testing the hormone estriol, which is helpful for difficult cases when doing bio-identical hormone therapy. Saliva hormone testing allows for charting changes in hormones over time (such as a monthly menstrual cycle) through multiple samples, thus providing information about the peaks and troughs of a person’s hormone levels.
- Saliva is best used to evaluate the balance and flow of the estrogens and progesterone in women who are still having menstrual cycles. It can also be used to evaluate cortisol secretion patterns by taking multiple samples over the course of a day and evening, giving you free cortisol and diurnal patterns. A saliva test measures free hormone, and its multi-point versatility makes it a better measure than serum for evaluating un-supplemented hormone status.
- Saliva hormone testing is also valuable in pregnancy, as salivary estriol spikes about two weeks before the onset of labor and can be used to identify women who are at risk for preterm labor.
Saliva Hormone Test Cons
- There is no common standard among saliva testing laboratories, and many are not FDA approved, meaning that they are not held to the high standards of clinical laboratories.
- Not all hormones, such as follicle- stimulating hormone (FSH) or IGF-1 (used as a marker for growth hormone) are offered in salivary tests by all laboratories.
- Saliva tests cannot test both free (active) and total levels of testosterone.
- Saliva production and collecting multiple samples is difficult for some patients. Dry mouth due to lack of saliva can be caused by some prescription drugs, atrophy of salivary glands, or because of certain types of autoimmune disorders that cause dry eyes and mouth.
- There are multiple restrictions regarding eating, drinking, gum-chewing, makeup use, topical application, and tooth-brushing that must be observed to get a usable saliva specimen.
- As a rule, most health insurance companies do not reimburse for hormone saliva testing.
- One of the most significant technological roadblocks in the development of salivary diagnostics is the low concentration of hormones found in saliva compared to blood (300 to 3,000 times lower than in blood). With saliva testing the hormones are found in much lower concentrations than in blood or urine. Hormones are passed from the blood into saliva by a process called ultra-filtration. For molecules to squeeze through by this process, they have to be very small. Because the levels are so tiny, this makes the reference ranges in salivary samples difficult to interpret for their clinical significance. Another reason that makes it much harder for labs to consistently report salivary hormones with as much accuracy as blood or urine.
- Contamination by blood, as from bleeding gums, even in invisible amounts, is common in saliva testing and can affect a person’s results and make the levels seem artificially high. Micro-damage from tooth-brushing can result in elevated salivary testosterone levels for up to an hour after brushing, even in the absence of visible signs of bleeding, such as “pink toothbrush.” This results in higher values than expected because of the added blood hormones introduced in the saliva. Since there is no easy way to adjust for this kind of contamination, the results must be discarded, and another sample taken.
- Other factors such as salivary pH and flow rate can affect results. In the past, when split samples from the same person were sent to different salivary testing labs, the results from the different labs were unfortunately very different, leading some researchers to discount saliva testing altogether. Fortunately, as the technology has improved, many of the labs have improved their ability to provide accurate and reproducible results. However, the fact remains that because hormone levels are much lower in the saliva, any lab that tests salivary hormones will need highly proficient quality control standards to assure consistent and reliable accuracy.
- Saliva can only be used to evaluate steroid hormones. Peptide hormones, such as growth hormone and thyroid, are not available. While estradiol, estrone, and estriol, progesterone, testosterone, DHEA, and cortisol are all available, depending on the lab, steroid hormone metabolites are not measured in saliva, limiting its utility in assessing metabolism of hormones.
- Saliva hormone tests struggles to accurately measure and decipher between low, normal and elevated levels of estrogen – sometimes they even co-mingle together. It’s simply not sensitive enough to see the various different levels of estrogen therefore lacking in accuracy, which is an issue for women when it comes to trying to figure out their estrogen state, which can impact overall health.
- Saliva measurements are greatly affected by the use of hormone therapy. Transdermal progesterone and testosterone, in particular, can result in supra-physiological levels in saliva testing, but all exogenous hormone use seems to distort results to some extent. Because of this, patients are instructed to discontinue hormone use for between 12 and 36 hours prior to collection, depending on the hormone preparation. This can pose problems for practitioners who want to monitor hormone therapy. Estrogen, for example, washes out of the system almost entirely in 20 hours and drops significantly within 12 hours.
- Saliva collection, like blood, is a single-point collection. Although cortisol can be collected at multiple points, sex hormones are measured from a single morning collection. Just as with serum tests, a single point of collection does not account for individual variation and may catch a peak or a valley in hormonal secretion – or perhaps a peak for one hormone and a valley for another.
- Some practitioners feel that relying exclusively on salivary hormone testing, despite obvious advantages in collection, can be clinically misleading.
- To help ensure accuracy, some labs and their total testosterone hormone testing have been CDC-certified every year since the program’s inception in 2011. Unfortunately, there is no similar certification program for overall saliva hormone testing at this time.
Regardless of your need for hormone tests, the saliva hormone test can prove to be just the thing that you and your practitioner decide is best for you.
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