|Saliva testing is the most accurate test
to determine steroid hormones (i.e. progesterone, estrogen, DHEA and
testosterone) levels when attempting to determine who needs hormone
Steroid hormones are fat soluble. This means that they
dissolve in fat or oil and not water. Since oil and water do not mix,
the body makes carrier proteins, called hormone binding globulins,
that when attached to a fatty hormone will allow it to mix in water.
This allows the fat soluble hormone to travel in the watery bloodstream.
Those steroid hormones attached or bound to carrier proteins in the
blood are not active, only the unbound or free
hormone molecules have the ability to cause the effect they were
made to have on the body. If we look at the hormone as a piece of candy
that your taste buds can recognize, then the candy wrapper is the
carrier protein surrounding the active hormone and protects the candy or
the message of the hormone while it is bound and circulating. If we measure the amount of hormone or candy
in the blood over 99% is wrapped, or bound as we refer to in scientific
language. Your blood stream is your largest hormone reservoir in your
body, but the hormones are inactive.
Once hormones are absorbed from your blood stream into your tissue,
they lose their carrier protein and become active. Your salivary glands
contain the same concentration of active hormones as your tissues
contain. If we measure the amount of hormone in the saliva we measure
how much is unwrapped or active and able to deliver the flavor or the
message of the hormone to the breast, uterus, ovaries, brain, and other
organs of the body. There are a number of factors that determine how
much hormone, especially estrogen, is unwrapped and active in the body.
Increased weight, diabetes, stress, low fiber/high fat diets can all
increase the amount of estrogen that is active. If too much is active,
you will produce symptoms associated with too much estrogen from the
The total amount of estrogen in the blood can be high, normal, or
low. Exercise, maintaining your ideal body weight, high fiber diets,
eating the proper fats, eliminating stress, avoiding external estrogen
can all decrease the amount of active estrogen in the body. Because
there are so many variables it is impossible to know what the level of
your individual hormones are without testing. This would be
like looking at you and guessing what your blood sugar level is, or if
your blood pressure is high, normal, or low. Since we would never treat
your blood pressure or your blood sugar without first testing for your
individual levels, I would not treat your hormone levels without first
determining their levels so we can accurately balance them to normal
Not only can saliva determine the amount of estrogen, it can also
determine the active amounts of progesterone, DHEA, testosterone, and
cortisol (your stress hormone) . All of these hormone levels may be
altered by menopause, your weight, your age, your stress level, your
diet, and multiple other factors.
Hormone replacement therapy is prescribed by many physicians without
first utilizing an accurate test that confirms that the therapy is
needed, and then to monitor the progress of the treatment! Millions of
women have been placed on hormone replacement therapy despite
significant short and long term side effects. I think that this is
wrong, and can also be dangerous to your health as hormones have both
positive and negative effects on the body, and too much of a hormone, or
an imbalance of hormones can lead to bad outcomes such as cancers of the
breast, prostate, uterus, and others. This was proven to be dangerous
for women by
the Women's Health Initiative Study!
Saliva testing is available from several labs across the country and
is easy for you to perform in the comfort of your own home and without
the need for needles.
Some insurance companies cover the cost of this invaluable testing.
If your insurance company does not cover the cost, the pricing is
reasonable and affordable, generally much less expensive than less
accurate blood testing! The pricing will obviously vary depending on the
type and number of tests needed to correctly assess your clinical
situation and will be determined at your consultation visit.
For your convenience, a brief summary of published, scientific
articles on saliva testing of hormones, particularly in reference to a
comparison with blood serum testing, is provided below. These articles
address a common misconception among health care providers that there is
little research to support the efficacy of saliva testing for hormonal
imbalance. The summaries also serve to illuminate the substantial volume
of clinical and scientific research that has in fact been published on
In summary, saliva provides a convenient, stress-free, way to collect
a diagnostic body fluid from which to determine, and then monitor, the
free or bio-available fraction of steroid hormones circulating in the
bloodstream and entering tissues. In addition, saliva testing is the
more accurate way to measure levels of human bio-identical hormones
delivered topically through the skin to manage hormone imbalances. As
can be seen in each of the publications summarized below, the literature
is clear that saliva and serum correlate extremely well.
Saliva Testing Support Documents
Note: summaries are listed in alphabetical order and
categorized according to hormone. Clicking on the hypertext at the
beginning of each summary provides linked access to the original journal
Aardal E, Holm AC. Cortisol in saliva-reference ranges and relation
to cortisol in serum. Eur J Clin Chem Clin Biochem 1995;33:927-932.
Parallel serum and saliva samples were acquired in 197 individuals,
in the morning and evening. A slight decrease in morning cortisol was
seen in the oldest individuals tested (61-70 years). As has been
demonstrated in other work, once serum cortisol exceeded » 450 nmol/l, a
marked increase in salivary cortisol was noted. This is attributed to a
rapid increase in free plasma cortisol once the available sites on
cortisol binding globulin are filled. The authors conclude by
enumerating the advantages of saliva over serum (simplicity, decreased
stress, convenience, sample mail-in, temperature stability).
Aardal-Eriksson E, Karlberg BE, Holm AC. Salivary cortisol- and
alternative to serum cortisol determinations in dynamic function tests.
Clin Chem Lab Med 1998;36:215-222.
Serum and salivary cortisol responses were compared in various
dynamic tests of HPA axis function including insulin tolerance, CRH
stimulation, and ACTH challenge. In 42 of 45 tests performed,
consideration of salivary cortisol led to the same conclusion as serum
cortisol. The authors conclude that due to a more pronounced cortisol
response in saliva, and a closer correlation between salivary cortisol
and serum ACTH, salivary cortisol may be used as an alternative
parameter in dynamic endocrine tests.
Allolio B, Hoffmann J, Linton EA, Winkelmann W, Kusche M, Schulte HM.
Diurnal salivary cortisol patterns during pregnancy and after delivery:
relationship to plasma corticotrophin-releasing hormone. Clin Endocrinol
The circadian rhythm of salivary cortisol levels was studied in 10
pregnant women every 4 weeks throughout pregnancy. In 12 women, diurnal
variation of salivary cortisol, serum cortisol, plasma ACTH, plasma CRH
and serum progesterone was examined late in the third trimester and
again 3-5 days after delivery. Mean salivary cortisol levels increased
throughout pregnancy, reaching levels almost twice that of controls by
late pregnancy, and falling rapidly with delivery. There was no
correlation between plasma CRH, plasma ACTH, serum and saliva cortisol
in late pregnancy. The authors conclude that although CRH levels
increase in late pregnancy (due to placental production), this CRH has
very little effect on baseline adrenocortical function. Instead, they
hypothesize that the high progesterone levels in late pregnancy induce a
state of glucocorticoid resistance, due to the antiglucocorticoid effect
Barrou Z, Guiban D, Maroufi A, Fournier C, Dugue MA, Luton
JP, Thomopoulos P. Overnight dexamethasone suppression test:
comparison of plasma and salivary cortisol measurement for the screening
of Cushing’s syndrome. Eur J Endocrin 1996;134:93-96.
Salivary cortisol was compared to plasma cortisol for screening of
Cushing’s Syndrome via overnight dexamethasone suppression test.
Compared to plasma, salivary cortisol demonstrated superior performance
with 100% specificity and 94% sensitivity (no overlap between controls
and patients with Cushing’s Syndrome). In addition, salivary cortisol
levels in women taking oral contraceptives were normal whereas the
corresponding plasma levels were elevated (false positive) in some
Belkien LD, Bordt J, Moller P, Hano R, Nieschlag E. Estradiol in
saliva for monitoring follicular stimulation in an in vitro
fertilization program. Fertil Steril 1985;44:322.
Serial serum and saliva measurements were compared in 23 patients
undergoing ovulation induction in an in vitro fertilization program.
Serum and saliva were well correlated (r=0.77) throughout, except for
salivary estradiol levels less than 4 pg/ml. (Note that estradiol can
easily be detected below this level with modern methods.) The authors
conclude that, “assessment of ovarian function in clomiphene citrate
(CC) or CC/hMG stimulated cycles can be performed precisely with the
saliva estradiol assay.”
Bolaji II, Tallon DF, O'Dwyer E, Fottrell PF. Assessment of
bioavailability of oral micronized progesterone using a salivary
progesterone enzyme immunoassay. Gynecol Endocrinol 1993;7:101-110.
These authors looked at salivary progesterone levels in 40
postmenopausal women taking 100 mg oral micronized progesterone in
cyclical fashion (23 days/month) for one year. These levels fell into
the range observed in the luteal phases of a control group of 40
normally cycling women. Five patients had simultaneous serum and saliva
levels of progesterone measured for 12 hours after ingestion of a 100 mg
dose of progesterone. Levels in both cases followed the same time curve,
with both peaking at 2 hours. This supports the notion that progesterone
diffuses rapidly from serum to saliva.