Over the years, I have found many problems with the widely touted saliva tests for hormone levels. In my experience, saliva tests are not accurate for measuring hormone levels or for hormone deficiencies.
As early as 1995, I tested several hundred patients with saliva tests and blood serum tests both done on the same women at the same time of day. I started out with an open mind, looking for a simple, reliable, inexpensive way to measure hormone levels that would correlate with women’s symptoms and would assist me in determining the dose for various prescriptions. I was shocked at what I found.
All of the test reports I received on my patients had widely varying numbers, as you would expect. But the shocking finding was that all of the explanatory reports for all of the patients had the same “diagnosis:” progesterone deficiency (a medical diagnosis only in the sense of infertility), “estrogen dominance” (not a real diagnosis), and adrenal fatigue or insufficiency (correctly called Addison’s disease, when proper tests have been used to diagnose it).
Yet blood tests from the same patient told an opposite story – markedly low estradiol, normal or high progesterone, and normal or high cortisol. Higher-than-normal cortisol is expected in menopausal women as part of the body’s stress response to the loss of estradiol.
None of the patients I tested had a blood test that showed a deficiency of the adrenal hormone, cortisol. Addison’s disease is medically urgent to diagnose and treat, and it has very characteristic body changes – marked weight loss, marked muscle wasting and weakness, darkening and splotchy skin, and loss of all body hair. It’s hard to miss.
Compounding pharmacies and some non-M.D./D.O. practitioners widely promote saliva tests sold through their practice. Some practitioners use saliva tests because under current prescribing regulations in most states, they cannot order blood tests. Such practitioners claim that saliva tests are more “reliable” than blood tests because they measure the free hormone. It turns out these claims are false, based on newer research.
Saliva tests were initially thought to have some promise because they were considered to be easy and convenient for patients. But infertility and most menopause specialists stopped using these tests because they simply weren’t reliable – they didn’t correlate with women’s symptom descriptions, they didn’t correlate with tissue samples results (such as endometrial biopsy), and they definitely did not correlate with the more useful serum hormone assays that are widely used in fertility and menopause centers throughout the world.
The Problems With Saliva Tests
Ovarian hormones are carried in the bloodstream three ways: strongly bound to sex-hormone binding globulin (SHBG), weakly bound to albumin (ALB), and in the free form (not bound to carrier protein). We used to think that only the free-form hormone was biologically active at hormone receptors, so we often ordered blood tests for both total and free hormone levels.
Recent research has shown body tissues use both weakly bound and free-forms of these hormones at receptors. Saliva tests only measure the free, unbound portion of the hormone molecule in serum, so they don’t give a complete picture of the available potentially active, or bioavailable, hormone.
Another serious problem is that the saliva test kits sold over the Internet and in pharmacies use plastic tubes. New research has found that these plastic tubes actually release estrogenic compounds that degrade the hormones and make the saliva levels unreliable.
Researchers in Germany showed clearly that glass tubes have to be used for saliva tests to have samples not contaminated by hormonally active compounds in plastics.
Another problem with saliva test kits in the United States is that many companies use hormone assays that were designed for blood, not saliva. This throws another flaw into the readings obtained with saliva tests.
Many variables affect the amount of saliva produced, the excretion of hormones from serum into saliva, and the amount of hormone in serum in the bound vs. free state. For example, many common medicines affect the amount and composition of saliva, such as medicines with anticholinergic or antihistamine effects. This includes many antidepressants, allergy medications, medicines to control bladder leakages, some headache and sleep medicines.
All of these decrease saliva production, which alters the free hormone in saliva. Medications that affect protein-binding also drastically alter the amount of bound vs. free ovarian hormone in serum.
The Gold Standard
After seeing all the problems and unreliable results with saliva tests, I only use blood (serum) hormone tests now. Serum measures are the worldwide gold standard in fertility and menopause research settings – these specialists stopped using saliva tests because they simply do not provide reliable information to help us in providing medically sound care for patients who are suffering from these problems.
The blood tests measure total levels of protein bound and free fractions to provide a complete picture of the biologically active hormones. Blood tests, along with a physician’s evaluation, should be the approach when diagnosing or monitoring response to hormone therapy and making assessments of hormone effects on complex problems involving multiple organ systems.
If you are having symptoms that don’t seem to be responding to the hormone therapy you are taking, and if all you have had are saliva tests, I encourage you to check my website, www.herplace.com, for my booklet that explains the most reliable ways to get properly tested so that you can find approaches that give you relief, and help your improve your health.
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