Salivary Hormone Testing

It is our belief at Advanced Integrated Healthcare that Saliva testing is proving to be the most reliable medium for measuring hormone levels. Hormone levels in saliva accurately represent the amount of hormone delivered to receptors in the body, unlike serum which represents hormone levels that may or may not be delivered to receptors of the body. Clinically, it is far more relevant to test the amount of hormones delivered to the tissue receptors as this is a reflection of the active hormone levels of the body.

Why use saliva?

Saliva testing is an easy and noninvasive way of assessing your patients 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 in 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 the 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 healthcare 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.

Serum measures the "protein bound" biologically inactive hormone levels in the body:

In order for steroid hormones to be detected in serum, they must be bound to circulating proteins. In this bound state, they are unable to fit into receptors in the body, and therefore will not be delivered to tissues. They are considered inactive, or non-bioavailable.

Only saliva testing measures topically dosed hormones:

The discrepancy between free and protein bound hormones 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.

Who should be tested?

Both men, women, and of course all teenagers experience changes in hormone levels with age.  Sometimes those changes result in unpleasant symptoms that demand attention.   Often, the changes are more subtle yet there is still an impact on overall health.  Hormone testing is applicable for:

• Men and women concerned with changing hormone levels as a result of age.
• Cycling teenagers and women experiencing PMS symptoms, perhaps related to a hormonal imbalance.
• Peri and post-menopausal 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. Estrone and estriol are also important sex hormones to consider testing. The main adrenal hormones are DHEA and cortisol. These seven 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. During the office consultation, a much more detailed explanation of the hormones and corresponding symptoms are outlined.  Below is a brief description of each of these hormones:

Estrogens:

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. Estrone and estriol are also useful hormones to test.

Progesterone:

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:

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:

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:

Your waking day hormone (highest in the morning and lowest at night). It is necessary for energy production, blood sugar metabolism, proper blood pressure levels, 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