Saliva Testing of Hormones

Why test saliva?

Because steroid hormones play such a vital role in maintenance of health, knowledge of an imbalance in any one or more hormones can help illuminate the cause of health problems and provide a rational basis for correcting the imbalance through diet, exercise, or hormone supplementation.

Are the levels of steroid hormones in blood and saliva the same? When the various glands manufacture the steroids they are released into the bloodstream bound to carrier proteins. Only a small fraction (1-5%) of a given amount of steroid hormone breaks loose from the carrier protein in the bloodstream and is free to enter target tissues. This free or unbound hormone is what we want to measure, since it is active or bioavailable to the target tissues such as the breast, uterus, brain, and skin.

Many studies in the scientific literature have shown that there is a strong correlation between the levels of steroid hormones in saliva and the bioavailable (free) levels of steroids in the bloodstream. The amount of steroid hormone that enters the salivary ducts and then saliva, is representative of the fraction of steroids in the bloodstream that are bioavailable to other tissues in the body.

Advantages of saliva vs blood testing of steroid hormones Saliva collection is easy, can be done anywhere, any time and at a much lower cost. Serum hormone testing is stressful, and the stress of a blood draw can sometimes alter the result. Blood has to be drawn at a doctor's office or drawing station, and it is more difficult to obtain samples at the desired times (e.g. early am), multiple times through the day or late evening. There is also an extra cost involved in drawing blood, independent of the cost for the test itself.

Hormones in saliva are exceptionally stable, allowing wide latitude in collection and shipment. Samples can be stored at room temperature for at least a week without loss of activity, so samples can be shipped to the testing facility by regular mail. Blood, on the other hand, must be kept cool on ice packs, increasing costs for shipping as well as the likelihood of error due to improper handling

Finally, as outlined in the following section, saliva hormone testing allows you to take more control over your own health. Saliva testing may help you to gain insight into health problems before you see your doctor. It will also allow you to monitor an OTC hormone supplementation program (eg natural progesterone cream or DHEA are widely available at health food stores) if improvement in quality of life, disease prevention, or anti-aging is your goal.

How Can Saliva Hormone Tests Help You?

There are several ways salivary hormone tests can help you to take responsibility for, and optimize your health.

The first way is to help identify possible causes of health problems. Depending on the specific hormones involved, certain symptoms or groups of symptoms are usually present when hormonal imbalance exists. For example, contrary to popular belief, depression is not caused by a prescription drug deficiency, but it can be caused by an imbalance between estrogens and progesterone, low androgens like DHEA and testosterone, or high cortisol. Genetics, dietary factors or other environmental factors may cause this imbalance, in turn.

Accordingly, depression might also be reversed by supplementation with the appropriate hormone(s) and attention to other factors; hormone testing can be used to guide this therapy. If hormone balance is restored but symptoms persist, then one has to look elsewhere for the cause.

Hormone testing can be used to guide supplementation, to determine if an oral hormone supplement such as DHEA is being absorbed, and if the dosage is appropriate. Bioavailability of oral hormonal supplements can vary widely. The saliva test can also help you evaluate if estrogens are well balanced with progesterone following progesterone cream supplementation. Too much estrogen, relative to progesterone, leads to excessive tissue proliferation, whereas too much progesterone in the absence of adequate estrogen can exacerbate estrogen deficiency problems.

Saliva hormone testing can also be vital for rational disease prevention and anti-aging programs. Testosterone, for example, is an important hormone in both sexes, for the maintenance of cardiovascular and bone health. Identification of a low testosterone level and correction with diet, exercise, and/or hormone supplementation could help prevent the development of cardiovascular disease and osteoporosis.

Anti-aging medicine is still in it's infancy, but hormone supplementation is an important aspect of anti-aging; restoration and maintenance of hormone parameters at youthful levels is one strategy that may extend your healthspan (span of healthy, productive years). Hormone testing is crucial for this approach as it is imperative not to exceed levels that might lead to adverse side effects.

Steroid Hormone Overview

Estrogens (estradiol, estrone, estriol) are predominately female hormones, and in adults, they are important for maintaining the health of the reproductive tissues, breasts, skin and brain. Excessive estrogens can cause fluid retention, weight gain, migraines and overstimulation of the breasts, ovaries and uterus, leading to cancer. Insufficient estrogen levels can lead to hot flushes, vaginal dryness, rapid skin aging, urinary problems, excessive bone loss and possible acceleration of dementia. An excess of estrogen, relative to testosterone, is thought to play a role in the development of prostate problems in men. Most scientists now agree that by-products of estrogen metabolism are the cause of both breast and prostate cancers.

Progesterone can be thought of as a hormonal balancer, particularly of estrogens. It enhances the beneficial effect of estrogens while preventing the problems associated with estrogen excess. Progesterone also helps create a balance of all other steroids. It also has intrinsic calming and diuretic properties. It is important in women, but it's importance in men for the maintenance of prostate health is only now being appreciated.

Androgens (testosterone, DHEA, androstenedione) play an important role in tissue regeneration, especially the skin, bones, and muscles. The principal androgen in both men and women is DHEA. DHEA levels decline with age, and in some cases, supplementation with DHEA can restore energy, improve immune function, lift depression and improve mental function. Testosterone is involved in maintenance of lean body mass, bone density, skin elasticity, sex drive and cardiovascular health in both sexes. Men make more of this hormone, accounting for their greater bone and muscle mass. Androstenedione is a precursor for both estrogens and testosterone, especially in females. It can be produced in excess by the ovaries, especially during early menopause, and can cause some of the "androgenic" symptoms such as scalp hair loss and facial hair growth.

Glucocorticoids, primarily cortisol, are produced by the adrenal glands in response to stressors such as emotional upheaval, exercise, surgery, illness or starvation. Cortisol plays an essential role in immune function, mobilizing the body's defenses against viral or bacterial infection, and fighting inflammation; however, chronic elevated cortisol levels suppress the action of the immune system and predispose to frequent infections. Cortisol levels are highest first thing in the morning, to combat the stress of overnight fasting and to animate the body for the day's activities.

The brain derives most of it's energy from glucose, so maintenance of adequate blood levels is a top priority. After a period of fasting, cortisol output increases, and this initiates catabolism, or the breakdown of protein into simple amino acids and their conversion into glucose to feed the brain.

Chronic, excessive stress (emotional or physical), protein deficiency, and lack of nutrients including Vitamins A,C and Pantothenic acid (B5) can cause the adrenal glands to become exhausted, so that they can no longer produce adequate cortisol. This leads to low blood glucose (hypoglycemia), excessive fatigue, and increased susceptibility to infection.

Tightly coordinated production of adrenal glucocorticoids is essential for optimal health. In normal individuals, the breakdown or catabolism of tissues by glucocorticoids is followed by the building up or anabolism of tissues by androgens. As we grow older, an excess of catabolic hormones over anabolic hormones develops, and this is in part responsible for the aging of all the body tissues, and the loss of our ability to repair damaged tissue. The same thing happens under chronic, excessive stress, and contributes to premature aging. Stress can literally burn our bodies out prematurely.