Saliva Hormone Testing For Hormonal Imbalance
What are the benefits of saliva hormone testing?
Saliva hormone testing is most useful for uncovering hormone imbalance. For example: discovering a woman has insufficient progesterone to balance high estradiol levels or; that high cortisol levels are interfering with the action of progesterone and testosterone. Once a hormone imbalance has been uncovered, nutritional or bio-identical hormone therapy can be instituted.
Saliva testing can also be used to approximate whether hormone levels are too high or too low as a result of supplementation, but the actual dosage adjustment will still be symptom driven. In other words, if hormone levels are above range, a dosage reduction may be indicated, but the practitioner must make his or her best estimation as to the dosage adjustment needed, and carefully monitor patient symptoms to ensure that adjustments are reasonable.
Saliva collection is painless and more convenient for the patient, particularly when multiple samples are required.
What exactly does a saliva hormone test measure: free or bio-available hormone?
There is a common misconception that only free hormone is available to tissue. Various lines of research over the past 20 years have converged to indicate that all forms of a given hormone are available to tissue. Free hormone, protein-bound hormone (albumin and SHBG-bound), red blood cell-associated hormone and conjugated hormone are all delivered to cells in varying amounts, depending on the type of tissue and whether the hormones are endogenous or exogenous. Free hormone levels in serum are known to underestimate bioavailable hormone levels, so measuring free hormones in serum may not accurately reflect what is being delivered to tissue.
Hormones pass into saliva from the cell membranes of the salivary gland. In other words, hormones must pass through saliva gland tissue to get into saliva, which means that a saliva hormone level measures delivery of hormone to tissue (cells) from the various reservoirs in blood. In contrast, a blood hormone level reflects hormone which has not yet been delivered to tissue. Because saliva reflects what actually gets into tissue rather than what might eventually get into tissue, it better reflects tissue (bio-available) hormone levels.
How do saliva hormone levels compare with blood?
Because both saliva and plasma are aqueous media, the amount of hormone they can pick up from non-aqueous reservoirs (e.g. binding proteins, red cell membranes) is limited by the solubility of these hormones. Hence, plasma hormone levels and saliva hormone levels are numerically similar (saliva/plasma is approximately equal to 1; range is 0.5 to 2). Clearly, there is a relationship between saliva and blood hormone levels, but the exact nature of that relationship is still under investigation.
Generally, normal ranges are derived from the statistical analysis of a large number of samples. The results can often be described by a Gaussian, or bell-shaped distribution curve. The normal range is then defined as that range into which 95% of the results lie, usually plus and minus two standard deviations from the mean. These ranges are defined without regard to symptoms and so an individual might very well be experiencing symptoms at a level which is within the normal range.
In 2003, Rocky Mountain Analytical undertook a statistical analysis of a large number of tested saliva samples. From this data we derived our current ranges, which are based on those levels within which 95% of our results lie for any given hormone. We call our ranges Observed ranges because many of the samples we receive are from women and men experiencing hormone-related symptoms, and who therefore may not be considered normal with respect to hormone balance. For that reason, we use the term within range rather than the misleading term normal, to describe a result that falls within the observed range.
Practitioners should not rely solely on whether a patient‘s hormone levels are within range or out of range. For example, a postmenopausal woman not supplementing with progesterone may have a salivary progesterone of 20 pg/mL, which is within range for her age group, and experience deficiency symptoms. A premenopausal woman may have the same level, which is below range for her age, and yet have no deficiency symptoms. Are the levels low or normal for these women? This is where it is important for the practitioner to assess symptoms and potential risk factors to determine whether any intervention is required. In the final analysis, the assessment of whether a hormone level is above, below or within range, is only one factor in patient management. Results must always be interpreted in the context of the full clinical picture.
There are different ranges for men and for women and the ranges for women are categorized according to menstrual status. Pre-menopausal women have ranges for follicular and luteal phase, and there are ranges for post-menopausal women as well. Ranges also differ for men and women who are supplementing with hormones. For a complete table of our saliva hormone test ranges, see the specification sheet for Saliva Hormone – Single Tube or Multiple Tubes.↑