At-Home Testing
*Saliva Testing identifies bioavailable hormone levels – the active quantity that's free to move into body tissue. Its non-invasive nature also makes it the gold standard for tests requiring multiple collections, such as diurnal cortisol.
Suitable for:
- Assessing “free” (unbound to carrier proteins) hormone levels
- Monitoring hormone replacement given orally, topically, vaginally or via pellets
- Collecting multiple samples during a day, e.g., determining diurnal cortisol levels for adrenal stress assessment
Not suitable for:
- Monitoring sublingual/troche hormone replacement
- Patients with dry mouth, e.g., due to Sjögren’s Syndrome
Dried Blood Spot Testing is ideal for measuring hormones and other analytes such as insulin, blood lipids, Vitamin D, thyroid hormones, and elements like lead and magnesium. Blood spot testing gives results equivalent to serum but with distinct advantages over serum testing for monitoring topical and vaginal hormone supplementation.
Suitable for:
- Assessing total circulating hormone levels (free plus protein-bound)
- Patients with dry mouth and/or children who may have difficulty collecting saliva
- Monitoring hormone replacement therapy (oral, sublingual, pellet)
- Assessing thyroid health, fertility parameters, and cardiometabolic risk factors
Dried Blood Spot testing is superior to Serum for:
- Assessing interstitial tissue/capillary hormone levels reflecting topical or vaginal hormone supplementation
- Toxic and nutritional elements requiring a whole blood sample
- Self-collection of sample at home at a time convenient to the patient and avoiding a trip to the phlebotomist
Dried Uring Testing is the patient-friendly, discreet, simple alternative to all-day urine collection in a jug. Only 4 samples in one day are needed to assess adrenal and sex steroid hormone metabolic by-products and neurotransmitters, while 2 samples accurately determine 24-hour excretion of essential elements like iodine and selenium, and toxic heavy metals like arsenic and cadmium.
Suitable for:
- Measuring steroid hormone metabolites, e.g., for breast cancer risk assessment
- Determining toxic element exposure and iodine/selenium sufficiency for thyroid health
- Determining diurnal cortisol production at 4 time points for stress assessment
- Assessing nocturnal and diurnal melatonin production
Not suitable for:
- Monitoring topical or intravaginal hormone replacement therapy
*Some ADVANTAGES of saliva testing compared to serum testing:
- Saliva shows the free, unbound fraction of steroid hormones in the bloodstream-it is these biologically active fractions that are bio-available to the tissues throughout the body. Blood and urine tests measure total levels.
- Collection times can be more optimal which is very important for baseline hormone testing and assessment of HRT dosing. Note: Some hormones naturally fall by 50-90% during the course of the day so collection time is important. Hormone production is optimal in the morning and less susceptible to variation caused by stress, eating and drinking, and exercise.
- Painless, noninvasive, simple, safe, and needle-free.
- Private and convenient for both the patient and doctor.
- Hormones are stable in saliva at room temperature for 7-10 days.
- Transport of saliva to laboratory by regular US mail.
- Less expensive than blood testing.
Estrogens, progesterone, testosterone, DHEA-S and cortisol are routinely measured in saliva. Steroid hormones in the bloodstream are mostly (95-99%) bound to carrier proteins, and in this form are unavailable to target tissues. Only the unbound fraction freely diffuses into tissues, including the salivary gland. Hormone levels in saliva therefore represent the quantity of the hormone that is currently available to target tissues and actively exerting specific effects on the body. Research has demonstrated clear correlations between salivary hormone levels and reported symptoms.
Saliva Sample Volumes
Why do we ask for a larger sample volume? Steroid hormones are secreted in a bursts and pulses by various glands throughout the body. The more saliva that is collected, the more the effect is averaged out, and thus the results become more reliable and of the highest clinical relevance.
The Science of Saliva Testing
Explore the evidence: These published studies highlight the reliability of saliva testing in clinical practice.
1. Cardoso EM, Arregger AL, Tumilasci OR, Contreras LN. Diagnostic value of salivary cortisol in Cushing’s syndrome (CS). Clin Endocrinol (Oxf). 2009;70(4):516-21.
2. Gröschl M. Current status of salivary hormone analysis. Clin Chem.
2008;54(11):1759-69.
3. Arregger AL, Contreras LN, Tumilasci OR, Aquilano DR, Cardoso EM. Salivary testosterone: a reliable approach to the diagnosis of male hypogonadism. Clin Endocrinol (Oxf). 2007;67(5):656-62
4. Gozansky WS, Lynn JS, Laudenslager ML, Kohrt WM. Salivary cortisol determined by enzyme immunoassay is preferable to serum total cortisol for assessment of dynamic hypothalamic-pituitary-adrenal axis activity. Clin Endocrinol (Oxf) 2005;63(3):336-41.
5. Zava D. Saliva hormone testing. Townsend Letter for Doctors & Patients
2004;January:120-4.
