Whether ’tis nobler to urinate… er, sorry, got carried away with the Shakespeare reference! Anyway, I have received some questions about hormone testing using 24 hour urine tests versus salivary hormone testing.
There seems to be a misconception about salivary hormone testing being more accurate than 24 hour urine, and that’s not the case. If anything, the 24 hour urine test typically gives the most reliable information about hormone status. Assuming full patient compliance with the specimen collection, it’s a top-notch test.
The problem with 24 hour urine testing is not one of accuracy and reliability, it’s one of convenience and compliance. It’s not a big problem for a patient who doesn’t have to work or take care of a family. Collecting a sample every time you urinate in a 24 hour period if you don’t have a lot of other things going on would probably not be that difficult.
But for someone who is trying to collect samples while at work, or while trying to run errands, fix meals, take care of kids, etc., collecting urine samples can be a tough task to add in and be consistent for a full 24 hours. I know some working moms who have told me that they have trouble finding time to go pee at all, let alone to take the care and time to collect a sample.
In my opinion, salivary hormone testing (using a reputable lab) provides reliable results in most cases with what is generally an easier to accomplish method of sample collection than 24 hour urine testing.
Typically, salivary testing is done using 4 samples taken over the course of a day from the time you wake up to the time you go to sleep, and the samples can be collected just about anywhere – you simply collect a small tube of saliva and put the cap on it. The labs request that the samples be frozen overnight before being mailed (this has nothing to do with the accuracy of the test, but it reduces the odor of the sample when it is opened at the lab), but otherwise requires no special handling. Saliva sample tubes are small enough that they easily fit in a pocket, and are pretty safe to carry around with you all day. Even in the worst case scenario of one of the tubes opening up in your pocket, you’d just get some saliva on your clothes. Yeah, you might get teased about the wet spot by coworkers, but ultimately, not much harm done.
Contrast this with trying to collect urine over a 24 hour period. You have to take the time to collect a specimen if you get up in the middle of the night to use the bathroom. If you work or run errands away from home, you have to find a restroom to collect the samples in (it’s usually frowned upon by the authorities to collect a urine sample in public), and then you have to carry the samples around with you (possibly spilling on you or in your purse, car, office, etc.). The option to carrying the samples around is to find a secure place to keep them. The fridge at work is NOT recommended – at best, you’ll gross out your co-workers and at worst, the office fridge-raider could wind up taking a swig thinking it’s juice and then all kinds of trouble could result (besides the issue with your co-worker, you’d have to start the test over again!).
So, while 24 hour urine testing for hormones is a very good test, and may be a necessary step in a few cases, the inconvenience makes it less than ideal. For this reason alone, I usually recommend saliva testing for hormones.
See my article on salivary hormone testing for more information.