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There are two common types of testing for hormone levels when working with women with symptoms of PMS or menopause and men with symptoms of andropause.  These are serum (blood) testing, which is favored by many conventional medical doctors, and saliva (”spit”) testing, which is favored by most “alternative” health care providers and those select few medical doctors who have looked beyond their medical school brainwash… er, training, yes, training is the word I’m looking for! 

I poke fun at the conventional medical docs who favor serum testing because when one sets aside preconceived notions and actually investigates the potential reliability (I say “potential” because reliability depends on the quality of the individual lab) of the two testing methods, saliva testing is the clear winner, especially if hormone balancing is to be done with any type of topical hormone (skin creams/gels, suppositories, patches, etc.).  In fact, serum testing is so unreliable with regards to monitoring the effects of topical hormone supplementation that it really could be considered totally useless - which is why conventional medical doctors typically recommend against topical hormones (more on this shortly). 

If salivary hormone testing is so much more reliable, why then do so many conventional doctors disparage it?  As I alluded to earlier, part of the problem goes back to their medical school training.  Blood testing is given a great place of honor among medical tests, and rightfully so for most types of testing.  Because doctors are taught, and have come to wholeheartedly believe, that blood testing is the “gold standard” for everything having to do with body chemistry, there is an automatic presumption that saliva testing would be a weak substitute at best.  Because of this strong preconceived bias in favor of blood testing, many doctors have drawn completely illogical conclusions regarding the experiments that have compared the reliability of blood testing to saliva testing.

Repeated experiments have shown that topical application of hormones in test subjects creates a much higher increase in the levels of hormone found in saliva testing than is found in serum testing.  In fact, topical hormone application produces only very minimal increases in serum hormone levels.  This has led many conventional doctors to draw two very illogical and very incorrect conclusions. 

The first conclusion is that saliva testing must be faulty because it shows a much greater increase in hormone levels - when topical hormones are applied - than serum testing (and since serum testing is the presumed “gold standard”, the saliva testing must be wrong in some way).  Now does that conclusion make any sense at all?  Of course it doesn’t!  When you give someone hormones, you should see their test levels rise.  Yet somehow, many medical doctors have concluded that the test that shows what you would expect it to show is wrong, and the test that didn’t show what you would expect it to show is right.  That medical school “training” is thorough!

Now they may be brainwa…, I mean, “trained” to think a certain way, but medical doctors aren’t stupid.  They know that with the experiments that have been done, their conclusion that salivary hormone testing is unreliable (as compared to serum testing) doesn’t make any sense, so they’ve had to come up with something to support that illogical conclusion.  This brings us to what I mentioned earlier about the conventional medical bias against topical hormones.  Since they presume that serum testing is accurate, and is in fact the “gold standard” of testing, and serum testing does not show a significant increase in hormone levels when a patient is given topical hormones, the only way to rectify this contradiction is to conclude (again, illogically and incorrectly) that topical hormones don’t “work” - that is, they are not absorbed to any great extent.  So, since they assume that topical hormones are unreliable, it is safe to assume that any test that can measure their levels in the body must also be unreliable.  I really have to marvel at the thoroughness and effectiveness of the medical school “training”!

The fact that saliva testing shows significant increases in hormone levels when topical hormones are used and serum testing does not is actually easily explained, but most conventional doctors have not bothered to investigate this phenomenon and instead fall back on the presumption that serum testing is always the best for anything regarding body chemistry.  To understand what is happening, first you need to know a little about the nature of how hormones travel in the blood.

Steroid hormones (such as estrogen, progesterone, and testosterone) are primarily found in the bloodstream bound to proteins.  Only about 1% to 5% of the steroid hormones in the blood are “free” (not bound to proteins).  Both saliva and serum testing measure free hormones.  When you take hormones orally, most of the hormones are absorbed from the GI tract bound to proteins, so oral hormones do not produce a huge increase in free hormones and therefore they do not show huge sudden increases in hormone levels on either saliva or serum testing. 

When hormones are taken topically (through skin creams/gels, suppositories, etc.), the free hormones are absorbed directly into the blood stream.  Yet as we said earlier, topical hormones do not produce signficant increases on serum (free)hormone tests (this is true of injectable hormones as well).  It is this contradiction that has created so much controversy.  The reason why serum tests do not show this large increase in free hormones is because the hormones are attracted to the blood cells and actually attach loosely to them.  Blood tests for hormones are done on the serum, not the cells (the blood samples are put in a machine called a centrifuge that separates the cells from the serum).  Technically, the hormones that are attached to the blood cells are still “free” but because the cells have been removed from the serum (along with most of the free hormones that have attached to them), the increase in hormone levels from the topically applied hormone supplements are not shown in the serum. 

In the body, as the blood circulates through the tissues, including the salivary glands, the hormones riding on the blood cells are distributed to the tissues. So, the extra hormones are passed into the saliva relatively quickly, and the saliva tests therefore do detect the hormones absorbed from the topical application. 

From all of this, I think it is clear that saliva testing should actually be the preferred method of hormone analysis for patients with symptoms related to PMS, menopause, and andropause, particularly if proposed treatment is to include any kind of hormone replacement/supplementation other than oral hormones.  But there is one potential drawback of saliva testing that needs to be considered - the testing procedures. 

From a lab procedure standpoint, saliva testing is more difficult to do than serum testing, and therefore, choosing a good lab is extremely important.  It is also important for testing to be done on multiple samples, because an individual’s hormone levels can vary considerably over the course of a day, week, and month.  This issue is less of a factor in men and post-menopausal women than in women who still are on a menstrual cycle, but it still needs to be considered.  I recommend using labs that test from multiple samples taken in the same day on all patients and in some cases it may be necessary to run a series of tests over a period of weeks.  Finally, most saliva samples are actually collected by the patient at home (not in a lab), and it is extremely important to follow all of the directions carefully in order to get an accurate test result.  

For additional information on hormone testing, feel free to contact me .

Stay tuned to my natural remedies blog for more on natural hormone balancing.

P.S. I’ve entered the title of this post in Problogger’s Killer Title Contest.

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