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Saliva testing, as opposed to blood serum testing, is the most reliable test to measure hormonal balance. However, you should be aware of some of the disadvantages and advantages of saliva hormone testing compared to blood testing.

David Zava, [Ph.D.] the founder and Chief Scientist at ZRT Laboratory, has been among the pioneer to promote the efficacy of saliva testing vs serum testing. He says:

Because of the rapid passive diffusion of steroids into the saliva, saliva testing remains the most reliable test to measure the level of bio-available progesterone in the body.

Only a small fraction of steroids in blood plasma serum are bio available.

In blood, 95-99% of the steroids are bound up by binding proteins such as sex hormone binding globulin (SHBG), cortisol binding globulin (CBG), and albumin. (3-5) The small fraction of steroids not bound is considered the free fraction, or that which is bio available as blood percolates through the capillary beds of tissues.

The free or bio available fraction of steroids in blood enters the salivary gland and the salivary duct by passive diffusion just as they enter other tissues of the body. Hence, saliva provides a convenient diagnostic fluid from which to monitor, non invasive, the bio available fraction of steroid hormones circulating in the bloodstream and entering tissues.

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 The advantages of saliva testing:

  • easy to collect and stress free.
  • Non-invasive (no needles)
  • Convenient collection and shipment by regular US mail
  • Inexpensive courier
  • Optimized for collection any time of day/month, any place
  • No special processing (E.g., centrifugation, ice-packs) prior to shipment
  • Hormones stable in saliva for prolonged period at room temperature
  • More reliable than serum for total bio available steroid hormone levels
  • Lower overall costs both for the patient, health care provider, and insurance carrier.

The disadvantages of saliva hormone testing:

  • Technically more challenging than serum testing of steroids, need 10-20 x sensitivity
  • Limited number of laboratories that can perform this test
  • Lack of technical expertise
  • Interfering substances-food, beverages
  • Saliva easily contaminated with topical hormones on lips or hands
  • Spurious results with periodontal disease (more problem with chewing gum)
  • Wrongly believing that serum is gold standard
  • Sub-lingual use of hormones often leads to inaccurate (high) results
  • No proficiency testing (CAP, AAB) that reflects saliva hormone levels
  • Topical application of hormones results in saliva levels higher than serum

The ideal saliva hormone test report should contain patient information not only about an individual's hormone level but how this relates to symptoms associated with hormonal imbalance. These other relevant information are essential to provide an ideal saliva hormone test report:

  • Gender, Age,
  • Menopausal status,
  • Menstrual cycle information,
  • If woman had her ovaries removed
  • Usage of hormones (types, delivery systems such as oral vs. topical, dosage) and when last used will impact the test results and ranges
  • Which phase of the menstrual cycle (follicular vs. luteal) as progesterone level will differ
  • The delivery systems when taking replacement therapy (oral vs. topical).

Those differences should be mentioned in the test result. Otherwise, the results can be misleading. For instance, a postmenopausal woman using progesterone cream will have a higher salivary progesterone levels than a post menopausal woman who is not supplementing.

The RATIO of Progesterone to Estrogen is more Critical than the LEVELS

To Conclude:

Saliva hormone testing is more convenient than serum hormone testing. It is less stressful, more cost-effective, and more representative of the bio-available progesterone or estrogen in blood. The ratio of progesterone to estrogen is easily done with saliva hormone testing.

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