I Could Just Spit!

The Joys of Salivary Hormone Testing

A lot of people in the medical biz have long touted the superiority of serum analysis in assessing hormone levels in the body. Conversely, many of those same people, along with some of us at T-mag, have been a little wary of saliva testing because of the notion that the tests just aren't as accurate as other types of analysis.

However, Joe Ailts, a lab supervisor at Pharmasan Labs, is here to present his case concerning salivary testing. He maintains that it's much easier, in some cases more reliable, and in all cases, much cheaper than serum analysis.

If you're interested in monitoring your hormone levels, saliva testing might just be the easiest and cheapest way to do it. Plus, you don't have to answer all those probing questions from your family doctor!

When it comes to measurement of hormones in body fluids, there are three routine methods to choose from. These include urinary analysis, serum (blood) analysis, and salivary analysis. Of those three, salivary analysis is the method least accepted by the general population. Why is that you may ask? For the same reason many believe resistance training is unhealthy, deadlifts are dangerous, and creatine causes cancer.

Each of the three hormone measurement methods has its advantages and disadvantages. I'd like to present a brief overview of the first two, and a little more in-depth explanation of salivary testing. My goal is not to discourage the use of urinary or serum testing, but to promote the many benefits of salivary testing.

Urinary Hormone Analysis

Quick question: How many of you would enjoy spending your entire day walking around with a four-liter jug of urine? Sounds like fun, right? And a sure way to impress the ladies. But that's what's required for urinary hormone analysis. From the time you wake up in the morning until you wake up the next morning, you need to collect every drop of urine you produce. It's called a 24-hour urine sample.

The fun doesn't stop there either. Rather than shipping a heavy jug of urine to the lab, you need to record the total volume expelled, mix it up, and then dip into it with a smaller transport vial. Then, if you're not entirely disgusted yet, you pack it up and ship it off.

Truth be told, urine does provide an accurate representation of total hormone production rates over a period of time. The methods of analysis are well established, and the results are reproducible. However, urine analysis cannot assess normal rhythms of hormone production.

Plus there's that whole collection process that you have to deal with.

Serum Hormone Analysis

Ah yes, the old favorite. Serum assays produce reliable, sensitive results, which provide an accurate assessment of a patient. Unfortunately, that isn't always the case. I'll explain why, but first let's have a look at the sample collection procedures.

I don't know what's worse, sitting in the clinic for an hour with a screaming two-year-old on one side, and Mr. Fluvirus who keeps coughing conveniently in your direction on the other, or the actual blood collection process of sticking a needle into your vein.

It really isn't so bad, being stuck with a small needle every now and then. But try being a participant in a university study, where the procedure calls for frequent measurements. Can you say "Swiss cheese"?

Like I said before, serum assays are reliable and quite sensitive, not to mention popular. The majority of testing facilities utilize serum testing as the standard for hormone analysis.

The major drawback to serum assays is that most measurements represent total (bound + free) levels of hormones. Most of the steroid hormones in the blood stream are bound to proteins. This means they are unable to latch onto receptor sites, including the receptor sites on muscle. A small percentage of hormones, however, are floating around in an unbound state. These are the ones that find the receptors, and activate their desired response.

Accordingly, what good does it do to know your Testosterone level if you have no idea how much of that T is free? Researchers have determined that the normal amount of free T is roughly 1-5% of total T levels. Keep in mind though, everyone is different. Let's say TC has a T-level of 500ng/dL, of which 1% is free. Let's say TC's dog has a T-level of 100 ng/dL, of which 5% is free. Doing the math, each has 5ng/dL of free T. Of those two, who do you think is Testosterone deficient?

Measurements of free hormones in serum are available upon request, but they are very expensive, require a few technically difficult steps, and are not as reproducible as laboratories would like. If a serum sample is sent in without a request for the free levels of hormone, they're then run as total levels, which don't do anybody a heckuva' lot of good.

Salivary Hormone Analysis

The use of saliva for hormone diagnostics has been around for more than 20 years. Saliva makes such an excellent medium because it is a natural filtrate of the free hormones in the blood. Hormones not bound to carrier proteins passively diffuse into saliva and target tissues, due to their relatively small size and nonpolar nature.

Here's where it gets interesting. How about creating an inexpensive, non-invasive test that provides reproducible, accurate data of the free levels of hormone all in the comfort of your own home? That's right. Simply spit into a vial and send it off to the laboratory. Nothing to it!

There is even scientific data to support the validity of saliva testing. (Rather than reprint paragraph after paragraph of potentially boring data, I'll just provide the "punch line".) Have a look:

Hormones in Saliva: Mode of Entry and Consequent Implication for Clinical Interpretation; Vining RF, McGinley RA and Symon RG. Clin Chem 29: 1752-1756, 1983

We conclude that the salivary concentration on unconjugated steroids may usefully reflect the concentration of free (nonprotein-bound) steroids in plasma.

Steroid assays in saliva: a method to detect plasmatic contaminations; G. Lac, N. Lac and A. Robert. Archives Internationales de Physiologie, de Biochimie et de Biophysique, 101, 257-262, 1993.

The correlations between salivary and plasmatic values are presented and confirm that this method is a reliable alternative for hormonal investigations.

Testosterone Concentrations in Human Seminal Plasma and Saliva and its Correlation with Non-Protein-Bound and Total Testosterone Levels in Serum; Sannikka TH, Terho P, Suominen J, et al. Int J Androl 6: 319-330, 1983

A sensitive, specific and precise non-chromatographic method for the radioimmunoassay of Testosterone in human seminal plasma and saliva from adult and pubertal males is described, and the values compared to total and non-protein-bound Testosterone levels in serum. There was a significant correlation between salivary and serum-free levels of Testosterone (r=0.75, P<0.001, n=67)

Salivary Testosterone Measurements: Reliability Across Hours, Days, and Weeks; Dabbs JM Jr. Physiology and Behavior 48: 83-86, 1990

Salivary assays offer a practical way of measuring Testosterone in free-ranging subjects outside the laboratory.

I could have included hundreds more articles similar to the references above, but they'd probably get a little boring. How about a real life situation?

A patient sent in a serum and saliva sample to our laboratory. Let's call him "Mr. Softwood". He was experiencing lack of libido, inability to maintain an erection, and poor sexual performance. For those with some knowledge in endocrinology, this is most likely a DHT problem. A complete analysis of Mr. Softwood's serum sample showed that he was in the normal physiologic range for each of the parameters measured, including DHT.

However, a complete analysis of Mr. Softwood's saliva sample showed he is normal for each of the parameters measured EXCEPT DHT.

The saliva test was more accurate in this situation because it represented the fraction of DHT that was available to the target tissues. Had this been just a serum analysis, Mr. Softwood's physician would have probably told him "Everything was okay," or "Go home and try harder next time." Or the classic "If the problem persists, come back in 10 days." Since the saliva test showed a DHT deficiency, we can assume that most of the DHT in his serum was bound to protein. Therefore, none of it could have an influence on his love machinery. Bummer!!

Hopefully, I've provided enough information here for you to consider the benefits of salivary hormone testing. Interested in giving it a shot? Simply log on to OptiMale.net, or call 877-729-6784 to order your kit. A single Testosterone test costs $25, while Testosterone plus estradiol is $40. There are also many more profiles available. Shipping to the lab is free. Results are mailed to you within 7 days and include a personalized interpretation of your hormone levels.