Hormone Testing in Saliva

Saliva (Advantages)

-Noninvasive (no needles)
-More convenient for health care provider and patient
-Optimized for collection any time of day/month, any place
-No special processing (eg, centrifugation, icepacks) prior to shipment
-Hormones stable in saliva for prolonged period of time
-Convenient shipment by regular US mail

Saliva Disadvantages

-Restricted to STEROID hormones-no thyroid or peptide (eg. FSH) hormones
-Technically more challenging: need 10-20x sensitivity-more problematic for hormones at very low concentration (i.e. estrogens)
-Interfering substances-food, beverages
-Sublingual use of hormones leads to spurious high test results (direct contamination of the oral mucosa)
-Problematic for those with poor saliva production

 Clinical Utility of Salivary Estradiol Test Results

-Do salivary estradiol levels show expected relationships with:
-Menstrual Cycle
-Premenopausal vs Postmenopausal
-Symptoms of Estrogen Imbalance-Deficiency and Excess
-Estrogen Supplementation


When physiological dosing of exogenous hormones are delivered though the skin (topical cream or gel) or oral mucosa (troche, sublingual drops) the level of the supplemented hormone is approximately:

–         10 x physiological level in saliva
–         = to physiological level in DBS
–         10 x lower than physiological level in serum

Two Schools of Thought

1. Serum Camp: High saliva hormone level represents a concentration artefact   in the salivary glands, and hormones are poorly absorbed through the skin because serum levels do not increase with topical delivery

2. Saliva Camp: High saliva hormone levels represents the bioavailable fraction of hormone uptake into tissues, and serum is a poor indicator of hormone uptake through the skin

Flaws in Both Camps

1. Serum Camp: No scientific explanation for why levels go up in saliva, nor a rationale explanation for why topical dosing seems to work clinically without raising serum levels

2. Saliva Camp: No explanation for why saliva hormone levels go far beyond physiological with physiological dosing without creating symptoms of hormone excess


When testing hormones in different body fluids the only thing you know with certainty is how much hormone is in the body fluid you are testing.

It may be incorrect to assume hormone levels in various body fluids (venous serum, capillary blood-DBS, saliva, urine) are reflective of TISSUE hormone levels

Some Science and Pseudo Science Behind Transdermal Hormone Delivery Hormone Absorption Through The Skin: What Do We Know?

What The Experts are Saying: OBG Management Jan 2009, Vol 21 No. 01
Interview with Joann V. Pinkerton, MD President NAMS

“The problem is that it is hard to determine whether estrogen is being adequately opposed, particularly when transdermal compounded progesterone is given, because the progesterone molecule is too large to be well-absorbed systemically.

Serum Camp

FLAWS (continued)

Assumes that venous blood returning to the heart is the same as arterial blood flowing into capillary beds and perfusing tissues (analogous to differences in levels of oxygen and nutrients)

Assumes only 10% of hormone applied topically is absorbed through the skin into the bloodstream (based on AUC for venous serum)

How do steroid hormones enter saliva?

As blood circulates around salivary glands steroid hormones not bound by blood components (ie, rbc, CBG, SHBG, albumin) freely diffuse through the cells of the salivary gland and into the salivary ducts.


When Hormones Are Applied Topically, There is an Increase in Saliva >> Serum

The question is?

Are higher salivary hormones following topical hormone delivery caused by a unique and selective uptake in the salivary gland (not see elsewhere in the body)


is uptake in the salivary gland representative of hormone uptake in other tissues throughout the body??

Distribution of Progesterone in Different Body Fluids Following 15 mg Topical Progesterone

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