Bioidentical Saliva Hormone Testing

Submitted August 29, 2006 4:42pm

Saliva hormone testing allows you to measure your levels of estradiol, progesterone, and testosterone. Comparing your female hormone levels to the normal range for your age will help you and your doctor evaluate how hormone replacement therapy will or has changed your hormone levels.

Hormones can be tested through non-invasive tests from blood and urine. Currently, saliva testing is able to test levels of estradiol, estriol, estrone, progesterone, testosterone, DHT, DHEA, melatonin and cortisol.

It is highly recommended to get a saliva test, for a base line level to start with before starting any hormone therapy. Then the tests should be repeated in 2 to 3 months. This way you will be able to evaluate if Hormone Replacement Therapy has affected your levels. It is then recommended to repeat the test again once a year while on this therapy. It is suggested that you test for Estriol, Estradiol, Estrone, Progesterone, Testosterone, Cortisol, DHEA, Melatonin, DHT and Pyrilinks D (urine test) for bones.

It is also very important and well suggested, that you get your hormones tested in your 30’s-40’s, before you have even entered perimenopause or menopause, to establish your normal hormone levels, and how your body metabolizes them. If you do the testing early, you will then have something to compare yourself, when you felt good and normal, to later when you begin menopause and your hormone levels begin to fall. This can help your healthcare professional prescribe the right dosages for you to get back on track.

Finding a satisfactory dose for you can take several months and anything that you can do in advance to speed up the process will only help you in the long run. Your doctor may see dozens of patients that each need their own individual dose, so he will be experienced in helping you find where you should be. Just make sure that you tell him everything that changes, so you can aid him in his prescriptions.

Saliva Testing Predicting Ovulation

Before a woman is about to ovulate, her saliva begins to form a distinct fern-like pattern, which is determined when viewed under a microscope. This change is due to an increase in the level of estrogen that is present, which in turn causes an increase in salinity. Salinity is what produces the fern-like appearance under the microscope. This ferning pattern begins to appear around 3 days prior to ovulation.

A “personal ovulation microscope” (e.g. Fertile Focus or Ovulook) allow you to predict fertility by observing the visual changes that take place in your saliva throughout your cycle. When you are on the verge of ovulation, the visible make-up of a woman's saliva undergoes several changes. This fern-like or ferning pattern can be easily identified when examined under the power of a 40X to 60X magnification lens - helping you predict ovulation and peak fertility.

How Do Saliva Ovulation Predictors Work?

With the ovulation microscopes, you simply apply saliva to a slide and wait five minutes. The slide is then inserted into the magnifying scope, allowing you to determine if the fern-like pattern is present and then predict ovulation. This ferning pattern can be easily identified when examined under the power of the microscope, helping you predict fertile or infertile times in your cycle.

According to research studies, saliva ovulation predictor tests are 98% accurate in clinical settings when all instructions are followed correctly. Other advantages of saliva ovulation predictors stem from the fact that they are re-usable, discreet, and easy-to-use.

The Basics on Saliva Hormone Testing

Saliva originates from the salivary glands, which are located under the tongue and along the sides of the mouth. Saliva is made up of a complex mixture of mucins, enzymes, antibodies, electrolytes, and hormones, all of which play a part in the beginning process of digestion and protect the oral mucosa.

The formation of saliva in the salivary ducts begins with electrolytes (particularly sodium) being actively pumped into the ducts by an energy dependent process. Water then diffuses by osmosis into the duct to reestablish a physiological osmolality. Blood components enter the watery fluid of the salivary duct by one of three processes: active transport, ultra-filtration or passive diffusion. Antibodies such as IgA and IgG are actively secreted into saliva by an energy dependent process. Small charged molecules like glucose enter saliva by ultra-filtration, the rate of entry of which is inversely related to molecular size. Steroids and other small neutral molecules not bound by blood proteins freely pass through the membranes of the salivary gland into saliva by passive diffusion.

The Passage of neutral steroids from the blood into the salivary ducts is about 10 times faster than the flow rate of saliva. Because of the rapid passive diffusion of steroids into the saliva ducts, saliva hormone levels are not altered significantly when the flow of saliva is increased with stimulants such as chewing gum. However, when a steroid is rendered more polar by metabolic conjugation (eg, sulfation, glycosylation) its rate of flow into saliva is significantly slower resulting in lower concentrations of the conjugated steroid as the saliva flow rate increases with use of stimulants.

Because only a small fraction of steroids in blood are considered bio-available, saliva, which has many free, or bio-available steroids, is considered to be the best method of measuring hormones.

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. 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-invasively, the bio-available fraction of steroid hormones circulating in the bloodstream and entering tissues. "Rule-of-thumb"--saliva hormones represent 1-5% of serum.

When steroid hormones are produced endogenously or are taken orally the salivary level of any particular steroid generally ranges from about 1-5% of the levels found in serum. The exception to this "rule-of-thumb" is when steroid hormones are delivered topically through the skin, where salivary hormones often exceed levels measured in serum.

Saliva Laboratory Testing: The Advantages and Disadvantages

There are numerous advantages to using saliva to test for steroid hormones compared to blood serum or plasma. But there are also disadvantages.

Advantages:

Collecting a saliva sample has ease to it since it can be done anytime, and anywhere. A blood sample has restrictions of the doctor’s office, and these settings can be stressful.
Saliva contains exceptionally stable steroid hormones, which allows for convenient collection and shipment at room temperature by inexpensive means. Serum, on the other hand, requires qualified personnel (phlebotomist), special procedures (needles and serum collection tubes) and equipment (centrifuge and lab space to house it) as well as specialized shipping vessels (ice pack) and express delivery (overnight). Moreover, hormone concentrations can vary depending on the time of day and month making it especially difficult to schedule optimal collection times with serum. Overall, the conveniences in testing salivary hormones makes it better for patients in lower overall costs, as well as lower costs for the health care provider, and insurance carrier.

Disadvantages:

The collection of saliva samples is more technically challenging than serum testing of steroids. Although salivary testing has many advantages over serum testing, there are still some disadvantages to saliva testing that should be acknowledged.
Technically, saliva testing is more challenging than blood testing, limiting the number of laboratories that are capable of performing the tests. Blood levels of steroid hormones are, on average, about 10 to 100 times higher than saliva levels and commercial test kits and ranges are based on these higher serum hormone levels. For example, most commercial test kits for estradiol provide standards and a sensitivity range within the expected serum levels of about 10 to 200 pg/mi. Salivary estradiol levels range from about 0.5 to 5 pg/mi, much lower than the standards and assay sensitivity provided by commercial kits. Therefore, laboratories performing saliva testing must have the technical expertise to either create their own tests or modify commercial test kits. Significant technical hurdles beyond the technical expertise of most commercial testing laboratory personnel must be overcome to make this transition.
Certain components can interfere with the testing of saliva. Foods, beverages such as coffee, and drugs taken just before collecting saliva can interfere or cause a transient shift in hormone levels. Mucins in saliva can interfere with the test, causing spuriously high levels. Some chewing gums and cottons used for saliva collection contain substances that interfere with some saliva tests, resulting in erroneously high hormone levels. Sugar in regular chewing gum can interfere with some saliva tests. Chewing gum or other physical agents (eg, parafilm) used to increase the flow of saliva can also cause more bleeding of the gums, especially if the individual has advanced periodontal disease. Since 95-99% of hormones are blood-bound, small amounts of blood in saliva could cause significant changes in hormones that are not truly representative of the bio-available fraction of the hormone.

The saliva tests can in some cases be contaminated from the hands or lips from the use of topical hormones, and should be avoided before the collection of a saliva sample.

Bioidentical Hormone Testing

Submitted September 2, 2006 11:24 am

Saliva hormone testing allows you to measure your levels of the hormones estradiol, progesterone, and testosterone. Comparing your female hormone levels to the normal range of hormones for your age will help you and your doctor evaluate how bioidentical hormone replacement therapy will or has changed your hormone levels.

Hormones can be tested through non-invasive tests from blood and urine. Currently, saliva testing is able to test levels of estradiol, estriol, estrone, progesterone, testosterone, DHT, DHEA, melatonin and cortisol.

It is highly recommended to get a saliva test, for a base line level to start with before starting any hormone therapy. Then the tests should be repeated in 2 to 3 months. This way you will be able to evaluate if Hormone Replacement Therapy has affected your levels. It is then recommended to repeat the test again once a year while on this therapy. It is suggested that you test for Estriol, Estradiol, Estrone, Progesterone, Testosterone, Cortisol, DHEA, Melatonin, DHT and Pyrilinks D (urine test) for bones.

It is also very important and well suggested, that you get your hormones tested in your 30’s-40’s, before you have even entered perimenopause or menopause, to establish your normal hormone levels, and how your body metabolizes them. If you do the testing early, you will then have something to compare yourself, when you felt good and normal, to later when you begin menopause and your hormone levels begin to fall. This can help your healthcare professional prescribe the right dosages for you to get back on track.

Finding a satisfactory dose for you can take several months and anything that you can do in advance to speed up the process will only help you in the long run. Your doctor may see dozens of patients that each need their own individual dose, so he will be experienced in helping you find where you should be. Just make sure that you tell him everything that changes, so you can aid him in his prescriptions.

About Hormone Testing

August 25, 2006

There are several tests done to detect if you are going through early menopause. Your doctor can perform these tests if you suspect that you are experiencing symptoms of perimenopause. Some of these include:

FSH -follicle stimulating hormone

A blood test can be done to determine the levels of FSH in your blood. Because your FSH levels rise when your ovaries stop producing enough estrogen, high FSH levels can signal that your body is entering menopause. This is the key test to determine your stage of menopause.

Normal Menstruating

Follicular Phase 2.5 to 10.2

Midcycle Peak 3.4 to 33.4

Luteal Phase 1.5 to 9.1

Postmenopausal 23.0 to >116.3

Estrogen (Estradiol) Levels
Estradiol is the primary human estrogen. When your ovaries begin to fail, your circulating estradiol levels drop. Doctors often give a serum estradiol concentration test to measure the amount of estradiol in your blood. If your estrogen levels are lower than normal, this is a signal of ovarian failure, or, in other words, early menopause.

If your estradiol levels are lower than 50 picograms per milliliter, you may still be having a period, but also may be experiencing symptoms of low estrogen.

Non-menopausal:

Follicular Phase 24-138

Luteal Phase 19-164

Periovulatory 107-402

Postmenopausal:

No HRT <36

With HRT 18-361

Another test is a thyroid test. Many doctors will also recommend that you have your thyroid tested when you suspect menopause. This is for two reasons: First, many women in premature menopause also are at a higher risk for thyroid problems. Second, many symptoms of thyroid disease overlap with menopausal symptoms. In fact, thyroid diseases often interfere with menstruation. Testing your thyroid will help determine whether you are in premature menopause, or if you have a thyroid disease.

Last, is a saliva test. Some doctors recommend saliva testing to measure hormone levels. This isn't as widely used as blood testing, but some say that it is quicker, less expensive and reliable. With salivary testing, your doctor takes samples of your saliva to see the levels of hormones you are producing and to determine if you have any deficiencies. Unlike the blood tests, the saliva hormone tests will show the levels of "free" hormones in your body. Free hormones are the hormones that aren't bound to proteins, but instead are able to move into cells. Because about 95% or more of your blood hormones are bound, the saliva tests measure only the remaining 1 to 5%. The results may be much lower than that which you see on your blood test results.

Should You Test for Bioidentical Hormones Or Not?

September 1, 2006

Some people believe that with all the new information we have about bioidentical hormones and its advantages that the testing should be standard routine. But there are several factors why it’s not. First, it is not "standard of care" or deemed medically necessary. This means that when you have a problem that may be related to your cycle and the hormone fluctuations that go with it, your doctor is not required to order a test to measure your hormone levels before you are treated. Actually, they can prescribe birth control pills or synthetic HRT at any time, with only personal information or a feeling that these drugs may be right for you.

The reasons why hormone testing, and prescribing natural hormones, is not standard practice has more to do with patent law and the pharmaceutical industry than anything else. There is also the fact that most medical schools have until recently ignored natural hormones as an option in treating women's hormonal imbalances. Drug companies are out to make money. Natural, plant-based hormones cannot be patented and marketed as exclusive products, therefore giving no advantage to the pharmaceutical companies. Even though safe, plant-based sources for making bioidentical natural progesterone and estrogen are readily available, pharmaceutical companies rarely use them (although the harm and findings of new studies about synthetic hormones is beginning to propel them in that direction). Instead they use lab-formulated synthetic progestins and estrogens to make their HRT formulas. When sales representatives talk with doctors, they offer flashy brochures and literature about double-blind studies conducted and/or financed, of course, by the drug companies. For some drugs, such as Viagra, manufacturers appeal directly to consumers, who in turn request that their healthcare providers prescribe these drugs.

Nobody is advertising for the use of natural hormones to medical offices because, at least for now, there is no money to be made. In fact, mainstream healthcare providers who are familiar enough with natural hormones to prescribe seem to be in the minority. So it is no surprise that mainstream medical practitioners are reluctant to initiate hormone testing to determine dosing for medicines they know little or nothing about.

The same goes for natural supplements and herbal remedies. These alternatives have neither private funding nor representatives hounding medical offices to tout their benefits. If medical providers want to find out about these alternatives, they must do just as you are doing, and educate themselves. Given their hectic schedules, time constraints, and demanding practices, it isn't too surprising that most healthcare practitioners haven't done so.

Most likely, the use of bioidentical hormones will eventually come into use because patients are going to demand it, many are already. Women are justifiably scared of synthetic HRT, and more information is getting out that therapy using natural, bioidentical hormones is a safe and effective alternative for relieving unpleasant symptoms.

Medical practitioners who lack education about hormone testing and treatment with the natural alternatives nevertheless claim that hormone testing is inaccurate because levels change constantly as a woman cycles through the month. It’s true that hormone levels do fluctuate and every woman is unique, but those facts don't cancel the value and accuracy of carefully conducted hormone testing, especially through saliva testing. It is being done successfully and has been absolutely invaluable in my medical practice and those of informed colleagues across the nation.
Saliva Cortisol Test

September 5, 2006

Your healthcare professional may order a saliva cortisol test when symptoms of Cushing’s syndrome and Addison’s disease are present. Both Cushing’s syndrome and Addison’s disease are serious adrenal disorders. Both testing of the urine as well as saliva are common testing methods for excess cortisol production. Once your healthcare professional has determined an abnormal level of cortisol, further testing will be done in order to determine cause and severity of the deficiency or excessiveness.

Symptoms of Cushing’s syndrome that may lead to a saliva cortisol test include:
- Obesity
- Muscle wasting
- Muscle weakness

Symptoms of Addison’s disease that may indicate the need to perform a saliva cortisol test include:
- Weakness
- Fatigue
- Increased pigmentation
- Others

For people with a normal cycle of cortisol levels, the levels are higher in the morning, and lower at night. If you work a night job, this pattern will not be maintained, and people with Cushing’s will also not maintain a normal pattern. Increased or normal cortisol concentrations in the morning, with levels that do not drop in the afternoon and evening suggest that your body is overproducing cortisol. If this excess cortisol is suppressed during a dexamethasone suppression test, it suggests that the excess cortisol is due to increased pituitary ACTH production. If it is not suppressed, then the increased cortisol could be due to an ACTH-producing tumor outside of the pituitary, a problem with the adrenal gland, or a medication that the patient is taking.

If the adrenal glands are overactive, then a patient may have Cushing’s syndrome, with symptoms and signs caused by prolonged exposure to the effects of too much cortisol. This may be due to excess production of cortisol by the adrenal glands, which is frequently due to a benign adrenal tumor, or excess ACTH stimulation, due to a pituitary or other ACTH-producing tumor. It can also be seen in patients who must take corticosteroid medications, such as those used to treat asthma. If decreased cortisol production is due to adrenal damage, then the patient is predicted to have Addison’s disease.