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Limitations of Serum AND Saliva for Testing Hormones 


Don’t they use Blood for that? It’s a question many people ask when informed that saliva can be used to test the levels of steroid hormones. Well, you can. In fact most GP’s prefer to test hormones in the traditional way. Before making up your mind though, you may wish to learn a little about your options. Just a quick disclaimer and off we go

N.B. TestoChecker provides hormone testing kits using both saliva and serum specimen types. Limitations of Serum AND Saliva for Testing Hormones – This short post is an honest attempt to present unbiased arguments for and against the use of both Blood and saliva for testing hormone levels in Australia. 

What are the Limitations of Blood for Testing for Hormones? 

saliva hormone testing

Is Blood testing hormone levels a good idea?

Blood hormone testing does not typically allow for the analysis of estrogen, androgen, and adrenal metabolites, which provide a wealth of data to assist the practitioner or user in understanding test results and forming a plan to fine-tune treatment.

adrenal hormone health

Blog post: ‘Adrenal Fatigue – Debunking the Myth’ [click]

Another limitation of blood hormone testing, is the “snapshot” aspect of a single point test. Steroid hormones like testosterone, cortisol and also precursor hormones androstenedione and DHEA are secreted in a pulsatile manner over the course of the day/night. Not knowing whether this level represents a crest, a valley, or somewhere in between means the result, whilst still of some value, is less so.

The hormones Melatonin and Cortisol are both examples of hormones not suited to serum. These hormones are “pulsatile” and it is this pulse or rhythm that is measured during day and night. It is far easier to spit into a collection vial throughout the course of the night/ morning, than would be to attend a blood collection centre. That doesn’t mean saliva is the superior testing method though, not by any means. Sure it has strengths as a testing medium, but it has shortcomings like any other.

What are the Limitations of Saliva for Testing Hormones?

All human biological specimen types have limitations and saliva is no exception. Let’s take a look at limitations of saliva for testing hormones specifically.

multi point cortisol testing

Saliva is perfectly suited to multi-point (multiple collection) hormone testing.

A limited number of hormones can be tested using Saliva

Only 10 or so hormones are tested this way when the human body secretes and circulates approximately 50 different hormones. Another weakness in the argument for use of saliva for testing hormones is the potential for blood spot contamination, or  contamination related to toxic metals i.e. dental and oral fixtures. This has to be accepted as a possibility at both the saliva collection point and subsequent transfer to the lab. 

Luteinizing hormone cannot be reported using Saliva 

When testing hormones related to fertility, we would ideally like to see Luteinizing hormone reported and that unfortunately isn’t possible at this stage using saliva. You need Serum for that.

Contamination can occur when Testing Hormones using Saliva 

Contamination can occur by simply brushing teeth or drinking coffee prior to sample collection. Tobacco and also Vitamin B12 are known to interfere with melatonin test results making strict adherence to collection instructions important.

Fortunately, any good laboratory will evaluate the suitability of the saliva sample before the actual testing can commence. This is referred to as the ‘Viscosity Test’, and the saliva sample may be rejected should it fail. This test will not identify slight contamination though, only if the saliva has maintained integrity during its journey to the laboratory.

 

blood test results

Saliva hormone testing is known as ‘Functional Pathology’ in Australia.

Hormone Saliva Testing in Lower Concentrations

That saliva has many diagnostic uses in a variety of clinical settings in not disputed. The highly sensitive modern test methods now match the convenience and ease in terms of appeal. Despite very low concentrations, a large number of hormones and drugs (monitoring) can nowadays be analysed using saliva even when present in low concentrations. That does not mean saliva is a perfect specimen type, but the data is continually improving in tandem with the increasingly sophisticated equipment used to measure it.

Industry accreditation favours the big labs

Hormone tests are sometimes combined by laboratory’s to make larger multi-hormone tests. Some of these test configurations have been scrutinized for both benefit and efficacy (value to the user) by a global laboratory regulatory authority. The cost of having an individual test or an entire laboratory accredited is excessive and so favours the larger commercial labs with deep wallets.

The awarding of that accreditation takes time, and demonstrates a commitment to excellence on the part of the laboratory itself. In cases where it is a specific test being accredited, practitioners have increased confidence in the [value of the] test results.

Which Hormones can be reliably tested using Saliva  

Below is the short list of individual hormones routinely tested using saliva by the larger laboratories. Caution is advised in cases where a practitioner offers a person saliva testing for a hormone that are NOT on this list:

  1. Testosterone
  2. Cortisol
  3. Melatonin
  4. Androstenedione
  5. Progesterone
  6. Estrone [E1]
  7. Estriol [E3]
  8. Estradiol [E2]
  9. DHEAs

Summary:

There is no clear winner here. Knowing which method is the right method for our needs is the key piece of advice I hope you take with you. In terms of number of applications, Serum takes the Crown. However saliva (as a testing specimen type) has demonstrated a clear advantage with regard to oral health, sex hormone testing and tracking, or the early detection of cystic fibrosis, Sjögren’s syndrome or adrenal cortex related disease.

I hope ‘Limitations of Serum AND Saliva for Testing Hormones’ was of some use to you.

Stay Safe. Keep on reading and researching. 

Author: G. Saywell [Testochecker employee]

TestoChecker® Hormone Test Kits
Phone: +64293271336
Address: 802 Pacific Highway, 
Suite 1A, Level 2, Gordon, NSW, 2072.
Purpose: We Take the Stress out of The Test!
Sources include: pubmed-diagnostic uses of saliva

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