Saliva hormone testing offers a non-invasive way to assess hormone levels, providing a convenient option for many. Its ease of sample collection, often done at home without a blood draw, makes it an accessible approach for those interested in understanding their hormone balance.
What Saliva Hormone Tests Measure
Saliva hormone tests primarily measure steroid hormones, including cortisol, estrogens (such as estradiol, estriol), progesterone, testosterone, and DHEA. These hormones diffuse into saliva as blood passes through the salivary glands.
Saliva tests measure the “unbound” or “bioavailable” fraction of these hormones. While most hormones in the blood are protein-bound, the unbound portion is biologically active and available for use by cells and tissues, providing a snapshot of what the body’s cells are experiencing.
Evaluating Test Accuracy
For steroid hormones, saliva testing is considered a reliable method for assessing physiological levels. This is true for cortisol, where salivary measurements correlate well with free, biologically active cortisol in blood. Saliva testing is also a well-accepted method for monitoring daily fluctuations of hormones like cortisol, known as the circadian rhythm.
Advances in laboratory techniques, such as liquid chromatography with tandem mass spectrometry (LC-MS/MS), have improved the accuracy and sensitivity of detecting hormones like estrogens and androgens in saliva. While some professional organizations state that saliva testing for hormone therapy adjustment lacks sufficient evidence, many studies show strong correlations between salivary and serum free hormone levels for various steroid hormones. The reliability of results can depend on the specific hormone, laboratory methodology, and intended clinical application.
Factors Influencing Accuracy
The timing of sample collection is important for hormones like cortisol, which follow a distinct circadian rhythm, being highest in the morning and declining throughout the day. Collecting multiple samples at specific times can provide a comprehensive profile of these fluctuating hormone levels.
Consumption of food or drinks, and the use of certain oral hygiene products like toothpaste or mouthwash, can contaminate saliva samples and skew results. Topical hormone creams can significantly elevate hormone levels in saliva, which may not accurately reflect systemic levels. Proper sample handling, including storage conditions and the type of collection device used, plays a role in maintaining sample integrity and ensuring accurate measurements.
Saliva vs. Blood Testing
The primary distinction between saliva and blood hormone testing lies in what they measure. Blood tests typically measure the total amount of hormones, including both bound and unbound portions. Saliva tests specifically measure the unbound, bioavailable hormones that are free to interact with cells and tissues. Each test offers unique insights into a person’s hormone status.
Saliva testing allows for multiple collections over a day or across a menstrual cycle to track hormone fluctuations. This is useful for assessing circadian rhythms or monitoring responses to certain hormone therapies, especially those applied topically. Blood tests, while more invasive, are often the standard for measuring a wider range of hormones and diagnosing many conditions, particularly when total hormone levels are of interest. The choice depends on the hormone being assessed and the clinical question.