I haven’t met many patients who enjoy performing a saliva test. It is often difficult to generate enough saliva to adequately measure hormone levels, but saliva testing is very important for guiding hormone therapy effectively and safely. I have spent many hours with a saliva specimen tube in hand and thoughts of my favorite food in my brain, trying desperately to generate enough saliva to fill the tube. My dog Boomer, a slobbery pit bull mutt, would have no problem with this, but I have yet to notice any hormone issues with him and do not need to test him. So, why do I put patients through this annoying process? It would be so much easier to simply get a blood test and be done with it. Actually, that is how it was done in the not too distant past. Patients were started on topical hormone therapy (creams and patches) for various hormone deficiencies, and hormone levels were then checked with standard blood tests. Almost always, the blood tests would show no change in hormone levels, so the hormone doses would be increased and blood levels checked again. Still, no change and doses would be increased further. This would continue until the patient was on huge doses of hormones and the hormone blood levels would finally increase. Often, the patient would feel horrible by this time because of excessive hormone doses.
As discussed in the article, “Creams, pills, patches, and pellets: The Many Forms of Bioidentical Hormones”, hormone creams and other topical hormone preparations are absorbed Into fatty tissue under the skin. From the fatty tissue, hormones enter blood vessels and the circulation. They are then distributed throughout our the body, where they enter cells, tissues, and organs to complete the functions they were sent to perform. Once hormones are absorbed and enter the circulation, they don’t stay there very long. They are rapidly delivered to destination tissues. So, if you try to find them in the blood through common blood tests, you won’t find them. Of course, if you are receiving huge doses of hormones, the tissues will become saturated with hormones and won’t be able to pull them from the circulating blood. Then you will see increase blood levels of hormones, but this does not help anyone guide therapy. It only let’s one know that they are receiving excessively high hormone doses.
What would be wonderful is if we had access to an organ that was receiving these hormones, so we could monitor hormone levels in that organ or tissue. Wait…we do! The saliva glands offer a great way to monitor topical hormone therapy. Reputable laboratories, such as ZRT laboratories, have done extensive research on hormone therapy and saliva testing. With saliva tests, physicians can accurately monitor topical hormone therapy. However, it is important to keep in mind that not all saliva tests are created equal. Any lab can collect saliva and make numbers print out on a piece of paper. It is important that testing is completed by laboratories that meet the following criteria:
- They are continually involved in research to improve testing techniques and accuracy
- They have a quality assurance program in place to continually monitor the accuracy of their current processes
- They have an established, positive reputation and track record in this rapidly growing field of integrative medicine and bioidentical hormone therapy
With all that being said, I would like to also stress that although accurate testing is important, it is only part of guiding a patient’s therapy. How a patient responds clinically is just as important, and a physician should not only rely on test numbers when treating a patient. We treat people, not numbers. If a patient has perfect test numbers, yet is experiencing a variety of side effects, therapy needs to be adjusted. Alternatively, patients are often very healthy, but their test results may not be perfect. All of this needs to be considered when making decisions about treatment.