Saliva Test Q & As



By John R. Lee, M.D. and Virginia Hopkins

Q: I use progesterone cream, and recently got a saliva hormone test. I was very disappointed to find that my progesterone level is very low. What could be the problem?

A: I had a phone conversation with the woman who made this query, and after asking a series of questions discovered that she had her uterus and ovaries removed, and that her doctor had told her to go off of progesterone cream for two weeks before taking the saliva test.

What was her doctor trying to test? We already know that she doesn’t have any ovaries, so she isn’t making any progesterone to speak of. After two weeks, the progesterone from the cream she was using would be long gone from her system. Why was her doctor testing what we already know, which is that she has a progesterone deficiency? It would be much more logical to test whether the progesterone she is taking is showing up in measurable levels in her saliva.

To find whether or not the cream being used provides the correct saliva progesterone concentration, I recommend obtaining the saliva specimen 8 to 10 hours after application of the cream. In general we find that saliva progesterone concentrations rise nicely within 2 to 3 hours after application and then fall 8 hours or so later. If the patient waits 24 hours after application to collect the saliva, the effect of the cream application will be gone. This is also a good reason for twice-daily dosing.

When looking at saliva test results, optimal concentrations do not mean that more is better. Optimal concentration should be no higher than that found in normal, healthy, ovulating women. Concentrations higher than normal can cause down-regulation (loss of effect) of progesterone receptors.

Q: I thought perhaps you would want to let your older ladies know that Medicare will pay for saliva tests. The way it is done is that the doctor makes up a prescription with the names of the hormones to be tested (I tell my doctor which ones I want to test), then the woman sends the prescription along with a front and back copy of her Medicare card in the kit she has used and her doctor is sent the results. She can get a copy for her files from her doctor. My doctor only likes blood tests and I let him take all that he wants but I pay attention to the results of the saliva test.

A: Thanks for sending on this information. It’s a wonderful example of someone who has educated herself and has found a way to work with her doctor that has a good outcome for both of them.

Saliva Testing Compared to Blood Testing

Q: I’m a health care professional who doesn’t use saliva testing because it doesn’t correlate with blood tests, so I don’t believe it’s accurate. Please respond.

A: Saliva testing isn’t supposed to correlate with blood testing because they’re measuring two different parts of the blood. A blood test measures the watery or serum portion of the blood, while a saliva test measures the “free” or bioavailable hormones in the red blood cell portion of the blood. One of the reasons saliva testing works so well is that it measures the free hormones, which is what really matters when looking at hormone balance. If you read the article I recommended for health care professionals, The Bichemistry of Saliva Testing, Dr. John Lee explains these concepts in detail.