Why We Like Saliva Testing

Let's clear up the confusion.


by John R. Lee, M.D., Dr. David Zava and Virginia Hopkins

The most common way to test hormone levels has been with a blood test that measures the hormone levels in the watery blood serum or blood plasma. This is called a serum blood test. In our opinion, these tests are not very useful because they don’t measure your bioavailable “free” hormones accurately. Serum blood tests can be particularly misleading when measuring hormone levels in a woman who is using transdermal (cream, gel) progesterone. Dr. David Zava explains, “When the ovaries produce progesterone and it enters the bloodstream, about 98 percent of it is tightly bound to proteins in the bloodstream, and is not “free” to move into the tissues of the body. In contrast, when hormones are delivered through the skin and enter the bloodstream, a much higher percentage are bioavailable. This shows up in tissues such as those in the salivary gland and then in saliva. Hormones delivered through the skin don’t accumulate in the bloodstream because they are efficiently delivered to tissues. This is why a daily dose of 15 to 30 mg of progesterone cream results in a very small increase (if at all) on a blood test, but a significant increase in a saliva test. The information you need to determine your hormone balance, is how much hormone is entering your tissues.”

Saliva Testing

Saliva testing is quicker, less expensive, and less painful than serum blood tests, and is a reliable way for your doctor to measure hormone levels and test for hormone deficiencies. It will confirm that the hormones you are taking are being absorbed and utilized; it doesn’t involve a trip to a lab or drawing blood; and it’s inexpensive enough that you can do a number of tests, for instance several over the course of a day or a month. For those women who wish to monitor their own hormone levels to find out if they are ovulating, for example, the tests can be ordered and easily done at home without a doctor’s prescription.

When you get the results of a saliva test, the normal range of estradiol in a premenopausal woman is 1.5 to 3 pg/ml, and in a menopausal woman is usually about half that, 1 to 1.5 pg/ml of estradiol. The healthy ratio of progesterone to estradiol is at least 200 to 1 and can go up to 1000 to 1 in women using transdermal (delivered through the skin with cream, gels, oils) progesterone. Therefore you would want the saliva progesterone level to be at least 200 pg/ml in a menopausal woman with an estradiol level of about 1 to 1.5 and even higher in a premenopausal woman with an estradiol level of 1.5 to 3 pg/ml.

When estradiol is lower than the optimal range and symptoms indicate an ongoing estrogen deficiency, it is often helpful to try some estrogen replacement. Because estrogen and progesterone function are interrelated, correcting an estrogen deficiency can also help you get optimal benefit from supplemental progesterone.

Normal or optimal ranges of hormones in saliva vary according to whether you’re premenopausal, perimenopausal, menopausal, or using some form of HRT. When you take the test, which involves spitting into one or more tubes and mailing them to the lab, your results will be compared to optimal ranges for your age and menopausal status.

Blood Serum or Plasma Testing

When your doctor orders a standard serum blood test to measure your hormone levels, it’s a test of the serum (the watery part of the blood). Serum levels of progesterone will rise to about 2 to 4 ng/ml in most women using 20 to 30 mg of progesterone cream. If your doctor measures your serum progesterone levels, here are some guidelines:

  • Normal, untreated (not on HRT) menopausal women will show an initial serum progesterone level that is less than 0.5 ng/ml.
  • After using progesterone cream, progesterone levels usually rise to 2 to 4 ng/ml.
  • In normal premenopausal women, luteal (midcycle) phase serum progesterone levels are 4 to 20 ng/ml.

Saliva testing is an inexpensive, uninvasive and easy way to get an accurate reading of your hormone levels in order to determine whether your estradiol, or progesterone, or testosterone level is in a healthy range. If you get a saliva test of these three hormones once or twice a year, you’ll have a good indicator of whether your hormones are in balance.

Blood Spot vs. Serum Blood Tests
The blood spot tests offered here are not the same as the serum blood tests that your doctor sends you to a lab for. The blood spot test measures capillary blood, which gives an accurate measure of bioavailable hormones, while the serum blood test measures the hormones found in the serum, or watery part of the blood, which does not give an accurate measure of bioavailable hormones.

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Saliva Tests vs Serum Blood Tests for Hormone Testing