I receive many phone calls from prospective patients who ask me the same question: Are you testing blood or saliva for hormone replacement therapy. This question originates from books of a visionary woman – Suzanne Sommers who almost singlehandedly revolutinazed our understanding of aging.

She writes about saliva hormone testing and her followers perceive a doctor who does not test saliva as not a “cutting edge” bio identical doctor.

What patients usually miss is that saliva is only one of the ways to check hormones and just like with food, which we not only taste, but also smell and see, testing saliva only will result in a two dimensional picture of hormone status.

So what is the best test for hormones that you should ask your doctor to do and how to interpret your results?

First of all we need to understand the difference between different hormone testing and the information we need to get from the test.

Hormones circulate in blood in 2 different forms “bound” and ” unbound” , our body makes a protein called Binding Globulin that attaches itself to hormone molecule and makes it inactive . It does not attach to all hormone molecules and some small part of hormone is circulating in the blood in an active unbound or Free form.

When body needs to increase the hormone action it just separates more hormone molecules for Binding Globuin and level of Free Hormone rises. The bound hormone is acting as a storage of active hormone which is available on demand.

For example 98 to 99 percent of Testosterone is found in a bound form.

Saliva is filtered from blood by salivary glands and hormones found in saliva are in their Free, Unbound form. Hormones bound to globulin is too large to pass the filter.

Saliva test is very useful because it shows the level of Free or Unbound hormones , but there is a problem –

Saliva test is very dependent on amount of water in saliva at any given time. As you know your mouth waters when you see an attractive food or tasty smell. Try to pretend to eat a lemon in front of a brass band, good chance whey will not be able to play due to to increased production of saliva. On the other hand your mouth could be too dry and obviously the hormone levels will be increased. The other drawback of saliva testing is that after hormone treatment is started saliva results may be inaccurate and do not correlate with other way of testing such as blood or urine.

Saliva test is very good to do initial hormone screening and especially for testing Stress Hormone – Cortisol because it is easy to collect a sample 4 times a day, and collection does not require medical personnel, special facility and painful needles.

Testing blood gives us different way of looking at hormones. It is like a photograph which gives us a picture of a moment caught on this photograph. Blood hormone levels also show us only the amount of hormone in transport system and not inside the cells.

In order to find out the level of Free Hormone the test for Binding Globulin must be done and level of Free Hormone is calculated using mathematical formula. Also keep in mind that blood sample need to be drawn in the lab or doctor’s office which is less convenient.

The Cadillac of hormone testing is 24 hour urine test for hormones.

All hormones and their metabolites are excreted in the urine. Assuming that average amount of hormones are produced every day 24 hour urine shows us how much of the hormone is produced during 24 hour period.

This test is labor intensive, you need to collect every drop of urine for 24 hours and keep urine in the refrigerator.

But you can test most of steroid hormones ( our test includes 28 hormones and metabolites) and see what path do they take in your body chemically by measuring their metabolites.

There isn’t a single best way to test hormones this is why choosing experienced Bio Identical Doctor is so important to decide which test is better for you.

Article written by Dr. Mikhail N. Berman, M.D.