Why Saliva Testing is the Best Way to Measure Sex and Adrenal Hormones

From the June 2014 Issue of the Hormone Balance Hotline

Every day, we get emails and phone calls from people who are confused over how to test their hormone levels. To cut through the confusion, let’s look at what Dr. Lee had to say about the subject. As you will learn, his insights make it easy to see why saliva testing is the ideal way to measure an important family of hormones.

The hormones we are referring to here are the steroid family of hormones. Steroid hormones include all of the sex hormones, such as progesterone, the estrogens (such as estradiol), and androgens (such as testosterone). The adrenal hormones, such as cortisol and DHEA, are also members of the steroid family.

The steroid hormones all share special properties that make them practically impossible to measure properly in blood, but easy to measure in saliva. Let’s read what Dr. Lee had to say about this subject in his book, What Your Doctor May Not Tell You About Menopause.

“The usual way to test hormone levels has been with a blood test that measures the blood serum or blood plasma content of the hormones. These tests are inherently irrelevant since bioavailable ‘free’ hormone is not soluble in serum. Bioavailable sex hormones are fat-soluble and circulate in blood via fatty substances not found in serum, such as red blood cell membranes.”

As Dr. Lee explains, the steroid hormones exist in the body in two forms. In their “free” or “unbound” form, steroid hormones circulate in the blood without being bound to protein molecules. Free/unbound hormones are rarely found in blood serum, which is what a blood test measures. Instead, they attach themselves to the surfaces of red blood cells, then “jump off” those cells and bind to hormone receptors in tissues all over the body. That is why free/unbound hormones are also called “bioavailable”. This means they are readily available for the body to use. They are the hormones that can affect how our bodies function and how we feel.

By contrast, steroid hormones in their “bound” form are joined to protein molecules and cannot bind to hormone receptors. They circulate through the blood serum and rarely attach themselves to blood cells. Until those binding proteins are stripped away, the hormone molecules cannot bind to cell receptors in our tissues.

If you find this hard to understand, think of your steroid hormones as if they were the food in your kitchen. At any given moment, most of that food is not ready to eat. It’s in a container or wrapper of some sort. Only a small portion of the food in your kitchen is out of the containers and ready to eat. This “free and bioavailable” food is similar to the free and unbound hormones, while the food in containers is similar to the bound/unavailable hormones.

Measuring What We Really Use

Since it is the free/unbound hormones that make the real difference in our bodies, how can we best measure them? Blood tests are not the answer because free/unbound hormones are almost entirely found on blood cells and not in blood serum. As Dr. Lee points out in his book, What Your Doctor May Not Tell You About Breast Cancer:

“...when blood is measured for hormones, what do you think is first removed to create the serum used for testing? You guessed it, red blood cells. Thus, blood tests completely miss the free hormones bound to your red blood cells.”

If we cannot use blood to measure our free/unbound hormones, what can we use? Here is what Dr. Lee says in What Your Doctor May Not Tell You About Menopause:

“We now know that the non-protein-bound hormone molecule, when circulating through the saliva tissue, will filter directly into the saliva, whereas protein-bound (non-bioavailable) hormone does not. Thus, saliva levels reflect tissue levels of sex hormones, and serum tests do not.”

As blood circulates in the capillaries around our salivary glands, some of the free/unbound steroid hormones disconnect from the blood cells and bind themselves to cell receptors within the salivary glands. Some of these hormones show up in the saliva that these glands secrete. This makes saliva an important fluid for hormone testing, as its hormone content is entirely free and unbound. Thus, saliva hormone levels tell us how much of the free/unbound steroid hormones are getting into our tissues where they can make a real difference in how we function and feel.

To better understand the difference between blood and saliva testing, let’s go back to our kitchen analogy that we described earlier. If we want to know how much food we are eating, would we measure the food in containers in our cupboards and refrigerator? Of course not. We would measure the food on our plates. By the same token, blood tests for the steroid hormones make the mistake of measuring the hormones that are bound to proteins, while saliva tests measure the hormones that are readily available to our bodies.

This does not mean that blood tests should never be used to test hormones. Some hormones, such as thyroid hormones, are best tested in blood. It can also be useful at times to test the steroid hormones in blood while also testing the proteins that bind to the hormones, such as Sex Hormone Binding Globulin (SHBG). Since SHBG is one of the primary proteins the body uses to bind steroid hormones, it can help you and your doctors estimate how much of your hormones are bound versus free.

Next Steps

If you believe you have an imbalance in your sex or adrenal hormones, we encourage you to consider testing those hormones using saliva. You can also use saliva testing to determine whether natural hormone supplements are keeping your hormones in balance. Unlike blood tests, you can purchase a saliva test without a doctor’s prescription and provide your samples in the privacy of your home. You mail the samples to a laboratory that specializes in saliva testing, then receive the results of your tests in the mail.

If you need more information about hormone testing, the Official Website of John Lee, M.D. (www.JohnLeeMD.com) can help you. Because we offer both saliva and blood spot tests for purchase from the site, we have extensive experience in advising our customers about hormone testing. You can learn more about saliva testing by reading an article by Dr. Lee on our site. If you are wondering which hormones you should test in saliva, we offer a free Hormone Balance Test that can help you find out if your symptoms could be caused by a hormonal imbalance and if so, what hormones you may want to test. We also proudly offer all of Dr. Lee’s books that give you the knowledge you need to test your steroid hormones and make informed decisions about balancing your hormones safely and naturally.