Subjects found on this page:
Saliva collection
When to
collect your saliva
How to collect your saliva
How to mail your saliva specimen
How often to test
About saliva testing
Why test saliva for hormones
What is a hormone
Some functions of your endocrine system
Aging and Hormone Replacement Therapy (HRT)
The first step in anti-aging medicine... HRT
Your bone health
About saliva hormone results
What was measured
How to use the saliva ranges
Your test results
Your results and the ranges
Individual and physiological variability
Importance of the collection time
Location within the ranges if you are not supplementing
Hormone levels that fall at the low end of or below the established saliva
ranges
Hormone levels that rise above the established saliva ranges
Expected levels from Hormone Replacement Therapy (HRT)
Saliva collection
Note: Please read all of this section before beginning saliva
collection.
Saliva collection is simple and can be performed in your home at
your convenience. Hormones in saliva are stable at room temperature for several
weeks so there are no special needs in shipping to us.
Just send your saliva specimen by regular mail to us in the
prepaid mailer provided.
Patients outside the U.S. will need to provide postage.
When to collect your saliva
In general, the following guidelines are recommended:
Naturally Occurring Hormone Levels
For all hormones
level testing, the best time to
collect saliva is in the early morning, preferably right after rising.
For Melatonin level testing,
saliva collected at 3 AM (interrupting your sleep cycle) when the
hormone peaks is best tested.
How to collect your saliva
Instructions:
-
For all hormones except
Melatonin, saliva is collected generally in the early morning (AM)
before brushing/flossing your teeth, eating, drinking or applying
makeup. For multiple sample collections, refrain from brushing or
flossing your teeth or eating within one hour of saliva collection.
-
Rinse your mouth at least twice with cool water, then chew the
sugarless gum provided for 1-2 minutes, swallowing saliva as usual.
You may continue to chew the gum during saliva collection but please
do not spit it into the collection tube. If, for some reason, you are
not able to chew the gum, saliva collection is still possible but may
take longer.
-
Begin the collection. Remove the cap of the saliva collection tube
and spit directly into the tube. Avoid touching the mouth of the tube
with your hands. All the same instructions apply to Melatonin testing,
except that it should be done at 3 AM.
Important: Hands can potentially contaminate the saliva during
collection. Wash your hands
thoroughly with soap and water before beginning.
-
Fill the tube at least 3/4 full and cap, making sure the cap is on
evenly and securely.
It may take you a few minutes to generate sufficient saliva.
-
Neatly print your name, date, and time of collection on the peel
off label and affix to the saliva tube.
-
Fill out completely the requisition form enclosed with your
collection kit. It is especially important to include the time and
date of saliva collection and to list any hormonal products you are
using. List each product separately and include preparation name,
amount taken and time of ingestion or application.
How to mail your saliva specimen
Fold the white copy of the requisition form and place it
in the prepaid mailer with the specimen tube wrapped with the yellow
cloth in the small plastic bag . Close the mailer and strike
smartly on a firm surface to secure contents. It is a good idea to put
extra tape
to close the end.
Send by U.S. mail. Patients outside the U.S. need to provide postage.
Please remember to include the requisition form.
If you have any questions regarding collection or mailing of your saliva
sample, please feel free to e-mail us at
amkat@adelphia.net
How often to test
Monitoring Hormonal Needs with Saliva
Testing
A baseline saliva hormone test done when you are in your thirties
provides an excellent picture of your healthy, youthful hormone levels.
These levels become valuable as potential target ranges when your
hormones begin to diminish and Hormone Replacement Therapy (HRT) becomes
an option.
Yearly saliva hormone testing beginning at age forty allows
you to track how quickly or slowly your hormone levels are shifting.
Regular monitoring helps determine when it is appropriate to begin HRT
(if that is your choice) and which hormones need to be supplemented.
Once you have selected your particular HRT, taking into
consideration the variety of preparations, types of delivery systems and
dosage, it is critical to monitor your newly-adjusted hormone levels
with saliva testing to make sure you are taking the appropriate amounts.
Once HRT has been optimized, yearly testing will reveal any
changes in your hormonal needs over time.
If, for any reason, you decide to alter your HRT, saliva
testing will be extremely useful in assisting you to make decisions
regarding your new HRT protocol.
About saliva testing
The knowledge that there are steroid hormones in saliva,
and that they can be measured, has been around for more than 30 years.
But it is only recently that technology has caught up with that
information, making it possible to accurately determine levels of
salivary hormones.
Now, with specific antibodies for key steroid hormones, our laboratory
can be an important partner in your quest for a longer, healthier and
sexier life.
Until recently, steroid hormone level evaluations were carried out on
blood samples, but blood collection has its limitations. It is invasive,
expensive, and difficult to time precisely.
Perhaps more importantly, blood hormone levels represent your body's
total hormone content. Most blood hormones (about 95%) are bound to
specific proteins which carry them through your bloodstream and can be
considered the hormone 'storage' fraction.
The other 5% represents your free hormones - those available to move
easily into your target organs and fulfill their functions. Your saliva
contains these free hormones which can be easily measured to give an
accurate picture of those hormones that are readily available to your
tissue.
Why test saliva for hormones?
-
With the convenience and privacy of home collection, saliva
hormone testing is non-invasive and economical.
-
Blood collection is sometimes very stressful while saliva
collection is simple.
-
Saliva sample collections can be timed precisely which is critical
for some hormones.
-
Multiple saliva collections can be taken in a single day to
evaluate daily fluctuation.
-
Saliva testing is an accurate, flexible tool for adjusting and
monitoring hormone replacement therapy (HRT).
-
Prepaid mailers containing your saliva specimen can simply be
dropped into your nearest mailbox for delivery to us. This convenience
is possible because saliva hormones are stable at room temperature for
at least 3 weeks.
-
Saliva testing measures the levels of the free, bio-available
hormones - those hormones which move freely into cells and carry out
the body's critical jobs.
What is a hormone?
A hormone is a chemical messenger that circulates throughout your body
telling your cells what to do. Hormones are produced by organs belonging
to the endocrine system.
Examples of endocrine glands are the pituitary, thyroid, thymus,
pancreas, adrenals, ovaries, and testes.
Some functions of your
endocrine system
-
Determines sex characteristics (male vs. female genitalia)
-
Enables a woman to become pregnant and carry a baby
-
Mediates sex drive
-
Enables individuals to build strong, healthy bones
-
Determines how slowly or quickly the aging process proceeds
-
Maintains the crucial balance between the body's electrolytes
(important minerals such as sodium, potassium, calcium and magnesium).
-
Monitors what’s going on in the environment, interpreting what a
person sees and experiences, and translating the information into
physical reactions which allow for adaptation to change and stress
Aging and
Hormone Replacement Therapy (HRT)
The good news is that we are retiring earlier and living longer. Life
expectancy for the average person has increased dramatically over the
last several decades. At birth, life expectancy for the average female
is 79 years, and for the average male is 72 years. Once reaching age 65,
we can expect to live to 84 and 80 years, respectively, and if we make
it to 75, the numbers increase to 87 and 85 years.
However, with living longer there are the serious issues of aging we
must face. For one thing, our bodies aren’t what they used to be. There
is a drop-off in our physical endurance with each succeeding decade of
life. That 30-minute workout now takes 45 minutes.
Our knees have shortened that 5K run to 3K. We don’t sleep as well as we
once did.
These are some of the changes that we notice.
But, there are changes taking place inside our bodies that we
can’t see. At the cellular level, our hormone production begins to
decline as we approach middle age. Slowly, almost imperceptibly, we
begin to see the effects of this hormonal shift. We start to notice
things like decreased energy, mood swings, memory trouble, decrease in
sexual energy and desire, thinning hair, weight gain, and the list goes
on.
In response to our concerns about how we age, the medical community
has focused its attention on the link between the age-dependent decline
of certain hormones and the quality of life we enjoy. Experts in
anti-aging medicine believe that hormone supplementation
significantly decreases the risk of many age-related diseases, therefore
helping not only to extend our life, but also enhancing its quality.
Hormones play a critical role in our health and vitality. One of the
best examples of this role is the diminishing levels of ovarian steroids
at menopause which can lead not only to immediate symptoms such as hot
flashes, but also to long term deleterious health effects such as
osteoporosis and accelerated cardiovascular disease. More recently, it
has been recognized that with age, men have decreasing amounts of
testosterone and DHEA (important androgens) which may be associated with
some of the debilitation that accompanies male aging. In response to
increasing demands from an aging population and a great deal of
scientific information, healthcare providers are recommending hormonal
supplementation to help maintain vitality and quality of life.
The first step in anti-aging medicine...
HRT
When it comes to hormone replacement dosages, one size does
not fit all. The way each person responds to replacement hormones is
unique. What works well for one may be too much or too little for
another. If a decision to begin HRT is made, a saliva hormone test can
be an important guide for determining how much hormone should be taken.
Testing can indicate physiological benefit. For example, if a healthcare
provider has prescribed a particular estrogen preparation and dosage, it
is important to know whether the dose is correct.
Too little estrogen will not address short term symptoms or give long
term protection. Excessive estrogen supplementation can lead to
recurrent vaginal yeast infection and/or bleeding, breast tenderness,
headaches, thinning hair, weight gain and depression.
Your bone health
Facts:
-
As a woman ages, her risk of developing osteoporosis is greater
than her combined risk of heart attack, stroke, and cancer of the
breast and uterus.
-
Millions of fractures associated with osteoporosis occur
each year.
Such statistics are sobering, especially when considering how current
treatment and medication can prevent this debilitating disease making
many fractures related to osteoporosis avoidable. Every woman needs to
be aware of her risk of osteoporosis.
The process of removing old bone and replacing it with new bone is
called bone turnover or bone resumption. Within bone, there are cells
called osteoblasts whose function is to make or form new bone. There are
other cells called osteoclasts that break down or reabsorb old bone. If
bone breakdown is happening faster than bone formation, the net result
will be an overall serious loss of bone - osteoporosis.
Until the age of about 30, the body builds bones efficiently. Then,
as part of the aging process, bones begin to break down faster than new
bone can be formed. In women, bone loss accelerates during menopause,
when the ovaries stop producing estrogen - the hormone that arrests bone
loss.
One significant benefit of hormone replacement therapy (HRT) is
protection against bone loss by returning estrogen levels to
bone-protecting pre-menopausal levels.
Research has shown that post-menopausal women taking estrogen
supplementation have about 50% fewer hip fractures and 75% fewer spinal
fractures (the most common fractures related to osteoporosis) than those
not taking an estrogen supplement.
About
saliva
hormone results
When you have your salivary hormones tested, you will be
able to look at your results to determine your present hormonal status
and see how to proceed in partnership with your healthcare provider.
What was measured
Your saliva hormone values give you an excellent picture
of your ‘free’ hormone levels. This free portion of your total hormones
is extremely important because it is these hormones which are available
to carry out critical jobs in different parts of your body. About 95% to
99% of your total blood hormones are bound to carrier proteins therefore
not available to your tissues.
On the other hand, the remaining 1% to 5% is free to move into your
cells and make changes. In general, if you have had blood hormones
measured, these results reflect your total hormone levels and not the
crucial ‘free’ fraction. Therefore you can expect your saliva results to
be much lower than the blood values.
How to use the saliva ranges
Basically, the goal of saliva hormone monitoring is to
determine whether or not hormone replacement therapy or another form of
intervention is appropriate for you. If you are already taking hormones,
testing will allow you to adjust dosages, both optimizing benefits and
minimizing risks. The concept of hormone dosing and titration (dosage
adjustment) is new and constantly evolving towards providing the optimal
level of replacement for health and vitality.
Our current gender and age-based saliva hormone ranges
are guidelines for targeting a hormone level that gives and sustains
optimal health. Ranges given for postmenopausal and older populations
are representative of normal, un-supplemented hormone levels and not
necessarily those which will provide maximum well being.
Your test results
The test results report form consists of the following:
- Saliva hormone levels for the requested hormones
- Graphic summary of hormone levels which is
particularly helpful if you have tested the same hormone more than
once
- Easy-to-read age, gender and treatment specific
Expected Saliva Hormone Ranges
- Specimen collection time and date
- Medical Director's signature and test report date
- An Accession Number - used when communicating with
the laboratory
Your results and the ranges
Our saliva hormone target ranges are based on a highly
significant number of individuals representing each of the defined
populations and provide an excellent means for comparison.
Individual and physiological
variability
Some of the ranges may seem broad, but this variation
aptly points out the wide individuality of hormone levels. For each of
us, our baseline hormone levels reflect our sex, our age and our genetic
background. Women have much higher levels of the estrogens and
progesterone than men, and cycling women have higher levels than those
of menopausal women who have ceased cycling. Men, in general, have
higher levels of testosterone and DHEA than women, but in both sexes the
level of each drops dramatically with age. Cortisol levels remain
constant throughout our lifetime, regardless of sex or age.
Importance of the
collection
time
The ranges represent saliva hormone levels from specimens
collected in the early morning. This fact is important because several
of the hormones (such as testosterone, cortical and DHEA) express
‘diurnal variation’ which means that levels drop over the course of the
day and are replenished by the body overnight.
If your saliva collection was not done in the early AM, it is important
to make note of the time difference so it can be taken into
consideration when evaluating your results. It is possible that your
healthcare provider requested an alternative collection time to assess
other aspects of supplementation so it is important to review timing
factors. If that was the case, follow the recommendations of your
healthcare provider.
Location within the
ranges if you are not supplementing
For optimal health considerations, the ideal target
within your appropriate saliva hormone range is from the middle to the
high level. For example, if you are a 51-year-old postmenopausal woman
and your testosterone value is 14 pg/ml, you might consider the
possibility of supplementation.
Hormone levels that
fall at the low end of or below
the established saliva ranges
Saliva hormone levels below or at the very low end of the
established range indicate sub-optimal values, and hormone replacement
therapy (HRT) should be discussed with your healthcare provider. HRT is
available in a wide variety of hormonal preparations and dosages. They
can be taken orally, through the skin, under the tongue or vaginally.
Ideal HRT target ranges should be established through a dialog with your
provider.
For example, if your testosterone or DHEA level is lower than your
age-specific range, do you supplement back to your age range or,
perhaps, back to a more youthful range?
Hormone levels that
rise above the
established saliva ranges
If any of your saliva hormone levels is above the range,
bear in mind the following:
- Hormone supplementation will cause high levels and
thought should be given to decreasing the dose.
- If your A.M. cortisol value is high, it could be the
result of a single, stressful event.
This elevation is a normal physiological response. But, chronically
high cortisol levels can be harmful to long term health.
- If any of your hormone values is higher than the
range or falls within a much more youthful range (20 to 29 years), it
is no cause for alarm and probably means you are healthy. However, if
your result is exceptionally high, exceeding the physiologic range for
a 20 to 29-year-old, it is a good idea to discuss this issue with your
healthcare provider.
Expected levels from
Hormone Replacement Therapy
(HRT)
Oral HRT: Taken as tablets or capsules, oral HRT causes
hormone levels to follow a cyclic pattern following ingestion which
means that it is important to understand the timing interval between
saliva collection and hormone usage. Oral doses, on the average, result
in peak levels about 2-6 hours following dosage, falling to the lowest,
trough level between 8-12 hours.
The established ranges on the back of your test results reflect trough
levels. Therefore, if you tested 4-6 hours after dosing, your levels
will be higher than the expected range.
