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There is much debate on this topic in the medical community.
http://www.virginiahopkinstestkits.com/salivavsblood.html
http://thyroid.about.com/od/gettestedanddiagnosed/a/salivatesting.htmMany of the anti-aging and BHRT practitioners swear by saliva testing for hormones (especially the 4-times cortisol test for adrenal function) and believe them to be more accurate than blood tests, although most will combine them with blood tests to get a better clinical snapshot.
http://www.suite101.com/content/the-accuracy-of-saliva-adrenal-cortisol-testing-a132752Medical Research says Saliva Cortisol Tests are Accurate
Medical groups that have studied adrenal-cortisol testing by saliva samples, have determined this type testing to be accurate, as well as less intrusive and more convenient than blood sampling. Mention is also made in these studies that multiple levels can be obtained at different points of a full day-cycle (24 hour period) which would be difficult to accomplish by blood sampling. Saliva samples can be done in the convenience of a person’s home while multiple blood draws would require long stays or repeated visits to blood draw clinics when taking multiple samples during a 24-hour period. When citing conclusions on saliva testing to detect Cushing’s syndrome, the Journal of Clinical Endocrinology & Metabolism states that it is as accurate as plasma measurements and better than urineglucocorticoid excretion.
The well-respected thyroid support site Stop the Thyroid Madness strongly recommends saliva testing:
http://www.stopthethyroidmadness.com/recommended-labwork/Here’s an excerpt from another forum:
In fact, saliva testing is the best way to test cortisol levels, for at least a couple of reasons.
First, it measures free cortisol, which is the fraction that binds to the glucocorticoid receptors and is the active form. The blood test measures total cortisol, including that bound to the carrier protein, which does not reflect the levels of the active cortisol.
Second, it is important, especially in CFS, to measure the diurnal variation of cortisol over an entire 24-hour period. This is readily done by saliva testing at home, while blood testing is not.
Here is the abstract of a recent review paper on this topic:
J Clin Endocrinol Metab. 2009 Oct;94(10):3647-55. Epub 2009 Jul 14.
Utility of salivary cortisol measurements in Cushing’s syndrome and adrenal insufficiency.
Raff H.
Endocrine Research Laboratory, Aurora St. Luke’s Medical Center, Milwaukee, Wisconsin 53215, USA. hraff@mcw.edu
Context: The measurement of cortisol in saliva is a simple, reproducible, and reliable test to evaluate the normal and disordered control of the hypothalamic-pituitary-adrenal (HPA) axis. There are a variety of simple methods to obtain saliva samples without stress, making this a robust test applicable to many different experimental and clinical situations. EVIDENCE ACQUISITION: Ovid Medline and PubMed from 1950 to present were searched using the following strategies: [
and and ] and [ and and ]. The bibliographies of all relevant citations were evaluated for any additional appropriate citations. EVIDENCE SYNTHESIS: Measurement of an elevated late-night (2300 to 2400 h) salivary cortisol has a greater than 90% sensitivity and specificity for the diagnosis of endogenous Cushing’s syndrome. Late-night salivary cortisol measurements are also useful to monitor patients for remission and/or recurrence after pituitary surgery for Cushing’s disease. Because it is a surrogate for plasma free cortisol, the measurement of salivary cortisol may be useful during an ACTH stimulation test in patients with increased plasma binding protein concentrations due to increased estrogen, or decreased plasma binding protein concentrations during critical illness. Most reference laboratories now offer salivary cortisol testing. CONCLUSIONS: It is expected that the use of the measurement of salivary cortisol will become routine in the evaluation of patients with disorders of the HPA axis. PMID: 19602555 [PubMed – indexed for MEDLINE]
Nighttime Salivary Cortisol: A Useful Test for the Diagnosis of Cushing’s Syndrome
http://jcem.endojournals.org/cgi/content/full/87/10/4515I thought this site from Dr. Wright’s lab [http://meridianvalleylab.com/hormone-testing%5D broke it down clearly:
Blood Hormone Testing
Best used for:* FSH,
* LH,
* Prolactin,
* TSH,
* RT3,
* Insulin
* DHT,
* Androstanediol, and
* Androstandiol/DHT ratio.Salivary Hormone Testing
Best used for:
* Circadian cortisol pattern, and
* Menstrual cycle evaluation.Urine Hormone Testing
Best used for:
* Female hormone balance,
* Androgen balance,
* Breast and prostate cancer risk factors,
* Adrenal health,
* Adrenal reserves,
* Growth hormone,
* 5α-reductase activity, and
* Monitoring bioidentical hormone therapy.What’s your opinion?
For men the only good test after doing a morning fasting Cortisol blood test that shows low is a 4x’s / day Saliva test to see how the rhythm looks. It needs to be high in the morning going lower by bedtime.
I have seen a lot of 4x’s / day Cortisol Saliva tests done for men that showed there Testosterone and Estraidol levels very high when they are very low and others that were on TRT that showed them very low. You just can’t test male sex hormones using Saliva testing.
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