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Hormone Testing Methods—Saliva, Blood, and FSH

Medically Reviewed by

Maintaining the right balance of hormones is vital to optimal health and well being for both men and women as they age. Physicians and other health practitioners have relied upon on several types of tests to determine hormone levels in individuals for a number of years. In fact, the National Institutes of Health (NIH) have used saliva testing in clinical research for over three decades.

Because various types of hormone tests monitor different levels of hormone availability in the body, results do vary and tests have certain advantages and disadvantages depending on individual circumstances.

Both blood and urine tests are used to determine hormone levels in the body. These include reproductive hormones, thyroid hormones, adrenal hormones, pituitary hormones, and many others.

Hormone Testing—Saliva, Blood, and FSH

Saliva testing is considered the most accurate when measuring the body’s availability for hormones such as, Cortisol, DHEA, Estrogen, Progesterone, and Testosterone. When compared to blood testing, saliva tests measure hormone levels circulating in the bloodstream, at the cellular level. It is not helpful however when used to test women undergoing sublingual hormone treatment, (drops or spray), or trans mucosal treatment, (lozenge or troche). These delivery methods concentrate hormones in the saliva, creating abnormally high readings that do not accurately reflect hormones in the system.

Physicians have used saliva testing for over a decade, while the National Institutes of Health have conducted research using this method for over 30 years.

Blood or Serum testing measures hormone levels based on a portion of the blood, (serum) drawn from an individual. Most blood or serum tests do not accurately reflect bioavailable hormone levels, or hormones active in the organs or tissues however. This is because blood testing can only monitor “free” or “total” hormone levels that indicate hormones that easily enter cells, or are attached to carrier substances in the bloodstream. Additionally, testing is inconsistent and may be inaccurate for women receiving transdermal hormone treatments (patch or cream), as hormones in the serum do not register in high amounts.

Follicle-Stimulating Hormone (FSH) testing is a blood test conducted at precise intervals by physicians to determine hormone levels of premenopausal women.

Most often used to treat women who complain of hot flashes or mood changes, it is not considered a comprehensive test for sex steroid hormone production or as an indicator of reproductive status for women. This is because FSH levels fluctuate a great deal during the decade preceding actual menopause.

The test must be taken at three, 60-minute intervals, beginning at 8am. An average reading of all three tests is then determined. Physicians then use this number to figure the best course of hormone treatment for a patient.

Testing and Treatment

Based on test results, physicians can then take a, “test-and-treat” approach to patient care. This allows a patient’s hormone levels to be evaluated, and an individual treatment plan to be customized, which may include the introduction of synthetic or bioidentical hormones, as well as dietary and lifestyle changes if necessary. This is superior to the treatment approach, where some health practitioners rely solely on patient symptoms before prescribing hormone treatments.


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