There are two common types of testing for hormone levels when working with women with symptoms of PMS or menopause and men with symptoms of andropause.  These are serum (blood) testing, which is favored by many conventional medical doctors, and saliva ("spit") testing, which is favored by most "alternative" health care providers and those select few medical doctors who have looked beyond their medical school brainwash... er, training, yes, training is the word I'm looking for! 

I poke fun at the conventional medical docs who favor serum testing because when one sets aside preconceived notions and actually investigates the potential reliability of the two testing methods, saliva testing is the clear winner, especially if hormone balancing is to be done with any type of topical hormone (skin creams/gels, suppositories, patches, etc.).  In fact, serum testing is so unreliable with regards to monitoring the effects of topical hormone supplementation that it really could be considered totally useless - which is why conventional medical doctors typically recommend against topical hormones (more on this shortly). 

If salivary hormone testing is so much more reliable, why then do so many conventional doctors disparage it?  As I alluded to earlier, part of the problem goes back to their medical school training.  Blood testing is given a great place of honor among medical tests, and rightfully so for most types of testing.  Because doctors are taught, and have come to wholeheartedly believe, that blood testing is the "gold standard" for everything having to do with body chemistry, there is an automatic presumption that saliva testing would be a weak substitute at best.  Because of this strong preconceived bias in favor of blood testing, many doctors have drawn completely illogical conclusions regarding the experiments that have compared the reliability of blood testing to saliva testing.

Repeated experiments have shown that topical application of hormones in test subjects creates a much higher increase in the levels of hormone found in saliva testing than is found in serum testing.  In fact, topical hormone application produces only very minimal increases in serum hormone levels.  This has led many conventional doctors to draw two very illogical and very incorrect conclusions. 

The first conclusion is that saliva testing must be faulty because it shows a much greater increase in hormone levels - when topical hormones are applied - than serum testing (and since serum testing is the presumed "gold standard", the saliva testing must be wrong in some way).  Now does that conclusion make any sense at all?  Of course it doesn't!  When you give someone hormones, you should see their test levels rise.  Yet somehow, many medical doctors have concluded that the test that shows what you would expect it to show is wrong, and the test that didn't show what you would expect it to show is right.  That medical school "training" is thorough!

Now they may be brainwa..., I mean, "trained" to think a certain way, but medical doctors aren't stupid.  They know that with the experiments that have been done, their conclusion that salivary hormone testing is unreliable (as compared to serum testing) doesn't make any sense, so they've had to come up with something to support that illogical conclusion.  This brings us to what I mentioned earlier about the conventional medical bias against topical hormones.  Since they presume that serum testing is accurate, and is in fact the "gold standard" of testing, and serum testing does not show a significant increase in hormone levels when a patient is given topical hormones, the only way to rectify this contradiction is to conclude (again, illogically and incorrectly) that topical hormones don't "work" - that is, they are not absorbed to any great extent.  So, since they assume that topical hormones are unreliable, it is safe to assume that any test that can measure their levels in the body must also be unreliable.  I really have to marvel at the thoroughness and effectiveness of the medical school "training"!

The fact that saliva testing shows significant increases in hormone levels when topical hormones are used and serum testing does not is actually easily explained, but most conventional doctors have not bothered to investigate this phenomenon and instead fall back on the presumption that serum testing is always the best for anything regarding body chemistry.  To understand what is happening, first you need to know a little about the nature of how hormones travel in the blood.

Steroid hormones (such as estrogen, progesterone, and testosterone) are primarily found in the bloodstream bound to proteins.  Only about 1% to 5% of the steroid hormones in the blood are "free" (not bound to proteins).  Both saliva and serum testing measure free hormones.  When you take hormones orally, most of the hormones are absorbed from the GI tract bound to proteins, so oral hormones do not produce a huge increase in free hormones and therefore they do not show huge sudden increases in hormone levels on either saliva or serum testing. 

When hormones are taken topically (through skin creams/gels, suppositories, etc.), the free hormones are absorbed directly into the blood stream.  Yet as we said earlier, topical hormones do not produce signficant increases on serum (free)hormone tests (this is true of injectable hormones as well).  It is this contradiction that has created so much controversy.  The reason why serum tests do not show this large increase in free hormones is because the hormones are attracted to the blood cells and actually attach loosely to them.  Blood tests for hormones are done on the serum, not the cells (the blood samples are put in a machine called a centrifuge that separates the cells from the serum).  Technically, the hormones that are attached to the blood cells are still "free" but because the cells have been removed from the serum (along with most of the free hormones that have attached to them), the increase in hormone levels from the topically applied hormone supplements are not shown in the serum. 

In the body, as the blood circulates through the tissues, including the salivary glands, the hormones riding on the blood cells are distributed to the tissues. So, the extra hormones are passed into the saliva relatively quickly, and the saliva tests therefore do detect the hormones absorbed from the topical application. 

From all of this, I think it is clear that saliva testing should actually be the preferred method of hormone analysis for patients with symptoms related to PMS, menopause, and andropause, particularly if proposed treatment is to include any kind of hormone replacement/supplementation other than oral hormones.

But due to dry mouth syndrome or for those who just prefer a finger stick test to collecting saliva the lab we use has developed a CAPILLARY BLOOD SPOT TEST!

"A very important reason to use blood spot testing is that, like saliva, hormones present in the "capillary" blood from the finger are more representative of the hormones being delivered to other tissues of the body. With hormones delivered through the skin (e.g., topical, vaginal, sublingual/troche) as supplements, the capillary blood spot hormone level rises in concert with an increase in salivary hormone levels because this represents hormone delivery to tissues throughout the body. In sharp contrast, blood taken by conventional venipuncture (serum) rises very little, not at all, or even decreases in some cases with skin delivery of hormones. This might seem odd, but blood being delivered back to the heart through the veins has already delivered its bioavailable hormone load, and hormones remaining in the bloodstream are tightly bound to serum proteins such as SHBG and albumin. An easy way to conceptualize capillary blood (teaming with bioavailable hormones) versus venus blood (depleted of bioavailable hormones) is to think of the oxygen content of red blood cells in the capillary beds versus the venus blood returning to the heart. Blood being delivered to the tissues through the arteries, arterioles, and finally through the capillary beds of tissues is charged with oxygen that is released into the tissues. Blood traveling back to the heart is depleted of oxygen. In a similar way, hormones delivered through the skin are picked up by red blood cells, and the hormone-laden red blood cells are then transported within seconds throughout the body to capillary beds of all tissues. There the hormones are released. This is why we see high capillary blood levels of hormones in blood spot testing and much less hormone in venipuncture serum when a woman or man is supplementing with natural hormone creams!

DOES A WOMAN WITHOUT A UTERUS NEED PROGESTERONE?

Q: My question is why do all the M.D.s that I have seen since my total hysterectomy say "No" to progesterone since I do not have a uterus and if I used it, it is a cause of breast cancer? With or without a uterus and ovaries, medically does a woman need to supplement progesterone and even some testosterone?

A: As so frequently happens, the M.D.s you are seeing are confused about the difference between the synthetic progestins such as Provera, and natural or bioidentical progesterone. They are not the same thing. You'll find an entire chapter on the subject in What Your Doctor May Not Tell You about Menopause. In short, progestins contribute to breast cancer, strokes, heart attacks, backaches, mood swings, and much more. Progesterone does not.

Progestins were created by scientists in a laboratory. They don't exist in nature. This is confusing to your body. If your doctors insist that progestins and progesterone are the same, ask them why progesterone levels in a blood test don't increase when you take progestins? Or why progestins aren't used in fertility treatments? Or why progestins cause birth defects yet progesterone is the major hormone of pregnancy?

As to why your doctor doesn't understand this, here's a very short history of HRT (hormone replacement therapy; synthetic hormones!) in the U.S., starting in the mid 1960s:

1. Estrogen is given to menopausal women as an anti-aging remedy.

2. Thousands of women die of uterine cancer as a result of taking the estrogen.

3. Scientists figure out that estrogen needs to be "opposed" by progesterone. But progesterone is a natural hormone that can't be patented, so quasi-progesterones called progestins are invented that are very potent and have some, but not all of the effects of progesterone. All of the progestins have negative, even dangerous side effects that progesterone does not have.

4. Clever marketing by drug companies creates thousands of confused doctors who, to this day, do not understand the difference between progestins and progesterone. It's right there in their medical school texts, but textbooks do not educate our doctors, drug companies educate our doctors.

5. Menopausal women are once again convinced by the pharmaceutical industry and their doctors that new combinations of estrogens and a progestin will protect them from uterine cancer and keep them young forever.

6. So many women complain about the terrible side effects of the progestins and refuse to take it that the medical rule becomes, "If you don't have a uterus to protect, you can take estrogen alone."

7. Millions of women have hysterectomies so that they can take estrogen without the progestins.

8. The Women's Health Initiative Study shows that conventional HRT (estrogen and progestin) increases women's risk of breast cancer, heart disease, gallbladder disease and strokes.

9. Millions of women go off of their HRT.

10. Now the doctors, still confused as ever, tell women that they don't need progesterone if they don't have a uterus, and that the progesterone causes cancer.

Doctors do not like being told that they are confused, but do you understand now just how confused they really are? They need to study their endocrinology textbooks and re-educate themselves about hormones. As long as drug companies are educating our doctors, we will be stuck in a dark age of medicine where profit rules and confusion reigns.

After a hysterectomy women not on HRT have twice the risk of dying from heart disease, brain disease and bone disease. It's not just a lack of estrogen that creates the increased risk, it's also lack of progesterone and testosterone. Hormones really do help!

After a hysterectomy women not on HRT have twice the risk of dying from heart disease, brain disease and bone disease. It's not just a lack of estrogen that creates the increased risk, it's also lack of progesterone and testosterone. Hormones really do help!

After a hysterectomy, women on conventional HRT have an increased risk of cancer and strokes, thanks to the progestins and excessively high doses of estrogen.

According to two large European studies, women with or without a hysterectomy who use bioidentical hormones (e.g. estradiol and progesterone) have no increased risk of any disease.

NOW IS THE TIME to start! (or start over!)... just give me a call.