Unraveling the Confusion over Saliva, Blood Spot, Serum & Urine Testing for Steroid Hormone Levels
Today’s health care practitioners face the challenge of helping patients cope with hormone imbalance. Whether that’s women suffering from hot flashes and night sweats or men troubled by symptoms of low testosterone, accurate testing is the best way to make sure hormone dosing is optimal.
Matching the type of testing with the type of supplementation has a great impact on the clinical usefulness of hormone assessments. If you’re measuring with the wrong method, tissue uptake of supplemented hormone may not be accurately reflected in test results – leading to inappropriate dosing.
For example:
Serum vs. Blood Spot:
While testing endogenous hormones in serum or blood spot reveals the same levels, assessing topical hormone supplementation with serum testing grossly underestimates the amount of hormone being delivered to tissues. Blood spot tests blood in the capillary beds (arterial/venous/lymphatic) from the finger, and thus better reflects tissue hormone levels.
Serum vs. Saliva:
With saliva measuring the bioavailable (non-protein-bound) fraction of circulating hormones that can freely diffuse into tissues, it provides a more accurate assessment of topical hormone supplementation than serum. Serum levels do not rise significantly after topical dosing. By contrast, saliva levels do – reflecting tissue delivery of the topically delivered hormone.
Blood Spot vs. Saliva:
Blood spot and saliva are highly accurate methods for assessing oral, topical, vaginal, injectable and pellet hormone delivery. However, saliva is not accurate for troche or sublingual hormone therapies because these deliver high amounts of hormone locally to the salivary glands – giving a false-high determination of whole body exposure to the supplemented hormone.
Blood Spot/Saliva vs. Urine:
Urine testing cannot accurately assess topical or oral medications – as it is not reflective of tissue uptake – and may show no uptake with topical or extremely high levels with oral medications. Urine testing is not recommended for assessing vaginal hormone delivery as there is a high risk of contamination of the urine sample leading to false-high results. Blood spot or saliva testing provide the best assessment of oral, topical and vaginal hormone supplementation.
Saliva vs. Urine:
Urinary hormone testing is the only way to see how the body is metabolizing hormones. Both saliva and urine can be used for measuring diurnal cortisol levels; but urinary free cortisol output reflects an average of the time since the previous urine void (hours), while saliva provides an instantaneous assessment at the time saliva was collected (minutes).
Learn more about measuring cortisol in saliva and urine.
SALIVA TESTING
Saliva testing is a non-invasive collection method where patients collect their saliva in plastic tubes in order to measure hormones like cortisol, estrogens, progesterone, and androgens. This non-invasive saliva collection is ideal for patients because it allows them to collect their sample in the privacy of their home or office.
Why Do We Test Hormones in Saliva?
Steroid hormones in the bloodstream are 95-99% bound to carrier proteins, and in this form are unavailable to target tissues. Saliva testing measures the amount of hormone available to target tissues – the bioavailable amount. For this reason, saliva testing better relates to specific symptoms of excess or deficiency, and is a good option for monitoring hormone therapy.
Some analytes cannot be tested using immunoassays, the methodology used for most of our saliva testing. For that reason, ZRT developed an LCMS Saliva Steroid Profile using liquid chromatography/tandem mass spectrometry (LC-MS/MS). This profile tests a broad range of bioavailable hormones and hormone metabolites in one convenient saliva sample collection. LCMS testing allows for accurate reporting of estrogens down to extremely low levels, such as those seen in men, children, and people using aromatase inhibitors, and includes a test for ethinyl estradiol, 3 hormone blockers, and melatonin.
BLOOD SPOT TESTING
Dried blood spot is a form of collection where patients place blood drops on a filter card after a finger prick with a lancet. Once dry, blood spot cards are extremely stable for shipment and storage, and the dried blood format offers excellent correlation with serum tests.
Why Measure in Blood Spot?
Blood spot is ideal for measuring hormones and other analytes such as insulin, blood lipids, Vitamin D, thyroid hormones, and elements like magnesium. It offers distinct advantages over serum because it eliminates the need for a blood draw – saving patients time and money.
ZRT developed the science for accurately measuring hormones in dried blood spot and is currently one of the only labs to offer this method commercially.
No Needles, No Office Visit
ZRT’s convenient blood spot collection eliminates blood draw needles, blood draw fees and the need to see a phlebotomist. Patients can collect their sample at home at the time that suits them. Research also shows that blood spot is more accurate than serum for measuring blood hormone levels in patients supplementing topically.
Unlike other labs, patients do not need to stop hormone supplementation to use ZRT’s testing because we have ranges adjusted for age, menstrual status and supplementation types. This is the ideal method for tracking the effectiveness of hormone treatments.
DRIED URINE TESTING
Dried urine is a form of collection where patients saturate a filter card with a urine sample. Once dry, urine cards are extremely stable for shipment and storage, and this method eliminates the need for jug urine collection.
Why measure in urine? Urine testing is the best way to measure adrenal and sex steroid hormone by-products and their respective metabolic pathways, providing a gauge for understanding the body’s hormone metabolism. Urine testing is also the preferred method for testing elements like iodine and heavy metals like arsenic and cadmium. Additionally, it’s the most common method for testing neurotransmitters.
Accurately measuring hormones in dried urine is another scientific first pioneered by ZRT.
Easiest Method for Urine Testing
ZRT’s dried urine method offers a discreet, at-home testing alternative and eliminates the hassles of all-day jug urine collection. Patients collect urine on a filter strip up to four times during the day. Dried strips are shelf-stable for 30 days and easy to mail back to the lab for analysis.
Unlike other labs, patients do not need to stop hormone supplementation to use ZRT’s testing because we have ranges adjusted for age, menstrual status and supplementation types. This is the ideal method for tracking the effectiveness of hormone treatments.
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