Saliva testing is the most convenient and least invasive manner to measure patients’ hormone status, as saliva measures the body’s “free” hormone levels. Clinically, the free hormone is considered to be the active hormone available for use by tissue. Thus, it is far more relevant to test the amount of hormones delivered to the tissue receptors, as this is a reflection of the active hormone levels within the body.

There are two types of hormones — bound and unbound — that circulate throughout the blood. Approximately 95 percent of hormones are bound, meaning they are bound by proteins and are therefore not available for tissue use. These bound hormones are too large to pass through the salivary glands and therefore cannot be measured by saliva. The remaining 5 percent of hormones are unbound and do not bind to protein, remaining active and fully available for tissue use. These hormones are able to pass through the salivary gland.

It is often difficult for healthcare providers to assess accurate hormone levels with serum, which makes it even more difficult to design a hormone replacement therapy for patients. Serum contains both bound and unbound hormones, yet a reliable method to identify an accurate ratio between these different hormones has yet to be determined.

Saliva, however, provides an accurate level of unbound hormones available in circulation. This is commonly a much lower value in comparison to serum, as it only assesses free hormones. When clinicians utilize saliva to measure effectiveness, they often find that it is higher than serum, indicating a decrease in hormone replacement therapy is necessary. By strictly using serum, clinicians have found that they needed to give excessive amounts of hormone therapy in order to cause an increase in serum hormone levels.

Serum measures both bound and unbound hormone levels. A valid test has yet to be developed that is able to both deliver a true ratio of bound versus unbound hormones and be applicable to each individual. Another downfall with using serum to measure a patient’s baseline and effectiveness of hormone therapy is that serum is typically taken once a day. However, in order to get an accurate idea of the baseline and therapy, measurements would need to be assessed at different time periods throughout the day because the body secretes hormones in a pulsatile fashion. Conversely, saliva only measures unbound hormone levels, and can thus be assessed four times daily.

The discrepancy between free and protein bound hormones becomes especially important when monitoring topical, or transdermal, hormone therapy. Studies show that this method of delivery results in increased tissue hormone levels (thus measurable in saliva), but no parallel increase in serum levels. Therefore, serum testing is not a reliable method to measuring hormone therapy.

Hormones are essential for our overall welfare. We frequently think of estrogen as being a female hormone, and testosterone as being a male hormone. But both men and women make both, plus several more must be in balance for optimum health. An imbalance of any one hormone can throw physical and mental health out of balance, causing aggravating and even serious health problems.

For decades western medicine has prescribed Hormone Replacement Therapy as a “one size fits all” approach. However, nothing could be further from the truth. Hormones are like fingerprints, and in order to achieve optimal health, people must be aware of their specific imbalances.

Being able to identify a hormonal imbalance is essential to design an effective treatment plan. If a patient is seeking bio-identical hormone replacement therapy (BHRT) or a topical therapy, free hormone levels must first be assessed before proceeding with a particular therapy.