124 TOWNSEND LETTER for DOCTORS & PATIENTS – JANUARY 2004
the ranges are not shifted to a supplemented level, test results
can lead to confusion and the impression that the patient has
some hormonal imbalance when, in fact, she may be enjoying
enormous benefit from the hormonal therapy.
The importance of matching symptoms with
The majority of individuals who test their hormones in saliva
or blood have a reason; they are suffering from symptoms that
impact the quality of their life. They recognize that these
symptoms often are based on hormonal imbalances. For
example, a woman suffering from PMS and fibrocystic breasts,
which have been getting progressively worse as she approaches
menopause, understands that this is due to hormonal changes.
She often wants to verify this hormonal imbalance by hormone
testing to justify some form of intervention. Or a man who suffers
from low energy, muscle loss, apathy, sagging sex drive, and
has lost that “get up and go” as he approaches his 50’s recognizes
something is wrong and seeks hormone testing to determine if
his problems are related to dwindling testosterone.
There is little question that an individual’s symptoms are
the primary driving force that compels them to seek professional
help, and spend money on hormone testing. Documenting these
symptoms and understanding their relationship to hormonal
levels has numerous advantages over just simply knowing an
individual’s hormone profile. Matching hormone profiles with
symptoms helps confirm that the hormonal imbalance is causing
the symptom. For example, if a woman has normal levels of
estradiol, but low progesterone during the luteal phase of her
menstrual cycle and she suffers with symptoms of estrogen
dominance (fibrocystic breasts, water retention, irritability,
PMS) these symptoms help confirm the hormonal imbalance
and point to treatment strategies that can be used to correct
Another reason it is useful for the testing laboratory to
document symptoms is because the health care provider ordering
the hormone test often does not fully understand how to
interpret the test results. This frequently results in a phone
call to the testing laboratory to help shed light on the hormone
test results. For a productive and meaningful discussion about
the test results, the health care provider and the professional
at the testing laboratory must both know the patient’s age,
menopausal status, what hormones they are taking, and their
symptoms. If these parameters are not documented on the test
report, time-consuming conversation often ensues in order to
provide a mutual understanding of the hormone test results in
relationship to the patient’s primary complaints. A patient’s most
pressing symptoms in relationship to hormonal imbalances are
often overlooked in a conversation where both parties do not
have access to this information.
Numerous studies and books21 have documented symptoms
in relation to hormonal imbalances. Some of the most common
symptoms in relationship to hormonal excesses and deficiencies
in women are listed in Figure 4.
In summary, saliva hormone testing is more convenient, less
stressful, more cost-effective, and more representative of the
bioavailable fraction of hormones in blood than serum hormone
testing. When hormones are delivered topically, serum hormone
testing grossly underestimates the bioavailable fraction of
hormones in blood and tissue hormone uptake and response.
This often leads to continued escalation of dosing despite tissue
saturation and symptoms of hormone excess. The ideal saliva
hormone test report should contain pertinent information not
only about an individual’s hormone level but how this relates to
symptoms associated with hormonal imbalance. Such
information helps both health care providers and their patients
come to a more educated decision about the most effective
treatment strategy (hormonal, nutrition, exercise, stress
David Zava, PhD
1815 NW 169th Place, Suite 5050
Beaverton, Oregon 97006 USA
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Ann NY Acad Sci, 146-160, 1993.
4. Kurz H, Trunk H, Weitz B. Evaluation of method to determine protein-binding
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Livingstone 1998, pp 321-338.
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Days, and Weeks, Physiol Behav 48: 83-86, 1990.
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steroid analyses to field conditions. Am I Human Biology 1: 249-255, 1989.
10. Dabbs JM. Salivary testosterone measurements: collecting, storing, and
mailing saliva samples. Physiology & Behavior 49: 815-817, 1991.
11. Zava, DT. Unpublished results, ZRT Laboratory.
12. O’Leary P, Foddema P. Chan K, Taranto M, Smith M, Evans, S. Salivary, but
not serum or urinary levels of progesterone are elevated after topical
application of progesterone cream to pre- and postmenopausal women.
13. Burry KA, Patton PE, Hermsmeyer K. Percutaneous absorption of
progesterone in postmenopausal woman treated with transdermal
estrogen.’Am J Obstet Gynecol 180: 1504-11, 1999.
14. Devenuto F, Ligon DF, Friedrichsen DH, Wilson ML. Human erythrocyte
membrane. Uptake of progesterone and chemical alterations. Biochim
Biophys Acta 193: 3647, 1969.
15. Koefoed P. Brahm I. The permeability of the human red cell membrane to
steroid sex hormones. Biochim Biophys Acta 1195: 55-62, 1994.
16. Chang K-I, Lee LTY, Linares-Cru.z G, Fournier 5, de Lignieres B. Influences
of percutaneous administration of estradiol and progesterone on human
breast epithelial cell cycle in vivo. Fertility Sterility 63: 785~791, 1995.
17. Miles RA, Paulson RI, Lobo RA, Press MA, Dahmoush L, Sauer MV.
Pharmacokinetics and endometrial tissue levels of progesterone after
administration by intramuscular and vaginal routes: a comparative study.
Fertility and Sterility 62: 485490, 1994.
18. Bulletti C, de Ziegler D, Flamigni C, Giacomucci E, Polli V. Bolelli G,
Franceschetti F. Targeted drug delivery in gynaecology: the first uterine pass
effect. Hum Reprod 12(5): 1073-1079, 1997.
19. Fanchin R, de Ziegler D, Bergeron C, Righini C, Torrisi C, Fydman R.
Transvaginal administration of progesterone. Obs Gyn 1997;90:396-401.
20. Cicinelli E, Petruzzi D, Scorcia P. Resta L. Effects of progesterone
administered by nasal spray on the human postmenopausal endometrium.
Maturitas 18: 65-72, 1993.
21. Lee, JR. Natural Progesterone; The Multiple Roles of a Remarkable Hormone.
BLL Publishing, Sebastapol, CA, 1993.
Saliva Hormone Testing
Reprinted with permission
Townsend Letter for Doctors & Patients
911 Tyler Street, Pt. Townsend WA 98368
360-385-6021 • www.townsendletter.com