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Hormone Testing: Saliva vs Blood Test

Balancing hormones can be tricky business. Every step of the process is important, from testing method to the interpretation of the results to compounding procedure to proper application. There truly are many moving part that must work together to ensure the best outcome for the patient.

In this article we are going to discuss the pros and cons of the two most common types of hormone testing because the first thing we must do when evaluating hormones is to gather information.


Blood Test Pros

Taking a blood sample for hormone testing is the most common method for assessing a patient’s hormone levels. For this test, a phlebotomist (a person trained in drawing blood from a patient) will use a needle to obtain a small sample of blood (about 1 to 2 teaspoonful) into a small test tube. A medical lab (either on site or more often off-site) will process the blood sample and obtain a level. This level is then compared to a reference range that has been developed by looking at the average levels of healthy patients.

A blood test is typically able to be performed in the doctor’s office, so the patient can usually avoid another stop in their already busy schedules. Also, these tests are often covered by a patient’s insurance, so the out-of-pocket cost is typically low.


Blood Test Cons

One downside to having a blood test performed is the invasive nature of the test. Many patients have an issue with being stuck with a needle whether it be due to a general discomfort or a medical condition that makes blood draws more difficult. Some critics say that this invasive test can itself effect hormone levels, especially cortisol which the body releases in response to stress.

However, the primary concern regarding blood testing is that it is the blood being tested. Our blood is the transportation system in our body. We know that it transports oxygen around the body, but also this is how hormones move throughout the body. When hormones are in the blood, 95-99% of them are bound to carrier proteins. A hormone that is bound to a carrier protein is not available to move into the cells of tissue where it can have its effect.  Therefore, a blood test is not looking at the bioavailable hormones, but rather a larger picture of the total amount of hormone in the body.

The most common method for administering bio-identical hormones is topically in the form of a cream or a gel. When hormones are applied topically, there is rapid uptake by the target tissue, and so a blood sample can show falsely low levels because less hormone is making it into the venous blood.


Saliva Test Pros

The same limitations that are a concern with blood tests are also some of the positive aspects of saliva testing. Hormones measured from saliva are “free” bioavailable hormones that are present in the target tissues and that are working in the body.  In essence, saliva testing allows us to see how much of your hormones are actually producing an effect in your body.

Saliva testing is also categorized as a non-invasive test because there is no needle stick required. The test is performed using a collection kit that is completed in the patient’s home.

Finally, patients that are already using a topical hormone cream are going to see more accurate results because of the uptake of the target tissues upon application.


Saliva Test Cons

Saliva testing is a less common method for assessing hormone levels than is blood testing in most physicians’ offices. Completing a saliva test requires a greater (albeit minimal) commitment from a patient. The patient must first obtain the saliva test kit. The test is performed at home, and is most often to be completed first the thing in the morning.  Obtaining the sample will take 15-30 minutes, so patients must make the time to do the test in order to obtain accurate results.

Another concern with saliva tests is the possibility of contamination of the test. Patients with gum disease can get minute amounts of blood in the test, which can alter the results. Care must be taken to avoid contamination such as not brushing teeth beforehand.

Out-of-pocket costs are often a concern to patients as well. With saliva testing, patients are typically responsible for the full cost of the test which can range from $50 to over $300 depending on the number of hormones being tested. This goes back to the fact that saliva testing is less common and is therefore not commonly covered by insurances.


Our Position on Hormone Testing

At Collier Drug, we use saliva testing almost exclusively for our patients at our Collier Compounding location. Our reason for choosing this method is tied to our belief that saliva testing offers the best picture of a person’s hormone balance (or imbalance) and therefore is tied to better outcomes for our patients when utilized correctly.

We also believe that the proof is in the pudding (or hormone cream in this case). Patients that have performed a saliva test and gone through our BHRT consultation, have seen tremendous results. Our process is built around providing the best outcomes for our patients, and that’s why we choose to use saliva testing in our practice.

For more detailed information about saliva testing, read our article “What is a Saliva Test?” Also, read some great information about hormone testing on the ZRT website. You can also find out about our testing/consultation procedures by reading “How to Get Started with Bio-Identical Hormone Replacement Therapy.”

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