How Accurate is Saliva Hormone Testing? (Saliva Hormone Testing Accuracy)

saliva hormone test accuracy

Saliva hormone testing is an excellent method for measuring steroid and sex hormone levels in men and women. While the reliability of saliva testing, in general, has been questioned in the past, current research studies suggest that saliva tests for sex hormones and cortisol are highly reliable, particularly in determining the levels of DHEA (male and female sex hormone precursor), estradiol, progesterone, and testosterone.

What is the purpose of hormone testing?

Only your doctor can say if you need your hormone levels checked. Despite the availability of various at-home testing kits that can be purchased without a prescription, there is no single definitive test that can detect hormonal imbalance or signs of aging. The National Institutes of Health (NIH), and most doctors do not recommend hormone testing outside the clinical setting, except for follicle stimulating hormone (FSH), which can determine if a woman is in menopause.

Your doctor may recommend testing your hormone levels if an underlying medical condition such as polycystic ovary syndrome (PCOS), thyroid problems, tumor, or Cushing’s syndrome, is suspected. PCOS is the most common hormonal imbalance in women. To come up with a diagnosis, your doctor will:

  • perform a medical examination
  • inquire about your symptoms
  • obtain a thorough medical and family history
  • ask about the medications you are taking
  • take a blood sample to check your hormone levels
  • perform a pelvic exam and ultrasound

Hormones commonly measured using a blood sample:

  • Luteinizing hormone (LH) — usually measured to diagnose fertility problems in men and women. High LH levels when a woman is not ovulating may indicate PCOS or menopause.
  • Follicle-stimulating hormone (FSH) — high FSH levels may indicate loss of ovarian function, menopause, or ovarian failure.
  • Testosterone — women with PCOS may have a high level of this hormone
  • Estrogens — women with PCOS may have normal or high levels of estrogens
  • Sex hormone binding globulin (SHBG) — may be lower than normal in women with PCOS

Is saliva testing more accurate than blood testing?

Serum (blood) hormone testing has long been the gold standard in measuring hormone levels because of its reliability and well-established reference ranges. It is highly sensitive for amino-acid derived hormones such as:

  • FSH
  • LH
  • Prolactin
  • Fasting insulin
  • Thyroid hormones
  • Thyroid antibodies

However, blood testing has limited benefit for sex hormones because it doesn’t measure the metabolites of these hormones. It also doesn’t distinguish bound hormones from free hormones. When testing for progesterone, estradiol, estrone, and estriol, free hormones assay are not usually available. On the other hand, a saliva test measures free hormone, and its versatility makes it a better method for assessing un-supplemented hormone status.

Why is it important to test for bound and free hormones?

Simply because both types are required for an accurate measurement. For instance, serum progesterone test result shows total progesterone and not free or unbound progesterone—the hormones that can easily enter cells.

This may lead to erroneous results in which your levels appear to be normal even if your bioavailable hormone level is high. So you may still feel the symptoms of hormone imbalance even if your test results come out normal. Both methods provide acceptable baseline measurements but saliva is more reliable, in the sense that it also measures free hormone.

Advantages of Saliva Testing

Noninvasive saliva collection permitted the evaluation and assessment of various endocrine studies that would have been challenging, if not impossible, using other conventional methods.

Measuring hormone levels using saliva rather than blood or urine has been gaining popularity over the last several years.

Saliva test kits are now available over the internet without the need for a doctor’s prescription and are being promoted for the detection of menopause and aging. The test is also highly reliable for measuring late-night cortisol levels in screening for Cushing’s syndrome.

The advantages of salivary testing over other conventional methods include:

  • Availability and non-invasive nature of saliva collection
  • Easier to collect and store compared to serum and urine
  • Convenient in multiple sample situations
  • Good patient compliance
  • Less expensive for patients and health care providers
  • Can help check for abnormal hormonal patterns
  • Greater sensitivity

Do Insurance Companies Cover Saliva Hormone Testing?

You should contact your insurance company to know if saliva testing is covered under your policy. Some insurance providers may provide coverage if you meet the following criteria:

  1. The saliva test is required to evaluate for suspected hypercortisolism or Cushing’s syndrome
  2. The saliva test is ordered by a qualified health professional
  3. The test is NOT being requested to diagnose or monitor menopause or diseases related to aging (osteoporosis) and other similar indications

Most insurance policies consider saliva hormone testing of premenopausal, perimenopausal, and postmenopausal individuals for the initiation of hormone replacement therapy (HRT) as “investigational” or not medically necessary.

Saliva Testing for Hormone Imbalance

If you are concerned about your hormone levels, consult your healthcare provider who can order appropriate diagnostic tests and prescribe the right treatment. The proposed use of saliva testing for individuals receiving bioidentical hormone therapy (synthetic hormones) or compounded preparations for menopause therapy is lacking evidence. Our hormones fluctuate based on different factors such as diet and hydration, thus these conditions are difficult to standardize.

While saliva tests may not be reliable for hormonal imbalance, it presents valid sex hormone measurements for estradiol, dehydroepiandrosterone (DHEA), progesterone, and testosterone in older adults, according to a 2009 study with 2,722 male and female participants. This data may be relevant in studying health and illnesses in later life. The researchers concluded that saliva was a good medium for testing sex hormones in older adults due to the ease of in-home collection.

Disadvantages of Saliva Testing

One of the drawbacks of saliva testing is that food, beverage, and medications taken just before the collection of saliva can cause a sudden shift in hormone levels and interfere with test results. Some chewing gums and cotton that are used for sample collection may contain substances that interfere with some saliva tests. If you are taking sublingual hormones, it can lead to false-elevated results. Topical hormones also cause salivary hormones to rise, sometimes even higher than serum levels.

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Compounded bioidentical menopausal hormone therapy. (2012). Fertility and Sterility, 98(2), 308-312. doi:10.1016/j.fertnstert.2012.06.002

Gavrilova, N., & Lindau, S. T. (2009). Salivary Sex Hormone Measurement in a National, Population-Based Study of Older Adults. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 64B(Supplement 1), I94-I105. doi:10.1093/geronb/gbn028

Oleary, P., Feddema, P., Chan, K., Taranto, M., Smith, M., & Evans, S. (2000). Salivary, but not serum or urinary levels of progesterone are elevated after topical application of progesterone cream to pre-and postmenopausal women. Clinical Endocrinology, 53(5), 615-620. doi:10.1046/j.1365-2265.2000.01130.x

Sheehan M. T. (2004). Polycystic ovarian syndrome: diagnosis and management. Clinical medicine & research, 2(1), 13–27.

Task, A. M. (2006). American Association Of Clinical Endocrinologists Medical Guidelines For Clinical Practice For The Diagnosis And Treatment Of Menopause. Endocrine Practice, 12(3), 315-337. doi:10.4158/ep.12.3.315

Vining, R. F., & Mcginley, R. A. (1987). The measurement of hormones in saliva: Possibilities and pitfalls. Journal of Steroid Biochemistry, 27(1-3), 81-94. doi:10.1016/0022-4731(87)90297-4

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