Are saliva tests more accurate than traditional serum tests when evaluating hormone imbalance?
A. This is another area of great controversy in medicine, and currently, there is no agreement as to which is best, esp. when evaluating sex hormones. Reproductive endocrinologists have traditionally relied on serum testing for decades, and continue to do so, whereas proponents of saliva testing argue that only the free (unbound to protein) and therefore, biologically active fraction of a sex hormone is important and representative of what is actually in the tissues, which is what is measured in saliva testing. It appears that saliva testing may be superior when evaluating transdermal application of testosterone, due to more extensive metabolism by enzymes in the skin, which might not be picked up in the blood test. Saliva testing has been found to be an accurate way of measuring adrenal cortisol levels. In general, Dr. Chen favors serum testing on most hormones (with the exception of multiple saliva tests throughout the day to evaluate adrenal cortisol levels) as she has seen numerous
