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Welcome to our final post in the hormone testing method series! I hope you have enjoyed this information as much as I have enjoyed sharing it. I’m so thankful to have this opportunity to share the things that I’m passionate about with you. Let’s get started right away with the saliva hormone testing method.
The process of saliva testing is similar to the urine testing in that you do the test in the comfort of your own home and mail your samples to the lab. Also, saliva testing uses the same system of having you test at specific time points during the day. I didn’t really elaborate on that in my last post, so I will explain the reason for the time point testing now. Your stress hormone, cortisol, rises and falls throughout the day and this rise and fall is called a diurnal pattern. Now, abnormalities in the diurnal pattern have been linked to all sorts of maladies from chronic fatigue to sleep apnea and even to a person’s ability to survive breast cancer. By testing at specific time points in the day, we get to see if your cortisol levels are rising and falling as they should. If you are not testing cortisol levels, there is no need to take multiple samples-- you can just do a morning level for the rest of your hormones.
I use saliva hormone testing on a routine basis in my practice (but wait, I thought you used urine testing?) and the lab I use is ZRT, because they are the best and always on the cutting edge of hormone testing. If you read my last post you know that I use saliva testing to adjust hormone dosing. That is because, once a patient is on topical hormone replacement therapy, saliva hormone levels most closely approximate actual tissue levels of hormones- which is what we want to know, right? I think we have already established that it doesn’t matter how much hormone is in your blood if it can’t reach the tissue where it is responsible for affecting your body.
There are some limitations to saliva testing too. First off, you have to assume that people are collecting the saliva correctly (and getting saliva and not sputum...not a
pleasant thought) and that they are not contaminating their sample and that they have waited the appropriate time between hormone application and saliva collection. If the correct steps are not followed, the results are not valid or useful. Also, there are differences in patients-- which is obvious, I know, but it must be noted that different people respond differently to hormones regardless of what their levels say. I believe that this is another reason that many providers have a negative attitude towards “BHRT”. Many providers put their faith 100% into science and statistics and practice medicine as though we have already discovered every single element of the human body. So to those people, it doesn’t make sense that you can treat one person to the ideal hormone levels and they feel great and you treat another patient to identical levels and they can’t tell any difference in the way they feel. In what we can prove scientifically, that just doesn’t make sense.
Well....I’m here to tell you that sometimes things just don’t make sense. Some people absorb differently, some people metabolize differently, some people have fewer hormone receptors than others. So, a number on a piece of paper is a fabulous guide but it is not the end all be all of hormone replacement therapy. There is an art to medicine and our advanced western medical community is set towards eliminating that art. Have you noticed that? It’s like, the worse the health of the American people gets, the tighter the medical powers that be try to grasp for control?
I see some future edits to that last paragraph :)
Anyway, back to saliva testing. As I said, I use it as a guide to determine what changes I need to make to someone’s treatment. The most important thing that I look at on a saliva test is the ratio of estrogen to progesterone. You want the amount of estrogen in your body to be balanced with a certain amount of progesterone (on ZRT’s reports the number you are looking for is 100). What does it mean for these to be balanced? When I first started implementing BHRT into my practice I found the answer to this question to be kind of fuzzy. Of course, there is the obvious-- that if you still have a uterus and you have too much estrogen in relation to progesterone you can start to have spotting, bleeding, etc. Post-menopausal bleeding ALWAYS needs to be evaluated by your prescriber. Improper hormone dosing can possibly cause an over- proliferation of the lining of your uterus, and in some cases, women have had to have a D&C. That is because estrogen is tissue building and progesterone is tissue inhibiting- so they complement each other.
Now, in women without a uterus, traditional medicine says that it is not necessary to prescribe progesterone. Traditional medicine says that progesterone is only necessary to protect the uterus. Functional medicine will tell you differently. There are multiple benefits of progesterone besides just protection of the uterus. I’m sure I’ll be devoting several posts to this topic, but for now, I’ll just ask you to trust me that women typically feel better and are more satisfied when Progesterone is a component of their hormone replacement therapy.
So, in a final summary of hormone replacement testing-- there are benefits and drawbacks to each method of testing. It is important to work with a provider who has a good understanding of these methods and when it is appropriate to use each one. Your provider should be able to methodically and artistically adjust your dosing based on the way you feel, plus the numbers on your lab reports, plus their experience, plus their knowledge of current medical literature. That’s a tall order, but great providers of hormone therapy do exist -- it just takes some digging to find them.