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Which Testing to Use?

A question I get asked frequently is which method I prefer for measuring hormones, ZRT saliva testing or ZRT capillary blood spot testing. Since both methods have shown to provide good results that reflect symptomology and represent the tissue levels of the hormones, my answer is whichever is appropriate for the individual patient.

Saliva testing is the only way I test cortisol levels. I strongly believe in getting a 4-point cortisol (4 times a day) pattern to know best how to treat the individual patient. Presently, venous serum and capillary blood spot testing have reference ranges for a twice a day measurement only, and the normal range for venous serum in the late afternoon is much too wide to be very useful.

ZRT's saliva testing has the advantage of the data that has been collected for over 1 ½ million patients, which correlates levels to symptoms and dosing. The more data, the easier it becomes to fine-tune the target range. Hormones in saliva are fairly stable. For patients having difficulty getting enough saliva for the morning sample, the saliva can be kept in the freezer and added to over 2-3 days to reach a sufficient amount. Saliva can be kept in the freezer for up to 30 days without any significant loss of hormones.

Saliva testing does have some disadvantages, and there are cases where capillary blood spot testing would be preferred. Some patients do not believe they can collect any significant amount of saliva, whereas blood spot collection can offer a simple solution. Other patients may have difficulty in generating saliva, such as with autoimmune disorders like Sjogren's syndrome, or patients on anti-cholinergic or antihistamine medications.

In my opinion, saliva testing should be avoided in patients taking their hormones by sublingual or buccal administration. These routes cause an accumulation of hormone in the tissue locally, and the value obtained by saliva testing will over-represent the amount present in the tissue systemically. I always use capillary blood spot testing when hormones are administered under the tongue or in the cheek pouch.

There are substances which are too large to be measured in saliva. These include the endocrine hormones, thyroid and insulin, as well as glucose, cholesterol, and Vitamin D. The levels of all of these are important to know when evaluating the hormone balance of a patient. Insulin, cortisol, and thyroid imbalances are the chief disrupters of sex hormone balance. Many of the symptoms thought to be caused by deficiencies or imbalances in the sex steroids can be caused or exacerbated by imbalances in these other endocrine hormones. Recent research has shown Vitamin D important to heart health, cancer protection, and the function of the thyroid receptor.

Because of these factors, I commonly use ZRT's combination test kit, measuring both saliva and blood spot which allows me to get the best overall evaluation of the endocrine system.

For example, most patients over the age of 40, male and female, have some degree of adrenal dysfunction. Even if it's not to the degree where it is significantly affecting symptoms, it is helpful to catch adrenal dysfunction at an early stage to prevent this condition from getting worse. Only a 4-point saliva cortisol test can accurately measure fluctuating cortisol. Many patients have symptoms that can be related to less than optimal thyroid function, and thyroid function is significantly affected by cortisol and progesterone level. That is why I find myself commonly wanting to examine thyroid levels in patient's initial evaluation. In addition, I always test Vitamin D, one of many keys to proper thyroid function. Thyroid and Vitamin D can only be tested with capillary blood spot testing.

The sex steroids can be accurately tested by either method – saliva or blood spot. I personally tend to gravitate towards saliva testing for females, most likely because I have used it for ten years and am extremely comfortable with the target ranges I strive for. However, it is hard not to recommend blood spot testing. It's so easy and convenient for the majority of patients to do at home, or can be easily done in a practitioner's office. For male patients, I tend to prefer blood spot testing, so I can also test the PSA. Blood spot also offers the advantage of looking at the cardio metabolic risk factors, which is appropriate for so many individuals. I find many patients have put off measuring these risk factors because of the inconvenience of seeing the doctor and then a phlebotomist for conventional venous serum testing.

About the Author

 

Jim Paoletti, RPh, FAARFM is Director of Provider Education for ZRT Laboratory, Beaverton, Oregon. Jim has over 25 years experience with bio-identical hormone therapies in clinical practice in retail pharmacy, as a pharmacy consultant, educator, and educational program developer.

Jim obtained his Bachelor's of Science degree in pharmacy from Ohio State University in 1976.  He is a graduate and faculty of the Fellowship of Anti-aging and Functional Medicine.

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