Did you know?
Low testosterone and DHT levels can greatly effect energy, mood, physical
strength and sexual function.
Modern lifestyle along with chemical pollution can cause elevated levels of
male estrogen which can reduce libido, increase body fat and enhance your risk
of
cardiovascular disease and prostate disease.
The proper balance of DHEA and cortisol make up the bodyĘs inner defense
against the pressures of stress, helping your body adapt in a healthy manner.
How is your testosterone health?
- Are you under a lot of stress?
- Do you feel fatigued?
- Are your muscles sore for a long time after a workout?
- Have you noticed a waning sex drive?
- Have you gained weight, particularly around your mid-section?
Do you feel depressed, irritable or unmotivated?
If you answered yes to two or more of these questions, you could be suffering
from male hormonal imbalance.
Find out for sure.
Based on more than twenty years of research, salivary hormone assessments
have become a preferred method of measuring hormonal health. In addition to
being less expensive and more practical than blood testing, salivary assessments
measure the active (bioavailable) levels of hormones rather than the inactive
(total or bound) levels of hormones.
Optimum hormonal health all starts with youthful levels of testosterone.
Testosterone is what makes a man a man and keeps you healthy and vital
throughout your whole life. Unfortunately, an abundance or recent research is
showing that testosterone levels are declining faster in modern man than ever
before. While researchers continue to debate the long-term significance of this
growing problem more and more men are suffering from a life that is less full
filling than they imagine as they grow older.
Take your health in your hands with the OptiMale Testosterone Health Check.
About Salivary Testing
The knowledge that there are steroid hormones in saliva, and that they can be
measured, has been around for more than 30 years. But it is only recently that
technology has caught up with that information making it possible to accurately
determine levels of salivary hormones. Steroid hormone levels have and still are
most commonly carried out on blood samples. But blood collection has its
limitations. It is invasive, expensive and difficult to time precisely.
Perhaps more importantly, blood hormone levels represent the body's total
hormone content. Since most blood hormones (about 95%) are bound to specific
proteins which carry them through the bloodstream they can be considered the
hormone 'storage' fraction. The other 5% represent the free hormones - those
available to move easily into the target organs and fulfill their functions.
Saliva contains these free hormones which can be easily measured to give an
accurate picture of those hormones that are readily available to the tissues.
Many studies in the scientific literature have shown that there is a strong
correlation between the levels of steroid hormones in saliva and the
bio-available (free) levels of steroids in the bloodstream. The amount of
steroid hormone that enters the salivary ducts and then saliva, is
representative of the fraction of steroids in the bloodstream that are
bio-available to other tissues in the body.
The Advantages of Saliva Testing
Saliva collection is easy, can be done anywhere, any time and very inexpensive.
Serum hormone testing can be stressful and inconvenient. Blood testing must be
scheduled and it is more difficult to obtain samples at the desired times (e.g.
early am) and multiple times through the day or late evening. There is also an
extra cost involved in drawing blood, independent of the cost for the test
itself.
Hormones in saliva are exceptionally stable, allowing wide latitude in
collection and shipment. Samples can be stored at room temperature for at least
a week without loss of activity, so samples can be shipped to the testing
facility by regular mail. Blood, on the other hand, must be kept cool on ice
packs, increasing costs for shipping as well as the likelihood of error due to
improper handling.
Collection and Processing
Five milliliters of saliva is requested. Following collection, saliva should be
either frozen or shipped to the lab within one day of collection. Saliva is
stable at ambient temperature for at least three weeks and a specimen received
within that time is acceptable.
Test results are then generated and mailed within five to seven working days
from date of receipt of the specimen to the laboratory, often sooner.
How Can Saliva Hormone Tests Help Your Patient?
The goal of saliva hormone monitoring is to determine whether or not hormone
replacement therapy or another form of intervention is appropriate. If your
patient is already taking hormones, testing will allow you to adjust dosages,
both optimizing benefits and minimizing risks. And since your patient may opt to
receive a copy of the test results directly, they will be able to play a more
active role in their own health care and are more likely to adhere to the
proposed hormone replacement intervention.
Why Test for Hormones?
- To establish a baseline before entering into a program of hormone
supplementation
- To establish if there is a deficiency of hormones or an imbalance of
hormones
- Confirmation that hormone supplementation is working
- To help confirm a medical diagnosis that may be hormone related
Advantage of Saliva vs. Serum Testing
- Closely Represents Physiological Levels
- Saliva reflects the biologically active (free) fraction of hormones in the
blood stream (unlike blood
or urine, which measures the total levels)
- Saliva testing allows for practical collection of multiple samples to
assess the circadian (cyclical)
rhythm of hormones such as testosterone and cortisol.
Patient Friendly
- Saliva testing is non-invasive, simple, stress free and painless. NO
NEEDLES!
- Saliva can be convenient collected in the privacy and comfort of home.
- Saliva testing is less expensive than blood testing.
- Because hormones are stable in saliva for two weeks or more samples can be
sent to the laboratory
by regular mail without special handling
More Advantageous to the Doctor
- Specimen collection supplies can be provided to the practice in a timely
manner.
- Technical and clinical support from MedLean
- Easy-to-read test results, graphs and ranges
- Rapid turnaround time of patient results
- Comprehensive professional guide for test result interpretation and
technical information
- Availability of patient educational material
Interpretation of Saliva Hormone Ranges
Laboratory values can only be fully interpreted in the context of the complete
clinical picture. Specific diagnoses cannot be made on the basis of laboratory
values alone. In addition, for diurnally variable hormones or supplementation,
the timing of collection of the specimen is critical. Normal ranges most be
calibrated relative to a specific time of day (early AM) and to specific times
relative to dosing of supplementation (trough levels). The normal ranges may not
be valid for different collection regimens (i.e. PM collection or to capture
peak levels).
Derivation of Ranges
Ranges are determined by testing both volunteers representing designated
populations and drawing from an extensive patient database. Each range is based
on as many as 800 analyses. These salivary hormone ranges capture 90% of normal
female and male values leaving 5% below and 5% above the normal range.
Correlation of these ranges with those in the literature for saliva steroid
hormones is excellent.
Unsupplemented salivary hormone ranges represent normal physiologic levels
for the groups of patients described (i.e. premenopausal, postmenopausal,
specific age groups and gender for androgens). These ranges do not necessarily
represent optimal levels for health since physiologically normal levels can be
risk factors for pathologic processes in certain groups (postmenopausal low
levels of estrogen put women at risk for bone fracture due to increased bone
turnover).
Age-based testosterone hormone ranges are guidelines for targeting levels
that give and sustain optimal health. Ranges normally given for older
populations are representative of normal, unsupplemented hormone levels and not
necessarily those which will provide maximum well being. Titration to more
youthful target ranges is an important therapy issue to consider.
Supplemented salivary hormone ranges are derived from groups of people on
usual dose ranges of standard medications. Thus, these ranges are expected
rather than optimal ranges as delineated by clinical endpoints. Dose levels tend
to be high rather than low and physiologic effect (i.e. relief of symptoms,
decrease in bone turnover rates) can be expected from the lower end of expected
dose ranges for supplementation in most patients.
Individual and Physiological Variability
Some ranges may seem broad but this variation aptly demonstrates the wide
individuality of hormone levels. As to be expected, women have higher levels of
the estrogens and progesterone than men, and cycling women have higher levels
than menopausal women. Men, in general, have higher DHEA and testosterone levels
than women, and in both sexes, the level of each drops dramatically with age.
Healthy state cortisol levels remain constant throughout life, regardless of sex
or age.
Time of Collection
The ranges represent saliva hormone levels from specimens collected in the early
morning unless otherwise noted. Since testosterone, DHEA and cortisol express
diurnal variation with levels highest just after waking, it is extremely
important that patients indicate the time of collection for an effective
hormonal evaluation. Saliva hormone ranges were developed with early AM
collections (between 6-8 AM), and they may not be valid for collections taken
outside this window of time. For patients taking supplementation, there is
obvious pharmacokinetic variation relative to the time of dosing. If peak levels
are desired, one may adjust the timing of collection to coincide with peak
supplemented hormonal levels. However, Clinical Laboratory ranges are not
adjusted to interpret peak levels.
Hormone Replacement Therapy (HRT) Pharmacokinetics
Delivery Systems
Oral HRT: Taken as tablets or capsules, oral HRT levels follow a cyclic pattern
following ingestion. Oral doses, on average, result in peak levels about 2-6
hours following dosage, falling to the lowest, trough levels between 8-12 hrs.
Transdermal HRT: Hormones can be delivered transdermally or transmucosally
(mouth, vagina or rectum) with a cream or gel. Saliva levels of hormones
delivered transdermally (such as progesterone which is readily available over
the counter in creams) are high relative to physiologic levels because of the
following (see full explanation below):
Hormones are more fully absorbed through the skin than from the gut and do
not experience the 'first liver pass' which breaks down over 80% of orally
delivered hormones. Hormone-containing creams are applied in large amounts (as
opposed to patches) and enter the system in a very short time.
When hormones are applied to the skin, we see very significant increases in
salivary levels of that hormone, but often we see very little change in the
serum level. This is because they are already in a biologically active form and
quickly carried throughout the body by the bloodĘs fatty components such as
chylomicrons or red blood cell membranes. They can be detected through the
saliva within a few hours of applying the cream. Serum testing is a valid way to
test hormones if they are produced within the body endogenously, or if you were
taking hormones orally. However when hormones are applied to the surface of the
skin, there is very little increase in serum levels but there's a remarkable
increase in saliva levels. We believe the reason for this is that when hormones
enter through the skin and enter the bloodstream, they're carried by red blood
cells to target sites where they're delivered. When blood is collected, the red
blood cells are spun down and removed, thrown away, and hormones tested in
serum. Therefore, serum is not representative of the bioavailable fractions of
hormones in the bloodstream in transdermal delivery. When using a transdermal
cream, it's best to not use a cream for 12 to 24 hours before collecting the
saliva specimen.
Patch HRT: HRT patches provide a continuous, steady-state delivery and are
applied every 3-7 days for woman and daily for men. Patch-delivered hormones
usually reach a peak by 24 hours followed by continuous levels for the duration
of the recommended patch interval.
They deliver very small amounts of hormones slowly, thus do not overwhelm the
binding capacity of the binding globulins. As expected, patches do not show a
transdermal cream pattern but give levels that look like endogenous production
or oral replacement at about 2 % of serum values.
Sublingual HRT: Sublingual delivery is similar to transdermal and the above
explanation applies. However, caution during sample collection must be taken
since occasionally the mouth will not clear the preparation and the saliva will
be directly contaminated with hormone. If this is a problem, a PM collection
prior to the next dose allows the mouth to clear during the day with increased
oral activity. This collection modification will solve the problem in most
cases.