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SALIVA TESTING OF HORMONES About Hormones What is a hormone? In simplest terms, hormones are chemical messengers that course through your bloodstream and enter tissues where they turn on switches to the genetic machinery that regulate everything from reproduction to emotions, general health and well being. Hormones can be thought of as the life giving force that animates you physically, mentally, and emotionally. Where are hormones made? Different glands and organs throughout the body produce hormones. For example, the pancreas produces the hormone insulin, whereas the ovaries produce estrogens and progesterone. Other glands such as the pituitary and hypothalamus in the brain secrete hormones such as FSH (follicle stimulating hormone) and LH (luteining hormone) that control how much estrogen and progesterone are produced by the ovaries. The Steroid Hormone Family Some hormones are composed of large proteins and others of small fatty substances derived from cholesterol. One class derived from cholesterol belongs to a family of hormones termed steroids. The steroid family is broken down into five major categories including estrogens (estradiol, estriol, & estrone), progesterones, androgens (DHEA, testosterone, and androstenedione), glucocorticoids (cortisol & cortisone), and mineralcorticoids (aldosterone). Cholesterol is converted to the mother steroid hormone, pregnenolone, which is then further converted in the ovaries, testes, and adrenal glands to the other hormones, as directed by protein hormone signals from the brain. The Brain Controls Steroid Hormone Synthesis How much and what type of steroid hormone is produced is controlled by specific chemical messages from the brain. In women, the brain message FSH (follicle stimulating hormone) signals the ovaries to produce estrogens. LH (luteinizing hormone), produced during the second half of the menstrual cycle then signals the ovaries to produce progesterone, which helps to balance and slow estrogen-stimulated growth. In men, LH signals the testes to manufacture testosterone. Stress, in the form of physical, emotional, or dietary, signals the brain to produce ACTH (adrenocorticotropin hormone), which in turn, signals the adrenal glands to produce cortisol that regulates glucose levels in the blood and activates immune response to foreign invaders such as viruses and bacteria. Why only some tissues respond to hormones Once the steroid hormones are released into the bloodstream, they are carried within seconds to different tissues throughout the body. While all cells of the body are bathed in the steroid hormones, only some respond to the hormone signal. For example, cells in the breast, uterus and brain respond to estrogens, whereas muscle cells do not. Response to a specific hormone requires the presence of a specific steroid-binding receptor protein present within the cell. When the steroid enters the cell, it binds and activates the receptor, which in turn, activates unique gene sites that orchestrate the production of new cell products such as enzymes, structural proteins, and new receptors to other hormones. For example, estrogens bind to estrogen receptor cells of the breast and uterus and trigger the synthesis of growth-promoting factors, leading to cell growth ands division. Estrogens also induce receptors for progesterone, allowing subsequent cell response to progesterone produced during the luteal phase of the menstrual cycle. Progesterone, through its own receptor system, invokes the synthesis of its own unique cell products, including secretory proteins (needed for the fertilized egg to adhere to the wall of the uterus) and proteins that down-regulate the receptor for estrogen, shutting off further tissue response to estrogens. In the brain, estrogens promote synthesis of neurotransmitters such as serotonin, essential for normal brain function. Each of the different steroid hormones is responsible for regulating thousands of unique and different cellular products needed for general cell maintenance and repair as well as reproduction, immune modulation, and brain function. In short, steroid hormones are powerful molecules essential for maintaining physical and mental health. So it is not difficult to see why an imbalance of any one hormone can throw your physical and mental health out of balance, causing aggravating and even serious health problems. Saliva Testing of Hormones Why test saliva? Because steroid hormones play such a vital role in maintenance of health, knowledge of an imbalance in any one or more hormones can help illuminate the cause of health problems and provide a rational basis for correcting the imbalance through diet, exercise, or hormone supplementation. Are the levels of steroid hormones in blood and saliva the same? When the various glands manufacture the steroids, they are released into the bloodstream bound to carrier proteins. Only a small fraction (1-5 %) of a given amount of steroid hormones breaks loose from the carrier protein in the bloodstream and is free to enter target tissues. This free or unbound hormone is what we want to measure, since it is active or bioavailable to the target tissues such as the breast, uterus, brain and skin. Many studies in the scientific literature have shown that there is a strong correlation between the levels of steroid hormones in saliva and the bioavailable (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 bioavailable to other tissues in the body. There are several advantages of saliva vs. blood testing of steroid hormones. Saliva collection is easy, can be done anywhere, anytime and most importantly, at a much lower cost. Serum hormone testing is stressful, and the stress of blood draw can sometimes alter the result. Blood has to be drawn at a doctor’s office or drawing station, and it is more difficult to obtain samples at the desired times such as early in the morning, late evening or even multiple times through the day. 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 a 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. How Can Saliva Hormone Tests Help You? There are several ways salivary hormone tests can help you and your patients to take responsibility for, and optimize their health. The first way is to help identify possible causes of health problems. Depending on the specific hormones involved, certain symptoms or groups of symptoms are usually present when hormonal imbalance exists. For example, contrary to popular belief, depression is not caused by a prescription drug deficiency, but it can be caused by imbalance between estrogens and progesterone, low androgens like DHEA and testosterone, or high cortisol. Genetics, dietary factors or other environmental factors may cause this imbalance, in turn. Accordingly, depression might also be reversed by supplementation with the appropriate hormones(s) and attention to other factors; hormone testing can be used to guide this therapy. If hormone balance is restored but symptoms persist, then one has to look elsewhere for the cause. Hormone testing can be used to guide supplementation, to determine if oral hormone supplements such as DHEA are being absorbed, and if the dosage is appropriate. Bioavailability of oral hormonal supplements can vary widely. The saliva test can also help you evaluate if estrogens are well balanced with progesterone following progesterone cream supplementation. Too much estrogen, relative to progesterone, leads to excessive tissue proliferation, whereas too much progesterone in the absence of adequate estrogen can exacerbate estrogen deficiency problems. Saliva hormone testing can also be vital for rational disease prevention and anti-aging programs. Testosterone, for example, is an important hormone for both sexes, in the maintenance of cardiovascular and bone health. Identification of a low testosterone level and correction with diet, exercise, and /or hormone supplementation could help prevent the development of cardiovascular disease and osteoporosis. Anti-aging medicine is still in its infancy, but hormone supplementation is an important aspect of anti-aging; restoration and maintenance of hormone parameters at youthful levels is one strategy that may extend your health span (span of healthy, productive years). Hormone testing is crucial for this approach as it is imperative not to exceed levels that might lead to adverse side effects.