Hormone Testing – Urine Tests vs Saliva Tests vs Blood Tests

Which is the best hormone testing method?

There is no single ideal method for assessing your steroid hormones. Blood, urine, and saliva hormone tests each have their advantages and disadvantages.  At Meridian Valley Lab (MVL), we offer all three of these hormone testing methods and can help you determine which method will provide you with the most useful information in a given clinical situation.

Blood Hormone Testing

Best used for:

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Hormone testing in serum is a direct assessment of circulating hormones.  Most reported hormone values are “total”, including both free and bound hormones. Testosterone is the exception, being offered as “free” as well as total testosterone. Serum hormone testing offers relatively accurate values with well-established reference ranges. However reference ranges are often broad, reducing their clinical utility.  Typically, serum estrogen measurements only include Estradiol (E2), although Estrone (E1) is also available. In serum, Estriol (E3) is usually available only as a measurement of unconjugated Estriol. This has limited usefulness as 90% of Estriol is conjugated. Free Estrone, free Estradiol, and free Progesterone are rarely measured. Measurement of most sex hormones in serum is necessarily a ‘snapshot’ look at hormones that may fluctuate greatly during day.

A few hormones are more accurately measured in serum than in urine. DHT and Androstanediol fall into this category. Meridian Valley Lab is pleased to be able to offer serum levels of 5α-DHT and 5α-Androstanediol, the more metabolically active of the Testosterone metabolites, as well as the 5α-Androstanediol/5αDHT ratio. This ratio holds great promise as a marker for the development of prostate cancer.

Other hormones that are best measured in serum include Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), Prolactin, Thyroid Stimulating Hormone (TSH), Reverse T-3, and Insulin.

Salivary Hormone Testing

Best used for:

• Circadian cortisol pattern, and
• Menstrual cycle evaluation.

Testing for hormones using saliva, is a method which has gained popularity in the recent years. This is due to the simplicity and noninvasive nature of sample collection. Saliva is beneficial for monitoring cortisol for the AM/PM circadian rhythm.  It can also be helpful to assess cyclical output of estrogen and progesterone throughout the month in a cycling or peri-menopausal woman.

Saliva tests reflect only the metabolic process of salivary glands and a limited passive diffusion of the hormones from the bloodstream; levels may be below detection limits in elderly patients. Saliva testing yields higher than physiological levels when using exogenous bio-identical hormone replacement therapy; this gives a false impression of overdosing. With the exception of looking at  blood, saliva tests have the disadvantage of being a ‘snapshot’ look at hormones that ebb and flow throughout at 24-hour period.

Urine Hormone Testing

Best used for:

• Female hormone balance,
• Androgen balance,
• Breast and prostate cancer risk factors,
• Adrenal health,
• Adrenal reserves,
• Growth hormone,
• 5α-reductase activity, and
• Monitoring bioidentical hormone therapy.

In addition to being a non-invasive, patient-controlled collection, a 24-hour urine sample is most accurate because it provides a stable indicator of output not susceptible to the hour-to-hour fluctuations seen in serum or salivary measurements. Urine hormone testing is well-established in medical literature as a reliable method of assessing physiological hormone levels.  Meridian Valley’s  24-hour urine profile reference ranges have been validated over many years of testing in a clinical setting and correlate well with patient symptoms and with therapeutic interventions.

Urinary estrogens can be a sensitive monitor of liver detoxification capability. Elevated urinary estrogens in normally-cycling women may indicate a history of exposure to compounds that stress the liver such as environmental chemicals. This phenomenon has also been observed in peri- or post-menopausal women who have previously taken conjugated equine estrogens.  Interventions intended to improve liver function result in a gradual normalization of the abnormal estrogen levels. Thus measurement of urinary estrogens can give insight into other aspects of physiology.

Urinary evaluations also allow the measurement of many estrogen metabolites that are now thought to play a more pivotal role in the positive and negative sequelae related to estrogens. A recent concept in hormone-related cancer prevention is the measurement of the ratio of two estrone metabolites: 2-hydroxyestrone and 16α-hydroxyestrone. A decrease in the 2/16α ratio is associated with an increased risk of breast and cervical cancer. This ratio is available only in a urine collection.

Similarly, the broad array of glucocorticoid and mineralocorticoid metabolites measured in a 24-hour urine hormone profile provides a more comprehensive picture of long-term adrenal health, short term stress response, cortisol/cortisone balance, and other measures of adrenal health and function than cortisol alone.

Hormone Tests: Urine vs. Saliva vs. Blood

Hormones are some of the most important factors affecting the way your patients feel.

Do you ever want another perspective from a physician experienced in hormone testing?

At MVL, we have been leading the way in hormone testing since 1976. Urine, saliva, and blood each have their merits and limitations. We can help you choose the best hormone test for your patient. Our staff of physicians bring nearly a century of practice experience to provide you with exceptional consultations. Clinicians who want the most comprehensive hormone testing at the lowest cost choose Meridian Valley Lab.

Clinical Research For More Practical Hormone Tests

MVL physicians and scientists are engaged in ongoing research and development so that we can always offer you the most clinically useful hormone testing.

Unmatched Consulting for Hormone Testing & Interpretation For Clinicians

Every urinary hormone profile you order includes up to 30 minutes of review with one of our consulting physicians. This time is designed to make sure that you can immediately put to use the wealth of information provided by these tests. In addition to assisting you in interpreting the results, our physicians draw on research and clinical experience to suggest a range of treatment possibilities. Dr. Jonathan Wright, MD is our medical director and provides ongoing to support to our consulting physicians.

We welcome you to use your free consults to help support your practice and get a peer’s perspective. Practitioners new to hormone testing or bio-identical hormone replacement therapy often prefer to review every hormone test with us. More experienced doctors may choose to call us only with their more complex cases. Regardless, we are here to serve you.

How do you set up your FREE consultation?

Just give us a call at 425-271-8689. Our customer service staff will be happy to set up an appointment for you. This service is only available to physicians. Patients are welcome to call with general questions.

Written Hormone Test Interpretations

Written interpretations of our hormone panels are available for an additional fee. Written interpretations are ideal for the busy practitioner who has difficulty fitting a phone consultation into her/his schedule, but would like to benefit from the experience and insight of our consulting physicians. Interpretations can also be very helpful when you are co-managing a patient with another health care practitioner who is unfamiliar with state-of-the art hormone testing.

Written interpretations can only be requested by and delivered to the physician ordering the hormone test. You are welcome to make a copy of the interpretation for your patient.

Learn More About 24 hr Urine Hormone Tests