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LC-MS/MS overcomes the limitations of immunoassays in hormone testing.  LC-MS/MS is the new gold standard with sensitivity, specificity, and ease second to none.  LC-MS/MS is the bench science now coming to the practice of medicine.

LC-MS/MS shown to be useful in evaluation in people with suspected elevated cortisol levels.  In this study, they found the dexamethasone suppression test was required.  The point however is that cortisol is a valid medium and this was with LC-MS/MS instead of the more commonly used ELIZA technique.

salivary testosterone and DHEA using LC-MS/MS accuracy exceeds 98.5%.  Compare that with historical 50% resolution of pain with a hysterectomy.  There is no perfect test, but if accuracy exceeds 98%, you have  reliable test.

salivary testosterone and DHEA evaluation by LC-MS/MS validated and shown to be applicable in the diagnosis and therapy in those men with low testosterone and DHEA.

LC-MS/MS shown to be reliable in salivary cortisol evaluation.  Obese individuals create special challenges with regards to coritsol levels, due to peripheral cortisol to cortisone conversion.   This study points out that saliva should not be used solely in the diagnosis of Cushing's syndrome due to unreferenced norms.   That however, doesn't nullify salivary cortisol.  It requires a look at the references.  for those that are obese and being evaluated for cushing's.  There is no perfect test.  T This study is a little misleading in its conclusion.  Salivary testing is valid, but the reference ranges in the obese with suspected cushing's syndrome needs further evaluation: according to these authors.

LC-MS/MS shown to be "accurate and highly sensitive" when compared to GC-MS for saliva testing of hormones.  Up to this point, GC-MS has been considered the "gold standard".

LC-MS/MS will be the new gold standard in hormone evaluation.