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Since when did one medium of evaluation become the only standard.  Since serum T has been the historical standard, that is the only window of evaluation??  This study points to higher free Testosterone levels in saliva versus serum. Has anyone ever thought that we are merely looking through different windows of the same process.  Each window here, serum and saliva, are merely giving us different information on hormones.  That doesn't make one right or wrong, it just requires interpretation.  Science is about being objective! Saliva is the best means to evaluate intracellular hormone levels.  These levels should be different than serum.  Why should anyone think that the total levels would correlate with that delivered to a cell.  Think.

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.

this study revealed increased breast cancer risk in women on "estrogen" and "testosterone" therapy.  Now, several problems here: first, are these synthetic hormone or bioidentical.  Second, the dosages appear, in what is written, to be supra physiologic.  Third, giving supra physiologic estradiol and testosterone will obviously create imbalances and growth potential.  Fourth, how were the women evaluated prior to starting hormone therapy and then were they remonitered (unlikely), fifth, were hormone metabolites evaluated (too, also unlikely).  This study has serious flaws and very little can be extrapolated other than: don't take supra physiologic hormone levels without appropriate evaluation.  Enough said

this study showed salivary cortisol to be an "excellent" means to evaluate both those with adrenal disease and adrenal dysfunction.  Salivary test is a good tool to evaluate the free active cortisol.

saliva testing is the new "gold standard" for hormone evaluation.  No testing method is perfect and thus there are guidelines for salivary collections.  However, saliva is equal too or superior to blood for hormone evaluation.

the standard technique of "free testosterone" calculation today is via equilibrium dialysis.  This article describes the problem with current evaluation techniques of current free testosterone evaluation: "this method, although sensitive and reproducible, is cumbersome and not easily adaptable to automated methods".  Most values of "free testosterone" today are either calculated or estimated as this article points out.  Why not just measure with saliva?!

Dr. Braverman nicely discusses the importance of evaluating leptin in the evaluation of obesity.

Wow, thyroid hormones play a significant role in cardiac remodeling post MI.  Thyroid hormones, "promotes tissue growth and differentiation and favorably remodels cardiac cell while increases cellular survival..."  How many people post-MI are having their thyroid evaluated, let alone correctly evaluated?

Salivary cortisol testing shown to have sensitivity and specificity that exceeds 90%.  Final Quote: "salivary cortisol will become routine in the evaluation of patients with disorders of the HPA axis

Individuals with ACTH secreting microadenomas have a higher incidence of hypothyroidism and should be evaluated. This only makes physiologic sense, knowing the impact on 5'deiodinase, and TSH production. Also of importance, is the methodology of cortisol evaluation.  They used salivary cortisol levels to follow.  This study was conducted at John Hopkins school of Medicine, Division of Endocrinology.  Some how others here in Louisiana have missed this (Namely LSBME and BCBS).

Review of xenoestrogens and techniques for evaluation.  Brief discussion of the different EDCs is included, but the majority of the study is to evaluate the different testing techniques.

Current recommendations on HGH origin, evaluation, and therapy.

over hydration increases risk of hyponatremia.  Body weight is inversely associated with Na levels.  Weight evaluations are an appropriate means to evaluate.  Endurance triathlon athletes can lose up to 5% without any negative physiologic impact.

New study from European Medicines Agency questions alot of the new cancer drugs brought to the market 2009-2013.  57% of the new drugs (39/68) were brought to the market without evidence of improved survival or quality of life.

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Though this study looked  at serum testosterone, GC-MS was shown to be valid technique to evaluate testosterone levels.

Sensitivity and specificity of saliva evaluation of cortisol approached 100%.   Salivary cortisol correlates extremely well serum cortisol levels.  Birth control pills did result in a decline, but still exceeded 95%.

This article discusses the superiority of saliva testing for cortisol evaluation in children.

Flat and/or abnormal diurnal cortisol patterns found to be associated with earlier mortality in breast cancer.  The flatter cortisol pattern, the earlier the mortality.  Several points here: this highlights the impact of cortisol on the immune system.  Second, this reveals how much of the research has moved to saliva as the gold standard.  This study by the NCI, used salivary cortisol to evaluate the risk of breast cancer survivors.

LC-MS/MS shows excellent sensitivity and specificity for cortisol evaluation