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Fantastic article on the review of the clinical use of saliva testing.  Of note, is the extensive documentation of the validation studies of hormone saliva testing.  Clearly, if a physician is against saliva testing, it is because of a lack of knowledge on the subject.

Saliva Testing of Testosterone is standard

Saliva is proving to be an exciting medium for functional testing.  Recently, studies have found saliva as a great medium to evaluate for cancer biomarkers.  This study find pancreatic cancer biomarkers in saliva.

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.

Topical hormones best evaluated via saliva and/or blood spot. Urine and particularly serum does not increase with dosing.  That does not mean the topical hormone therapy is ineffective, just that serum and urine are not optimal to follow topical therapy.  When looking at endogenous hormones without any therapies: serum, saliva, urine, and blood spot are equivalent.

Interleukins IL-1alpha and IL-1beta in saliva found to not be signifcantly different than serum.  Point: saliva is a good medium to evaluate many other biomarkers, inflammatory markers in this case.

Another study validates saliva as a reliable method for hormone testing.  The author concludes: "steroid concentrations in saliva are independent of flow rate and reflect those in the free fraction in plasma".  This study also discuss potential collection problems and means to resolve them.

No test is perfect. This study analyzes problems with saliva hormone testing.  The authors of this study found saliva testing optimal for cortisol and less so for sex hormones.  Other studies have contradicted this conclusion.

salivary cortisol shown to accurately reflect the systemic cortisol burden.  This study concluded that saliva cortisol was an accurate assessment tool for the free, biological cortisol in the body.  Saliva an appropriate assessment tool, in the place of serum.

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.

This study suggests that "salivette" devices alter saliva hormone concentrations.  Salivette's are usually cotton rolls in saliva tubes.  At Seasons, we do not use the Salivette rolls.

saliva testing used in early disease detection

statement, "assay of saliva E3 should replace serum E3 measurement..."  Saliva testing is very sound science!

Transdermal progesterone levels are quickly transported to saliva.  This quick transport, while serum doesn't equally reflect progesterone, has puzzled many.  Theories have been proposed, yet no answers.   This study looked at whether 5alpha reductase expression in the skin would metabolize the progesterone  and this explain the difference in the two test mediums.  The authors of this study concluded that 5alpha reductase is the not the reason for the difference found in saliva and serum.  the same can be applied to urine as well.

Don't chew gum to increase saliva for saliva testing.

Another study supports saliva hormone testing.  This study involved 2,722 individuals and tested estradiol, progesterone, DHEA and testosterone in men and women.  All of these are sex hormones.  Someone needs to tell the insurance companies that the overwhelming evidence supports saliva hormone testing.  But, that would mean they are even interested in the science.

MS-LS show to be highly sensitive in the dual identification of testosterone and cortisol in saliva. These hormones were found to be stable up to 28 days at room temperature. This disproves the argument that saliva, as a test medium, has a very short shelf life.

saliva testing of hormones said to be "reliable and, in some cases, even superior to other body fluids".  Of course, no test is perfect, but saliva test provides that best assessment available

saliva testing of stress and sex hormones have been utilized since the early 1980's and described as "well validated" in the literature.

This is a summary of just some of the evidence that disputes BCBS saliva policy. The important notes are this is just SOME (much more is available) and that these articles PREDATE the author date of the policy. With BCBS, it is not about scientific evidence, it is just they don't want to pay for saliva testing. That is ok, just be honest about it.