Saliva Hormone Testing
How It Works, How It Differs, and Why It Matters for Topical Hormones
If your prescriber has suggested a saliva test, or you use a hormone cream and want to understand your results, this page walks through what saliva measures, how it compares with a blood draw, and how to collect a sample you can count on.
What Saliva Measures
Steroid hormones such as estradiol, progesterone, testosterone, DHEA and cortisol travel through the bloodstream mostly attached to carrier proteins. Only a small share is unbound, or "free," and that free share is the part your tissues can actually use.
The free portion is also the part that passes from the blood into saliva. So a saliva test gives a picture of the hormone that is available to your body, rather than the total amount in circulation.
Because hormone levels in saliva are much lower than in blood, saliva testing relies on laboratories that use highly sensitive methods designed for it.
How Saliva Testing Is Different
Collected at home
No needle and no lab visit. You collect the sample yourself and mail it to the laboratory, and samples hold up well at room temperature on the way.
Several samples, one day
Cortisol follows a daily rhythm. Collecting saliva at set points from morning to night shows that whole daily pattern.
Across your cycle
In the years before and during perimenopause, estrogen and progesterone shift from week to week. Home collection makes it practical to sample on the days your prescriber chooses, or across a whole cycle.
No needle stress
The stress of a blood draw can raise cortisol by itself. Saliva collection avoids that, which is one reason it is widely used for cortisol.
Timing matters for every hormone test. See our suggested labs page for the full list of labs to discuss with your prescriber and how hormones change across the cycle.
Why It Matters for Topical Hormones
A hormone applied to the skin does not travel through the body the same way as one taken by mouth. It is absorbed through the skin and carried to tissues, and a standard serum test may not fully reflect that.
Research on topical progesterone shows this clearly. A 2000 study in Clinical Endocrinology found that after women applied a progesterone cream, their saliva progesterone rose within hours while their serum progesterone showed no change. A 2013 study in Menopause followed postmenopausal women using topical progesterone and sampled saliva, fingertip blood and a standard blood draw over a full day. Saliva levels were about 10 times higher, and fingertip blood levels about 100 times higher, than the levels in a standard blood draw.
In practice, that means a standard blood draw can look low for someone who is using a hormone cream. This is why many clinicians who prescribe topical hormones use saliva or fingertip blood spot testing, and why how and when a sample is collected makes such a difference to the result.
We see this often with the bioidentical hormone preparations we compound. Estrogens and testosterone are prepared as hypoallergenic creams, an olive oil base topical, or vaginal preparations, and progesterone and DHEA are also available as oral capsules. Your prescriber chooses the form and uses your results to set the strength.
Getting a Good Sample
A few simple habits help your sample give a clear result. Your kit's instructions come first; these are the ones that help most.
- Follow your timing. Collect at the times your kit or prescriber specifies, including where your sample falls relative to your last hormone application.
- Keep hormone cream out of the sample. Wash your hands well before you collect, and apply your hormone away from your face and mouth so none reaches the tube.
- Skip brushing and gum beforehand. Brushing can cause tiny amounts of bleeding that affect the result, and chewing gum changes saliva flow.
- Tell your prescriber how you use your hormones. If you use a hormone that dissolves in your mouth, a blood spot test may be a better fit than saliva.
How We Can Help
Once your prescriber has your results and a plan, we are glad to help with the rest.
Hormones made for you
We compound bioidentical estradiol, estriol, progesterone, testosterone and DHEA to your prescriber's order, in the form and strength they specify.
Explore women's healthAdjusted when your results change
If your prescriber changes the strength after a follow-up test, send us the new prescription and we will prepare it to match.
Made around your sensitivities
If you react to dyes, fillers or common cream ingredients, your prescriber can ask for a hypoallergenic base or our olive oil base topical, and we will prepare it that way.
Quality you can check
Everything is made to order at our PCAB-accredited pharmacy in Johnson City, Tennessee, and a pharmacist reviews your formulation before it is made.
Wherever you live
We are licensed in all 50 states and the District of Columbia, with a 48-hour compounding time on most preparations. Shipping time is additional.
Already have a prescription?
Transfer it to us and we will take it from there.
Transfer a prescriptionFrequently Asked Questions
What does a saliva hormone test measure?
Saliva testing measures the free, or unbound, portion of a hormone. Most of a steroid hormone in the bloodstream is attached to carrier proteins, and only the small unbound share passes into saliva. That unbound share is the part that is available to your tissues.
How is saliva testing different from a blood test?
A standard blood draw usually measures the total amount of a hormone in serum, bound and unbound together. A saliva test looks at the free portion. Saliva is also collected at home, without a needle, which makes it practical to take several samples at set times.
Why does saliva testing matter if I use a hormone cream?
Hormones applied to the skin travel through the body differently from hormones taken by mouth. Studies of topical progesterone have found that saliva levels rise after a cream is applied, even when a standard blood draw shows little change. That is why many clinicians who prescribe topical hormones pay close attention to how their patients are tested.
Which hormones can be measured in saliva?
Saliva panels commonly include estradiol, progesterone, testosterone, DHEA-S and cortisol. Your prescriber chooses the panel that fits your situation.
Why is saliva used for cortisol?
Cortisol naturally rises and falls across the day. Because saliva can be collected at home several times in one day, it can show that daily pattern, and it avoids the stress of a needle, which can affect cortisol on its own.
How do I collect a good saliva sample?
Follow your kit's instructions closely. In general: collect at the times your prescriber or kit specifies, skip brushing your teeth and chewing gum beforehand, and wash your hands well so no hormone cream on your skin gets into the sample. Apply your hormone away from your face and mouth.
Is saliva testing right for everyone?
Saliva works well for many people who use creams and other topical hormones. If you use a hormone that dissolves in your mouth, it can remain in the mouth and affect a saliva result, so your prescriber may suggest a blood spot test instead.
Who orders the test?
Your prescriber orders your lab work and interprets the results. If your prescription changes afterward, send us the new prescription and we will prepare it to match.
Can you ship to my state?
We are licensed in all 50 states and the District of Columbia. We compound at our pharmacy in Johnson City, Tennessee and ship from there. We have a 48-hour compounding time on most preparations; shipping time is additional.
We're Here to Help
From Your Results to Your Prescription
When your prescriber is ready, they can send your prescription to us — our details are on our prescriber page — or you can transfer one you already have.
Questions? Call 423-975-0597 for current pricing and shipping options for your state.