About Test Results

Saliva Hormone Results
When you have your salivary hormones tested, you will be able to look at your results to determine your present hormonal status and see how to proceed in partnership with your healthcare provider.

What was Measured
Your saliva hormone values give you an excellent picture of your ‘free’ hormone levels. This free portion of your total hormones is extremely important because it is these hormones which are available to carry out critical jobs in different parts of your body. About 95% to 99% of your total blood hormones are bound to carrier proteins therefore not available to your tissues. On the other hand, the remaining 1% to 5% is free to move into your cells and make changes. In general, if you have had blood hormones measured, these results reflect your total hormone levels and not the crucial ‘free’ fraction. Therefore you can expect your saliva results to be much lower than the blood values.

How to Use the Saliva Ranges
Basically, the goal of saliva hormone monitoring is to determine whether or not hormone replacement therapy or another form of intervention is appropriate for you. If you are already taking hormones, testing will allow you to adjust dosages, both optimizing benefits and minimizing risks. The concept of hormone dosing and titration (dosage adjustment) is new and constantly evolving towards providing the optimal level of replacement for health and vitality.

Our current gender and age-based saliva hormone ranges are guidelines for targeting a hormone level that gives and sustains optimal health. Ranges given for postmenopausal and older populations are representative of normal, unsupplemented hormone levels and not necessarily those which will provide maximum well being. For example, an estradiol level of 0.7 pg/ml falls within the normal range for a postmenopausal woman, but is probably insufficient for heart and bone protection. Titration to more youthful target ranges is important to discuss with your healthcare provider.

Your Test Results
The Aeron LifeCycles test results report form consists of the following:

	Saliva hormone levels for the requested hormones
	Graphic summary of hormone levels which is particularly helpful if you have tested the same hormone more than once
	Easy-to-read age, gender and treatment specific Expected Saliva Hormone Ranges
	Specimen collection time and date
	Aeron Medical Director's signature and test report date
	An Aeron Accession Number - used when communicating with the Laboratory

Your Results and the Ranges
Aeron LifeCycles saliva hormone target ranges are based on a highly significant number of individuals representing each of the defined populations and provide an excellent means for comparison.

Individual and Physiological Variability
Some of the ranges may seem broad, but this variation aptly points out the wide individuality of hormone levels. For each of us, our baseline hormone levels reflect our sex, our age and our genetic background. Women have much higher levels of the estrogens and progesterone than men, and cycling women have higher levels than those of menopausal women who have ceased cycling. Men, in general, have higher levels of testosterone and DHEA than women, but in both sexes the level of each drops dramatically with age. Cortisol levels remain constant throughout our lifetime, regardless of sex or age.

Importance of the Time of Collection
The ranges represent saliva hormone levels from specimens collected in the early morning. This fact is important because several of the hormones (such as testosterone, cortisol and DHEA) express ‘diurnal variation’ which means that levels drop over the course of the day and are replenished by the body overnight. If your saliva collection was not done in the early AM, it is important to make note of the time difference so it can be taken into consideration when evaluating your results. It is possible that your healthcare provider requested an alternative collection time to assess other aspects of supplementation so it is important to review timing factors. If that was the case, follow the recommendations of your healthcare provider.

Location Within the Ranges if You are not Supplementing
For optimal health considerations, the ideal target within your appropriate saliva hormone range is from the middle to the high level. For example, if you are a 51-year-old postmenopausal woman and your testosterone value is 14 pg/ml, you might discuss with your healthcare provider the possibility of supplementation.

Hormone Levels that Fall at the Low End of or Below the Established Saliva Ranges
Saliva hormone levels below or at the very low end of the established range indicate sub-optimal values, and hormone replacement therapy (HRT) should be discussed with your healthcare provider. HRT is available in a wide variety of hormonal preparations and dosages. They can be taken orally, through the skin, under the tongue or vaginally. Ideal HRT target ranges should be established through a dialog with your provider. For example, if your testosterone or DHEA level is lower than your age-specific range, do you supplement back to your age range or, perhaps, back to a more youthful range?

Hormone Levels that Rise Above the Established Saliva Ranges
If any of your saliva hormone levels is above the range, bear in mind the following:

	Hormone supplementation will cause high levels and thought should be given to decreasing the dose.
	If your AM cortisol value is high, it could be the result of a single, stressful event. This elevation is a normal physiological response. But, chronically high cortisol levels can be harmful to long term health.
	If any of your hormone values is higher than the range or falls within a much more youthful range (20 to 29 years), it is no cause for alarm and probably means you are healthy. However, if your result is exceptionally high, exceeding the physiologic range for a 20 to 29-year-old, it is a good idea to discuss this issue with your healthcare provider.

Expected Levels from Hormone Replacement Therapy (HRT)
1. Oral HRT: Taken as tablets or capsules, oral HRT causes hormone levels to follow a cyclic pattern following ingestion which means that it is important to understand the timing interval between saliva collection and hormone usage. Oral doses, on the average, result in peak levels about 2-6 hours following dosage, falling to the lowest, trough level between 8-12 hours. The established ranges on the back of your test results reflect trough levels. Therefore, if you tested 4-6 hours after dosing, your levels will be higher than the expected range.

2. Patch HRT: Hormone-containing patches (mainly estradiol) provide a continuous, steady-state delivery of the hormone to the body and are applied every 3-7days. Saliva hormone levels reflecting patch delivery are very close to normal, cycling premenopausal levels. Hormone levels delivered by a patch peak at 24 hours, followed by a steady state delivery up to the duration of the recommended patch interval. There is variability as to the duration of action so it might be a good idea to test a point within the patch interval to determine the optimal duration for you.

3. Cream, gel or sublingual (under the tongue) HRT: Hormones that are delivered through the skin (transdermally) in a cream or gel, or under the tongue (sublingually), result in saliva hormone levels that are very high. The reason is that these hormones are more fully absorbed through the skin than from the gut and do not pass through the liver (a process which breaks down 80% of orally delivered hormones). Transdermally delivered hormones enter your system in a large quantity all at once. These high saliva values are predictable, expected and reflect adequate blood hormone levels. Aeron LifeCycles ranges reflect expected saliva hormone values from a large population of cream and gel users. Further clinical studies are needed for a better understanding of transdermal delivery and to define optimal dosage recommendations.

Urine Pyrilinks-D Result

What was Measured

Your urine was tested for deoxypyridinoline (Dpd) by the Pyrilinks-D assay. Dpd is a specific urinary marker for bone resorption (loss). Your bone is in a constant dynamic state of building up and breaking down, and when the breaking down exceeds the building up, your bone thins and becomes porous, a condition known as osteopenia. If the thinning is not interrupted by intervention, you become susceptible to bone disease (osteoporosis) and, ultimately, serious fractures. If your Dpd level is higher than the acceptable range for healthy bone turnover, you should consult your healthcare practitioner.

Your Test Result

Your urine Pyrilinks-D test result consists of one page that contains your name, your healthcare provider’s name, both addresses and your Pyrilinks-D result, displayed and graphed. The Aeron Medical Director’s signature and date are at the bottom. The back of the page provides information about ‘Bone Density / Turnover Assessment’ including the normal range for female and male Pyrilinks-D values.

Your Result and the Range

A Pyrilinks-D Value Greater than 6.5
A value higher than 6.5 indicates that your rate of bone loss is greater than that for healthy young men and women. You are losing bone faster than you are building it. In general, if this rate of bone loss continues, you could be more prone to disease. It is suggested that a visit to your healthcare provider is in order if the value is greater than 6.5 to discuss possible causes and solutions.