Hormonal Update Volume 3 Number 10

Saliva Hormone Test Results: What You Can Expect

Often the first question asked when someone receives his or her saliva hormone level test result is, "Are my hormone levels normal?" Unfortunately, the term normal is difficult to apply when it comes to hormones. Everyone's hormonal milieu is highly individual. The rhythm and flow of a person's hormone production is highly dependent on his or her biochemistry and metabolism. Just look at the following chart. Alicia, Stacey, and Jacqueline are all the same age, thirty-five, and still menstruating regularly. Yet, their hormonal profiles are all quite different. 

                            Estradiol      Progesterone
      Alicia               1.8 pg/ml         0.06ng/ml
      Stacey             2.0 pg/ml         0.10ng/ml
      Jacqueline        2.3 pg/ml         0.40ng/ml

Although there is a high degree of individual variability in hormone levels, there is a trend that is common among most people. Hormone levels typically drop with age. Generally, lower hormone levels are associated with symptoms or increased risk of disease. More youthful levels tend to correspond with better health, vitality and energy. 

Ideally, if every woman had a baseline hormone level test taken when she was in her early thirties it would give her and her healthcare practitioner a barometer for determining her optimal hormone levels throughout her life. Yet, most women do not have this kind of information. For that reason, Aeron LifeCycles Laboratory has developed a set of guidelines called expected ranges. 

Expected ranges can assist patients and healthcare practitioners in determining optimum hormone levels and, if necessary, identifying when a woman's hormone levels might benefit from supplementation with replacement therapy. By comparing a woman's hormone levels with those of others in her age group, her physician can assess whether or not her hormone levels fall within these expected ranges.

What is an Expected Range?

By evaluating the test results of thousands of patients Aeron has been able to define expected hormone level ranges that reflect physiologic levels. A physiologic level is an unsupplemented or "natural" level. We have also been able to ascertain expected ranges based on supplementation with various delivery systems, including tablets taken orally, and creams, gels and patches applied transdermally. Expected ranges result from the statistical comparison of the hormone levels of groups of individuals, generally consisting of eight hundred or more participants. Expected supplemented ranges are derived from the statistical comparison of those using particular hormones and delivery systems. Aeron is the only salivary testing laboratory that has developed expected supplemented ranges for the various hormone delivery methods. 

The data resulting from our statistical comparisons has revealed that most cycling or premenopausal women have physiologic estradiol levels that range between 1.0 and 5.0 pg/ml when measured in saliva. Postmenopausal physiologic estradiol levels generally fall below 1.5 pg./ml. Therefore, if a postmenopausal woman who is not taking any estrogen has an estradiol level of 0.8, it could be said that her estradiol level is normal. That's because it falls within the expected range for her category (postmenopausal, unsupplemented). However, this level is not necessarily optimal. The standard belief is that the optimal estradiol level for a woman is within the physiologic premenopausal range. This is the level she experienced when she was still cycling and was less at risk for disease. 

An optimal hormone level is one that produces the greatest symptom relief and disease protection with the lowest possible dose. It is also highly individual. For example, we have found that most women who take estradiol orally and then test their estradiol level in saliva eight to twenty four hours after consumption have levels between 2 and 20 pg./ml. This is the expected range for a woman taking estradiol in pill form. Ninety percent of all women tested fall within this range. Half of the remaining ten percent fall below this range, and half above. Within that range, however, what works for one woman can be vastly different than what works for another. 

The next chart illustrates the hormonal individuality among four women who were all given the same dose of estrogen replacement - a 1 mg oral estradiol tablet. The women all started with similar baseline hormone levels of estradiol.

                        Baseline Estradiol         Supplemented
    Nadine            0.8 pg/ml                     3.5 pg/ml
    Carol               0.5 pg/ml                     2.0 pg/ml
    Trish               0.9 pg/ml                     8.0 pg/ml
    Angela            1.1 pg/ml                     22 pg/ml

As you can see each woman's response to the same therapy is different. Both Nadine and Carol's supplemented levels are within the range that represents a premenopausal level for most women. Carol's 2.0 pg/ml is at the lower end of the range for a premenopausal woman, and may be optimal for her, but not as effective for someone else. If Carol's symptoms do not recede at this level it may be an indication that her dose needs to be increased slightly. Trish's level is slightly above the physiologic range but well within the expected supplemented range. Her healthcare practitioner may want to evaluate her dose and delivery system to see if her symptoms could be alleviated with a lower dose. On the other hand, Trish may need that higher level in order to achieve symptom relief. Angela's estradiol level is above the supplemented range which suggests that her dose or delivery system may be providing too much estrogen. Angela's doctor will most likely lower her dose or find another delivery system. By and large physicians generally hope to achieve symptom relief at the lower end of the supplemented range.

Expected Ranges are Important

Many postmenopausal women have symptoms that affect their quality of life -hot flashes, night sweats, memory loss, vaginal dryness, and loss of libido to name a few. They are also at an increased risk for many serious diseases such as osteoporosis, colon cancer, and Alzheimer's. A decline in hormone production is thought to be a causative factor or at least an additional risk factor. Clinical studies have revealed that women with more youthful levels enjoy fewer symptoms and reduced debility.

Hormone replacement therapy is designed to restore hormones to more youthful levels. Too much of a hormone, or even too little can result in side-effects, symptoms and disease. Most physicians and healthcare practitioners want to relieve patient symptoms while providing protection from diseases such as osteoporosis using the lowest possible hormone dose. The most recent research shows that lower doses are not only effective for symptom relief and disease protection, but are likely safer as well. Monitoring hormone levels before and after therapy serves as a valuable guideline for determining whether or not hormone replacement is needed, and whether the levels achieved are effective and within the expected range.

Aeron's expected ranges can help a healthcare practitioner determine how effectively a hormone is being absorbed. Not all delivery systems work in the same way. The method of delivery, which is the way hormones enter the system, can greatly affect how they are metabolized and utilized. Transdermal applications, for example, enter the system almost immediately. Orals have to be digested and can lose much of their potency when processed by the liver. Delivery systems can vary so greatly that even among transdermal applications there can be differences in absorption between creams and gels. When it comes to HRT, finding the right delivery system is just as important as finding the right dose.

Optimizing Replacement