Hormone supplements and mail order saliva testing

I wrote this an a subtle approach, but in actuality it's fierce slam against testing. The reply resulted in further debate that I attach below the original writ.-dras


I followed hits from a google search for "saliva" and "hormone"; and, putting scientific debate of HRT aside, the whole notion of having one of a dozen common symptoms as just need to send money along with spit in return for a recommendation to take a costly mail order nutritional supplement seems dubious. Especially in the presence of nationally accepted medical standards for diagnosing and treating age related disease (http://www.aace.com).

I quickly put together some summary questions that may need to be answered before many like me will jump on the saliva hormone testing bandwagon.

Is saliva consistently able to provide technically comparable testing results in the presence of changing factors that influence saliva make up? Has the published discussions about these factors been resolved? (Binding affinity for specific protein carriers; saliva flow; use of pharmacologic agents that may displace bound hormones; hormone metabolism by salivary gland epithelial cells or oral bacteria; circadian rhythms; and contamination of the saliva specimen with blood, food, gingival fluid or tissue debris.) If so, are there standardized protocols for measuring hormone levels in saliva?

Has testing sensitivity, specificity, or positive and negative predictive values for salivary hormones when used related to menopause or aging been established?

Are the results of salivary hormone testing an integral part of a clinical pathway to direct patient treatment of conditions related to menopause or aging?

Finally, are there enough clinical or other advantages of salivary hormone testing to justify its use over any established alternative?

Most of the answers will need to come from studies and clinical trials, some with health impact outcome measurements to be influential.

1.	Saliva as a diagnostic fluid. Conference proceedings. Panama City Beach, Florida, October 22-25, 1992. Ann N Y Acad Sci 1993;694:1-348
2.	Lawrence HP. Salivary markers of systemic disease: noninvasive diagnosis of disease and monitoring of general health. J Can Dent Assoc 2002;68(3):170-4
3.	Vining RF, McGinley RA. The measurement of hormones in saliva: possibilities and pitfalls. J Steroid Biochem 1987;27(1-3):81-94

Further response to a proponent of spit testing:
I admit I am not well read on HRT, saliva testing and supplemental hormone or alternative hormone therapy. I glanced over the long list of references you provided. In past study, it seemed I had a much shorter and much more relevant list of references using a MEDLINE online search.

I think it's demonstrated that clinical studies and expert opinion are interpreted and disputed for different arguments. This is the essential process for the advancement of the technology. This process also should take time. Today's "cutting edge" of theory and understanding is often later put aside. It's important to understand what the cumulative knowledge thus far tells us about practical intervention. Accepted clinical pathways are those that offer the most predictable end results.

I do think that basing a need for supplement prescriptions on saliva testing is a high risk for being charlatanism. I don't understand the significance that the NYS approved a lab that does saliva testing. And, the economic benefits for convenience of testing becomes moot if the tests' sensitivity, specificity, or positive and negative predictive values for salivary hormones when used related to menopause or aging have not been established.

In the absence of a high-level dissertation on hormonal interactions within the human body, I will turn to published assessments of the clinical technology from an organized group of leading professional nutritionists. The American Association of Clinical Endocrinologists' (AACE) recently organized Nutrition Guidelines Task Force "consists of endocrinologists who are experts and practitioners in the field of clinical nutrition. More than 50% of their practice is in the area of nutritional medicine, and they are active members of AACE. Each contributor has published in the field of nutrition and is active in one or more of the major nutrition societies in the United States."

"Overall, AACE recommends that only proven therapies (grades A, B, and C in Table 3) be used to treat medical conditions. A patient’s uncertainty may be clarified by helping the patient to understand the different levels of provability and scientific substantiation. Furthermore, the clinical evidence can guide therapeutic recommendations for a specific diagnosis. If the patient becomes argumentative, and simply cannot prioritize scientific substantiation over testimonial data or excessive risk, then the encounter should end."

http://www.aace.com/clin/guidelines/Nutraceuticals2003.pdf