“Hot flashes? Just spit right here, ma'am.”

Most people expect to pee in a cup when they visit their doctor ... but spit in a cup?

Most people expect to pee in a cup when they visit their doctor ... but spit in a cup?

A few years ago, it was alternative practitioners who originally popularized salivary testing as a way to measure hormone levels and determine dosage of compounded menopausal hormone therapy. The practice finally started to fall out of favor over the last year or so when public awareness increased that saliva was not a valid way to individualize hormone therapy.  I thought I was through explaining to patients that the hundreds and sometimes thousands of dollars they had spent on saliva analysis was essentially worthless, and then just today, not one but two new patients presented me with   pages of saliva testing results as an integral part of their medical record.  So what’s going on?

It all started when the late Dr. John Lee promoted the idea of salivary hormone testing in his best seller, Hormone Balance Made Simple.  His current website states, “Knowing your saliva hormone levels is an important first step in assessing where your hormones may be out of balance … research indicates that the most accurate way to do so is through saliva.” To his credit, the very small print at the bottom of the page does acknowledge that his home hormone testing products (sold for the low, low price of  $265)  “are not offered for the diagnosis, cure, mitigation, treatment, or prevention of any disease or disorder nor have any statements herein been evaluated by the Food and Drug Administration (FDA).”

Now, no one argues that estrogen and progesterone levels are detectable in saliva, and it would be great if a drop of spit could actually unravel the mysteries of menopause.   Unfortunately, despite the fact that there are still many practitioners eager to take your saliva and your money, salivary hormone levels have not been proven useful in any scientific studies in determining the necessity for, or the appropriate dosage for hormone replacement.

Theoretically, it makes sense that the saliva (which is filtered from the blood) would be a good way to measure hormone levels but there is absolutely no scientific evidence that saliva levels correlate to blood levels or response in treatment. Furthermore, salivary hormone levels vary depending on diet, time of day of testing, and many other variables.  

The American College of Obstetrics and Gynecology issued a bulletin in 2005 stating that hormone levels in saliva are not biologically meaningful and are not recommended. In addition, hormone therapy does not belong to a class of drugs in which there is a narrow known window for what is needed.  A specific hormone level may provide one woman total relief of symptoms. Another women might need a higher level to get the same effect. Using saliva to test hormone levels (not to mention repeating the test at regular intervals to see if hormone replacement is “working”) is often just another example of profit motivated entrepreneurs taking advantage of vulnerable women who are only trying to take hormones in a safe, responsible way.


The best indicator that you are taking enough estrogen is how you feel.  The fact that you no longer have hot flashes, vaginal dryness, mood swings or insomnia and can remember why you walked into a room is a better indication that you are taking the right amount of estrogen than any laboratory test. If you are taking standard levels of hormone replacement yet continue to have symptoms, a blood test is sometimes helpful to see if your symptoms are from lack of estrogen or something else. Save your money and your saliva.

For more information, visit The North American Menopause Society or The American College of Obstetricians and Gynecologists.

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