What You Need to Know About Hormone Testing: Which Test to Get and Why

You know you need to pay more attention to your adrenal health and hormone levels, but which test is a good test? Blood levels or saliva? Here are my suggestions for the bests tests.

What Hormones Do We Want To Check Levels Of?

The health and fitness world has been abuzz with talk about adrenal health and hormonal balance. This has left many of us looking for ways to get our hormones and adrenal levels checked out so we can address any issues that might be standing in the way of our goals. Great idea! In fact, I love this idea and offer the service to my online clients as well as my medical patients.

Many of you are probably looking for quick, easy, and affordable ways to get these levels checked out too. I want to make sure you spend your money wisely and get accurate results. So, we’re going to talk about the best methods of evaluation to check adrenal hormones (mainly cortisol) and sex hormones like testosterone, estrogen, and progesterone. I’ll recommend some reputable companies, as well.

Blood Testing Or Saliva Testing? It Depends…

Traditionally, lab work refers to checking serum or blood levels. However, there are other methods of evaluating hormone levels such as saliva. There are pros and cons to both of these evaluation methods:

Blood Testing – Blood is inconvenient for many as you need to have a health care provider order the labs for you, you have to go to a location to have the labs drawn, and if insurance doesn’t cover the labs, they can be quite pricey. However, blood analysis is very accurate and tests, as well as testing facilities and labs, are highly regulated. So, with blood levels, you know you are getting reliable results.

Saliva Testing – Saliva or sputum tests can often be ordered by patients themselves or by non-medically licensed individuals. They are more convenient because the tests can be done at home and without scheduling an appointment, and many times the cost is not as high as blood tests. However, sputum and saliva can give you unreliable results.

Multiple studies have shown hormone levels vary significantly when salivary testing is done using cotton and polypropylene collection devices. Cotton collection devices or “rolls” result in elevated estradiol and testosterone levels, while polypropylene rolls result in lower estradiol and testosterone levels. Research has also found that small amounts of blood from the oral mucosa, variance in collection of the samples, and storage of the samples after they are collected can cause irregularities and inaccuracy as well. Furthermore, even if the samples are collected in the most perfect of circumstances, salivary levels of hormones vary so quickly and drastically they cannot be considered accurate. In fact, most insurance companies will not cover the cost of these tests because of these problems.

Now, sputum testing for cortisol is a completely different story. Salivary cortisol measurements have been studied and are considered reliable enough to use to diagnose adrenal diseases like Cushing’s syndrome. Cortisol levels seem to be more stable and have less variance than sex hormones regardless of collection devices and storage. This is fortunate because cortisol levels should be measured at multiple times throughout the day and at night in order to access if a person is producing appropriate amounts at appropriate times throughout the day. Having to send a person to a lab multiple times during a 24-hour period would be incredibly inconvenient. I can attest from personally seeing the results of saliva cortisol tests that they are both reliable and consistent with serum levels and patient symptoms.

hormone testing, adrenal health, cortisol tests, blood tests, saliva testsNow, before anyone gets his or her panties in a bunch I just want to clarify that I don’t just personally hate saliva testing. It would be incredibly convenient and easier for everyone if in fact they were reliable enough to trust for accurate levels. But the research tells us they are not and my personal experience backs that up. I have had many patients bring in saliva tests that didn’t correlate with their symptoms or their history.

When Symptons Don’t Match Test Results

For example, I once had a female patient bring me her saliva hormone results she had recently done through another health care provider. The results indicated her testosterone and estrogen were sky high. This seemed extremely strange to me as she was having hot flashes, low libido, wasn’t sleeping, and was having drastic mood swings. Those symptoms are not consistent with high estrogen or testosterone levels. Also, keep in mind this patient was in her fifties and menopausal. If you aren’t ovulating, you probably aren’t making much estrogen or testosterone. You might be producing some testosterone from your adrenals and some estrogen from fat cells but those levels wouldn’t be clinically high. So, as I always do when seeing a new patient, I got blood work done. As I expected, her estrogen and testosterone were actually very low. I’ve had many other patients with similar issues with saliva tests and I’m sure I’m not the only clinician to experience this.

Obtaining erroneous saliva hormone results not only results in a waste of money for the patient, but it also prevents patients from getting medical care and treatment in a timely manner. Many people may be living with unbalanced hormones unnecessarily because their saliva tests have been incorrect. That’s a big problem.

So, two things to remember:

  1. Saliva for cortisol is great.
  2. Blood levels for hormones like estrogen, testosterone, progesterone, and other sex hormones are your best bet.

What Companies Are Good To Use For Hormone Testing?

I’ve worked with several companies through the years and I can say there are some that are better than others when you are ordering cortisol testing and trying to find someone to order blood work for you. NeuroScience, ZRT Laboratory, and BioHealth Laboratory have four-point cortisol saliva test kits that enable the patient to get an idea of how they produce cortisol throughout the day. The kits are relatively easy to use and ship back to the company. Generally, it’s very easy for a patient to order the tests kits themselves or find a health care provider who can do it for them.

hormone testing, adrenal health, cortisol tests, blood tests, saliva testsFor hormone testing, I recommend either asking your health care provider to order them for you or you can find qualified professionals through numerous websites. WellnessFX and Accesa Labs are both great resources that can set you up with a provider who will order and review your labs with you. Often times you can have the labs drawn at a location convenient to you, which saves you time and money. If you’d rather find a qualified healthcare provider you can see in person who specializes in hormones, BioTE Medical is another great resource.

I hope this cleared a few things up and I also hope it helps many of you get accurate labs results. Proper hormone balance and adrenal health is absolutely vital to your overall health and longevity, not to mention your fitness.


1. American Association of Clinical Endocrinologists (AACE). Medical guidelines for clinical practice for management of menopause. Endocrine Pract. 1999;5:355-366. Accessed February 15, 2002.

2. Cardoso, Estela M. L., Alejandro L. Arregger, Omar R. Tumilasci, and Liliana N. Contreras. 2009. “Diagnostic value of salivary cortisol in Cushing’s syndrome (CS).” Clinical Endocrinology 70, no. 4 (April): 516-21. Accessed July 11, 2013.

3. Celec, Peter, and Daniela Ostatníková 2012. “Saliva collection devices affect sex steroid concentrations.” Clinica Chimica Acta 413, no. 19-20 (October): 1625-28. Accessed July 11, 2013.

4. Flyckt RL, Liu J, Frasure H, Wekselman K, Buch A, et al. (2009) “Comparison of salivary versus serum testosterone levels in postmenopausal women receiving transdermal testosterone supplementation versus placebo.” Menopause 16: 680–688. Accessed July 11, 2013.

5. Granger, D. 2004. “The trouble with salivary testosterone.” Psychoneuroendocrinology 29, no. 10 (November): 1229-40. Accessed July 11, 2013.

6. Gröschl, Michael, Henrik Köhler, Hans-Georg Topf, Thomas Rupprecht, and Manfred Rauh. 2008. “Evaluation of saliva collection devices for the analysis of steroids, peptides and therapeutic drugs.” Journal of Pharmaceutical and Biomedical Analysis 47, no. 3 (July): 478-86. Accessed July 11, 2013.

7. Whembolua, Guy-Lucien S., Douglas A. Granger, Sarany Singer, Katie T. Kivlighan, and Jeffrey A. Marguin. 2006. “Bacteria in the oral mucosa and its effects on the measurement of cortisol, dehydroepiandrosterone, and testosterone in saliva.” Hormones and Behavior 49, no. 4 (April): 478-83. Accessed July 11, 2013.

8. Wood, P. 2009. “Salivary steroid assays – research or routine?Annals of Clinical Biochemistry 46, no. 3 (April): 183-96. Accessed July 11, 2013.

Photos courtesy of Shutterstock.