Salivary Hormone Testing

Transcription

1 ChiroCredit.com/OnlineCE.com Presents: Intro To Hormones 102 Salivary Hormone Testing Part 1 - Testing by Ronald Steriti, ND, PhD 2008

2 Salivary Hormones Free steroids enter the salivary gland and duct by passive diffusion in the same way as they enter other tissues of the body. Saliva provides a convenient diagnostic fluid from which to noninvasively monitor the bioavailable fraction of steroid hormones circulating in the bloodstream and entering tissues.

3 Convenient At-Home Testing Saliva is much easier to collect than blood or serum It requires no specialized equipment, expertise, or trained staff to collect It can be done at-home by the patient, quickly and easily It s great for those afraid of needles!

4 Salivary Hormone Levels When steroid hormones are produced endogenously or taken orally, the salivary levels generally range from about 1-5% of that found in serum. When steroid hormones are delivered topically through the skin, the salivary hormones levels often rise dramatically.

5 Advantages of Saliva Testing Saliva testing is easy and simple, and saliva can be collected any place or time of day Steroid hormones are exceptionally stable in saliva, allowing for convenient collection and shipment at room temperature by inexpensive couriers. Salivary test kits usually come in a preaddressed mailer

6 Disadvantages of Saliva Testing Analyzing saliva is more technically challenging than serum testing of steroids. Salivary hormone levels are much lower than that of blood: 10-20x more sensitivity is needed Most physicians are unfamiliar with salivary hormone testing

7 Results Reporting Unlike conventional labs, results are typically mailed directly to the patient, usually with a copy sent to the physician Some companies follow the medical model, which requires a prescription for the lab, and the results are mailed only to the physician

8 Interpretation Salivary hormone panels are readily available over the counter by many companies. Although it is possible for people to test themselves, interpretation of hormones is not easy, especially when using over the counter hormone supplements

9 Interfering with Saliva Testing The following can interfere with salivary hormone levels: Foods, beverages such as coffee, and drugs taken just before collecting saliva Sugar in regular chewing gum Some cottons used for saliva collection Small amounts of blood in saliva, since 95-99% of hormones are blood-bound

10 Instructions Before collecting a saliva sample, do not eat or drink, chew gum, take medications, brush or floss your teeth. Do not use a cotton swab for collecting saliva.

11 Topical Steroids Contamination with topical hormone supplements can occur, resulting in falsehigh levels. Those using topical steroids should: Avoid using them on the face and neck the day before collection Wash their hands before collection to avoid contaminating the tube

12 Sublingual Hormones Sublingual hormone use can cause falsehigh results if the hormones have not had ample time to clear the oral cavity. Those taking sublingual hormones should abstain for 36 hours before testing.

13 Proficiency Testing Saliva and serum testing laboratories are governed by CLIA (Clinical Laboratory Improvement Act) However, both saliva and serum testing laboratories use serum, not saliva, for proficiency testing. Therefore, saliva testing labs are not checked for accuracy or reproducability.

14 Salivary Hormones The following hormones can be measured in saliva: All three Estrogens: Estrone (E1), Estradiol (E2), and Estriol (E3) Progesterone and Pregnenolone Testosterone and Dihydrotestosterone (DHT) Cortisol, DHEA and DHEA-S Melatonin

15 Conventional Labs Salivary panels offer more extensive testing than conventional medicine, which is primarily a diagnostic tool. Salivary panels are often used by physicians specializing in natural hormone replacement They are a tool used to design custom formulas, to track progress, and modify the dose and formula when needed.

16 Different Labs & Panels Salivary hormone testing is a relatively new field As such, each company has its own panels, sometimes with similar names There may be differences in: Which hormones are measured How many times they are measured

17 Salivary Hormone Panels There are usually panels for men and women. Menopause panels are typically one-time measurements, while panels for cycling women often measure once a week for a month. Adrenal function tests are often recommended with hormone panels, since adrenal fatigue often accompanies hormone imbalance. The adrenals are a secondary producer of hormones.

18 How Often to Test In post-menopausal women (not taking hormonal supplements), hormonal testing is recommended yearly. During hormonal supplementation, it is recommended to test at least every 6 months. More frequent testing may be appropriate based on presenting symptoms.

19 Hormone Metabolism

20 Hormone Metabolism The sex hormones are formed from cholesterol Cholesterol desmolase is a mitochondrial cytochrome P450, also known as side-chain cleavage enzyme, or P450scc. Most of the enzymes which break down hormones are part of the P450 enzyme system.

21 Pregnenolone Pregnenolone is considered a mother hormone, since it is a precursor molecule for the other sex hormones Progesterone and pregnenolone can form aldosterone, which stimulates renal absorption of sodium and excretion of potassium

22 Pregnenolone and Memory Pregnenolone may be "the most potent memory enhancer yet found," Pregnenolone regulates the storage and recall process of brain cells

23 Progesterone Progesterone induces the cyclic changes in the endometrium that allow implantation of the fertilized ovum. Progesterone is responsible for maintenance of the uterus during pregnancy, suppression of uterine contractions until just prior to parturition and preparation of the breasts for lactation.

24 Progesterone Levels During the luteal phase, the corpus luteum produces progesterone and levels increase sharply for a maximum of 5 to 10 days. If implantation of a fertilized ovum does not occur, a steep decline in these levels is seen at about 4 days prior to the menstrual period.

25 Roles of Progesterone Natural diuretic and anti-depressant Catabolic effect- promotes the burning of fat for energy (thermogenesis) Aids thyroid hormone action Normalizes zinc and copper levels Protects against osteoporosis (controversial) Protects against fibrocystic breasts Helps protect against breast cancer

26 Clinical Indications Secondary amenorrhea to induce withdrawal bleeding Premenopausal abnormal bleeding Female infertility due to insufficient secretion during the luteal phase To reduce uterine activity in premature labor Premenstrual syndrome caused by unopposed estrogen (estrogen dominence) Hot flashes in menopausal women

27 Estrogens Estrogens are secreted by the graffian folicle during the proliferative phase of menstruation. Estrogen prepares the uterus for implantation of the fertilized egg. Estrogens increase libido (estrous behavior, estrus is heat ). Estrogens have an anabolic effect: building muscle and bone, increasing weight

28 Three Types of Estrogen Estrone (E1) is a potent estrogen that increases risk of cancer. Estradiol (E2) is a potent estrogen that increases risk of cancer. Estriol (E3) is a weak estrogen that does not stimulate cell proliferation.

29 Estrogen Ratios The normal estrogen ratio is: E1:E2:E3 = 1:1:8 The estrogen quotient: E > 1 E1+ E2 should be greater than 1

30 Estradiol (E2) Estradiol is the most potent estrogen. In women, estradiol is responsible for growth of the breast and reproductive epithelia, maturation of long bones and development of the secondary sexual characteristics. Estradiol is produced mainly by the ovaries with secondary production by the adrenal glands and conversion of steroid precursors into estrogens in fat tissue.

31 Estradiol Cycle During the early part of the menstrual cycle, estradiol levels remain nearly constant. This is followed by a rapid increase reaching a peak the day before or the day of the Leutinizing Hormone (LH) surge (ovulation). It is generally believed that the rise in estradiol is the factor which triggers LH release. Following ovulation there is a drop in estradiol followed by a second rise, which corresponds with the formation of the corpus luteum.

32 Estradiol and Menopause At menopause, estrogen concentrations in the body fall to low levels. This decrease is often accompanied by vascular instability (hot flashes and night sweats), a rise in incidence of heart disease, and an increasing rate of bone loss (osteoporosis). Estrogen replacement for alleviation of menopausal symptoms or to prophylaxis against heart disease and osteoporosis has become very common.

33 Estrone (E1) Estrone is produced primarily from androstenedione originating from the gonads or the adrenal cortex. Interconversion of estrone and estradiol also occurs in peripheral tissue. Bioassay data indicate that the estrogenic action is much less than estradiol. Estrone is a primary estrogenic component of several pharmaceutical preparations, including those containing conjugated and esterified estrogens.

34 Estrone and Menopause In premenopausal women, more than 50% of the estrone is secreted by the ovaries. In prepubertal children, men and non-supplemented postmenopausal women the major portion of estrone is derived from peripheral tissue conversion of androstenedione. In premenopausal women estrone levels generally parallel those of estradiol. After menopause estrone levels increase, possibly due to increased conversion of androstenedione to estrone.

35 Estriol (E3) Estriol is produced almost exclusively during pregnancy. Estriol has been suggested to be less carcinogenic than estradiol and estrone in animal studies. It has been shown that estriol does not induce endometrial proliferation to the extent of the other estrogens.

36 Estriol and Menopause Topical estriol has also been used for the relief of postmenopausal genital atrophic changes and urinary incontinence.

37 Cycling Female Panels Salivary panels for menstruating women usually include weekly measurements of estradiol, progesterone and testosterone over a 1-month period. Recall that progesterone levels spike before menses (during the luteal phase)

38 Menopause Panels Salivary hormone panels for menopausal women typically measure all 3 estrogens (estrone, estradiol, estriol), progesterone and testosterone. Samples may be either a 1-shot, or several samples over 3-5 days.

39 Tryptophan Tryptophan is the precursor to serotonin, melatonin and niacin Tryptophan is needed for proper brain function Requirements: RDA mg qd Sources: cottage cheese, beef liver, peanuts, turkey, tuna Tryptophan may be useful in PMS, and for migraines

40 Tryptophan Metabolism

41 5-HTP 5-HTP is formed from tryptophan 5-HTP forms serotonin and melatonin with the cofactor vitamin B6 L-Tryptophan is not available over the counter, although it is not specifically a controlled substance

42 Vitamin B6 Vitamin B6 (Pyridoxine) a cofactor for conversion of 5-HTP into Serotonin Vitamin B6 is useful for PMS, depression and insomnia

43 Melatonin Melatonin is produced by pinealocytes in the pineal gland and also by the retina, lens and GI tract. It is naturally synthesized from the amino acid tryptophan (via synthesis of serotonin) by the enzyme 5-hydroxyindole-Omethyltransferase.

44 Melatonin Melatonin levels are high at night where it facilitates deep sleep Production of melatonin by the pineal gland is inhibited by light and permitted by darkness. Melatonin may be measured in saliva, usually four times daily to assess its diurnal rhythm

45 Antioxidant Melatonin is a powerful antioxidant Melatonin, on the other hand, once oxidized, cannot be reduced to its former state because it forms several stable endproducts upon reacting with free radicals. Therefore, it has been referred to as a terminal (or suicidal) antioxidant