Hormone Testing: When to Use Serum, Saliva, and Urine (Jan 2014) Townsend Letter for Doctors & Patients

From the Townsend Letter
January 2014

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Hormone Testing: When to Use Serum, Saliva, and Urine
by Pushpa Larsen, ND; Michael Kaplan, ND;
Leah Alvarado, ND; and Mi-Jung Lee, ND, LAc

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Notes
1.      Brambilla DJ et al. Intraindividual variation in levels of serum testosterone and other reproductive and adrenal hormones in men. Clin Endocrinol (Oxf). 2007;67:853–862.
2.      Plymate SR et al. Circadian variation in testosterone, sex hormone binding globulin, and calculated non-sex hormone binding globulin bound testosterone in healthy young and elderly men. J Androl. 1989;10:366–371.
3.      Mishra RG et al. Metabolite ligands of estrogen receptor-beta reduce primate hyperreactivity. Am J physiol. 2006;290(1):H295–H303.
4.      Maehle BO et al. Estrogen receptor beta – an independent prognostic marker in estrogen receptor alpha and progesterone receptor-positive breast cancer? APMIS. 2009 Sep;117(9):644–650.
5.      Imanov O et al. Estrogen receptor in health and disease. Biol Reproduct. 2005;73(5):866–871.
6.      Elshafie M et al. Transdermal natural progesterone cream for postmenopausal women: inconsistent data and complex pharmacokinetics. J Obstet Gynecol. 2007. 27(7)655–659.
7.      McGregor JA. et al. Salivary estriol as risk assessment for preterm labor: A prospective trial. Am J Obstet Gynecol. 1995;Oct;173(4):1337–1342.
8.      McGregor JA. et al. Diurnal variation in saliva estriol level during pregnancy: A pilot study. Am J Obstet Gynecol. 1999 Jan;180(1 pt3):S223–S225.
9.      Heine RP et al. Serial salivary estriol to detect an increased risk of preterm birth. Obstet Gynecol. 2000. Oct;96(4):490–497.
10.    Granger DA et al. The "trouble" with salivary testosterone. Psychoneuroendocrinology. 2004 Nov;29(10):1229–1240.
11.    O'Leary P et al. Salivary, but not serum or urinary levels of progesterone are elevated after topical application of progesterone cream to pre- and postmenopausal women. Clin Endocrinol. 2000;53(5):615–620.
12.    Lewis JG et al. Caution on the use of saliva measurements to monitor absorption of progesterone from transdermal creams in postmenopausal women. Maturitas. 2002;41(1):1–6.
13.    Ginsberg ES. et al. Half-life of estradiol in postmenopausal women. Gynecol Obstet Invest. 1998;45(1):45–48.
14.    Hirohata T et al. Urinary growth hormone level and insulin-like growth factor-1 standard deviation score (IGF-SDS) can discriminate adult patients with severe growth hormone deficiency. Endocrine J. 2013;60(3):369–373.
15.    Kovacs J et al. Measurement of urinary melatonin: a useful tool for monitoring serum melatonin after its oral administration. J Clin Endocrinol Metab. 2000;85(2):666–670.
16.    Stanczyk FZ et al. Standardization of steroid hormone assays: Why, how and when? Cancer Epidemiol Biomarkers Prev. 2007 Sep;16(9):1713–1719.
17.    Bradlow HL et al. 2-hydroxyestrone: the ‘good' estrogen. J Endocrinol. 1996 Sep;150 Suppl:S259–S265.
18.    Saeed M et al. Formation of depurinating N3Adenine and N7Guanine adducts by MCF-10F cells cultured in the presence of 4-hydroxyestradiol. Int J Cancer. 2007 Apr 15;120(8):1821–1824.
19.    Fuhrman BJ et al. Estrogen metabolism and the risk of breast cancer in postmenopausal women. J Natl Cancer Inst. 2012 Feb 22;104(4):326–339.
20.    Falk RT et al. Relationship of serum estrogens and estrogen metabolites to postmenopausal breast cancer: a nested case-control study. Breast Cancer Res. 2013 Apr 22;15(2):R34.
21.    Dalessandri KM. et al. Pilot study: Effect of 3,3'-diindolymethane supplements on urinary hormone metabolites in postmenopausal women with a history of early-stage breast cancer. Nutr Cancer. 2004;50(2):161–167.
22.    Anderson et al. Nutrition and epigenetics: an interplay of dietary methyl donors, one-carbon metabolism and DNA methylation. J Nutr Biochem. 2012 Aug;23(8):853–859.
23.    Catechol-O-methyltransferase [Web page]. GeneCards. http://www.genecards.org/cgi-bin/carddisp.pl?gene=COMT&search=COMT.
24.    Tomlinson J et al. 11b-hydroxysteroid dehydrogenase type 1: A tissue specific regulator of glucocorticoid response. Endocr Rev. 2004;25(5);831–866.
25.    Jerjes WK, Taylor NF, Peters TJ, Wessely S, Cleare AJ. Urinary cortisol and cortisol metabolite excretion in chronic fatigue syndrome. Psychosom Med. 2006;68(4):578–582.
26.    Lotinun S et al. Tissue selective effects of continuous release of 2-hydroxyestrone and 16alpha-hydroxyestrone on bone, uterus and mammary gland in ovariectomized growing rats. J Endocrinol. 2001;170(1):165–174.
27.    Vassiliadi D et al. Increased 5 alpha-reductase activity and adrenocortical drive in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2009;94(9):3558–3566.
28.    Baisier WV et al. Thyroid insufficiency. Is TSH measurement the only diagnostic tool? J Nutr Environ Med. 2000;10:105–113.
29.    Hoshiro M et al. Comprehensive study of urinary cortisol metabolites in hyperthyroid and hypothyroid patients. Clin Endocrinol. 2006;64(1):37–45.
30.    Taniyama M et al. Urinary cortisol metabolites in the assessment of peripheral thyroid hormone action: application for diagnosis of resistance to thyroid hormone. Thyroid. 1993;3(3):229–233.

Pushpa Larsen, ND, graduated from Bastyr University in naturopathic medicine, naturopathic midwifery, and spirituality, health and medicine. She is a regular contributor to naturopathic and integrative-medicine publications and a sought-after speaker for continuing-education seminars. Dr. Larsen has written and presented webinars on many topics in laboratory medicine. She consults with hundreds of doctors every year on the use and interpretation of hormone profiles, blood viscosity, and other tests offered by Meridian Valley Lab. plarsen@meridianvalleylab.com.

Michael Kaplan, ND, is a naturopathic physician specializing in men's health. He divides his time between his private practice at the Tahoma Clinic North Seattle and Meridian Valley Lab, where he trains physicians on the safe and effective use of bioidentical hormone replacement.

Leah Alvarado, ND, completed her undergrad degree in molecular and cellular biology at Texas A&M University and received her doctorate in naturopathic medicine from Bastyr University. She is a senior consulting physician for Meridian Valley Lab, teaching other doctors to interpret labs and prescribe hormones. She has coauthored three publications on hormone replacement therapy and food allergies.

Mi-Jung Lee, ND, LAc, has a doctorate in naturopathic medicine and degree in Chinese medicine and acupuncture. She is a consulting physician at Meridian Valley Lab and has trained extensively in the use and monitoring of bioidentical hormone replacement therapy. Dr. Lee is also skilled in mesotherapy, a minimally invasive anti-aging therapy from Europe. She practices at the Tahoma Clinic in Redmond, Washington.

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