Scroll Top

Saliva Hormone Testing & Unintentional Exposure to Bioidentical Hormones

Saliva Hormone Testing & Unintentional Exposure to Bioidentical Hormones
Best DiagnosTechs Test Panels that screen for unintentional exposure to bioidentical hormones and monitor optimal BHRT dosing
By Med Support News October 5, 2025

Best DiagnosTechs Test Panels that screen for unintentional exposure to bioidentical hormones and monitor optimal BHRT dosing Unintentional Exposure to Bioidentical Hormones

~ A Public Health Concern ~

You just received the results of an Expanded Post Menopause Hormone Panel for your patient on bioidentical hormone therapy (BHRT), and the saliva hormone levels are highly elevated. The levels are so high, they are supraphysiologically elevated, and you suddenly feel panic as questions race through your mind.

How is it possible that the results are this high when her hormone levels were low a few months ago, and I prescribed reasonable doses of bioidentical hormones? Does my patient have a hormone-secreting tumor? Will she think I prescribed doses that were too high? Are these test results accurate?

What do I do now?

Unintentional Exposure to Bioidentical Hormones ~ A Public Health Concern Test Best Saliva Male Female Testing

Extremely elevated saliva hormone levels can be frustrating. It is understandable and normal to question the accuracy of supraphysiologic test results that do not align with the clinical presentation. Despite being frustrating, these unusual test results are truly one of the benefits of saliva hormone testing. Please continue reading to learn more!

Best DiagnosTechs Test Panels that screen for unintentional exposure to bioidentical hormones and monitor optimal BHRT dosing Extremely High Saliva Hormone Levels?

When a saliva hormone level is exceptionally elevated, recent intentional or unintentional exposure to the hormone must be considered and ruled out.

Research shows that saliva and serum hormone levels correlate well with endogenous hormone production. However, the topical application of bioidentical hormones leads to significant differences. Pharmacokinetic studies of topically applied bioidentical hormones show that serum hormone and urine metabolite levels increase minimally after topical administration. Saliva levels, though, significantly increase and exceed serum levels by as much as 100-fold.1

In our laboratory, saliva hormone levels may exceed 100,000 pg/ml at times. Please note that saliva hormone levels will never exceed 100,000 pg/ml due to endogenous production. Therefore, when the saliva hormone level is supraphysiologically elevated, you and your patient may remain calm and put on your detective hats to determine the source of the bioidentical hormones. Recent cutaneous exposure, environmental contamination, and direct saliva sample contamination can contribute to concerningly high test results.

Best DiagnosTechs Test Panels that screen for unintentional exposure to bioidentical hormones and monitor optimal BHRT dosing Patients Unknowingly Exposed to Estrogens and Other Bioidentical Hormones

Unfortunately, undisclosed or “hidden” hormones are present in some personal care products (PCPs). PCPs include cosmetics, hair care products, moisturizers, lotions, lip balms, serums, sunscreen, and more.

Despite not being listed as ingredients, bioidentical hormones are in some PCPs. Manufacturers and raw material suppliers should not add ingredients to products without disclosing them; however, it does occur, according to research and our internal data.

A group of oncologists published a study about this common phenomenon in the Journal of Clinical Oncology in 2009. The oncologists purchased “youth-enhancing” PCPs and sent them to a laboratory for analysis. The test results confirmed the presence of bioidentical estrogens in several commercially available skin moisturizers. They published the details in the article ~ Breast cancer patients unknowingly dosing themselves with estrogen by using topical moisturizers.2

Best DiagnosTechs Test Panels that screen for unintentional exposure to bioidentical hormones and monitor optimal BHRT dosing Progesterone, androgens, and other bioidentical steroid hormones may also be present in PCPs. Bioidentical progesterone can be added to general, daily moisturizers. Progesterone is primarily viewed as a safe, protective, and balancing hormone. However, some researchers speculate that progesterone is an underlying cause of breast cancer; therefore, avoiding unintentional exposure could be preventive.3,4

Many over the counter (OTC) lip balms, nasal sprays, eardrops, and eyedrops contain steroids. Hydrocortisone and corticosteroids are often listed as ingredients in these products, but patients may overlook the fact that they contain hormones, which can lead to skewed test results.

Best DiagnosTechs Test Panels that screen for unintentional exposure to bioidentical hormones and monitor optimal BHRT dosing Saliva Testing Screens for Unintentional Exposure to Bioidentical Hormones

Saliva hormone testing is the only option to screen for unintentional percutaneous exposure to bioidentical hormones. Hormones applied to the skin are robustly present in the saliva but minimally diffuse into the blood. As noted in a study by O’Leary et al., the saliva, but not serum, progesterone level significantly increases after application to the skin.5

Since bioidentical hormones are in some personal care products and can contaminate the environment of those using BHRT, saliva hormone testing is the only clinically indicated option to uncover and eliminate these potentially hazardous hormone exposures.6

Best DiagnosTechs Test Panels that screen for unintentional exposure to bioidentical hormones and monitor optimal BHRT dosing Research shows the use of hair care products during childhood is significantly associated with the earlier onset of menstrual periods (menarche), and the frequent use of certain hair care products by adults is associated with an increased risk of developing ovarian cancer.7,8 Are the deleterious effects of hair care products due to the presence of undisclosed bioidentical hormones? Saliva testing could provide more insight!

Screening for exposure to exogenous bioidentical hormones is most important for all patients with a personal or family history of hormone-sensitive cancers, including ovarian cancer, uterine cancer, prostate cancer, and breast cancer. Screening for unintentional exposure to bioidentical hormones is also essential for anyone with children or pets in the home, as it helps prevent their exposure to these hormones.

Best DiagnosTechs Test Panels that screen for unintentional exposure to bioidentical hormones and monitor optimal BHRT dosing Determine the Source of the Bioidentical Hormones

After receiving elevated saliva hormone test results, the next step is to determine the source or sources of the bioidentical hormones. As noted above, research shows that saliva hormone levels exceed serum levels by as much as 100-fold for several hours after bioidentical hormones are applied to the skin.1 Therefore, when saliva hormone levels are unexpectedly elevated, consider asking these questions to determine the source of the exposure:

  • Did the patient avoid bioidentical hormones the day before and the day of saliva collection, as recommended in the collection instructions?
  • Did the patient touch a bottle or vial of bioidentical hormones, leading to exposure?
  • Does the patient apply their BHRT while wearing gloves to prevent surface contamination in their environment?
    • If so, did they dispose of the gloves cautiously without touching the sink or other surfaces?
    • If not, what surfaces did the patient touch with their contaminated hand after applying BHRT?
      • Did they touch the sink, a hand towel, a doorknob, a drawer, a light switch, or something else?
        • If so, the environment is contaminated with bioidentical hormones, which can lead to unintentional exposure and direct contamination of the saliva sample. When product residue remains on the skin, fingers, face, or lips, it is more likely to get into the vial.
  • Is someone else in the home or family using bioidentical hormones?
  • Does the patient or someone in their household use personal care products (PCPs), such as cosmetics, hair care, creams, lotions, moisturizers, balms, serums, or anti-aging blends?
    • PCPs can contain undisclosed bioidentical hormones, leading to environmental contamination and exposure.
    • Is someone visiting the home and using PCPs?
    • Did the patient begin using a new PCP?
  • Did the patient apply any essential oils?
  • Did the patient use any OTC medications, such as nasal sprays, lip balms, ear drops, eye drops, or creams?
  • Where was the saliva collected, and is that environment contaminated?
  • Did the exposure occur outside the home? At the gym or work?
  • Could anyone else, including pets or children, be exposed to bioidentical hormones?
    • If so, order a non-invasive saliva hormone panel for all family members to screen for unintentional exposure to bioidentical hormones.

Best DiagnosTechs Test Panels that screen for unintentional exposure to bioidentical hormones and monitor optimal BHRT dosing Saliva Hormone Testing – The Only Option for Monitoring BHRT Creams

While serum hormone levels do not significantly increase after applying bioidentical hormones to the skin, research confirms that topically applied hormones do affect hormone-sensitive tissues. A clinical trial conducted by Leonetti et al. demonstrated that topically applied progesterone has a significant impact on internal hormone-sensitive tissues.9

Several additional published observations show a therapeutic effect of transdermal progesterone on the endometrium in the uterus despite very low serum and plasma progesterone levels. These published observations confirm that bioidentical hormones are distributed to hormone-sensitive tissues when applied to the skin, likely via lymphatic transport.1,10,11

Since topically applied hormones can affect hormone-sensitive tissues without reliably increasing blood hormone levels, only saliva hormone testing can provide insight into the tissue exposure to bioidentical hormones following topical hormone application. Understanding the pharmacokinetics is critical when monitoring BHRT dosing.1,9-11

Best DiagnosTechs Test Panels that screen for unintentional exposure to bioidentical hormones and monitor optimal BHRT dosing free hormone levels Exposure to Endocrine Disruptors & Xeno-Estrogens

Please note that our saliva steroid hormone assays precisely test the levels of bioidentical hormones. Therefore, our steroid hormone tests do not screen for or diagnose exposures to endocrine-disrupting xenoestrogens, such as organochlorine pesticides, dichlorodiphenyltrichloroethane (DDT), bisphenol A (BPA), bisphenol S (BPS), phthalates, polychlorinated biphenyls (PCBs), and parabens.12,13

Best DiagnosTechs Test Panels that screen for unintentional exposure to bioidentical hormones and monitor optimal BHRT dosing Accurately Test Free Hormone Levels in Saliva

When a patient’s test results show an exceptionally elevated hormone level, consider asking them to carefully avoid exposure to all exogenous steroid hormones, and then repeat the test.

Suggestions to confidently avoid unintentional exposure to bioidentical hormones before saliva hormone testing:

  • One to two days before saliva collection:
    • Wipe down surfaces in the environment to remove bioidentical hormones.
    • Launder bed linens and hand towels.
  • The day before and the day of saliva collection:
    • Avoid exposure to all bioidentical hormones, including OTC products.
    • Discontinue the use of personal care products (PCPs), including lip balm, cosmetics, and sunscreen.
    • Avoid the use of essential oils.
    • Avoid exposure to other household members who use BHRT or suspicious PCPs.

Once unintentional exposures and direct saliva sample contamination are eliminated, test results will accurately reflect the circulating free hormone levels.

If you or your patient are overwhelmed by an exceptionally high saliva hormone level, you could consider testing the total hormone level in the serum while awaiting the results of the repeat saliva testing. When the saliva level is elevated due to endogenous production, the total hormone level in the serum will also be elevated. A normal or low serum level will confirm the high saliva hormone level was likely caused by exposure to exogenous hormones.

Best DiagnosTechs Test Panels that screen for unintentional exposure to bioidentical hormones and monitor optimal BHRT dosing Follow-Up Appointment – The Sources of the Bioidentical Hormones

Per patient report, she began using three new anti-aging products: an eye cream, a daytime moisturizer, and a nighttime serum. She applied the products and her BHRT with bare hands; therefore, hormone-containing residue contaminated many surfaces in her home. Applying the anti-aging serum at bedtime led to the contamination of the lamp by her bed and her pillow. The significant environmental contamination caused regular, unintentional exposures and the direct contamination of the saliva sample with bioidentical hormones. Her small dog had also started losing fur due to the bioidentical hormones on her hands and in the home.

Best Test for Free Circulating Hormone Levels in Saliva

Additional Resources

Please review the ‘Hormones in Cosmetics and Personal Care Products‘ and ‘Interactions with Testing – FAQ for Providers‘ resources on the Provider Tools page in your Provider Portal for more information. Consider ordering saliva hormone testing for all patients to screen for potential exposures.

Best DiagnosTechs Test Panels that screen for unintentional exposure to bioidentical hormones and monitor optimal BHRT dosing

Test Your Patients for Unintentional Exposure to Bioidentical Hormones with the Best Saliva Panels

DiagnosTechs was the first laboratory to introduce saliva hormone testing into routine clinical practice over 35 years ago and is known worldwide for saliva hormone testing.

Order these DiagnosTechs Test Panels to screen for unintentional exposure to bioidentical hormones and monitor for optimal BHRT dosing:

To place a test order, click here. DiagnosTechs will drop ship test kits directly to your patients. You may select this option at the top of the order form.

Please visit our Provider Tools page for more information on selecting the appropriate test, interpreting test results, and available treatment options.

Best DiagnosTechs Test Panels that screen for unintentional exposure to bioidentical hormones and monitor optimal BHRT dosing References:

  1. Du JY, Sanchez P, Kim L, et al. Percutaneous progesterone delivery via cream or gel application in postmenopausal women: a randomized cross-over study of progesterone levels in serum, whole blood, saliva, and capillary blood. Menopause. 2013;20(11):1169-1175. doi:10.1097/GME.0b013e31828d39a2
  2. Olson AC, Link JS, Waisman JR, et al. Breast cancer patients unknowingly dosing themselves with estrogen by using topical moisturizers. J Clin Oncol. 2009;27(26):e103-e104. doi:10.1200/JCO.2009.23.1225
  3. Coelingh Bennink HJT, Stanczyk FZ. Progesterone and not estrogens or androgens causes breast cancer. Climacteric. 2024;27(2):217-222. doi:10.1080/13697137.2023.2292073
  4. Coelingh Bennink HJT, Schultz IJ, Schmidt M, et al. Progesterone from ovulatory menstrual cycles is an important cause of breast cancer. Breast Cancer Res. 2023;25(1):60. doi:10.1186/s13058-023-01661-0
  5. O’Leary P, Feddema P, Chan K, 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 (Oxf). 2000;53(5):615-620. doi:10.1046/j.1365-2265.2000.01130.x
  6. Hidden hormones in personal care products. DiagnosTechs, Inc. April 23, 2025. Accessed June 11, 2025. https://www.diagnostechs.com/2022/09/14/hidden-hormones-in-personal-care-products/.
  7. James-Todd T, Terry MB, Rich-Edwards J, et al. Childhood hair product use and earlier age at menarche in a racially diverse study population: a pilot study. Ann Epidemiol. 2011;21(6):461-465. doi:10.1016/j.annepidem.2011.01.009
  8. White AJ, Sandler DP, Gaston SA, et al. Use of hair products in relation to ovarian cancer risk. Carcinogenesis. 2021;42(9):1189-1195. doi:10.1093/carcin/bgab056
  9. Leonetti HB, Wilson KJ, Anasti JN. Topical progesterone cream has an antiproliferative effect on estrogen-stimulated endometrium. Fertil Steril. 2003;79(1):221-222. doi:10.1016/s0015-0282(02)04542-9
  10. Stanczyk FZ. Treatment of postmenopausal women with topical progesterone creams and gels: are they effective?. Climacteric. 2014;17 Suppl 2:8-11. doi:10.3109/13697137.2014.944496
  11. Zava DT, Groves MN, Stanczyk FZ. Percutaneous absorption of progesterone. Maturitas. 2014;77(2):91-92. doi:10.1016/j.maturitas.2013.10.006
  12. Reddy V, McCarthy M, Raval AP. Xenoestrogens impact brain estrogen receptor signaling during the female lifespan: A precursor to neurological disease?. Neurobiol Dis. 2022;163:105596.
  13. Konduracka E, Krzemieniecki K, Gajos G. Relationship between everyday use cosmetics and female breast cancer. Pol Arch Med Wewn. 2014;12