T Nation

HRT Doctor Visit

 I had my second visit with the HRT doctor today, left very confused.  My test levels have always been in the low 200's, regular doctor always said that "it is within acceptable range".  So I decide to go to to a HRT doctor.  I have the typical symptoms of low test.  I bring in past blood tests that show my low test levels.  He agrees but says he want to do more tests, I think that was reasonable.

 Instead of a blood test, he has me do a saliva test for hormones.  Actually I had to fill 4 separate vials with saliva at 4 different times of the day and mail the kit in.  He also had me do a blood test for thyroid function.  Here are the results:

Free Testosterone 97; 40-70 pg/ml range (way high) (How is this possible?)
Estrone 30; 30-58 pg/ml range (within barely)
Estradiol 4; 1-3 pg/ml range (high)
Estriol 11; 5-40 pg/ml range
Progesterone 119; 5-95 pg/ml range

Free Cortisol Rhythm
6a-8a 14; 13-24 nM
11a-1p 6; 5-10 nM
4p-5p 3; 3-8 nM
10p-12 4; 1-4 nM
Cortisol Load: 27; 23-42 nM

DHEA 18; 3-10 ng/ml range (He was concerned that this was so high.)

Free T4 1.23 ng/dL .82-1.77 range
Free T3 3.2 pg/mL 2.0-4.4 range
TSH 1.380 .450-4.5 range

Now I have never heard of the saliva tests.  How is it that all my blood tests show my test levels in the low 200's, but my Free Test on the saliva test is elevated and high.  The doctor said he prefers the saliva tests because blood tests show levels while the blood is in transit from one place to another.  And that the saliva test shows levels in the tissues.  This was his explanation as to the discrepancies in my test levels between the blood test and saliva test.

I am wondering now if I chose the wrong doctor.  He said that if hormone replacement was necessary, he uses plant based hormones.  And after this second visit, he seems to lean towards the homeopathic side of medicine.  He was suggesting that I buy a couple of "natural" supplement from a website associated with the doctor's group he is with.

But back to the test results, what do you guys think?


I would not waste you money on saliva because it has shown to be in accurate in all hormones except cortisol.
First of all any Dr that has to use saliva (not covered by insurance) and not medically accepted should not be practicing HRT in the first place. This guy sounds like a scam artist and crack pot.

Just the idea of selling supplements from a particular website is huge red flag what his true motives are. We are very open in recommending supplements but will give the patient where to find them for best brand and quality at different places. Please dump this guy like a bad habit. You are going down a road of false promises and hope with no medical backing..NOT GOOD. If you need a good dr in your area tell us where and be glad to make recommendation. You are basically being taken to the cleaners..


most alternatives docs that I respect and follow believe that saliva tests are only good for Cortisol testing. All other saliva tests are dubious (according to them).

I would recommend getting a third opinion if possible with some additional blood tests to confirm or refute the saliva tests (per the blood test sticky).

your cortisol looks low and indicates a problem.

your FT3 is slightly low as well. nothing huge, but below ideal levels.

what are your body temperatures at waking and at 9am, 1pm, 5pm?

what about D25-OH, ferritin, B12, etc.?

plant-based hormones like what? progesterone? I personally find it hard to believe in homeopathic medicine, and I run as fast as I can from anyone who pushes their own "natural" supplements - or who requires office visits for injections.

Vitamins/Minerals are a good idea in general, but herbal supplements are a crap shoot. you have no way to know how your system will react, and there are too many other variables to deal with already without throwing in yet another uncontrollable element.


Yeah, that is what I thought. I am in the Cincinnati area, so if you know of a good doc please let me know. Thanks guys.


Any recommendation in the Cincinnati area would be much appreciated.


I have been researching more doctors in the area. Most claim that they practice "bioidentical hormone replacement." What do you guys think of this? I also found one doc that advertised replacement therapy by placing a hormone pellet under the skin. Ever heard or know of this?


pellet should be a last resort in my opinion.
bioidentical only applies to women's hormones not mens.


We talked about bio-id hormones in your post titled the same. Please read that and remember.

You can get a male panel done at leg.org, on sale now through May.

We need age and lots of other info, read the advice for new guys sticky. Edit info into your opening post in this thread.

DHEA levels change during the day, might have caught a peak.