Blood vs. saliva - Letters to the Editor - Letter to the Editor

Townsend Letter for Doctors and Patients, Jan, 2004 by Stanford Field

Editor:

What is the Issue?

Many medical doctors question the effectiveness of transdermal steroid hormones such as testosterone and progesterone. They say that these hormones are not appreciably absorbed into the bloodstream from the skin, and therefore, they do not have a significant physiological effect. This argument is based on the fact that when these hormones are used transdermally, they do not significantly raise the "blood" levels of the hormones. This is not only what doctors have been taught, but also what has been reinforced by the pharmaceutical industry which sells high-impact, unnatural (not bio-identical) steroid hormones.

From the doctors' perspective, that is the end of the argument. That is an understandable way to deal with the fact that neither doctors nor anyone else can keep up with the speed of biochemical and medical discoveries. It's really up to the patient to become knowledgeable about his problem and attempt to educate (or give some clues) to the doctor.

In contrast to conventional medicine, a small group of scientists and alternative medicine doctors have been successfully improving the health and slowing the aging of patients by using steroid hormones such as dehydroepiandrosterone, progesterone, testosterone, and the estrogens (estrone, estradiol and estratriol). The dosage of these hormones is adjusted by analyzing the results of saliva tests.

This report has two primary objectives: (1) to determine whether saliva testing or blood testing is more accurate for steroid hormones, and (2) to determine whether transdermal application of steroid hormones does or does not raise blood concentrations of the hormones.

To achieve these objectives it is necessary to know some of the scientific details that support each position.

What are Steroid Hormones?

An endocrine steroid hormone is a chemical substance that is formed in a gland and is carried in the blood to target cells to exert specific physiological effects.

A steroid is any of numerous compounds that are derived from cholesterol. Cholesterol, itself, is derived from acetyl groups (a unit containing two carbon atoms) by a complex enzymatic process. The acetyl groups are formed in the biochemical processing of food into energy.

Although steroid hormones are present in the body in extremely low concentrations (parts per trillion in the blood and saliva), they exert potent physiological effects on sensitive tissues. The steroid hormones act on target cells to regulate gene expression and consequent protein biosynthesis. All steroid hormones are lipophilic (fat-soluble) and most are carried in the aqueous bloodstream bound to carrier proteins which are water-soluble. However, a small amount of steroid hormones are being carried in the aqueous part of the bloodstream not bound to anything. These "free" hormones are available to enter cells.

The "free" steroid hormones can diffuse through the target cell membrane which is made of fat and readily allows the passage to the interior of the cell. The hormone is attracted to high-affinity steroid receptor proteins. The hormone-receptor complex is then translocated into the nucleus of the cell which contains the genetic information. A particular genetic process is initiated in which specific proteins are synthesized. Those proteins go on to exert physiological effects that are then attributed to the steroid hormone.

Blood

Since this report is concerned with blood analysis, it is important to understand the general composition and characteristics of blood. Blood is a fluid consisting of red and white cells suspended in an aqueous plasma. The cells make up about 45% of the mixture (called the hematocrit) and the watery plasma is about 55% of the mixture. The majority of cells in the blood are red blood cells (erythrocytes). The most important constituent of the red blood cell is hemoglobin whose main function is to transport oxygen from the lungs to the somatic (body) cells.

The other cells in blood are white blood cells (leukocytes) that include platelets. The white blood cells are nearly twice the size of red blood cells and are concerned with immunity. For example, the white cells can engulf bacteria and foreign particles in a process called "phagocytosis."

The platelets function to control bleeding after an injury. The platelets liberate serotonin when the blood vessels are damaged. This causes small blood vessels (capillaries) to strongly contract, which reduces bleeding.

The blood also contains fibrinogen and other factors that cause blood to clot. The fibrinogen is a soluble protein precursor of fibrin which is an insoluble protein that forms the main part of a blood clot. Incidentally, a developing therapy uses enzymes to dissolve fibrin while the damaged area is being reconstructed.

Another interesting aspect of blood is how much glucose (sugar) it contains. A normal blood glucose reading of 90 mg/dl translates to about 5 grams in the whole bloodstream throughout the body. When a soft drink or morning cereal containing 30-40 grams of sugar comes down the hatch, it overwhelms the balance and stability of the glucose being supplied to all the cells of the body. The pancreas quickly secretes insulin to drive down the glucose, and a wild, unbalanced cycling occurs. This hyper-dose of sugar affects smaller bodies (young children) in ways that create Attention-Deficit-Hyperactivity-Disorder (ADHD). It is commonly treated, not by removing the source of sugar, but by drugging the child with amphetamines (Ritalin).