Salivary Testosterone: Relationship to Unbound Plasma Testosterone in Normal and Hyperandrogenic Women

Abstract

A sensitive radioimmunoassay (RIA) was used to measure salivary testosterone levels in normal women, in patients with polycystic ovaries (PCO), and in women with hirsutism. There was a highly significant correlation (r = 0.79, P less than 0.001) between the concentration of testosterone in saliva [12.3 +/- 7.8 (SD) pg/ml] and the concentration of unbound testosterone in plasma (5.2 +/- 3.1 pg/ml) in matched samples collected from 56 women including normals, patients with clinical signs of hyperandrogenism, and women treated with a combination of cyproterone acetate (CA) and ethinyl oestradiol (EE). The unbound plasma testosterone was measured in the dialysate directly using a sensitive RIA. Salivary and plasma testosterone levels in patients with PCO (20.6 +/- 8.5 and 626 +/- 187 pg/ml respectively, n = 14) and in those with hirsutism (13.9 +/- 5.6 and 421 +/- 170 pg/ml, n = 30) were significantly higher (P less than 0.001) than levels in normal women (7.7 +/- 2.6 and 196 +/- 68 pg/ml, n = 36). Treatment for 3 months with CA and EE resulted in a decrease (mean 68%) in salivary testosterone levels in all patients studied (n = 15), but the suppression of plasma testosterone (mean 34%) was not observed in all cases. It is concluded that measurement of salivary testosterone gives a useful indication of levels of biologically available androgen in hyperandrogenic women, before and during CA/EE therapy.

Further Evidence for the Usefulness of the Salivary Testosterone Radioimmunoassay in the Assessment of Androgenicity in Man in Basal and Stimulated Conditions

“…However, higher [12,13] and lower [3,6] concentra tions have been reported. The mean level of T in female saliva was close to values pub lished previously [4,5], but higher levels [12,13] were also reported. The concentration of T in saliva and the calculated percent 'free' T index in the present study are quite close to the published estimation of free T in plasma [8], As a close correlation between salivary T and plasma-free T levels was reported in other studies [3,4,6,7], salivary T clearly seems to provide a reliable index of the con centration of free, unbound T in plasma.…”

“…Recent reports [3][4][5][6][7] indicate a good cor relation in both sexes between testosterone (T) in saliva and 'free' T concentrations in plasma, a finding of important clinical signif icance as it is now accepted that the free T fraction is associated with biological activity. Indeed, the metabolic clearance rate of T was shown to correlate with the levels of nonpro tein-bound T [8], Moreover, this small un bound fraction (1-4% of the total concentra tion) generally correlated more closely with the clinical suspicions of hypo-or hyperandrogenicity than do the total T levels as mea sured by plasma R1A [4,6,7], Concentra tions of T in saliva samples seem to be inde pendent of the flow rate of saliva, provided that limited volumes (3-5 ml) are collected [1,9], However, conflicting estimates of the true value of T concentration in saliva are reported in the literature [1,7],…”

The Diagnostic Applications of Saliva— A Review

“…By a direct radioimmunoassay technique, a high correlation between salivary and serum-free testosterone concentration (r = 0.97) and salivary and serum total testosterone concentration (r = 0.7-0.87) was reported (Vittek et al ., 1985). A significant correlation (r = 0.79) between the concentration of unbound salivary and serum testosterone was observed when hormone levels in normal and hyperandrogenic women were evaluated (Baxendale et al ., 1982). Monitoring salivary testosterone levels may also be useful in behavioral studies of aggression, depression, abuse, and violent and antisocial behavior (Dabbs, 1993;Granger et al ., 1999).…”

The Effect of Pretreatment of Saliva on Steroid Hormone Concentrations

“…Concentrations (mean ± SEM) of steroids in whole saliva and supernatant saliva: n = number of subjects, r = correlation (Pearson) between individual steroid levels in whole saliva and supernatant saliva assay, * = p < 0.0001. 4. Relative difference between whole saliva and supernatant saliva (mean ± SEM): n = number of subjects, P = probability of Wilcoxon signed rank test, ns = not significant.…”