Practical Advantages:Convenience
This panel requires 11 saliva samples that are collected at the patient's convenience. Patient samples are collected and mailed to the laboratory without involving clinic staff and with no biohazard risks; no blood, no mess. The test also avoids the inconvenience of women performing a 24 hour urine collection in a gallon sized container.

Economical
This eleven sample profile of estradiol and progesterone plus cycle averages of testosterone and DHEA costs less than 2 estradiol and progesterone blood tests, or a single steroid urine analysis.

Scientific Advantages:Correlation with Free Bioactive Fraction in Blood. The general consensus is that the unbound or free fraction of steroid hormones exerts the biological influence on tissue. The bioactive fraction accounts for most of the extravascular hormones in the tissue space (4). Recent work indicates that salivary estradiol, progesterone, DHEA and testosterone levels correlate well with their respective serum free fractions (5, 6, 16, 17).

Superior to Serum Progesterone & Body Temperature Records
In a study comparing saliva progesterone values to body temperature records and serum progesterone over 3 consecutive menstrual cycles in 41 women, the conclusion was: "Basal body temperature records or mid luteal serum progesterone measurements were less satisfactory indices of luteal function than a salivary progesterone profile." Finn, M.M., et al. Gynecol. Endocrinology 3:297-308 (1989).

Ovarian Output & Reserve Estimation
Since the output of both progesterone and estrogens varies with the day of the cycle, the single serum or urine samples preclude the ability to estimate ovarian cycle output and reserves. The FHP™ hormone mapping includes ovarian output and reserve estimates.

Clinical Applications
The FHP™ has broad clinical applications that include:

Luteal Phase Defects (LPD) & PMS
The term LPD describes abnormalities in the luteal phase of the female cycle which includes defects in hormone concentrations and balance. Luteal phase defects are common and affect between 8% (7) and 35% (8) of patients, depending on the sub-population studied. Luteal phase defects show abnormalities in progesterone output and can be classified into 3 subclasses: LPD-I, LPD-II, LPD-III.
LPD-I: The luteal defect related to shortening or lengthening of the luteal phase. The normal luteal phase length is 12-18 days. Clinically, LPD-I is associated with inability to conceive, scant/heavy menstrual flow, increased risk of proliferative diseases, insomnia and various emotional problems.
LPD-II: The luteal defect related to reduction in overall progesterone output due to an underdeveloped corpus luteum or suboptimal pituitary stimulation (weak LH pulse). Clinically, LPD-II is associated with water retention, breast tenderness, spotting, increased irritability, headaches, insomnia and a constellation of cognitive and emotional problems.
LPD-III: The luteal defect related to uneven distribution of progesterone throughout the luteal phase. Women with this defect usually show low progesterone in the last 5-7 days before menstrual flow. Clinically, in LPD-III the symptoms (same as LPD-II) are often confined to the last 5-7 days before menstrual flow.
Our FHP™ report will make the distinction and suggest guidelines for therapy in all LPD subclasses.

Urine and serum hormone concentration in mid-luteal phase are practically useless in LPD detection. The inadequacy has been worded as follows: "We reject the notion that a single mid-luteal phase progesterone assay is sufficient to make the diagnosis of luteal phase defect (7)." The mid-luteal phase progesterone assay "is of little or no assistance in establishing a diagnosis" of luteal phase deficit [Wentz, A.C. Clinical Obstet. Gynecol. 22:169 (1979)].

In summary, mid-luteal testing is a technique shown to have poor or minimal correlation with luteal insufficiency on a patient-by-patient basis (7,8,9).

Anovulation
The salivary FHP™ can be used to detect anovulatory cycles (6) which may occur in about 22% of young women age 20-31 years (12). This is a common cause of in- fertility and may result from excessive and chronic stress. We have verified this notion over the years through the use of the salivary Adrenal Stress Index™ performed at our laboratory.

Other Applications
The FHP™ can be successfully used in investigating the following problems: Ovulation problems, sexual differentiation problems, estrogen-progesterone imbalance, pituitary-ovarian axis dysregulation, functional infertility and miscarriage, polycystic ovarian disease, recurring headaches and hot flashes, libido problems and hirsutism.

Customizing Hormone Therapy
Presently, hormone therapy is very empirical and a one-size-fits-all approach is applied to most women. Due to variability among women, a more customized and scientific approach is required. The FHP™ panel report analyzes hormone production trends and functional inter-relationships which facilitates customized treatments. Then, hormone replacement therapy can go beyond package insert protocols. For example, the optimal treatment plan for a 25 year old is not likely the best therapy for a 48 year old approaching menopause.

Risk assessment of Breast and Uterine diseases
The relation of estrogen dominance to increased risk of proliferative diseases in breast & endometrial tissue is universally accepted. The FHP™ & e-FHP™ report includes the Follicular Estrogen Priming Index (E fi) that quantifies the impact of excess estradiol in menstruating women. Patient-specific recommendations are routinely included in the report. Please note that certain estrogen metabolites are falsely promoted as markers for breast cancer risk. A recent study which compared 2/16 Hydroxyestrone ratio in women with breast cancer to a control group of cancer-free women, concludes that there is no support for the hypothesis that the ratio of 2/16 hydroxyestrone is an important risk factor for breast cancer (J Nat'l Cancer Inst 1999 Jun 16:91(12):1067-72).

The FHP™ allows an in-depth functional analysis of hormone relationships that affect long-term health.

FSH & LH
The Expanded Female Hormone Panel™ includes 4 or 5 FSH & LH measurements. The salivary FSH & LH constitutes a measurement of tissue concentration of the bioactive hormone. Ovarian estrogen production is dependent on presence and rhythmicity of FSH. Ovulation and progesterone production are dependent on the midcycle LH surge. By coupling FSH with estrogen and LH with progesterone (Fig. 2 & 3), we have a powerful diagnostic tool to differentiate ovarian-based from pituitary (brain)-based cycle irregularities. This is highly relevant in PMS, infertility and early menopause-like symptoms. Elevated FSH does not always imply low estrogen, it may indicate a desensitized axis from previous use of birth control pills. FSH & LH can be ordered as individual tests.

Testosterone & DHEA in Women
In women, the effects of testosterone on certain target tissues counteract those of estrogen. Increased testosterone in women is associated with increased libido, enhanced spatial, mathematical, artistic and musical abilities. Increased testosterone levels have a nonlinear correlation with performance (18, 19, 20).

Excessive testosterone production in women is a good indicator of ovarian cysts. Many of these women show abnormally rapid rates in converting androstenedione to testosterone (21). The efficacy of antiandrogen treatment in women with excessive testosterone can be effectively monitored by salivary testosterone (22).

On the other hand, women with low testosterone may show a catabolic tendency and reduced libido, and may require low dose augmentation with testosterone. Salivary testosterone is well suited for initial and post therapy follow-up evaluations. The panel also includes a measurement of the cycle average of DHEA free fraction. DHEA is the molecular precursor of the androgenic and estrogenic hormones. Often, low DHEA is the cause of insufficient testosterone and estrogen production.

As women become increasingly aware of the role that hormones play in their health throughout their entire lives, they are realizing the urgent need for reliable, clinically relevant assessment of hormone activity. The Female Hormone Profile is a safe, non-invasive saliva assay that analyzes levels of progesterone, testosterone and ß-estradiol over 28 days. Because these hormones shape the course of a woman's menstruation cycle, imbalances can produce disruptions in mood, sleep patterns, appetite, sexual drive and PMS symptoms.

The Female Hormone Panel provides clinical direction for successful treatment of women with menstrual irregularities, difficulties with ovulation, functional infertility, pre-menstrual syndrome, menopause, osteoporosis, and other hormone related disorders. Once abnormal patterns are accurately detected, an effective, customized treatment plan can be developed to restore a patient's natural hormonal rhythms.

All lab tests can be done through the mail in the privacy of your own home, except blood tests, we send you to a lab to have your blood drawn for these. After you pay for the test we mail you the kit, the results take two weeks, the test results will be mailed to us and we will call you to go over the results, its that easy! All tests include the consultation for the report of findings.

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Call our office for details.
800-956-7083 OR 818-707-3126