Saliva vs. Blood vs. Urine Testing for Hormones

Saliva vs. Blood vs. Urine Testing for Hormones

By Jordan Stachel, MS, RDN, CPT

Testing for hormones can be done through different modalities. A healthcare provider may test your saliva, blood, or urine to measure your hormone levels. If you are wondering how saliva vs. blood vs. urine testing for hormones works and which may be the best option for you, read this article for more information.

All About Saliva Testing

It is possible to have a sample of your saliva analyzed to determine your hormone levels.^[1] Some people prefer this type of testing as it is very non-invasive and involves collecting a sample of spit. Saliva tests can look at moment-to-moment changes in your steroid hormones to see how they are fluctuating.

While saliva testing is moderately accurate, there are some disadvantages to the testing. These include:^[1]

• You need to store the samples immediately in a freezer.
• Results can be affected by gum health, smoking, food intake, coffee or alcohol consumption, mood, and exercise.

Because of these variables, saliva testing is often not the first type of testing selected, especially when you have the option to do blood or urine testing. However, if a woman wants to use saliva testing to see fluctuations in her menstrual cycle, this may be a moderately reliable method to see short-term fluctuations. More research on this is needed for conclusive results.

All About Blood Testing

Another way to test hormones is by doing a blood test.^[2] Blood tests are commonly used to assess various hormone levels, and the results are considered to be fairly accurate. Your healthcare provider can use blood tests to measure many different hormones, as well as proteins like sex hormone–binding globulin (SHBG). SHBG is a protein that binds to various sex hormones in the blood.

During a blood test to measure hormone levels, you can expect a similar protocol to any routine blood draw. A healthcare provider will collect a sample of blood, and the sample will be sent for analysis. You usually do not need to prepare for this type of test, and there are no outsized risks associated with it.^[2]

You can also take an at-home hormone blood test. Everlywell offers several at-home hormone tests that you can take from the comfort of your home. The Men’s Health Test looks at four key biomarkers to provide insights into hormones. These insights are helpful as hormones affect body composition, energy, and mood. The at-home blood test from Everlywell looks at cortisol, dehydroepiandrosterone (DHEA), estradiol, and free testosterone. Other at-home testing options are also available.

All About Urine Testing

Another way to measure hormones is through urine testing. Healthcare providers have used urine tests to look at some hormones, particularly in women. Women who have changing hormone levels, are pregnant, are perimenopausal, or post-menopausal can also take certain at-home tests to examine their hormones.^[3]

Urine tests can measure the amount of follicle-stimulating hormone (FSH) in the urine. Some women elect to measure hormones with this test, and it can sometimes be more accurate during menopause, as estrogen levels drop and FSH levels typically rise. However, because hormones ebb and flow for all women, these urine tests are not a definitive method for determining menopause.

Sometimes your provider may use urine testing to measure cortisol, the main stress hormone in the body. Cortisol plays several roles, so measuring levels can help ensure they are not too high or too low.^[4] Healthcare providers also commonly check adrenocorticotropic hormone (ACTH), which helps regulate cortisol release.

Since there are no extra risks associated with urine tests, they can be helpful tools for determining if some hormones are within normal ranges. It is always best to follow up with a healthcare provider for interpretation of your results, additional testing, or next steps.

Which Test Should You Choose?

Ultimately, each testing method has pros and cons. There is no one-size-fits-all approach and no clear consensus on which method is ultimately best. At-home blood tests can be the most comprehensive way to look at several hormones at once, so some people choose this method to get a complete picture.

You can consult a healthcare provider for next steps and to decide which testing makes the most sense for you. Everlywell 360 offers a comprehensive care platform where you can consult qualified providers and get the care you need. From there, if appropriate or desired, Everlywell offers several at-home testing options to help you gain insight into your hormonal health.

References

1. Stern J, Arslan RC, Penke L. Stability and validity of steroid hormones in hair and saliva across two ovulatory cycles. Comprehensive Psychoneuroendocrinology. 2022;9:100114. doi:10.1016/j.cpnec.2022.100114. https://pmc.ncbi.nlm.nih.gov/articles/PMC9216405/
2. SHBG blood test. MedlinePlus. Last reviewed December 14, 2022. https://medlineplus.gov/lab-tests/shbg-blood-test/
3. Should You Take an At-Home Menopause Test? Cedars-Sinai. Published May 9, 2024. https://www.cedars-sinai.org/blog/should-you-take-an-at-home-menopause-test.html
4. 24-Hour Urine Cortisol. University Hospitals. Reviewed 2025. https://www.uhhospitals.org/health-information/health-and-wellness-library/article/lab-tests-v1/24-hour-urine-cortisol