"Hormone Balancing" Programs: Questions About Saliva Tests, Adrenal Fatigue and Custom Hormones

Fatigue, weight gain, brain fog and hot flashes can send you looking for answers, and some wellness programs promise to “balance your hormones.” Many start with a saliva or hormone panel, then recommend custom-compounded hormones, “adrenal support” supplements or both, often for a package price. Here is what national expert bodies say about each step, and what to ask.

Step 1: The saliva or hormone panel

The National Academies, reviewing the evidence for the FDA, noted that professional organizations have called saliva testing unnecessary and not proven to be accurate or reliable, because hormone levels change from day to day. One study in postmenopausal women found no correlation between saliva and blood testosterone measurements.¹

The review also notes that ACOG² advises using symptoms, not hormone levels, to guide menopause treatment, and found no established evidence base for routinely using sex hormone levels to set doses for menopause symptoms.¹

Try: “What will this test tell us that changes my treatment? What evidence shows it’s accurate for that purpose, and what does it cost?”

Step 2: An “adrenal fatigue” diagnosis

The Endocrine Society³ says there is no scientific proof that adrenal fatigue is a true medical condition, and that tests marketed for it aren’t based on good scientific studies.³

It also warns that taking adrenal hormone supplements you don’t need can cause your own adrenal glands to stop working, and that stopping them can lead to a life-threatening adrenal crisis.³ Tiredness, weakness or low mood can come from conditions such as adrenal insufficiency, depression or sleep apnea, which need proper evaluation.³

Try: “If you think my adrenal glands are involved, which standard tests for adrenal disease would you order, and what conditions should we rule out first?”

Step 3: Custom-compounded hormones

ACOG² advises against routinely prescribing compounded “bioidentical” hormone therapy when FDA-approved options exist, and notes the term “bioidentical” is often used as a marketing term.²

Try: “Is this an FDA-approved product or compounded? If compounded, why isn’t an approved patch, gel, spray, ring or pill right for me?”

Step 4: The package price

Before you sign up, ask for:

• A written list of every test, visit, supplement and prescription in the package, with prices
• Whether any part can be billed to insurance or paid with an HSA or FSA
• How long the program runs, whether it renews automatically, and how to cancel

A second opinion

The Menopause Society’s⁴ Find a Menopause Clinician directory lists clinicians, including those certified as MSCPs, who can review your symptoms and options.⁴

My Body Changed. Now What? includes a Visit Brief. Use it to list your symptoms, the tests and products you’ve been offered, and the answers to these questions. See the book.