Salivary Hormone Update November 2004 - Australia

An update from ARL, Australia …

Analytical Reference Laboratories, Melbourne, Australia alerted its customers early November that it had been advised by the Health Insurance Commission that as of 1 November 2004 Salivary Hormone Testing (MBS item number 66695) would no longer be covered under the Medicare Benefits Schedule.

This means that a salivary hormone test (e.g. oestradiol, progesterone, testosterone) requested by our medical doctor is no longer partially Medicare rebateable.

Apparently ARL was notified of this change without prior warning or consultation. And due to these changes all salivary hormone tests are now pre-paid tests.

I emailed Colm Benson, Health Services Manager at ARL to learn a little more about the ?why? behind this move by the HIC. Colm responded, “We don?t know the ?why? as yet. The HIC made the change to the MBS without any consultation or prior warning. The change is effective from 1 Nov 04 and we were notified on 1 Nov 04. We are trying to find out more info and will keep you posted.”

Prior to these changes, a salivary hormone profile of three hormones (oestradiol, progesterone, testosterone) would cost a patient A$149.45 less the Medicare rebate of A$57.45. Now, with said changes enforced upon ARL, the full cost of a salivary assay is to be pushed back on to the person who can least afford it … the patient.

This decision by the HIC very specifically targets Aussie women who, with their GPs, have come to rely on salivary hormone testing to monitor effective and safe transdermal hormone replacement therapy.

Drs. Gillson and Zava, in a fully referenced paper on ‘Salivary Hormone Analysis‘ detailing the theory and science behind saliva hormone testing write, “Transdermal delivery of hormones is extremely efficient, and this efficiency is simply not reflected by blood testing.”

Serum concentrations may not increase but there may be dramatic changes at the cellular level. In actual fact, when blood serum levels of progesterone are seen to rise, it is probably a sign of overdosing.

Saliva testing is quicker, less expensive, non-invasive, and less painful than blood tests, and the home collection kits allow us to check our hormone levels (up to six hormones can be monitored from each single sample) at the same time each day throughout our cycle (follicular phase, luteal phase, or full cycle investigation) for a more accurate profiling.

Saliva testing, therefore, provides an accurate measurement of free hormones that are actively filtering out of blood into tissue of the body.

This is particularly relevant when monitoring the ratio of all our hormones, and our risk of developing breast and uterine cancer when we become estrogen dominant.

I’m currently on a course of transdermal progesterone supplementation, and I have a pathology request here in front of me from my GP to investigate clinical adrenal insufficiency. She has requested that I have my estradiol, progesterone, testosterone, DHEAS, and cortisol levels tested. This test kit is now going to set me back $197.25 which, in all honestly, I cannot afford, hence it won’t happen.

As a direct result of these imposed changes, I’m forced to assume the risk of unmonitored hormone replacement therapy (as other women like me will have to do). Basically, we cannot afford to wear the financial burden salivary assays authorised by our treating GP will place on our family’s purse strings.

Then today, ARL posted a ‘Salivary Hormone Medicare Rebate Update’. Following the recent change to the MBS regarding Salivary Hormone Testing, ARL claims it is the only laboratory to submit a detailed protest relating to the exclusion of salivary hormones, (MBS item number 66695) to the Pathology Table Services Committee (PSTC).

The PSTC has agreed to refer the matter back to the Biochemistry Working Party for further review.

The Biochemistry Working Party will review such items as:

• Saliva vs. Blood


• Collection contamination


• Analytical testing


• Clinical benefits of salivary hormone testing

If you would like to submit information regarding this issue please email your comments and data to pstc@health.gov.au and copy Colm Benson at colmb@arlaus.com.au.

As more information comes to hand Colm will forward it to you via email. You can contact him on (613) 9539 5469 or 0409 310 736 if you would like to discuss this matter further.