Salivary testosterone: a reliable approach to the diagnosis of male hypogonadism

Effects of a supraphysiological dose of testosterone cypionate on salivary gland function in adult male Wistar rats

The abusive use of anabolic androgenic steroids has become a serious health problem worldwide, but its effects on oral health are still poorly understood. Therefore, the objective of this study was to evaluate the effects of a supraphysiological dose of testosterone cypionate (TC) on salivary biochemical, histomorphology, immunohistochemistry, and redox state parameters of parotid and submandibular glands. Twenty male Wistar rats, 12 weeks old, were divided into two groups (n=10/group): a control group and TC group, which received a dose of 20 mg/kg, once a week, for 6 weeks. Post treatment, the saliva and glands were collected. A supraphysiological dose of TC increased plasma and salivary testosterone concentrations. Although TC did not alter salivary flow, pH, and buffering capacity, the treatment increased the salivary secretion of total protein and reduced amylase, calcium, phosphate, and potassium. TC reduced the connective tissue area in the parotid gland and acinar area of the submandibular gland, while increasing the granular convoluted tubule area in the submandibular gland. Proliferating cell nuclear antigen was higher in the acinar cells of the submandibular glands from the TC group. Moreover, TC increased concentrations of total oxidant capacity and damaged lipids in both salivary glands, while total antioxidant activity and uric acid were lower in the submandibular gland, and reduced glutathione was higher in both glands. Superoxide dismutase, catalase, and glutathione peroxidase activities were higher in the parotid gland, while only glutathione peroxidase activity was lower in the submandibular gland of the TC group. In conclusion, TC abuse may be a potential factor for dysfunction of the parotid and submandibular glands, becoming a risk factor for the oral and systemic health of users.

Salivary Testosterone Levels and Pain Perception Exhibit Sex-Specific Association in Healthy Adults But Not in Patients With Migraine

This study investigated the sex-specific associations between pain perception and testosterone levels in healthy controls (HCs) and patients with migraine. Male and female HCs and migraine patients were recruited. A series of questionnaires were completed by the participants to evaluate their psychosocial profiles, which included data on mood, stress, and sleep quality. Heat pain thresholds and suprathreshold pain ratings at 45 °C (referred to as the pain perception score [PPS]) were assessed using the Thermode system. Salivary testosterone levels were analyzed using a commercial enzyme-linked immunosorbent assay kit. A total of 88 HCs (men/women: 41/47, age: 29.9 ± 7.7 years) and 75 migraine patients (men/women: 30/45, age: 31.1 ± 7.7 years) completed all assessments. No significant differences were observed in either the psychosocial profiles or heat pain thresholds and PPSs between the sexes in the control and migraine groups. A positive correlation between testosterone levels and PPSs was identified in the male controls (r = .341, P = .029), whereas a negative correlation was identified in the female controls (r = -.407, P = .005). No such correlations were identified in the migraine group. This study confirms that a negative association is present between PPSs and testosterone levels in female controls, which is in line with the findings that testosterone is associated with reduced pain perception. Our study is the first to demonstrate a sex-specific association between PPSs and testosterone levels in HCs. Moreover, this study also revealed that the presence of migraine appears to disrupt this association. PERSPECTIVE: This study revealed that testosterone levels demonstrate opposite associations with pain perception in healthy men and women. However, the presence of migraine appears to disrupt this sex-specific association.

Effects of 12 Months' Treatment with Testosterone Undecanoate on Markers for Erythropoietic Activity and Safety Aspects in Transgender and Cisgender Hypogonadal Men

BACKGROUND

To investigate the erythropoietic activity and safety aspects of testosterone undecanoate (TU) injections in transgender men, assigned female at birth.

METHODS

Twenty-three men (13 hypogonadal cisgender men and 10 transgender men) who initiated TU at the study start (naïve) and 15 men (10 hypogonadal cisgender men and 5 transgender men) on steady-state treatment with TU (non-naïve) were included in this prospective 1-year observational study. A control group of 32 eugonadal cisgender men was investigated once at baseline. Complete blood count, testosterone in serum and saliva, and plasma lipids, and liver enzymes were assessed.

RESULTS

For naïve transgender men, a significant increase in hemoglobin concentration was noted (mean (SD)), 141 (8) g/L to 151 (13) g/L, while no increase was seen in naïve hypogonadal cisgender men. At the end of the study, naïve transgender men exhibited comparable levels of hemoglobin, hematocrit, and testosterone levels in serum and saliva to hypogonadal cisgender men, as well as to the eugonadal cisgender men. During the study, HDL-cholesterol decreased significantly in naïve transgender men, 1.4 (0.4) mmol/L to 1.2 (0.4) mmol/L, P = 0.03, whereas no significant change was noted in naïve hypogonadal cisgender men. Liver enzymes remained unchanged in all groups.

CONCLUSIONS

After 12 months of treatment with TU in naïve transgender men, hemoglobin and hematocrit increased to levels within the cisgender male reference range. A slight decrease in HDL-cholesterol was seen in naïve transgender men but liver enzymes remained unchanged.

Testosterone and the Amygdala's Functional Connectivity in Women and Men

The amygdala contains androgen receptors and is involved in various affective and social functions. An interaction between testosterone and the amygdala's functioning is likely. We investigated the amygdala's resting-state functional connectivity (rsFC) network in association with testosterone in 94 healthy young adult women and men (final data available for analysis from 42 women and 39 men). Across the whole sample, testosterone was positively associated with the rsFC between the right amygdala and the right middle occipital gyrus, and it further predicted lower agreeableness scores. Significant sex differences appeared for testosterone and the functional connectivity between the right amygdala and the right superior frontal gyrus (SFG), showing higher testosterone levels with lower connectivity in women. Sex further predicted the openness and agreeableness scores. Our results show that testosterone modulates the rsFC between brain areas involved in affective processing and executive functions. The data indicate that the cognitive control of the amygdala via the frontal cortex is dependent on the testosterone levels in a sex-specific manner. Testosterone seems to express sex-specific patterns (1) in networks processing affect and cognition, and (2) in the frontal down-regulation of the amygdala. The sex-specific coupling between the amygdala and the frontal cortex in interaction with the hormone levels may drive sex-specific differences in a variety of behavioral phenomena that are further associated with psychiatric illnesses that show sex-specific prevalence rates.

Longitudinal Course of Sex Steroids From Pregnancy to Postpartum

CONTEXT

Sex steroids (SS) typically rise during pregnancy and decline after birth, but no consistent reference values exist for these hormonal courses. We aimed to establish an overview of SS secretion patterns during the peripartum and to better understand how SS contribute to maternal and fetal pathologies.

EVIDENCE ACQUISITION

A systematic literature search was conducted in accordance with the PRISMA guidelines using PubMed, Cochrane Library, and PsycINFO. Additionally, we conducted a supplementary manual search of references. Observational studies published in English and assessing estradiol, progesterone, and testosterone over the course of the peripartum in physically healthy female subjects were included, without restrictions on year of publication. Extracted data were analyzed descriptively and visually.

EVIDENCE SYNTHESIS

SS increase progressively during pregnancy, with an extremely wide range of reported concentrations, especially in the third trimester. In fact, reported concentrations varied up to 5000-fold at comparable measurement time points.

CONCLUSIONS

A comprehensive understanding of the influence of SS levels on associated maternal and fetal pathologies is currently hindered by 2 main factors. First, reported SS levels vary widely during the peripartum period. Second, the current state of knowledge on how SS are associated with pathologies in mothers and babies is largely based on correlational studies, and causality thus remains unclear. Consequently, we recommend the development of a systematic reference framework that follows the suggestions presented in this review. This would enable the establishment of SS reference values for a healthy population, resulting in the possibility to draw conclusions about deviations and related pathologies.

Correlations between salivary- and blood-derived gonadal hormone assessments and implications for inclusion of female participants in research studies

Even in the 21st century, female participants continue to be underrepresented in human physiology research. This underrepresentation is attributable in part to the perception that the inclusion of females is more time consuming, less convenient, and more expensive relative to males because of the need to account for the menstrual cycle in cardiovascular study designs. Accounting for menstrual cycle-induced fluctuations in gonadal hormones is important, given established roles in governing vascular function and evidence that failure to consider gonadal hormone fluctuations can result in misinterpretations of biomarkers of cardiovascular disease. Thus, for cardiovascular researchers, the inclusion of females in research studies implies a necessity to predict, quantify, and/or track indexes of menstrual cycle-induced changes in hormones. It is here that methodologies are lacking. Gold standard measurement requires venous blood samples, but this technique is invasive and can become both expensive and technically preclusive when serial measurements are required. To this end, saliva-derived measures of gonadal hormones provide a means of simple, noninvasive hormone tracking. To investigate the feasibility of this technique as a means of facilitating research designs that take the menstrual cycle into account, the purpose of this review was to examine literature comparing salivary and blood concentrations of the primary gonadal hormones that fluctuate across the menstrual cycle: estradiol and progesterone. The data indicate that there appear to be valid and promising applications of salivary gonadal hormone monitoring, which may aid in the inclusion of female participants in cardiovascular research studies.

Steroidome and metabolome analysis in gilt saliva to identify potential biomarkers of boar effect receptivity

Optimal management of gilt reproduction requires oestrus synchronization. Hormonal treatments are used for this purpose, but there is a growing demand for non-hormonal alternatives, especially in organic farms. The boar effect is an important alternative opportunity to induce and synchronize oestrus without hormones. Before puberty, gilts exhibit a 'waiting period' during which boar exposure could induce and synchronize the first ovulation. We searched for salivary biomarkers of this period of boar effect receptivity to improve detection of the gilts to stimulate with the perspective of enhancing the efficacy of the boar effect. Saliva samples were collected from 30 Large-White×Landrace crossbred gilts between 140 and 175 days of age. Gilts were exposed twice a day to a boar and subjected to oestrus detection from 150 to 175 days of age. Among the 30 gilts, 10 were detected in oestrus 4 to 7 days after the first introduction of the boar and were considered receptive to the boar effect, 14 were detected in oestrus more than 8 days after first boar contact, and six did not show oestrus and were considered non-receptive. Saliva samples from six receptive and six non-receptive gilts were analyzed for steroidome and for metabolome using gas chromatography coupled to tandem mass spectrometry and ¹H nuclear magnetic resonance spectroscopy, respectively. Four saliva samples per gilt were analyzed: 25 days and 11 days before boar introduction, the day of boar introduction, 3 days later for receptive gilts or 7 days later for non-receptive gilts. Twenty-nine steroids and 31 metabolites were detected in gilt saliva. Salivary concentrations of six steroids and three metabolites were significantly different between receptive and non-receptive gilts: progesterone and glycolate 25 days before boar introduction, 3α5β20α- and 3β5α20β-hexahydroprogesterone, dehydroepiandrosterone, androstenediol, succinate, and butyrate 11 days before boar introduction, and 3β5α-tetrahydroprogesterone on the day of boar introduction. Thus, nine potential salivary biomarkers of boar effect receptivity were identified in our experimental conditions. Further studies with higher numbers of gilts and salivary sampling points are necessary to ascertain their reliability.

Erectile Dysfunction in Young Men: Testosterone, Androgenic Polymorphisms, and Comorbidity With Premature Ejaculation Symptoms

BACKGROUND

The association between erectile dysfunction (ED), free testosterone (T), and androgenic genetic polymorphisms is still unclear. As most studies in the field have focused on older (>40 y.o.) men, data from young men is scarce. In addition, the clinically observed comorbidity between ED and premature ejaculation (PE) has not been explained.

AIM

The aim of the present study was 3-fold: to assess in a sample of young men (1) the association between ED and T; (2) the role of androgenic genetic polymorphisms in the aforementioned association; and (3) comorbidity between ED and PE symptoms.

METHODS

Statistical analyses were performed on a population-based sample of 2,302 Finnish men, (M_age = 26.8 years). Hormone samples were available from 317 men, and genotype information was available from a minimum of 1,144 men depending on genetic locus. For twin analyses, the sample contained 533 male individuals from opposite-sex fraternal twin pairs, 491 identical male individuals (110 complete pairs), 493 male individuals from male fraternal twin pairs (92 complete pairs), and 658 siblings of twins.

OUTCOMES

The main outcome measure includes association between levels of salivary T and ED, main effects of the androgen-related genetic polymorphisms on ED scores. Bivariate twin models of PE and ED were fitted to elucidate possible shared etiology.

RESULTS

We found no significant association between T levels and ED and no significant main effects of the androgenic genetic polymorphisms on ED. We found no evidence suggesting that any of the genetic polymorphisms would moderate the association between T and ED symptoms. We found shared unique environmental influences between PE and ED (r_E = .28).

CLINICAL TRANSLATION

Obtained data suggest that ED has T-independent causes and that any comorbidity between PE and ED is not explained by a set of genes affecting both phenotypes.

STRENGTHS & LIMITATIONS

First, the sample size for both parts of the study was relatively small, which may make some statistical analyses underpowered. Furthermore, as the sample was a population-based sample of relatively young men, the number of clinically relevant ED cases was low. Second, some concerns about T derived from saliva exist because saliva sampling comes with increased risks of error particularly because saliva samples are more vulnerable to contamination.

CONCLUSION

We found no significant association between free T levels, androgenic genetic polymorphisms, and ED in the younger age cohort. Twin analysis suggested a common nonshared environmental component in PE and ED. Zhuravleva1 ZD, Johansson A, Jern P. Erectile Dysfunction in Young Men: Testosterone, Androgenic Polymorphisms, and Comorbidity With Premature Ejaculation Symptoms. J Sex Med 2021;18:265-274.

Olfactory Exposure to β-Caryophyllene Increases Testosterone Levels in Women's Saliva

INTRODUCTION

From previous studies, we hypothesized that olfactory exposure to β-caryophyllene stimulates women's libido. However, Japan's sex culture is so closed that it is difficult to test this possibility without accumulating scientific evidence. Therefore, it is necessary to measure the concentration of sex-related hormones in saliva, an experimental technique that is relatively easy to obtain research permission, and to obtain a scientific basis to convince ethics committee reviewers.

AIM

The aim of this study is to investigate whether β-caryophyllene increases salivary testosterone concentrations associated with libido and vaginal sensation during intercourse in women.

METHODS

19 women in the follicular phase of the menstrual cycle participated in the study. The subjects then sat in front of the odor exposure device we had created. Each subject was exposed to dipropylene glycol for 20 minutes, followed by 3% β-caryophyllene for 20 minutes. Saliva was collected 4 times: before and after control exposure, and before and after β-caryophyllene exposure.

MAIN OUTCOME MEASURE

Salivary testosterone and estrogen concentrations were measured with a competition ELISA.

RESULTS

β-caryophyllene significantly increased the salivary concentration of testosterone (control vs β-caryophyllene; 0.97 ± 0.05 vs 1.13 ± 0.03, P = .00, 95% confidence interval of control: 0.84-1.09, 95% confidence interval of β-caryophyllene: 1.04-1.20) but not estrogen (control vs β-caryophyllene; 1.05 ± 0.03 vs 1.07 ± 0.04, P = .69, 95% confidence interval of control: 0.96-1.12, 95% confidence interval of β-caryophyllene: 0.98-1.15).

STRENGTHS & LIMITATIONS

The personal preferences of the subjects and the order of exposure may have affected the results.

CONCLUSION

β-caryophyllene may be a remedy with fewer side effects for women with decreased libido. We believe that β-caryophyllene may be a remedy for women with decreased libido. However, this hypothesis must be tested by further clinical studies. Wataru Tarumi, Kazuyuki Shinohara. Olfactory Exposure to β-Caryophyllene Increases Testosterone Levels in Women's Saliva. J Sex Med 2020;8:525-531.

Methods for Regulating and Monitoring Resistance Training

Individualisation can improve resistance training prescription. This is accomplished via monitoring or autoregulating training. Autoregulation adjusts variables at an individualised pace per performance, readiness, or recovery. Many autoregulation and monitoring methods exist; therefore, this review’s objective was to examine approaches intended to optimise adaptation. Up to July 2019, PubMed, Medline, SPORTDiscus, Scopus and CINAHL were searched. Only studies on methods of athlete monitoring useful for resistance-training regulation, or autoregulated training methods were included. Eleven monitoring and regulation themes emerged across 90 studies. Some physiological, performance, and perceptual measures correlated strongly (r ≥ 0.68) with resistance training performance. Testosterone, cortisol, catecholamines, cell-free DNA, jump height, throwing distance, barbell velocity, isometric and dynamic peak force, maximal voluntary isometric contractions, and sessional, repetitions in reserve-(RIR) based, and post-set Borg-scale ratings of perceived exertion (RPE) were strongly associated with training performance, respectively. Despite strong correlations, many physiological and performance methods are logistically restrictive or limited to lab-settings, such as blood markers, electromyography or kinetic measurements. Some practical performance tests such as jump height or throw distance may be useful, low-risk stand-ins for maximal strength tests. Performance-based individualisation of load progression, flexible training configurations, and intensity and volume modifications based on velocity and RIR-based RPE scores are practical, reliable and show preliminary utility for enhancing performance.

Screening and identification of salivary biomarkers for assessing the effects of exogenous testosterone administration on HPG and HPA axes and ECS

The contents of steroids and endocannabinoids along with the ratios between them would be candidate biomarkers for sensitively and comprehensively assessing the role of testosterone in regulating the activities of the hypothalamus-pituitary-gonadal (HPG) axis, the hypothalamus-pituitaryadrenal (HPA) axis and endogenous cannabinoid system (ECS). However, previous studies mostly used the contents rather than the ratios as biomarkers. This study aimed to systematically screen and identify sensitive biomarkers from 21 candidates including both the contents of nine steroids and one endocannabinoid and their ratios in saliva. Three screening criteria were whether there were intergroup differences, time-dependent changes and considerable relative stability during a 4-h period after exogenous testosterone administration. This study used LC-APCI⁺-MS/MS to determine the salivary levels of the candidate biomarkers on 62 male healthy undergraduates who were divided into testosterone administration and placebo control groups. The results revealed that salivary testosterone, androstenedione, DHEA and the ratios of testosterone to estradiol and AEA, and of cortisol to testosterone and DHEA were sensitive biomarkers for assessing the effects of testosterone administration on the three neuroendocrine systems because they all showed significant intergroup differences and time-dependent changes and good relative stability. Salivary cortisol, cortisone and the ratios of testosterone to androstenedione and DHEA and of androstenedione to estrone, and of cortisol to cortisone, androstenedione and AEA might be suitable biomarkers because they met only two of the three criteria, but needed to be validated in the future. The rest biomarkers were unsuitable because they mostly showed no significant intergroup differences, blunt time-dependent changes and poor relative stability.

A Randomized, Double-Blind, Placebo-Controlled, Crossover Study Examining the Hormonal and Vitality Effects of Ashwagandha ( Withania somnifera) in Aging, Overweight Males

Ashwagandha ( Withania somnifera) is a herb commonly used in Ayurvedic medicine to promote youthful vigor, enhance muscle strength and endurance, and improve overall health. In this 16-week, randomized, double-blind, placebo-controlled, crossover study, its effects on fatigue, vigor, and steroid hormones in aging men were investigated. Overweight men aged 40-70 years, with mild fatigue, were given a placebo or an ashwagandha extract (Shoden beads, delivering 21 mg of withanolide glycosides a day) for 8 weeks. Outcome measures included the Profile of Mood States, Short Form (POMS-SF), Aging Males' Symptoms (AMS) questionnaire, and salivary levels of DHEA-S, testosterone, cortisol, and estradiol. Fifty-seven participants were enrolled, with 50 people completing the first 8-week period of the trial and 43 completing all 16 weeks. Improvements in fatigue, vigor, and sexual and psychological well-being were reported over time, with no statistically significant between-group differences. Ashwagandha intake was associated with an 18% greater increase in DHEA-S ( p = .005) and 14.7% greater increase in testosterone ( p = .010) compared to the placebo. There were no significant between-group differences in cortisol and estradiol. In conclusion, the intake of a standardized ashwagandha extract (Shoden beads) for 8 weeks was associated with increased levels of DHEA-S and testosterone, although no significant between-group differences were found in cortisol, estradiol, fatigue, vigor, or sexual well-being. Further studies with larger sample sizes are required to substantiate the current findings.

Advancements in the gold standard: Measuring steroid sex hormones by mass spectrometry

Sex hormones, such as testosterone and estrogens, play an essential role in regulating physiological and reproductive development throughout the lifetime of the individual. Although variation in levels of these hormones are observed throughout the distinct stages in life, significant deviations from reference ranges can result in detrimental effects to the individual. Alterations, by either an increase or decrease, in hormone levels are associated with physiological changes, decreased reproductive capabilities, and increased risk for diseases. Hormone therapies (HTs) and assisted reproductive technologies (ARTs) are commonly used to address these factors. In addition to these treatments, gender-affirming therapies, an iteration of HTs, are also a prominent treatment for transgender individuals. Considering that the effectiveness of these treatments relies on achieving therapeutic hormone levels, monitoring of hormones has served as a way of assessing therapeutic efficay. The need for reliable methods to achieve this task has led to great advancements in methods for evaluating hormone concentrations in biological matrices. Although immunoassays are the more widely used method, mass spectrometry (MS)-based methods have proven to be more sensitive, specific, and reliable. Advances in MS technology and its applications for therapeutic hormone monitoring have been significant, hence integration of these methods in the clinical setting is desired. Here, we provide a general overview of HT and ART, and the immunoassay and MS-based methods currently utilized for monitoring sex hormones. Additionally, we highlight recent advances in MS-based methods and discuss future applications and considerations for MS-based hormone assays.

Differences in Psychoneuroendocrine Stress Responses of High-Level Swimmers Depending on Autocratic and Democratic Coaching Style

The aim of the present study was to analyse differences in the psychoneuroendocrine stress responses of high-level, young swimmers depending on whether an autocratic and democratic coaching style was applied. Modifications in cortisol and the motivational climate of 18 young swimmers (15.3 ± 1.86 years, 10 females and 8 males) were analysed before and after two training sessions with equivalent training loads but directed by two coaches applying different approaches, i.e., autocratic (A) and democratic (D). The basal testosterone levels of the coaches were also assessed. The basal testosterone concentration was higher in coach A than in coach D; the athletes perceived them as autocratic and democratic, respectively. Swimmers under coach A’s instructions showed higher cortisol levels, suggesting higher cortisol production related to coaching style. Furthermore, differences in the motivational climate concerning ego (i.e., athletes comparing their ability with that of other athletes) were observed with coach A, whereas differences in motivational climate concerning the task (i.e., athletes comparing their ability with their own past performance) were observed with coach D. Cognitive variables showed negative perceptions affecting athletes’ training experience and performance when they were screamed at or insulted by coach A. There were no gender or age differences in cortisol production or motivational climate. In conclusion, this study suggests that an autocratic coaching style modulates cortisol release in both genders, affecting young elite swimmers’ motivational climate and training experience.

Fathers' cortisol and testosterone in the days around infants' births predict later paternal involvement

Human paternal behavior is multidimensional, and extant research has yet to delineate how hormone patterns may be related to different dimensions of fathering. Further, although studies vary in their measurement of hormones (i.e., basal or reactivity), it remains unclear whether basal and/or reactivity measures are predictive of different aspects of men's parenting. We examined whether men's testosterone and cortisol predicted fathers' involvement in childcare and play with infants and whether fathers' testosterone and cortisol changed during fathers' first interaction with their newborn. Participants were 298 fathers whose partners gave birth in a UNICEF-designated "baby-friendly" hospital, which encourages fathers to hold their newborns 1 h after birth, after mothers engage in skin-to-skin holding. Salivary testosterone and cortisol were measured before and after fathers' first holding of their newborns. Basal and short-term changes in cortisol and testosterone were analyzed. Fathers were contacted 2-4 months following discharge to complete questionnaires about childcare involvement. Fathers' cortisol decreased during the time they held their newborns on the birthing unit. Fathers' basal testosterone in the immediate postnatal period predicted their greater involvement in childcare. Both basal and reactivity cortisol predicted fathers' greater involvement in childcare and play. Results suggest that reduced basal testosterone is linked with enhanced paternal indirect and direct parenting effort months later, and that higher basal cortisol and increases in cortisol in response to newborn interaction are predictive of greater paternal involvement in childcare and play, also months later. Findings are discussed in the context of predominating theoretical models on parental neuroendocrinology.

The Effect of Psychological Stress on Salivary Testosterone in Puberty Children

BACKGROUND

Psychological stress is a condition that is experienced by many adolescents which affect the Hypothalamic-Pituitary-Gonadal axis. Testosterone is known as a sex steroid hormone that is susceptible to acute stress and can be measured through saliva. Disruption of the reproductive system can affect the sexual maturation process.

AIM

To understand the difference in salivary testosterone levels in puberty children before and after given a stressor.

METHODS

A quasi-experimental intervention study was conducted at Antonius Bangun Mulia junior high school, Medan, North Sumatera, in July-October 2017. Subjects were students aged 12-14 years with sexual maturity G2 for boys and M2 for girls. Psychological stress intervention was generated by the Wechsler intelligence scale for children fourth edition (WISC IV). Saliva was collected before and after the intervention. The analysis was done with Wilcoxon test and a P value < 0.05 was considered significant.

RESULTS

Forty-two subjects of 24 male students and 18 female students with sexual maturation Tanner II (54.8%) and Tanner III (45.2%). This study obtained that there was a statistically significant difference in salivary testosterone levels before and after the subject was given a stressor (P = 0.015, CI 95%). This difference also was seen within sexual maturation Tanner II (P = 0.045, CI 95%). No difference was observed in testosterone levels based on gender, male students (P = 0.065, CI 95%) and female students (P = 0.112, CI 95%).

CONCLUSION

Stress can affect salivary testosterone levels. There was a statistically significant difference in salivary testosterone levels before and after psychological stress in puberty children.

Simultaneous determination of three estrogens in human saliva without derivatization or liquid-liquid extraction for routine testing via miniaturized solid phase extraction with LC-MS/MS detection

Accurate quantitation of estrogens (i.e, estrone (E1), estradiol (E2) and estriol (E3)) is valuable for clinical assessment of human health and disease. Alterations in estrogen levels have been implicated in numerous pathological conditions. However, inadequacies in sensitivity and specificity, cumbersome sample preparation and invasive specimen collection hamper the usability of available methods for clinical applications. Herein, a simple, rapid, highly sensitive and specific LC-MS/MS method was developed and validated for the simultaneous determination of three estrogens in human saliva providing a non-invasive alternative to conventional blood samples. For the first time, a 96-well hydrophilic-lipophilic-balanced (HLB) microplate was employed for clean-up and enrichment of estrogens in a single extraction without the requirements of derivatization, evaporation, liquid-liquid extraction and online extraction. A rapid LC chromatographic separation with a turnaround time of 5.0min was achieved on a BEH C18 XP column. The use of 0.1mM ammonium fluoride (NH₄F) as LC additive, and integration of summated and scheduled multiple reaction monitoring (MRM) transitions substantially improved the sensitivity to 1pg/mL, allowing the accurate quantitation of trace levels of three estrogens in one run. The assay was fully validated with good performance for extraction efficiency (67.0-85.6%), matrix effect (89.6-100.2%), linearity (from 1.0pg/mL up to 1000pg/mL), accuracy (98.9-112.4%) and precision (≤7.4%). Additionally, the assay was unaffected by 34 structurally-similar, potentially interfering substances tested at high clinical concentrations. The applicability of the assay was demonstrated by assessing the reference intervals of authentic saliva samples from healthy adult males, pre- and post-menopausal females. The easy sample preparation, fast LC and multi-analyte MS/MS detection utilizing noninvasive saliva as a specimen delivers a simple, practical, sensitive and accurate tool suitable for the high throughput measurement of E1, E2 and E3 in clinical laboratories.

Saliva: a reliable sample matrix in bioanalytics

Saliva is gaining increasing attention as a bioanalytical sample matrix. Mostly because of the easy and noninvasive collection, it is not only beneficial in endocrinological and behavioral science, but also in pediatrics. Saliva also has the advantage of being the only body fluid which can be collected even during physical exercise, for example, during sportive activities, and there are physiological characteristics that make it superior to serum/plasma or urine for specific scientific questions. This review provides an insight into the physiology of saliva formation, explaining how certain compounds enter this bodily fluid, and gives advice for collection, storage and analytical methods. Finally, it presents a number of reliable and proven applications for saliva analysis from scientific fields including endocrinology, sports medicine, forensics and immunology.

Testosterone in human studies: Modest associations between plasma and salivary measurements

Testosterone is involved in many processes like aggression and mood disorders. As it may easily diffuse from blood into saliva, salivary testosterone is thought to reflect plasma free testosterone level. If so, it would provide a welcome noninvasive and less stressful alternative to blood sampling. Past research did not reveal consensus regarding the strength of the association, but sample sizes were small. This study aimed to analyse the association in a large cohort. In total, 2,048 participants (age range 18-65 years; 696 males and 1,352 females) were included and saliva (using cotton Salivettes) and plasma were collected for testosterone measurements. Levels were determined by enzyme-linked immunosorbent assay and radioimmunoassay respectively. Free testosterone was calculated by the Vermeulen algorithm. Associations were determined using linear regression analyses. Plasma total and free testosterone showed a significant association with salivary testosterone in men (adjusted β = .09, p = .01; and β = .15, p < .001, respectively) and in women (adjusted β = .08, p = .004; and crude β = .09, p = .002 respectively). The modest associations indicate that there are many influencing factors of both technical and biological origin.

The relationship of salivary testosterone and male sexual dysfunction in opioid-associated androgen deficiency (OPIAD)

BACKGROUND

Opioids are an effective treatment for chronic non-malignant pain (CNP). Long-term use risks and side effects such as opioid-induced androgen deficiency (OPIAD) exist. This could be measured by saliva testosterone (Sal-T).

OBJECTIVES

To evaluate OPIAD in long-term opioid use in CNP patients.

METHODS

A cross-sectional study included CNP male outpatients under opioid treatment. Total-Testosterone (Total-T), Free-Testosterone (Free-T), Bio-Testosterone (Bio-T) and Sal-T were measured. Correlations were calculated by Spearman's rho (SPSS 20).

RESULTS

From 2012 to 2014, 134 from 249 (54%) consecutive male outpatients reported erectile dysfunction (ED), 37% of them related to opioids and 19% evidenced OPIAD. A total of 120 subjects (94 cases and 26 matched-controls) were included. A significantly lower luteinizing hormone, Total-T and Free-T were found, as well as, a significant correlation between Sal-T and Total-T (r = 0.234, p = 0.039), Bio-T (r = 0.241, p = 0.039), IIEF (r = 0.363, p = 0.003) and HAD-anxiety (r = -0.414, p = 0.012) in OPIAD patients. Sal-T levels were significantly lower in patients with severe-moderate ED versus mild ED (p = 0.045) and in patients with severe ED versus moderate-mild ED (p = 0.036).

CONCLUSIONS

These data demonstrate the high prevalence of ED in long-term use of opioids, part of this is associated to OPIAD, which can be tested by Sal-T as a non-invasive approach.

The effect of sex and time of day on testosterone concentrations in equine saliva and serum

In terms of exercise, testosterone is important for the growth and maintenance of skeletal muscle mass. Sampling saliva could be a non-invasive alternative to blood sampling for the quantification of testosterone levels in horses. The objective of this study was to compare testosterone concentrations in saliva and serum (sampled simultaneously) from horses of different sexes and at different times throughout the day. A total of 67 warmblood riding horses (21 geldings, 22 mares and 24 stallions) were included in the study. Saliva and blood samples were collected in the morning (06:00-08:00), at midday (11:00-13:00) and in the evening (17:00-19:00). The results demonstrated a weak correlation between saliva and serum testosterone concentrations (rs=0.25, P=0.04). Stallions had higher serum testosterone concentrations than mares and geldings (P<0.001), but there was no significant effect of sex on salivary testosterone concentrations. The time of day did not affect the concentration of testosterone in either saliva or serum. In conclusion, our results indicate that saliva samples cannot be recommended for measuring testosterone levels in horses. However, further research is needed to identify the disturbing factors.

Testosterone administration in females modulates moral judgment and patterns of brain activation and functional connectivity

Morality is defined as prescriptive norms regarding how people should treat one another, and includes concepts of fairness, justice, and rights. One recent study with moral dilemmas suggested that testosterone administration increases utilitarian judgments, which depends on second-to-fourth (2D: 4D) digit ratio, as a proxy of prenatal priming. However, the neural mechanism by which acute testosterone modulates moral reasoning remains to be determined. Using a placebo-controlled within-subject design, the current study examined the neuromodulatory effect of testosterone in young females by combining moral dilemmas, 2D: 4D, functional magnetic resonance imaging (fMRI), and subjective ratings of morally laden scenarios. Results showed that testosterone administration elicited more utilitarian responses to evitable dilemmas. The high 2D: 4D group scored more punishments for moral evaluation, whereas the low 2D: 4D group did the opposite. The activity in the amygdala, anterior insular cortex, and dorsolateral prefrontal cortex (dlPFC) was increased when participants evaluated morally unorthodox actions (intentional harm). The activity in the posterior superior temporal sulcus/temporoparietal junction (pSTS/TPJ) to accidental harm was decreased, specific to the high 2D: 4D group. The functional connectivity between the amygdala and dlPFC was reduced. The activity in the pSTS/TPJ to perceived agency predicted utilitarian responses to evitable dilemmas. The findings demonstrate the acute effect of testosterone on neural responses associated with moral judgment, and provide evidence to support that prenatal sex-hormones priming could be important for early neurodevelopment, which plays a crucial role in the neural and behavioral manifestations of testosterone on adult moral reasoning. Hum Brain Mapp 37:3417-3430, 2016. © 2016 Wiley Periodicals, Inc.

Low Testosterone Levels and Reduced Kidney Function in Japanese Adult Men: The Locomotive Syndrome and Health Outcome in Aizu Cohort Study

OBJECTIVES

Findings from several experimental studies in animals have suggested a protective action of testosterone on kidney function, but hard evidence for such an association in humans is scarce. We examined the association between testosterone levels and kidney function among adult men living in super-aged communities.

DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS

We conducted cross-sectional study involving residents aged 40-80 years who participated in annual health check-ups in 2 communities. A total of 1031 men were recruited in 2010. Main exposure was salivary testosterone (sT) levels measured using an enzyme-linked immunosorbent assay. Main outcome was estimated glomerular filtration rate (eGFR) determined by age, gender, and serum creatinine levels.

RESULTS

For the 848 participants analyzed, median age and eGFR were 69 years and 69.1 mL/min/1.73 m(2), respectively. On comparison of 90th-percentile sT levels with lower levels, our general linear model with restricted cubic splines showed that lower sT levels were associated with decreased eGFR after adjustment for sociodemographic characteristics, comorbidities, and blood pressure. For example, fifth percentile sT was associated with decreased eGFR, with a difference in eGFR [-3.43 mL/min/1.73 m(2) (95% confidence interval, CI -6.02 to -0.84)] comparable in magnitude to the reduction in eGFR observed for a 6-year increase in age in our population. The association between low testosterone levels and decreased eGFR remained similar even when analyses were restricted to participants aged over 60 years (734 participants, median age 71 years).

CONCLUSIONS

Results from our study indicated that having low testosterone levels was independently associated with reduced eGFR in adult men. Our finding of this association between low testosterone levels and reduced kidney function needs to be corroborated among persons with chronic kidney disease or in a longitudinal study.

Salivary Heparanase Level Is a Potential Biomarker to Diagnose and Prognose the Malignant Salivary Gland Tumor

Background

Upregulation of heparanase has been reported in an increasing number of human cancer tissues. However, the level of salivary heparanase and its clinical significance in patients with salivary gland tumors remain unclear.

Methods

Salivary heparanase levels in patients with salivary gland tumors were detected using enzyme-linked immunosorbent assays (ELISAs) and the clinical significance was evaluated by analyzing the correlations among salivary heparanase levels, clinicopathological parameters, and clinical outcomes.

Results

The levels of salivary heparanase were significantly higher in patients with malignant salivary gland tumors than in benign tumors and normal controls (P<0.0001). High salivary heparanase levels were positively correlated with increased lymph node metastasis (P = 0.0235) and poorer tumor node metastasis stage (TNM) (P = 0.0183). Survival analyses revealed that high salivary heparanase levels were associated with worse overall survival (P = 0.0023) and disease-free survival (DFS) (P = 0.0025).

Conclusions

The study shows that salivary heparanase levels, as detected by the ELISAs, can be used to diagnose and provide an accurate prognosis for malignant salivary gland tumors. Salivary heparanase level was an independent predictor in patients with malignant salivary gland tumors.

Measuring Recovery in Elite Rugby Players: The Brief Assessment of Mood, Endocrine Changes, and Power

PURPOSE

There is demand in applied sport settings to measure recovery briefly and accurately. Research indicates mood disturbance as the strongest psychological predictor of mental and physical recovery. The Brief Assessment of Mood (BAM) is a shortened version of the Profile of Mood States that can be completed in less than 30 s. The purpose of this study was to examine the BAM as a quick measure of mood in relation to recovery status in elite rugby players alongside established physiological markers of recovery.

METHOD

Using elite rugby union players (N = 12), this study examined the utility of BAM as an indicator of mental and physical recovery in elite athletes by exploring pattern change in mood disturbance, energy index, power output, cortisol, and testosterone 36 hr before and 12 hr, 36 hr, and 60 hr after a competitive rugby match.

RESULTS

Repeated-measures multivariate analysis of variance indicated significant changes in all variables across the 4 time points (p < .05, η(2) range = .20-.48), concurrent with previous study findings. Although visual inspection of the graphs indicated that the pattern of change for mood disturbance and energy index mapped changes in all physiological variables, only a low correlation was observed for power output (r = - .34).

CONCLUSIONS

Although BAM scores changed significantly over time in accordance with the hypotheses, further testing is required to confirm the utility of the BAM as a measure of recovery. The results indicate that the BAM could be used as 1 indicator of recovery status alongside other measures.

Voltammetric Behavior of Testosterone on Bismuth Film Electrode: Highly Sensitive Determination in Pharmaceuticals and Human Urine by Square‐Wave Adsorptive Stripping Voltammetry

In this paper, an electrochemical application of bismuth‐film electrode (BiFE) fabricated via ex‐situ electrodeposition onto a glassy carbon electrode for testosterone determination was investigated in aqueous and aqueous/surfactant solutions. In cyclic voltammetry, the compound showed one irreversible and adsorption‐controlled reduction peak. The BiFE revealed good linear response in the examined concentration range of 1 to 45 nmol L−1 testosterone in BrittonRobinson buffer, pH 5.0 containing 3 mmol L−1 cetyltrimethylammonium bromide. The limit of detection was 0.3 nmol L−1 (0.09 ng mL−1). Finally, the BiFE was satisfactorily applied for quantitation of testosterone in both pharmaceutical (oil‐based ampoule) and biological (human urine) samples.

Testosterone modulates preattentive sensory processing and involuntary attention switches to emotional voices

Testosterone is capable of altering facial threat processing. Voices, similar to faces, convey social information. We hypothesized that administering a single dose of testosterone would change voice perception in humans. In a placebo-controlled, randomly assigned, double-blind crossover design, we administered a single dose of testosterone or placebo to 18 healthy female volunteers and used a passive auditory oddball paradigm. The mismatch negativity (MMN) and P3a in responses to fearfully, happily, and neutrally spoken syllables dada and acoustically matched nonvocal sounds were analyzed, indicating preattentive sensory processing and involuntary attention switches. Results showed that testosterone administration had a trend to shorten the peak latencies of happy MMN and significantly enhanced the amplitudes of happy and fearful P3a, whereas the happy- and fearful-derived nonvocal MMN and P3a remained unaffected. These findings demonstrated acute effect of testosterone on the neural dynamics of voice perception. Administering a single dose of testosterone modulates preattentive sensory processing and involuntary attention switches in response to emotional voices.

Saliva testosterone and cortisol in male depressive syndrome, a community study. The Sudurnesjamenn Study

INTRODUCTION

The association between testosterone levels and depression is unclear. The relationship has been described as complex, i.e. more U (J)-shaped than linear in some previous studies.

AIM

The primary aim of this study was to examine the relationship between saliva testosterone level variations and different levels of male depressive symptoms in a community sample. The secondary aim was to investigate whether simultaneous testing of evening cortisol and testosterone improved the detection of depression.

METHODS

In a community study, 534 males were screened, using the Beck Depression Inventory (BDI), the Gotland Male Depression Scale (GMDS) and the Montgomery-Åsberg Depression Rating Scale (MADRS). Those with signs of depression (n = 65) and randomly selected controls (n = 69) had psychiatric evaluation for depressive disorder. In a sub-sample (n = 51) saliva testosterone was measured twice on a single day.

RESULTS

Testosterone morning values were significantly higher than evening values (236 vs. 145 pg/ml, P = 0.009). Evening testosterone was significantly higher in depressive males, according to both MADRS (P = 0.028) and BDI (P = 0.036). Having depression increased the likelihood of being in the highest third of testosterone levels (BDI P = 0.021; MADRS P = 0.018). Positive correlation was between total BDI score and elevated evening testosterone with and without psychotropics (P = 0.017; P = 0.002). Correlation was between elevated evening cortisol and evening testosterone levels (P = 0.021) though simultaneous testing did not increase specificity of detecting depression.

CONCLUSION

Evening saliva testosterone measurements seem the most informative, as they correlate with male depressive syndrome. Simultaneous testing for evening cortisol and evening testosterone levels did not increase specificity for clinical diagnosis of depressive disorder.

Associations between Salivary Testosterone Levels, Androgen-Related Genetic Polymorphisms, and Self-Estimated Ejaculation Latency Time

Introduction

Recently, testosterone (T) has been shown to be associated with premature ejaculation (PE) symptoms in the literature. Furthermore, studies suggest that the etiology of PE is partly under genetic control.

Aim

The aim of this study was to reassess findings suggesting an association between testosterone (T) and a key symptom of PE, ejaculation latency time (ELT), as well as exploratively investigating associations between six androgen-related genetic polymorphisms and ELT.

Materials and Methods

Statistical analyses were performed on a population-based sample of 1,429 Finnish men aged 18–45 years (M = 26.9, SD = 4.7). Genotype information was available for 1,345–1,429 of these (depending on the polymorphism), and salivary T samples were available from 384 men. Two androgen receptor gene-linked, two 5-alpha-reductase type 2-gene-linked, and two sex hormone-binding globuline gene-linked polymorphisms were genotyped.

Main Outcome Measures

Ejaculatory function was assessed using self-reported ELT.

Results

We found no association between salivary T levels and ELT. We found a nominally significant association between a 5-alpha-reductase type 2-gene-linked polymorphism (rs2208532) and ELT, but this association did not remain significant after correction for multiple testing. One single nucleotide polymorphism in the sex hormone-binding globulin gene (rs1799941) moderated (significantly after correction for multiple testing) the association between salivary T and ELT, so that A:A genotype carriers had significantly lower salivary T levels as a function of increasing ELT compared with other genotype groups.

Conclusions

We were unable to find support for the hypothesis suggesting an association between T levels and ELT, possibly because of the low number of phenotypically extreme cases (the sample used in the present study was population based). Our results concerning genetic associations should be interpreted with caution until replication studies have been conducted. Jern P, Westberg L, Ankarberg-Lindgren C, Johansson A, Gunst A, Sandnabba NK, and Santtila P. Associations between salivary testosterone levels, androgen-related genetic polymorphisms, and self-estimated ejaculation latency time. Sex Med 2014;2:107–114.

Saliva-based biosensors: noninvasive monitoring tool for clinical diagnostics

Saliva is increasingly recognised as an attractive diagnostic fluid. The presence of various disease signalling salivary biomarkers that accurately reflect normal and disease states in humans and the sampling benefits compared to blood sampling are some of the reasons for this recognition. This explains the burgeoning research field in assay developments and technological advancements for the detection of various salivary biomarkers to improve clinical diagnosis, management, and treatment. This paper reviews the significance of salivary biomarkers for clinical diagnosis and therapeutic applications, with focus on the technologies and biosensing platforms that have been reported for screening these biomarkers.

A critical evaluation of salivary testosterone as a method for the assessment of serum testosterone

Although salivary testosterone (T) is often used in clinical studies accuracy is mostly questionable. State of the art data for men is sparse and for women absent. Our objective was to perform a critical evaluation of salivary T (Sal-T) as a method for indirect assessment of serum T using state of the art methods. Saliva was collected via 'Salivette' and 'passive drooling' methods. Sal-T and free T in serum after equilibrium dialysis were measured by LC-MS/MS RESULTS: Evaluation of Sal-T results versus free T by equilibrium dialysis (ED-T) for men gave: 'Salivette' Sal-T=0.05+0.88x ED-T, r=0.43; 'passive drooling' Sal-T=0.17+0.91x ED-T r=0.71. In women, correlation was comparable but values are higher than free T: 'passive drooling' Sal-T=0.12+2.32x ED-T, r=0.70. The higher than expected T values in saliva, appear to be explained by T binding to salivary proteins. Iso-electric focusing of saliva proteins, followed by fractionation and LC-MS/MS assay of T showed marked testosterone peaks at pH 5.3 and 8.4, providing evidence for T binding in saliva to proteins such as albumin and proline rich protein (PRP).

CONCLUSIONS

Passive drooling is the collection method of choice for testosterone in saliva. Sal-T is not directly comparable to serum free T due to T binding to saliva proteins, which substantially affects the low Sal-T in women but not the higher Sal-T in healthy adult men.

Salivary testosterone measurement by liquid chromatography tandem mass spectrometry in adult males and females

BACKGROUND

Salivary testosterone (Sal-T) may be a useful surrogate of serum free testosterone. The study aims were to use a novel liquid chromatography tandem mass spectrometry (LC-MS/MS) assay to determine whether Sal-T concentrations accurately reflect Sal-T concentrations in both sexes and to investigate practical aspects of sample collection.

METHODS

Saliva and serum samples were collected in 104 male and 91 female subjects. A more sensitive LC-MS/MS assay was developed to enable Sal-T quantitation in the low concentrations found in females. Saliva (200 µL) was extracted with 1 mL of methyl-tert-butyl ether following the addition of D5-testosterone. Quantitation was performed using a Waters TQ-S mass spectrometer.

RESULTS

The assay achieved a lower limit of quantification of 5 pmol/L, sufficiently sensitive to measure testosterone in female saliva. Sal-T showed a diurnal variation but samples taken at weekly and monthly intervals showed no significant differences. Sal-T was stable at ambient temperature for up to 5 days, after freeze-thawing and 3 years frozen storage. Reference intervals for Sal-T were 93-378 pmol/L in males and 5-46 pmol/L in females. Sal-T correlated significantly with serum calculated free-T in males (r = 0.71, P < 0.001) and in females (r = 0.39, P < 0.001).

CONCLUSIONS

These results confirm that testosterone can be reliably and accurately measured by LC-MS/MS in both adult male and female saliva samples. These results lay the foundation for further exploration of the clinical application of Sal- T as a reliable alternative to serum testosterone in the diagnosis and management of androgen disorders and assessment of androgen status in clinical research.

Relationship Between Pregame Concentrations of Free Testosterone and Outcome in Rugby Union

Purpose:

To assess the measures of salivary free testosterone and cortisol concentrations across selected rugby union matches according to game outcome.

Methods:

Twenty-two professional male rugby union players were studied across 6 games (3 wins and 3 losses). Hormone samples were taken 40 min before the game and 15 min after. The hormonal data were grouped and compared against competition outcomes. These competition outcomes included wins and losses and a game-ranked performance score (1–6).

Results:

Across the entire team, pregame testosterone concentrations were significantly higher during winning games than losses (P = 5.8 × 10−5). Analysis by playing position further revealed that, for the backs, pregame testosterone concentrations (P = 3.6 × 10−5) and the testosterone-to-cortisol ratio T:C (P = .038) were significantly greater before a win than a loss. Game-ranked performance score correlated to the team’s pregame testosterone concentrations (r = .81, P = .049). In backs, pregame testosterone (r = .91, P = .011) and T:C (r = .81, P = .05) also correlated to game-ranked performance. Analysis of the forwards’ hormone concentrations did not distinguish between game outcomes, nor did it correlate with game-ranked performance. Game venue (home vs away) only affected postgame concentrations of testosterone (P = .018) and cortisol (P = 2.58 × 10−4).

Conclusions:

Monitoring game-day concentrations of salivary free testosterone may help identify competitive readiness in rugby union matches. The link between pregame T:C and rugby players in the back position suggests that monitoring weekly training loads and enhancing recovery modalities between games may also assist with favorable performance and outcome in rugby union matches.

Measurement of testosterone in human sexuality research: methodological considerations

Testosterone (T) and other androgens are incorporated into an increasingly wide array of human sexuality research, but there are a number of issues that can affect or confound research outcomes. This review addresses various methodological issues relevant to research design in human studies with T; unaddressed, these issues may introduce unwanted noise, error, or conceptual barriers to interpreting results. Topics covered are (1) social and demographic factors (gender and sex; sexual orientations and sexual diversity; social/familial connections and processes; social location variables), (2) biological rhythms (diurnal variation; seasonality; menstrual cycles; aging and menopause), (3) sample collection, handling, and storage (saliva vs. blood; sialogogues, saliva, and tubes; sampling frequency, timing, and context; shipping samples), (4) health, medical issues, and the body (hormonal contraceptives; medications and nicotine; health conditions and stress; body composition, weight, and exercise), and (5) incorporating multiple hormones. Detailing a comprehensive set of important issues and relevant empirical evidence, this review provides a starting point for best practices in human sexuality research with T and other androgens that may be especially useful for those new to hormone research.

The effects of saliva collection, handling and storage on salivary testosterone measurement

Several endocrine parameters commonly measured in plasma, such as steroid hormones, can be measured in the oral fluid. However, there are several technical aspects of saliva sampling and processing that can potentially bias the validity of salivary testosterone measurement. The aim of this study was to evaluate the effects caused by repeated sampling; 5 min centrifugation (at 2000, 6000 or 10,000g); the stimulation of saliva flow by a cotton swab soaked in 2% citric acid touching the tongue; different storage times and conditions as well as the impact of blood contamination on salivary testosterone concentration measured using a commercially available ELISA kit. Fresh, unprocessed, unstimulated saliva samples served as a control. Salivary testosterone concentrations were influenced neither by repeated sampling nor by stimulation of salivary flow. Testosterone levels determined in samples stored in various laboratory conditions for time periods up to 1 month did not differ in comparison with controls. For both genders, salivary testosterone levels were substantially reduced after centrifugation (men F=29.1; women F=56.17, p<0.0001). Blood contamination decreased salivary testosterone levels in a dose-dependent manner (men F=6.54, p<0.01, F=5.01, p<0.05). Salivary testosterone can be considered A robust and stable marker. However, saliva processing and blood leakage can introduce bias into measurements of salivary testosterone using ELISA. Our observations should be considered in studies focusing on salivary testosterone.