Chemiluminescent immunoassay overestimates hormone concentrations and obscures testosterone sex differences relative to LC-MS/MS in a field study of diverse adolescents

Background

Methodological comparisons of hormone quantification techniques have repeatedly demonstrated that, in adults, enzyme immunoassay (EIA) inflates steroid hormone concentrations relative to mass spectrometry. However, methodological comparisons in adolescent samples remain rare, and few studies have examined how chemiluminescent immunoassay (CLIA), another popular immunoassay, compares to mass spectrometry. Additionally, no studies have examined how differences in analytical techniques may be affecting relationships between steroid hormone levels and outcomes of interest, such as psychopathology. This pre-registered analysis of an existing dataset measured salivary cortisol and testosterone using both CLIA and liquid chromatography dual mass spectrometry (LC-MS/MS) in a repeated measures (516 samples) sample of 207 9th graders.

Methods

In aim 1, this study sought to expand on past findings by 1) measuring inflation of testosterone and cortisol by CLIA in a relatively large adolescent sample, and 2) showing that CLIA (like EIA) testosterone inflation was especially true in groups with low ‘true’ testosterone levels. In aim 2, this study sought to examine the impact of hormone quantification method on relationships between hormone levels and psychopathological measures (the Children's Depression Inventory, the Perceived Social Stress Scale, the UCLA Loneliness Scale, and the Anxious Avoidant and Negative Self Evaluation subscales of the Social Anxiety Scale for Adolescents).

Results

We found that CLIA, like EIA, inflated testosterone and cortisol levels and overestimated female testosterone resulting in suppressed sex differences in testosterone. We did not observe these same patterns when examining testosterone in individuals with differing levels of pubertal development. Results of psychopathology analyses demonstrated no significant method differences in hormone-psychopathology relationships.

Conclusions

Our findings show that CLIA introduces proportional bias in cortisol and testosterone in a manner that suppresses sex differences in testosterone. Steroid measurement method did not significantly moderate the relationship between hormones and psychopathology in our sample, though more work is needed to investigate this question in larger, clinical samples.

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Pre-registered comparison of 516 samples of CLIA and LC/MS-MS-assessed cortisol and testosterone from 207 adolescents.

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CLIA overestimated cortisol and testosterone relative to LC-MS/MS and suppressed sex differences in testosterone.

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No significant moderating effect of method on hormone-psychopathology relationships.

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LC-MS/MS should be used to measure steroid hormones when possible.

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Further research is needed to examine how method differences may be impacting hormone-psychopathology findings.

Recognizing normal reproductive biology: A comparative analysis of variability in menstrual cycle biomarkers in German and Bolivian women

The idealized "normal" menstrual cycle typically comprises a coordinated ebb and flow of hormones over a 28-day span with ovulation invariably shown at the midpoint. It's a pretty picture-but rare. Systematic studies have debunked the myth that cycles occur regularly about every 28 days. However, assumptions persist regarding the extent and normalcy of variation in other cycle biomarkers. The processes of judging which phenotypic variants are "normal" is context dependent. In everyday life, normal is that which is most commonly seen. In biomedicine normal is often defined as an arbitrarily bounded portion of the phenotype's distribution about its statistical mean. Standards thus defined in one population are problematic when applied to other populations; population specific standards may also be suspect. Rather, recognizing normal female reproductive biology in diverse human populations requires specific knowledge of proximate mechanisms and functional context. Such efforts should be grounded in an empirical assessment of phenotypic variability. We tested hypotheses regarding cycle biomarker variability in women from a wealthy industrialized population (Germany) and a resource-limited rural agropastoral population (Bolivia). Ovulatory cycles in both samples displayed marked but nonetheless comparable variability in all cycle biomarkers and similar means/medians for cycle and phase lengths. Notably, cycle and phase lengths are poor predictors of mid-luteal progesterone concentrations. These patterns suggest that global and local statistical criteria for "normal" cycles would be difficult to define. A more productive approach involves elucidating the causes of natural variation in ovarian cycling and its consequences for reproductive success and women's health.

Field methods and strategies for assessing female reproductive functioning

A detailed understanding of female reproductive functioning is important to many disciplines including anthropology, evolutionary theory, demography, psychology, and biomedicine. In this article, I describe strategies and methods that have been used successfully in community-based studies of human reproduction, many in remote locales, to produce high quality biomarker data. These techniques are applicable to a wide range of research questions and populations, and to persons from adolescence through senescence. I give particular attention to the inherent challenges imposed by the cyclical and somewhat unpredictable nature of the hypothalamic-pituitary-ovarian axis including the necessity and difficulty of ascertaining the timing and occurrence of ovulation, the limits of different sampling regimes for capturing fluctuations in reproductive hormones, and the critical importance of recognizing and, when possible, reducing selection bias. I discuss the relative advantages and disadvantages of collecting saliva, urine, and dried blood spots, and describe some of the subtleties involved in collecting contamination-free samples. Once samples are collected, they must be stored in a manner that minimizes degradation; I describe techniques to keep samples cold even without access to electricity or dry ice. I also discuss various issues that should be considered during initial discussions with a laboratory and when samples are assayed by the laboratory. I include examples of techniques that have worked well in actual field studies, and examples of flawed analytical approaches that should be avoided. With these and other tools, even under technology-sparse conditions, researchers can investigate variability in human physiology across the breadth of human habitats.

Measuring Implicit Motives with the Picture Story Exercise (PSE): Databases of Expert-Coded German Stories, Pictures, and Updated Picture Norms

We present two openly accessible databases related to the assessment of implicit motives using Picture Story Exercises (PSEs): (a) A database of 183,415 German sentences, nested in 26,389 stories provided by 4,570 participants, which have been coded by experts using Winter's coding system for the implicit affiliation/intimacy, achievement, and power motives, and (b) a database of 54 classic and new pictures which have been used as PSE stimuli. Updated picture norms are provided which can be used to select appropriate pictures for PSE applications. Based on an analysis of the relations between raw motive scores, word count, and sentence count, we give recommendations on how to control motive scores for story length, and validate the recommendation with a meta-analysis on gender differences in the implicit affiliation motive that replicates existing findings. We discuss to what extent the guiding principles of the story length correction can be generalized to other content coding systems for narrative material. Several potential applications of the databases are discussed, including (un)supervised machine learning of text content, psychometrics, and better reproducibility of PSE research.

Testosterone, cortisol, and human competition

Testosterone and cortisol figure prominently in the research literature having to do with human competition. In this review, we track the history of this literature, concentrating particularly on major theoretical and empirical contributions, and provide commentary on what we see as important unresolved issues. In men and women, athletic competition is typically associated with an increase in testosterone (T) and cortisol (C). Hormone changes in response to non-athletic competition are less predictable. Person (e.g., power motivation, mood, aggressiveness, social anxiety, sex, and baseline levels of T and C) and context (e.g., whether a competition is won or lost, the closeness of the competition, whether the outcome is perceived as being influenced by ability vs. chance, provocations) factors can influence hormone responses to competition. From early on, studies pointed to a positive relationship between T and dominance motivation/status striving. Recent research, however, suggests that this relationship only holds for individuals with low levels of C - this is the core idea of the dual-hormone hypothesis, and it is certain that the broadest applications of the hypothesis have not yet been realized. Individuals differ with respect to the extent to which they embrace competition, but the hormonal correlates of competitiveness remain largely unexplored. Although rapid increases in both T and C associated with competition are likely adaptive, we still know very little about the psychological benefits of these hormonal changes. Administration studies have and will continue to contribute to this inquiry. We close with a discussion of what, we think, are important methodological and mechanistic issues for future research.

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.

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.

Revisiting hyper- and hypo-androgenism by tandem mass spectrometry

Modern endocrinology is living a critical age of transition as far as laboratory testing and biochemical diagnosis are concerned. Novel liquid chromatography-tandem mass spectrometry (LC-MS/MS) assays for steroid measurement in biological fluids have abundantly demonstrated their analytical superiority over immunometric platforms that until now have dominated the world of steroid hormones determination in clinical laboratories. One of the most useful applications of LC-MS/MS is in the hypogonadism and hyperandrogenism field: LC-MS/MS has proved particularly suitable for the detection of low levels of testosterone typical of women and children, and in general more reliable in accurately determining hypogonadal male levels. This technique also offers increased informative power by allowing multi-analytical profiles that give a more comprehensive picture of the overall hormonal asset. Several LC-MS/MS methods for testosterone have been published in the last decade, some of them included other androgen or more comprehensive steroid profiles. LC-MS/MS offers the concrete possibility of achieving a definitive standardization of testosterone measurements and the generation of widely accepted reference intervals, that will set the basis for a consensus on the diagnostic value of biochemical testing. The present review is aimed at summarizing technological advancements in androgen measurements in serum and saliva. We also provide a picture of the state of advancement of standardization of testosterone assays, of the redefinition of androgen reference intervals by novel assays and of studies using LC-MS/MS for the characterization and diagnosis of female hyperandrogenism and male hypogonadism.

Salivary testosterone in female-to-male transgender adolescents during treatment with intra-muscular injectable testosterone esters

INTRODUCTION

In our hospital, female-to-male (FtM) transgender adolescents from the age of 16 are treated with two- or four-weekly intra-muscular injections of testosterone-esters. Some patients treated with four-weekly injections have complaints of fatigue and experience mood swings towards the end of the inter-injection period, which calls for an evaluation of the time-course of testosterone levels between injections. Evaluation of salivary testosterone is a practical approach for sequential measurements. Since only ∼2% of total serum testosterone is present in saliva, a sensitive assay is necessary. The objective was to develop an isotope dilution-liquid chromatography-tandem mass spectrometry method (ID-LC-MS/MS) for salivary testosterone measurements and to evaluate the testosterone profiles after testosterone-ester mixture injections in FtM-adolescents.

EXPERIMENTAL

FtM treated with 125 mg/2 weeks or with 250 mg/4 weeks depots of testosterone-ester mixture collected saliva at different time intervals. Salivary testosterone was measured by a thoroughly validated ID-LC-MS/MS assay.

RESULTS

An ID-LC-MS/MS method for measuring salivary testosterone was developed with adequate accuracy and specificity. The reference range was established at 135-400 pmol/L. Testosterone levels peaked supra-physiologically immediately post-injection, and decreased to levels within the male reference range after nine days in all patients. 250 mg/4 weeks depots resulted in values below the reference range at the end of the 4 weeks.

DISCUSSION

The development of an adequate ID-LC-MS/MS method for measuring salivary testosterone allowed us to investigate the testosterone profile in FtM-adolescents after testosterone-esters mixture injections. These injections lead to extreme concentrations which may affect the wellbeing of the patients.

Influence of treatment for disruptive behavior disorders on adrenal and gonadal hormones in youth

The study examined whether psychosocial intervention for children diagnosed with a disruptive behavior disorder (DBD; n = 84) changed concentrations of cortisol and testosterone across a 3-year follow-up when compared to a matched, nonclinical, healthy comparison (HC; n = 69) group. Boys and girls (6-11 years) with a DBD were randomly assigned to one of two arms of a multimethod intervention. Hierarchical linear modeling revealed that children undergoing psychosocial intervention for a DBD experienced a significant decline in diurnal cortisol change over time (p < .05) when compared to the HC condition. Boys with a DBD diagnosis had significantly lower mean cortisol concentrations prior to treatment (p < .05) and showed a significantly steeper increase in mean cortisol over time (p < .05) when compared to HC boys. Treatment effects for diurnal cortisol change were replicated in the boys-only analysis. No treatment effects were noted for testosterone in either analysis.

Testosterone and Self-Reported Dominance Interact to Influence Human Mating Behavior

In this study, 76 men came into the lab in pairs and engaged in a 7-minute videotaped mate competition for the attention of an attractive female confederate. Pre-competition testosterone (T) levels were positively associated with men’s dominance behaviors and with how much the confederate indicated that she “clicked” with each participant. Dyadic analyses showed that self-reported dominance moderated the effects of T on one’s own dominance behaviors and on opponents' dominance behaviors. Specifically, among men high in self-reported dominance, there was a strong positive association between T and their own dominance behaviors and a strong negative association between T and opponents' dominance behaviors. However, among men low in self-reported dominance, there was no association between T and dominance behaviors. These findings provide novel evidence linking T with evolutionarily adaptive behaviors in humans and suggest that T interacts with people’s explicit dominance motives to regulate behaviors that enhance mating success.

Women's intercollegiate volleyball and tennis: effects of warm-up, competition, and practice on saliva levels of cortisol and testosterone

In virtually all sports, participants "warm-up" prior to formal competition. Women athletes from a highly ranked varsity college volleyball team and, in a second study, a highly ranked varsity college tennis team gave saliva samples before warm-up, at mid-warm-up (volleyball) or after warm-up (tennis), and immediately after intercollegiate competition. For volleyball and tennis, warm-up was associated with a substantial elevation in saliva levels of testosterone which was carried over through the period of actual competition. Cortisol levels were relatively unchanged during warm-up, but typically rose during competition. Thus, as women prepare for athletic competition by warming up, testosterone levels rise in apparent anticipation of the coming contest and then remain high through the period of play. In volleyball and tennis, after-practice testosterone level was significantly higher than before-practice level, and practice session increases in testosterone (but not cortisol) were positively correlated with increases in testosterone during intercollegiate competition. When practice and competitive play share as yet undetermined key elements, individual differences in this endocrine response to "competition" appear stable across practice and intercollegiate competition.

Chewing gum has large effects on salivary testosterone, estradiol, and secretory immunoglobulin A assays in women and men

Salivary assays are increasingly prevalent in behavioral research, and chewing gum is a widely used sialogogue. Methodological investigations into sialogogues have provided mixed results, and few of these have incorporated multiple analytes, gums, and genders. To test effects of gum on salivary testosterone (T), estradiol (E), and immunoglobulin A (IgA) assays, participants (86 women; 91 men) provided two saliva samples, the first of which was unstimulated. Participants were randomly assigned to one of the following seven conditions for the second sample, which was provided after the first: No Gum or one of six sugar-free gums with one of two flavors and three brands. This design avoided the confounding of time and condition by comparing endogenously vs. exogenously induced changes in analytes. Chewing gum significantly decreased production time for the second saliva samples by 3-6 min, and had very large effects on assay results, leading to lower IgA and higher T and E in men and women. Variability was large and differed by gender/sex. Implications include strong gum-assay immunoreactivity, the importance of gender/sex in methodological investigations, and that immunoreactivity can differ in degree and direction depending on analytes.

Seasonal and circadian variation in salivary testosterone in rural Bolivian men

Testosterone (T) plays a key role in the increase and maintenance of muscle mass and bone density in adult men. Life history theory predicts that environmental stress may prompt a reallocation of such investments to those functions critical to survival. We tested this hypothesis in two studies of rural Bolivian adult men by comparing free T levels and circadian rhythms during late winter, which is especially severe, to those in less arduous seasons. For each pair of salivary T(AM)/T(PM) samples (collected in a approximately 12-h period), circadian rhythm was considered classic (C(CLASSIC)) if T(AM) > 110%T(PM), reverse (C(REVERSE)) if T(PM) > 110%T(AM), and flat (C(FLAT)) otherwise. We tested the hypotheses that mean T(AM) > mean T(PM) and that mean T(LW) < mean T(OTHER) (LW = late winter, OTHER = other seasons). In Study A, of 115 T(PM)-T(AM) pairs, 51% = C(CLASSIC), 39% = C(REVERSE), 10% = C(FLAT); in Study B, of 184 T(AM)-T(PM) pairs, 55% = C(CLASSIC), 33% = C(REVERSE), 12% = C(FLAT). Based on fitting linear mixed models, in both studies T(OTHER-AM) > T(OTHER-PM) (A: P = 0.035, B: P = 0.0005) and T(OTHER-AM) > T(LW-AM) (A: P = 0.054, B: P = 0.007); T(PM) did not vary seasonally, and T diurnality was not significant during late winter. T diurnality varied substantially between days within an individual, between individuals and between seasons, but neither T levels nor diurnality varied with age. These patterns may reflect the seasonally varying but unscheduled, life-long, strenuous physical labor that typifies many non-industrialized economies. These results also suggest that single morning samples may substantially underestimate peak circulating T for an individual and, most importantly, that exogenous signals may moderate diurnality and the trajectory of age-related change in the male gonadal axis.

Oral contraceptives decrease saliva testosterone but do not affect the rise in testosterone associated with athletic competition

Women athletes from intercollegiate soccer, volleyball, and softball teams, and women skaters from a team competing in an amateur roller derby league, contributed saliva samples before warm-up and immediately after the completion of one or more sanctioned competitions. Women using oral contraceptives (OCs, n=29) had a significantly lower mean level of saliva testosterone (T) than non-users (n=51). Thus, OCs contribute predictable variation to individual differences in saliva T, and OC use is likely to contribute to individual differences in measures of psychological processes and/or behavior which are causally related to individual differences in circulating testosterone. Most of the women (n=68) played during one or more of the competitions for which they contributed saliva samples. Whether for soccer, volleyball, softball, or roller derby, competition was associated with a robust increase in saliva T. Although OC users had significantly lower saliva T levels than non-users before and after-competition, both users and non-users showed virtually the same increase in saliva T over the course of competition. While the most proximal cause of this increase is not known, it is probably not the result of an increase in gonadotropin (GTH) secretion since an increase in GTH secretion would presumably be prevented by OC use.

Liquid chromatography-tandem mass spectrometry (LC-MS/MS) assay for simultaneous measurement of salivary testosterone and cortisol in healthy men for utilization in the diagnosis of late-onset hypogonadism in males

It is well known that late-onset hypogonadism in males can cause a variety of symptoms, and the differential diagnosis is relatively difficult, including psychological disorders, stress, and mood disturbances. The level of serum cortisol can be measured to reflect a patient's level of stress. Salivary hormones facilitate the evaluation of physiological hormonal actions based on free hormone assay. For the simultaneous measurement of testosterone and cortisol levels in saliva, we validate a sensitive liquid chromatography-tandem mass spectrometry (LC-MS/MS) assay. Concerning accuracy and precision, the lower limit of quantification of salivary testosterone and cortisol were established as 5 and 10 pg/mL, respectively. Testosterone and cortisol in saliva is stable for 2 days, 14 days, and 28 days at room temperature, refrigeration and frozen, respectively. Freezing and thawing for 3 cycles and stimulation of salivation with gum chewing do not alter the measured values of testosterone and cortisol. Total, bioavailable, and free serum testosterone showed slight diurnal changes, but total and bioavailable serum cortisol showed marked diurnal changes. Salivary testosterone levels negatively correlate with age, regardless of the time of saliva collection (r=0.64, p<0.05). However, there is no relationship between salivary cortisol and age (r=0033, p>0.05). LC-MS/MS allows rapid, simultaneous, sensitive, and accurate quantification of testosterone and cortisol in saliva for the diagnosis late-onset hypogonadism or other hormone related disease.

Devices for home evaluation of women's health concerns

PURPOSE

Devices used for home evaluation of fertility, pregnancy, menopause, colon cancer, breast cancer, and urinary-tract and vaginal yeast infections are discussed.

SUMMARY

Ovulation-prediction devices monitor natural changes in a woman's body during the menstrual cycle, including changes in basal body temperature, urinary luteinizing hormone, and urinary estrone-3-glucuronide concentrations. Also available are devices that identify changes in the content of sodium chloride and other electrolytes in saliva and cervical-vaginal mucus. Home pregnancy tests are designed to detect human chorionic gonadotropin in the urine. Both urine and saliva tests are available for home evaluation of menopause; the most common devices use urine to measure follicle-stimulating hormone. The saliva tests measure estradiol, progesterone, and testosterone. Devices for home screening for colon cancer use either the guaiac test or the fecal immunochemical test. For aid in breast self-examination, patients may use a simulated-breast product designed to train them to detect lumps or a thin, silicone-containing pad intended to increase the sensitivity of the fingers to abnormalities. Urine-dipstick tests can be used to screen for urinary-tract infection, and a swab or panty liner can be used to detect vaginal pH changes indicative of vaginal yeast infection. Home-based tests may be convenient and economical but also have limitations; pharmacists can help educate patients and clinicians.

CONCLUSION

Many devices are available to help evaluate women's health concerns at home.

Validation of salivary testosterone as a screening test for male hypogonadism

BACKGROUND

Saliva collection is an easy, non-invasive method to measure hormones.

METHODS

Two studies were performed. In the first, a convenience sample of 1,454 males who had submitted saliva for salivary testosterone measurements were studied. In the second study, we intensively studied symptoms and measurements of total testosterone, free testosterone symptoms and measurements of total testosterone, free testosterone and bioavailable testosterone in relationship to salivary testosterone in 127 men. A secondary endpoint was to examine the relationship of salivary testosterone to hypogonadal symptoms in the ADAM and AMS questionnaires.

RESULTS

In the first study, we have shown that salivary testosterone, measured in 1,454 males aged 20 to 89 years, declines by 47% over the lifespan. In the second study, salivary testosterone was strongly correlated with bioavailable testosterone (p < 0.000001) calculated free testosterone (p < 0.00001) and total testosterone (p < 0.002). Salivary testosterone was significantly related to hypogonadal symptoms on the St. Louis University ADAM questionnaire and the Aging Male Survey.

CONCLUSIONS

These studies support the use of salivary testosterone as an acceptable assay for screening for hypogonadism. Salivary testosterone is not a better assay than other measures to diagnose hypogonadism.

Effects of implicit power motivation on men's and women's implicit learning and testosterone changes after social victory or defeat

Two studies examined interactions of implicit power motivation and experimentally varied victory or defeat in a contest on implicit learning of a visuomotor sequence associated with the contest outcome and changes in testosterone and self-reported affect. In men and women, power motivation predicted enhanced learning (sequence-execution accuracy) after a victory and impaired learning after a defeat. In men, power motivation predicted testosterone increases among winners and decreases among losers, and testosterone decreases mediated the negative effect of power motivation on learning in losers. In women, power motivation predicted postcontest testosterone increases, particularly among losers. In both men and women, self-reported affective states were influenced only by contest outcome and were unrelated to participants' testosterone changes or implicit learning.

Salivary testosterone and body composition among Ariaal males

To determine if testosterone is negatively related to acute and/or chronic nutritional status among men in a subsistence society, saliva samples and anthropometric measures were compared among nomadic and settled Ariaal pastoralists of northern Kenya. Fifty-six nomadic men and 62 settled men facing drought conditions, estimated ages 22-96 years, were sampled. Measures included height, weight, four skinfolds, and %body fat by bioelectric impedance (BIA). Saliva samples were assayed for testosterone using radioimmunoassay. Overall, both body mass index (BMI) (avg. = 17.8 +/- 6.0 kg/m(2)) and salivary testosterone (T) levels (avg. am value = 176.8 +/- 74.8 pmol/l) were low compared to values from Western populations. Comparison of the two subpopulations revealed no significant difference in height, weight, BMI, or lean body mass. However, nomadic males exhibited significantly smaller skinfolds. Evening, but not morning, salivary T values differed between the subpopulations. Age-related changes in body composition included a significant decline in BMI with age, related to loss of body fat, but with little change in lean body mass. Age-related declines in BMI and %body fat were more pronounced among the nomadic males. am salivary T values declined with age; again, the decline was significantly greater among nomadic males. pm salivary T levels showed no significant decline with age. When controlled for residence and age, salivary T was positively related to %body fat and WHR ratio, but not lean body mass. These results provide evidence that salivary T is related to acute nutritional status among males in an energetically stressed subsistence population, in accordance with life history theories of somatic allocation.

The diagnostic applications of saliva--a review

This review examines the diagnostic application of saliva for systemic diseases. As a diagnostic fluid, saliva offers distinctive advantages over serum because it can be collected non-invasively by individuals with modest training. Furthermore, saliva may provide a cost-effective approach for the screening of large populations. Gland-specific saliva can be used for diagnosis of pathology specific to one of the major salivary glands. Whole saliva, however, is most frequently used for diagnosis of systemic diseases, since it is readily collected and contains serum constituents. These constituents are derived from the local vasculature of the salivary glands and also reach the oral cavity via the flow of gingival fluid. Analysis of saliva may be useful for the diagnosis of hereditary disorders, autoimmune diseases, malignant and infectious diseases, and endocrine disorders, as well as in the assessment of therapeutic levels of drugs and the monitoring of illicit drug use.

Implicit motives and gonadal steroid hormones: effects of menstrual cycle phase, oral contraceptive use, and relationship status

Implicit motives for power and affiliation, salivary levels of testosterone, estradiol, and progesterone, and relationship status were measured in 18 normally cycling (NC) women, 18 women using oral contraceptives (OC), and 18 men at three assessments, corresponding to the menstrual, midcycle, and premenstrual phases of women's menstrual cycle. NC and OC women had elevated levels of affiliation motivation and decreased levels of power motivation at midcycle. Power motive changes were particularly pronounced in NC women across cycle phases. OC women and participants not engaged in an intimate relationship had significantly heightened levels of affiliation motivation, averaged across all cycle phases. Testosterone and power motivation, both averaged across all cycle phases, were positively correlated in men and in single women, but not in women engaged in an intimate relationship. Averaged levels of estradiol and power motivation were positively correlated in engaged women, but not in single women or men. Averaged levels of progesterone and affiliation motivation were negatively correlated in men, and there was evidence for a positive association between luteal affiliation motivation and periovulatory and luteal progesterone in NC women. This study therefore provides evidence that implicit motivational states fluctuate across the menstrual cycle, that the power motive is associated with testosterone and, in women, with estradiol, and that the affiliation motive and progesterone are associated in different ways in men and NC women.

Testosterone, sexuality and antisocial personality in rapists and child molesters: a pilot study

Morning and afternoon levels of saliva testosterone levels in Finnish imprisoned rapists (n = 10) and child molesters (n = 10) were compared to those in randomly selected control subjects (n = 31). The associations of saliva testosterone with sexual behavior and antisocial personality traits were explored in all groups. The sexual offenders and control subjects did not differ in the between-subjects main effect estimated for the averaged morning and afternoon testosterone levels. Seven rapists and three child molesters met the criteria for antisocial personality disorder (ASP). In the sexual offenders, a summed ASP index was positively correlated with mean saliva testosterone. Sexual activity as estimated from self-reports of sexual intercourse and masturbation was significantly related to testosterone in both rapists and child molesters but not in the control males. The implications of these results are discussed.

Sensation seeking and hormones in men and women: exploring the link

Risky behaviors (e.g., binge drinking, drunk driving, risky sex) are increasing among U.S. college students, and the personality trait of sensation seeking provides a potential link between such norm-breaking behaviors and biological processes. We examined the relationship between sensation-seeking behaviors and two hormones, testosterone and cortisol, in male and female college students. Hormone levels were hypothesized to contribute to the variability of individual scores on Zuckerman's Sensation-Seeking Scale. As expected, males scored higher on the scale than females, but the data failed to support the generally accepted positive relationship between testosterone and sensation seeking for either sex. Instead, our results support the existence of a significant inverse relationship between cortisol and sensation seeking in men, but not in women, even after adjustment for testosterone levels and age. Our study contributes to the current literature by (a) supporting the association between risky behavior and a hormone other than testosterone, (b) being the first to examine the association between cortisol and sensation seeking in women, and (c) identifying a possible effect of gender on the association between hormones and sensation-seeking behaviors. Gendered social norms and expectations are likely to be partly responsible for this effect. Theory-guided interdisciplinary research is needed to improve understanding of the biological influences on human behavior, and special attention must be paid to social context, women's perceptions of their expected behavior, and gendered socialization regarding norm-breaking or risky behaviors, which may obscure biological links to female behavior.

Biosocial aspects of domestic violence

Domestic violence, defined as acts of verbal abuse and physical violence performed against women by current intimate main partners, was surveyed by means of the Conflict Tactics Scale. We examined the relationships between a biological variable (testosterone level), social variables (demographics, social integration), and behaviour (substance use) and self-reported domestic violence. Forced-entry OLS regression models allowed us to study how social and behavioural variables modified the effects of testosterone on this specific violent behaviour. The sample consisted of 54 men who had a main sexual partner and who identified themselves as Black, White, or Hispanic. The men were recruited from various social-service-agency sites in the area of Miami, Florida, on the basis of their risk factors for HIV/AIDS. The sample can best be described as culturally diverse men of low socioeconomic status who had a main sexual partner. A high percentage of participants reported some level of both verbal and physical aggression towards their partners. Testosterone levels were significantly associated with levels of both verbal aggression and physical violence self-reported by the men. Testosterone level, demographic characteristics, and alcohol consumption contributed to explaining the variance in self-reported verbal and physical abuse. The high heritability of testosterone level and its association with violent behaviour warrant the inclusion of this variable in studies of antisocial and criminal behaviour including domestic violence.

Sex differences in cognition: the role of testosterone and sexual orientation

The performance of both heterosexual and homosexual males and females was compared on four cognitive tasks which have been shown to reveal evidence of sexual dimorphism. In one spatial and one verbal task, significant sex and orientation effects were found. Significant relationships were also found between salivary free-testosterone levels and performance on both spatial tasks, but no significant associations were found for performance on the two verbal tasks. The present study revealed both within- and between-sex differences in cognition and indicates that these differences may be partly accounted for by the activational effects of free testosterone.

Salivary testosterone determination in studies of child health and development

Measurement of hormones in children's saliva has excited interest because of numerous potential applications in developmental studies. Although assays of children's saliva for some hormones (e.g., cortisol) are widely available and used, the availability and use of assays of children's saliva testosterone is restricted. By adapting a commercially available serum testosterone kit, our laboratory has developed a reliable, efficient, and highly sensitive procedure for measuring testosterone in children's saliva that does not require separation or extraction. The minimum detection limit was 0.8 pg/mL. Intraassay coefficients of variation (CV) were between 3.66 and 6. 78% at concentrations 9.25 to 86.41 pg/mL, and interassay CVs were between 5.70 and 6.61% at concentrations of 7.3 to 118.51 pg/mL. The standard curve was highly reproducible (M slope = -0.70 and Mr = 0. 99). Method accuracy, determined by spike recovery, and linearity, determined by serial dilution, were 99.20 and 92.80%, respectively. Values from matched serum and saliva samples showed strong linear relationships. The assay captured near 99.09% of the range of individual differences in boys' (N = 90) and girls' (N = 85), ages 8-12, am and pm salivary testosterone levels. This assay can be easily applied to the investigation of testosterone-behavior relations in the context of studies on child health and development. It may help many child development researchers improve or expand their research activities.

Testosterone changes during vicarious experiences of winning and losing among fans at sporting events

Basking in reflected glory, in which individuals increase their self-esteem by identifying with successful others, is usually regarded as a cognitive process that can affect behavior. It may also involve physiological processes, including changes in the production of endocrine hormones. The present research involved two studies of changes in testosterone levels among fans watching their favorite sports teams win or lose. In the first study, participants were eight male fans attending a basketball game between traditional college rivals. In the second study, participants were 21 male fans watching a televised World Cup soccer match between traditional international rivals. Participants provided saliva samples for testosterone assay before and after the contest. In both studies, mean testosterone level increased in the fans of winning teams and decreased in the fans of losing teams. These findings suggest that watching one's heroes win or lose has physiological consequences that extend beyond changes in mood and self-esteem.

A time-resolved fluorescence immunoassay for the measurement of testosterone in saliva: monitoring of testosterone replacement therapy with testosterone buciclate

Monitoring of testosterone replacement therapy requires a reliable method for testosterone measurement. Determination of salivary testosterone, which reflects the hormone's biologically active plasma fraction, is a superior technique for this purpose. The aim of the present study was to establish a new sensitive time-resolved fluorescence immunoassay for the accurate measurement of testosterone levels in saliva and to validate it by monitoring testosterone replacement therapy in eight hypogonadal men. A clinical phase I-study with the new ester testosterone buciclate was performed to search for new testosterone preparations to produce constant serum levels in the therapy of male hypogonadism. After two control examinations eight male patients with primary hypogonadism were randomly assigned to two treatment groups (n = 2 x 4) and given single doses of either 200 mg (group I) or 600 mg (group II) testosterone buciclate intramuscularly. Saliva and blood samples were obtained 1, 2, 3, 5 and 7 days post injection and then weekly for three months. The time-resolved fluorescence immunoassay for salivary testosterone shows a detection limit of 16 pmol/l, an intra-assay CV of 8.9% (at a testosterone concentration of 302 pmol/l), an inter-assay CV of 8.7% (at a testosterone concentration of 305 pmol/l) and a good correlation with an established radioimmunoassay of r = 0.89. The sample volume required by this method is only 180 microliters for extraction and duplicate determination. The assay procedure requires no more than three hours. In group I (200 mg) testosterone did not increase to normal levels either in saliva or in serum. However, in group II, androgen levels increased significantly and were maintained in the normal range for up to 12 weeks with maximal salivary testosterone levels of 303 +/- 18 pmol/l (mean +/- SE) and maximal testosterone levels of 13.1 +/- 0.9 nmol/l (mean +/- SE) in serum in study week 6 and 7. The time-resolved fluorescence immunoassay for salivary testosterone provides a useful tool for monitoring androgen status in men and women and is well suited for the follow-up of testosterone replacement therapy on an outpatient basis. The long-acting ester testosterone buciclate is a promising agent for substitution therapy of male hypogonadism and in combination with testosterone monitoring in saliva offers an interesting new perspective for male contraception.

Testosterone and pupillary response to auditory sexual stimuli

Low-, medium-, and high-testosterone subjects listened to four 30-s recorded stimuli while a computer system continuously measured their pupil size. The stimuli dealt with sex, aggression, and two neutral topics. Subjects dilated more to sex than to the other topics. Male and female subjects responded similarly, although low-testosterone males did not dilate as long as other subjects to the sexual stimulus. Auditory stimuli avoid a brightness artifact associated with visual stimuli. Auditory stimuli can be used in a variety of pupillometry studies, including studies of ongoing conversation and social interaction.

Age, testosterone, and behavior among female prison inmates

OBJECTIVE

The objective of the study was to determine how testosterone levels, both alone and interacting with age, were associated with criminal behavior and institutional behavior among female prison inmates.

METHOD

Subjects were 87 female inmates in a maximum security state prison. Criminal behavior was scored from court records. Institutional behavior was scored from prison records and interviews with staff members. Testoster-one levels were scored from radioimmunoassay of saliva samples.

RESULTS

Product-moment correlations revealed first-order relationships among age, testosterone, criminal behavior, and institutional behavior. Structural equation analysis suggested a causal model in which age leads to lower testosterone, which in turn leads to less violent crime and less aggressive dominance in prison.

CONCLUSION

Testosterone is related to criminal violence and aggressive dominance in prison among women, as has been reported among men. Changes in these behaviors with age are in part explained by a decline in testosterone levels.

Use of filter paper for sample collection and transport in steroid pharmacology

Field studies of androgen pharmacology are complicated by the necessity to collect, process, and store blood samples in a central facility. We have assessed the feasibility of using capillary blood spots collected by fingerprick and dried on filter paper for pharmacokinetics and pharmacodynamic measurements with nandrolone and testosterone RIAs modified for extracts from capillary blood spots. Assays on punched spots of 7.9-mm diameter (14.9 μL of dried blood) permitted accurate quantification of testosterone down to 0.4 nmol/L from a single spot and nandrolone down to 0.9 nmol/L from two spots. Stability of the steroids in dried blood spots to adverse environmental conditions, notably increased temperatures, was investigated both in the laboratory and in field studies of dried spots sent through the postal system. Storage or postal transport under moderate conditions appeared to have no deleterious effects on apparent androgen concentrations. However, under extreme conditions of storage at 50 °C for a week or more, or transport to a very hot tropical location, a rise in the final concentration of nandrolone, and, to a lesser extent, testosterone when corrected for tracer recovery, was noticed. These effects were largely due to apparent susceptibility of tritiated tracer, but not unlabeled androgens, to thermal degradation. In a pilot pharmacological study involving intramuscular injection of 100 mg of nandrolone decanoate in 1 mL of arachis oil, nandrolone concentrations in concurrently collected plasma as well as venous and capillary blood spots showed good agreement. Testosterone concentrations in contemporaneously collected plasma and venous blood spots also showed very good agreement. We propose that these methods may allow patients and experimental subjects to self-collect samples at remote or field locations for convenient mailing to a central laboratory for androgen assay. Applications of this methodology are now under way.