acceptable evidence that 'bioidentical' hormones are safe or effective. Patients should be discouraged from taking them." Salivary testing and compounding BHT is frequently associated with the testing of saliva to establish a baseline hormone level and compounding of the substances by pharmacists (according to a doctor's advice) to produce preparations (and blood levels) of hormones that are specific to each patient. There is no research demonstrating any benefit to either of these practices. Although promoters of BHT claim that saliva testing can be used to customize hormone levels for individuals, and tests are used to determine which hormones are supposed to be deficient and require supplementation, there is no scientific basis to support the use of saliva testing. Estrogens are secreted in pulses within and over days, resulting in varying levels in saliva. Certain compounding formulations also attempt to use a single profile for all women, with no evidence that a specific profile is beneficial in all cases and no recognition that women differ in their sensitivity to hormones and metabolic rate. Testing-based customizing also does not account for much of the effects, and synthesis of hormones occurs within tissues rather than in the blood, so blood or saliva hormone levels may not necessarily reflect the actual biological activity. Other concerns include lack of evidence that samples are stable during storage and transportation, poor replication of results and considerable variation among assays. There are also no studies that link symptoms with blood or saliva hormone levels. The FDA recommends adjusting hormone therapy to the symptoms of the patient, and that there is no reason to adjust the dosing or monitor patients receiving BHT. BHT skeptics have also pointed out that there is no certainty regarding hormone levels in the body. The North American Menopause Society has supported warnings about the potential harm BHT could cause, as it unnecessarily compounds drugs that are already FDA-approved in ways that lack an evidence base of safety or harm. The warnings are supported by the Society of Obstetricians and Gynaecologists of Canada. Although promoted as a way of customizing treatment, hormone therapy does not require customization; the use of testing to determine the number of hormones administered could result in the dose being higher than the minimum recommended level to alleviate symptoms, or the administration of unnecessary hormones to asymptomatic women may result in greater risks to the patient. Analysis of the material used