Hormone Testing - The How, Why, and Details
This is a HOT topic. So many women either know or suspect they have a hormone issue. Often, they are not offered proper hormone testing when they seek help. They are told something like "You are too young to have those issues" or "Wait until you miss your cycle for X months and then we will test your hormones" or my favorite... "I don't see anything out of range" when the blood work results come back.
So, let's talk about why you might want to have your hormones tested:
1) It's your body and you want to know what's going on. You don't need to have any "symptoms" to want to make sure everything looks good. This is very proactive and a great idea, but most people react more to symptoms and problems than to proactive health management. Some of the testing can help you evaluate possible future risk of breast cancer which I think is enough of reason by itself. I love when people fall into this proactive category, and I will always help someone assess their health whether symptomatic or not!
2) You are experiencing irregular menstrual symptoms like heavy bleeding, cramping, mood swings, anxiety, etc. Anything out of the ordinary for you is worth investigating.
3) You are Peri or Menopausal and having debilitating issues like hot flashes, vaginal dryness or atrophy, low libido, etc. These are miserable and can be helped!
4) You are having Fertility issues like trouble conceiving or maintaining a pregnancy.
Most people seek out help for one of those reasons. I have seen and dealt with all of them in practice. They are devastating and can seriously effect your quality of life. It makes me so angry when I hear a patient tell me another doctor has told them they won't test their hormones because they have had a hysterectomy or that they are old and will just have to deal with their hot flashes, vaginal dryness or whatever they are experiencing. Often, there is something that can be done. This is where a functional work up and testing is super helpful.
Asking the right questions is the starting point. This takes more than 5 minutes, which is all most insurance based providers are able to spend with patients. After you ask the right questions, you can order tests for the patient. There are 3 options for hormone testing:
Blood (serum) - This measures a one-time snapshot of hormones that are bound to carrier proteins in the bloodstream. This gives us an approximate indication of how much hormone is availalbe for use, but is more of an estimate since hormones bound to carrier proteins are not active. This has been the "gold standard" for years and is the fastest, least expensive and easiest way to test hormones, especially if you are already drawing labs. This provides some information. I recommend this for patients where we want to assess hormone levels in the context of overall health. Meaning, it's not a deep dive, but it's a good estimation of whether hormones are doing what they should be doing. I usually recommend this for those who want to know about their hormones, but it's not the main concern and they are not battling a specific hormone complaint or issue like those listed above
Saliva - This has some advantages over blood. First of all, the Saliva panel I use includes an adrenal stress index which is very helpful. Both the reproductive and stress hormones are measured at intervals throughout the day, which is much more useful than the one-time blood test since hormones fluctuate widely throughout the day. Saliva testing also measures the free (unbound) levels of hormone so we know how much hormone is actually free and useable. In the blood, all the hormone is bound, so we don't have that info. This is a step up from blood testing in terms of the comprehensive nature of testing.
Urinary Metabolites (Dutch Testing) - This is, in my opinion, the most comprehensive hormone test available. Samples are collected over a 24 hour period so you have all the benefits of catching the fluctuations like you did with saliva. You also measure the free levels of hormones vs. the bound hormone. With urine, however, you also get to see how the hormones are being broken down and metabolized by the body. This is not available in blood or saliva. This is true for stress hormones and reproductive hormones. Because we can see this, we know if the issue is the hormone production itself or the way the body is or isn't breaking down and eliminating hormone metabolites. In my opinion, this is super helpful to help with the underlying causes of hormone disregulation. This is my favorite test. If someone is having hormone-related issues, I recommend this test. It is the most expensive test option, however, which is why I will use saliva in those cases where it just isn't financially feasible.
I have created a graphic that shows these types of tests
I hope you found this information helpful. If you would like to discuss your individual hormone concerns, I am happy to jump on a free discovery call and walk you through some testing options if I think that would be right for you. Just click below!
To your health,