Hormone Testing 101
There is a ton of mixed advice on the topic of hormone testing and I’m sure that each hormone expert has a slightly different opinion on this complicated topic!
Here at Nourished with Nina, my job is to give you the most valuable information I know, collected by various hormone experts and resources! ;)
In this post, I will give you an overview on the pros and cons of hormone testing, as well as some some valuable testing resources, so you can make an informed choice about what is best for your unique situation.
The first important thing to note here is that your hormones are CONSTANTLY changing.
They shift cyclically during the 4 phases of your menstrual cycle (menstruation, follicular, ovulation, and luteal), and can even vary on the day-to-day!
For example, estrogen is the highest during the first half of your cycle and begins to decline as progesterone takes over in the second half. This is the standard cyclical dance from month-to-month.
Even so, your body’s hormone levels can also be affected on the day-to-day. What you eat in a single day, how you exercise, and even your daily stress levels can alter your hormone levels.
All this to say, if and when you decide to test, it’s important to note that specific tests only show a “snapshot” of your hormonal picture. And, at times, may be an inaccurate depiction of your true levels.
this is why it is important to know about the different hormone tests out there, what hormones are being tested, and how to interpret the accuracy of your results.
The 3 popular tests
Serum (blood) test
When you walk into your physician’s or gynecologists’ office, it is standard practice that they will run a female hormone panel through a blood test.
This test will give you information on your major female hormones: estrogen, progesterone, FSH (follicle stimulating hormone, LH (luteinizing hormone), SHBG (sex hormone binding globulin), prolactin, and thyroid hormones.
This is, of course, wonderful information to have! But, there are a few downsides to the standard blood test that you should be aware of…
Although it’s nice to know the level of specific hormones in your blood, this number doesn’t actually tell us much about your overall hormonal health.
This is because a blood test doesn’t account for the free and active use of a specific hormone in your blood. It only tests for the total or “bound” hormone levels present.
Meaning, you may fall in the “normal” range for progesterone in your blood (for example), but you actually have no clue how much of that progesterone is bioavailable (or free) and being used by the body.
This is a huge problem when trying to get to the root of your hormone imbalances. A blood test can come back as “normal” but you still feel absolutely terrible, or perhaps are still struggling with fertility issues.
“Imagine you have a baseball team on the field. Think of your total, bound hormones, as the guys sitting on the sidelines. The free hormones are the guys actually playing the game. Now, does it matter who is sitting on the sidelines or who is playing in the game? We need to know who is playing on the field.”
The total level doesn’t matter if the “players” aren’t performing well. And this is where a blood test falls short. Also keep in mind that the normal range of these hormones is very broad. Meaning, if your results are on the low or high end of the spectrum, and still considered normal, you can STILL be struggling with unwanted symptoms.
Finally, a blood test only shows your hormones as a snapshot in time. This is why some naturopathic doctors and and functional medicine doctors prefer the saliva and dutch test to get a more specific and more comprehensive overview of how your hormones are actually functioning in the body.
Not only are saliva tests non-invasive (not everyone likes needles!) but they also allow you to take multiple samples over the course of a day or even a month. This can give you A LOT of really valuable information (especially if you test over 30-days) as to your overall hormone levels.
In addition, saliva tests look at your free and bioavailable hormones … so what your body is actually able to use! This is really nice, because then you can affectively match your menstrual symptoms with the correlating data.
Saliva tests also collect the level of cortisol in your system. When it comes to adrenal issues, chronic fatigue, anxiety … (and much more) information on this hormone is extremely helpful.
One downside to the saliva test is that it cannot test thyroid hormones (another very important piece of the puzzle). This is where a blood test is highly recommended.
Saliva tests are also not usually not covered by insurance. Whereas a doctor can usually get insurance to cover the cost of a needed blood test, unfortunately, saliva typically comes out of pocket.
Having said that, this is a test that you can also order on your own! But I highly recommend finding a naturopathic and functional medicine doctor you can trust to interpret the results.
Dutch (Urinue) Test
I just learned more about the DUTCH test in a fabulous interview of The Period Party a few days ago.
Honestly, I have been looking at testing my hormones again, and I think this is the way I am going to go! Although I haven’t experienced this test for myself ….YET… I wanted to give you all the information I have gathered on the resource thus far.
Just like saliva, a urine test looks at your bioavailable hormone levels. This is a total win! Remember, it’s the level of hormones your body can actually use.
The Dutch test is also proving to be the most accurate and comprehensive of all 3 tests, and the more detailed information you can get out of testing, the better.
Am I right? Here’s why…
The Dutch test collects 4 dried urine samples. These samples are then tested for the free cortisol level in your system and also the metabolites (how you body processes) the estrogen, progesterone, androgens, and cortisol in your system.
Testing the metabolites (unique only to urine tests), and knowing HOW your body is processing and eliminating your hormones, allows you to gain further insight on how to heal your imbalances and follow a more detailed protocol. It’s not always just about the level of hormones, but what your body is actually doing with them.
Urine test to check out: DUTCH Test
Timing is very important
As with all testing, timing is crucial.
It’s best to test (rhyming not intended, haha!) around day 21 if you have a typical 28 day cycle. If you have longer cycles, you can plan to test about 7-10 days before your period is expected.
Again, this is all bio-individual according to the specific tests you need, but if you’re trying to test for low progesterone levels for example, testing at the beginning of your cycle would make zero sense as that’s when your progesterone levels are the lowest to begin with! Ya with me? :)
So, should you test?
This is totally up to you!
There are obviously pros and cons of all 3 tests, their results, and their accuracy. In addition, testing can be quite expensive.
In my personal opinion, there is a lot you can do nutritionally and through lifestyle modifications FIRST before spending the money on testing. Give yourself at least 3 months of making some necessary changes, and see how you feel!
But, if you have been struggling for a while and your symptoms or not getting better - testing is a fantastic way to get some insight. I loved seeing the results of my saliva test a couple years ago and I am exited to try out the Dutch test in the near future.
The more information you have, the more informed choices you can make! And I am all about backing you with the most information possible so you can become your own health advocate and starting healing :)
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This blog post is for informational and educational purposes only. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis.