In my naturopathic medical practice, I commonly have patients come in who want to have their hormones tested. They feel something isn’t right. They don’t feel their best, and they suspect that hormones are to blame, so they want to be tested. But hormone testing isn’t as simple as it seems. We have to find the right type of test for the individual. The good news is that there are more options than ever for investigating hormone imbalances in men and women. With the right information, we can target our therapies to directly address the core of the issue and get better results faster.
When premenopausal women have something clearly abnormal going on with their hormones, it’s a good idea to do blood hormone testing. For instance, if a woman rarely or never menstruates, we need to rule out conditions like pituitary tumors, autoimmune diseases of the ovaries, and Polycystic Ovarian Syndrome (a.k.a. Anovulatory Androgen Excess). I generally run an extensive panel of pituitary and ovarian hormone levels in those cases.
If a woman is menstruating normally but still feels her hormones are off, the utility of blood testing is questionable. Testing must be timed with the cycle to make any sense of the numbers. But the reference ranges of what is considered normal are so large that most times women will be told they fall somewhere within what’s considered the “normal” range. That’s not helpful for someone who is infertile, or who suffers from serious PMS, low libido or chronic fatigue.
In cases where we need more information to get to the root of the hormone imbalance, urinary hormone panels are proving to provide a lot of nuanced information. The advantage of a comprehensive urinary hormone metabolite analysis is that it not only gives information about the typical hormones like estrogens, progesterone, androgens, cortisol and melatonin, but it also looks at their precursors or parent hormone. So if any levels are off, we can look upstream to see where the problem started. Urinary hormone testing also shows how the hormones are being metabolized or broken down. Sometimes it’s the breakdown products of the hormones that are the problem.
We also know that all the hormones are deeply connected. The thyroid, pituitary, ovarian/testicular, and adrenal hormones all affect each other. Urinary hormone testing can give insights as to the interplay of these four systems. Then we can target our efforts to get the greatest ripple effect on the whole hormone system.
Salivary hormone testing is another option for hormone testing, but it just isn’t the best way to test for hormones like estrogen and testosterone. I reserve this method for testing the adrenal hormones cortisol and DHEA. For people with insomnia, chronic fatigue, or anxiety, getting insight on the hypothalamus/pituitary/adrenal axis can shed light on these chronic issues. Since cortisol levels change throughout the day, it’s great to be able to collect a simple salivary sample four times a day. That said, urinary hormone metabolite panels also can be done four times a day, and they provide all that information and much more.
To monitor hormone levels in women who need to take prescription hormone replacement therapy in perimenopause and menopause, blood testing or even urinary testing can be utilized. Naturopathic physicians can order these lab tests for their patients, and extended health insurance often helps cover the costs.
So if you have been told your hormones are “normal” but you suspect that something is not quite right, there may be other ways to get answers.