03 Dec Hormone Testing
This is an excerpt from “Awakening Athena” by Kenna Stephenson, MD. In some instances, I have added some information.
Testing Hormone Levels
Hormone balance is essential to good health for women of all ages. Unfortunately, the accuracy of the tests used to determine hormone levels varies widely. Below are the types of tests that can be used to determine hormone levels:
24-Hour Urine & Saliva Testing
Saliva testing has been used in clinical research, including studies conducted at the National Institutes of Health (NIH) for more than 30 years. Urine and Saliva testing has been available to physicians for over a decade, and many insurance companies provide reimbursement. Over years of clinical practice, it has been shown that these tests are the most accurate measurement of the body’s availability of the hormones Cortisol, DHEA, Estrogen, Progesterone, and Testosterone. Urine & Saliva more correctly identify the level of hormones at the cellular level, in contrast to a serum (blood) test, which measures the level of hormones circulating in the bloodstream.
Saliva testing is not helpful, however, to monitor women who are taking hormones in a sublingual (drops or spray) or tansmucosal (lozenge or troche) format. These forms of hormone delivery concentrate the hormones in the salivary glands and the resulting saliva levels are too high to be useful. 24-Hour Urine testing is preferred in these cases. Saliva is best reserved for adrenal hormone testing while the 24-Hour Urine test is best for measuring all the body’s sex hormones.
Serum or Blood Testing
Most serum tests define the normal range of hormones very broadly, which is a distinct disadvantage to their use. After a woman’s blood has been drawn, a portion of the blood sample (the serum) is used to measure hormone levels. Most serum testing measures the level of “free” hormone (the hormone that can easily enter the cell), the level of the “total” hormone (the hormone attached to substances that carry hormones in the bloodstream), or a calculated combination of both free and total levels of hormone. It is not an accurate reflection of the bioavailable hormone (the amount of hormone that is active in organs and tissues). In addition, the results of the serum testing are often inconsistent, especially if the hormone value indicated is in the low-normal range. Serum testing is less helpful in monitoring women using transdermal (patch or cream) forms of hormones, as the hormone is bound to the red blood cell surface and does not register in the serum in very high amounts.
I do however opt for blood testing in most cases with my patients as a cost-conserving option. If however, a woman’s serum test results are normal and I cannot understand why she continues to experience the symptoms of hormone imbalance or if I’m treating more complicated cases of infertility, PCOS, or reproductive cancer, the 24-hour Urine or Saliva testing provides a more exact range of normal results.
Follicle-Stimulating Hormone (FSH) Testing
FSH, another serum test, is frequently used to determine the hormonal status of premenopausal women who may complain of hot flashes, mood changes, or other symptoms. The FSH test should not be used as an accurate measure of sex steroid hormone production or as an indication of reproductive status for most women, because the level of FSH fluctuates widely during the decade before menopause.
A properly conducted FSH test requires that blood be drawn three times at 60-minute intervals beginning precisely at 8am. The FSH reference ranges are based on the average of those three levels. In many cases, only one blood sample is drawn for evaluation, usually during the appointment with the woman’s physician at a time other than 8 a.m. The vital clinical decisions about a woman’s hormonal status and subsequent treatment are usually based on that single test. When hormone imbalance is detected early and steps are taken to correct it, symptoms can be relieved, and progression to disease states may be prevented.