How The Latest Hormone Testing Can Help You Get Back Into Balance
If you suspect hormone problems, but the test results that your healthcare provider ordered appear to be normal, you may need a better test, doctor, or both. Hormone testing can be overly simplified, or overwhelmingly complicated. That’s why it’s extremely important to take an investigative approach to look deeper. This article lists the different types of tests available, and will help you decide which test method is best for you.
Saliva hormone testing
If you’ve had any lab work ordered from your medical physician, you probably had one of 2 types of tests: saliva or blood (serum). More commonly, saliva samples are taken to measure hormones like estrogen and testosterone. There are two major issues with this:
- Serum (blood) testing is more reliable and is considered the gold standard
- Saliva testing traditionally only looks at the basic forms of testosterone, estradiol, and progesterone, while ignoring the other metabolites, or forms. This is crucial because different metabolites of hormones have different physiological effects. One example is that 5a-DHT has a different androgenic effect than 5b-androstanediol.
Serum hormone testing
If you’ve had blood drawn to measure your levels of hormones, be aware of the pitfalls of this type of testing:
- SHBG (sex hormone binding globulin) is a protein in blood that strongly binds the majority our hormones like testosterone. When hormones are bound to SHBG, they do not actively impart biological effects on our tissues. Think of hormones bound to SHBG like cash in a safe. You can’t spend that cash until you’ve unlocked your safe, and physically pulled the money out. Since only 1-5% of hormones in our blood are free, or bioavailable, blood measurements don’t give you the whole picture (1).
- Blood tests typically ordered do not measure other biomarkers beyond the basics. Many times, your doctor might only order testosterone, DHEA, estradiol, and progesterone. They may order DHEA-S and a few cortisol points if you’re lucky. In order to see how your body is producing and metabolizing these hormones, you’ll need a test that does more.
The Multiple Variables When Measuring Hormones
When it comes to hormone testing, do not fall into the limited mindset that it’s all about how much we produce. All too often, we overlook the critical fact that hormone metabolism and detoxification play equally important roles. Many physiological processes affect hormone production and metabolism, from nutrition, physical activity, stress management, sleep hygiene, and more. Exposure to environment toxins that we may not consider toxic significantly impair our cellular production of hormones. This study shows fetal exposure to BPA, a ubiquitous material in today’s world of plastics, impairs the development of reproductive germ cells (2).
Let’s take a look at one possible cause of hyperandrogenic (too much testosterone). If we see high levels of testosterone on a test, we might assume this person was producing way too much testosterone, or they are supplementing with supraphysiologic levels (not good for men, and really not good for women). However, without measuring other, more implicit testosterone metabolites, we may see that this person has normal testosterone metabolism. So what gives? Since the majority of circulating testosterone is tightly bound to SHBG, this person may have low SHBG levels, increasing the bioavailability of circulating testosterone(3). This may show up as acne, male pattern baldness, excess facial hair, or even infertility.
In order to accurately assess how our body is producing, metabolizing, and detoxing hormones, we need to look at more than just the basic forms of each hormone. To grasp a fuller picture, we need to measure the following:
- DHEA, DHEA-S, etiocholanolone, androsterone
- Testosterone as 5a-DHT and androsterone
- Estrone, estradiol, estriol
- Free cortisol rhythm, and total metabolized cortisol
A More Comprehensive Approach
The DUTCH test measures a large amount of hormones and metabolites to give you lots of information about your hormonal health. If conventional saliva/serum cortisol testing is a still frame picture of your hormones, the DUTCH test is movie. It offers a simple, easy way for you to capture your cortisol rhythm throughout the day and evening. And since cortisol is an extremely important influence on the rest of your sex hormones, you’ll see the relationship between cortisol and all the other hormones. The DUTCH test also indirectly measures organic acids for neurotransmitters like dopamine and serotonin, but I’ll save that for another post.
Meanwhile, you can read more about the efficacy and accuracy of the DUTCH test here.
If you’re interested in getting a full, comprehensive look at your hormonal health, check out our functional medicine approach.