How I Test Your Hormone Levels, And Why.
I often hear my patients tell me in their initial appointments that they are fatigued, overweight, irritable, having menstrual issues, or suffering from hot flashes. When I hear of these symptoms from them, I want to get a picture of where their hormones are as these signals are indicative of what is going on in their body. Without an understanding of what state their hormones are in, it is difficult to know exactly how to get to the root cause of these issues. Often patients with the above symptoms are given antidepressant medications that often do not work for them, and so they search for another option.
Often my first step is doing hormone testing. For me, there are three main organ systems I want to look at: the adrenals, sex hormones, and thyroid. The mentioned symptoms can also apply for my male patients as well, but with a low libido rather than menstrual issues.
Doctors test hormones differently. Options include saliva, blood, or urine. When I am testing sex hormones (estrogen, progesterone, testosterone and DHEA) I will use urine, or saliva testing. If a patient is on hormones I will use urine testing as I want to see what the body is eliminating. If she is menstruating then I will do a month long saliva test looking at her estrogen and progesterone levels throughout her cycle. For my post-menopausal women I will do either a 1 or 3 day collection of saliva hormones.
As for the Thyroid testing it is always, and only, done through blood where I will look at TSH, free T4, and free T3. For some patients, I will also look at thyroid antibodies as these will be important in how I treat my patient.
The adrenals, in my world, are always tested through saliva. I will have my patients spit four times in one day as there is a rhythm to the cortisol being released by the adrenals. Cortisol levels are going to be the highest in the morning, and as the day goes on the cortisol levels will get lower. Our cortisol will rise as we sleep so that the level will again be high in the morning which will help us to wake up.
For all of these hormones, it is important to not only look at their range, but to look at their relation to the levels of other hormones. This is especially important when looking at estrogen and progesterone as they need to be in balance with each other. If either one is high, the body will show signs of not only the high one, but also signs that the other is low in relation. This will also happen if, lets say, estrogen is normal, and progesterone is very low. The body will then be dealing with not only low progesterone symptoms, but also “high” estrogen even though estrogen is not truly high. It is all relative. Because of this I often find it important to look at hormone levels before treatment is initiated to make sure the right course is being taken.
If you are dealing with hormonal symptoms, or are just not feeling like yourself just remember that your hormones are in control. If you are going through peri-menopause, menopause, or dealing with fertility issues then looking at your hormones might be one important step to help support your body.