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The best way to test your hormones is going to depend on which hormones you want to get tested, and unfortunately there is not one perfect test that does “everything”! So if you have the many different symptoms of hormone imbalance then this guide to hormone testing will help you decide the best way to test your hormones.
The three main methods of testing your hormones include blood, saliva and urine testing, and they all have there own advantages and disadvantages. This article will describe the different testing methods and the best time to use each kind of test when testing your hormones.
When people think of hormones they often think about the sex hormones, or thyroid hormones, but there are many different hormones in the body including the adrenal hormones cortisol, cortisone and DHEA, plus other hormones like insulin, growth hormone, leptin, ghrelin and many others.
The main hormones we are going to focus on are the sex hormones, adrenal hormones and thyroid hormone, if you are interested in testing some of the other specialized hormones contact us and I will let you know the best options.
The standard thyroid test done by your doctor usually only includes Thyroid Stimulating Hormone (TSH), and if that is in the “normal” range then you are told that your thyroid is fine. But TSH is only the message from the brain to the thyroid, so the TSH test is not actually testing thyroid function, and while the TSH levels are important, if you have the symptoms of low thyroid function then it is important to get a comprehensive thyroid test.
Also the reference range for TSH is very broad which is what most doctors look at, but the optimal range is between 0.5 and 2.5, or even less than 2.
The most common way to test thyroid function, and the test that is considered the gold standard is a blood test, but it is important that you get a complete thyroid test and not just the TSH test.
You can still have normal TSH and even normal T4 levels but have a low thyroid function, check out this video below and I explain the importance of the complete thyroid test, and show a number of different examples of “perfect” TSH levels but low levels of the metabolically active T3. Note the measurement units in the U.S are different but the principal is still the same.
You can also test thyroid function using a 24 hour urine sample, this is not commonly done due to the inconvenience of collecting a 24 hour urine sample, but it is a good option for anyone who has a phobia with needles, or has another reason why they cannot do a blood test.
The thyroid urine test does not measure TSH but it does measure free T4 and free T3 and the results correlate well with blood testing. Another advantage of urine testing is that you can also test selenium, iodine and tyrosine which are the cofactors in making T4 and helping with T4 to T3 conversion.
The sex hormones can be tested using blood, saliva and urine, with a blood test being the most common method used by doctors. Once again there are advantages and disadvantages to each method and we will go through each one, this will help you assess what is the best option for you.
When you go to a doctor you are commonly only tested for estradiol, progesterone and testosterone, just getting these markers tested is not going to tell you a lot about your hormones as it is measuring total hormone levels and not the free “bioavailable” hormones.
However blood testing can be quite valuable if you if you do a more extensive sex hormone test, one of the advantages of blood testing over saliva testing and urine testing is that it can assess Luteinising hormone (LH) and Follicle Stimulating Hormone (FSH) which is the hormone messages from the pituitary to the ovaries or testes telling them to make more hormones.
The disadvantage of blood testing is that you cannot assess the metabolites of estrogen to assess estrogen detoxification, poor estrogen detoxification is associated with cancer, fibroids and PMS. You cannot assess the metabolites of testosterone including 5a-DHT which is the more androgenic form of testosterone, but very high levels are associated with acne, hair loss and cancer.
It is because of these disadvantages that I recommend the DUTCH hormone test which we will discuss in the urine testing for hormones.
This is my favourite way to test sex hormones using the DUTCH Hormone test and you can read my complete review of the DUTCH test where I discuss all of the different things it assesses besides the sex and adrenal hormones.
The advantage in urine testing is that it can assess the sex hormones plus how your body is metabolizing the hormones, this is important when you are assessing why the hormone levels may be out of balance. It also assesses the free hormones, this is what is available to the body and not just the total hormone level.
Another advantage of urine testing is that the test can be done at home without the need to go to a lab, this is convenient and saves time, urine testing is also great for people who don’t like needles.
One of the disadvantages of urine testing is that it does not assess LH and FSH, so it cannot tell you what messages are being sent from the brain to the ovaries or testes. LH and FSH are important markers and if someone does have major hormone issues I will often recommend that they test both blood and urine levels.
The DUTCH hormone test is the best way to assess the urine sex hormone levels, it also assesses adrenal function and this is important as adrenal hormone imbalance can be one of the main causes behind an imbalance in the sex hormones.
This image below gives you a list of all of the sex hormones that are assessed on the DUTCH hormone test.
This is a good way to assess the bioavailable sex hormones (and free cortisol), including the 3 different types of estrogen, testosterone and progesterone.
The saliva test is easy to do like the DUTCH hormone test, as it can be done at home and then shipped back to the lab, some people do have issues with getting enough saliva which can be a problem.
The saliva test does not give you the metabolites of the sex hormones which is why I prefer either the DUTCH hormone test or the extensive blood testing.
Once again the adrenal hormones can be tested with blood, urine or saliva testing and this time blood testing comes in a distant third with the urine test a clear winner if you do the DUTCH Hormone test.
The reason that blood testing is so poor for assessing adrenal function is that it is only practical to do one sample in a day, but cortisol and cortisone levels fluctuate throughout the day and this is very important when assessing adrenal function.
A blood test for cortisol is normally done in the morning, and if done through a doctor will only assess total cortisol, and not the bioavailable free cortisol. It is possible to also test cortisol binding globulin which will help to assess the free cortisol level, but it still only gives one snapshot of your cortisol levels.
I would only recommend blood testing as part of an overall blood test just to give you a bit of an idea of your morning cortisol, and only if cortisol binding globulin is also tested.
This is my favourite way to test the adrenal hormones, and that is because we have the DUTCH hormone test. DUTCH stands for Dried Urine Test for Comprehensive Hormones, and as the samples are collected on a special litmus paper before being left to dry, they are very easily mailed back to the lab for analysis.
The reason the DUTCH hormone test is the best for assessing adrenal function is that it measures total cortisol production over the day, plus it measures your free cortisol levels at 4-5 different points throughout the day so that we know your cortisol rhythm which is also important.
The DUTCH hormone test also measures cortisone and the metabolites of cortisol and cortisone which can help to understand how quickly your body is metabolizing these hormones.
Below is an image of all of the markers on the adrenal section of the DUTCH hormone test, this is on top of assessing all the sex hormones in the image above. The new DUTCH test also measures melatonin and some organic acid markers for inflammation and nutrient deficiencies.
For a long time testing adrenal function using saliva was the go to standard as it measures free cortisol levels, and it is easy to do 4 different samples throughout the day to assess the rhythm of cortisol.
But the saliva test does not measure your total cortisol production, or how your body is metabolizing cortisol so just knowing your free cortisol levels can be a bit misleading.
It is possible to be producing a ton of cortisol but the saliva test will only show very low levels of free cortisol, or the opposite can occur. Without knowing all of the information it is impossible to know what is happening with the adrenals so that I can recommend the right treatment plan.
The only time that I can see the saliva cortisol test being valid is if it is also combined with a 24 hour urine test to also assess total cortisol production, but it would be a lot better and easier to do the DUTCH hormone test.
At Planet Naturopath we provide hormone testing for all of the recommended hormone tests. The clear winner for testing thyroid function is blood testing and you can order this test at the Extensive Thyroid Test page.
For assessing your sex hormones, adrenal function and other health markers I highly recommend the DUTCH test which you can order at the DUTCH Hormone Test page.
When assessing your sex hormones sometimes a good option is also blood testing, especially if you want to assess LH and FSH which are messages from the brain to make hormones, contact us to order this test.
If your not sure what is the best option for you then schedule a consultation and I will help guide you through the best options to help you improve your health.
Michael is head consultant at Planet Naturopath - Functional Medicine and Nutrition Solutions.
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