Hormone Testing: what to check and why

pcos belly

Many patients ask me what tests should I get for my hormones. There are several testing options available including blood tests, saliva tests, and urine tests. There are also multiple companies that provide these tests. This article covers the common hormone imbalances I see and how I test for them.

5 Hormone Imbalances to Be Aware Of

  1. High Cortisol. The adrenal glands secrete the hormone cortisol for our flight or fight response. But our modern lifestyle with high stress causes constant secretion of cortisol which burns out our adrenal glands. Low energy, waking up tired, insomnia, and feeling irritable are signs of adrenal fatigue.
  2. Low or High Estrogen. Estrogen is produced by the ovaries, adrenal glands, and fat tissue. It dominates the menstrual cycle in the first 14 days. High estrogen symptoms include brain fog, irregular menses, mood swings, breast tenderness, and weight gain. Environmental exposures cause elevated estrogen stress, poor liver function, and poor gut health. Low estrogen symptoms include irregular or absent menses, low libido, vaginal dryness, hair loss, night sweats, and migraine headaches. Low estrogen is caused by stress, nutritional deficiencies, menopause, and environmental exposures.
  3. High Insulin. Insulin is the hormone released by the pancreas that communicates with the cells to allow glucose into the cell. Symptoms of high insulin include belly fat, irritability, confusion, hirsutism, and inflammation. Long-term exposure to high insulin results in diabetes because the pancreas can not keep up with the demand.
  4. Low Progesterone. Progesterone is the complement of estrogen produced by the ovaries. Symptoms include breast tenderness, irregular menses, anxiety and depression, short cycles, and higher rates of miscarriage. Low progesterone is caused by poor estrogen detoxification, nutrient deficiencies, and stress.
  5. High Testosterone. Testosterone is produced in the ovaries, adrenal glands, as well as other tissues in the body. High testosterone symptoms include acne, hair loss, and increased facial hair. PCOS is characterized by elevated testosterone. 
top hormonal imbalances

What Hormones Do I Test?

Metabolic

I test the metabolic hormones using blood or serum tests. 

Fasting insulin and glucose are essential to calculate HOMA-IR, which gives you information about the level of insulin resistance. 

thyroid panel (TSH, free T4, and T3) evaluates a thyroid problem. 

Women over 35 often have abnormal insulin, growth hormone, and testosterone that cause weight gain. 

Sex Hormones

The female sex hormones are tested via blood, saliva, or urine. They will vary widely throughout the month, so make sure you test them on the correct day. I will review the female sex hormones and when to get them tested. 

FSH and LH 

FSH & LH are pituitary hormones that stimulate the ovaries to make estrogen and progesterone. The two that coordinate estrogen and progesterone release from the ovaries are stimulating follicle hormone (FSH) and luteinizing hormone (LH). It should be tested around day 3, no later than day 8.

Normal FSH Values: 

  • Menstruating women 4.7 to 21.5 mIU/mL (4.5 to 21.5 IU/L) 
  • Post-menopause 25.8 to 134.8 mIU/mL (25.8 to 134.8 IU/L) 

Normal LH Values: 

  • The follicular phase of the menstrual cycle: 1.9 to 12.5 IU/L 
  • Mid-cycle peak women 8.7 to 76.3 IU/L 
  • The luteal phase of the menstrual cycle is 0.5 to 16.9 IU/L Post menopause 15.9 to 54.0 IU/L

LH: FSH Ratio Normal is typically 1:1. If LH is double the FSH value, this can indicate PCOS.

Estrogen

Test on day 3 of the cycle.

Estrogen values: 25-75 pg/ml Elevations over 80 on day three can hinder ovulation (suppression of FSH). 

Low estradiol can be seen in menopause or with low ovarian reserve. Pg/E2 Ratio Ratio of estrogen to progesterone (Pg/E2 ratio) can also be helpful. It should be between 100-and 500. Lower ratios indicate lower progesterone vs. estrogen; thus estrogen dominance. Elevated is progesterone dominance or at least relatively low estrogen. 

DHEA-S 

DHEA-s is an adrenal-based androgen. DHEA-s can be converted into testosterone and then estrogen. Elevation of DHEA-S can indicate an adrenal-based PCOS issue. Low levels are seen in inflammation and HPA-axis dysfunction (commonly called adrenal fatigue). 

Typical normal ranges for females are: Ages 18 to 19: 145 to 395 µg/dL or 3.92 to 10.66 µmol/L Ages 20 to 29: 65 to 380 µg/dL or 1.75 to 10.26 µmol/L Ages 30 to 39: 45 to 270 µg/dL or 1.22 to 7.29 µmol/L Ages 40 to 49: 32 to 240 µg/dL or 0.86 to 6.48 µmol/L Ages 50 to 59: 26 to 200 µg/dL or 0.70 to 5.40 µmol/L Ages 60 to 69: 13 to 130 µg/dL or 0.35 to 3.51 µmol/L Ages 69 and older: 17 to 90 µg/dL or 0.46 to 2.43 µmol/L You will see it typically on labs as 41.2 – 243.7 ug/dL but use age ranges to know for sure. 

What Test is better? 

I always start with blood tests. The tests listed above can be obtained at a conventional lab, and any doctor can order these. 

If we want to dive deeper into the "why " then I use saliva or urine tests. 

DUTCH

Dried Urine Test: Looks at the above hormones as well as their metabolites (how the hormones are broken down). MY favorite is the DUTCH Complete Test. It includes:

  • Progesterone & progesterone metabolites
  • Estrogen & estrogen metabolites
  • Androgens & androgen metabolites
  • Cortisol & cortisol metabolites
  • Cortisone
  • Creatinine
  • DHEA-S
  • Melatonin
  • Neurotransmitter organic acids for dopamine and norepinephrine/epinephrine
  • Nutritional organic acids for B12, B6, and glutathione
dutch test sample

SALVIA TEST (zrt)

Can measure sex hormones and cortisol

Measure 4x a day

I use it for HRT management

Pros: Great for adrenal fatigue, hrt management.

Con: Cost, $350/test

Takes some time.

zrt
zrt results

How to Test Your Hormones at Home?

You can order basic blood work panels through EverlyWell without a doctor's order. Or the functional medicine tests mentioned above are ordered through a functional or integrative medicine doctor but done at home. 

Follow me on Instagram, or You Tube to learn more about how to balance your hormones and reclaim your health.

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Hey, it's Dr. Jen.

I am so glad you are here! OB/GYN. Mamma of 4. Self-proclaimed foodie. Avid outdoor enthusiast. I am a hormone guru who healed my own PCOS and hypothyroidism through diet and lifestyle shifts.

My natural medicine blog contains tips about health, natural living, and some of my favorite hormone-friendly recipes.

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Dr. Jennifer Roelands

I’m an Integrative Medicine trained OB/GYN and expert in PCOS who healed my own PCOS and hypothyroidism.

I partner with patients to uncover the underlying causes of their unexplained symptoms so they can feel like themselves again.

Using holistic medicine, functional testing, and mind-body tools I create personalized plans unique to your root cause(s) to remove obstacles to healing, correct imbalances, and allow the body to heal.

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