Written by: Dr. Janine Mackenzie, ND
One of the most common things I test in my patients is hormones. Traditionally, hormone testing has been done using serum. Recently, saliva and urine have gained popularity.
Each method of testing has its own advantages and limitations, and each has its best use.
Serum Testing aka Blood Testing
This is the most common way to test hormones. If you asked your medical doctor to test your hormones, you will be sent for blood work and the liquid portion of your blood will be examined. This way of testing has its advantages. Simple collection, little patient involvement, well established reference ranges, and these values are widely understood in the medical community no matter what specialty.
This type of collection is ideal for peptide hormones like LH, FSH, prolactin, fasting insulin, thyroid hormones, antibodies, and sex hormone binding globulin (SHBG).
For sex hormones, it is more limited. These hormones are found in many states in the body and a distinction between free and bound (stuck onto protein or another carrier) must be made. Estradiol, estrone, estriol and progesterone are all reported as total hormone and free hormone counts are not commonly available. This may lead to misleading results when interpreting because of abundances of bound hormone which are generally not active in the body. Serum testosterone is the exception that is commonly available as total and free and can be used for assessing balance.
Another limit to serum testing is that it is a single snapshot in time when the blood was drawn. Hormones by nature are released in a pulsatile fashion over the course of the day or month. Determination of whether the result is “normal” requires knowing the time of day and day of the menstrual cycle. A progesterone value on its own doesn’t mean much unless we know the timing of when the test was performed. A value from day 3 and a value from day 21 of a regular 28-day menstrual cycle will be vastly different.
This method has gained popularity over the past decade, especially in functional medicine. This method tests the steroid hormones that are not bound to proteins and can freely pass through cells into the salivary glands, these values correspond to serum free hormone levels
One of the main advantages of using saliva to test hormones is that it is non-invasive and easy to collect. In addition, multiple collection points over a day or month is convenient for patients as they can collect the samples at home.
Is best used to evaluate the balance and flow of estrogens and progesterone in women who are still cycling by showing the rhythms of hormones that cycle. It can also be used to determine the cortisol secretion pattern by taking 4 samples throughout the day to provide a cortisol curve.
Some disadvantages to saliva hormone testing are it can only be used to evaluate steroid hormones like estrogen, progesterone, and cortisol Peptide hormones such as growth hormone, FSH, LH, and thyroid are not available. Saliva measurements are greatly affected by the use of exogenous hormones (Bio-identical hormone replacement therapy).
This method is a way of evaluating steroid hormone metabolites, basically this means it is measuring the breakdown products of hormones. This method is often a 24-hour collection and accounts for the whole day. It measures the unbound hormone which reflects the available fraction of hormones. An advantage of this method of testing is that we are able to trace how the hormones are broken down, this is important when evaluating estrogen. It is well established that some metabolites of estrogens are “good” while other are carcinogenic
(the 2-OH estrogen metabolite increases breast cancer risk). Being able to evaluate the relative balance of protective estrogens to harmful estrogens is beneficial for ensuring safe hormone treatments.
Urine testing is also excellent for evaluating the cortisol curve and adrenal health as different time points in collection allow for a full daily look at how the cortisol changes in response to daily events and tasks. In addition, cortisone is analyzed which is the storage form of cortisol and by looking at the patterns of cortisol and cortisone we can determine the strain on the adrenal system and the ratio of the two can illustrate adrenal function.
Depending on the patient case and the hormones we want to know will dictate which type of testing I choose. Often I ’Il choose a combination of blood and urine testing that gives me a full picture of what is going on hormonally.
If you would like to book a personalized appointment with either Dr. Janine Mackenzie or Dr. Sarah Soles, click on this link to be brought to our online booking page https://cheamwellnessgroup.janeapp.com/#/naturopathic-medicine or call our clinic at 604-776-2432.