Something feels off in my body but my regular tests are all “normal”.
I think I have a hormone imbalance but how can I know which hormone it is?
I asked my doctor to test my hormones and they said no!
I want to know what is going on, can I get my hormones tested?
These are some of the most common things we hear from the people who reach out to us.
It can be so frustrating to know something isn’t right in your body, but your doctor tells you, “everything is normal” or “you just have to live with your symptoms”. Too often patients leave feeling gaslit, ignored, dismissed, and told by their doctors there’s nothing they can do.
The truth is, you are the expert in your own lived experience. If you are feeling that something is off, it probably is, and you don’t just have to live with it!
There are ways to get answers, yes you CAN test your hormones, and yes you can restore your balance and start feeling better. We’re so glad you’re here!
FOUR KEY HORMONES TO TEST
In this article, we’re going to walk through the top four types of hormones to test (adrenals, insulin, thyroid and sex hormones) so you can know what to ask for in order to better understand what’s going on. We’ll cover what markers to test for each type of hormone, when to time the tests for the most useful information, whether to test blood, urine or saliva, and how to think about whether that testing would be useful in your decision making right now or whether to try other things first.
To help you think about what you might want to test, you can learn more about which hormones may be related to which symptoms in our article “Could it be my hormones?”.
Adrenal function is at the root of almost every other hormone imbalance so this is a great place to start! (This is why our signature program, Replenish, is focused on learning about and supporting your adrenal health.)
The adrenal glands produce the main stress hormone, cortisol. They are also the primary source of the hormone DHEA, and are able to produce other hormones too. Cortisol is the main hormone we measure to test adrenal function, and we can also look at DHEA levels to understand the whole picture better.
Cortisol levels vary over a 24-hour day, as it helps to set the body’s circadian rhythm. It is supposed to be highest as you are waking, tapering down through the day, and then should be low at bedtime. Testing, therefore, is best done by collecting several samples over the course of a day in order to see the pattern. Cortisol is not simply “high” or “low” but rather “high for this time of day” or “low for this time of day”. And the overall pattern can be normal, flattened or reversed.
The best adrenal tests are done with either saliva or urine where you collect samples at home at several different times over a day.The most useful data comes from testing on an average day, not the most stressful or the most relaxed. These home testing kits are usually ordered through a functional medicine lab (instructions for self-ordering this test are included in our Replenish program), as these tests are not typically used in conventional medicine.
NOTE: While cortisol can be measured in a blood test, you usually only get one blood draw per day, so you miss out on seeing the pattern. Also, blood draws can be stressful which would impact your cortisol level.
2. INSULIN (and blood sugar)
Another foundational part of hormone balancing that can be tested is your blood sugar (glucose). Fluctuations of glucose can impact almost all of our hormonal symptoms such as energy, mood, sleep, weight gain, brain fog and more. And the hormone insulin, which is secreted in higher levels when the body struggles to regulate glucose, creates inflammation in the body and is involved in many chronic diseases. Blood sugar testing is an area that is well worth looking into for both your short term and long term health.
There are 3 numbers that we recommend testing: fasting glucose, fasting insulin and HemoglobinA1C (HgbA1C). These can all be done with one morning blood draw while you are fasting (12hrs water only) and can be done through any standard blood testing lab.
Fasting glucose and insulin give a snapshot of how your body is regulating your blood sugar on that day and in that moment. If fasting insulin is high (or even in the higher part of the normal range) that is a sign of insulin resistance and a risk for pre-diabetes. And the HemoglobinA1C tells you how your blood sugar has been averaging over the last 3 months.
If any of these are outside of ideal ranges, or if you need or want to have more information about your blood sugar, we also love recommending use of a Continuous Glucose Monitor (CGM). (This is the focus of our Know Your Numbers program where our blood sugar coach will walk you through the ins and outs of how to do this.)
Because your glucose fluctuates so much through the day, a single blood test only tells you what is happening at that moment. A CGM, which you wear for 2 weeks straight, can give you SO much more information so you can see how your glucose levels fluctuate after you eat certain foods, do certain exercises, experience certain stressors, get a good or bad night of sleep, etc.
Learn more about CGMs in our article “Why do we care about blood sugar?”.
Thyroid is another key hormone that is important to test. Most conventional doctors will only order one or two thyroid markers, but we recommend a full panel of 6 different tests in order to better evaluate your thyroid picture.
Our complete panel = TSH, Free T4, Free T3, Reverse T3, TPO Antibody, Thyroglobulin Antibody
These can be all done through any standard blood testing lab, though some can be rather expensive and your doctor may not order them all for you. (If you are curious about getting these tests at reasonable prices, ask us about our Hormone Harmony Foundations program where we have arranged a really great cash-pay option where you can self-order your labs and then meet with one of our NDs to review the results.)
TSH, or Thyroid Stimulating Hormone, is the most commonly tested thyroid marker, but it is actually produced by the pituitary. When it is high, that indicates that the thyroid is low (or sluggish and not functioning well), thus requiring a stronger “stimulating” signal to try to get it to work.
T4 is the main hormone that the thyroid gland itself produces and secretes out into circulation. Fun fact: the 4 in T4 refers to the 4 iodine molecules that are on that hormone. The body then converts T4 into T3 by removing one of the iodine molecules. We recommend measuring both Free T4 and Free T3 to get a thorough picture of the free (unbound) circulating levels of thyroid hormones.
Reverse T3 is a “backwards” version of T3. It interacts with the thyroid receptors on our cells, but it is inactive and therefore blocks the active form of T3. When you have high reverse T3, this can result in low thyroid activity in your cells.
TPO Antibody and Thyroglobulin Antibody are both markers that we use to screen for Hashimoto’s Thyroiditis, which is an auto-immune condition and a very common cause of hypothyroid (low thyroid). If these are positive, then it is important to not only address the thyroid levels so you can feel better, but also to work to balance the immune system in order to address the root cause.
4. SEX HORMONES (estrogen, progesterone, testosterone)
Testing for sex hormones can definitely be more complicated than the first three types of hormones listed above. Lab testing can be useful when done well, but it is not always necessary! Tracking your symptoms and noting what is happening at what point in the cycle is also a key way to learn about how your hormones may be influencing the symptoms you are experiencing.
Having said that, sex hormones can be tested in blood, urine or saliva, and each of these has its pros and cons. Blood tests have a fast turnaround time for results and are usually easier to get. Blood levels can tell you how much of that hormone is floating around in the bloodstream at that moment, while both saliva and urine tests usually have multiple collections over the course of a day, giving you a better idea of the average levels over that day.
Estrogen and progesterone may also be tested on different days over a month in order to understand the ups and downs of the menstrual cycle. In general, saliva tests tend to be reflective of the free (unbound) amount of the hormone that is available to the tissues, and urine tests can look not only at how much hormone you have but also the levels of downstream metabolites so you can learn how the body is processing those hormones.
Testosterone is the most straightforward of the three sex hormones. It does not vary with the menstrual cycle, so it can be tested at any time, even for people who are cycling. If testing in blood, we recommend looking at Total as well as Free levels of testosterone, because the amount that is free (or unbound) is the amount that is most active and available. It can also be helpful to measure Sex Hormone Binding Globulin (SHBG) which is the main protein that binds up much of the testosterone. If you want to look closer at your androgens (e.g. if you have PCOS – polycystic ovarian syndrome) you might also want to test DHEA-S and Dihydrotestosterone (DHT) for more information.
If you are not menstruating or cycling at all (see below if you have irregular cycles) then testing for estrogen and progesterone can also be done at any time if you are post-menopausal (at least one year since your last period). Levels of both will tend to be lower than they were when you were cycling. These also need to be monitored with repeat tests if you are taking hormone therapy, and the timing of the test collection needs to take into consideration the timing of when you take your dose. Your levels will be higher soon after your dose and will taper down until you take your next dose, so we usually recommend trying to time the test half way between doses, but there can be reasons to test at other times too.
Progesterone testing, if you are menstruating, needs to be timed carefully in order to be useful. It is important to understand that progesterone is primarily produced by the ovaries only *after* ovulation. Levels will usually be very low in the first half of the menstrual cycle, during the period and up until ovulation (so Days 1-14 in a 28-day cycle). Then from Day 15-28 progesterone rises and drops in a bell curve shape, peaking at the midway point on Day 21 which is the best time to check to see how much progesterone you are producing.
For people with irregular cycles, or if you aren’t sure when you cycle because you’ve had a partial hysterectomy, we prefer to say that “7 days after ovulation” is the ideal time to test progesterone. The level does stay fairly close to the peak for a day or two on either side of this, so do the best you can with predicting the timing of this peak, and be sure to consider (or let your doctor know) the timing from your last period and when your next period comes after the test. PRO TIP: You can use an “ovulation predictor” home test kit, which you can pick up from any pharmacy, to measure urine Luteinizing Hormone (LH) which peaks the day before you ovulate, and then test 7 days after that.
Estrogen also has ups and downs over a cycle and most commonly you would measure for a low point on Day 3-5 and a high point on Day 21 (or on “7 days after ovulation”), because estrogen also has a peak at the same time that progesterone does.
Cycle mapping: Some urine and saliva testing lab companies also offer test kits where you can take samples every few days throughout an entire menstrual cycle, in order to track the timing of the ups and downs of your estrogen and progesterone over the month. These are more effort to collect and a bit more expensive, but can really help you better understand what is going on.
Note on hormonal medications: Some medications will impact your levels so talk to your doctor about whether to test, and if so what and when. Typically is not very useful to test the sex hormones while taking birth control pills as the levels of testosterone, progesterone and estrogen will all be suppressed.
WHERE TO START WITH TESTING YOUR HORMONES
Here at The Women’s Vitality Center, if you are interested in hormone testing, we usually recommend starting with testing the adrenals, insulin/glucose, and thyroid (plus a panel of other general health markers). It is not always necessary or useful to test the sex hormones at first because a careful review of your history, your symptoms and the timing of your symptoms can tell a lot about what is going on with your sex hormones. Plus, if you are in perimenopause, it’s important to understand that every month can be quite different so sometimes it makes the most sense to stabilize the sex hormones by focusing on overall health and the other hormones first!
That said, you can definitely turn to testing the sex hormones when that is needed, and we can help you decide when that would be useful to do, the best method to do so and how to time the testing carefully, so you can get the information you need.
Looking for more guidance? Schedule a complimentary Vitality Discovery Call. We’d love to learn more about what is going on with you and help figure out your next steps. We have options ranging from our coaching programs that focus on adrenals or blood sugar, to teaching you how to self-order your own tests online and then consult with one of our NDs to review the results, to the most comprehensive support we have, our membership-based private practice where our experts customize your care and guide you every step of the way.
If the other things you’ve tried so far haven’t made enough of a difference, and you are wanting to get more insight through lab testing, we’re here to help! Once you understand more about what is going on in your body, you can create an effective plan to restore your balance and start feeling better as quickly as possible.