Here's the bottom line on hormone testing. Some health care providers test hormone levels and some do not. One can make an argument for hormone testing and on the other hand can argue against hormone testing.
Here's a case for testing. When a patient has symptoms of having low potassium what does a doctor do? The doctor may make recommendations of improving the patients diet to see if symptoms go away. If the patient cannot increase their potassium enough thru the proper diet an MD may write a prescription for Potassium Chloride. The doctor will do a blood test to determine what the patient's potassium levels are and prescribe potassium supplementation accordingly. Also, the doctor will retest potassium from time to time to make sure the therapy is adequate and that the patient's potassium levels are within a normal and safe range. Note that doctors don't say to patients here's some potassium just keep taking this. If you have side effects like your heart acting up call me and we might decrease your dose. MD's use lab work to help them dose and monitor potassium. So, here's a question for you... Doesn't it make sense that if a doctor thinks that a woman's hormone levels are low that he should check her levels before prescribing hormones? Hormones are potent natural substances that are to be respected. If hormone levels are too high or too low patients can have symptoms. Estrogens have been linked to certain types of cancer. Therefore, doesn't it make sense to monitor hormones like estrogen? The last thing a woman needs is estrogen supplementation if her estrogen is already at a normal or high level. Some women are given rx's for testosterone because they tell their doctor that they have a low libido. There is no reason to give a woman with a low libido testosterone if she has plenty of testosterone on board. If MD's checked women's testosterone levels from the onset then there may be no reason to put the patient on a 3 to 6 month trial of the hormone.
Now for the other side of the coin; Here's some logic that supports not testing hormone levels. All that lab work does is give a doctor a snap shot of what a woman's hormone levels are at the very moment that the blood sample is drawn. Hormone levels change day-by-day, hour-by-hour, and even minute-by-minute. Just because your lab work says that your hormone levels are at a certain set of numbers on one particular day does not mean that is what they will be on the next day. Another consideration is that the normal ranges for hormones like progesterone, estriol, estradiol, estriol, testosterone, etc. have a fairly wide range of numeric values which is considered "normal". Maybe a hormone has a normal range of 50 to 200. This means while one patient has a value of 50 and another patient has a value of 200 both patients are considered as having normal lab values. Many times a patient will have symptoms of hormonal imbalance and when the doctor orders lab work the lab work does not reflect how the patient is feeling. Symptoms do not always match lab work.
So, what's the deal with lab work? Is it of any value or not? I believe that health care providers need to simply take a balanced approach to this topic. We should not simply treat patients by the numbers. In other words, we should not treat patients solely based on lab work. On the other hand, we do not want to simply treat patients based on how they feel (by their symptoms only). What we should do is both. We should treat patients based on their symptoms and on their lab work. First, we need to listen to the patient and allow them to tell us what their chief complaints are. Then we should check their hormone levels and cross our fingers that the lab work comes back revealing hormonal imbalances based on the patients symptoms. When the labs match the symptoms we can then determine which hormones and how much of each hormone needs to be prescribed.
Generally, we want to put more stock in symptoms than on lab work. Our goal is to rebalance hormones so that symptoms of imbalance go away. Another goal is to make sure that a person's hormone levels stay within a normal range. We do not want to see patients over prescribed hormones so that they have too much progesterone or estrogen. Lab testing of hormones should simply be viewed for what it is. It is simply a good tool we have at our disposal to make sure that we are on the playing field. To play football you must be on the playing field. Doing lab work allows MD's to apply scientific evidence based medicine to their patients. It assures everyone that the patient's hormone levels are staying within safe normal physiologic levels.
Let's finish this topic by looking at a special way of testing your hormones. Doctors can test your hormone levels in blood, urine, or saliva. The vast majority of health care providers test for substances in blood. So patient's typically have to run over to the lab and have blood drawn to test their hormones. What many doctors do not know is that there is a simpler less expensive and more accurate way to test hormone levels. That method is thru salivary testing. Salivary testing can be done in the privacy of your own home. It is non invasive and less stressful. It is very simple to do and generally less expensive. Saliva testing of hormones is more accurate because it tests only for your "free" hormone levels. (please look at our topic of free verses bound hormones on our home page for an explanation of what free and bound hormones are). Since doctors generally are never taught about salivary testing in school they do not incorporate it into their practice of medicine. Many doctors have never heard of salivary testing. Some have heard of it and have written it off as voodoo. Generally speaking, if a person is not up on a subject they are down on the subject that's just human nature. So, it is normal for a doctor to not be interested in saliva testing. But if a doctor is open-minded he will discover that saliva testing is very scientific. In fact, the technology has been around since the late 1950's. There are scores of papers that have been published that validate salivary testing as an accurate method for testing hormone levels. Many of these publications have been in reputable journals like the New England Journal of Medicine and JAMA. And as was mentioned earlier, saliva testing only tests for "free" hormone levels whereas blood or serum testing only tests for total hormone levels which includes bound and free hormones all lumped together.
What if your doctor ordered cortisol levels and sent you to the lab at 3PM to do the test? Cortisol levels change hour by hour as the day progresses. Cortisol is highest upon awakening and at its lowest level at bedtime (if you have good adrenal health and a normal cortisol profile). A 3PM cortisol level is not going to be that informative. It would be much more informative to have at least 2 cortisol levels done in one day preferably one when you awake and one at bedtime. This is impractical to do at a lab. Also, cortisol increases in your blood stream when you are under stress. For some patients, it is stressful to have a needle stuck in their arm to draw blood so your cortisol could be unusually high at the moment your blood is drawn which would then reflect incorrect lab results. Saliva testing is simply more accurate than blood testing when looking at hormone profiles. Blood work may even reveal opposite results of saliva results. For example, since progesterone attaches itself to red blood cells and red blood cells are centrifuged out of blood samples which leaves only serum, progesterone gets discarded with the red blood cells. Blood work might imply that a patients progesterone levels are low especially when a woman is using topical progesterone instead of oral progesterone.