You probably never think about your hormones—until symptoms that they may be out of balance, such as weight gain or sexual issues, crop up. Hormones then have your attention big time. But how do you figure out what’s wrong…or how to correct it? The best place to start is with a comprehensive hormone profile.

Hormones are the body’s “messengers.” They are chemicals, produced primarily in endocrine glands, that travel through the bloodstream and “tell” various organs and systems what to do. Hormones control a wide range of body processes, including metabolism, growth and reproduction. Normally, they’re produced in just the right amounts—not too much, not too little. However, triggers such as stress, illness and even aging, can disrupt this fine balance and cause hormones to be over- or underproduced. Common symptoms for both men and women include weight gain, sudden problems with blood sugar metabolism such as a sudden rise in A1C levels, mood fluctuations and fatigue. Specific symptoms for women include problems conceiving, perimenopausal or menopausal issues (hot flashes, vaginal dryness)…and for men, low libido, belly fat and muscle weakness. That’s when a complete hormone profile can help figure out what’s going on.

This kind of testing isn’t part of a regular checkup. It is usually ordered by an endocrinologist or a naturopathic physician and may not be covered by insurance, although a lab that specializes in hormone testing may be able to provide information to insurance companies that will help with reimbursement. The doctor who orders the tests will also interpret them for you—usually in consultation with the lab—and explain the significance of the results and discuss any steps to take based on them. The specific hormones most often tested are steroid hormones—specifically, the sex steroids (testosterone and three types of estrogen—estrone, estradiol, and estriol)…and the adrenal steroids (cortisol and cortisone).

HORMONE PROFILE TESTING OPTIONS

  • Blood (serum) test. Best for: Assessing levels of thyroid hormones, checking for suspected adrenal tumor, confirming menopause (in women) and checking for testosterone deficiency (in men). No prep, such as fasting, is required. However, a woman who is still menstruating should schedule the test for about three weeks from the start of her cycle (the first show of blood). Drawbacks: A blood test can provide only a snapshot—not a full overview, such as how hormones are being metabolized in the body. If a blood test does indicate a possible hormone issue, depending on which hormone, how far from normal range it is, the patient’s symptoms and other factors, a doctor might start hormone therapy—for instance, bioidentical hormones—before doing 24-hour urine or other testing. Testing cost: About $100.
  • 24-hour urine test: This is the most accurate kind of hormone test. Also, probably the least popular, since it of requires collecting a full day’s urine—from after the first pee in the morning of the start day to the first pee the next day. The urine is collected in a cup and then poured into a jug, which needs to stay refrigerated until the sample is sent to a lab. Advantages: This type of test gives the most complete picture, because it catches hormonal fluctuations over the course of a full day. In this way, it is able to assess not only the levels of hormones, but what they’re made of (precursors) and how they’re being processed by the body (metabolites). This kind of test is always good to perform at midlife for a good baseline…or when the symptoms of stress and/or menopause first appear. Testing cost: About $300.
  • Note: While a saliva test is also available—and appealing, because it’s easy to collect and noninvasive—the methodology for collection is imprecise and the hormones are measured in such small concentrations that some are virtually undetectable. Hormones might sometimes also be tested by a “spot” saliva or blood test, usually offered by nonlicensed professionals. These test only a tiny sample, and in my opinion both of these methodologies are clinically worthless.

Laboratories I recommend for hormone testing: Genova Diagnostics in Asheville, North Carolina, 800-522-4762, GDX.net…Meridian Valley Lab in Tukwila, Washington, 855-405-8378, MeridianValleyLab.com…and Rhein Consulting Laboratories in Portland, Oregon, 888-292-1988, RheinLabs.com.

One final note: Always inform the health-care provider ordering and interpreting your test if you’re on any hormonal birth control, including pills and inserts. Also, be sure your doctor knows if you’re taking hormones, such as for low thyroid or low testosterone, including bioidentical hormones.