What Are The Different Ways Of Testing Hormones?
There are conflicting opinions as to what is the best way for testing the levels of sex hormones. The various ways that are used to test hormones are:
- Blood tests
- Saliva tests
- Urine tests
- Dried Blood tests
Many health professionals use blood tests for testing the sex hormones. Although blood tests are valuable for testing the thyroid hormones, blood tests are not valuable for measuring the sex hormones or adrenal hormones.
For example, blood tests measure the total amount of sex hormones that are in the blood stream, which includes the amount of hormone that is bound up in the bloodstream by steroid hormone binding globulin and therefore, for the most part, is not readily available. Therefore, blood tests do not give a true picture of how much hormone is available [called bioavailability] at the tissue level where it is used in the body.
Also, usually only one specimen of blood is taken to test the sex hormones. As a woman’s estrogen level changes every six to eighteen hours and her progesterone is released in spurts throughout the day, this does not give a true and accurate picture of what is happening to a woman’s sex hormone levels from day to day or even within the day.
The only estrogen that is tested with blood tests is estradiol. Estradiol is the estrogen that has been researched the most by the pharmaceutical companies for use in birth control pills and other synthetic preparations. A woman’s body makes approximately 30 estrogens including the 3 most important ones, estrone, estradiol and estriol. Both estrone and estradiol make up 10 to 20 percent of a woman’s estrogens and are known to help protect against osteoporosis. Estriol makes up 60 to 80 percent of a woman’s estrogens and is known to help protect against cancer. On the other hand, excess synthetic estrone and estradiol are known to increase the risk of causing estrogen associated cancers.
Therefore, it is extremely important to do multiple tests on all three estrogens and test them both before and after treatment. The testing of all three estrogens cannot be done with blood tests and frequent blood tests throughout a woman’s reproductive cycle, if ever done, would be inconvenient and stressful to a patient as well as expensive.
Although it can be difficult for women to produce enough saliva first thing in the morning to have a good sample, saliva tests have been used and proven accurate in testing the sex hormones and the adrenal hormones for over twenty years. Saliva tests give a true indication of the bioavailable hormonal levels at the tissue level, and the three important estrogens [estrone, estradiol and estriol] as well as progesterone, testosterone, and the adrenal hormones DHEA and cortisol can be easily tested.
Moreover, as a woman’s estrogen level changes every 6 to 18 hours and progesterone is released in spurts throughout the day, more than one specimen needs to be taken even for women in menopause in order to obtain a true picture of what is happening with her hormones. Saliva tests can be easily done at home by a woman and are usually less expensive than it would be to have many blood tests.
One urine test that has been available for many years indicates that a woman is having bone loss. If a woman has had bone density tests and has been found to have osteoporosis, this urine test can also be used as a follow up test to see if she has a decrease in bone loss once she has been on treatment for osteoporosis. This urine test can show that, with treatment, the woman is not losing bone. The fact that the test shows that the woman is not losing bone, does not however, prove that a woman’s bones are being rebuilt. A bone density test need to be done in order to prove that.
In the past couple years, some health professionals have been recommending that the best way to test the sex hormones and the adrenal hormones, is by using a 24 hour urine test. In the past, this would have meant that the container of urine would have needed to be refrigerated until all the urine had been collected. Now, with the use of a preservative in the collection bottle, the urine does not need to be refrigerated.
Theoretically, collecting her urine over 24 hours would solve the concern that a woman’s estrogens change every 6 to 18 hours and that her progesterone is released in spurts throughout the day. However, the urine test does not measure the amount of sex hormones or adrenal hormones that are available at the tissue level. Instead, what is being measured are the metabolites or waste products from the breakdown of a woman’s hormones. Health practitioners then try to determine from these waste products how much hormones a woman is actually making and using in her body and what amounts are available at the tissue level.
Although the 24 hour urine test appears to have some limited value in looking at how many high risk metabolites are being eliminated from the body, many labs and health practitioners have not found this to be a useful or accurate way of measuring the sex hormones and the adrenal hormones. This testing procedure appears to be equivalent to taking a sample of urine and trying to test it to decide what foods that individual ate during the day.
Dried Blood Tests
Some labs have developed a technique that uses dried blood to assess the hormonal levels of an individual. The advantages of using dried blood specimens are as follows:
- dried blood is not hazardous to mail / ship
- hormones remain stable in the dried blood for months
- the collection procedure is simple and can be done by a patient
- dried blood can be used to test many of the same sub stances as serum / plasma
- dried blood can be collected any place, any time of the day or month
Although the testing of the dried blood has proven to be reliable and reproducible in an individual lab, the results might vary from one lab to another. The reason for this is that some labs just weigh the dried blood collected on the blotter like paper to try to determine the amount of hormones, while other labs [correctly] put the blood on the blotter like paper into solution and measure the amount of hormones. Also, the disadvantages of testing blood drawn from the arm also holds true for dried blood samples. Although more than one dried blood sample can be collected fairly easily, only one estrogen [estradiol] can be tested using the blood.
However, there are special situations in which I do use the dried blood test. For example, I used the dried blood method in order to test the sex hormones and adrenal hormones of a paraplegic woman in her reproductive years as she could not produce enough saliva and it would have been very difficult [and cruel] to arrange to draw her blood from her arm eleven times during her cycle.
In conclusion, using multiple saliva tests is still the most convenient, reliable and economical way at this time for testing the sex hormones and the adrenal hormones.