Perspectives on lab testing

There are so many different ways to test the biochemistry of our blood. None of them are perfect – and all of them are useful. The trick is to take all of the information with a grain of salt.

I like to think of the metaphor of a map. If the whole of YOU was a map – then the information from any given lab test would represent landmarks along the way – a gas station, a school, a familiar tree. The information helps us get to where we’re going – but it is only a very small piece of the map. Sometimes that information can actually be unhelpful and create a roadblock to where we are going – for instance if someone has low testosterone – then we can get very fixated on getting those levels to optimize without considering other factors – which may point to the deeper roots of a person’s experience and patterns. And then of course there are exceptions to this – certain quantitative factors that are keys in regaining health. I will talk about that more later.

Doctors and health practitioners are always fighting about which test is best, most important, the most relevant, the most accurate – My humble opinion is that they all provide useful information when taken with a grain of salt. At the end of the day – there are many factors at play within our bodies that we are unaware of and don’t have control over – so the best advice is to stay open-minded and continue along in the process of life and healing.

Below I discuss a breakdown of the 4 most commonly used hormone lab tests.

1. Saliva

This test is perhaps the most simple hormone test when it comes to sample collection. After spitting into a tube multiple times over the course of one day or several days, a laboratory can analyze individual or combined samples to determine individual or average measurements of hormone levels. Samples can be collected at home.

Saliva tests offer a good picture of free hormones that are actively available to the body as opposed to the total amount of hormones in your bloodstream. However, some hormone concentrations are inherently higher or lower in saliva than in blood or urine, so there can be limitations to this type of hormone testing. There are also additional variables to take into account with saliva testing, such as pH levels in the mouth, the effects of teeth brushing, food intake, and make-up use.

In general, hormones for which saliva testing is well-suited include:

• estrogen
  • estriol
  • estradiol
  • estrone
• progesterone
• testosterone
• DHEA-S (dehydroepiandrosterone)
• cortisol

Ultimately, saliva tests can play a vital role in diagnosis and are often the preferred method of assessing the progress of hormone replacement therapy—especially topical HRT treatment options. Saliva testing can also ideal for measuring cortisol, as the anticipation of blood tests themselves can cause a stress response in some people, temporarily inflating cortisol numbers. It is also easy to produce saliva samples throughout the day to determine patterns of stress.

2. Urine

When it comes to hormones, urine testing typically involves collecting multiple samples of urine at multiple times of day in the privacy of your home or collecting all of your urine for 24 hours in a jug. Multiple samples can be critical to gaining insight into your hormonal health by capturing hormone fluctuations throughout the day. The larger sample volume and variety can also help practitioners account for variables such as urine concentration.

Like saliva tests, urine tests measure free hormones, including:

• estrogen
  • estrone
  • estradiol
  • estriol
• progesterone
• testosterone
• DHEA-S
• cortisol
• melatonin

Urine testing is the one type of hormone testing that allows practitioners to assess how the body is metabolizing hormones. This is an opportunity to identify risks—such as cancer risk—when hormones are not breaking down optimally in the body. Urine tests are also capable of measuring more types of estrogen hormones than blood tests are. Urine cortisol testing has been shown to be equivalent to salivary cortisol testing and has the additional benefit of assessment of cortisol metabolites.

3. Blood Serum

The blood serum test for hormone levels is a typical blood draw taken in your practitioner’s office or lab and used to determine the concentration of specific hormones in your bloodstream. Unlike a blood spot test, which is stored as dried blood and then rehydrated for analysis, a blood serum test analyzes blood in its original form. As such, it may have a shorter shelf life than blood spot samples but a slightly wider range for hormone testing. To ensure efficacy, you may be required to fast for a period of time prior to the blood draw.

Blood serum testing can be used to assess a wide range of hormones and other analytes, including:

• insulin
• thyroid hormones
• testosterone
• estrogen
  • estradiol
• progesterone
• LH (luteinizing hormone)
• FSH (follicle-stimulating hormone)
• prolactin
• DHEA-S
• SHBG (sex hormone-binding globulin)
• PSA (prostate-specific antigen)
• cortisol

While highly versatile, blood serum tests may not be ideal for measuring hormone levels influenced by topical therapies.

4. Blood Spot

Minimally invasive and convenient, blood spot testing requires only drops of blood following a finger prick. The blood is dropped directly onto a filter card in multiple spots and left to dry. In some cases, this test can even be done at home, as the dry blood samples are stable enough to deliver to a lab. Lab technicians then rehydrate the blood spots in order to test in a manner similar to blood serum testing.

Although blood spot samples offer the benefit of longer-term stability than blood serum samples, this method is more limited in the variety of hormones and other analytes that it can test for. Blood spot tests may be used to assess:

• insulin
• thyroid hormones
• estrogen
  • estradiol
• progesterone
• DHEA-S
• testosterone
• SHBG
• PSA (prostate-specific antigen)
• LH
• FSH

Despite the more limited scope of blood spot tests, they can produce highly accurate results for many critical hormones and are an effective method of monitoring hormone levels.