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Hormone Testing
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Hormones are found in the blood, saliva, and urine. The most accurate way to check hormone levels is to determine levels in the blood. Blood tests can determine both the level of the free hormone and the amount of hormone that is bound to its carrier protein. Blood tests can accurately determine deficiencies in the hormone, and can show if adequate replacement has been prescribed. The downside of a blood test is that hormone levels change from moment to moment and day to day. Thus the hormone level is being evaluated only at that particular time.
Proponents of saliva testing argue that only the free hormone is measured and, therefore, determines the level of active hormone available to tissues. A limitation of salivary testing is that when hormone levels are low, there may not be sufficient hormone in the saliva to measure. In addition, saliva levels can become contaminated if any blood is in the specimen. Many practitioners feel that saliva tests are extremely inaccurate and hormone levels in the saliva are not consistent with levels in the rest of the body.
Unfortunately, all hormone testing cannot measure what is happening at the receptor site or hormone levels in tissues. If proper hormone levels are not achieved, then the person is not getting the full benefit of the replacement hormone. Each person responds differently to a dose of hormones because absorption and metabolism of hormones varies among individuals. Additionally, hormone levels can be affected by the route of administration of the hormone.
If a woman is going to be prescribed hormones, I recommend checking a blood level before starting, and then again in two to three weeks after starting. It is important to take the hormone as prescribed when evaluating hormone levels. When hormone levels are checked, it is optimal to check the level approximately 2-6 hours after taking the hormone. This is when the hormone level is peaking. If patients are not feeling the desired effect of the hormone or are having abnormal symptoms, it is recommended to recheck the blood level of the hormone, so micro-adjustments can be made.
Estrogen levels can be drawn at anytime if a woman is menopausal because she is no longer making estrogen in a reproductive manner. In a reproductive woman, estrogen levels peak at day 12-13 and have a second peak between days 20-22. This is the optimal time to check estrogen levels. The same is true of progesterone. Menopausal women are not ovulating, so they are not producing progesterone. Timing of the blood draw is not critical in these women. If a woman is menstruating, drawing progesterone 4-12 days before the next menses, when progesterone is peaking, is the optimal time.
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