Perhaps you’ve done some digging online and thought, “My hormones are definitely out of balance – I need testing!” …But where do you even start?
Part of the challenge is that hormonal symptoms are often overlapping and they are so interconnected. For example, an irregular menstrual cycle could be related to an imbalance in estrogen and progesterone, abnormal cortisol levels or even low thyroid function. Low sex drive or fatigue could be because your testosterone is low (yes, for females, too) or because your thyroid is not working optimally.
The other issue is that there are a variety of tests available for each hormone, and they come with their own set of unique advantages and disadvantages. Here is an incomplete overview of some of your options working with a Naturopathic Doctor:
- Blood/Serum Sex Hormones:
This is the standard method of testing hormone levels and would also be in line with the majority of research related to hormone therapy. Certainly an advantage here is that you can ask your Medical Doctor or Nurse Practitioner if they are willing to test these for you and they are OHIP-covered (this would include testosterone [both total and free], AM cortisol, Thyroid Stimulating Hormone [TSH], progesterone, estrogen, DHEA and insulin). If your MD or NP is unwilling to test for these, your ND certainly can send you to the lab. One disadvantage is that each of these markers is measured at one point in time – cortisol is known to fluctuate throughout the day.
- Blood/Serum Thyroid Panel:
TSH is the first and most commonly tested marker for thyroid function, but far from the only marker. Active thyroid hormones such as T4 and T3 provide a more comprehensive picture of how your thyroid is working, not to mention anti-thyroglobulin antibodies and thyroid peroxidase antibodies (markers of autoimmune thyroid activity). If you are looking for a thorough overview of your thyroid function, your ND can offer this thyroid panel.
- Dried Urine Testing of Comprehensive Hormones (aka DUTCH):
This test covers sex hormones and cortisol function, as well as how they interact with one another, detoxification pathways and even hormone metabolites (ie breakdown products of each hormone). As the name implies, it provides a comprehensive overview of your major hormone pathways and also is a convenient at-home urine collection that measures levels throughout 4 different times of the day. Unfortunately, this test does not include thyroid markers, and the more thorough overview certainly comes with a higher price tag than serum testing.
- Saliva Testing for Cortisol:
This test provides an alternative measurement for cortisol levels throughout the day (upon rising, mid-morning, afternoon and before bed) if you are strictly interested in assessing adrenal function and stress rather than all of your sex hormones (estrogen, progesterone, DHEA and testosterone). This is significantly more cost-effective than the DUTCH test and also a convenient at-home test if you don’t like the idea of drawing blood from a needle.
There are still other options available, but these are arguably the most common. At the end of the day, if you have already explored one or more of these tests and still don’t have answers, then there may be other reasons why you are feeling unwell. Consider nutrient testing, blood sugar dysregulation, food sensitivities… or better yet, speak with your ND! With a proper intake and the right line of questioning, they will have a much better idea of which tests are most indicated.
Check out another article by Dr. Colin O’Brien, ND: Insulin Resistance: The Importance of Testing Insulin and Not Just Blood Glucose, to learn more about the importance of testing.
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