Urine Hormone Testing​

Hello and Welcome! Glad to see you here on Legacy Compounding’s Blog!I’m super excited to give you some education today on Urine Hormone Testing. In our last post, we discussed the strengths and limitations of blood hormone testing, and in our next post, I’ll be covering saliva hormone testing. So, here we go, down the rabbit hole again. Urine hormone testing is the least used hormone testing method, but it just happens to be my favorite type of hormone test, at least for baseline levels. Why? I’m so glad you asked!The first thing I need to clarify is that I only use this test for baseline levels to determine if a patient is a good candidate for hormone replacement, to begin with, and to be able to fully customize a treatment plan. Urine hormone testing gives you a WEALTH of information that is not available with blood or saliva testing. The drawback to urine testing is, much like blood level testing, when you are taking topical hormones they don’t really raise the hormone levels in urine. So, once I have a patient started on hormone replacement I will follow up with saliva testing to help me adjust doses.Urine testing is a relatively new method for testing hormones. Rewind, that’s not true. Urine testing has been around for ages and in recent history, it has been the gold standard for cortisol testing (cortisol is your stress hormone, to give you an overly simplified definition). However, it hasn’t been widely used to test hormones because it has always been very impractical. Someone would have to collect their urine (all of it) for 24 hours, and even then, how sure could you be that they really got it all? And who wants to do that anyway? So, there were some pretty significant barriers to urine testing.But leave it to scientists to keep pecking away at something until they figure out a better method. Enter: Dried Urine Collection methods. With this method, you take a special absorbent collection paper, urinate into a cup at specific time points, and dip the collection paper into the cup. Next, you lay the papers out to dry, pack them, and ship them to the lab. It can all be done from the comfort of your own home and, as I said before, the results give your provider a lot of information that they wouldn’t have access to with a blood test or a saliva test (of course, your provider has to know what to do with this information).Let’s pause for a moment. You may have noticed that I use the term “provider” a lot in place of “doctor”. In case you were wondering, the reason I do this is because there are a growing number of healthcare specialties that are able to provide you with healthcare besides just doctors. There are physician assistants, nurse practitioners, pharmacists, chiropractors, naturopaths...and I’m sure I’m still leaving someone out! So, that’s that. Back to business.I use a company called Precision Analytical for all of my urine hormone testing because I trust them implicitly, I love the patient/provider educational tools that they provide, and they put these great graphics into their lab reports that help the patient to really get a grasp of what is going on in their body. I’m including a sample report in this post, which I won’t go over in great detail right now, but you can get an idea of the length of the report and the amount of information it contains. Knowledge is power, right?So, to determine if a patient is a good candidate for hormone replacement therapy we obviously want to look at hormone levels and verify that the levels are actually low. So, the urine test will tell you what those levels are and if any hormones need to be replaced. And here is where things get really interesting. A urine hormone test will also give you the levels of hormone metabolites in your body-- which allows us to see what your body is doing with the hormones that you have. It gives us insight into how you metabolize your estrogen, which gives us a glimpse of your breast cancer risk. It shows us if you tend to take your Testosterone and convert it to DHT-- which causes acne and alopecia. It tells us not just how much cortisol you have, but how many cortisol metabolites you have...the implications of which I can’t even tell you in one sentence, it has to be a completely separate post of its own.This test give me the ability to tell someone, “hey, I know your estrogen is low but we really shouldn’t supplement estrogen in your case because it could increase your risk of developing breast cancer.” or “Based on your estrogen metabolism and family history, you can feel pretty safe with estrogen replacement.” Now, obviously I can’t see into the future and the full breast cancer risk model is still being developed, but working with the knowledge that is available to us right now, I am confidently able to help patients and providers decide if estrogen replacement is the right choice.So, I’ve really just given you the tip of the iceberg on urine hormone testing but I know you can only absorb so much information in one sitting, so until next time I hope this information has enriched your knowledge base.​

Blood Hormone Testing​

When you are wondering if you have a hormonal abnormality, the first thing to do is make a list of your symptoms. In most of my patients, I can get a general idea of what their hormones are doing based on symptoms alone but this needs to be confirmed with hormone testing and I need to look for nuances that will help me to tailor a treatment plan that is unique to each patient. There are multiple ways to test hormone levels, and depending on who you are talking to, there are different opinions on which method is best. So today, I’m beginning a series of blog posts about the various testing methods that are out there and the testing protocol that I use in my personal practice. Let me stress first, that whatever method is used will have it’s own strengths and weaknesses-- there are even limitations to the protocol that I use, but what you want is for your provider to use a standard protocol which they are comfortable with and have had a history of success with. So...let’s dive in! The first method I’m going to talk about in this series is blood testing. I’m discussing this method first because it is the MOST commonly used method of testing. I would like to tell you that is because it’s the best method, but I actually believe it is the worst method--it’s just more convenient and profitable for healthcare providers (don’t shoot the messenger here!). You see, your healthcare provider can usually draw your blood in-house and send it out for testing, which is a service that they bill for-- and it is almost always covered by insurance. So, the benefit to you is that it is an easy test to have done and it usually won’t cost you anything out of pocket, and your provider gets a small cut on the side. But for me, that is where the benefit ends. You see, hormones are partially bound in your bloodstream to something called sex hormone binding globulin (SHBG), and when they are bound they are basically inactive-- they can’t leave your bloodstream and bind to the receptors in your tissue because they are bound to this other entity. The only hormones that are active in your body are the FREE portions. When you measure hormone levels in blood, you are measuring BOUND and the FREE hormone levels, and the free level can vary tremendously from person to person depending on how much SHBG a person has. Now, there is a method to try to correct for this by measuring SHBG and doing a calculation to determine how much of the hormone is free, but personally, I prefer to use methods that just measure the free hormone to begin with (and honestly, most providers that I’ve worked with that use blood levels don’t even bother with the SHBG calculation). WOW - that was technical. Now, let’s move on to another complex topic regarding blood testing. What we have just discussed is your level of hormones that are naturally produced in your body at any given moment. What happens when you replace a hormone deficiency with “exogenous hormones”? Exogenous hormones are ANY hormones that you take in the form of a medication(synthetic, bioidentical, “natural”, prescription, over-the-counter ...stay tuned, there will DEFINITELY be a post at some point to discuss all of these crazy terms and the truth behind them).This is where the rub happens with a lot of healthcare practitioners, particularly the GYN sort. Let me be clear, there are differences between hormones such as estrogen, progesterone and testosterone, as to how they are absorbed and metabolized; so I am speaking in generalities here and there are nuances specific to each hormone. But, in general, you can take a hormone by mouth and get a very predictable rise in blood hormone levels. Which is kind of nice right? Oh how doctors love this -- it just ties everything into a pretty little package and makes your medical record look so pretty!!! Then came WHI (eye-yi-yi, that’s another topic for another day)...and a few other studies (posted below) and it turns out that oral estrogens are not so great for people. In fact, they tend to raise your blood clotting risk. Thanks but no thanks right? So, topical hormones really seem to improve patient’s symptoms and they don’t raise your clotting risk (YAY!!!), but they also don’t raise your blood levels, like, at all. So, a provider will test your baseline hormone levels before you are taking any hormone replacement, then they give you some topical hormones, you feel better, they retest your blood and it looks like nothing is there. And any self-respecting provider is going to get their drawers in a wad over this. They need those stinking levels to rise in order to prove to...well, somebody...that you aren’t just having a placebo effect. This is why there are now quite a few providers that are using hormone pellets. They insert the hormone pellets and you get a nice rise in your hormone levels. So, that’s cool. I know a lot of patient’s who love their pellets. I urge you to be cautious with the use of pellets, because I have also treated quite a few patients that have had less than glamorous pellet experiences. It really depends on the knowledge and experience level of your provider here. OK, well, I’ve rattled on enough for one post. I pray it has been useful information for you! Check back often for more information about hormones and other wellness topics. ​

Does LDN Really work for Autoimmune diseases?

LOW DOSE NALTREXONE (LDN)Low Dose Naltrexone has been very much discussed lately because the word is out that it really helps with autoimmune diseases. Autoimmune diseases are associated with a malfunction of the immune system which causes the body to attack its own tissues instead of just foreign substances. WHAT ARE AUTOIMMUNE DISEASES?There are more than 80 types of autoimmune diseases affecting more than 50 million Americans of whom 75% are women. Symptoms associated with the autoimmune disease include inflammation, fatigue, muscle aches, low fever, swelling, redness, rash, diarrhea, stomach disorders and many more. Some of the more common autoimmune diseases are: -Rheumatoid arthritis. The immune system attacks the joints causing pain and swelling.-Lupus. Autoimmune antibodies attach to tissues throughout the body.-Inflammatory bowel disease (IBD). The immune system attacks the lining of the intestines,-Ulcerative colitis. IBD disease affecting the large colon.-Crohn’s Dissease. IBD disease affecting the small intestines or entire GI tract.-Irritable bowel syndrome (IBS). No inflammation but stomach pain, cramps, diarrhea.-Multiple Sclerosis MS). The immune system attacks nerve cells causing weakness, muscle spasm, and poor coordination.-Psoriasis. Immune attacks the skin producing scaly plaques on the skin.-Graves disease. Immune system produces antibodies that stimulate the thyroid gland to overproduce excess amounts of thyroid hormone (hyperthyroidism).-Hashimoto’s thyroiditis. Immune system produces antibodies that attack the thyroid gland destroying the cells that produce thyroid hormone. (hypothyroidism).-And many more The diagnosis and treatment of autoimmune diseases are both complicated and difficult to treat. Most medications at best give temporary symptom relief. The good news is that Naltrexone in low doses has a proven track record of having very positive outcomes with most autoimmune diseases.  SO WHAT IS NALTREXONE?Naltrexone is classified as an opiate antagonist that binds to the opioid receptor. This effectively blocks the receptor, preventing the body from responding to opioid drugs. It is used to treat addiction to opiate drugs. The prescription drug comes in a tablet of 50mg and is used in a dose of 50mg to 300mg daily to completely block the opioid receptor. In a low dose, usually 4.5mg a day, there is only temporary blockage of the opioid receptor.When the low dose wears off the body responds by producing thousands times more of the natural endorphins in the body. The increase in endorphins modulates the adverse immune response resulting in a dramatic improvement in autoimmune diseases. Studies and personal testimonials are proving that LDN may be the best answer to treating most autoimmune diseases. LDN has very few if any side effects, is relatively inexpensive, and easy to take at once a day dosing usually at bedtime. LDN does require a prescription from your physician and is available at most compounding pharmacies. Your physician will start you at a lower dose, usually 1.5 mg, and increase at biweekly intervals until the maintenance dose of 4.5mg is reached. Legacy Compounding has many patients taking LDN for autoimmune diseases with very favorable results. Refer to some of the testimonials on this website. If you have any questions or need more information please feel free to contact us. ​

Do You need Hormone Replacement Therapy?

​I hear it everyday: “My hormones are all out of whack, I just know it!” I would venture to guess that about 80% of women think that their hormones are out of balance. So how do you know if you are truly experiencing an imbalance?1.   If you think you are out of balance, you are probably right. Hormones and the ways they affect your body are complicated and it doesn’t take much to get things “out of whack”, especially in today’s world of high-stress, fast food, and chemical overload.2. . There are certain symptoms that are tell-tale signs like, irregular menstrual cycles, weight gain, mood swings, migraines, hot flashes and night sweats...just to name a few. There are some hormone abnormalities that we can detect based only on your symptoms (and can sometimes recommend helpful OTC medications or supplements).3.  By far, the best way to find out if you have a hormonal abnormality is to take a hormone test. Which is our main topic today- because there are lots of different ways to get tested and people always ask me which way is best. Let’s talk about blood testing first.This is the MOST commonly used testing method, mainly because of the cost and convenience. But don’t be fooled; just because it is the most common method doesn’t mean it is the best. Some hormones in blood are protein bound, which makes them inactive and a blood test measures both the free and the bound hormone. Unfortunately, the amount of bound hormone can vary widely from one person to the next. So we need to look for a test that only measures the free/active hormone. For this reason, blood levels do not get my highest recommendation (although, there are some cases where blood levels are useful). My favorite testing method is the urine test. I use this test to evaluate almost all of my patients before they begin hormone replacement therapy. The first benefit is that it only measures “free” hormone levels, so you get a more clear picture of the hormone that is available for your body to use. Also, this test gives us some insight into hormone metabolism, methylation, breast cancer risk and so much more! It is a little more tedious than the blood test because you complete it at home by collecting 4-5 urine samples at specific time points during the day. Most of my patients agree that the data we get from this test is well worth the additional effort on your part. Finally, this test really helps me to tailor a treatment to your body’s needs because I have so much more information to work with.The last method I want to tell you about is saliva testing. This is the test we like to use after you have started HRT. Saliva testing is the best way to measure your free hormone levels once you start using medications because it most accurately measures how much of the medications are actually reaching your tissues, which is where all the action happens.If you are interested in having your hormones tested, email me at Catherine@legacycompounding.com and I can help you get started today!​


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