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.