‘Doc, I really don’t feel like myself. I think it’s my hormones. Could it be my hormones? Can you test my hormones?’
How many times have I heard new clients tell me this story? They go to see their GP, Gyno, or Internist, asking to have their hormones tested. Only to be told that there is no testing for hormones. Or that it’s not necessary to test hormones. Only to leave feeling dismissed, with no answers to why they do not feel well.
While I understand that your GP, Gynocologist, and Primary Care Physician are not the jack of all trades,’ there are many tests for hormones. There are blood tests, urinary testing, and even saliva testing. The more difficult part of hormone testing is the interpretation. The basic lab values assigned by the labs are very vast, and without experience and training, it can be quite difficult to determine if there is a hormone imbalance.
If you are feeling like you have a hormone imbalance or having symptoms concerning your hormones, below is a list of common hormones to be tested and why. Because blood lab testing is so popular, I am going to stick to blood testing. Later we will have more labs and interpretations for urine and saliva.
To start, blood testing is just a look at one moment in time with respect to your hormone levels. In a menstruating woman, her hormone levels are changing every day. But in a menopausal woman where the ovarian function has ceased, her hormone levels are going to be pretty level day to day. So in a female that is still having her period, I like to try and aim for getting the blood drawn around day 12 and/or day 21. In a 28-day cycle, the estrogen will surge around day 12, and the progesterone will surge on day 21. This can give us better insight into her levels of progesterone and estrogen. In a menopausal woman that has not had a period or has sporadic periods with common menopausal symptoms, I will have her draw her blood any time of the month.
FSH and LH:
FSH stands for follicle-stimulating hormone, and LH stands for luteinizing hormone. These are not actually hormones. They are stimulating hormones.’ Meaning both the FSH and LH are released from the pituitary gland (in your brain) in response to estrogen and progesterone production. The FSH and LH work in what is called a negative feedback loop.’ Meaning if the levels of estrogen and progesterone are high, then the FSH and LH are low. In turn, if the estrogen and progesterone levels are low, then the FSH and LH are high. It is like when you want your husband to take out the garbage. If he doesn’t, you might raise your voice until he does. It is the same with all stimulating hormones. If the ovarian production of hormones is low, as in menopause or perimenopause, the FSH and LH levels will look high.
Estradiol and Progesterone:
Always test estradiol to get specific results for estrogen levels. Estradiol is much more specific for estrogen levels than simple total estrogens. Ideally, in a menstruating woman having the blood test around day 21 will give you insight if that woman is ovulating. It will so give you insight if there is progesterone deficiency or estrogen dominance. Just a little background. In a perfect 28-day cycle, the period is from about days 1-4, and the estradiol and progesterone are low. After the shedding of the uterus (period), the estradiol starts to climb, peaking at day 12. The rise in estradiol will cause ovulation on about day 14. Where the egg leaves the ovary to travel down the fallopian tube is a spot called the corpus luteum. The corpus luteum will start to secrete progesterone. This is why I like to test progesterone post-day 14 (around day 21). If there is no progesterone post-day 14 then that means there was no ovulation. If the progesterone is low, then there could have been ovulation, but the secretion of progesterone is low. This is very common in perimenopause (ages 40-50yo). Now, if post day 14, the estradiol is quite high, then that woman is experiencing estrogen dominance. Estrogen dominance and progesterone insufficiency have a lot of symptoms and are very treatable, but that is another blog/podcast.
Testosterone and DHEA:
I consider testosterone to be more of an adrenal hormone for females. Testosterone is a reproductive hormone for men but for women, it is not. Women make DHEA from the adrenals, and it will convert to testosterone. We do make a little testosterone from the ovaries, but the majority is from the conversion of DHEA to testosterone. Both DHEA and testosterone are considered androgens. Meaning they can cause more androgen symptoms such as acne, hair loss, and irritability. But I feel testosterone and DHEA are super important to the balance of hormones in a woman’s life. But if the estrogen and/or progesterone are dropping/declining, then the testosterone and DHEA can become the leader of the pack. They are unbuffered by estrogen and progesterone, thus causing androgen symptoms. Testosterone is usually pretty stable throughout the cycle (it can increase during ovulation). But you can blood test for testosterone pretty much any time of the cycle. DHEA should be tested as DHEA-Sulfate. DHEA-Sulfate is a metabolite of DHEA. But it is much more specific as a marker for DHEA than a total DHEA.
Cortisol:
Cortisol in a blood test is not very accurate. Ideally, the more accurate form of cortisol testing is saliva testing. In fact, multiple saliva samples in a 24-hour period give very specific results. As cortisol is released from the adrenal glands in a diurnal curve. Meaning it is highest in the morning, drops slowly in after, and is the lowest at night so that you can get a good night’s sleep. But for convenience sake, I will do a serum/blood cortisol level. It does give you some insight as to where the cortisol levels are at. Especially if the saliva test is too costly for a client or too time-consuming to be collecting samples of saliva in a day.
Insulin:
Insulin is often not tested. I love to have a fasting-insulin blood test. It is so common in hormonal imbalance, such as perimenopause or menopause, to have weight gain. As soon as a woman hits perimenopause, it is like they gain 10-15 lbs overnight. This can be due to insulin. Insulin a fat-storing hormone. If there are higher normal levels of insulin, that makes it really easy to gain weight and difficult to lose.
Thyroid Testing:
Just because the thyroid has such an impact on the female hormones, I always do thyroid function blood testing. TSH (thyroid stimulating hormone) is another stimulating hormone from the pituitary gland. It monitors overall thyroid levels in the body. Never base a simple TSH on the function of the thyroid. Always get a FreeT4 and a FreeT3. The thyroid mainly makes T4, which will then travel in the body, and the peripheral tissues will convert T4 to free T3. Free T3 is the active hormone of the thyroid. So it is important to know that the T4 is converting to T3 for thyroid function.
If you have never had your thyroid tested before, make sure to test for Hashimoto’s antibodies. The main Hashimotos antibodies are thyroid-peroxidase antibodies (TPO) and antithyroglobulin antibodies (TGab). Hashimotos and Hashimoto’s antibodies are a whole lengthy podcast, but be sure to check at least once in your lifetime to see if you have Hashimotos.
As I mentioned at the beginning, many docs will not test your hormones. If you are having trouble getting your hormones tested, go to progressyourhealth.com/labs. We have comprehensive hormone panels and individual ala-cart tests. If you are reading this, then it is enough to assume you are ready to take control of your hormonal health. We are here to help and guide you on that process.
For a list of some of the panels we offer, click here.
If you have questions, feel free to contact us.
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In this episode, we discuss the best way to reduce triglycerides. Sasha, a podcast listener, asked us how to lower her triglycerides. We then go into depth about triglycerides, how to lower them, and why they could be high in the first place.
How to read a lipid panel
Supplements for lowering triglycerides
Lifestyle changes for lowering triglycerides
What do high triglycerides mean?
Building blocks for triglycerides
Improving metabolic health
Can menopause increase triglycerides?
High triglycerides and thyroid hormones
Sacha’s Question:”I know this isn’t a hormone question but was hoping you could give me some direction. I was wondering what is the best way to lower triglycerides? thank you for your help!”
If you have a question, please visit our website and click Ask the Doctor a question.
Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns youmay have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
In this episode, we discuss a podcast listener’s question. ‘Alesha’ is concerned that she should not take estrogen replacement therapy because she has fibroids. This is a common concern. The idea that estrogen can cause or propagate fibroids has left many menopausal women without support for their symptoms. Just because women have or have had a history of fibroids does not mean they are not a candidate for estrogentherapy. In fact, women with fibroid can take estrogen hormone replacement therapy.
In this episode, we go into depth about taking estrogen with fibroids. And we break Alesha’s question into:
What are fibroids?
Fibroids and estrogen replacement therapy
Can I take estrogen if I have fibroids?
What is adenomyosis?
Estrogen’s role in fibroids
Difference between perimenopause and menopause
How menopause can affect prediabetes
Alesha’s Question:
“Is there any hope for someone with adenomyosis take estrogen? If so, when is the right time? I know adenomyosis is stimulated by estrogen. I even had 1 dr offer a hysterectomy so I could take estrogen without any issues ??!! I have a history of heavy periods have had many trans vag ultrasounds and biopsy’s over the years Uterus was enlarged, lining was wnl. Had a hysterscopy to remove some cysts they found 4 hrs ago. Last ultrasound showed probable adenomyosis.i am almost 57and I am in late perimenopause. Cycles have been erratic just went 6 months without a cycle then had a normal cycle…for years of perimenopause I had symptoms of high estrogen. Most of the time for the last year I had symptoms of low estrogen. Poor sleep waking up 4-5x night, dry skin, vaginal dryness, night sweats, brain fog, difficulty concentrating which makes my job very difficult. I have also developed mild sleep apnea(sleep lab) and after my last physical I am on the edge of pre diabetes. ( am normal weight, I walk daily and lift weights, eat high protein diet with lots of veggies and healthy fats.) I am currently taking a progesterone troche( 1/4 lozenge 50mg 2x day) and vaginal estrogen. I was taking an oral progesterone 300 mg thought it would help with sleep but didn’t. The progesterone has helped with GI issues, puffiness, bloating, cramping and anxiety.”
If you have a question, please visit our website and click Ask the Doctor a question.
Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
In this episode, we talk about POI (primary/premature ovarian insufficiency) and earlymenopause. Samantha sent in a question about whether she is in menopause or hasPOI at the age of 36.We break Samantha’s question into:- What is POI (Premature/Primary ovarian insufficiency)?- Taking estradiol during perimenopause- Difference between perimenopause and menopause- What is an FSH?- Insulin resistance and perimenopauseSamantha’s Question:I am 36 and have been slowly noticing perimenopause/low estrogen symptoms for thepast year and a half. I went to an online provider and started HRT and haveexperienced so much relief! From mental symptoms to night sweats to dryness(everywhere) I have started to feel so much better being on estradiol and progesteronefor 3 months. I have been working with a functional nutritionist on my diet, walking daily,etc.i had gestational diabetes for all 3 pregnancies and also got my tubes removed lastyear. After I came off the birth control all of my symptoms started! I recently saw mynormal OBGYN so I could get my HRT through insurance and he agreed- but made itclear this isn’t menopause, could be POI, but seemed skeptical. I got bloodwork doneand my FSH has risen in the past few months from a 3.7 to an 8. But it’s still considerednormal. All of my thyroid and other bloodwork also comes back normal. Is POI apossible diagnosis? I feel crazy!!If you have a question, please visit our website and click Ask the Doctor a question.
Disclaimer: All content in this blog, including text, images, audio, video, or other formats,was created for informational purposes only. This video, website, and blog aim topromote consumer/public understanding and general knowledge of various healthtopics. This content is not a substitute for professional medical advice, diagnosis, ortreatment. Please consult your healthcare provider with any questions or concerns youmay have regarding your condition before undertaking a new healthcare regimen.
Never disregard professional medical advice or delay seeking it because of somethingyou have read on this website. If your healthcare provider is not interested indiscussing your health concerns regarding this topic, then it is time to find a new doctor.
Can you be in both in perimenopause and menopause? Can you be menopausal andperimenopausal at the same time? The difference between perimenopause andmenopause is not a line in the sand. It is not like crossing through the Peace Arch fromBlaine Washington to the country of Canada. And at times, there is nothing peacefulabout perimenopause or menopause.There is a gray area where you are just moving out of perimenopause and intomenopause, where you are not quite in perimenopause but are not completely inmenopause. We delve deeper into the place that is between perimenopause andmenopause:- What is the difference between perimenopause and menopause?- Can you be both in perimenopause and menopause?- The difference between perimenopause and menopause- What it feels like to go from perimenopause to menopause- Can you take estrogen or biest when you are going from perimenopause tomenopause?- Is bleeding in menopause considered perimenopause?- Top symptoms of perimenopause- Top symptoms of menopause- Are you a candidate for estrogen replacement in perimenopause?If you have a question, please visit our website and click Ask the Doctor a question.Disclaimer: All content in this blog, including text, images, audio, video, or other formats,was created for informational purposes only. This video, website, and blog aim topromote consumer/public understanding and general knowledge of various healthtopics. This content is not a substitute for professional medical advice, diagnosis, ortreatment. Please consult your healthcare provider with any questions or concerns youmay have regarding your condition before undertaking a new healthcare regimen.Never disregard professional medical advice or delay seeking it because of somethingyou have read on this website. If your healthcare provider is not interested indiscussing your health concerns regarding this topic, then it is time to find a new doctor.
In this episode, we discuss a listener’s question about how to apply estriol to your face. ‘Connie’ is confused about whether she can use her Biest cream on her face. And she wanted to know the difference between estriol and Biest when it comes to treating menopausal symptoms.
We analyze Connie’s question into:
Applying estriol to the face
What is biest?
What is estriol?
What is the difference between estriol and biest?
Applying estriol vaginally
It is not a good idea to apply biest to vaginal tissues if you have a uterus
Connie’s Question:
“HI there, I loved your article on estriol for the face. I was prescribed an 80-20 bi-est cream for HRT. My question is, how is that different from a 0.3 estriol cream for the face like the kind My Alloy makes? Could I just use more of my Biest cream on my face? Would that be stronger than the My alloy 0.3 estriol cream? Lastly, the .3 estriol cream is not supposed to affect your overall hormone levels, but the Bi-est cream is supposed to affect your hormones and relieve symptoms of menopause. Why does one estriol work differently than the other? Thank you so much for any guidance you may be able to offer. It’s so hard figuring all of this out!”
If you have a question, please visit our website and click Ask the Doctor a question.
Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
In this episode we talk about where to apply hormone creams. Sadie, our listener wants to know if she needs to rotate the application sites of her hormone cream.
In this episode we discuss:
Where to apply biest cream
What to apply testosterone cream for females
Places you should not apply your testosterone cream
Best absorption sites for hormone creams
Sadie’s Question:”I have been using hormones for a little over a year. I swear by them!! I have not rotated sites at all. I use testosterone/DHEA cream behind both of my knees and E3/E2 on both of my inner thighs every morning. I take a progesterone capsule at bedtime. My doctor and everything I read says to rotate sites. I found an article by Dr. Collins and now I found your article about not having to rotate sites, so I am going to keep doing what I have been. I put the cream on both of the backs of my legs and thighs. My question is should I alternate one back of knee and then the other and the same with the inner thighs or does it matter?
If you have a question, please visit our website and click Ask the Doctor a question.
Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.