‘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 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 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.
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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Episode 052 – What Biest Ratio is Best for Menopause?
This is such helpful information. I have often wondered who 80:20 is good for and who 50:50 is good for.
One thing I'm still confused by is the estrogen weight gain component. You said that estrogen (as well as menopause in general) could be the cause of her weight gain. I can relate. I was very thin my whole life, now 53 and about 30 lbs overweight. But you also said she might benefit from getting her estrogen balanced, and she was not using enough.
If too low a dose made her gain weight, won't an increased dose cause more weight gain? I have heard other podcasts and read articles that in menopause, we gain weight because our estrogen falls. Estrogen seems to be blamed for weight gain, whether it's high or low. Can you help clarify? There's something I'm not understanding. Thank you! Tracy
Often estrogen has been the scapegoat for weight gain. I'm sure you have heard too much causes weight gain. Too little can pack on the pounds. It can be pretty confusing. So which is it? Is too much estrogen causing my pants to become uncomfortably tight? Or is it too little estrogen that has given me the gut I never had?
Well, it’s not that simple. Estrogen levels do have a hand in weight gain and weight loss. But it is not the only variable. It really is the combination of the balance of estrogen with other hormones in your body. To name a few main players, progesterone, insulin, and cortisol, as well as enzymes, lipoprotein lipase (LPL), and hormone-sensitive lipase (HSL). Okay, I know that sounds vague and doesn't answer the question. Let's back up a bit and look at what women are saying about estrogen.
As soon as menopause hits, women complain that they are instantly 15-30 lbs heavier. Not because of diet or lifestyle. It's like menopause adds an unwanted 15-30 lbs overnight. Then some women are on hormone replacement therapy, taking estrogen, and are horrified because the HRT caused them to gain 10 lbs in a month. So what is it? Did the lack of estrogen in menopause cause that 20 lb weight gain? Or did that hormone replacement estrogen create rolls that were never there? Well, actually, both are true. Before you throw out your jeans in favor of high-waisted yoga pants, let’s learn about the other players in weight gain.
Progesterone will buffer estrogen. Estrogen does like to grow things'. That is why in puberty, you grow breasts and hips. Progesterone helps to balance some of the growth' that estrogen can cause. That is why in perimenopause, when the progesterone drops and the estrogen is running the show, the weight gain begins. That is also why when a woman starts estrogen therapy for menopause but not enough progesterone, there is weight gain.