The practice of hormone therapy has come under a lot of criticism in the last few decades. Historically, synthetic hormones have been prescribed for women based on little more than the diagnosis of “menopause”, or for men based on age. While the nature of the hormones themselves – estrogen from horses, and synthetic progestins – have been shown to be problematic (a topic for another post!), there is a deeper issue at hand with the common practice of not testing before prescribing.
With a goal of safely and effectively balancing hormone levels for both symptom management and health promotion it is important to aim before firing! And that means testing hormone levels before and during treatment (ideally with bioidentical hormone therapy).
Hormones exist in the body both bound to a “chaperone” binding protein, as well as in free form, ready and available for interaction with the receptor on particular cells. Hormones can be measured in three different fluids: blood/serum, urine, and saliva.
Blood testing is the most invasive option, costs vary with each hormone, and the results are available quite rapidly. But blood levels give the total amount of each hormone including what is bound, and doesn’t reflect levels that are readily available for action in the body. This can leave results up to interpretation when levels appear normal but symptoms are present.
Urine testing looks at the breakdown products of various hormones. Original hormone levels can be inferred only. Urine testing is useful for obtaining information about various enzyme pathways, which in turn can be used to assess relative health risks. For example, some estrogen metabolites are associated with increased risk of breast cancer while other are associated with protection from breast cancer. Knowing which pathways are dominant allows for proactive prevention of certain diseases.
Saliva testing is the most valuable for obtaining a snapshot of hormone levels that are in free form. In other words, salivary hormone levels reflect the levels of hormones that are actually available to communicate with cells and influence their function, which is clinically useful information.
Because hormones work in concert a panel of 8-10 hormones is typically ordered for the initial “snapshot”, although saliva can be used to assess individual hormone levels as needed (ie. for follow up). The process is simple and non-invasive, and the results are immensely helpful for your ND to consider where you are at in your current health and the best pathway forward towards your optimal health goals.