Unlocking Hormonal Health: A Comprehensive Guide to Understanding and Choosing the Right Hormonal Testing for Your Patients

Scientists have identified over 50 hormones that influence almost every organ and function in the body. Many patients will be affected by hormone imbalances over the course of their lives. For reference, nearly 5 out of every 100 Americans over 12 years old will develop hypothyroidism, and as many as 85% of postmenopausal women experience symptoms related to menopausal hormone changes. Utilizing hormonal testing allows patients to get the proper treatment for underlying hormone imbalances to improve their quality of life. 

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Understanding Hormones and Their Role in Health

Hormones are the body's chemical messengers. They are produced in endocrine glands (hypothalamus, pituitary, pineal, thymus, pancreas, thyroid, adrenal, ovary, and testes) and then travel in the bloodstream to other tissues and organs. Hormones control hundreds of bodily processes, including growth, reproduction, metabolism, blood pressure, blood sugar, sleep, and mood. Hormones are powerful, so even small changes (too little or too much) can cause problems.

Types of Hormonal Imbalances

Since there are so many different hormones in the body, it will come as no surprise that people can experience many different types of hormone imbalances. In this article, we will be focusing on imbalances in thyroid, adrenal, and sex hormones. Multiple hormones affect the same organs and bodily functions, which means that the symptoms of different hormone imbalances often overlap. For example, the symptom of weight gain can be seen in thyroid, adrenal, and sex hormone imbalances. 

Hormones also affect the activity of other hormones; an imbalance in one hormone can have downstream impacts on other hormones. The symptoms of hormone imbalances can be nonspecific, meaning they could be caused by a different underlying medical condition entirely. Due to this complexity, it is important to order the proper testing to ensure that the correct balances or imbalances are diagnosed and treated. Some common symptoms of hormone imbalances include: 

• Fatigue
• Weight changes
• Hair loss
• Irregular menstruation
• Low libido
• Acne
• Infertility
• Insomnia
• Increased thirst
• Frequent urination

Thyroid Dysfunction

Thyroid disorders are common in the US, affecting over 10% of the population. The thyroid is a butterfly-shaped gland found in the neck. Its main job is to control the body's metabolic rate. 

In hypothyroidism or underactive thyroid, symptoms like fatigue, weight gain, constipation, depression, dry skin, hair loss, and inability to tolerate cold temperatures are common. In hyperthyroidism or overactive thyroid, symptoms like anxiety, palpitations, weight loss, hair loss, swelling of the neck (goiter), and insomnia are common.

Adrenal Imbalances

The adrenal glands are triangle-shaped glands that sit on top of the kidneys. The adrenal glands release cortisol, aldosterone, DHEA, epinephrine, and adrenaline, which control functions like metabolism, stress response, immune function, and blood pressure. Symptoms like fatigue, weight changes, high or low blood sugar, high or low blood pressure, frequent illnesses, hirsutism, and acne can all be signs of a potential adrenal imbalance. While individuals can have imbalances in any of the adrenal hormones, functional medicine practitioners frequently measure cortisol and DHEA to see how the adrenal glands are responding to stress.

Sex Hormone Imbalances

Reproductive hormones include hormones like estradiol, progesterone, testosterone, luteinizing hormone, and follicle-stimulating hormone. Symptoms of a sex hormone imbalance in women include acne, hair loss, irregular menstrual cycles, hot flashes, low libido, excess body hair (hirsutism), vaginal atrophy and dryness, and infertility. Symptoms of a sex hormone imbalance in men include erectile dysfunction, gynecomastia, infertility, low libido, and loss of muscle mass.

The Role of Hormonal Testing

Hormonal testing allows practitioners to identify specifically which hormones are imbalanced. Working with a functional medicine practitioner is important to help patients understand the complex interactions between all of the body's hormones and how imbalances are contributing to symptoms of concern. In some cases, hormone dysfunction can have deleterious effects on one's health. Earlier detection allows for intervention that can prevent further complications.

Choosing Hormonal Testing Methods

There are a few testing methods available to measure hormones, including blood, saliva, and urine. Blood testing has been the standard for diagnosing hormone imbalances, but saliva and urine testing are noninvasive options that can provide some additional insights. Saliva has the advantage of measuring bioavailable hormone levels, and urine testing provides the opportunity for hormone metabolite measurements. Hormones can fluctuate throughout the day and throughout the month. Both saliva and urine testing allow patients to more easily collect multiple samples to track these daily or monthly rhythms. (12, 15, 26)

Thyroid Testing

Thyroid function is assessed using blood testing. Generally, TSH is used as a screening tool for thyroid disorders. However, relying on TSH alone could possibly miss 7% of patients with thyroid dysfunction. A complete thyroid panel measures TSH, T4, T3, free T4, free T3 and thyroid antibodies. Measuring all of these markers allows you to assess the total thyroid hormone production, how well T4 is being converted into T3, whether there are enough free or bioavailable hormones, and if there is an autoimmune condition affecting thyroid function.

Adrenal Testing

Our two adrenal glands release hormones in response to a variety of stressors. They are controlled in part by the hypothalamus and pituitary glands in the brain, which is why we often refer to this group of glands as the hypothalamic-pituitary-adrenal (HPA) axis. Pathological conditions of the adrenal glands exist, such as Addison's disease or Cushing's Syndrome, in which too much or too little cortisol is produced. In other cases, more mild changes to the normal daily rhythm of cortisol production can be seen in response to stress. Adrenal hormones can be measured using blood, saliva, and urine testing. Genova's Adrenal Stress Profile with Cortisol Awakening Response measures the diurnal rhythm of cortisol with four salivary measurements throughout the day. It also measures the Cortisol Awakening Response (CAR), which can provide more information on how the body is responding to stress. The DUTCH Adrenal test uses dried urine to assess for the daily free cortisol and cortisone patterns as well as the cortisol and cortisone metabolites. (2, 23, 26)

Sex Hormone Testing

Like adrenal hormones, sex hormones can be measured using blood, saliva, and urine testing. The Female Hormone Panel and Male Hormone Panel measure the primary reproductive hormones to identify imbalances. In cases of tracking hormones after topical hormone therapy, ZRT's Salivary Profile I would be a good option for men or women. (27) 

In cases of women experiencing irregular menstrual cycles, single collection labs might miss possible hormone imbalances. The DUTCH Cycle Mapping (urine) or Genova's Rhythm test are great options in this scenario because they take multiple measurements of estrogen and progesterone throughout the monthly cycle. (4, 24)

Interpreting Hormonal Test Results 

Standard lab ranges are generally determined based on population studies. Sometimes, tests will have just one standard range, and sometimes, they might have a different range based on age, race, sex, or other factors. The "normal" range is usually determined by analyzing the data to calculate the mean and standard deviation in order to determine the range of values that are within the 95% confidence interval. Therefore, the standard reference ranges are often quite broad. Functional medicine practitioners prefer to look at a narrower optimal range to hopefully intervene earlier in a disease process. In the case of thyroid, a narrower reference range for TSH has already been proposed.

When to Retest Labs

Deciding if or when to retest will vary on a case-to-case basis. As an example, let's discuss thyroid assessment. If your provider ordered a thyroid panel and identified subclinical hypothyroidism (slight elevation in TSH but normal T4 levels), he or she might decide to retest your levels in 3 months instead of instigating treatment right away. If your provider diagnoses hypothyroidism (high TSH, low T4 levels), he or she will most likely start you on a treatment and retest your hormones again in approximately six weeks. This is yet another reason why it is so important to work with functional medicine practitioners. They can help patients navigate when it is appropriate to start interventions and what level of intervention is necessary. They can also instruct patients on if they need to continue monitoring hormones and how frequently. (13, 22) 

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Summary

Navigating the complexities of hormones and hormone imbalances can be difficult for patients to manage on their own. Due to the many nonspecific symptoms that can be caused by hormone imbalances, functional medicine practitioners can rely upon hormone testing (via blood, urine, and/or saliva) to properly identify which hormones are imbalanced or if patients' symptoms are due to a different issue entirely. Testing also provides the opportunity to track the efficacy of treatment protocols once they have been started.