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Health Protocols

Female Hormone Restoration

Pros and Cons of Different Hormone Testing Methods

There is continuing debate regarding the best testing methods for hormone status. Hormones can be analyzed in the blood, urine, or saliva. There are benefits and drawbacks to each of these methods.

Saliva Testing

Pros - This easy, at home collection process is a measurement of bioavailable hormone levels.

Cons - Accuracy and testing variability are issues to consider. Hormone levels in saliva can vary with saliva flow rate, time of day, timing of hormone therapy, eating, and tooth brushing, as well as gum disease (even if subclinical), and there are no salivary tests for hormone metabolites (Sood 2011; Larsen 2014).

Urine Testing

Pros - This method provides a 24-hour picture of hormone levels. Because it captures both the peaks and troughs that occur during the day, it is not susceptible to moment-to-moment fluctuations. A 24-hour urine test can be used to assess the three main estrogens— estrone, estadiol, and estriol—as well as progesterone, pregnenolone, testosterone, and DHEA. Urine testing can also be used to assess metabolites like 2- and 16-hydroxyestrone (Larsen 2014). Urine testing is excellent at providing an overview of an individual’s hormone metabolism that cannot be seen in blood or saliva.

Cons – Urine testing is considered less convenient by some patients, and comprehensive 24-hour urine panels may be more expensive than other types of testing (Larsen 2014). It can show high levels of hormones despite low blood levels for hormones like testosterone which are carried by sex hormone binding globulin (SHBG). If SHBG levels are low in the blood, testosterone is not preserved adequately and the free form is excreted from the kidney in excess and thus can show high levels despite low levels in the blood.

Blood Testing

Pros - This method has been used consistently for decades and has well-established reference ranges. Serum testing is relatively inexpensive, routine, and readily available through blood draw centers (Larsen 2014).

Cons - Blood draws involve needle sticks. Blood testing provides only single-point evaluation, and because hormone levels can fluctuate widely during the day, reference ranges are typically broad. Although estradiol, estrone, testosterone, and DHEA can be evaluated, blood testing has limited ability to assess non-pregnancy levels of estriol in women using transdermal preparations so it is not suggested to test blood levels of estriol. Furthermore, with the exception of testosterone, these tests generally measure total amounts (bound and unbound) of hormones being tested, which are not as clinically meaningful as free hormone levels. Finally, there is no blood hormone metabolite testing available (Larsen 2014).