Life Extension Magazine December 2014
Ask The Doctor
What Is The Best Way To Test Your Hormones?
By Scott Fogle, ND
Q: What is the best way to test my hormones? I see that there are different methods such as saliva, blood, and urine.
A: I am constantly asked this question regarding the various methods available for hormone testing. Unfortunately, there’s not a simple answer because each of the methods has unique pros and cons. The question is compounded by the fact that doctors and researchers have differing opinions on which testing method is the best. Making the matter even more complex, laboratory companies with vested interests also muddy the waters by presenting biased evidence showing that their way is the best way.
So what is the truth? Each of the methods for testing hormones has its pros and cons. Each method can provide valuable and important information, but because the information is different for each method, the method(s) you use should be determined by your diagnostic needs. Ideally, a physician will determine the best testing method after carefully listening to a patient’s medical and family history combined with the results of a physical exam.
Some conditions are easy to test for, such as menopause, which typically only needs one testing method, any of which can work fine. At Life Extension®, we typically suggest blood testing for menopause since it is easy, inexpensive, and accessible.
Other conditions, such as when a woman is struggling with terrible perimenopausal symptoms, are more difficult to test for because hormone levels change daily and are hard to pin down. Since a blood test is only a snapshot in time, the 24-hour urinary hormone test or multiple saliva tests done in spaced intervals can often provide more helpful information.
In certain complex situations, more than one testing method may be needed. In fact, at Life Extension, we may suggest doing both the blood and urine test at the same time in difficult situations, such as when a woman is struggling to find the right hormone dosages while going through a difficult perimenopausal phase or a man is trying to figure out why his testosterone levels are not improving with testosterone therapy. While more expensive, combining two different methods of testing provides more valuable information than doing only one method and can provide that extra insight needed for challenging cases.
Three Types Of Tests
Remember, there is no one perfect way to test hormones. Each test has its merits and its limitations. Let’s look at each method for its unique strengths and weaknesses.
Blood testing is a tried-and-true way to check hormones and is regarded by many to be an excellent approach. It is readily accessible, and has good correlation with symptoms. It can test both free (active) and total levels of testosterone (something saliva and urine can’t do). It can also be used to assess levels of sex hormone binding globulin (SHBG), which is important for maintaining reservoirs of sex hormones, as well as for protecting them from being excreted or metabolized too quickly. For men, annual blood testing is important because it’s the only way to accurately measure PSA levels. Whether a man chooses to restore youthful hormone balance or not, annual PSA tests to assess the health of one’s prostate gland are vitally important.
To help ensure accuracy, the CDC recently launched a volunteer program for labs that has further advanced accuracy and reliability in blood testing. The CDC makes available on its website (www.cdc.gov), the names of labs that have passed the performance criteria for the CDC Testosterone Reference Method in adult male and female serum. In fact, the methods used by Life Extension for its free and total testosterone have been CDC-certified every year since the program’s inception in 2011. Unfortunately, there is no similar certification program for saliva or urine hormone testing at this time.
However, blood testing also has some limitations. First, it only provides a single snapshot in time and sometimes more information is needed since hormones can have daily and monthly rhythms. Also, for those doing bioidentical hormone replacement, it’s important to know that blood testing cannot easily be used to assess estrogen metabolites to provide a 2/16 hydroxyestrone ratio. This ratio can be helpful since there are scientific studies that found some of the estrogen metabolites may promote cancer while others may have beneficial anticancer qualities. Blood testing does very well assessing estradiol levels, but blood testing cannot be used to check estriol levels. Since most bioidentical hormone replacement is typically done using a combination of estradiol and estriol, sometimes it is helpful to check both. However, for many women, an improvement in estradiol correlates with improvement in estriol so it is not necessary to test for estriol except in situations where the woman’s symptoms are not improving as expected.
The 24-Hour Urinary Panel
The 24-hour urinary hormone panel has several positive qualities. First, it provides the average hormone level over a 24-hour period, removing the variable of daily fluctuations in one’s hormone levels. It also tests for all three estrogens (estrone, estradiol, and estriol) and provides additional helpful information, such as the levels of 2/16 hydroxyestrone ratio and 2-methoxyestradiol (suspected to have anticancer qualities). Although the test is more expensive than blood or saliva, it tests more hormones and hormone metabolites than any blood or saliva panel, which results in a higher level of information that is especially helpful in difficult cases.
Even though it has so many benefits, the 24-hour urinary hormone panel has a few limitations as well. The main problem is that it only measures the hormones the body is excreting in the urine. And while excreted hormones often correlate with tissue and blood levels, this is not always the case. This method is also inconvenient because it requires a person to collect all their urine over a 24-hour period.
Saliva testing is very easy to do. It doesn’t require a blood draw and it looks at free hormone levels. It also can test for the hormone estriol, which is helpful for difficult cases when doing bioidentical hormone therapy such as BiEst or TriEst. Saliva testing allows for charting changes in hormones over time (such as a monthly menstrual cycle) through multiple samples, thus providing information about the peaks and troughs of a person’s hormone levels.
These are all positive aspects to saliva testing. However, there are limitations too. The first is accuracy. In all laboratory testing, the more you have of any substance, the greater your accuracy will be in testing it. The problem with saliva testing is that hormones are found in much lower concentrations in saliva than in blood or urine. This makes it much harder for labs to consistently report salivary hormones with as much accuracy as blood or urine. In addition, contamination from bleeding gums or even aggressive tooth brushing can affect a person’s results and make the levels seem artificially high.
Further, other factors such as salivary pH and flow rate can also affect results. In the past, when split samples from the same person were sent to different salivary testing labs, the results from the different labs were unfortunately very different, leading some researchers to discount saliva testing altogether. Fortunately, as the technology has improved, many of the labs have improved their ability to provide accurate and reproducible results. However, the fact remains that because hormone levels are much lower in the saliva, any lab that tests salivary hormones will need highly proficient quality control standards to assure consistent and reliable accuracy.
Consider The Pros And Cons
As you can see, each of the different methods for hormone testing has its merits and limitations depending on your diagnostic needs.
It is important to understand the pros and cons of each method and to use the method (or methods) that will provide the most helpful information for your unique situation.
Life Extension offers several excellent blood hormone panels as well as a comprehensive 24-hour urinary hormone panel. For most people seeking to obtain a comprehensive picture of their hormone status, the blood hormone panels are a great place to start. Life Extension’s health advisors are available to help you obtain more information on which tests may be best for your unique situation.
Why Do Results Differ From Lab To Lab?
Another question frequently asked is why hormone results from LabCorp are different than results from Quest for the same hormone test.
At Life Extension, we often encounter customers who are concerned because they received a hormone result from Quest that their doctor ordered, and it doesn’t match the result from Life Extension using LabCorp.
What most people don’t realize is that there is no standardization between commercial blood labs for hormone testing. It is a common assumption that all labs are testing hormones the exact same way and that the numbers should be the same between labs. Unfortunately, this is not the case. Because different labs use different methods, the results are not directly comparable. And since the methods, the reagents, and the equipment are all different, the number you get from one lab may not be comparable to the number from another lab—even though the name of the test is the same.
This is so frustratingly common that when I read a study on hormone testing, the first thing I do is go to the “Materials and Methods” section to see which lab did the test and what methodology was used. Only then can I put the hormone levels reported in the study into the proper perspective. This lack of standardization between labs makes it very frustrating for clinicians and researchers alike.
To make matters worse, there are also multiple ways to test the same hormone within each lab. Testosterone is the classic example. The two primary methods used to assess testosterone in the blood are an immunoassay methodology or liquid chromatography coupled with tandem mass spectrometry. This situation leads to a lot of confusion among patients and doctors alike.
The best solution is to stick with the same lab and use the same methodology each time.
Foreign Testing Numbers Don’t Match American Numbers
Blood work done in other countries is often reported in different units than in the US. Other countries often report results as a molar concentration. For example, in other countries, testosterone is commonly reported as nmol/L (nanomole/liter), while in the US, it is reported as ng/dL (nanogram/deciliter). This means that in order for the units to match up, conversions must be made.
However, even after converting the units, there is still the issue of possible differences in methodology, especially when testing for hormones. It is less of an issue with tests such as CBC (complete blood count), chemistry, and glucose since there is better standardization among those common tests (although it will always depend on the lab doing it). But the fact that there is no standardization for hormones between labs can make it very challenging for doctors to compare hormone results from overseas labs.
Although a comparison can be approximated, it will never be as good as having your lab work done consistently through the same lab, which is highly recommended whenever possible.
Hormone testing becomes increasingly important as you age. Testing can allow you and your physician to anticipate and prevent various health conditions that are directly attributable to hormonal imbalance. It is therefore important to have your hormones tested annually. Each test has its own strengths and weaknesses depending on your diagnostic goals.
If you have any questions on the scientific content of this article, please call a Life Extension® Health Advisor at 1-866-864-3027.
Dr. Scott Fogle is the Director of Clinical Information and Laboratory Services at Life Extension®, where he oversees scientific and medical information as well as its laboratory division.