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Top 7 Hormones You Should Be Testing

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September 18, 2017
hormone testing, naturopathic doctor toronto

If you don’t know this already, Naturopathic Doctors like myself, love discovering the root cause of your problems. Once we find the root cause and address it, your unwanted symptoms will disappear. For good. Sometimes it can be easy to find the root cause (ie. You can’t sleep because you’re drinking a coffee 30min before bed), and sometimes it can be more difficult (ie. your period is irregular). 

Just because the cause isn’t blatantly obvious, doesn’t mean that it’s impossible to discover. In these situations, we’ll commonly recommend lab testing to see how your body is functioning at a chemical and cellular level. 

When it comes to irregular, heavy or painful periods, hormone testing is the way to go. Using the information we get from hormone testing, Naturopathic Doctors can create a plan with the best treatment for you. This is especially helpful if you’ve used Dr. Google in the past to treat singular symptoms. Our hormones can be quite complex, and different patterns may be be responsible for what you’re experiencing. If you find yourself constantly at the health food store looking for a supplement per symptom – investing in hormone testing will likely serve you better in the long run. 

Symptoms associated with hormonal imbalance

– Weight gain OR weight loss
– Breast tenderness
– Abdominal cramping
– Bloating
– Headaches
– Skin changes
Hair changes
– Low sex drive
– Insomnia
Fatigue
– & MORE!

Hormones you should test:

1. Estrogen

Estrogen is not a singular hormone, it’s present in three forms: estradiol, estrone and estriol. When we think of estrogen, we’re actually thinking of estriol which is the predominant form. Estrogen is mainly produced by the ovaries, and by the adrenal glands (in menopause) and fat cells in smaller quantities. This is the main hormone of the menstrual cycle, especially the first half of your cycle where it controls the thickness of the uterine lining.

How estrogen works

Estrogen helps to: control vaginal moisture, enhances sex drive, prevents UTIs and urinary incontinence. Moreover it has great effects on the brain, nervous system and the skin. 

When to test estrogen

Day 3 (ie. 3 days after the start of your period) or day 21 (with progesterone)

Why you should test estrogen

If you experience: abnormal vaginal bleeding, inability to become or stay pregnant, irregular cycles or menopause. 

Optimal Lab Range

Follicular Phase: 91-275 pmol/L (25-75pg/mL)

What it means

HIGH estrogen happens because of: early puberty, ovarian or adrenal tumour, hyperthyroidism, cirrhosis, and drugs. May increase during perimenopause due to the rise of FSH.

LOW estrogen happens because of: menopause, PCOS, ovarian dysfunction, low pituitary hormones, eating disorders, extreme endurance exercise. 

2. Progesterone

Progesterone is another hormone produced in the ovaries, and following menopause is produced in small amounts by the adrenal glands. This hormone dominates the second half of the menstrual cycle as it leads to the thickening of the uterine wall in case a fertilized egg implants. In the event that fertilization does not occur, progesterone levels decrease and triggers the start of your period. 

How progesterone works

Progesterone helps promote urination, improves sleep, aids in mood and works with the thyroid to stimulate metabolism. A little known fact, but when you’re undergoing chronic periods of stress, your body will use progesterone to make cortisol. 

When to measure progesterone

Day 21 (or 7 days after ovulation)

Optimal Lab Range

18 ng/mL (57nmol/L)

Levels higher than 16 nmol/L strongly suggest that ovulation has happened.

What it means

HIGH progesterone because: luteal phase of the menstrual cycle, ovarian cysts, overproduction by the adrenal glands, adrenal tumours, or congenital adrenal hyperplasia. 

LOW progesterone because: No periods, decrease in ovarian function, miscarriage, threatened abortion. 

3. Testosterone

Testosterone is an androgen – a male hormone. Nevertheless, this hormone is produced within the ovaries and adrenal glands of women. As women age, production of this hormone decreases. 

How testosterone works

This hormone is normally low in women and is associated with sex drive, bone density, muscle mass and strength.

When to measure testosterone

Anytime during the cycle. Be sure to measure free and total testosterone for a better idea. 

Don’t forget to test

DHEA-S and SHBG (sex hormone binding globulin)

What it means

HIGH testosterone is associated with a common condition called Polycystic Ovary Syndrome (PCOS), congenital adrenal hyperplasia or an ovarian/adrenal gland tumour. Women who are also taking forms of estrogen, may have higher testosterone levels.

LOW testosterone is associated with fatigue, loss of muscle mass and strength, low libido, lack of motivation, and lowered mood.  

4. Cortisol

Known as our stress hormone, cortisol is produced by the adrenal glands.

How cortisol works

Cortisol helps the body adapt to daily stressors. However with prolonged stress, the adrenal glands may become fatigued and stop producing this stress hormone. 

Best type of test

This is a test that benefits from saliva or urine testing, because you’re able to visualize your body’s cortisol pattern throughout the day, and how your body is handling stress.  

When to test

Anytime you want. Best to do 4-point testing to get an idea of what your curve looks like.

What it means

Excess cortisol can cause havoc on our body and interfere with other hormones including the thyroid hormones, testosterone and progesterone. 

5. Thyroid Stimulating Hormone (TSH)

The thyroid is incredibly important for metabolism and the overall function of the body. It also controls menstrual regularity, fertility, body weight, energy, heart rate, and more!

How TSH works

TSH acts as the barometer of the body and indicates if thyroid gland is working properly (and is an indicator of T3 in the pituitary). Additionally, thyroxine (T4), triiodothyronine (T3) and reverse T3 should be tested alongside TSH to get a solid picture of how the thyroid is functioning. 

When to measure TSH

In the morning, any day during the cycle.

Don’t forget to test

Thyroxine (T4), triiodothyronine (T3) and reverse T3 should be tested alongside TSH to get a solid picture of how the thyroid is functioning. 

Optimal Lab Range

1.0-2.0 miU/mL

What it means

LOW TSH is indicative of hyperthyroidism. 

HIGH TSH is indicative of hypothyroidism.

6. Follicle Stimulating Hormone (FSH)

Follicle stimulating hormone is produced by the pituitary gland. 

How FSH works

This hormone acts to stimulate the ovary in preparation for ovulation. As women age, FSH becomes the predominant pituitary hormone. 

When to test FSH

The morning of day 3.

Don’t forget to test

LH and estradiol

Optimal Range

4.8 miU/mL

What it means

FSH is usually higher than LH.

HIGH: Levels will rise during perimenopause, as the pituitary gland tries to get the ovary to release a follicle.  

LOW: High leptin levels may inhibit FSH causing poor follicular development and preventing ovulation. FSH may also be low in PCOS.

7. Lutenizing Hormone (LH)

How LH works

Lutenizing hormone is produced by the body’s pituitary gland due to a signal of high estrogen from the dominant follicle. A surge of LH trigger’s the egg maturation and causes it to be released from the follicle. This signifies that ovulation is ready to occur.  

Using ovulation tests is a good way to determine if a surge of LH is being produced by the body, in addition other ovulatory signs to be aware of are a slight increase in body temperature (thanks to progesterone) and egg-white cervical fluid.  If women have relatively more LH than FSH, this may also signal PCOS.

When to test LH

The morning of day 3.

Don’t forget to test

FSH and estradiol.

Optimal Range

4.8 miU/mL

What it means

HIGH: indicative of PCOS, especially a LH to FSH ratio greater than 2:1 is sign of PCOS.

Bonus Tests

Ferritin

It’s never a bad idea to test your ferritin levels. Ferritin is the storage form of iron. If you’re experiencing heavy periods, you may actually be deficient iron which can cause it’s own array of unwelcome symptoms. 

Optimal Range

60-80ng/mL

Tips for your visit with a ND

Type of Test

Blood

This is your standard blood test performed in a laboratory. This is a preferred option for testing FSH and LH, total estrogen, progesterone and testosterone, along with the other hormones mentioned above. It measures both active and inactive hormones as a total – ie. you cannot see each one separately.  

Saliva

This is at-home specialized test where we use saliva to monitor excesses or deficiencies within the body, as well as look for patterns (ie. diurnal patterns of cortisol). Saliva testing allows us to look at ‘free’ hormones (not bound by proteins), and expands our clinical picture with respect to your condition. Preferred: baseline of cortisol pattern. 

Urine

Urine testing provides an average of your hormone levels and assesses their metabolites (ie. understanding if we are clearing the estrogens). Currently, there are 2 types of urinary tests: the first where you are collecting urine in liquid form, and the second where you are collecting dried samples of urine. Good for: understanding estrogen and cortisol pathways and how they detoxify within the body. Urine will not tell you your overall levels within the body.  

Reading the Results

Normal vs. Optimal

Naturopathic doctors want you to feel fantastic, and one of the ways we do that is assessing your lab work and determining if it’s optimal rather than normal. Typically doctors compare lab findings with their associated reference ranges to determine if the results are normal or abnormal. If your lab work falls into the normal reference range, then you shouldn’t be having any signs of symptoms of a pathology. Right? Wrong. People can be in this reference range AND continue to have specific signs and symptoms.

This is why naturopathic doctors strive to ensure that while your lab work be in the normal reference range, it also be in the optimal range. This allows us to help treat our patients preventatively, before any imbalances manifest into serious health conditions. 

Next Steps

Naturopathic Prescription

Based on your test results from hormone testing, your Naturopathic Doctor will create a custom treatment plan that will help you feel like your best! Treatment may involve dietary and lifestyle changes, and/or botanical or nutritional supplementation. But the best part is – you don’t need to self prescribe for your symptoms anymore! We’ve got you covered. 

Your homework

Once you have your results and plan in hand, it’s up to you to take the next steps! It can be daunting – but if your doctor is supportive, they’ll do their best to make sure that integrating the plan is as easy as possible. Moreover, once you have your plan it doesn’t mean your ND doesn’t want to see you again – it’s the opposite! We want to make sure that the changes are fitting your lifestyle, eliminating your symptoms and getting to the root of the issue. If some tweaks need to be made along the way, so be it!

Are you ready?

If you’ve been suffering with unwanted symptoms for years, if you want to get pregnant, or if you generally just want to feel fantastic -here’s your permission split to finally invest in yourself. Hormone testing will give us answers to what is going on, but it’s up to you to take that first step and book an appointment. You deserve to live your best life, and I am going to help get you there. 

PS. If you love learning about your hormones and your period, be sure to sign up for my monthly newsletter called The Flow for great and informative content like this!

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