Is blood testing the best way to check your hormones?

In today’s blog, we’re going to go through what blood testing is good for, what it’s not good for and how you can use the results to help you cure your hormonal acne.

Blood testing is great to pinpoint a few different things.

The number one thing is pathology. That’s diseases. It’s when things have gone seriously wrong in your body or you have a major hormone imbalance. Blood testing is great for picking these things up.

Blood testing is also great for identifying nutritional deficiencies. Things like vitamin and mineral deficiencies, which we’ll look at some results in a minute and see what they look like.

But when we think about hormonal acne and PCOS (poly cystic ovarian syndrome) though, blood testing is only going to pick up hormone imbalances if there’s a big problem. But, the one area blood testing is always good for it is when we want to look at baseline hormone levels.

In women, this is at the beginning of your menstrual cycle (the second or third days of your period). This is when it’s good to use a blood test because you can get your baseline hormonal values and see if there’s any significant dysfunction there.

Figure 1

Figure 2

At baseline the hormones you want to look at are FSH, LH, Estradiol and Progesterone (see above images). At the beginning of your cycle the progesterone’s always going to be low, which is why you see it quite a low in the above results. This is because progesterone doesn’t come up until after you ovulate. So early in your cycle ovulation hasn’t occurred yet so it will naturally be low.

The hormones and potential hormone imbalance we’re really interested in looking at at this early stage of the cycle are FSH and LH and the ratio of FSH to LH. In the first few days of the period, at the very beginning of the cycle, the FSH and LH ratio should be one to one. These two hormone levels should be more or less the same.

In the Figure 1, we see the FSH a fair bit higher than the LH. FSH (Follicle Stimulating Hormone) is responsible for stimulating the growth of the ovarian follicles. Whereas LH (Luteinizing Hormone) is the hormone that triggers ovulation.

Here the FSH is much higher than the LH, and this imbalance could indicate there’s a deficiency of LH which could result in suppressed ovulation. And if you look at the clinical notes in Figure 1, this test was done because the patient was experiencing Amenorrhea, which means no period. And so the low LH could be a reason for that.

But when we’re thinking about hormonal acne, the pattern we’re more looking for is where LH is double or more the FSH. In Figure 2 we’ve got 14.5 for the LH, 6.1 for the FSH. This pattern can be an underlying cause of hormonal acne because excess LH can trigger the ovaries to make excess male sex hormones like testosterone. And excess testosterone leads to excess oil production and excess oil causes acne.

Figure 3

But when we think about hormonal acne and underlying male sex hormone excess, blood testing can be good, but it doesn’t always pick up the imbalance. Unless the imbalance is really severe, as we see in Figure 3.

In these results you can see the testosterone, the free androgen index (which is measure of active male sex hormones) and the free testosterone (which is the active testosterone, as opposed to the total testosterone) are all high. At least three times higher than they should be. This indicates this woman has a lot of male sex hormone floating around her body and it is the number one reason why she had hormonal acne.

So, blood testing is great for picking up these really big imbalances, but, as we’ll go through a bit later on, if the balance is much more subtle, blood testing often doesn’t pick the imbalance up.

Figure 4

Besides identifying profound sex hormone imbalances blood testing is also great for checking important vitamin and mineral levels.

In Figure 4 we’ve got iron. The reason you need to check your iron levels is to make sure you don’t have iron deficiency anaemia (not enough iron in the blood stream). On this test, the iron is pretty much okay. We’ve got 12.4 and 19.7, the range is 5 to 30 so these two results are sitting well within those. So the iron in the blood test is pretty good.

The other marker we’re looking at in iron studies is the Ferritin. Ferritin is your stored iron, whereas Iron is the level of iron in the blood. Here the Ferritin has been sitting at the low end for a while, 36, then down to 15. The range is 15 to 200, so this indicates there’s not much iron in reserve.

When your Ferritin level is low it can be the reason why when you get your period, and lose a little bit of blood, you feel tired. There’s just not that reserve there to pick you up.

Figure 5

In Figure 5 we’ve got vitamin B12. It’s important to know your vitamin B12 levels because low vitamin B12 causes a second type of anaemia. B12 is important for energy, it’s important for nerve function and it’s important for red blood cell health. B12 helps your red blood cells divide and if you don’t have enough B12 your red blood cells get quite large and they can’t travel through the capillaries properly and deliver oxygen to your body.

In Figure 5 the vitamin B12 level is pretty much okay. It’s 275. About mid-range.

Figure 6

Vitamin D is another important vitamin and one that you should get checked regularly. I like to see it around 100. This person’s 90, so that’s pretty good. Most commonly though, I see vitamin D around the 50 to 60 level. I think this is too low.

Figure 7

In Figure 7 we’ve got zinc. Zinc is not a common mineral your doctor will check for you, but if you can get your doctor to check it then then to do it. Checking zinc is really worthwhile because zinc helps your body process male sex hormones and stops cells over reacting to male sex hormones.

Zinc also helps grow the ovarian follicle and the egg, and it helps heal your skin. It’s a great nutrient to have optimal levels of and so it’s good to know what your levels are like.

In Figure 7 we can see zinc is 10.2. This is down the lower end, making it a little bit on the low side.

Figure 8

Blood testing is also very good for checking to see whether your liver’s working properly. In most cases when we look at liver function test results we’re not looking for liver failure, but just to see is there any liver inflammation. Common reasons for the liver to become inflamed are medications like Accutane/Roaccutane, not eating right and drinking too much alcohol.

In Figure 8 we can see in the earlier test results, the two liver enzymes, AST and ALT, were high. GGT the other liver enzyme is okay. When either of the three liver enzymes are elevated, it’s an indication the liver is inflamed. It’s a sign liver cells are being damaged and as the liver cells break apart the enzymes within them come out and appear in the bloodstream. So, when the enzyme levels (AST, ALT and GGT) go up it means liver cells are being damaged.

Figure 9

Blood sugar and insulin are also best checked with a blood test. You might’ve seen your glucose levels on your blood tests before. Glucose can be measured a couple of ways. It can be a fasting glucose check, which is what the F is for in Figure 9. Or a random glucose check, which is what the R is indicates. Fasting is the most accurate way to check it because you haven’t eaten. Eating fluctuates the level. In Figure 9 we see the values are all within range.

When we’re thinking about hormonal acne, checking blood sugars is very important because high blood sugar levels indicate high insulin levels. Excess insulin in your body can drive the ovaries to make excess testosterone and other male sex hormones.

Figure 10

Here in Figure 10 we see the results from a fasting insulin test and the result is good, it’s around 4. We want it less than 7 because 7 to 10 can be early indication of insulin problems. 10 to 14, is definitely an indication of mild insulin resistance. 14 and above is full blown insulin resistance.

As I mentioned, if you have hormonal acne we’re very interested in excess insulin in the blood stream because it stimulates the ovaries to make extra testosterone. As the male sex hormones rise it triggers excess oil production in the skin and the excess oil clogs the pores and causes acne.

However, even if both of these are okay, but you suspect you might still have an issue with insulin resistance, then the oral glucose tolerance test is a good test to do. This is where you are given a little cup of pure glucose syrup to drink. This challenges your blood sugar regulating system and you can see how it responds to the sugar hit. To assess this your blood glucose and insulin levels are checked just before you take the drink, then an hour later, then at the two hour mark.

Figure 11

Here in Figure 11, the blood sugars have stayed relatively normal. The insulin however starts at 7 (borderline). Then it gets up to 60 at the one hour mark, which is right on the borderline again. Then it drops back by the two hour mark.

What this shows is that, while this person hasn’t got full blown insulin resistance, there is a problem. And this could be triggering over production of the male sex hormones.

Blood tests are also the best way to check thyroid hormone levels to assess thyroid function. Your thyroid is the gland that’s responsible for controlling your metabolic rate. This controls your weight, your menstrual cycle and your energy levels.

Figure 12

If we look at these results in Figure 12, we’ve got TSH, Free T4, Free T3. TSH is thyroid stimulating hormone. This is the signal from your brain to your thyroid. If the brain thinks there’s not enough thyroid hormone in the body, then it will increase TSH, this stimulates the thyroid to produce more thyroid hormone. If it thinks there’s too much thyroid hormone in the body it will pull back on TSH and secrete less of it to slow down thyroid hormone production.

When we look at the results in Figure 12, you’ll see there’s three sets of results. Two times they only thing checked was TSH, but on one occasion all three hormones were checked. I like to see all three checked because it gives you a much better idea of what’s going on. Not just whether the brain thinks there’s enough thyroid hormone, but what the actual thyroid hormone levels (FT4, FT3) are like too.

This is important to get a clear idea if the thyroid’s working correctly, because you can have a relatively normal TSH but still have issues with the actual thyroid hormone levels. And you would never know if this is the case unless you get all three hormones checked.

Doctors aren’t always that keen to check all three, but if you push them to do all three then that is always the best.

Now as I mentioned at the beginning of this post blood tests aren’t great at identifying everything. They are best for pinpointing profound hormonal imbalances, diseases and nutritional deficiencies. But when there’s mild hormone imbalance, which is often the case with acne issues, you’ll often find blood tests come back normal. Here’s an example of that.

Figure 13

Here in Figure 13 we’re looking at the male sex hormones again. The testosterone and FAI (Free Androgen Index) are in range (testosterone 0.2 – 1.8 and FAI 0.2 – 4.0) both times. They look relatively normal, but this person had hormonal acne so there was definitely some issue with male sex hormones. It just wasn’t showing up in the blood tests.

So, if you get your blood tests back and they look normal, it doesn’t necessarily mean that things are normal, it just means that things aren’t profoundly out of balance. I see results like these all the time when patients bring in blood tests. Everything looks normal, but their skin and the type of acne they have screams out male sex hormone imbalance.

But it’s not just mild sex hormone imbalances blood testing isn’t very good at picking up. Blood testing isn’t the best way to pinpoint hormone rhythm problems. Our bodies run by the circadian rhythm (the night and day cycle), and many of our hormones fluctuate over the night and day. And the main one that I’m always interested in is the stress hormone cortisol.

Cortisol should be at its peak in the morning and then drop down over the day and hit its lowest point at night. So, to test it properly you need to take multiple samples over the day.

When you get a blood test, generally, you only want to have one in a day. You don’t want a needle stuck in you multiple times. So, for this reason blood testing is not very good for tracking hormones over the day because we want to collect multiple samples.

Figure 14

Here, in figure 14, we’ve got a morning cortisol and the range is 284. It’s within range but I’d say it’s a little bit low for that time of the day. It was the morning so it should have been near the top of the range.

To assess cortisol rhythm I like to check it four times in one day. And because you probably don’t want to have to go to the pathology lab four times in one day to get blood drawn, then blood testing isn’t the best way to assess cortisol levels.

So, that’s where we look at a different type of testing.

For minor imbalances, when things are just a little bit out of whack, and for looking for hormonal rhythm problems, saliva testing is the best. It’s better because you can take as many samples as you like in one day. It doesn’t hurt. It’s not invasive. And you don’t need a doctor’s referral.

In my next blog and video post I’ll reveal the benefits of saliva testing over blood testing and how we can use it to pick up the hormonal imbalances that are driving hormonal acne.

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