Hormone testing is helpful for investigating symptoms such as irregular menstrual cycles, acne, painful or heavy periods, severe PMS, or infertility.
In order to provide the best form of health care, we often do saliva, blood or urine testing to figure out what your hormones are doing under the surface.
Here is a guide to help you feel prepared for hormone tests.
Types of hormone tests
There are many different types of hormone tests that you can do and they vary in format depending on –
- the hormones they test for
- the time of month or day they need to be done
Depending on what you are looking for it can sometimes be best to get a blood test. Whereas at other times it’s best to check your hormone levels via saliva or urine samples instead.
Most hormones are made via signalling of the pituitary gland, ovaries and gonads via the brain’s CPU called the hypothalamus.
For women, the production of hormones happens cyclically throughout the month, whereas for men it is steady.
Some hormones are made in different amounts throughout the day, for example, the stress hormone cortisol.
To help you understand the various types of testing better here is a guide to the various types of hormone testing you can do.
Hormone Blood Tests
When testing hormones via a blood sample, for women it’s important to remember what day of your cycle the blood tests are done so they can be interpreted accurately. If a doctor tells you that you don’t need to know what day of your cycle the blood test was done, remember that you do.
For example, progesterone is very low for the first half of the menstrual cycle but is then high in the second half of the cycle after ovulation. Oestrogen on the other hand rises in the first half of the cycle and then slowly drops off after ovulation.
Post-menopausal Women & Men
For men and post-menopausal women, sex hormones are produced at a constant rate and don’t fluctuate. However, for all people, sex hormones should be tested first thing in the morning as their levels naturally drop over the day.
Other hormones such as insulin need to be tested at the start of the day on an empty stomach in order to interpret them correctly. But for most other hormones it doesn’t matter if you’ve got a full or empty stomach.
Do you need a doctor’s referral to get a blood test?
These days you can do blood testing without seeing a doctor, but generally, you would visit your doctor to get a blood test referral form and then go to the pathology collection centre to get your blood drawn. The referral form is the official document that authorizes the pathology centre to collect the blood samples.
It’s common for pathology collection centres to be located in the doctor’s practice for ease of collection.
The person collecting blood samples at a pathology lab is called a phlebotomist, and they undergo training to ensure the safe and effective collection of pathology requests.
Hormone Saliva Test
A blood test isn’t the only way to check your hormone levels. You can also use saliva too. One of the benefits of doing saliva hormone testing is that you do not have to go to a collection centre or take a blood sample, you can do the testing at home.
Saliva testing gives a more holistic picture than a blood test because it not only assesses reproductive hormone levels but also the effect stress hormones have on the body’s ability to make reproductive hormones.
We use saliva hormone testing with our patients because the results give us a clearer insight into how well the sex glands (ovaries and testicles)and adrenal glands are functioning.
Urine hormone testing
A third way to test hormone levels is with urine. The Dried Urine Test for Comprehensive Hormones (otherwise known as DUTCH) looks at metabolites of our hormones to see how well the body is making and detoxing hormones. This test is perfect for people who have had long and complex hormonal symptoms where past treatment hasn’t been successful.
Two benefits of urine hormone testing is that it’s easy to do, and gives a comprehensive assessment of reproductive and adrenal hormones. And just like saliva testing, you don’t have to go into a pathology collection centre to collect the samples because the collection is done in the comfort of your own home.
How to prepare for a hormone blood test
For accurate blood collection results it’s important to read any instructions noted on the test referral form by the referring doctor. Some blood tests, such as insulin and glucose, require fasting. So always check your test request form to see if the doctor has noted ‘fasted insulin and glucose’. If not fast overnight just in case in order to get accurate results.
For fasting blood test results you must not eat or drink in the 12 hours before the test. So it’s best to do the test first thing in the morning before any exercise. Most collection centres will be open early in the morning to facilitate this, and if you are someone who gets a bit shaky when you haven’t eaten it’s a great idea to bring something with you to eat or drink afterwards, such as a freshly squeezed fruit juice.
To prepare for any blood testing, it’s wise to make sure that you are not dehydrated, as this can make it more difficult for the phlebotomist to draw blood from a vein. If you are someone who suffers from low blood pressure, you may want to lie down before having the blood collection in case you faint.
Always ask for a copy of your test results, because even if you are told they are normal may still be clues as to what might be going on when reviewed from our holistic lens.
How to prepare for saliva hormone testing
Depending on the specific hormone you are looking for, saliva hormone testing may need to be done at a specific time in the cycle if you are a woman.
When you are investigating estrogen and progesterone you need to do this on day 21 of a 28-day cycle, or 7 days prior to ovulation. To look for androgens like testosterone, you can do this on any day of the month, while stress hormones such as cortisol need to be taken at a specific time through the day or night,
Many saliva hormone tests will require the first collection to be done while fasting, which means it is done within the hour after waking up before any food or drink has been consumed. It is also important to avoid stimulants on the day of testing, so don’t have anything containing caffeine and avoid smoking because this can affect your cortisol results.
Saliva cortisol testing is done at 4 points throughout the day, morning, midday, afternoon, and evening to graph your daily cortisol production. Naturally, cortisol should be highest in the morning, and gradually come down to be low at night. If you are someone who works nightshift or has an irregular sleep schedule, you might have to adjust the testing times to reflect your typical day-to-day wake and sleep patterns.
If you are unsure about the timing of a test because your menstrual cycle is irregular, it can be helpful to review the last 3 menstrual cycles you’ve had and obtain an average. If it has been years or months since you experienced a menstrual cycle, your naturopath or doctor might suggest you do the testing on any day since it is unknown when your next cycle will be. The results are always read within the context of your cycle, even if that means you didn’t have a period within the timeframe of doing the testing.
How to prepare for urine hormone testing
The process to prepare for urine testing is very similar to that of saliva testing. For the most part, the urine testing is looking at progesterone and estrogen around day 21 of a 28-day cycle or 7 days prior to ovulation.
Urine testing is taken throughout the day at various times to look at your adrenal hormone levels, so it is important to stick to the timing for accurate results. Unlike saliva testing, you don’t have to avoid eating within an hour of taking the test but you must still avoid smoking and stimulants for the day.
If you are taking any amino acids, supplements, or herbs it might be advisable to stop taking these within a certain time of doing the testing so it is important to refer to the particular instructions for the test you are using.
Which hormones will be tested?
Here are some of the things your health care team might request depending on your symptoms:
- Luteineizin hormone (LH)
- Follicle-stimulating hormone (FSH)
- Thyroid stimulating hormone (TSH) and thyroid hormones T3 and T4
Other tests that sometimes help put the pieces of the puzzle together include thyroid antibodies, vitamin D, liver function testing, growth hormone, iron, B12, and a lipid panel.
What type of results can I expect from a hormone test?
If you experience chronic elevated stress levels, you might find that your cortisol levels are high. However, in long-term chronic stress, you can also experience low cortisol, as your body struggles enough after a long time of overproduction. The symptoms of low cortisol can be indistinguishable from low cortisol, which is why it is important to check.
In some cases of hormonal acne, you might experience high DHEAS. this hormone is made from our adrenals but it is considered an androgen, similar to testosterone. Usually linked to chronically elevated stress hormones, DHEAS can affect your reproductive hormones and cause symptoms like acne, irregular periods, low motivation, and energy among other things.
if you are experiencing acne, or irregular cycles or suspect you suffer from PCOS, it’s important to check your testosterone levels. High testosterone can be responsible for oily acne-prone skin, insulin resistance, and irregular periods.
For some people, high estrogen can cause heavy or painful periods and more pronounced PMS symptoms such as low mood or fluid retention. It is always important to check this alongside progesterone and at the right time of the month because the relationship between estrogen and progesterone can lead to hormone imbalances that masquerade as high estrogen.
This hormone must be tested after ovulation, as that is the only time it will be high throughout our cycle. If you are ovulating this will be high in a blood test, but in a saliva hormone test, it can show whether our stress response is using our resources instead of producing reproductive hormones.
While a hormone test is a great place to start if you are experiencing any of the above mentioned symptoms, it is very confusing to know where and how to start. Working with a naturopath will ensure that you get to the bottom of your symptoms with the right type of testing at the right time of the month, instead of spending thousands of dollars on unnecessary testing at the wrong time of the month.
Now that you know how to prepare for hormone test, you might be wondering what the next step would be. If you feel that you might benefit from some additional tests, book an initial consult with us so that we can discuss the best options for you.