Introduction To Laboratory Tests
Laboratory tests seek to answer questions raised by doctors after talking with and examining the patient. For example: How can I confirm the diagnosis? Are related illnesses present? Is the treatment working? Are side-effects present?
Laboratory tests are usually carried out on samples such as blood, dried blood spots on a card, saliva, single urine samples and 24-hour urine collections. The type of sample will depend on what is being measured, the accuracy required and/or the age of the patient. Once the sample is taken, the patient does not need to be present for the results to be produced.
The results of hormone tests when healthy vary in response to natural pressures such as food, drink, rest, exercise and the menstrual cycle, which can make results in health and disease overlap. In dynamic tests doses of hormones, drugs, glucose and natural pressures such as exercise or restriction of water intake, are used to control the influences on results and make them more predictable.
What Day Is Best For Testing
It depends on your goals. For fertility, check estradiol and FSH on day 3 of your menstrual cycle. This is a measure of egg quality and drives progesterone levels. For peak estradiol, check on day 12 of your cycle. I use that for bone mass. For progesterone and to check ovulation, I check day 21-22. If you dont know what day, aim for estradiol and progesterone on day 21-22 as most lab data are standardized for those dates before menopause. If your cycles are very irregular, test day 21-22 after a period.
Do All Patients Need Blood Tests For Hormone Levels
Dr Aziz-Scott: Although treatment is bespoke to you, patients will follow a similar patient journey, and in the initial consultation, blood tests for hormone levels are required for all patients. In some cases, women may come to the clinic with blood tests conducted externally by their GP, or another healthcare professional.
We do see patients that have had a Dried Urine Test for Comprehensive Hormones . The DUTCH test is a urinary assessment of hormones and can provide a great deal of useful information about the different hormone systems in the body. It is very useful in assessing how estrogen is metabolised and this is a very important factor to consider once you are on BHRT as certain estrogen metabolites can be toxic and increase breast cancer risk.
Depending on a patients individual situation, we may be able to work with DUTCH test results, but serum blood hormone levels are the gold standard of testing to provide an accurate baseline. Many clinics offer finger prick tests, but we opt for serum blood tests as these are less likely to provide erroneous results and unnecessary additional costs if repeats needed. Once we begin treatment, the monitoring process is also much more efficient with serum blood tests.
Your Marion Gluck Clinic doctor will advise you of the tests required during your consultation and will explain the options for how you can have blood drawn.
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How And When Will The Patient Find Out The Results
Results are returned to the doctor or specialist nurse who is looking after the patient. They may be contacted immediately to discuss the results or wait until they are next seen in clinic.
Results must be interpreted in the context of other medical details. With endocrinology in particular, the same numerical result may signify health in one person, but a problem in another. Patients should discuss results with their doctor rather than trying to interpret them themselves.
Routine results are produced within one working day providing additional measurements are not required, for example, if it has to be double-checked. Results on samples sent to reference laboratories for special tests may take one to four weeks to return.
Here Are Our Tips On How To Get What You Want And Need Out Of Hormone Testing
Your visit to the OBGYN:
- Get the test taken during the first few days of your cycle , if possible.
- Ask your OBGYN for a hormone panel test that includes estrogen, progesterone, FSH and LH .
- Ask additionally for a thyroid test, blood sugar test and Vitamin D3 test. These are also important indicators for hormonal health.
- Ask that they also run a general blood test you want to be checked for iron saturation, anemia, and C-reactive proteins particularly.
- Ask for a print out of your results to take home if they are not made available online for you to access.
Assessing the results:
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Possible Causes Of Abnormally Low Cortisol Levels
Addisons disease
Also called primary adrenal insufficiency, this is a condition that occurs when the adrenal glands are damaged and become unable to produce enough cortisol and/or other stress hormones. This is most often caused by auto-immune activity, where the immune system attacks the bodys own tissues. Other potential causes include long-term use of steroid medications, certain blood thinners, tumors and infections.
Problems with the pituitary gland
Low cortisol levels can be caused by the pituitary gland failing to release enough ACTH. This latter is important to trigger adequate amounts of cortisol to be released from the adrenal glands. This is typically referred to as secondary adrenal insufficiency, or hypopituitarism and, can be caused by trauma to the pituitary gland, brain tumors, pituitary gland tumors, stroke, autoimmune diseases and tuberculosis, among many other possible causes.
When Should I Test
When it comes to checking your reproductive hormones, timing matters. In women under 40, its best to test hormone levels on around day 21 of their cycle, if they typically have 28-day cycles. If a woman has longer cyclesfor instance, 40-day cycles then its best to test hormones about 7-10 days prior to their period due date. This is because its best to assess a womans progesterone level during her mid-luteal phase. If youre not menstruating regularly, testing can be done at any time.
Testing may vary, so make sure you follow instructions on the kit and/or consult your doctor.
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What Is The Best Way To Medically Treat A Hormone Imbalance
How a hormone imbalance is treated depends on the condition and the practitioner. Options include medication, creams, pessaries, the pill and hormone replacement therapy .
Regular HRT medication contains synthetic hormones but there are natural options. As an expert in natural medicine, Dr. Eccles believes that the best way is to use bio-identical hormones since these do not appear to have the long-term downsides and risks that we can see with synthetic hormones.
While many of us prefer natural methods and some of us swear by them, the jury is still out on their efficacy. The NHS currently doesnt offer bio-identical hormone therapy, stating that its not known how effective they are in reducing menopausal symptoms.
How To Check Hormone Levels
We usually think of hormones as those related to our being, like estrogen and progesterone and testosterone . But we have more than a few of these naturally occurring chemicals that help maintain balance in the body to achieve optimal health and function. Here is some information on how to check hormone levels when you need to make sure your body is in proper balance.
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Everlywells Mens Health Test
Everlywell says it only works with labs that have been certified at the state and federal levels.This test looks at four hormones associated with general health in males, including dehydroepiandrosterone sulfate . This hormone plays an important role in producing testosterone and estrogen and supports the development of male sexual characteristics. The other three hormones that the test checks for are:
- cortisol
- free testosterone
The kit requires a person to give a blood and saliva sample.
Doctors that are board-certified in the persons state review the results, and a person can see their results online within a few days. A person also receives detailed information about what the results may indicate and other personalized information.
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What Causes An Imbalance In Hormones
Hormone imbalance can be the result of various issues. There may be an underlying medical condition that is causing a shift in the level of hormones. Also, you may be taking medicines that are causing a change in your hormonal balance. At times, even minor stress can cause hormonal imbalance.
In women, polycystic ovary syndrome or PCOS is a leading cause for hormonal imbalance. The changes in hormone levels due to PCOS come with a whole different set of symptoms, which include irregular periods, darkening of skin, excessive hair on face and chin and weight gain.
Men also go through hormone imbalance. Changes in the hormone levels for men are usually caused by low levels of testosterone. Since testosterone plays a vital part in mens health, low testosterone levels can result in complications. Common symptoms of low testosterone include breast tissue development, erectile dysfunction, loss of bone mass, reduction in body hair and infertility.
How Can I Find Out If I Have A Hormone Imbalance
The only way to confirm a hormone imbalance is to test your hormone levels. Both blood tests and saliva tests are proven techniques in assessing a hormone imbalance. i-screen uses blood tests to accurately determine sex hormone and thyroid hormone levels, but prefers saliva testing to assess cortisol levels. This is because cortisol levels follow a diurnal pattern which means tests must be conducted throughout the course of the day this makes blood testing inconvenient.
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Symptoms And Potential Complications
Imbalances in female hormones can have far-ranging effects on the body, producing a variety of physical, emotional and cognitive changes. These changes can cause symptoms that may include:
- Menstrual cycle changes, including shorter or longer times between periods, and periods that are longer, shorter, heavier or lighter than normal.
- Hot flashes and night sweats.
- Insomnia and other sleep disturbances
- Diminished sex drive
- Unexplained weight gain, especially in the abdominal area, hips and thighs
- Skin changes, such as thinning, dryness and wrinkling
- Dry, brittle hair
Female hormone imbalance can increase a woman’s risk of a number of diseases and health problems. Among the most serious of these is heart disease, with risk increasing as estrogen levels decrease. Women with hormonal imbalances are also at greater risk for osteoporosis, since low levels of estrogens can interfere with the absorption of calcium and other nutrients essential to the maintenance of bone health and density.
Why Cortisol Testing Is Important
Cortisol testing is important because that system does not always function in the normal, healthy manner outlined above. Sometimes cortisone levels can stay too high for too long, which can have far-reaching effects on your health, such as:
- Anxiety
- Problems with memory and/or concentration
Issues That Can Cause Abnormally High Cortisol Levels include:
1- Chronic stress: The bodys natural fight-or-flight stress response system is set up to manage short-term stress situations. Stress in todays world is often a longer-term health issue. Rather than being stressed by a sudden encounter with a predator, a situation that can be resolved quickly by running away, we are more likely to face ongoing problems that cause stress, like job pressures, for instance, or financial ones. This can cause long-term activation of the stress response system, leading to chronically high levels of cortisol.
2- Problems with the pituitary gland: Tumors on the pituitary gland or excess growth of the gland can cause it to release too much ACTH, increasing cortisol levels.
3- Problems with adrenal glands: Tumors on the adrenal glands can cause overproduction of cortisol.
4- Other tumors: Growths in other areas of the body can increase cortisol production.
5- Medications: Overuse of corticosteroid medications or long-term use of them can lead to abnormally high cortisol levels.
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The Best Way To Test Thyroid Function
The standard thyroid test, done by your doctor, usually only includes Thyroid Stimulating Hormone , and if that is in the normal range then you are told that your thyroid is fine. But TSH is only the message from the brain to the thyroid, so the TSH test is not actually testing thyroid function, and while the TSH levels are important, if you have the symptoms of low thyroid function then it is important to get a comprehensive thyroid test.
Also, the reference range for TSH is very broad which is what most doctors look at, but the optimal range is between 0.5 and 2.5, or even less than 2.
Why Take A Womens Hormone Test
A hormone level test can tell you a lot about your bodyâs well-being. The test results can point you to a hormone imbalance, which can affect your health. This is because hormones regulate many vital functions in the body by acting as âchemical messengers.â So out-of-balance hormones can disrupt your bodyâs normal, healthy functioningâand result in a variety of symptoms.
For example, if your thyroid hormones are out of balance, you might experience symptoms like fatigue, cold sensitivity, irregular periods, dry skin, thinning hair, and more.
Or if your steroid hormones are imbalanced, you could have symptoms like increased body fat, lowered sex drive, loss of strength, and so on.
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Adrenal Testing With Saliva
For a long time testing adrenal function using saliva was the standard as it measures free cortisol levels, and it is easy to do 4 different samples throughout the day to assess the rhythm of cortisol.
But the saliva test does not measure your total cortisol production, or how your body is metabolizing cortisol so just knowing your free cortisol levels can be a bit misleading.
It is possible to be producing a ton of cortisol but the saliva test will only show very low levels of free cortisol, or the opposite can occur. Without knowing all of the information it is impossible to know what is happening with the adrenals so that I can recommend the right treatment plan.
The only time that I can see the saliva cortisol test being valid is if it is also combined with a 24-hour urine test to also assess total cortisol production, but it would be a lot better and easier to do the DUTCH hormone test.
More Information About Hormone Testing
Hormone levels change as you agesome change throughout the day. We use hormone testing to detect and evaluate hormone imbalances that may be making you sick. We often conduct hormone testing using a blood sample, but some tests require urine or saliva samples.
We frequently test levels of:
- Estrogen and testosterone
- Adrenal gland hormones, such as cortisol
- Growth hormone, prolactin and other pituitary gland hormones
- Thyroid hormones, such as thyroxine
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Preparing For Hormone Testing At Cedars
We explain the tests you need and answer any questions you may have.
Here’s what to expect:
- Stop certain medications: We let you know whether to stop taking drugs such as oral steroids or estrogen supplements before your test.
- Visit one of our labs: You go to a Cedars-Sinai lab and provide a blood, urine or saliva sample. If you need stimulation or suppression testing, we let you know in advance how long you’ll need to stay.
- Collect samples at home: If we need samples over a period of time, you may be able to perform testing at home. We give you special containers for collecting saliva or urine samples and detailed instructions on how to handle them.
- Receive more than one form of hormone testing: Blood testing is one way we evaluate hormone imbalances. We may recommend additional tests, including stimulation or suppression tests, to learn more about what’s causing the imbalance.
- Undergo other forms of testing: For problems such as tumors or a possible cancer diagnosis, we use imaging to learn more about their size, location and nature.
Have Questions or Need a Second Opinion?
To make an appointment or refer a patient, call us or send a message to the Endocrinology care team.You can also have us at your convenience.
Natural Ways To Support Healthy Hormones
While you should always speak to your doctor if you have hormonal imbalance, he might not have to give you any kind of medication to restore the balance. This is particularly true if the imbalance is caused by something like diet or stress. In general, people who have the following criteria are at higher risks of developing hormonal imbalances:
- Being overweight or obese
- Consuming an excessive amount of alcohol
- Being exposed to pesticides and toxins
- Experiencing high stress levels
- Not sleeping enough
Many of these risk factors are easily controlled when you’re mindful of your diet, exercise routine, and daily habits. If you quit smoking, moderate your drinking, or avoid exposure to pesticides, you can help reduce your risk factor for hormonal imbalances and naturally keep them moderated.
Changing the way you eat can go a long way towards improving your hormonal balance. For example, when you exchange carbohydrates for healthy fats, like coconut oil and avocado, you can lower your bodys inflammation and help maintain your hormone at the right levels. Consuming enough proteins will help control the ghrelin hormone that makes you feel hungry. This gives you the feeling of fullness and then, you will stop eating at the appropriate time and maintain a healthy weight.
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