Hormones – By Dr. Alan Christianson
Hey, there! Dr. Alan Christianson here, and I want to talk about your hormones and how to best test them. There is a pretty strong sense that having healthy hormones is critical to being healthy, happy, lean, energized and all those other good things, but there is a lot of confusion and controversy about if and how you should measure them.
Should you measure your hormones? That is an easy one. The answer is heck yeah! You want to know whether or not they really are the source of your symptoms: the fatigue, insomnia, hot flashes, weight gain, dry skin, chronic pain, digestive issues, anxiety, and you name it! First off, see whether or not your hormones are the culprit. If they are, you want to know which hormones. Past that, you want know if you have too much or too little or if the timing is off. They can all be factors. If that is not enough, you will also want to know if what you are doing to help your hormones is working or not. Are you making steps in the right direction? Those are the benefits and values of testing your hormones.
How do you test your hormones? I started practicing in the 1990’s when some of the alternate methods of testing hormones came about. I’ve used everything: the blood, saliva and urine literally hundreds of thousands of times each. I have gotten a real strong sense which tests are accurate, which ones are reproducible (meaning if you repeat it on the same person), and which ones are really important to help you feel better.
Blood tests work great for hormones that come from the thyroid, ovaries, testicles and adrenals. For the thyroid, we want to know how your brain is talking to your thyroid. Which hormones are coming out of it? We want to know whether or not you are attacking the gland and whether or not the gland is inflamed. There was a time when some labs did saliva panels for these, but they have dropped this practice since even the biggest advocates have acknowledged they are not as accurate. This is because those hormones are present in such microscopic amounts in the blood that they are hard enough to measure that way. The amount in saliva are even smaller – such tiny fractions that it is harder to measure these types of hormones accurately in saliva. So, for the blood test, you want to measure the TSH, 3t3, 3t4, antithyroglobulin, antithyroperoxidase, thyroglobulin and reverse T3. That’s a real good workup as far as your thyroid goes.
Let’s go over testicles and ovaries. For these hormones, blood tests also work really well. There are a lot of salivary tests and some urine tests I’ve used over the years. The hormones from these glands are chemically categorized as steroids. All that means is they are made of cholesterol. Testosterone, progesterone, estriol, estradiol and estrone are made from cholesterol. They are cholesterol byproducts, so to speak, and are really large molecules that can’t get consistently into the saliva. So, the same problem shows up. They are there but not in consistent fractions in saliva. These hormones are in two states: free and active or bound and inactive. We get a sense of both the free levels and the bound levels in the blood but not as big of a body of data on free levels in the saliva. The third drawback is if you are taking some kind of hormone therapy, the salivary levels can be very inconsistent. This means that right after you swallow a pill or apply a cream, your salivary levels are going to be sky-high for a few hours and then, are going to plummet. So, it’s hard to gauge whether you are getting way too much or none at all, depending on when you measure. So, for both genders, a good, blood workup can include testosterone free and total (ideally), along with hydrotestosterone, estrone, progesterone, estriol and estradiol. That gives a good gauge of the testicles and the ovaries.
If you are a woman having regular menstrual cycles, you want to have your blood drawn right around the third week of your cycle. We consider day one as the first day your period starts. Then, you count forward. Assuming you are on a 20-30 day cycle, we want this to be between day 17 and 23. That is most important for the estradiol and the progesterone. You won’t be making these two hormones at consistent enough amounts at other times of your menstrual cycle. So, you will not know if a high or low was a true problem or just had to do with the timing. With everyone else, there is no real timing that is relevant.
Now, how do we measure the adrenal hormones? Here, I actually mix and match a little bit. There are several, measurable hormones and a few, practically measurable hormones. The main, adrenal hormones are pregnenolone, DHA and cortisol. I love to test those three through the blood at a single point in time, preferably in the morning. The DHA, pregnenolone and cortisol are also measurable through saliva, and there are many salivary panels that will give you all of those. When I ask someone to invest in their health, I want them to focus on what really matters. I encourage salivary tests for the four cortisol readings. These salivary tests really shine because they can give you an accurate picture of how you make cortisol as the day progresses. They tell you how much you make in the morning versus noon, afternoon and night, which is an important thing to be aware of. There are few people that have an adrenal disease where they can’t make it, or they make crazy amounts all the time. There are a lot people that have adrenal dysfunction, meaning they make the wrong amounts at the wrong times. We can only catch that through the salivary panels. I also like having a blood reading for cortisol because there are times when someone may have bleeding gums or other factors that make their salivary levels look a little weird. If we have a blood test on them, preferably at the same time of day as one of the salivary samples, we can catch that and make really good sense of it.
There are two other adrenal hormones that are possible to measure. The first is androstenedione, which is one of the weak, adrenal, male-like hormones. It is one of the masculinizing hormones that both genders make. The second is aldosterone, which is a big part of balancing your sodium, potassium and fluid levels. Aldosterone measurements are not accurate. You can stand, sit or have had some water recently, and results can change so much. Androstenedione is measurable but is one we don’t have as much data on about its relevance. So, I don’t focus on these as much.
Thanks for hanging out with me in this beautiful place. Dr. Alan Christianson here, and we will talk again real soon.