Regular readers will know that I consider it very useful for people with chronic health issues to have their hormone levels checked out.  When hormone levels are out of balance, it can contribute to a wide variety of symptoms, including:

• Irregular or painful periods
• Difficulty conceiving
• Painful bladder syndrome or interstitial cystitis
• Vulvodynia
• Vaginal dryness
• Lichen sclerosus
• Premenstrual syndrome or premenstrual dysphoric disorder
• Panic disorders, depression, mood swings, or insomnia
• Thrush
• Uterine fibroids
• Polycystic ovary syndrome
• Thyroid hormone imbalance

I often find myself recommending people to get hormone tests done and have previously written in detail on the subject in this blog post about Medichecks and this one about Genova Diagnostics and Precision Analytical.  I thought it might be nice to write a summarised version of the different methods of measuring hormones, outlining the pros and cons for each.  This will therefore be the topic of this month’s blog! 

Basic GP Blood Tests

In the first instance, you can ask your GP to run blood tests to measure your hormones.  Nowadays they don’t normally take the blood personally, but they do place the order regarding which tests are to be done.  The blood will then either be drawn by a nurse at the practice, or you will be sent to the phlebotomy department of your local hospital.  You hand in the form (or perform some digital equivalent) and the blood is taken.  Results are sent back to your GP.  Some practices will only contact you about the results if there is a problem.  I like to phone and request a printout of mine so that I can see exactly how far in or out of range I am for each hormone and keep the results for my records.  I highly recommend that you do this; the results are yours to see and there is nothing troublesome or difficult about asking for a copy! 

Pros

• On the NHS, the blood tests will free of charge.
• The blood draw only takes a few seconds, plus a minute or two each side to sort out the equipment and paperwork.
• Results are normally back with the GP within a few days.
• If there are problems or imbalances, any subsequent NHS treatment will be free of charge.
• If you’re having your sex hormones tested, the GP will probably run other checks at the same time.  These might include serum cortisol, serum ferritin, liver function markers, basic thyroid function markers, urea and electrolytes, and a full blood count. 
• If you’re lucky, you’ll find out the problem and a solution without needing to progress to any of the other tests.

Cons

• You might not be able to test more obscure hormones like DHEA or AMH on the NHS.
• Some people are too afraid of needles to have a blood test.
• If you have periods, you usually have to take the test at a specific time of the month.  This can be difficult to plan for if your menstrual cycle is irregular. 
• The results only give a snapshot of a single point in time.  Some hormones fluctuate a lot over the course of a day (for example, testosterone in younger men) or month (for example, oestradiol in menstruating women), so a normal result at one time doesn’t rule out issues at another time. 
• Blood tests don’t measure hormone metabolites.  Hormone metabolism is necessary for activation, inactivation and clearance.  It can be useful to know how effectively you are metabolising hormones and also which pathways are dominant.  Oestrogen, for example, can be metabolised in different ways, some of which are more desirable than others.  You won’t get this kind of information from a blood test. 
• Blood tests directly measure only bound hormones, which are already attached to proteins and are biologically inactive.  It can be more useful to measure unbound or ‘free’ hormones, which are biologically active.  There are algorithms that can calculate likely levels of free hormones, but as far as sex hormones are concerned, they are generally only used for free testosterone/androgen and it is not a direct measurement. 

Private Blood Tests

You can use online blood testing services to order your own tests.  I have written in the past about Medichecks, which offers a range of tests covering sex hormones, thyroid hormones, vitamin and mineral markers, and more.  You can test for single hormones if there is one particular thing you’d like to check, or you can order bundles that check for multiple biomarkers.  Some of the tests are available as finger prick tests, or you can go to a clinic for a blood draw or book a nurse to come and take the blood at home.  There are other places where you can book private blood tests online, but other than Medichecks, I’ve only ever used Hormone Lab UK (supplier of ZRT tests). 

Pros

• You can choose the exact tests you want, when you want them.
• The blood draw only takes a few seconds, plus a minute or two each side to sort out the equipment and paperwork.
• You might be able to obtain the sample using a finger-prick test instead of a venous blood draw.
• Medichecks offer a service where you can book a nurse to come to your home.  You can then keep the nurse’s contact details to use in future bloodwork from other labs! 
• Results are normally emailed to you within a few days. 
• Medichecks includes comments and advice from a qualified doctor with your results, although you can opt out of this if you prefer. 
• You can access tests not normally available on the NHS, such as DHEA and AMH. 

Cons

• Both finger-prick tests and blood draws involve needles, which is off-putting to those with a needle phobia. 
• It can be very difficult to get enough blood using a finger-prick test.  I always book a nurse to come and draw the blood for me, even if they then have to tip it into a test tube intended for finger-prick collection! 
• If you have periods, you usually have to take the test at a specific time of the month. 
• As with basic blood tests, the results only tell you about a single snapshot in time. 
• Hormone metabolites are not measured. 
• Only bound hormones are directly measured. 
• You have to pay.
• Your GP might not take privately obtained tests seriously and may be unwilling to provide treatment based on the results. 

Saliva Tests

Reproductive hormone levels can be checked using saliva samples.  For men and postmenopausal women, the best tests require four or five saliva samples be collected over the course of a day.  Genova Diagnostics and Hormone Lab UK both offer tests like this.  You can’t buy directly from Genova, but various nutritionists, naturopaths and private doctors offer their products without the need for a consultation – in the past, I have used Smart Nutrition.  You can buy similar tests directly from Hormone Lab UK without going through a practitioner. 

For menstruating women, Genova Diagnostics offers a superior salivary test – the Rhythm Plus.  This collects saliva samples on multiple days over the course of a menstrual cycle so that monthly fluctuations can be monitored.  For one day only, multiple samples are collected so that cortisol, DHEA and melatonin can also be checked. 

If you can’t afford the best kind of saliva test, there are companies that offer cheaper ones where you just take one sample on one single day.  These might be sufficient for men and postmenopausal women, or for women who want to know about one specific time of month only.  However, for cycling women with more complex health issues, I recommend the Rhythm Plus if at all feasible. 

In all cases you collect the saliva samples by spitting into collection tubes at set times of day.  You then put them in the freezer and when all samples have been collected and frozen, you post the tubes and your paperwork back to the lab. 

Pros

• Saliva testing is non-invasive and completely painless.
• Saliva tests directly measure free hormones, i.e. those that are actually available to act on target tissues.  Many integrative doctors and alternative medicine practitioners consider this superior to measuring bound, inactive hormones. 
• Where multiple samples are collected, the results give a more complete picture than the single snapshot provided by a blood test.  This helps to detect imbalances at particular times of day/month. 
• Saliva tests often measure extra biomarkers like melatonin and DHEA that are not always available on the NHS. 

Cons

• It takes a surprisingly long time to collect enough saliva to fill the test tube and you are not allowed to eat, drink, or clean your teeth beforehand!  For tests conducted over an entire menstrual month, this soon becomes quite tiresome! 
• Some people are unable to produce enough saliva  to complete the test – certain medications can cause dry mouth, for example.  If you are not sure whether you’ll be able to manage, I recommend obtaining a measuring cylinder and attempting to collect 3ml of saliva as soon as you wake up in a morning, before eating or drinking.  You get 30 minutes to complete the sample and you must achieve 3ml of clear saliva – the bubbles don’t count. 
• Many conventional doctors consider salivary hormone testing to be a load of nonsense and won’t provide any treatment based on the results. 
• Hormone metabolites are not measured. 
• You have to pay – and the better tests are quite expensive. 
• You have to wait longer for the results than with a blood test – normally two to three weeks. 
• Once you have the results, you might have to pay someone to help you understand them and decide what to do next.  For the Genova tests you do get notes with your results, but unless you are quite knowledgeable you might struggle to know how to action them.  I don’t know whether you get notes with Hormone Lab UK or not.    

Dried Urine Testing

Another way that your sex hormones can be measured is via DUTCH testing, which stands for Dried Urine Test for Comprehensive Hormones.  This is offered by Precision Analytical and can be purchased from several nutritionists, naturopaths and integrative doctors without the need for a consultation.  I obtained my most recent one from Smart Nutrition.  Some of the DUTCH tests can be taken by both men and women, while others are for women only.  The DUTCH Complete measures organic acids as well as sex hormones, while the DUTCH Plus measures organic acids, sex hormones and stress response hormones.  DUTCH Cycle Mapping options are available for women who want to measure their sex hormones across multiple days of a menstrual cycle. 

The gist is that you urinate on four or five paper strips over a 24 hour period and leave them somewhere to dry.  You then post them back for analysis.  Men and postmenopausal woman can take the test anytime.  Cycling women have to take it a set number of days after ovulation, so it might be necessary to buy an ovulation predictor kit from a chemist or supermarket if you don’t have perfectly regular cycles. 

Pros

• Non-invasive and painless for those who don’t have bladder pain conditions.
• Measures conjugated hormones, which is the form hormones are excreted in after they have been used by the body – a reflection of bioavailable hormone levels. 
• Measures hormones metabolites.  As discussed above, some hormones may be metabolised by different pathways and it is good to see whether ‘good’ or ‘bad’ pathways are dominant for you. 
• Gives an incredibly detailed picture of what hormones you are actually using and whether you get rid of them in a healthy manner.
• Takes into account hormone fluctuations throughout the day, rather than being a one-sample snapshot.
• Many integrative doctors and alternative medicine practitioners consider DUTCH the gold standard of reproductive hormone testing. 
• Lots of useful add-on analytes are available if you want to check more than just your sex hormones.
• You get very comprehensive notes to go with the results. 
  

Cons

• You have to restrict your fluid intake while taking the test, which might be problematic for those prone to bladder infections or pain.  However, the testing period can begin at dinnertime (or your equivalent time if you work shifts) one day and end at lunchtime (or your equivalent time) the next day.  You only need to begin fluid restriction a few hours before starting the test and you’re still allowed at least 900ml once it has started.  On the second day, you’re allowed to drink a small amount between samples and by the time you’ve been up for 2-3 hours, it’s all over and you can go back to drinking normally. 
• If you are interested in your HVA organic acid result, you need to restrict certain foods for 48 hours before taking the test.  I wasn’t, so I didn’t! 
• If you struggle to urinate, you might find producing the samples at the required times difficult. 
• Many conventional doctors consider DUTCH hormone testing to be a load of nonsense and won’t provide any treatment based on the results. 
• You have to pay and it is quite expensive. 
• You have to wait longer for the results than with a blood test – normally two to three weeks. 
• Unless you are experienced in interpreting hormone results, it is unlikely that you will understand them or know how to action them on your own.  Both the results and the notes are very detailed and intended for professional use.  They’re great though! 

Hopefully the above information will help you to select the test that is best for you.  I’ve had all of them, some more than once, and they do all have advantages and disadvantages.  I guess you will now want to know which one I would pick for you. 

• To begin with, go to the GP and get basic tests.  It’s free, so why not? 
• If you want to measure a one-off single hormone like AMH or DHEA, go to Medichecks or similar.  You can then either purchase the single thing you want, or splash out and get one of the panels that includes the main thing you want. 
• If you’re a menstruating female with complex issues, get the Rhythm Plus and/or one of the DUTCH Cycle Mapping options.   
• Anyone who can afford it, get one of the DUTCH options.  They show loads of information that you can’t get anywhere else. 
• The most thorough picture will come from combining blood and saliva and urine, so if you’ve got the means to do so, get them all.
  

I should probably point out that while I’ve had all of these tests, I didn’t get them all done at once.  With hindsight, I’d have saved myself a lot of time, money and aggravation if I had had them all done at once, but I didn’t know about salivary and urine testing for years.  Even if I had have done, I wouldn’t have been able to afford to get everything together anyway.  I’ve had my own tests over the course of about 12 years and if I can, I retake one of the big ones every few years because obviously ours hormone levels change throughout our lives.  I have recently redone the DUTCH test, so join me in next month’s blog to hear more about that! 

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