hormone testing FOR WOMEN
IN ORDER TO DEMYSTIFY HORMONE TESTING, THERE ARE THREE TRUTHS YOU NEED TO KNOW:
Though there are a laundry list of hormones that function daily in our bodies, the tests that we generally order focus on the trifecta of sex, adrenal, and thyroid hormones. We look at the normal ranges of feminine hormones - estrogen, progesterone, and testosterone - but also the subsets of estrogen within those, as well as important thyroid and adrenal hormones. All of these systems are connected and rely on each other to keep your total hormonal levels balanced at any given time in the body.
Some tests are better than others for checking certain levels, and some hormones fluctuate on a daily level, so they need to be tested more than once at specific times within a day. In actuality, you may need more than one test to get a comprehensive look at your current hormonal levels.
And although the medical community has developed what is accepted as a “normal” range, that doesn’t take into account your unique history and genetic makeup. What is “normal” on paper may not be normal for you. If you fall close to either the bottom or top range of a level, there may be an underlying issue. In addition, some hormones are dependent on others, so, for example, a low normal in one area with an abnormal level in another may indicate the precursor of a developing issue. Be sure to discuss your results as a whole with a respected healthcare provider who will take into consideration your entire health history in addition to these test results.
Below you will find my top tests to run, along with recommended ranges:
DISCOVER which hormones are out of balance WITH
MY FREE HORMONE QUIZ
CBC - COMPLETE BLOOD COUNT
Most blood tests begin with what is called a CBC, or a Complete Blood Count, to breakdown and evaluate the blood cells in your body to get an accurate picture of your bodily levels. It looks at the following:
RBCs (Red Blood Cells) 4 million to 5 million cells/mcL
These carry oxygen and filter carbon dioxide. A stable number helps keep your body fueled, while too low signifies anemia.
WBCs (White Blood Cells) 4,500 to 10,000 cells/mcL
These help your body fight infection. High levels indicate inflammation or infection; low levels show your immune system is compromised.
Platelets 140,000 to 450,000 cells/mcL
These help your blood to clot.
Hb or Hbg (Hemoglobin) 12-15 gm/dL
This is a protein that holds oxygen.
Hct (Hematocrit) between 36%-44%
This is the percentage of red blood cells to total blood. A low scores mean you need iron, while a high score indicates dehydration or other issues.
MCV (Mean Corpuscular Volume) between 80-95
This is the average size of your RBCs (red blood cells). Larger than normal cells indicate vitamin or folate deficiencies, while smaller indicate a form of anemia.
Your trusted healthcare provider should look for any discrepancies in these levels and also take into consideration the results of these levels in relation to your hormonal levels and any other tests that you request.
HORMONES TESTED
While there are many hormones at work in the body, hormone testing generally focuses on three areas: sex hormones, adrenal hormones, and thyroid hormones.
Why those three? Because they control the majority of the hormonal work of the body. When we have an accurate picture of what is happening in those three areas, we can begin to understand what is happening in your body when considering symptoms, issues, and other concerns.
Let’s take a look at these three areas and the hormones for each…
SEX HORMONES
Because your hormonal levels fluctuate through each phase of your menstrual cycle, these levels are listed as ranges within each of these phases.
Your test results should indicate which phase you are in if you aren’t sure yourself. For more information on the phases of your menstrual cycle and how to support your hormones through each, check out my article here.
Estrone (E1)
This greatly influences tissue growth; protects the heart, blood vessels, and brain; may contribute to estrogen-dominant issues and is often considered pro-carcinogenic. Metabolites are either good or bad depending on individual nutritional standing; levels fluctuate depending on menstrual stage.
< 200 pg/mL Luteal Phase
<150 pg/mL Early Follicular Phase
100 - 250 pg/mL Follicular Phase
3 - 32 pg/mL Post-menopausal
<150 pg/mL Nonpregnant
Estradiol (E2)
This is the strongest and purest estrogen in the body that helps with everything from blood vessels to cholesterol to skin health to brain function to immune system support. It must be properly balanced with progesterone and other estrogens to avoid estrogen dominence effects on sensitive female reproductive organs.
27 - 246 pg/mL Luteal Phase
0 - 246 pg/mL Follicular Phase
0 - 30 pg/mL Postmenopausal (untreated)
0 - 93 pg/mL Postmenopausal (treated)
0 - 102 pg/mL Oral Contraceptives
Estriol (E3)
This is the unconjugated, normally weak form of estrogen that increases during pregnancy. It opposes growth of cancerous cells and protects breast, lung, and digestive tissues. It also can aid in alleviation of some menopausal symptoms, and boasts anti-inflammatory and gut-protective qualities.
< 0.08 ng/mL Nonpregnant
Progesterone
This balances estrogen throughout the body while supporting the reproductive system and affecting bone, skin, and brain health. It also affects mood and is necessary for cortisol balance as well as thyroid balance for a regulated metabolism.
0.72 - 17.8 ng/mL Luteal Phase
0.33 - 1.2 ng/mL Follicular Phase
0 - 1.0 ng/mL Postmenopausal
0.34 - 0.92 ng/mL Oral Contraceptives
Testosterone
This is a powerful steroid hormone that contributes to bone health, libido, and muscle mass. It helps with normal hormonal balance, converts to estrogen, and is regulated by LH and FSH. It is important to measure both total and free testosterone to find out what is available in the body.
Total Testosterone
0 - 73 ng/dL Ovulating
0 - 43 ng/dL Postmenopausal
Free Testosterone
0.3 - 1.9 ng/dL
FSH (Follicle Stimulating Hormone)
This triggers estrogen production in the body and is used to denote ovarian function. Levels increase during ovulation and during ovarian failure, so it is also used to gauge menopause status.
1.2 - 90 mIU/mL Luteal Phase
2.8 - 11.3 mIU/mL Follicular Phase
21.7 - 153.0 mIU/mL Postmenopausal (untreated)
9.7 - 11.0 mIU/mL Postmenopausal (treated)
0 - 4.9 mIU/mL Oral Contraceptives
SHBG (Sex Hormone Binding Globulin)
This is a protein produced by the liver that binds estrogen and testosterone within the bloodstream to assist with keeping levels balanced.
18 - 144 nmol/L Normal Range
LH (Luteinizing Hormone)
This triggers ovulation and pairs with FSH to promote fertility. It increases mid-cycle to stimulate the release of progesterone and regulates ovarian estrogen production. It is influenced by levels of prolactin, and high levels are normal during menopause
0 - 14.7 mIU/mL Luteal Phase
1.1 - 11.6 mIU/mL Follicular Phase
11.3 - 39.8 mIU/mL Postmenopausal
0 - 8.0 mIU/mL Oral Contraceptives
ADRENAL HORMONES
Cortisol
Levels of this hormone indicate how well your body handles stress. These levels fluctuates throughout the day and should be measured in the morning via blood, and then 4x throughout the day via saliva.
- Serum Cortisol in AM
- Levels of this glucocorticoid hormone (released from adrenal cortex) show how well you handle stress.
- 10-20 mcg/dL
- Four Diurnal Cortisol (Tested 4x day via saliva)
- 3.1 - 22.4 ng/dL
DHEA-S (Dehydroepiandrosterone sulfate)
This is the most abundant sex hormone in body, as it is the main precursor to both estrogen and testosterone. Levels affected by menstruation. This hormone affects the immune system, cognition, and bone health. It also prevents aging.
35 - 430 ng/dL
Prolactin
This keeps other hormones in balance by inhibiting their production. Prolactin also regulates metabolization of calcium, helps regulate inflammation and metabolic processes, and stimulates breast milk production in lactating women.
1.9 - 23.1 ng/mL
IGF-1 (Insulin-like Growth Factor)
As the prime mediator of growth hormone (GH), IGF-1 is produced primarily by the liver. It promotes cell growth in the body, including bones, muscles, nerves, skin, and other organs.
57 - 241 ng/mL
Androstenedione
This is a steroid hormone that influences testosterone levels in the bloodstream. It promotes muscle growth and supports natural levels of testosterone and estrogen.
0.3 - 3.3 ng/mL
THYROID HORMONES
TSH (Thyroid-Stimulating Hormone)
This helps us to see how the brain communicates with the thyroid.
0.500 - 2.00 uIU/mL
T3 (Triiodothyronine)
This is the active form of the thyroid hormone, which affects nearly every physiological process in your body, from heart rate and body temperature to growth and metabolism.
100 - 180 ng/dL
Free T3
T3 is the active form of thyroid hormone, and free T3 shows what is unbound and available in your bloodstream. It has major impacts on your metabolism and most important level to keep balanced.
2.5 - 4.4 pg/mL
Thyroxine (T4)
This is the main thyroid hormone in its inactive form, for storage. It must be converted to T3 by liver and kidneys.
6.0 - 12.0 ug/dL
Free T4 (Thyroxine)
T4 is the storage form of the thyroid hormone. After being triggered by TSH, T4 converts to T3 (the active form of the thyroid hormone).
1.00 - 1.50 ng/dL
Reverse T3 (RT3)
Here is another nactive form of thyroid hormone. High levels indicate adrenal issues or increased inflammation.
9.0 - 21.0 ng/dL
TPOAb (Thyroid Peroxidase Antibody)
This is a thyroid antibody in blood, indicating the immune system is attacking the thyroid and signifying an autoimmune disorder.
0 - 20 IU/mL
AntiTg Antibody
This antibody is not normally found in bloodstream. It rises well before problems with other thyroid hormones and indicates the presence of an autoimmune thyroid problem.
< 90 IU/mL
ADDITIONAL TESTS
Fasting Insulin/Glucose
This test is used to diagnose pre-diabetes (100-125 mg/dL), diabetes (>126 mg/dL), and metabolic syndrome. Insulin resistance influences cholesterol, blood glucose levels, and blood pressure. You must fast for at least 8 hours prior to the test
<90 mg/dL
HDL (Cholesterol)
This is “good cholesterol” that promotes heart health by helping to remove the harmful LDL cholesterol from the bloodstream by transporting it to the liver for excretion from the body.
>39 mg/dL
Hemoglobin A1C
Hemoglobin with glucose attached to it to help evaluate your average glucose levels. Pre-diabetes ranges from 5.7-6.4% while diabetes is anything greater than 6.4%.
4.8-5.6%
25-Hydroxy Vitamin D
This vitamin helps the body absorb and allocate calcium for bone growth, as well as support other bodily functions.
30.0 - 100.0 ng/mL
Vitamin B12
This vitamin promotes nerve and blood health as well as DNA production. It also prevents anemia and keeps blood balanced.
>150 ng/dL
Folate
This natural form of vitamin B9 is needed for synthesis of DNA and other genetic material as well as for cellular health.
2-20 ng/mL
When you assess the test results, pay attention to the “normal ranges.” Discuss them with your trusted health-care provider, and bear in mind that just because your number falls into the “normal” range, that doesn’t mean that it’s normal for you. Any number at the higher or lower end should be questioned.
HORMONE TEST TRIFECTA
There are actually three different tests that I recommend to my patients to get the most comprehensive results for their hormone levels so we can really figure out what is going on: Blood, Saliva, and Urine. Each has its own merits, but there are also drawbacks to each. In a nutshell, the best solution is to get a combination of tests, or choose the one that best fits your specific needs.
Blood Test - CBC, Thyroid
In addition to the CBC for an overall look at blood levels, I recommend blood testing for thyroid levels. It gives us a snapshot only of a moment in time, but allows us to test a wide range of thyroid hormones for a specific look at active levels. If we notice discrepancies, then we can go back and order more blood testing to see where and when levels are varying.
The drawback to blood testing for thyroid levels is that it is hard to tell the difference between bound and free hormone levels. Free levels are very relevant when we look at how much of a hormone is available for use in your body, a level that many doctors overlook.
Saliva Test
Saliva tests are great for cortisol levels because they are comprehensive and most can be done in the comfort of your own home. This is ideal, since this test is best when repeated at multiple points throughout the day; at the bare minimum it should be done in the morning and then the evening, since your cortisol levels should fluctuate during your day.
The drawbacks to saliva testing lie in the fact that the convenience of DIY opens it up to human error. You have to follow the instructions explicitly, avoiding eating, teeth brushing, mouth washing, gum chewing, etc. in order to have accurate results. They can also be altered if you are using prescribed topical hormones, so don’t choose this test if you fall in that category. Plus, these tests are only available for steroid hormones, not thyroid hormones, so it won’t give you a complete picture.
Urine Test - DUTCH (Dried Urine Test for Comprehensive Hormones)
An amazing gain in testing is the more recent DUTCH tests, which uses samples of urine throughout the day to test for a comprehensive panel of hormonal levels. You simply soak a pad with pee and then let it dry before sending it in. It collects a huge amount of data, including sex and adrenal hormones plus metabolites, which gives a wider perspective for hormonal levels.
The drawbacks are that it is expensive and the results are complicated. Even if you can do individual collection of multiple samples, the results still need to be interpreted by a medical professional. But the sheer quantity of the results often make it worth it, especially for your metabolite levels.
Your trusted healthcare provider should look for any discrepancies in these levels and also take into consideration the results of these levels in relation to your hormonal levels and any other tests that you request.
THE BOTTOM LINE
Only you and your trusted healthcare provider can decide what are the best tests for you, though I recommend asking for the following:
CBC
Thyroid tests, including TSH, Free T3, Free T4, Reverse T3, TPOAb, and AntiTgAb
Adrenal tests, including Morning Serum Cortisol, 4 diurnal Saliva Cortisol tests, Free & Total Testosterone, and DHEA
Progesterone on day 21-23 (if cycling)
Fasting Insulin and Glucose, HDL, and Hemoglobin A1C
IGF-1 (growth hormone)
25-hydroxy-vitaminD, Vitamin B12, and Folate
Together you can assess your results, taking into consideration your current age, lifestyle, and symptoms that you may be experiencing. Remember that YOU are in charge of your own healthcare. Trust yourself and your inclinations when having these important conversations with your healthcare providers.