Bioidentical hormone testing is a complicated and important part of the BHRT process. Bioidentical hormone replacement therapy can be a very effective way to re-balance hormone levels and give certain hormones a boost. However, the doctor needs to be sure that you will respond to BHRT, and more importantly that it is actually an imbalance that is causing you problems in the first place. People may want to rush in and start their therapy with bioidentical hormones right away, but there are very important steps that must happen first, and in this post we cover one of the more important steps in the process, natural hormone testing.
Bioidentical Hormone Testing Overview
Bioidentical hormone testing is the first step that any good doctor will perform before considering BHRT. It may seem like this would be an easy process, and that quite quickly an assessment could reveal exactly which bioidentical hormones would help, but it is actually quite complex in some cases to decide which natural hormones would be helpful. Let’s take the issues involved in measuring the levels of one of the more frequent targets of bioidentical hormone replacement therapy, progesterone. We use this particular hormone as an example, but Bioidentical hormone testing for others is quite similar.
Bioidentical Hormone Testing and Progesterone
Progesterone is a central hormone with many direct functions, and it also helps create an effective balance of estrogen and testosterone. A precursor to the “stress hormone” cortisol, progesterone can be depleted if you are experiencing a lot of stress in your life. There can also be declines for other reasons as well. Progesterone can be measured prior to BHRT through blood levels both at the beginning of treatment and during, although some have noted that serum (blood) progesterone levels are not accurate when a person is using a bioidentical cream. Saliva testing for Progesterone levels is not as accurate because it only measures the amount of this natural hormone that is freely available at the point in time when the test is given. This can be helpful during treatment as a quick and easy test of how things are going, but may not be accurate enough for the initial assessment.
One drawback to saliva testing is that it may take longer for levels to come down if you have levels that are too high after bioidentical hormones are used. You need to be sure to tell your doctor about any over the counter preparations you have taken, or any relatively recent bioidentical hormone replacement therapy you have had if she or he is doing a saliva test – some of your level measured in this way may be artificially high because the progesterone that was boosted remains available in the saliva.
Bioidentical hormone testing for other hormones
The same type of Bioidentical hormone testing can be used for a variety of hormones, and your doctor will choose which hormone level(s) to test based on your symptoms, history, and other reports. She or he can also do a panel that involves several of the potential targets for bioidentical hormone replacement therapy to compare and contrast. You will also have Bioidentical hormone testing throughout the course of your treatment so you know how things are progressing. And then after your BHRT is finished you will also want to have testing if your symptoms return, or just at certain intervals to ensure that you maintain the positive effects.
It may be tempting to make conclusions based solely on symptoms, family history, and your own gut feeling, but hormone level assessment can truly ensure that your doctor gets your formulas just right from the start. This is a valuable step in the process and one that cannot be overlooked. It also provides a baseline so that you can know exactly how much you’ve progressed during the course of your therapy.
Natural Hormone Testing with Saliva
As we mentioned above, Bioidentical hormone testing can be done in many ways, including through the use of a comprehensive medical history, various blood tests that can help rule other causes of symptoms out, and different means of measuring current hormone levels. As we also alluded to, there is one way of measuring current hormone levels that has recently fallen out of favor, and perhaps for good reason, and that is saliva testing.
Saliva testing was once an accepted way to measure hormone levels, and therefore to detect the need for replacement. However, we do not subscribe to the idea that saliva testing, especially when used alone, should be relied on as the only way to determine whether bioidentical hormone replacement should be pursued. A person with a hormone deficiency, such as a woman who is experiencing menopause often will have natural hormonal fluctuations during the day. Each change in hormone level by itself cannot be considered proof of an overall imbalance. A saliva test may show that estrogen is low in this case, but this snapshot may not be telling of the overall picture. All of that
Perhaps the best way to determine whether bioidentical hormone replacement therapy is for you, then, is to go by symptoms and history, as well as a comprehensive battery of tests that ensures that your symptoms are not from something completely different. This is why we also recommend that you talk to your regular doctor before pursuing bioidenticals so that she or he can give you a well-rounded examination to be sure that hormone replacement is for you. Bottom line, do not count on a simple one time saliva test to determine whether you should pursue this treatment.
Problems with Bioidentical Hormone Testing
Many doctors recommend natural hormone testing before a person starts with bioidentical hormones or regular hormone treatments. And this may be a prudent thing to do, since symptoms alone cannot tell the whole story as far as what is going on with hormone levels. It is best to somehow get a clear and scientific picture of what hormones are low before embarking on a course of bioidentical hormone replacement therapy. But is it really possible to get such a clear picture of something as difficult to measure as hormone levels? In some cases, unfortunately, the answer is no given the problems mentioned in the last section with saliva testing and some issues with blood testing too.
While blood testing is seen as a more accurate way to do natural hormone testing, the problem there is not with the testing but more with the nature of hormones themselves – given that levels can vary day by day, and even within any particular day, the testing may be measuring at a time when levels are particularly high or low. Finally, we have the problem of most women not having a baseline hormone test that the doctor can compare the new results to see if there has been a change. Here is a good description of how doctors should choose among different natural hormone tests
So what is the answer then? Usually a doctor will combine several approaches when determining the need for natural hormones. Gathering a detailed history plays a large role, as does family history and a deep understanding of any other medical issues, and after all of that Bioidentical hormone testing can be quite helpful.
Natural Hormone Testing Process
Bioidentical hormone testing takes place before you start taking bioidentical hormones so your practitioner can determine which hormone you need augmented. In some cases the following list can be reduced because your needs are more obvious, while in other cases it is unclear exactly how you would benefit from BHRT. In any case, some degree of laboratory hormone testing is always beneficial to determine what exactly you need from natural hormone replacement therapy. Any or all of the following will be performed.
Natural Hormone Testing before your first appointment
Prior to your first appointment, your doctor will request that you have a series of natural hormone testing blood tests done to determine which hormones you need replaced or augmented, including the following:
- Testosterone will be measured in two ways – Free (i.e. useable) and Total to see whether you need natural hormone replacement for this common problem – both women and men.
- Estradiol will of course be measured in most hormone testing since it is the most common hormone that needs augmenting in women as they age, and this is the most common target for bioidentical hormone replacement
- Estrone Sulfate is also a hormone that is often lost during aging and can be addressed through the use of certain bioidentical hormones, so most hormone level testing includes this as well
- Progesterone may be the second most common hormone replacement need in women as they age so the testing will measure whether you have enough
- Follicle Stimulating Hormone is diminished during aging and while this is not a hormone that is necessarily replaced with BHRT, it can be a marker that something else is wrong, so hormone testing will cover this
- DHEA, in this case DHEA Sulfate will be measured because these are commonly low and could be causing your symptoms
Natural Hormone Testing as a rule-out
You will also need to be tested to be sure there is not some other cause of your symptoms that does not have to do with hormone deficiencies. Thus several natural hormone testing labs will be done to be sure that it is not some other type of medical condition and that you are healthy enough for BHRT, for example:
- TSH, T3 free & T4 for thyroid function will often be an adjunctive part of bioidentical hormone level testing because low thyroid function can have some of the same symptoms as low hormones
- Electrolytes and Sodium for general health will be done because again it must be determined that you are in good health and nothing else is going on that is actually causing the symptoms before you have bioidentical hormone replacement therapy
- Potassium levels are measured
- Bilirubin, AST and ALT for liver function to be sure that you will be able to correctly metabolize the bioidentical hormones
- Creatinine, Blood Urea Nitrogen for kidney function again to check for health and your ability to rid your body of waste
- Glucose and cholesterol will also be checked
Natural Hormone Level Testing Conclusion
This may seem like a lot of blood testing, both natural hormone testing and other medical work-ups, but it is absolutely important that you are sure that there is no other reason for your symptoms and that the bioidentical hormone formula that will be used (or in the case of custom compounding, designed) will be most effective for you. One of the reasons that bioidentical hormone replacement originally had a poor reputation is that it was used too widely – even on people who did not need it. This if course led to reports of it not working well. For this reason, and also because they generally care about your health and well-being, a bioidentical therapist will do this comprehensive natural hormone testing lab work which normally takes about 21 days to complete.
Here is some information about what types of hormone testing are best for which hormones, and Wone in Balance also discusses you hormone testing choices.
We also cover how to choose the best bioidentical hormone doctors.
If you have had natural hormone testing and want to share your experience and how the results to others, please feel free to use our comments section to describe your own bioidentical hormone testing.