Hormone Testing…Which Way is Best?
Hormone testing is a key part of effective hormone replacement therapy.
Not just to diagnose hormone imbalances…but also to monitor the results of your hormone replacement therapy and ensure hormones remain within optimal ranges.
Hormone levels can be tested in one of four different ways. Each has its own advantages and disadvantages:
- Blood serum test
- Blood spot test
- Saliva test
- Urine test
This is exactly like a blood draw at your doctor’s office.
Serum tests are the most widely accepted blood tests and are the standard that other tests are compared against.
Like other blood draws, serum tests for hormone testing need to be taken by a certified lab technician and can’t be performed at home.
Serum tests provide the most complete information about hormone levels in your bloodstream.
However, they do not provide data about hormone metabolism and they can be impractical for testing hormone levels that vary throughout the day (like cortisol).
A blood spot test uses a blood sample just like a serum test. The primary difference is how the sample is acquired and stored. For a blood spot test, a finger prick is used to obtain droplets of blood. The droplets are then dried on a filter card that can be mailed to a lab for evaluation.
While blood spot tests are convenient because they can be performed at the patient’s home, they have some important drawbacks. One is that many patients will have trouble generating a sufficient blood sample from one finger prick. Another drawback has to do with accuracy of results (or lack thereof). The potential for contamination of the sample can also be an issue.
At first glance, saliva tests appear to be the easiest tests to administer. The patient just spits into some plastic tubes and then mails the tubes to the lab. Sounds simple and convenient, right? Not always.
Believe it or not, it can be hard for many patients to generate the amount of spit necessary for saliva tests.
As far as results go, some research suggests that saliva tests may provide a more accurate measure of hormones in the body when those hormones are topically applied during hormone replacement therapy. However, while serum tests can understate what a person has in their body when hormones are topically applied, saliva tests tend to do just the opposite.
There are also practical considerations when it comes to sample contamination. For patients who topically apply their hormones, even the tiniest amount of residue from a hormone cream will contaminate the sample. So let’s say a patient applies her hormone cream and then washes her hands. There will still be a small amount of cream residue left behind. If the patient touches her mouth, and then tries to collect a saliva sample, that sample will likely be contaminated, and levels will come back inflated.
Having said all that, there are instances where saliva tests are the best choice. They can be very helpful for patients who are needle-phobic, and they are preferred for checking cortisol and melatonin levels.
Hormone testing using urine is roughly the same as the urine tests your doctor performs as part of your regular checkup. The sample is either collected in a specimen bottle or the patient can saturate a filter card (which is dried before mailing). Either can be done at a doctor’s office, testing lab, or in your home.
However, urine testing only measures the metabolic products of your hormones. This can provide valuable information about the way hormones are processed by your body. However, it doesn’t provide useful information about actual hormone levels in your body.
So Which Test is Best?
The answer is…it depends on the patient, the hormone, and the information needed.
In most cases, blood serum testing provides the most reliable information about hormone levels in your blood. It also has very little chance for the sample to be contaminated.
However, cortisol and melatonin levels vary depending on what time of day it is. Multiple tests during the day are needed to establish an accurate and meaningful profile for these hormones. This would be inconvenient for blood or urine testing…but is much easier using saliva testing.
Urine testing is valuable for testing hormone metabolites. It can also be useful for testing neurotransmitters and when testing for heavy metals.
Due to issues with accuracy and challenges around collecting a complete sample, we don’t use blood spot testing at all.
At Renew Youth we use blood serum testing to monitor most hormone levels because:
- It has long been the standard for testing and has a well-established track record with regard to accuracy
- The sample is acquired in a controlled environment
- There is much less possibility of contamination
In some cases…such as cortisol testing or hormone metabolite testing…we will recommend other sampling methods if they are more appropriate.
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