Oh hormones, it’s definitely a love hate relationship for most people (although you’re probably more on the hate side if you’re reading this post).
Hormones are chemical messengers, created in the endocrine glands, that control a large majority of our everyday bodily functions.
Everything from hunger and feeling tired, to blood sugar regulation and the ability to reproduce is controlled by, you guessed it - hormones.
And when they’re not working as they should (either too many or not enough are getting produced, or they’re being produced at the wrong times), hormone imbalances can make us feel pretty terrible.
Most of us turn towards conventional medicine to give us insight into our hormone function, but unfortunately, conventional medicine might not have the most accurate view of what’s really going on with this complicated body system.
Which is why, for Part 3 of my series on how you can dig deeper into your health concerns even when your doctor says you’re fine, I’m taking a closer look at the differences between conventional hormone testing and functional hormone testing.
If you missed Part 1 and Part 2 of this series, you can check them out here and here. Trust me, if you’ve ever left a doctor’s office more confused about your health than you were when you entered, you’ll want to read those posts!
But, now on to hormone testing and why just relying on the results from your conventional doctor’s office might end up derailing you on your path towards healing.
Typically, hormone testing is either done at a gynecologist’s office (for reproductive hormones like estrogen or testosterone), or an endocrinologist's office (for any hormone related testing - thyroid, insulin, or even reproductive).
I’ve never visited an endocrinologists office, but I’ve seen my gynecologist many times with hormone related questions - all of which have been answered with a blood test.
Blood tests are very accurate for determining levels of certain hormones (like TSH and insulin), but are less accurate for measuring other hormones (like estrogen metabolites and cortisol).
Which is why I’m a huge proponent of functional hormone testing via, wait for it - urine! And there are two main reasons why.
Difference between bound and free hormones
In order to explain to you why functional urine hormone testing is better than conventional blood hormone testing, we need to first understand how hormones work in our bodies.
Hormones are produced in their respective endocrine organ (insulin is produced in the pancreas, cortisol is produced in the adrenal glands, and so on).
Once that hormone is produced, it needs to find its way through the body so it can send its messages and cause changes in other body tissues. For example, estrogen is produced by the ovaries, but it has an effect on your urinary tract, bones, skin, and many other organs.
In order to travel throughout the body, hormones must bind to other molecules for the long journey. For example, sex hormones are able to be transported throughout the body when they are bound to a protein called sex hormone binding globulin (SHBG).
While hormones are bound, they’re not usable by your body (we often call this “bioavailable”). They’re simply in a state of moving from one location to another, they’re not actively causing any changes in your body.
Testing for these hormones in their bound state, really doesn’t tell us a whole lot.
We want to know at what levels and at what times certain hormones are bioavailable and actually being used by our bodies. We don’t really care how much of the hormone is in it’s bound state, since our bodies can’t use them in that form anyways.
But, when you test for hormone levels using conventional blood testing, in most cases there is no distinction between bound and free levels of hormones.
This means that when you get your hormone levels tested at your doctor’s office, you have no idea if those hormones are in your body as bound (not able to be used), or free (ready and able to be used).
However, when you test your hormones through a functional medicine practitioner, they’re most likely to use an alternative method, like urine for example.
The most common urine hormone test is the DUTCH (dried urine test for comprehensive hormones) run through Precision Analytics.
Urine testing only measures the levels of free, bioavailable hormones. So you’re positive that what you’re measuring is actually what’s available at that moment for your body to use - so much more useful than what you’d get from a conventional blood test.
It wouldn’t be out of the question for your blood hormone results to say that everything is normal and completely within range, while your results from a DUTCH test show that your hormone levels are too low.
And this is actually what happened to me.
About a year ago I was experiencing some symptoms of hormonal imbalances that I’d never had before - night sweats, hot flashes, and hormonal acne.
I was working with a functional dietician at the time who suggested that I get some of my hormone levels tested the next time I visited my gynecologist.
My yearly appointment was scheduled for a few weeks later, so I was able to ask my doctor to test some of my hormones. A few minutes and a blood draw later, I assumed all of my questions regarding my weird symptoms would be answered.
However, when I got the results back, everything looked completely normal and within range (if you’ve been following along with this series, this shouldn’t be a surprise)!
The doctor tested my DHEA-S, Testosterone, and FSH, among a few other things. You can see my results in the picture below.
These results would be expected if I was feeling fine and not having any symptoms, but since that was not the case, this was not has helpful as I was hoping.
So, I decided to take this hormone investigation into my own hands and run a DUTCH test through a functional medicine practitioner.
The results of my DUTCH test were a little more insightful, to say the least.
My DHEA-S levels were through the roof, and my Testosterone was basically non existent, as seen in a clip from my DUTCH results below.
This phenomenon is actually quite common in a stressed out body. Both high DHEA-S and low Testosterone levels are an indicator of chronic stress - which was exactly what my body was experiencing after years of chronic gut infections and antimicrobial therapies.
This more complete view into my hormone status definitely helped to explain my night sweats, hot flashes, and hormonal acne.
All of these symptoms could be explained by an increase in stress hormones (DHEA-S) produced by my overburdened adrenals.
Since the DUTCH test looks at only the active, available, form of my hormones, I was able to get a more representative view of what was actually going on in my body - my low bioavailable testosterone wasn’t masked by the normal levels of bound testosterone that showed up in my blood test results.
This allowed me to start a protocol to ease my stress burden and start to regulate my hormones - something I wouldn’t have been able to do by just relying on blood results alone.
Hormone snapshot versus hormones over time
Another big difference between conventional hormone testing via blood and functional hormone testing via urine is the time period over which you get to view your hormone status.
Hormones fluctuate so much and are going to be at different levels depending on the time of day and the time of month. So, simply drawing blood at the random time that you happen to be in the doctor’s office is usually not the most accurate representation of what’s really going on.
When you do DUTCH testing, you’re taking several urine samples over the course of an entire day.
This allows you to get a glimpse into what your hormone levels (specifically cortisol) are doing at different times of the day - which is very important to know so that you can supplement appropriately.
There is also a DUTCH test that allows you to take urine samples over the entire month so that you can get a cyclical look into your sex hormones and how they’re changing over your entire cycle. (I didn’t do this version, because money, but it’s on my bucket list if I ever win the lottery)
But, by collecting samples at different times during the day, I was able to get an interesting picture of how my cortisol levels were changing, and what I needed to do to correct it.
You can see in my 24-hour cortisol chart, below, that my cortisol was way out of range in the morning, and then was on the low end of the range at night.
This was able to give me an explanation for why I was having trouble sleeping (my cortisol was so low that blood sugar was crashing and my liver was having to produce more glucose to keep it stable, thus waking me up), and why I was feeling jittery and having heart palpitations in the morning around breakfast (my cortisol was spiking).
If I had just gotten my cortisol levels tested via blood, I definitely wouldn’t have been able to pick up this interesting pattern, and my treatment plan wouldn’t have been as effective.
In an attempt to regulate my cortisol, my functional practitioner suggested that I take a cortisol lowering herb (like rhodiola) in the morning and a cortisol boosting herb (like licorice) in the evening.
Without this information from the DUTCH test, I may have been taking the wrong supplement at the wrong time, and could have ended up confusing my body even more.
Which is why I’m a huge proponent of using functional urine testing over a period of time versus just doing a one-off blood test at your doctor’s office. You get so much more valuable and accurate information!
The Bottom Line
Hormone testing is important and can tell you a ton of useful information that can point you in the right direction to healing your body.
However, not all hormone testing is going to give you the most accurate and useful information.
Which is why I wouldn’t rely on hormone testing via blood at your conventional doctor’s office.
Blood testing just isn’t able to pick up the differences between bound and free hormone levels, and it’s just a single snapshot of something that fluctuates so greatly.
Instead, try working with a functional medicine practitioner and test your hormones via urine (like with the DUTCH test).
This form of testing is so much more accurate, and will give you loads of valuable information that will hopefully point your practitioner towards a treatment plan to help regulate those all important hormones.