When patients have hormone-related symptoms, it is usually not a clear-cut case of one hormone level being abnormal or even one hormone system. In fact, because of the role that hormones play as chemical messengers to wake up the genome in specific target tissues throughout the body, it makes sense that all hormones work in concert with each other to maintain a state of balance.
This could be likened to the instruments in an orchestra playing together in harmony; when one instrument is off key or playing too loudly or softly, the overall harmony is affected. In a similar manner, the adrenal, thyroid, and sex hormones work in harmony, and when one or more of the hormones in any one system becomes unbalanced, this affects the harmony or balance of the whole system. Symptoms common to hormonal imbalances in the endocrine systems are seen as the body struggles to maintain balance, but does not succeed. Without an overall picture of which hormone systems are affected, it is often difficult to know the best clinical course of action for correcting the imbalance.
Hormone “Profiles” are multiple hormone tests bundled into one convenient kit. Usually priced lower than the sum of the individual tests, these provide a more economical method to assess a patient’s overall hormonal status, giving a better picture of the hormone imbalances that are causing symptoms. Instead of treating a secondary hormonal imbalance caused by an abnormality in only one of the hormonal systems (e.g., low libido caused by low testosterone), you can address the underlying issues that lie at the root of the problem, and therefore, better guide your patients towards overall wellness.
Laboratory tests should be preformed on the initial visit along with a thorough workup of the patient including physical exams and health evaluations, medical/family/surgical histories, current and past medications, etc. The patient should return to the clinic in 6-8 weeks for a follow-up visit after the initiation of hormone replacement therapy. At this visit, labs tests can be retaken, and the patient reassessed to adjust hormone doses. Typically, after patient symptomatology is well-controlled, they can be assessed every 3 to 6 months for maintenance visits. It is important to remember that a patient should be on hormone replacement therapy at the lowest dose possible to achieve results and for the shortest amount of time necessary.
The most important lab values needed to properly evaluate the patient’s bioidentical hormone replacement therapy are listed below. Other tests may be required depending the provider and focus.
Hormone testing gives the practitioner and bHRT specialists the ability to accurately detect hormone imbalances, help monitor dosing, and increase patient compliance. The combination of lab results and symptom review effectively direct the protocols necessary to reach an optimal outcome.
Saliva testing, the preferred method of testing, measures the amount of hormones that are available to the hormone-responsive tissue. Saliva testing measures the change in hormone levels when hormone supplementation is given and provides the practitioner with a valuable clinical tool.
To explain further, the steroid hormones deliver their message to cells exiting the capillaries to enter cells, bonding with their specific receptors. These “free or unbound” hormones circulate through the liver, and become protein-bound with Sex Hormone Binding Globulin (SHBG) or albumin, or stay unbound. Once hormones are bound by protein, they become water-soluble, thus facilitating their excretion in urine.
Measuring the level of protein-bound hormones in the urine or serum does not measure the more clinically significant free, bioavailable (active) hormones. Non-protein bound bioavailable hormones diffuse easily from the blood capillaries into the salivary glands and saliva. In contrast, the protein-bound, non-bioavailable hormones do not pass into the salivary glands, making saliva testing a more accurate test.
The chart below shows some of the differences between saliva and serum testing.
|Follicle Stimulating Hormone (FSH) (IU/L)||Peak occurs at midcycle; increases with menopause|
|Estradiol (E2) (pg/ml)||Gradually declines with age; decreases 40-60% from baseline at menopause|
|Estrone (pg/ml)||Premenopausal women estrone levels generally parallel to those of estradiol; after menopaus, estrone levels no longer parallel to estradiol, instead, estrone levels is higher than those of estradiol|
|Luteinizing Hormone (LH) (IU/L)||Increases with menopause|
|Progesterone (P4) (ng/ml)||Max occurs during pregnancy; gradually declines with age; decreases 12 folds compared with baseline at menopause|
|Total Testosterone (ng/dl)||Decreases with menopause|
|Free Testosterone (pg/ml)||Decreases with menopause|
|Dehydroepiandrosterone Sulfate (DHEAS) (ug/dl)||Peaks at early 20's, then gradually declines with age|
|17 Hydroxyprogesterone (ng/dl)||Decreases with menopause|
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