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HORMONE TESTING AND INTERPRETATION

Hormonal testing methods

Urine Hormone Testing:

 Twenty-four-hour urinary hormonal function monitoring is a reliable tool for hormone levels and hormonal activity. Urine tests will assess hormone levels over time and determine the free unbound hormones just like in saliva tests. Urinalysis also monitors hormone levels in the body. It may also quantify downstream sex hormone metabolites, or breakdown products, which include several circulating estrogens in the body and other breakdown products. It is beneficial as it helps ensure that hormones are broken down into metabolites that decrease disease risk and do not raise the risk of certain pathological processes. Urine hormones represent the combination of endocrine production and peripheral hormone production with their metabolites. 

 

Saliva Hormone Testing

According to Dr Pamela Smith of A4M (P. W. Smith, 2010, p. 253), The saliva test measures only the "free" form of hormones. On the contrary, blood levels measure both the free and bound hormones. She explains that free hormone molecules are the only ones that the body can use especially as bound hormones are preserved, and not available for immediate use. Using saliva levels to dose a trochee hormone replacement treatment or an oral dosing will generally lead to an inaccurate dosing. Furthermore, saliva testing is the best method of calculating hormone levels as it enables improvements over days, as opposed to a one-time blood sample showing levels only at the time of the test. To appreciate it even further, saliva research reliability is dependent on understanding the difference between saliva and serum steroid hormones. That difference depends on whether the hormones in the medium used for testing are bound to proteins or not. Most Hormones occur in two forms: free (5%) or bound protein (95%).

Only free hormones are biologically active or bio-available for body receptor delivery Protein bound hormones do not fit the receptors and are deemed not bioavailable. When blood is filtered through the salivary glands, the components of the bound hormone are too large to pass through the cell membranes. The unbound hormones alone pass through and into the saliva. Saliva testing measures the bioavailable hormone, the clinically relevant proportion of the hormones that are delivered to the receptors. Salivary hormone levels are as expected, significantly lower than serum levels, since only the unbound hormones are measured. Patients are often overdosed when health care providers measure serum hormone levels and prescribe hormone replacement therapy based on those results. If the patients are then tested using saliva, the results are extraordinarily high, and confusion is created because of the lack of correlation between both methods. Topical application of the treatment of bio-identical hormonal is gaining tremendous popularity since it is easy to administer and monitor. With oral administration of progesterone, there are more risks involved. Estrogen given by mouth can increase blood pressure, increase triglycerides, increase estrone, cause gallstones, elevates liver enzymes, Increase SHBG (decreases testosterone), Interruption of tryptophan metabolism and consequently serotonin metabolism. It also lowers growth hormone, increase prothrombic effects, Increase CRP, Increase carbohydrate cravings (p. S. MD, 2016) 

Testing for Hormone Metabolites:

 Androgen Metabolites. 

The metabolites of androgen hormones like testosterone can also create health and wellness issues. For example, if excessive testosterone is metabolized into the potent 5- alpha-DHT, it can lead to acne as well as loss of hair or overgrowth of hair in men and women. It can likewise boost the risk of prostate cancer in men with high estrogen. 

Cortisol Metabolites. 

The stress hormone cortisol is metabolized right into tetrahydrocortisol (THF) in the liver. Because enhanced cortisol metabolism increases cortisol production, it can be beneficial to check for THF and various other metabolites when stress-related problems are a problem. Measuring the sex hormone metabolites shows enzyme activity and encourages deeper involvement to individualize and tailor the treatment. Hormone metabolite testing can help to determine whether the development of a given hormone is high or low, and whether these hormones are safely extracted from the body or build up to the point that they can trigger health risks. Hormone metabolite testing is advisable when an individual has symptoms of hormonal imbalance, symptoms of menopause, symptoms of estrogen dominance during hormone therapy, symptoms of adrenal fatigue with normal saliva cortisol levels, family history of hormone-driven cancers such as breast cancer or prostate cancers. Hormones serve as chemical messengers in their active form to regulate, promote, or activate different body processes. As active hormones complete their work and new hormones are formed, the urine must clear active hormones from the body. Since steroid hormones do not work well in water, they cannot get into the urine. Instead, the liver and kidneys must break down such hormones to produce water-soluble metabolites that can be excreted. Some metabolites may be harmful if produced excessively, which is an essential reason to check for hormone metabolites when toxicity is suspected. The liver's ability to efficiently metabolize estrogens was found to affect breast cancer risk. Depending on which metabolic pathways predominate, too much of such unhealthy estrogen metabolites (e.g., 4-hydroxy estrogens) can accumulate-and this may correlate with breast and other hormone-dependent cancers. 

Sex Hormone Binding Globulin testing

SHBG is a testosterone and DHT carrier protein, and somewhat an estradiol (E2). If the SHBG levels are high, less E2 and testosterone are available for body use. Correspondingly, low levels of SHBG mean that more E2 and testosterone are available for use. Low levels of SHBG may represent a marker for low thyroid function. High levels of insulin and high levels of prolactin alter the SHBG levels. It may increase your SHBG by 50 percent if you are taking estrogen orally. If you take Premarin, it may increase your SHBG levels by 100 percent. Transdermal application of estrogen raises SHBG nominally, unless in overdose situations (Smith, 2010, p. 57). As a transport protein for androgen and estrogen hormones, SHBG plays an essential role. SHBG is primarily made in the liver though small quantities are produced by several other tissues. The primary role of sex hormone-binding globulin, released into the bloodstream, is to bind testosterone and estradiol, preventing these hormones from affecting the end tissues. Consequently, abnormally high levels of SHBG can lead to insufficient amounts of bioavailable testosterone and estradiol, resulting in a functional deficiency in these hormones. Some correlations between low SHBG levels and increased cardiovascular risk have been found. Because of this, the SHBG test is often ordered along with the test for estradiol and the total and free test for testosterone to see how SHBG blood levels affect these hormones (Smith, 2010, p. 255 & 284). Abnormal levels of SHBG often manifest symptomatically in estradiol-and Testosterone-related patients. Symptoms such as excessive hair growth and sexual abnormalities can cause SHBG abnormalities. The SHBG test also serves to calculate the Free Androgen Index (FAI) (Al Kindi, Al Essry, Al Essry, & Mula-Abed, 2012). The free androgen index is calculated by taking the total level of testosterone and dividing it by the level of SHBG (total testosterone / SHBG); and multiplying it by 100 if desired. Healthy men typically have a FAI greater than 30, while healthy women have a FAI lower than 10. The IGF test is performed with the SHBG test, as high IGF levels are associated with low SHBG levels (Anderson, 1974), (Selby, 1990), (Laurent et al., 2016). 

Blood and/or Serum Testing

 Although measuring serum or blood spot endogenous hormones shows the same amounts, measuring topical hormone treatment levels with serum monitoring massively underestimates the volume of hormone distributed to the tissues. Blood spot method is used to measure blood from the finger in the capillary beds such as arteries, veins, or lymphatics, which represents the amounts of hormones in the tissues. The mainstream scientific professionals recognize blood or serum hormone measuring as the method of choice because it has the benefit of being straightforward. Serum is incredibly good and suitable for studying peptide hormones such as FSH, LH, prolactin, fasting insulin, thyroid hormones, T3, T4, Reverse T3, top antibodies, Sex Hormone Binding Globulin (SHBG), Testosterone, estradiol, and Progesterone. Although serum hormone measurement is often used in sex hormones, it is nowadays highly discouraged due to its more restricted usefulness especially when trying to measure hormones administered via the transdermal route. Most laboratories do not differentiate between bound and free hormones. There is also the fact that serum testing is a "snapshot" of the daily hormone level. Timing of samples in a serum test poses a significant problem. Estradiol (E2) is the most frequently detected sex hormone in serum while estrone (E1) is also present in several laboratories. However, the Serum Estriol (E3) monitoring is not conducted regularly. E3 is an essential estrogen, usually deemed defensive since it attaches to Beta (ERb)3, an estrogen receptor that is known to increase differentiation and decrease cell differentiation. Monitoring of serum progesterone supplementation often presents an issue. Transdermal progesterone increases plasma progesterone rates in a statistically meaningful manner. Such an improvement is insignificant, and this raises the possibility of inefficient progesterone dosing as clinicians aim to reach their therapeutic targets. Furthermore, serum hormone monitoring usually does not enable the assessment of estrogen, androgen, and adrenal metabolites and may offer a plethora of knowledge to help the doctor identify the state of their patient to help fine-tune care choices. 

What are Bio-identical Hormones?