Are you struggling with unexplained symptoms like severe weight gain or loss, fatigue, or acne?
You’ve gone to the doctor, maybe even seen multiple specialists, but you’re left frustrated because they didn’t know what was wrong.
They did some testing. Your labs came back normal. They sent you home.
Ugh… it feels like you’re back at square one.
While I don’t know the exact situation you’re in, I do know what that’s like. And I see many patients at Wild Side Wellness come to me with the same story.
So know that you’re not alone in this.
Throughout my years in practice, I’ve done my fair share of hormone testing. Now I want to give you the inside scoop of how I go about determining:
- When to test hormone levels
- What hormones should be tested
- How to test your hormone levels
The foundation of hormone testing for women is understanding how your menstrual cycle works. So I’ll share some facts about your menstrual cycle and then dive into all things hormone testing.
The Connection Between Your Hormones and Your Period
Your hormone levels aren’t the same throughout the month. That’s because hormone levels vary based on innumerable factors like:
- Your stress levels
- How much sleep you get
- Your eating schedule
As a woman, one of the biggest factors behind your hormone levels is your menstrual cycle. You probably started your period when you were 10-15 years old. For healthy individuals, you’ll continue to have a period throughout your life (except when you’re pregnant) until menopause starts at around 50.
But do you know exactly what’s happening to your body every 28 days? It might be time for a refresher, so let’s dive in.
What Happens Every 28 Days of Your Menstrual Cycle?
- Day 1 of Your Menstrual Cycle: This is the first day of full flow of your period. You’ll see bright red blood for the first time (spotting days don’t count). This is because your uterus is shedding its lining.
Your sex hormones progesterone and estrogen just took a dive (since you didn’t become pregnant when you were ovulating) which causes your body to release follicle-stimulating hormone (FSH). FSH signals to your ovaries to create follicles to prepare for ovulation. The follicles contain eggs.
Your period lasts on average between 2-7 days.
- Day 14 of Your Menstrual Cycle: Your period’s done, and there’s no more bleeding. This is super important because the average day women begin ovulating is day 14, so this is our baseline when we’re discussing hormone testing.
What happens when you ovulate? Ovulation is when a mature follicle in one of your ovaries releases an egg. The egg can implant itself in your uterine lining if it’s fertilized by a sperm (aka you become pregnant), or it’ll break down within 24 hours and pass out of your body during your next menstrual cycle (in about 14 days).
During days 12-14, your estrogen levels are really high which triggers luteinizing hormone (LH) to be released. It’s that rise of LH that causes ovulation.
- Day 28 of Your Menstrual Cycle: Every woman is different, so you may not have a 28-day cycle. But for the sake of explaining hormone testing, I’ll assume you do have a 28-day cycle. But you can always speak with your doctor to determine your specific menstrual cycle time.
If you get pregnant before the end of your menstrual cycle, your estrogen and progesterone levels will remain high. But if pregnancy doesn’t occur, estrogen and progesterone take a deep dive down, and we go back to day 1.
Here’s a side note: If you’re on hormonal birth control, you won’t ovulate and you don’t have the typical period. You’ll have what doctors call “withdrawal bleeding.” The bleeding will normally be less heavy than your actual period. If you have a copper IUD, you may ovulate but it won’t allow a fertilized egg to survive.
Ok, hopefully that overview didn’t bring back bad memories of high school sex ed… Let’s move on to specific hormones you can test.
What Hormones Can You Test?
I’ll be honest: Hormone names can be intimidating. But know that you don’t have to understand everything about your hormones to get them tested. Here’s a list you can share with your doctor, or you can use to determine which at-home hormone test to complete.
But, if you have specific hormone questions it’s best to talk with your doctor.
Here’s a list of 15 common hormones to test:
- Follicle-stimulating hormone (FSH)
- Thyroid-stimulating hormone (TSH)
- Free thyroxine (T4)
- Free triiodothyronine (T3)
- Thyroid peroxidase (TPO)
- Thyroglobulin (TgAb) antibodies
- Thyroid receptor antibodies
- Reverse T3
- Dehydroepiandrosterone (DHEA)
Knowing which hormones to test is your first step. The next step is knowing the best time to test your hormone levels. Because even though your hormone levels may be coming back normal, something else could be going on behind the scenes.
When Is the Optimal Time to Test Your Hormones?
You’re struggling with hormone imbalances but you’re getting “in range” blood test results back. If this is the case, then we need to look at the timing behind when you’re getting your hormones tested.
I’ll break your hormones into categories and tell you exactly when you should be testing them.
Your sex hormones include the top five from the list of 15 hormones above. Let’s look at when they should be tested. Knowing the stages of your menstrual cycle will help. Remember, day 1 of your menstrual refers to the first day of your period.
- Estrogen: I recommend checking your estrogen levels around day three of your period and between days 19-22. This can help us determine if your symptoms are due to estrogen dominance (aka too much estrogen). Some symptoms of estrogen dominance include heavy periods, irritability, moodiness, and weight gain.
- Progesterone: I test my patients’ progesterone levels between days 19-22 of their menstrual cycle. Remember, this is after ovulation has occurred and it’s normally when progesterone is at its highest.
If you don’t have a 28-day menstrual cycle or you don’t ovulate on day 14, talk with your doctor to determine when you begin ovulating so you can get your progesterone tested at the correct time. Some symptoms of ovulation could include:
- Higher body temperature
- Clear, egg white-colored vaginal discharge
- Follicle-stimulating hormone: To evaluate your egg reserves and fertility, I test FSH on day three of your cycle. If it’s not possible for you to get tested on day 3, you could get tested between days 2 and 4.
Your FSH results can help me determine a polycystic ovarian syndrome (PCOS) diagnosis (although additional testing will be needed).
- Estradiol: Did you know that your estrogen levels and the type of estrogen you produce depend on the season of life you’re in?
If you’re in menopause, estrone (or E1) becomes the dominant form of estrogen in your body.
If you’re in your reproductive years, the dominant form of estrogen in your body is estradiol (or E2). So you’d only want to check estradiol if you’re in your reproductive years since it’s the dominant form of estrogen.
- Testosterone: If you have low testosterone levels, you may have symptoms such as: depression, extreme fatigue, and low libido. If you have high testosterone levels, you may have severe acne, irregular periods, facial hair growth, and/or PCOS.
Testosterone testing doesn’t depend on your menstrual cycle, but it’s best to test in the morning between 7 AM to 10 AM. This is because your testosterone levels are highest in the morning, so we’ll get the most accurate reading then.
To understand the full picture of your testosterone levels, make sure you’re testing:
- Total testosterone
- Free testosterone
- Sex hormone-binding globulin (SHBG)
What about other hormones? Keep reading to learn about when you should test your thyroid hormones and other hormones.
Your thyroid is a small, butterfly-shaped gland that’s part of your endocrine system. Your endocrine system is made up of glands that produce hormones and release them into the blood. So, it’s critical to test the organs and glands in your endocrine system when trying to understand your hormones.
Your thyroid hormones can be tested during any part of your menstrual cycle. However, they’re best tested in the morning. If you’re getting tested for thyroid hormones, I recommend not taking biotin at least 72 hours (or 3 days) before your tests. That’s because biotin interferes with lab tests like thyroid panels and leads to false levels of T4, T3, and TSH.
Let’s look at hormones 6-12 from the list I shared above.
- Thyroid-stimulating hormone (TSH): When you’re getting your thyroid hormones tested, most doctors will only test for TSH. But, what is it exactly?
TSH is made in your brain. It tells your thyroid when to produce hormones T3 and T4. Although TSH signals the production of other hormones, we want to be sure you’re also tested for the 6 hormones below to get a full picture of your thyroid and endocrine system.
- Free thyroxine (T4): Think of thyroid-binding globulin (TBG) like a sticky note. However, instead of falling off easily, it binds to a hormone like super glue binds two pieces of wood together.
TBG binds to T4 and makes sure that it gets to the part of the body it needs to go safely. I want to measure free T4, or the T4 in your body that isn’t bound to TBG, to give me a better idea of what’s going on in your body.
- Free triiodothyronine (T3): Just like T4, TBG also binds to T3.
T3 plays an important role in your metabolism, gut health, and digestion, as well as your mood.
- Thyroid peroxidase (TPO) and Thyroglobulin antibodies (TgAb): Have you ever heard of Hashimoto’s disease? It’s an autoimmune disorder where your immune system attacks your thyroid. It can cause an underactive thyroid (or hypothyroidism). TPO and TgAb can be measured to determine if you’re suffering from Hashimoto’s.
Common symptoms of Hashimoto’s disease include extreme fatigue, weight gain, brain fog, fertility issues, and feeling constantly cold.
- Thyroid receptor antibodies: We touched on hypothyroidism with Hashimoto’s, but what if you’re experiencing an overactive thyroid (or hyperthyroidism)? This is called Graves disease.
It’s less common than Hashimoto’s disease, but it can occur. I’ll want to look at your thyroid receptor antibodies to see what’s going on.
- Reverse T3: What’s the difference between free T3 and reverse T3?
T3 is an inactive thyroid hormone. You’ll experience high reverse T3 levels if you’re under physical or emotional stress.
Wow, what a thorough list of hormones! You’ll see why testing just for TSH – like most doctors – won’t give you a full picture behind your thyroid and your overall endocrine system.
Lastly, let’s look at three other popular hormones.
Testing Insulin, Cortisol, and DHEA
- Insulin: Insulin is a hormone produced in your pancreas that regulates how much glucose is in your blood. If you have a lack of insulin, this could lead to diabetes.
Insulin is normally tested with fasting blood glucose, so it’s normally done first thing in the morning on an empty stomach. Just like testing your thyroid hormones, supplements with biotin should be stopped at least 72 hours (or 3 days) before you get tested.
Testing for insulin can help us understand if you have PCOS or diabetes.
- Cortisol: Cortisol is a hormone produced by your adrenal glands (the glands right on top of your kidneys). It’s released when you’re stressed. When cortisol levels are high, sex hormone progesterone is low. This is important to know, especially if you’re trying to conceive.
Cortisol is also tied to your blood sugar and hair loss. It can be tested at any time of the month, and it’s best tested first thing in the morning. Sometimes if there are concerns with your cortisol results an additional test called adrenocorticotropic hormone (ACTH) may be recommended.
- DHEA: DHEA is an anti-aging hormone that can be converted into sex hormones testosterone or estrogen. Testing DHEA can give important information about your adrenal glands since levels decline as you get older.
We can test DHEA any time of the month, and I normally test them with cortisol and the other sex hormones.
There you have it! While insulin, cortisol, and DHEA hormone test timing don’t depend on your menstrual cycle like testing for thyroid hormones, there are some points in the day where it’s best to test these hormones.
How Can You Test Your Hormones?
So now you know what hormones to get tested. But what kind of hormone testing should you do? I recommend two tests.
DUTCH Hormone Testing
Precision Analytical Inc.’s DUTCH Hormone Test (Dried Urine Test for Comprehensive Hormones) is a comprehensive test that gives you info about:
- Basic hormones
- Estrogen, androgen, progesterone, and cortisol metabolites
- Free cortisol pattern
The best part – it’s painless. We collect four simple, dried urine collections over a 24 hour period. The patient or client urinates on the filter paper or collects it in a cup and dips the filter paper inside.
The DUTCH Test brings together information you’d receive from hormone tests like saliva, blood, and 24-hour urine tests and provides us a better picture about what’s going on in your body.
You can order the DUTCH test online, but you’ll need a licensed medical professional to interpret your results for you. I walk my patients and clients through the test and results. If you have any questions, we’d love to help you understand your hormones and get to the root cause of your hormone problems.
Blood Testing for Hormones
While the DUTCH Hormone Test gives a comprehensive picture of your hormone levels, some hormones are best tested through a blood test. Here are hormones we can measure in your blood:
- Thyroid hormones
Let’s Test Your Hormones
I know hormones can be really complicated, but I hope this gave you an overview of which hormones are best to test and when they should be tested.
My goal is to empower you with the understanding to advocate for your health. You deserve a healthy, vibrant, and thriving life.
Do you have any questions about testing your hormones?
Are you interested in getting your hormones tested?
To set up an appointment with me, email [email protected] or call/text 519-400-4520.
If you want to learn more about hormone health, follow me on Instagram.
I’m cheering for you and your hormone health,