Why your blood work can be normal, yet you don’t feel normal and you are experiencing symptoms of hormone imbalance…

The “you are healthy on paper” or “your labs are normal” story is one that I hear OFTEN.  I’ve been there too and when you hear this you feel as if it is a “get out of jail free card” for your doctor. It doesn’t even make sense because if everything was normal, then you wouldn’t be spending your time in a doctors office.

Too often patients symptoms are dismissed and no one bothers to investigate into what is really happening when there is not “proof” that your hormones are out of whack.  The reality is though that blood and serum tests are not always accurate and often miss imbalances that other tests can pick up and explain why you are feeling the way you do. But how can blood work be so out of sync with what is happening in your body and the symptoms that you are facing?


Let’s look at a patient case:

Suzie is a very busy and hard working 37-year-old woman. She is a mother of two and works full-time. She attends exercise classes at the gym a few times per week, tends to skip meals during the day and loses “will power” at night. She can feel overwhelmed and anxious at times because she has a lot on per plate but otherwise considers herself pretty health. 

Over the last few months, she has noticed her typical PMS irritability extending from 1-2 days to 1-2 weeks prior to her period. Her cycles are also becoming shorter, heavier, more painful. She is also noticing more of brown staining vs bright red for the first couple days and her sex drive is non-existent.  She feels fatigued in the AM and craves coffee and sugar in the afternoon.  She just doesn’t feel like herself and is starting to worry she is in early menopause.  She goes to her doctor explaining her concerns and blood work is taken. Her doctor calls back to inform her that “her hormone levels are normal” and her symptoms are normal for her age and situation. 

Why blood and serum hormone tests do not reflect your symptoms

#1. Blood and Serum testing fail to provide the entire picture of what is going on with you hormonally. What is typically ordered is “free” hormone levels (what is available to enter the tissues to carry out the intended reaction and function) and “total” hormone levels – the amount of hormone in the bloodstream bound to carrier proteins. When hormones are attached to carrier proteins they are not readily available to be used in the cell. Majority of hormones are actually bound to carrier proteins but free and total hormone levels alone are not enough.


#2.  Blood and Serum levels provide no insight into how your body is processing hormone and if they are safely and efficiently breaking down hormones.  Hormones such as estrogen are broken down into what we call metabolites in the liver (in the case of estrogen it is through phase 1 detoxification). Some metabolites can be more beneficial and some can be harmful. How hormones are broken down determines how hormones receptors will be stimulated or inhibited throughout the body.

Even if hormones are broken down adequately they have the potential to be re-circulated if gut health is not also taken into consideration. As it turns out having altered gut flora impacts the levels of an enzyme called beta-glucuronidase. When beta-glucuronidase levels are high, more estrogen is being recycled, which can contribute to estrogen dominance. Luckily there is an easy way to test the entire function of the gut using the GI-MAP stool test. 


#3.  Blood and Serum Tests won’t tell you if estrogen dominance is present.  It is not always about having too much estrogen. Estrogen dominance symptoms such as; PMS, heavy periods, anxiety/depression, breast tenderness, acne, cramps, clotting, irregular periods – can also arise due to relative estrogen dominance. This means that estrogen can actually be normal but progesterone is too low. The balance of estrogen to progesterone should always be taken into consideration


#4. Conventional blood tests do not accurately reflect the status of adrenal hormones. The adrenal glands are two walnut-shaped glands that sit on top of the kidneys. They release stress hormones like cortisol, adrenaline, and DHEA. Adrenal hormones directly influence the sex hormones estrogen, progesterone, and testosterone. When the hypothalamic pituitary-adrenal axis is not functioning properly (the brain <–> adrenal communication highway) sex hormone function is impacted.  A single blood sample of cortisol provides very little information as cortisol varies throughout the day.

Cortisol follows a specific pathway peaking approximately minutes after waking then declines throughout the day.  With a random or even morning blood test we get no information on the actual amount of cortisol in the body, the rhythm or how the stress hormones are being broken down and processed.  In addition, if needles really stress you out or you had a particulary crazy day this can impact your blood test.


#5. Monitoring hormone replacement therapy treatments can be challenging. Depending on the route of administration of hormones, blood and serum testing rarely shows any shift. In addition, results must be carefully interpreted based on the way you take hormones (oral, topical, etc).


What you should instead use to measure hormones 

The test I run and recommend in my practice to diagnose hormone imbalances is the DUTCH. The Dutch test stands for Dried Urine Test for Comprehensive Hormones.  We use metrics for everything in our life yet we settle for less than good when it comes to our hormone testing, and we shouldn’t. You deserve to feel your best and that all starts with accurate testing to get you on the best plan possible.

The reason I use DUTCH is that it addresses the common pitfalls seen with conventional blood and serum testing. It tells us hormone levels throughout the day (not just one snapshot in time), it shows adrenal influence, as well as how hormones are being broken down and metabolized. Lastly DUTCH now includes nutritional organic acid metabolites and neurotransmitter metabolites. With these, we can predict B12, B6, glutathione, Dopamine, Norepinephrine/Epinephrine, Melatonin, and oxidative stress levels.

Here are the key hormones tested:

  1. Cortisol
  2. Cortisone
  3. Estrogen + metabolites
  4. Progesterone
  5. DHEA
  6. DHEA-S
  7. Testosterone
  8. DHT
  9.  Melatonin

How will the results of DUTCH impact your treatment plan?

  1. Accuracy is everything when it comes to diagnosing and monitoring your health. With DUTCH you obtain a more precise understanding of estrogen, testosterone, and progesterone compared to blood. This is because you get a complete picture of how the adrenal AND reproductive hormones are working (or not working) together. You cannot treat one without knowing the other.
  2. For anyone dealing with fatigue, autoimmunity, or sleep issues knowing the function of the adrenal glands and how cortisol changes throughout the day (cortisol follows a predictable rhythm) can more effectively guide treatment.
  3. Urine testing shows estrogen metabolites or how you are breaking down estrogen. If your liver is not metabolizing estrogen efficiently if you have outside sources, or estrogen is being reabsorbed by the gut you are at risk for developing hormone imbalances and may even be increasing your risk for estrogen-related cancers.
  4. Urine testing shows the balance of estrogen and progesterone. If this is shifted you may have an absolute or relative estrogen dominance. It is important to know which one of the two is going on because in one cause you will want to lower estrogen and in the other you may want to increase progesterone or modulate estrogen.  Estrogen dominance is commonly the root cause of PMS, irregular cycles, fibroids, PCOS, ovarian cysts, infertility, miscarriage breast tenderness, and endometriosis. It can also worsen menopausal symptoms like hot flashes, night sweats, and weight gain.
  5. Testosterone, DHT and DHEA. These levels are often overlooked in women and can be responsible for fatigue, low libido, weight gain, bone loss, mood swings as well as anxiety and depression.
  6. Melatonin, neurotransmitter and vitamin levels. DUTCH now uses organic acid testing to test for glutathione, melatonin, oxidative stress, B12, B6, dopamine, norepinephrine/epinephrine, serotonin. These results further enhance treatment and are implicated in energy, sleep, mood, and hormone detox abilities.
  7. Monitoring the efficacy of hormone replacement therapy. By monitoring accurately your hormone levels while on HRT you can create a safer more effective protocol.

With your DUTCH we can identify the exact imbalances that exist and how the hormones are interacting and influencing one another. This allows for the development of a structured program designed specifically for you. The core foundation of your hormone balancing plan will include;

  1. Diet – The right nutrition plan for you based on your unique needs, current situation and physiology.
  2. Lifestyle changes – mental, emotional, behavioral – that will support your adrenal glands or hypothalamic pituitary adrenal axis. This often includes recommendations on sleep, mindfulness, exercise (the right type and amount for you) and other relaxation techniques.
  3. Optimization support – supplements, herbs, and medicinal foods when necessary to establish optimal being.


Getting to the root cause of your hormone imbalances is easy when the proper testing is completed. Sticking with the dietary, lifestyle and supplemental supports can be challenging which is why at the Wild Side Wellness we have created a system to support you every step of the way.

To learn more about the Wild Side and the get to the root cause of your hormone imbalances call 519-500-5525 or email [email protected]