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  Test / Monitor Hormone levels  
 
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Hormone testing for sex hormones such as estrogens, progesterone, testosterone, DHEA, LH, FSH, prolactin and binding globulins (SHBG) is an important step in determining hormone abnormalities that may be causing or contributing to symptoms. Deciding which of these tests to perform requires your doctor's assistance and understanding of the nature of your complaint. Blood, saliva, and urine tests are available. An advantage of salivary testing in women is that samples can be taken and frozen over a period of time and then collectively tested for hormone levels and patterns. Salivary testing is not useful for follow-up testing when transdermal hormone creams are used: reported values are falsely elevated. Testing information is available at Great Smokies Diagnostic Laboratories as well as many other sites.

24-hour urinary testing is a good method of determining hormone levels, both initially and for follow-up. Timing of the test in relation to the menstrual cycle is important for accurate and usable results with regard to estrogens and progesterone levels. Your doctor can advise you when it is best collect the sample. Some testing information is available at Meridian Valley Laboratory.

Generally, bioidentical hormone replacement is recommended by natural doctors when any hormone level is found to be low.
 

 
 

Test / Monitor Hormone levels can help with the following:
 
 
Aging  Premature/Signs of Aging
 Early reduction in quantity or bioavailability of multiple hormones hastens the aging process. The hormones most likely to be involved include estrogens, progesterone, testosterone and DHEA.

Autoimmune

  Sarcoidosis
 Your doctor can measure the levels of the 1,25 D hormone and also of 25-hydroxyvitamin D, its precursor. When the D-Ratio is calculated from this blood work, it gives a measure of the amount of granulomatous inflammation which is present in a sarcoid patient's body. This D-Ratio can be tracked to ascertain the effectiveness of the antibiotic therapy.

Vitamin D is stored in the body's fat. Sometimes it may take several months until the blood work shows that the 25 D level has fallen, and the reserves in body fat have been used up. Although the fatigue usually eases fairly quickly, numbness and muscle pain only ease after the fat stores have been significantly depleted.

  Hyperthyroidism

Hormones

  Low Progesterone or Estrogen Dominance
  Low HGH (Human Growth Hormone)
  Low Pregnenolone Level
  Low Melatonin Level
  Low Estrogen Levels
  Progesterone Excess
  Elevated Testosterone Level, Male
  Elevated Testosterone Level, Female
  Low Testosterone Level, Female
  Hypopituitarism / Empty Sella Syndrome
 Individual hormone replacement may be required when the pituitary master gland is failing to control the output of other endocrine glands. These hormones could include thyroid, adrenal (cortisol and DHEA), and HGH.

  Hyperprolactinemia
 Prolactin levels may be ordered when a patient has symptoms of a prolactinoma such as: unexplained headaches, visual impairment, and/or galactorrhea. They may also be ordered, along with other tests, when a woman is experiencing infertility or irregular menses; or when a man has symptoms such as: a decreased sex drive, galactorrhea, or infertility. Prolactin levels are also often ordered in men as a follow-up to a low testosterone level.

When a patient has a prolactinoma, prolactin levels may be ordered to monitor the progress of the tumor and its response to treatment. They may also be used at regular intervals to monitor for prolactinoma recurrence.

  Hirsutism
 The most important lab test to consider is testosterone and free testosterone. DHEA can be converted to testosterone and so should also be measured. If periods are irregular, FSH and prolactin should also be checked.

  Low Sex Drive
 Midlife is a time when sex desire decreases for many women. Inevitably, in most men also, sex drive decreases with age. This is often due to declining hormone levels, especially testosterone. Hormone replacement is particularly effective at this time for restoring libido.

  Low DHEA Level
  Hypothyroidism
  Low Adrenal Function / Adrenal Insufficiency
 Although not a sex hormone, cortisol is an important hormone. A deficiency can cause fatigue with a resulting loss of sexual desire.

Immunity

  AIDS / Risk
 Several studies have shown that testosterone levels are generally lower and that testosterone administration alleviates fatigue and depression in men with HIV/AIDS. In one study, 80% of men reported significant improvements in their energy levels. [General Hospital Psychiatry, July 1998]

Lab Values

  Low Total Cholesterol
 A chronically low serum cholesterol level can be an unsuspected problem. Since cholesterol is the precursor to the adrenal and sex steroids, low levels may mean an insufficient supply of raw material for hormone production. When there are indications of hormone insufficiency, appropriate lab testing should be conducted.

Laboratory Test Needed

  Hormone Levels That Should Be Checked

Metabolic

  Male Gynecomastia
 Estradiol is the growth hormone of the breast, and an excess of estradiol leads to the proliferation of breast tissue. Under normal circumstances, most estradiol in men is derived from the peripheral conversion of testosterone and adrenal estrone. The basic mechanisms of gynecomastia are a decrease in androgen production, an absolute increase in estrogen production, and an increased availability of estrogen precursors for peripheral conversion to estradiol.

Risks

  Increased Risk of Breast Cancer
 Testing for estrogen, progesterone and testosterone may help to properly evaluate breast and ovarian cancer risk. Some estrogens, as well as testosterone, may aggravate the risk whereas progesterone has a protective effect.

There are additional estrogenic tests that can be done to evaluate breast cancer risk. There is considerable and increasing research concerning the 2/16-alpha hydroxyestrone ratio. A very recent human study states: "2-hydroxyestrone levels and 2/16-alpha hydroxyestrone ratios were significantly lower, while 16-alpha hydroxyestrone levels were higher in breast cancer patients." The 2/16-alpha hydroxyestrone ratio appears to be a very significant predictive factor of breast cancer. Many laboratories are offering these tests now.

  Increased Risk of Alzheimer's / Dementia
 Make sure estrogen and testosterone levels are normal.

  Increased Risk of Ovarian Cancer
 Testing for estrogens and progesterone may help to properly evaluate breast and ovarian cancer risk as some estrogens will promote risk while progesterone may protect against this cancer risk.

Skin-Hair-Nails

  Male Hair Loss
 There have been several reports that supplemental DHEA has accelerated hair loss in susceptible men and women. Hormone level testing is advised prior to hormone use.

  Female Hair Loss
 There have been several reports that supplemental DHEA has accelerated hair loss in susceptible men and women. Hormone level testing is advised prior to hormone use.

Tumors, Malignant

  Breast Cancer
 Estrogen is metabolized in two ways. Along one pathway, it is converted into a powerful metabolite, 16alpha hydroxyestrone (16alpha OHE1), that acts to stimulate target tissues. Levels of 16alpha OHE1 can rise in response to obesity, alcohol consumption, and toxic exposure. High levels of this potent metabolite are linked with increased risk and poorer prognosis in conditions associated with estrogen excess, including breast cancer and lupus.

Alternately, the body can break down estrogen into a much weaker metabolite, called 2 hydroxyestrone (2 OHE1). This metabolite binds weakly to cell receptors and may slow cell proliferation. However, excessive levels of 2 OHE1 may increase the risk of developing conditions associated with estrogen deficiency, such as heart disease, depression, and osteoporosis.

A proper balance between 2 OHE1 and 16alpha OHE1 is the key to optimal health. Measuring these primary estrogen metabolites allows practitioners to develop individualized therapy based on each woman's unique health risks.

Uro-Genital

  Menopausal Status / Issues
 Checking primarily for estrogens and progesterone at this time of life, with subsequent hormone balancing, can provide both immediate and long-term benefit.

  Andropause/Male Menopause
 Hormone testing and replacement will help to reduce symptoms and prevent the consequences associated with premature hormone reductions seen in male menopause. If levels are found to be low, testosterone replacement is recommended, especially if LH or PSA is elevated and the prostate enlarged. [Int J Androl 2002 April; 25(2): pp. 119-25]

  Perimenopausal Status / Issues
  Female Infertility
 Because male infertility is related to approximately 50% of all infertility cases, it is important to conduct a semen analysis to make sure that this is not the cause of the problem.

Ideally, you will have already begun tracking your ovulation through fertility awareness or a fertility monitor. This will provide your doctor with valuable information about your ovulation. Usually the first question regarding female fertility is whether you are ovulating or not.

The first tests performed by your doctor involves measuring your follicle stimulating hormone (FSH) and luteinizing hormone (LH) to establish a baseline. This is performed on the third day of your cycle. A second test for LH may occur on the day of the LH surge, which is before ovulation in most cases.

Additional tests may include:
  • Cervical mucus tests: This involves a postcoital test (PCT) which determines if the sperm is able to penetrate and survive in the cervical mucus. It also involves a bacterial screening.
  • Ultrasound tests: This is used to assess the thickness of the lining of the uterus (endometrium), monitor follicle development, and check the condition of the uterus and ovaries. An ultrasound may be conducted two to three days later to confirm that an egg has been released.
  • Hormone tests: These tests are done to assess the various hormone levels that contribute to the reproductive process.
      These hormone tests include the following:
    • Luteinizing Hormone (LH)
    • Follicle Stimulating Hormone (FSH)
    • Estradiol
    • Progesterone
    • Prolactin
    • Free T3
    • Total Testosterone
    • Free Testosterone
    • DHEAS
    • Androstenedione

  Polycystic Ovary Syndrome (PCOS)
 The most worrisome consideration in PCOS is the presence of an androgen-producing neoplasm. It is for this reason that a measurement of total testosterone and DHEA is recommended.

  Amenorrhea
 Comprehensive sex hormone testing is important in discoverying the underlying cause of amenorrhea. This can involve testing for LH and FSH along with estrogen, progesterone and prolactin.

  Endometriosis
 Estrogen excess or progesterone deficiency may contribute to the severity of the symptoms.

  Erectile Dysfunction (ED, Impotence)
 Testosterone is the major hormone produced by men, but does not directly affect a man's erectile ability as much as it does libido or sexual desire. Men with low testosterone, however, have shown improvement in ED with hormone replacement. A clinical trial of testosterone for all types of erectile dysfunction is not recommended.

When considering lab testing, a full panel of tests should be considered such as DHEA, testosterone (total and free), DHT, sex hormone binding globulin (SHBG), estradiol, luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (best taken at 9am to avoid diurnal variations), progesterone and a PSA test for prostate cancer.

Testosterone replacement, preferably applied to the skin or by injection, typically ranges from 25-100mg of natural testosterone per day usually given in two divided doses.

DHEA has been reported to be low in some men with erectile dysfunction. In one double-blind trial, 40 men with low DHEA levels and ED were given 50mg of DHEA per day for six months. Significant improvement in both erectile function and interest in sex occurred in the men assigned to DHEA but not in those assigned to placebo. No significant change occurred in testosterone levels or in factors that could affect the prostate gland. [Urology 53: pp.590-5, 1999]
 
 


KEY
May do some good
Likely to help
Highly recommended