What hormone test do you need to know if your hormones are balanced?
The answer lies in what you want to learn about your body! There are over 50 hormones identified in the human body. Although hormones are similar in shape, each of them has different effects and purposes, and these arise from the slight variation in their molecular structure. There are hormones associated with different parts of the body and different stages of life so deciding what hormones you need to measure can be tricky. To make matters more complicated, doctors have different biomarkers they value.
Everlywell’s Perimenopause Test
To figure out which blood test may be right for you, let’s look at Everlywell’s Perimenopause Test which measures estradiol, luteinizing hormone, and follicle-stimulating hormone.
Everlywell considers estradiol as “the main estrogen in women and is produced by the ovaries. It is one of the main sex hormones responsible for ovulation—and is measured by this hormone test for women. After menopause, estrogen levels decline significantly. Estradiol is also responsible for the health and normal function of other sexual organs, such as the breast, vagina, and uterus.”
Estradiol is important to measure, but not just because of the stated reasons above. Estradiol is a hormone that women should test because of its role in estrogen dominance, even in menopause. The risk for breast cancer increases with age; most breast cancers are diagnosed after age 50. About 80% of all breast cancers are “ER-positive.” That means the cancer cells grow in response to estrogen. Therefore, testing estradiol is an important biomarker for checking the balance of hormones and may be an important biomarker for breast cancer. Keep in mind that there are four major naturally occurring estrogens in women are estrone (E1), estradiol (E2), estriol (E3), and estetrol (E4). Estradiol is most commonly tested simply because it is believed to be the strongest. However, the other estrogens may be important to measure as well, especially if the patient is at high risk for breast cancer.
Everlywell also measures Luteinizing Hormone (LH) because it “is the hormone that is responsible for ovulation. A normal hormone level for LH in the second half of the menstrual cycle is reassuring that there are no major hormonal imbalances interfering with normal ovary function.” Everlywell also measures the follicle-stimulating hormone (FSH), which “is the hormone responsible for the growth and maturation of follicles, which are the source of estrogen and progesterone which every woman needs to have a normal menstrual cycle. A normal FSH level indicates that a woman has a suspected normal number of eggs for her age.”
Dr. Ray Peat explains why LSH and FSH may be elevated when there is a hormone balance. “P. M. Wise has demonstrated that the “menopausal” pituitary hormones, high levels of LH and FSH, are produced because the regulatory nerves in the hypothalamus have lost their sensitivity to estrogen, not because estrogen is deficient. In fact, he showed that the nerves are desensitized precisely by their cumulative exposure to estrogen. If an animal’s ovaries are removed when it is young, the regulatory nerves do not atrophy, and if ovaries are transplanted into these animals at the normally infertile age, they are fertile. But if animals are given larger doses of estrogen during youth, those nerves atrophy prematurely, and they become prematurely infertile.”
Everlywell’s Perimenopause Test may be helpful if you just want to measure estrogen, LSH, but one biomarker that is important to measure, but not included in the test is progesterone. Progesterone is particularly important for women because progesterone opposes estrogen and calms cortisol. Therefore an important indicator of balanced hormones is the ratio of estrogen to progesterone. Many providers view the optimal ratio is about 5-10x as much progesterone as estrogen for blood serum. Everlywell tests blood spots rather than serum, so the ratios may be different. Regardless, the ratio of estrogen to progestogen is key to understanding if a women’s hormones are balanced.
Everlywell’s Postmenopausal Test
Everlywell’s Postmenopausal measures estradiol and progesterone. Thankfully, this test does include progesterone. However, to truly understand a women’s hormones, a more comprehensive test is needed which could include DHEA, cortisol, insulin, testosterone, and thyroid biomarkers. Hormones are not isolated messengers, they are all acting in concert. For that reason, a holistic view of more than just two hormones is needed. For example, if insulin is high, that can affect estrogen and vice versa because estrogen can stimulate insulin and promote weight gain. Furthermore, low thyroid is linked to high estrogen. For the purpose of truly understanding what is going on in the body, measuring more than just two hormones may be more helpful.
Everlywell’s Women’s Health Test
Everlywell’s Women’s Health Test measures LH, FSH, DHEAS, cortisol, thyroid-stimulating hormone, free T3, free T4, free testosterone, and thyroid peroxidase antibodies. This test is more comprehensive than their perimenopause and postmenopause tests.
This test measures DHEA because “DHEAS is an androgen hormone that is produced by the adrenal glands and the ovaries. It is involved in the production of other hormones in the body, such as testosterone and estrogen.” The test also measures cortisol because “cortisol is also the body’s main stress hormone. Your sample is collected four times throughout the day, and your results will reflect your cortisol levels during those times.”
Furthermore, the test measures the basic thyroid markers. “Thyroid-stimulating hormone, TSH, is the hormone responsible for controlling thyroid hormone production by the thyroid gland. The hormone TSH is considered the most sensitive marker for screening for thyroid diseases and conditions. Levels of this fluctuate when individuals have an under or overactive thyroid gland. Free T4 is the predominant hormone produced by the thyroid gland. Levels fluctuate when individuals have an under or overactive thyroid gland. Testing your free T4 with this thyroid function test lets you see if your thyroid hormone production is at a normal level. Thyroid peroxidase antibodies are antibodies that can bind to thyroid enzymes, suppressing thyroid function. They are elevated in a condition called Hashimoto’s disease, which is the most common type of hypothyroidism in the USA.”
The thyroid biomarkers give important information about thyroid function, but it is important to remember that there is a wide range for ‘normal.’ The wide range may indicate you are within normal ranges, but not at an optimal range. Thyroid results should also be paired with symptoms such as pulse and temperature measurements. Low thyroid is often paired with cold hands, cold feet, and cold body temperature.
Is the Women’s Health Test enough or should any other hormones be measured? While measuring hormones, it may be beneficial to also measure metabolic health markers including insulin and HbA1x. The following is parsed from the Diet Doctor.
“HbA1c is an important measure because it can be used to diagnose type 2 diabetes or pre-diabetes. It can also be used to monitor how well you are managing your blood sugar levels if you have type 2 diabetes or pre-diabetes, especially if you’ve made changes to your diet and lifestyle…It differs from a fasting glucose measurement in that fasting glucose is a snapshot of your blood glucose level at that one moment in time, when you first wake up in the morning before eating. The HbA1c, however, is a longer-term measurement that reflects your average blood sugar over the previous three months.
Insulin has many roles. Its primary role is to keep our blood glucose levels in a very tight range — called blood glucose homeostasis. That’s because both too high and too low blood glucose levels are dangerous and damaging to the body. When glucose levels rise, more insulin is secreted. When glucose levels fall, less insulin is secreted. Since higher levels of insulin have been associated with numerous chronic health conditions, it makes sense that keeping insulin in a lower physiologic range may be better for your long-term health.” – Diet Doctor
Why night you care about HbA1c or fasting insulin?
High levels of HbA1c and insulin are indicators of metabolic health. They may indicate pre-diabetes, diabetes, or even PCOS. Elevated testosterone in women is a symptom of insulin resistance High insulin levels signal to the ovaries to produce greater amounts of androgens, this is especially common in PCOS.
Testing hormones can provide valuable information about the function of the human body. Knowing what to test and how to properly analyze the results are important to make the most of the test and to make a plan to fix any imbalances and reclaim your health.