We’re going to talk about testing hormone levels. Even if your doctor tells you, you can’t, there’s no point in it, or they don’t know how to interpret it, that’s just not the case. There are amazing ways to test your hormones and gather information about what’s going on in your body.

Start Out With Blood Work 

So conventionally, we would do blood work to check your hormone levels. We would draw your blood on day 3 or 10 of your cycle. You can get a good idea if you made enough estrogen or too much estrogen. It can tell you your FSH level which is the follicle-stimulating hormone that’s coming from your brain, talking to your ovaries, and telling your ovaries how much estrogen to make. Follicle-stimulating hormone is sometimes checked to see if you’re going into menopause because as your body starts to no longer make as much estrogen the FSH levels increase because your brain and your ovaries are always talking. If your ovary isn’t responding to what the brain says and the brain says to make more estrogen and the ovary doesn’t make more estrogen then the brain starts screaming. It starts singing louder and louder by producing more and more FSH and in return the FSH level gets higher when your ovaries are no longer producing enough estrogen. So, that’s why FSH is elevated in menopause. It’s also elevated in premature ovarian insufficiency and diminished ovarian reserve when you’re dealing with fertility issues. So checking those levels on cycles day 3 or 10 can be very beneficial.

On cycle day 21, if you’re having a normal 28 day period, we can measure your progesterone level. Your progesterone level will start to increase during the luteal phase if you have ovulated. Progesterone is actually produced in the ovary from the little cyst that released the egg and lets you ovulate. The corpus luteum and that cyst that releases the progesterone can get measured on day 21. 

Watch the video version of this blog post here.

Measuring Your Hormones

We can measure how much your body makes of a certain hormone. We can also measure free and total testosterone and sex hormone-binding globulin. Sex hormone-binding globulin is what transports your hormones around your body so that you can send those signals. I like to think of sex hormone-binding globulin like a bus. The hormones get on the bus, they ride the bus around to different places, and then the bus drops the hormones off to do their work and send their signals. However, sometimes the bus is really big. So, a lot of hormones get on the bus and nobody gets off or the bus is really small and none of the hormones can get out and go where they need to go. 

Your sex hormone-binding globulin level is important to know if your hormones are all stuck and bound to this globulin. Or are they free and available to send signals? That can impact whether or not the level of hormones you do have is actually able to do its job. So that’s an important piece as well and that can be looked at in bloodwork. 

An important piece to understand is that the ranges on the lab reports are not optimal. They are very wide and they are to determine an outright disease. So, if your levels are outside of those ranges, you definitely have a diagnosable disease. However, you could be inside of that range and still not be optimal and therefore have a hormone imbalance. Especially if your estradiol or estrogen is a little bit high and your progesterone is a little bit low. That little bit on both ends makes a big ratio difference and feels like a major hormone imbalance. It’s really important that the practitioner that’s ordering these hormones understands how to interpret the results. 

That’s where a lot of conventional gynecologists fail women because they don’t understand the nuances of optimization and all the details that go along with hormone balance. 

What Is Your Body Doing With These Hormones?

We can find out if your sex hormone-binding globulin is holding all these hormones or they’re not even available to send their signals. But, we also need to know once the signal has been sent, what is your body doing with that hormone? It should normally be getting deactivated, aka metabolized in the liver, and sent to the urine and stool for excretion and removal. However, that doesn’t always happen. There are amazing functional medicine tests in the urine and saliva that can show us how your hormones are being metabolized and handled through your body and if they are being appropriately deactivated and removed. So, there’s so much testing that we can do in the functional medicine space that will give you many more answers to what’s going on. 

DUTCH Testing is Another Way of Testing Hormone Levels

I do want to share with you an example of a DUTCH test. DUTCH stands for Dried Urine Testing for Comprehensive Hormones. You get a kit, pee on these pieces of paper, they dry, you send them in, and then they test, not only the levels of your hormones but what your body’s doing with them.

Example of results from DUTCH hormone test

Understanding Our Hormones

First I want you to understand that all our sex hormones and our stress hormones come from a cholesterol backbone. So we need healthy cholesterol fats to even make our hormones. That’s key number one, you need enough healthy fats in your diet. That looks like at least three to four servings every day of grass-fed butter, ghee, avocado, avocado oil, healthy animal fats from grass-fed beef, pasture-raised chicken, organic free-range eggs, nuts, seeds, coconut, and coconut oil are all great sources.  

So you have a cholesterol backbone. Then your ovaries and your adrenal glands make sex hormones. They start out and make pregnenolone. Pregnenolone gets made into progesterone. Progesterone is our calming balancing hormone. It is what’s needed to keep the lining of your uterus stable and not overgrow. It keeps estrogen in check. 

Estrogen is a growth hormone. It makes things grow. It makes your uterus, boobs, and hips grow. Progesterone keeps all that from overgrowing. It also can be very calming because progesterone gets metabolized by two different pathways. It can go down the 5-beta pathway or the 5-alpha pathway. The 5-alpha pathway is more of a neurotransmitter and it can cross the blood-brain barrier and can actually affect your mood. It has to do with the GABA pathway which is one of our main calming neurotransmitters. So having enough progesterone and having it metabolized on the 5-alpha pathway can be like your natural anti-anxiety. It helps you sleep and feel balanced and good. 

Pregnenolone goes also to DHEA underseen down, those can be turned into testosterone. Testosterone can go down the 5-beta or 5-alpha pathway as well. As the opposite of progesterone five, alpha down, that testosterone pathway is more androgenic, meaning more manly. We don’t want too much 5-alpha metabolism of testosterone that makes DHT. This looks like hair loss on your head, acne, abnormal chin hair growth, and belly hair growth. All of that means you are producing too much testosterone. You don’t want your testosterone to be metabolized down the 5-alpha pathway. You can see more visuals on the YouTube channel. 

Understanding Our Estrogens

From there, you can make your estrogens. You have three main forms estrone (E1), estradiol (E2), and estriol (E3). Those are the three main hormones that are running our bodies. Estradiol is that growth hormone that’s responsible for reproduction. So it grows the lining of your uterus every month and hopefully, you have progesterone to keep that in check.

But as you can see, it can go in and turn into estriol or estrone. Estrone is also not only made by your ovaries, but also by your fat cells. And too much estrone is a bad thing. We want to make sure that we don’t have too much estrone around because that can increase our risk of breast and uterine cancer. Testosterone can get aromatized to estradiol or estrone. In fat cells, it almost always gets aromatized into estrone. So women who carry extra fat cells on their bodies can’t release that weight. They’re more prone to having too much bad estrone and that is why obesity is a risk factor for uterine cancer and breast cancer. 

If you follow the Youtube video you will notice in the sample case, it’s way too much. You should not be all the way far to the right. If you look to the far left, you see this purple area. That is a menopausal level and that would be super low. So what happens is, estradiol our main reproductive hormone, gets turned into estrone. Estrone goes down one of three pathways. And that’s what we’re going to talk about. or estradiol gets made into estriol and can go down this intermediate pathway of 16-alpha hydroxy estrone. Things are always shifting and changing your hormones. When you do bloodwork, oftentimes a doctor will just measure an estrogen level. For the lab that you get drawn at that could mean they’re measuring all three of these estrogens or it might be just the estradiol. It’s sometimes hard to know, but you can specifically ask for estradiol, estrone, and estriol. 

So what we see here is estrone gets metabolized down these two hydroxy estrone pathways, which is the most protective pathway. That means it went through phase one of the liver detoxification process appropriately and your body inactivated it so that you can hopefully remove it from the body. It can go down this blue pathway, which causes this intermediate of 16 hydroxy estrone. This intermediate can be a bad carcinogenic intermediate form. We don’t like it to be too high in this case because then it can get reabsorbed. We don’t want too much reabsorption either. 

We also don’t want to go down the red pathway, which causes 4-Hydroxyestrone. 4-Hydroxyestrone can damage the DNA in our cells and increase our risk of cancer. So this DUTCH test shows a nice pie chart with the different percentages of how your estrogen got metabolized during the phase one process of your liver. You do not want more than 11% of that going down the red pathway. If that is the case, we need to get you on some major antioxidants. You need to be eating brightly colored vegetables and fruit, taking NAC, and helping glutathione production. Glutathione is our major antioxidant that goes around and cleans house. It gets rid of all that broken DNA and damaged cells so they can’t go rogue and cause cancer. 

When You Need To Take Action 

If this quinolone reaction is happening down this toxic pathway, it’s really important to know and take action. You can also support this green pathway, this phase one detoxification through the liver, by pushing this 4-Hydroxyestrone over to the green pathway. You make sure the liver detox pathway is functioning well. That looks like eating enough cruciferous vegetables such as broccoli, Brussel sprouts, cauliflower, cabbage, and bok choy because they have compounds in them called diindolylmethane and indole-3-carbinol. Those compounds help phase one of the liver so that you can get your estrogens through that process to get deactivated. So I encourage women if they have too much of these 4-Hydroxyestrone or too much estrogen overall with symptoms of estrogen dominance to take diindolylmethane and indole-3-carbinol. Diindolylmethane can be found in supplement form and it can be very effective at pushing more estrogens down the green pathway so that fewer are going down the red pathway.

This part of the test, if you can see it on here, is the second phase of detoxification in the liver. So once it comes down to two hydroxy estrone it has to get methylated. It has to get a methyl group put on it to completely deactivate it for the liver to be able to excrete it out of your body. Methylation donors are B vitamins mostly. It requires enough B-12, B-6, and folate, which is B-9, and also magnesium for this process to proceed.

A lot of times we’ll see B vitamin deficiencies back up this process. If you see way over here on the left with the methylation activity, meaning things are not getting methylated. So we’re getting a backup. It’s like the garbage got taken out to the curb through phase one detox, but then the garbage man didn’t come by and pick it up off the road. So, now you have garbage stacked up in front of your house. 

The other component of this is that you can have genetic mutations that make you not methylate things as easily or as well. MTHFR is a very common mutation that you can have. And COMT is another one. I have both actually and I don’t methylate things very well. I need extra activated methylated B vitamins as a supplement, as well as magnesium to complete this process to get my estrogens deactivated and cleared out of my systems. So, if you did this test, you would be able to see if your liver is detecting these processes appropriately, or do I need more support on that front? 

The third phase of your hormones is elimination. So that is getting them out in the urine and in the stool. Having them back up in the stool is a major problem. So say, you are sending your estrogens down the good green pathway, your liver is hydroxylating and methylating. Everything’s working well and things get to your stool. But, if you have the wrong bacteria in there, then that methyl group can be cut off and you can reabsorb your estrogens. If you’re constipated then there’s more time to reabsorb those. All of these factors can affect how much circulating levels of estrogen you have in your body. 

That is why I love this DUTCH test. You can see all these intricate details that you can’t see in blood work and you can’t get from just talking about symptoms. The cool thing is there are so many things that you can do to intervene and change this situation. It’s super important to get yourself evaluated if you are having symptoms, feeling imbalanced, and figure out exactly what is going on. Let’s get all the pieces of the puzzle and figure that out. 

That’s A Wrap 

I hope you now have a better understanding of how you really can test your hormones. That was only one little piece. There are other tests that you can take. There are Dutch Cycle Mapping Tests. For these tests, you test for an entire month to see how your hormones are being made and produced to create your menstrual cycle. If you are having fertility issues, irregular periods, question anything about your like cycle all month long, the cycle mapping test is really amazing as well.

There are so many ways to get answers to what’s going on. You don’t have to rely on a couple of bloodwork tests that are covered by insurance that your doctor has not been trained to really interpret and deal with. Seek more answers and you can always reach out and work with me one on one. Or you can go to ifm.org and find a functional practitioner in your area. There are trained providers that know how to balance your hormones.