Hormones are your body’s chemical messengers. In essence, they instruct your cells how to operate. It’s important hormones are balanced – if they are out of kilter it can affect your health in numerous ways.
In this article we’ll look at how to tell if your hormones are out of balance, explore different ways of testing and provide you with information about choosing the most appropriate test.
Measuring hormone levels
Hormones are molecules which travel around in the blood until they reach a target organ, where they cause a specific effect.
Take oestrogen as an example. This female hormone is released by the ovaries and travels to the uterus where it causes the lining of the womb to thicken in preparation for pregnancy. So it might seem logical that if a sample of blood or urine was taken and the amount of oestrogen in it was measured, this would give a good approximation of a person’s overall oestrogen levels.
However, hormone testing is not as straightforward as this, let’s find out why.
Factors to be aware of with hormone testing
Tests looking just at total levels of hormones may not give the full picture. This can be because:
· Hormones can exist in the body in active or inactive forms. The active (free) form is the one which stimulates the target tissues, whereas the inactive hormone is used to store the hormone. In inactive form it’s bound to a protein, so has no effect on tissues and this form is simply used to carry the hormone from one place to another. It’s important a test gives the levels of both free and bound hormones.
· Hormones can exist in different types, varying according to their potency. So any test would need to distinguish between the various types and differing strengths of hormones, to give a meaningful result.
· Hormones, once they’ve done their job, need to be processed by the liver and excreted from the body in the urine. There are different pathways hormones can travel on their way to being excreted. In other words, hormones can be processed in various ways by the liver. Each pathway results in a slightly different intermediate substance or metabolite being produced, which all exert diverse effects on the body. It’s useful to test these hormone metabolites, to see how the liver is processing hormones.
· Hormonal balance is achieved as a result of complicated feedback loops in which the levels of hormones either encourage or inhibit the release of other hormones. It’s important to look at the levels of these releasing and inhibiting hormones too. For example, in the case of thyroid hormones, thyroxine release is caused by an increase in the level of thyroid-stimulating hormone (TSH), which is in turn influenced by the amount of thyroxine in the blood. Once enough thyroxine is released, levels of TSH will decrease. By looking at the ratio of these different hormones, we can more easily tell why levels may be out of kilter.
· Conventional tests only measure hormone levels against an average for a ‘normal’ population. Your personal average may well be within the range but, let’s say, at its top end. So if you discover a particular hormone is towards the bottom of the range, it could still be considered to be average, but may be atypically low for you personally.
· Your hormonal picture changes from day to day or even minute to minute. A single test sample will only provide a snapshot from one moment in time. Ideally, several different samples should be taken to provide an average reading.
Testing thyroid hormones
Your thyroid is incredibly important. Think of it as your body’s accelerator pedal, determining how rapidly you burn off fuel to produce energy.
A blood sample is an accurate way to measure thyroid function. However, conventional GP tests usually only measure a few of the substances which are important for assessing thyroid health.
Such tests often only assess the levels of TSH, which measures the message the brain is sending to the thyroid gland, as well as the type of thyroxine, in the form of T4.
Thyroxine can exist in two different forms, T4 and T3. They differ in how many iodine molecules they are linked with.
The assumption is if TSH and T4 are normal, then the thyroid is healthy. However this alone doesn’t tell the full story. Most of the T4 in blood is bound to carrier proteins, so it’s inactive and doesn’t affect tissues, and must be converted to T3 before it can have any effect. Some people may not be very efficient at this conversion.
So it’s important to measure levels of T3, giving a more accurate indication of how much active hormone is available. It can also be useful to measure free T4, rather than lumping it together with bound T4. If the total T4 is high and T3 is low, the body may be inefficient at converting thyroxine to its active form.
A good test will also examine blood levels of a substance called reverse T3. Sometimes, when T4 is being converted to active T3, the process goes awry and reverse T3 is created; this can be caused by high levels of inflammation in the body, nutrient deficiencies, infections or stress. Reverse T3 doesn’t have the same effects as regular T3. So seeing the ratio of reverse T3 to T4 and T3 can be useful, particularly if someone has been told their thyroxine levels are normal, but they’re still having symptoms of low thyroid.
Finally, it’s also useful to look at blood levels of thyroid antibodies. These can mean your body is attacking your thyroid and can sometimes be detected in the blood before thyroid symptoms occur.
Testing sex hormones
Imbalances in sex hormones, namely oestrogen, progesterone and testosterone, can result in many adverse symptoms.
Blood tests are useful for measuring follicle stimulating hormone (FSH) and luteinising hormone (LH). These hormones cause ovulation and tell the ovaries to make oestrogen.
However, urine tests can measure the amount of the sex hormones actually available to the body, as well as their various forms. Oestrogen, for example, can exist as different types – oestradiol, oestrone and oestriol. Oestradiol is the most potent form, so it’s useful to assess the ratios between the three types.
Urine tests can also detect what happens to the hormones once they’ve done their job. When the body detoxifies sex hormones ready for excretion from the body, the metabolites produced differ in their ability to affect tissues.
In the case of oestrogens, the most common type of metabolites produced are called 2-hydroxy-oestrogens, which are fairly weak and thought to be protective against oestrogen-dependent cancers. 16-hydroxy-oestrogens on the other hand are strongly oestrogenic. Studies suggest the relative amounts of 2 and 16 forms of hydroxy-oestrogens can influence susceptibility to hormonal cancers (1). In a similar way, metabolites of testosterone can also be measured in urine.
DHEA is the starting point from which progesterone and testosterone are manufactured, so it’s useful to test this hormone as well to see if it is any different from the norm.
Testing adrenal hormones
Your adrenal glands have the task of helping you react to and deal with stress. Adrenal imbalances can result in fatigue, insomnia, aches and pains, digestive disturbances and food cravings.
The main hormone responsible for dealing with stress is cortisol. It can be accurately measured in a urine sample, which can distinguish between total cortisol and free cortisol.
The release of cortisol follows a 24 hour pattern, being highest in the morning, then gradually declining during the day. Taking four or five urine samples at specific time intervals, including immediately after waking up, can determine if the diurnal range is similar to that which is expected. This is generally impractical when testing blood levels. The bonus is urine is easily collected at home.
High cortisol, or cortisol which deviates from the expected daily pattern, can indicate ongoing stress is affecting cortisol production, whereas low cortisol can indicate stress has adversely affected the adrenal glands over a period of time.
Once cortisol has done its job, it will be transformed into other substances, so it’s useful to test the levels of these cortisol metabolites too.
Because adrenal health is closely related to the sex hormones, it is preferable to look at the levels in conjunction with one another.
Takeaway
If you have been told your hormone levels are normal, the limitations in standard testing may mean any imbalances have not been identified.
If you would like to explore your hormone levels further and find out how they may be affecting your health, a consultation with an Amchara Personalised Health practitioner will combine a full case history, to assess your health goals, nutritional status and lifestyle choices, with appropriate functional tests, to give an accurate picture of your hormone levels.
Many people find the results of these tests extremely useful, particularly if they have had tests carried out with a GP, the results of which have been normal in the face of continued adverse symptoms. Armed with the results of accurate and comprehensive tests, your practitioner can recommend targeted nutritional and lifestyle strategies to balance your hormones.
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