Today, we are going to address a question so many have asked: What basic blood work do you need in order to determine if your hormones are out of balance?
After thirty years of treating hormonally-challenged patients, I have learned that it is so important to assess the signs and symptoms of hormonal imbalance and use your lab results and blood work to confirm them.
This is the blood work I like to look at to determine if your hormones are out of balance:
Basic Blood Work: Comprehensive metabolic panel, lipid panel, CBC, HGBA1C, c-peptide, prolactin, DHEA-S, TSH, FT4, FT3, IGF-1, FSH, and LH.
Rarely do I look at individual sex hormones. This is because looking at estrogen, progesterone, and testosterone levels in women (especially one in her reproductive years) is futile. Unless you’re checking every single day of the cycle, you’re not going to get adequate measurements. There are a few days of the cycle that will show some peak measurements. For example, checking progesterone seven days before a period can determine if ovulation happened and if it produces enough progesterone to maintain a pregnancy.
The more accurate test for sex hormones is looking at the pituitary hormones.
Measuring pituitary FSH and LH shows if you’re making optimal levels of estrogen, progesterone, and testosterone for your body. FSH stands for follicle-stimulating hormone, which reflects how much estrogen you’re producing. And LH, or luteinizing hormone, reflects progesterone production in women and testosterone production in men.
FSH is elevated when you’re going through perimenopause and menopause because your estrogen levels are low.
Your pituitary gland is a better barometer of YOUR normal hormone levels.
Individual blood levels are compared to norms, which are the average level for other people your age and gender. But hormones have been declining – 20 years ago testosterone levels were almost double what they are now. So just because you’re in range with everyone else does not mean those levels are optimal for you.
Since we don’t usually check your hormones when you’re young, healthy, and feeling fine, we don’t have a basis of comparison for you. However, your pituitary knows what’s optimal. Your symptoms can be more reflective of your hormones than lab tests. But with that being said, I have found that if I look at certain blood levels at certain times of the day, and certain times of the month in menstruating women, then I am able to determine endocrine function.
Typically, only TSH, or thyroid-stimulating hormone, is measured when getting a read on your thyroid hormone imbalance. TSH is produced by your pituitary gland in response to your circulating thyroid hormone – both T4 and T3. Like all endocrine hormones, it’s your hypothalamus that reads the circulating hormones and then tells your pituitary gland to make more or less stimulating hormones.
So if T4 and T3 levels are too low for you, your hypothalamus will tell your pituitary gland to make more TSH. This will stimulate your thyroid to make more T4, which gets converted to the active form, T3.
If you’re only measuring TSH, you’re not getting the full picture of thyroid function. You need to measure free T4 (fT4) and free T3 (fT3) to know what’s really going on with your thyroid function. Only free unbound thyroid hormone affects cell activity.
If autoimmunity is suspected, then I also measure anti-thyroid antibodies like TPO.
So what about blood work for your adrenals that produce hormones?
I measure DHEA-S to determine basic adrenal function, I almost never measure cortisol levels. That’s because I have to have Addison’s disease to see a super low cortisol level. Even if you have adrenal fatigue and are not making much cortisol, you usually have enough reserve to spike cortisol for a blood test. It rarely shows your true adrenal function.
DHEA, on the other hand, follows cortisol production, and the sulfated version lasts a long time. So measuring DHEA-S gives you a window into adrenal function. If I suspect my patient has severe adrenal fatigue, I’ll measure pregnenolone and unconjugated DHEA to check their adrenal reserve.
This is another hormone that I look at, which is usually ignored by most health care providers. Prolactin is produced by the pituitary gland in a circadian fashion, meaning high at night and low during the day. Pregnant and lactating women make the most prolactin. Prolactin helps regulate our immune system, and high daytime prolactin levels can block hormone receptor sites. It’s usually best to measure prolactin between 8 & 9am, and your level should be under ten. If it’s higher than that, you still have too much prolactin on board from the nighttime, and you’ll probably notice that you are not waking up very perky because prolactin keeps you in a sedated state so your immune system can do its job at night. Daytime prolactin tends to be high in people who are overweight or have an autoimmune condition.
I then look at human growth hormone activity by measuring IGF-1 – which is an insulin-like growth factor. IGF-1 is the mediator for human growth hormone. HGH is produced by the pituitary gland and has a very short half-life, so it must be continually measured to get an accurate reading. Human growth hormone levels naturally lower as we age, but if it’s too low, we have trouble healing. IGF-1 can be falsely elevated if you are diabetic with super high blood sugars.
I include a comprehensive metabolic panel in my hormone work-up to be sure my patients’ kidneys and livers are functioning normally.
A lot of my patients come in taking lots of different supplements and certain herbs, especially Chinese herbs that can actually cause kidney issues. Sometimes, they’re taking so many supplements and so many medications that they’re having liver problems. I need to know their basic metabolic function because I don’t want to give them more to take before helping them detoxify.
This is important because steroid hormones are made from cholesterol. Steroid hormones include sex and adrenal hormones. Your total cholesterol and your LDL cholesterol will be elevated when you’re not making enough sex or adrenal hormones.
I don’t just do a basic lipid panel, but I measure the sub-particle sizes of LDL and HDL. I’m looking for large buoyant particles, and the bigger the particle, the better. Large buoyant HDL and LDL are protective, and will not cause arteriosclerosis. So if the total cholesterol is high, but it’s mostly made up of large particles, I’m not worried about the patient having heart disease. I’m more concerned that they’re not producing enough steroid hormones.
This blood test shows a complete blood count to make sure there’s no sign of anemia or bone marrow deficiencies. I want to make sure that my patient does not have underlying disorders contributing to their symptoms or caused by their hormonal imbalances.
I also want to check their glucose metabolism by measuring C-peptide and HGBA1C.
HGBA1C is a protein molecule on the red blood cell that reflects how much blood sugar you’ve had floating around in your bloodstream for the last six to eight weeks. About the lifespan of a red blood cell.
A more immediate measurement of insulin production is C-peptide. C-peptide is the protein molecule that insulin is bound to when it is released by the pancreas. Insulin will immediately bind to circulating glucose, so it is a pretty consistent measurement of pancreatic function. If C-peptide is extremely low, you’re not making enough insulin, which is typical in people with insulin-dependent type 1 diabetes. If your C-peptide is high (over four), you’re making too much insulin. This reflects insulin resistance at the cellular level and is a sign of type 2 diabetes.
The triad of adrenal DHEA-S, thyroid hormones, and C-peptide or HGBA1C gives me information about whether or not the hypothalamus is out of balance.
This type of blood work is key to the whole picture because the hypothalamus is controlling all of these endocrine glands.
However, I can’t measure the hormones from the hypothalamus. Therefore, I need to look at the function of the glands controlled by the hypothalamus to determine whether or not there’s miscommunication with the hypothalamic pituitary endocrine gland axis or not.
For instance, if your fT4 and fT3 levels are low, but so is your TSH, then you have hypothalamic-pituitary-thyroid miscommunication.
Is there more blood work to check your hormones?
When I first began studying neuro-immune-endocrinology, I played around with lots of different laboratory tests to try to determine what would confirm or deny what I was seeing in my patients. I did 24-hour urine tests, salivary tests, and blood tests. Urine reveals hormone metabolites, while saliva can indicate hormones at the tissue level. Blood reveals what hormones are available in the body. None of these tests truly tell us exactly what’s going on with your hormones, which is why it’s more important to assess the signs and symptoms of hormonal imbalance, and use the lab tests to confirm.
I know this is a lot of complicated information, which is why you should sign up for my free Hormone Reboot Training. Here you’ll get exclusive access to the same education I give to my patients; I help them interpret their results.
Hope to see you there!