Questions to Assist Understanding of Hormonal Tests
a) What specimen should I use for hormone testing? Saliva, blood or urine?
There are advantages and disadvantages for all the different types of hormone tests. There is no right or wrong choice.
Serum hormone testing is the standard way to measure hormones. The disadvantage however of testing this specimen type is that it measures total hormone levels. In contrast, urinary and salivary tests measure unbound hormones. Most hormones are bound to binding proteins in the body which control the hormone's activity. Unbound hormones represent the active working hormones in the body, whilst bound hormones cannot interact with receptors and are therefore 'inactive'.
Therefore urinary and salivary hormone levels probably correlate better with clinical status. Another advantage of urinary and salivary testing over blood tests, is that they provide a stress-free, painless and non-invasive specimen collection procedure, that can be performed in the privacy of the home. The major difference between urinary and salivary hormone testing is that whilst the urinary tests measure the total daily production of hormones, saliva tests only measure hormone levels at a moment in time. This can be an advantage however, when the hormone such as cortisol or melatonin fluctuates throughout the day, or if midnight sampling is required. Specific reference ranges for different hormones and administration routes are also available for the saliva tests. This therefore makes salivary hormone testing optimal for those on hormone supplementation.
b) What day of the month should I collect my sample for hormone testing?
For premenopausal women it is advisable to collect the sample on day 19-21 of your menstrual cycle (Day 1 is the first day of your menstrual period). Menopausal women can collect the specimen on any day of the month.
c) My practitioner told me to collect on day 21 of my cycle, and I did but my period came on day 22. What should I do?
It can be difficult to know when to test hormone levels in women that have an irregular cycle. Ideally specimen collection should be performed 7-9 days before the start of the menstrual cycle in women who are ovulating (i.e. day 19-21 of a 28 day cycle). For women with irregular cycles, different practitioners will ask patients to follow different guidelines for specimen collection depending on how they want to analyze the test results. There are two standard options i) produce your sample on day 21 even if you have a long or short menstrual cycle ii) produce a sample 7 days before the onset of menstruation, i.e. For a woman with a 21 day cycle, collect the sample on day 14. For a woman with a 33 day cycle, collect the sample on day 26. Whichever guidelines you and your practitioner decide to follow ensure that you record when you produced your specimen, how long your cycle was and when your period came. Give this information to your practitioner to help them interpret your hormone test precisely.
d) I don't know when day 21 of my menstrual cycle is because my cycle is irregular. What should I do?
If you do not have a menstrual cycle, collect your sample on any day of the month. If your cycle is irregular, recollect the number of days in each of your past 3 menstrual cycles. Calculate the average length of your menstrual cycle over these last 3 months; add up the number of days in each of the three last menstrual cycles and divide by 3. Then follow the guidelines in question c (above) for specimen collection. If you are supplementing with hormones, refer to the specimen collection instructions.
e) What about if I am on birth control pills? Is it still worth taking a hormone test?
When you are on birth control pills it is worthwhile analysing cortisol, DHEA and melatonin. The sex steroids should not be tested if your aim is to establish your body's own levels. However, you could test estrogen, progesterone and testosterone, for example, after coming off the birth control pills. Wait until you have experienced your first menstrual period after stopping the contraceptive pill. Collect your sample on day 20, after the first day of your period (Day 1 is the first day of your menstrual period).