Monday, January 25, 2010

Why you need your hormones tested

People of any age can have hormones out of balance, especially women.  The years before menopause begins is an extremely common time for women to get health issues related to hormone imbalances.  But I've also known very young women in their late teens and early 20's with severe problems (i.e., migraines) related to hormones. 

When I talk about "balancing hormones", I am only referring to taking some form of natural hormones (either bio-identical, glandulars, or other).  I never recommend taking synthetic hormones, although synthetic thyroid hormones often work out okay for many. 

So the crucial first step in making sure the hormones are balanced is to get them tested.  Especially if you plan on having any kind of hormone replacement. The alternative is get treatment based on your symptoms, without testing.  This works too, especially if you have a knowledgeable practitioner.  But you'll never regret getting a baseline profile of where your hormones are at, before starting to adjust them.

Problems with hormone dosing based on symptoms only.  There are a few pitfalls with dosing based on symptoms only.

1) You may have a doctor or practitioner who’s not as knowledgeable as they could be, and you get a wrong starting dose. If it’s too low, you’ll get no relief of symptoms, and if it’s too high, could cause even more symptoms.

2) Taking a hormone does not always get an immediate response. It can take weeks, and several months (usually 8 weeks), to change and stabilize a hormone’s levels. That being said, one may notice an immediate relief of some symptoms – it often happens this way. It just takes awhile to see what dose works, and get stabilized.

3) All the hormones are connected, and operate based on their relationship to other hormones. So if you’re given too high a dose, for example, it can mess up your other hormones too. And then you have even MORE symptoms than you started with, and will probably end up stopping the new hormone altogether. Until you’re back where you started.

Given the above possible problems, it’s likely you’ll end up stopping your new hormones, thinking they “don’t work” if the starting dose is too far off.  This is really too bad, because they could have worked really well! If only you were on the correct dose to begin with.

I’ve tried it both ways -- replacing hormones based on symptoms and tests. By and large, having a baseline of where your hormones are at tends to work better, over the long run. Your chances of getting on the right dose increase hugely when you get yourself tested – first.

Now, how to get your hormones tested is the next step.  

Saliva vs. blood testing
Blood testing of hormones only shows a snapshot of where your hormones were at the moment your blood was taken. In a pinch, it’s okay to at least get an idea. However, if you get stressed having your blood drawn, then this may skew your results. Because stress will change your hormone profile.

But with saliva testing, you can take samples throughout the day, during the month over an entire cycle – whatever is needed. This shows how your hormones are actually working.

For testing the adrenals (cortisol), it’s really important to have saliva testing to see the range from early morning to bedtime.  

Also, saliva testing is really easy! You get a “kit” (a box with everything needed) that you take home, and with the instructions given, do all the samples yourself. You then mail the box to the lab and the results are sent to your doctor/practitioner.

Which hormones to have tested

Many of the major players are listed below.  Each hormone has several different functions, so whether you’re post-menopausal (your periods have stopped, or intermittent), or in perimenopause (the years leading up to menopause), or your health is suffering (chronic fatigue, fibromyalgia, autoimmune, etc.), you'll need a profile of at least some of the major players:

estrogen(s) like estradiol and estriol
cortisol (the stress hormone from the adrenals)
thyroid (T3 and T4) (these are blood-tested)

There are other options too but the above are the most common. 

Every person has a unique hormone profile
There is a range of “normal” levels for each hormone. However, each of us have very different amounts of hormones operating at any given time. It makes sense when you think about it. How our ovaries are working (if we still have them), how much stress is in our lives, how we eat, any illnesses, the hormone profile we were born with (our genetics) – all of these things, and more, can come into play. This is partly what gives us our uniqueness.

What is “normal” for one person, will be different for another. This is so true when it comes to hormones. When I got my hormones tested for the first time, I remember my testosterone level was really really high -- much higher than the normal range. But this was my normal. It seemed odd at the time, but I came to learn that I function better and have more energy, more like myself, when my testosterone levels are high. This is one of the benefits of self-education, because rarely would a practitioner attempt to treat my low or even “average” testosterone levels, based on lab results.

Also, things can change, over time, and they often do. That’s why you (and your practitioner) will need to monitor your hormone replacement, based on your symptoms, and adjust accordingly. 

Your starting dose will likely need to be adjusted
The process of menopause can last for years (5-7 even) and the process of recovering health can sometimes last for years too. So whatever your starting hormone dose is, chances are very good it will need to be adjusted. Maybe within weeks, it’s hard to say. Depends on your hormone profile, needs, and symptoms.

And if you’re taking hormones for another reason – due to stress, estrogen dominance, pain – whatever – your dose may still need to be adjusted over time. Don’t be alarmed -- it comes with the territory.

Important tip! Never get any hormone combined with another hormone. You need to be able to adjust each hormone separately. This is really important! A common situation is getting an estrogen (e.g., estradiol) prescribed in combination with progesterone. Well, what if after a few months you need more progesterone, but not more estrogen? It just doesn’t work to have them combined.

A great book on everything related to hormone replacement: “Hormone Revolution” by Susan Lark, MD. She also has a website.

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