Hormone health and getting labs done is definitely a hot topic these days. I am glad it is getting more attention. However, labs can be complicated. Understanding the context will always be key, so I wanted to share some basics about getting routine lab work and give an example of what a comprehensive panel actually looks like.
Routine Labs
First off, why is getting routine lab work important?
Getting routine labs done (via blood, urine, saliva)
allows us to see what is going on internally. Think about it this way; when our cars make funny noises, we can guess what it is, or we can actually get an under-the-hood examination by a professional and know for sure. That is what getting hormone labs are like. Labs don’t lie.
I instruct all of my clients to get a full hormone panel at least once a year. And that is assuming they are feeling good, no symptoms, and no red flags in the panel. Now, if someone is symptomatic and shows some red flags in their initial lab work, I may want to see various labs as often as every three to four months.
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One caveat to getting hormone labs: Getting them through your doctor can be a bitch, especially if you want a comprehensive panel and not just two to three things. We have to remember that getting full labs yearly is a very proactive method of care. Unfortunately, in western medicine, care is very reactive. Therefore many doctors will not order labs for you unless you are sick and deem it 100 percent necessary. This is complete bullshit, but that is what you will run into most of the time. But if your doctor is more functional or progressive, they will order it for you no problem, and that way, insurance can cover some of the cost.
If the doctor's route doesn’t work out, you can always get labs done privately. You do not have to go through a doctor. Websites such as Life Extension, PrivateMD Labs, etc., all allow you to buy your labs upfront, walk into a LabCorp to get blood drawn, and then your results are emailed to you. Easy peasy. The only downside to that is you must be proficient at understanding labs or hire someone who is. Labs can be very confusing to read, and while I deem myself pretty good at reading them, I still learn new things every day. You also cannot go off the reference ranges provided. Those are not meant to determine optimal health or function. Learning the optimal ranges and how all values should be compared to one another is no easy task.
Below is what I typically ask my clients for in regards to a comprehensive hormone panel. Again, I recommend that my clients get this once a year and sometimes multiple times a year if they have any dysfunction we need to monitor.
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Lab Prerequisites
Here are a few prerequisites for getting blood drawn:
- I like to see morning fasted labs for a comprehensive panel. No food for eight to ten hours, but drink plenty of water. Dehydration can throw off values. I recommend drinking at least 20oz water before getting blood drawn.
- Stop taking your multivitamin (and biotin) four days before testing.
- Take all other medications as usual. (Birth control, thyroid meds, etc.)
Comprehensive Blood Panel
Below is a comprehensive panel, very similar to ones you will find from Life Extension or PrivateMD Labs:
Sex Hormones
- DHEA Sulfate
- Total Testosterone
- Free Testosterone
- Estradiol (E2)
- Progesterone
- Luteinizing Hormone (LH - for women only)
- Follicle-Stimulating Hormone (FSH - for women only)
- Sex Hormone Binding Globulin (SHBG)
A Note Regarding Sex Hormone Testing
If you are on hormonal birth control or PED’s, these markers are clearly affected.
Women on hormonal birth control: Your labs will read your current natural hormone production, which is intentionally suppressed by the birth control. Your exogenous hormones will not read on blood work because they are not bioidentical; birth control is synthetic. So do not be alarmed if your sex hormones come back postmenopausal on labs.
Thyroid Hormones
- Thyroid Stimulating Hormone (TSH)
- Free T3
- Free T4
- Reverse T3
- Thyroxine-Binding Globulin (TBG)
- TPO Antibodies (if tested once and are fine, may be no need to test yearly)
- TGAb Antibodies (if tested once and are fine, may be no need to test yearly)
A Note Regarding Thyroid Hormone Testing
It is very important to test all of these variables. Understanding thyroid labs is like reading a book. It would be best if you read the whole thing to know what is going on. If you only read the first chapter, you cannot predict how the book will end. The same thing applies here.
Stress Hormones
- Cortisol
A Note Regarding Cortisol Testing
I personally like to see morning labs to see morning cortisol. However, cortisol fluctuates throughout the day. So in a perfect world, it is best to see cortisol by saliva or urine samples taken throughout a full day. A sample of blood work at least gives us a snapshot. If I see abnormalities in the morning cortisol, I will instruct my client to look into getting a DUTCH test to see how it fluctuates throughout the day.
Insulin Resistance Markers
- Insulin
- Ferritin
- Hemoglobin A1C
A Note Regarding Insulin Resistance Testing
Again, this is also why I prefer fasted labs. Most doctors will only run A1C, but that does not show us anything about our fasted insulin. Tracking insulin levels over time can help us identify dysfunction (PCOS, diabetes, etc.,) EARLY and we can act preventively instead of reactively.
Inflammation and General Health Markers
- Complete Metabolic Panel
- Lipid Panel
- CBC
- Vitamin D 25-hydroxy
- C-Reactive Protein (high sensitivity)
A Note Regarding Inflammation Testing
Most of these will be tested normally at your doctor’s office except for Vitamin D and C-Reactive Protein. This is unfortunate because both are extremely important and can be out of range without noticeable symptoms. But of course, seeing things like fasted blood glucose, lipids, and overall blood health is largely important as well.
So these are the basic guys! Clearly, there are many more markers to test, but these are what I believe should be run at least once a year. Even if nothing is “wrong,” it is a great idea to have years of data so you can track trends and attack any issues that may arise early, versus being caught off guard. And with a full panel under your belt, you can go deeper into a specific area with more blood work if you notice dysfunction. So this will at least let you know where to start!
As always, I hope this helps guide your hormone panel efforts and let me know if you have any questions in the comments.
Header image credit: Jarun Ontakrai © 123rf.com
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