Lab testing of most hormones is used to establish a baseline, monitor treatment and ensure safety. Not all hormones being replaced need laboratory testing.An example of one such hormone is melatonin, which is produced by the pineal gland and helps to regulate sleep. Lab testing will not tell us if you will tolerate a particular hormone or combination of hormones. Lab testing does not predict if a hormone will have a beneficial effect on symptoms or illnesses, how much to use, the duration of treatment or how effective a hormone will be in preventing future illness, i.e. preventative effects. Thus, hormone prescriptions are adjusted based partly on lab testing but patient symptoms and well-being are generally the best guide. Tests may provide qualitative data to help determine whether unresolved symptoms are a result of excess or insufficient supplemental hormones.
Many people are not hormone deficient, as their lab tests are in the normal range for their age, but may still benefit from replacement. In this case, hormone levels are ‘insufficient’ relative to a younger or healthier person or relative to the lab values associated with the lowest risk of future illness. By optimizing to levels that are found in the healthiest people, i.e. the use of physiologic doses, normal age related decline and thus the consequences of hormone decline are prevented. This optimization of levels is what is meant by balancing hormones. Blood testing is preferred due to its availability and accuracy. Although a 24 hour urine collection is the ‘gold standard’ for the steroid hormones, it is usually unnecessary for effective prescribing. Saliva is the least accurate method of testing, except for measuring adrenal cortisol levels, where it is very useful.