Choose Lab Tests Wisely by Dr. Joseph J Collins, RN, ND
Realizing that saliva assays exhibit hormone concentrations at the tissue level at a given point in time1, we can recognize that making a decision about hormone levels based on one saliva sample is not a valid decision.
Previous research, and clinical experience, has revealed that reliability can be increased by using more than one measurement 2. How much they fluctuate and what to do about this fluctuation in regard to your Menopause Type® can only be determined by the Female Hormone Health Profile.
The best way to evaluate hormone levels during and after menopause is through the collection and testing of at least three samples, so that fluctuations can be evaluated. Multiple-sample assessment is required because unstable hormonal fluctuations have been observed years after menopause 3. These hormonal fluctuations play a role in many of the symptoms and problems associated with menopause including migraine headaches, obesity, mood changes, and bleeding irregularities in both perimenopause and postmenopause women 4,5,6,7. (for references please see: Female Hormone Health Profile)

If Using Serum Hormone Tests: If using serum hormone tests it is important to always measure SHBG when measuring sex hormones in both men and women. Without SHBG there is no information on the affect that estrogens have on this very important serum protein. If SHBG is too high it can interfere with testosterone function in both men and women. If too low, it can increase risk of cancers.
Cortisol and DHEA-S should be added if there is suspicion of adrenal fatigue or adrenal stress. Androstanediol glucuronide is helpful in evaluation of either PCOS in women or prostate hyperplasia in men. The testing of 17-hydroxyprogestone is also valuable in PCOS evaluation.
For thyroid evaluation, TSH is not an accurate marker of thyroid function. T3 and T4 are actual measurements of thyroid hormones. Reverse T3 should be added if the patient is showing signs of hypothyroidism, even though their T3 & T4 are normal. Reverse T3 (which is a T3 antagonist) is elevated in liver disease, toxin. poisoning, stress, fever/chronic infection, fasting, severe dietary restriction and malabsorption. It is also important to measure anti-TG and anti-TPO. If any of those antibodies are elevated, then thyroid function can be suppressed, even with normal T3 & T4 levels.
Here is a list of profiles that give the best indication of hormone levels:

Female Hormone Profile: Estradiol, Estrone, Testosterone, Progesterone, SHBG (add Cortisol & DHEA if adrenal fatigue is suspected) – (add Cortisol, DHEA-S, androstanediol glucuronide & 17-hydroxyprogestone if PCOS or PCO-like syndrome is suspected)

Male Hormone Profile: Testosterone, DHT, Estradiol, Estrone, Progesterone, SHBG (add Cortisol & DHEA if adrenal fatigue is suspected) – (add Cortisol, DHEA-S & androstanediol glucuronide if prostate hyperplasia is suspected). Also measure and monitor PSA levels.

Thyroid Profile: TSH, T3, T4, anti-TPO, anti-TG (add rT3 if toxin/liver, stress, fever/chronic infection, fasting/dietary restriction/malabsorption

Next: Proper Use of of BHRT

For information on specific protocols, please go to: Protocols

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On one hand we are faced with traditional serum testing that is often done incompletely – lacking SHBG assessment for sex hormones, or just testing TSH for thyroid function. In that situation we struggle to advance diagnostic medicine to be comprehensive enough to have value based on new science. It is a case of tradition trumping science.
On the other hand we are faced with salivary testing that is done improperly – it is aggressively marketed without full disclosure of the science which reveals its’ limitations such as single day assessment of sex hormones being clinically invalid. It is a case of marketing trumping science.
Knowing the limitations of lab tests allows us to make the required adjustments to overcome those limitations. Both serum and saliva can be done correctly – and can yield information that can be gained by no other means.
If Using Salivary Hormone Tests, Measure Hormones on Multiple Days: Single hormone assessment is not an accurate demonstration of your hormonal patterns, which fluctuate from day to day. Saliva hormones, fluctuate from day to day.