There are four ways that we can measure hormones in the human body: blood (serum), urine, blood spot, and tissues. A biopsy may give the most accurate levels of one’s hormone levels in the breast or endometrium. While such measurements are possible, they aren’t practical, or commonly performed, but for very select circumstances.
Serum: This is the most common form of measuring hormones, but may be the least valuable. As we know, a hormone’s level in the blood probably doesn’t reflect its levels in the tissues. Hormones are known to be carried on proteins, notably SHBG, sex hormone binding globulin. In this case, the serum total hormone level, including both bound and free hormones, doesn’t tell us what amount of this hormone pool is accessible to the tissues. Testoster0ne is often measured in its free and bound forms; estr0gen rarely.
Urine: The only hormones found in the urine are the ones that have been through the two detox pathways Phase I and II. If anything, these modified hormones may most distantly reflect what’s going on at the tissue level. This is a great place to look if you want to know about your estr0gen metabolites, specifically the balance between the hydroxy- and methoxy- estrones. I don’t reach for the urinary studies when I want to know what’s happening at the tissue level.
Hormone Levels at the Tissue Interface
Saliva: The salivary tests offer a good glimpse at what is likely going on at the capillary interface. The salivary acinus gland is enveloped in a nest of capillaries and reflects the hormonal levels where they leave the bloodstream to enter the tissues. More importantly, salivary tests measure the free, unbound hormones. For this reason, it is an excellent choice for measuring the sex hormones and cortisol.
The shortcoming of this method is that were one to have even the slightest amount of oral blood, from flossing, brushing one’s teeth, or a touch of gum disease, the results could be significantly skewed. If you’re using oral hormonal drops or troches, don’t even consider using this method. Confusion and misdirection are assured.
Blood Spot: I feel that this may be the most accurate and practical way to assess hormonal levels in our tissues. Of course, the breast, brain, endometrium, and fingertips all use estrogen differentially via different concentrations of the hormone receptors on cell membranes. What I like about Blood Spot is that it samples capillary blood, lymph, and some ruptured cell walls. The traumatic nature of a “fingerstick” may give us the most information, broadly speaking, about hormonal levels in the tissues.
Sex Hormone Measurements: What’s Best?
In sum, there’s no perfect test. Knowing the advantages– and disadvantages– of the different modalities is a great place to start.
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