Guest blog by Kristin Thomas, FDN-P, HHC, founder of Thrive by Food.
“Your lab results all look normal,” your doctor says to you after a recent blood test. You walk out of the office discouraged about why nothing seems to explain your hormonal symptoms or inability to get pregnant. Pap smears come back normal, blood work looks fine — what’s missing?
While conventional lab tests can detect many severe conditions, what they’re not so great at is looking in between the lines to find hidden indicators of disease or stress in the body that could actually be behind your main health concerns. They’re also not great at detecting the early stages of a condition, such as adrenal dysfunction, estrogen dominance, or the effects of stress on your cycle. These signals are incredibly insightful as they can explain why you may be having trouble getting pregnant or having symptomatic periods and can help pinpoint both lifestyle and dietary changes that can help bring your body back into balance.
As a functional diagnostic nutrition practitioner, clients come to me everyday with test results from their doctors, frustrated why no one can give them answers to their biggest health complaints. Working with a functional practitioner like myself, we take a different approach by running the most advanced and thorough tests for hormones, thyroid, neurotransmitters, and much more. In this post, I’d like to explain the key markers standard lab work is missing that you should be testing for so you can finally get real answers and an action plan to move your hormone health forward.
The Lab Tests You’re Not Getting (But Should Be)
There are five key indicators of hormone imbalance that are behind things like infertility, PCOS, endometriosis, PMS symptoms, mood imbalances, and much more. These are areas which can be tested for, trouble is, conventional medicine isn’t looking there — but you should be. Here’s the breakdown:
Chances are, a regular blood test will look for your estrogen levels, but there are a couple things wrong with the testing approach that can seriously mislead the results. First, estrogen is highest during the luteal phase of your cycle (specifically, days 19-21 if you have a normal 28-day cycle), which is why it’s the best time to test your sex hormones. So many times clients show me their blood hormone results that were taken on a completely random day of their cycle. Estrogen fluctuates like the night sky during your cycle, and the reason testing them during the luteal phase is best is because since that’s when it’s highet, that shows us the maximum amount of estrogen your body can produce. This can tell us a lot about how the levels are when they’re even lower during other phases of your cycle. If estrogen is low during the luteal phase, it’s often completely tanked at other phases, for example.
Another issue with conventional estrogen testing is it often only tests for one estrogen marker, or it’s an average of them all. Did you know that there are actually TEN estrogen metabolites and ALL of them are important to test individually? They include estrone (E1), estradiol (E2), estriol (E3) as well as seven estrogen metabolites, some of which are considered good estrogens and some of which can be DNA damaging if not detected. See below for a breakdown of the estrogens (a real test result) from one of the tests I run in my practice:
Testing just one estrogen marker does not give you the whole picture. As you’ll note above, the test I run is a urine test, not a blood test, and this is another important point. Urine testing allows us to get very granular with hormone detection because urine is a direct result of our metabolism, showing how our body actually produces AND utilizes hormones. Blood only shows what’s currently in circulation, so, again, it only shows part of the picture.
Your androgen hormones include testosterone (critical to be in balance for women looking to conceive) as well as DHEA (an adrenal hormone) and two androgen metabolites. DHEA is the parent hormone to testosterone, so it’s important to understand what DHEA looks like in comparison to testosterone to form an accurate impression. In the diagram to the right, you’ll see this sample shows DHEA is on the low end and testosterone is below range (below the star).
If DHEA is low, for example, chances are testosterone is also low, which tells us to address the low DHEA so we can rebalance testosterone, too. Certain metabolites in the androgen pathway also make androgens more potent, which may or may not be a good thing depending on your case.
Testing these hormones via urine testing can show us how your androgen hormones are performing and metabolizing, showing us the entire picture and allowing us to strategically rebalance these pathways. Unfortunately, I see all the time men getting prescribed testosterone cream for low testosterone, but it ends up being that their DHEA is low and simply by addressing their DHEA, we can bring testosterone up without synthetic use of hormones. Similarly with women, I see them being wrongly directed, which can make their androgens worse in the long-run.
Cortisol: Understanding Your Body’s Stress Response
Cortisol is an adrenal hormone that dictates your circadian rhythm and energy throughout the day.
It influences the production of many other sex hormones, including estrogen, so if cortisol is out of whack, chances are estrogen and other sex hormones will be, too. Not many conventional tests look at cortisol at the same time as sex hormones, which leaves a big piece of the picture missing. Today, so many women are living in a state of chronic stress — from work, to managing a home, to taking care of a family, and all the pressures we put on ourselves and face from society today. It’s a lot — and it’s taking a toll on our adrenal glands where cortisol is produced.
Testing cortisol helps paint a picture of how well your HPA axis (hypothalamus gland, pituitary gland, and adrenal gland) are functioning. Without a well-functioning HPA axis, no amount of bioidentical hormone replacement therapy (BHRT) or herbal supplementation will fully fix it. The first step in rebalancing your sex hormones, if your cortisol is off, is to address cortisol and your HPA axis. Often that alone can help to rebalance your downstream sex hormones.
Neurotransmitters: What Does Your Brain Say?
Neurotransmitters, or signals in your brain that tell your body what to do (e.g. feel happy, feel sad, feel excited, make hormones, don’t make hormones) are a key input to the hormone production process. If your neurotransmitters are out of balance, often due to chronic stress, inflammation in the body, poor sleep, and nutrient deficiencies, your adrenal and sex hormones will be, too. This is another key area the same urine test I run in my practice tests for, giving you the most comprehensive look at what’s going on all across your body that could be leading you to why you feel the way you do today or are having trouble conceiving.
Based on which neurotransmitters are out of balance, we can strategically support them, which has a downstream positive effect on your adrenal and sex hormones.
Thyroid: A Comprehensive Look
Chances are you’ve had your thyroid tested, but let me guess….it was just the TSH (thyroid stimulating hormone) that was tested. The thyroid is the master hormone in the body, so if it’s over or under functioning, that will make it very hard for your sex hormones to be in balance. I’m a huge advocate of running a comprehensive thyroid panel, which includes all of the following markers:
- Free T4
- Free T3
- Reverse T3
- Thyroid Peroxidase (TPO)IgG
- Thyroglobulin IgG
The first three markers are key thyroid hormones that are the true indicators of hypothyroid or hyperthyroid (and can also show trends one way or the other if they’re not quite out of balance yet, allowing you to catch an issue sooner). The last two markers measure antibody (or immune activity) against the thyroid. This is especially important to test if you have an autoimmune condition like RA, MS, ulcerative colitis, Celiac or Crohn’s Disease. If your immune system is attacking the thyroid, it will be impossible to have a well-functioning thyroid, and as a result, adrenal and sex hormones, so addressing and calming down the immune system is the first-level priority in this case.
Putting This All Together
As you can tell, in functional nutrition, we always look upstream for hidden indicators of stress and disease in the body that can paint a full picture of what’s going on for a person. It’s in a patient’s best interest to look for all of these markers, otherwise it’s incredibly difficult to truly help them have healthy, happy hormones and to feel well. The tests functional practitioners like myself run are about twenty years ahead of what’s run in conventional medicine, so it’s not that your doctor has been running the wrong tests, per se, they’re just outdated and, unfortunately, can’t tell the whole story or read between the lines — which is likely why you’ve been left without answers.
The test I’ve mentioned throughout this post is called the DUTCH test (which stands for Dried Urine Test for Comprehensive Hormones). While consumers can order it directly from the website, it’s far more expensive and does not come with any analysis of the results, which to the untrained eye, this test is quite overwhelming! I work with women everyday to run the DUTCH test, as well as thyroid tests, food sensitivity tests, stool tests, and much more, to identify what in their body is imbalanced. We then use that information to rebuild health — boosting fertility, hormonal health, digestive health, thyroid health — full body health.
Ready for Answers?
If you’re interested in getting real answers, I’d be honored to work with you, pretty lady! To get started, please sign up for a free 20-minute introductory call so I can get to know more about you and your health goals and we can pinpoint the exact right tests for you. This kind of work is a beautiful compliment to the Circle+Bloom programs, as full-body health is truly a mind-body effort. I’m a personal user of Circle+Bloom and use the programs in my practice all the time to help women address the stress and mindfulness aspect of their health while we do testing and address diet and re-balancing the body naturally.
It’s an incredible process when you can look at your hormones at such a deep and meaningful layer. If you’re trying to conceive, want to get rid of painful cycle-related issues, or want answers no one else has been able to get you via testing, I’d love to hear from you!
Kristin Thomas is a certified Functional Diagnostic Nutrition (FDN) practitioner and holistic health coach who specializes in hormone health, digestive health and autoimmunity with additional training in SIBO, thyroid conditions, detoxification, and stealth infectious disease. She’s lived through chronic illness and reversed her own hormone imbalances, ulcerative colitis, and other health challenges such as leaky gut, food sensitivities, adrenal fatigue, a half dozen gut infections. Today, she helps clients determine what lab tests will best illuminate why they feel sick and what actions to take to feel better. She then guides them toward better health by eliminating the factors creating the loss of function, putting meaningful lifestyle interventions in place, homing in on the right diet, and working to unblock the physical and emotional factors that led to poor health. You can visit thrivebyfood.com to learn more and apply to work with her.