Wednesday, February 8, 2017
Wisdom Wednesday: Urine Hormone Testing
I have written several blogs about HRT (hormone replacement therapy) including bio-identical hormone therapy. Sometimes, HRT is prescribed based on the age of the patient and/or their symptoms. However, most of the time some sort of laboratory panel is run to evaluate hormone status prior to treatment. These tests are often repeated over time to measure the effect of the therapy.
Clinically, I use hormone testing to verify my QA (Quintessential Applications) findings and assess the patient response to nutritional therapy.
Some hormones can be tested from blood and many more from saliva. More recently, the dried urine test has become the most comprehensive, cost effective method for hormone analysis.
Serum testing from blood was the industry standard for many years and is still performed by many gynecologists. The drawbacks are cost, convenience (requires a blood draw) and limitations. In order to adequately test cortisol, you need to perform four blood draws over the course of 24 hours. Although you can measure the major sex hormones, you cannot measure the metabolites from phase 1 liver detoxification.
Salivary hormone testing is much more convenient. It can be done from the home and although the preparation is a little tedious (time restrictions on food, brushing the teeth, etc.), you can easily spit in a test tube four times over 24 hours to measure the daily fluctuations in cortisol. However, like blood, you cannot measure hormone metabolites and it is relatively expensive.
DUTCH (dried urine test for comprehensive hormones) has the convenience of salivary testing, it very cost effective, and is much more comprehensive than either blood or saliva.
The hormone metabolites measured on the dried urine analysis provide significant insight into hormonal balance. For example, as estrogen is used in the body it is processed through the liver into one of three metabolites – 2-hydroxyestrogen, 4-hydroxyestrogen, or 16-hydroxyestrogen. The 2-form is safe, the 4-form can be carcinogenic, and the 16-form is always carcinogenic. The ratio of these various metabolites is vital to assessing the patient’s risk of estrogen dominant cancers. As a side note, Premarin and Prempro, commonly used HRT medications, only break down into the carcinogenic 16-form.
The various hormonal imbalances noted from DUTCH testing can be easily modified with common nutritional therapies. Cruciferous vegetable extract will improve the 2:4:16-hydroxyestrogen ratio. Adrenal adaptogens will return the free cortisol pattern to normal. DHEA will support production of testosterone and progesterone. Chaste tree will modulate all sex hormones and Tribulus will stimulate the hypothalamus to increase any low hormone level.
The Bottom Line:
If you feel you have a hormonal imbalance or have previously been tested with blood or salivary testing, please consider the DUTCH test. Currently, the lab has established a price of $250 for the comprehensive profile. This includes free cortisol, estrogen, progesterone, testosterone, DHEA and a dozen metabolites from these sex hormones.