Bioidentical Hormone Replacement Testing

Bioidentical Hormone Replacement Testing

Bioidentical Hormone Replacement Testing&mdash An Overview

by Rashmi Gulati, MD

Dr. Rashmi Gulati

In order to gauge your current state of health, Patients Medical may request that copies of your last two years of medical testing be sent to us for review and comparison, and we will often recommend further testing as needed. Our center does request certain types of testing that are not commonly performed in more mainstream medical clinics. Depending on the circumstances, these tests may include a comprehensive sex steroid panel, estrogen metabolites, neurotransmitter analysis, comprehensive thyroid panel, or adrenal stress index. Because we take a whole-person approach we may also recommend evaluation of other bodily systems through food sensitivity testing, comprehensive stool testing, or Candida antigen testing, for example, to seek further upstream for the origins of imbalances in the body. Some of these are discussed in detail in the links in this section.

What to Expect on Your First Visit

First office visits typically last 45-60 minutes. Your doctor will review your intake form with you and gather a detailed medical history. A partial physical exam is usually performed, and medical records are often requested from your primary care physician and/or other doctors. Specialty laboratory testing may be recommended. Most clients are offered an initial protocol consisting of nutritional supplementation and dietary and lifestyle recommendations.

  1. First Visit: Blood Test

    Blood tests may be recommended to assess and identify kidney, liver, blood sugar and other key factors such as blood cholesterols. The results are explained to the patient, giving him/her a fuller understanding of the blood chemistry, so that they may take control.

    Patients may be required to fast for 14 hours before the test. Water may be consumed freely, but not tea, coffee, juices or other beverages. Appointments are normally arranged for mid-morning so that food and drink can be consumed up until 8pm the prior evening. On the day of the appointment, any prescribed medication should be taken with water as normal.

    Patients are recommended to bring food to eat after the blood sample has been taken. Diabetics should advise the clinic, and separate arrangements will be made.

  2. First Visit: Urine Analysis

    Urinalysis may be recommended to evaluate for pH, urinary metabolites, or establish kidney functioning. Patients may be required to collect urine over a period of 24 hours. This should be collected as near to the date of the blood test as possible, but must not include the 14-hour fasting period prior to the appointment.

    You will receive specific instruction for a 24-hour urine assessment, but our generally recommended timetable is that the first urine of the day should be excluded, then all subsequent urine for the next 24 hours collected in clean plastic containers. (If collection starts at 8am, this process must be followed until 8am the following day.) For example, if you have been scheduled for a 10am Friday appointment, then fasting commences Thursday at 8pm. Urine collection starts Wednesday 8am and proceeds until Thursday 8am.

    Containers should be clearly labeled with the patient's full name and brought to the clinic at the time of their appointment.

  3. First Visit: Resting ECG for Doctor's Report (dependent upon the patient's individual circumstances)

    The electrocardiograph (ECG) determines the condition of the heart and measures its actions and the pulse.

    The doctor in charge reports any findings in his medical notes.

Specific Bioidentical Hormone Testing

A hormone will only perform a function in the body if it "fits" into its target receptor. A hormone can be thought of as a "key," and its target site (such as an organ) has receptors with specially shaped "locks" on the cell walls. If the key (hormone) fits the lock (on the receptor), then the hormone will work to turn on or turn off, up-regulate or down-regulate specific cell processes. The endocrine glands receive feedback from the body so they can adjust the hormones and pulse them out at appropriate levels at the appropriate times.

Hormone Level Testing—Testosterone and Other Androgens

Men need a steady flow of testosterone, or androgens, as this hormone is responsible for the normal growth and development of male sex organs, and the maintenance of secondary sex characteristics. Without adequate testosterone, you may feel anxious, depressed, intellectually muddled, or develop a low sex drive. Low levels of testosterone may also result in a decline in muscle mass and strength, and an increase in upper body and abdominal fat.

Hormone panels that test for testosterone evaluate levels of testosterone, and possibly associated other androgens and binding factors, in the blood. Testosterone affects sexual features and development. In men, it is made in significant amounts by the testicles. In both men and women, testosterone is made in small amounts by the adrenal glands, and, in women, by the ovaries.

Indications and Contraindications

A hormone panel testing for testosterone is used to evaluate male and female conditions such as:

  • Precocious puberty
  • Infertility
  • Tumor marker for ovary and testicle tumors
  • Ambiguous sex characteristics
  • Decreased sex drive
  • Erectile dysfunction
  • Delayed puberty
  • Irregular periods in women

How do you prepare for hormone level testing for testosterone?

No special preparation is required. There is no fasting required for this test. However, it is necessary to draw blood for testing testosterone levels early in the morning because this is when testosterone levels are at their highest.

How does it feel? How long will it take?

The hormone level test for testosterone is a painless procedure that usually lasts for three minutes or less. Some patients may feel a slight stinging sensation when the needle is inserted into the vein in your arm to draw blood. After the test, a minimal amount of throbbing may occur at the site.

Expected effects of the test

Normally, there are no major effects of this test. Commonly, patients may feel a little soreness, and slight bleeding may occur at the site. Slight bruising or swelling may develop.

Special instructions following the test

After drawing the blood, we cover the needle site with a bandage and apply pressure for a few minutes. If the site becomes swollen, warm compresses can be applied a few times a day. You may resume your regular daily activities following the test.

Interpretation of Results

Normal Findings

In men, normal levels of testosterone may fall between 3-10 ng, or 10-35 nmol/L (SI units). Levels in the same individual may vary according to time of day, season, and exercise.

Normal levels of testosterone in women are less than 1 ng/mL (SI units).

In prepubertal boys and girls, normal levels of testosterone are 0.05-0.2 ng/ml (SI units).

Abnormal Findings

Increased levels of testosterone may be indicative of the following conditions:

Males:
  • Hyperthyroidism
  • Testicular tumors
  • Encephalitis
  • Pinealoma
  • Congenital adrenal hyperplasia

Females:

  • Ovarian tumor
  • Adrenal tumor
  • Congenital adrenocortical hyperplasia
  • Polycystic ovaries

Decreased levels of testosterone in males may be indicative the following conditions:

  • Hepatic cirrhosis
  • Primary and secondary hypogonadism
  • Hypothalamic disease
  • Pituitary disease
  • Klinefelter's syndrome

Notes:

Testosterone levels in men typically decrease with age. They gradually begin to fall from the age of 40 years, and decrease by approximately 0.3% per year. It has been estimated that up to 20% of men over 60 will experience a decline in androgen production to a degree suggestive of androgen deficiency.

Hormone Level Testing—Estrogens

Estrogens are responsible for female sexual development and function, such as breast development, fertility, and the menstrual cycle. In women, estrogens are produced mainly in the ovaries and in the placenta during pregnancy. Small amounts are also produced by the adrenal glands. In men, small amounts of estrogens are produced by the adrenal glands and testicles. Small amounts of estrone are made throughout the body in most tissues, especially fat and muscle.

An estrogen profile measures levels of the three main estrogen hormones (estradiol, estriol, and estrone) in a blood or urine sample, and additional tests may be recommended to evaluate the ratios of estrogen metabolites present in the body.

  • Estradiol is the most commonly measured type of estrogen for nonpregnant women. The amount of estradiol in a woman's blood fluctuates throughout her menstrual cycle during the fertile years. After menopause, estradiol production drops to a low but constant level.
  • Estriol levels may be measured during pregnancy, as estriol is produced in the largest amounts by the placenta, the tissue that nourishes and links the fetus to the mother. Estriol can be detected as early as the 9th week of pregnancy, and its levels increase until delivery. Estriol can also be measured in urine.
  • Estrone may be measured in women who have transitioned through perimenopause to determine their estrogen status. It also may be measured in men or women who may be at risk of cancer of the ovaries, testicles, or adrenal glands.

Indications and Contraindications

Hormone level testing of estrogens is used to evaluate for conditions such as:

  • Hypopituitarism
  • Menstrual problems (amenorrhea)
  • Fertility problems in females
  • Tumor markers for estrogen-causing cancers
  • Ovarian tumors
  • Birth defects
  • Males with gynecomastia (enlargement of the breast)
  • Efficiency of estrogen metabolism
  • Menopausal status

How do you prepare for hormone level testing for estrogen?

No fasting is required for either blood testing or urine testing of estrogens. Simple and easy instructions will be provided on how to collect the urine sample. Inform your physician if you are menstruating, pregnant, or using contraceptives.

How does it feel? How long will it take?

The blood test for the hormone estrogen is a painless procedure that lasts only a few minutes. Some patients may experience a slight stinging sensation as the needle is being inserted into the vein in your arm to draw blood. After the test, a small degree of throbbing may occur at the site.

The 24-hour urine test for estrogens involves collection of urine passed during a 24-hour period. For urine collection, avoid contaminating the sample by urinating briefly before catching the sample midstream, by not defecating immediately beforehand, and by not placing any foreign objects (e.g., toilet paper) in the container.

Expected effects following the test

There are no risks or complications for either the blood or urine tests for estrogen hormones. In blood testing, patients may experience some minimal soreness or slight bleeding at the site. Bruising or swelling may also occur.

Special instructions after the test

After drawing the blood, the needle site will be covered with a bandage and pressure applied for several minutes. If the site becomes swollen, warm compresses can be applied a few times a day. You may resume your regular daily activities after the test.

The urine specimen should be kept refrigerated during the 24-hour period before submission, and the urine-filled container should be delivered immediately after the 24-hour collection. The patient is encouraged to drink fluids during the 24 hours.

Interpretation of Results

Normal Findings

Estradiol
  Normal Result (blood test) Normal Result (24-hour urine)
Child <10 yrs < 15 pg/mL 0-6 µg/24 hr
Adult male 10-50 pg/mL 0-6 µg/24 hr
Adult female (pre-menopause) 20-450 pg/mL 0-10 µg/24 hr
Adult female (post-menopause) ≤ 20 pg/mL 0-4 µg/24 hr

Estriol (increasing estriol levels indicate normal fetal growth)
  Normal Result (blood test) Normal Result (24-hour urine)
Male/ Child <10 yrs N/A 1-11 µg/24 hr
Adult female (pre-menopause) N/A 0-14 µg/24 hr
Adult female (post-menopause) N/A 0-11 µg/24 hr
Pregnant: 1st trimester < 38 ng/mL 0-800 µg/24 hr
Pregnant: 2nd trimester 38-140 ng/mL 800-12,000 µg/24 hr
Pregnant: 3rd trimester 31-460 ng/mL 5,000-12,000 µg/24 hr

Total Estrogen
  Normal Result (blood test) Normal Result (24-hour urine)
Male/ Child <10 yrs N/A 4-25 µg/24 hr
Adult female (pre-menopause) N/A 4-60 µg/24 hr
Adult female (post-menopause) N/A 4-60 µg/24 hr
Pregnant: 1st trimester N/A 0-800 µg/24 hr
Pregnant: 2nd trimester N/A 800-5,000 µg/24 hr
Pregnant: 3rd trimester N/A 5,000-50,000 µg/24 hr

Abnormal Findings

Increased levels may be indicative of the following conditions:

  • Ovarian tumor
  • Testicular tumor
  • Adrenal tumor
  • Development of female secondary sex characteristics
  • Precocious puberty
  • Hyperthyroidism
  • Hepatic cirrhosis
  • Pregnancy of twins/triplets

Decreased levels may be indicative of the following conditions:

  • Failing pregnancy
  • Turner's syndrome
  • Hypopituitarism
  • Hypogonadism
  • Menopause
  • Anorexia nervosa
  • Stein-Leventhal syndrome

Hormone Level Testing—Progesterone

Progesterone is a female hormone produced most abundantly by the ovaries during release of a mature egg from an ovary (ovulation). Progesterone helps prepare the lining of the uterus (endometrium) to receive the egg, should it become fertilized by sperm. If the egg is not fertilized, progesterone levels drop and menstrual bleeding begins.

A progesterone test measures the amount of the hormone progesterone in a blood sample.

Indications and Contraindications

Hormone level testing for progesterone is used to evaluate or monitor conditions such as:

  • Infertility
  • Ovulation
  • Difficulty in becoming pregnant or a difficult pregnancy
  • High-risk pregnancies
  • Adrenal glands disorders
  • Menopausal status

How do you prepare for hormone level testing for progesterone?

No fasting is required prior to testing for progesterone. Inform your physician if you are menstruating, pregnant, or using contraceptives. Your physician might require you to discontinue any medications containing estrogen or progesterone for one month beforehand.

How does it feel? How long will it take?

The hormone level test for progesterone is a painless procedure that usually lasts only minutes, about three minutes or less. Some patients may note a slight stinging pain as the needle is being inserted into the vein in your arm to draw blood. After the test, a small amount of throbbing might occur at the needle site.

Expected effects after the test

There are no risks or major complications of progesterone testing. In some cases, patients experience minimal soreness or bleeding at the site. Bruising or swelling may occur.

Special instructions after the test

After drawing the blood, the needle site will be covered with a bandage and pressure applied for several minutes. If the site becomes swollen, warm compresses can be applied a few times a day. You may resume your regular daily activities after the test.

Interpretation of Results

Normal Findings

Progesterone

 

Normal Range

Female: 1-14 days (menstrual cycle)

< 50 ng/dL

Female: 15-28 days (menstrual cycle)

300-2500 ng/dL

Child: up to 15 years

< 20 ng/dL

Male adult

10-50 ng/dL

Female adult (postmenopausal)

<40 ng/dL

Pregnancy: 1st trimester

725-4400 ng/dL

Pregnancy: 2nd trimester

1950-8250 ng/dL

Pregnancy: 3rd trimester

6500-22900 ng/dL


Abnormal Findings / Other findings

Increased levels of progesterone may be indicative of the following conditions:

  • Pregnancy
  • Molar pregnancy
  • Ovulation
  • Adrenocortical hyperplasia
  • Ovarian cysts

Decreased levels of progesterone may be indicative of the following conditions:

  • Possible miscarriage
  • Toxemia of pregnancy
  • Preeclampsia
  • Fetal death
  • Amenorrhea
  • Ovarian hypofunction

Notes:

During pregnancy, the placenta also produces high levels of progesterone, starting near the end of the first trimester and continuing until the baby is born. Levels of progesterone in a pregnant woman are about 10 times higher than they are in a woman who is not pregnant.

Some types of cancer cause abnormal progesterone levels in men and women


Begin Your Journey to Wellness with Patients Medical

Our job at Patients Medical is to listen, to connect the dots between a patient's medical history, symptoms, and their underlying causes. Patients Medical is a superb place for women and men to secure integrative and holistic health care from providers who give personalized care, partner with the patient to focus on the root cause of their illness, support their recovery, and help them maintain good health.

To make an appointment with one of our physicians, please call us at 1-212-794-8800. We look forward to hearing from you.

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