The Basics of Hormone Testing Compare the pros and cons of serum, , 24-hr urine and testing with and without HRT. Effective HRT Limited HRT Not Strengths Weaknesses Monitoring Monitoring Recommended

Serum testing is reliable and well-suited The testing of does not Oral and Hormones applied to Sublingual hormones as well for testing reproductive hormones. include the daily free pattern DHEA as well as mucosal membranes (i.e. as oral Pg can lead to highly or metabolites. hormone patches, vaginal) are difficult due to misleading results. While it does not include metabolites, pellets and injections unpredictable peaks and serum testing for “total” and “free” E2, T, While testing sex hormones are monitored well. valleys. Be careful not to overdose and Pg is the gold standard (if not on HRT). is effective, there are limited when using transdermal

Serum metabolites available. products.

The benefit of measuring free cortisol Accuracy for estrogens is Oral estrogens and Hormones applied to Sublingual hormones throughout the day is well documented. not adequate for proper DHEA as well as mucosal membranes (i.e. and oral Pg should not differentiation of pre and hormone patches vaginal) are difficult due to be tested. Saliva’s best use is in testing Pg and E2 postmenopausal women and injections are unpredictable peaks and throughout the . Accurate (compared to serum/urine). monitored well if valleys. While it is popular to monitor and adequately sensitive salivary testing the lab quality is transdermal hormones can be useful for identifying ovulatory The benefit of measuring free of high caliber. with saliva testing, this is and luteal peaks. cortisol is undermined by the not recommended (see Saliva lack of cortisol metabolite comments on reverse side). measurements.

Urine testing, when done well, is Adrenal testing lacks the daily Hormone patches, When hormones are Oral Pg requires an accurate method for assessing free cortisol pattern. Many labs pellets and injections swallowed results are additional metabolites reproductive hormones. See note on test “total” cortisol, not “free.” are monitored well. artificially increased due than usually offered. * Testing. to 1st-pass metabolism. All urine *Testosterone Testing The timing and manner Vaginal hormones often The inclusion of metabolites offers can show falsely low results if of collection must be contaminate samples. Urine additional information that is not a genetic defect in metabolism carefully considered. Skip available in serum or saliva. exists. It is more prevalent in oral estrogens, DHEA those of Asian descent. the day of testing. If any testing includes extra sublingual hormone is metabolites to identify when swallowed, results are of 24hr this occurs. limited value.

Uniquely comprehensive Not appropriate for those Works uniquely well As above for 24hr Urine. Recommended for testing with the easiest with abnormal creatinine for oral Pg (additional When hormones are monitoring metabolism patient collection. excretion (kidney issues). metabolites) and taken by mouth and are patterns but NOT vaginal hormones swallowed, E2 and T may appropriate hormone Increased clinical utility for cortisol testing by Same as above for urine *Testosterone Testing. (special method to be artificially increased due dosages for oral estrogens providing the daily free pattern and metabolites. remove contaminating to 1st-pass metabolism. In and most sublingual Click here to see a video to hormone). these cases, the test is used hormones. Extensive estrogen and metabolites. explain this complex hormone Works well for for evaluating metabolism testing issue. hormone patches, patterns, but is of limited pellets and injections. use (or sometimes no use) for monitoring the dose.

What about transdermal creams? See comments on the reverse side for clarity on this controversial issue. dutchtest.com Good Effective Options Testing Matrix & Video Tutorials Not Ideal, Use with Caution Not Recommended

For Optimal Hormone Monitoring T = Testosterone E2 = Pg = Progesterone Baseline Testing (no HRT) With Hormone Replacement

Patches, Pellets Transdermal (skin) Oral Pg Oral Estrogen Vaginal/Anal Sublingual Sex Hormone Adrenal Injections Creams/Gels Well accepted and Lacking the daily Actual Pg The return to Rise and fall is Serum is Results return ThereMonitoring is no transdermalreliable test hormonesfor reliable FDA-cleared (diurnal) free values do not baseline is much unpredictable, so well-suited for close to baseline optimizingis contraversial dosages and notwith methods, but limited cortisol pattern increase to slower than with timing the testing testing with too fast for transdermalentirely clear. hormones. With Serum metabolites offered. as well as premenopausal Pg. Effective for well is difficult. these forms reliable testing modest doses, salivary results metabolites. levels and estrogens and of HRT. (<3hrs). showGenerally, dramatic salivary increases values increaseand return to DHEA. serum/urinedramatically valuesmore than increase serum or baseline quickly. onlyurine, slightly especially (at times, for progesterone. not at all). E2 in particular is Lacking cortisol Metabolites can Likely less Rise and fall is Likely less Contamination Available data does NOT support difficult to measure metabolites, the cause falsely accurate than unpredictable, so accurate than of the mouth theSaliva conclusion testing is that not salivaryeffective for in saliva. Levels of gold-standard elevated values. serum due to timing is difficult. serum/urine lasts far measurementsmonitoring therapy are clinicallyas values: E2 are 1000x less for assessing Lab values may general analytical Saliva not proven due to general longer than meaningful. Values are wildly • Often differ more than 5-fold Saliva than in urine and total cortisol increase with difficulty for this ROA. analytical the systemic variable and often contaminated. * from one day to the next accuracy is highly production. dosages but are difficulty* hormone # Results go up dramatically if method-dependent* not clinically increase. the• Do application not appear site to isreflect close to meaningful. thesystemic saliva gland. exposure Pg values have been shown to be exceptionally • Can remain elevated for Results highly Lacking the Not effective Adjusting dosing Works for Pg, A very good Adjusting dosing elevated more than 7 months after more than 6 months after the dependent on lab daily (diurnal) unless testing using urine E2, T are likely option. using urine treatment stopped. Symptoms 24hr cessation of therapy (with Pg) quality. Quality free cortisol includes testing is difficult contaminated. Metabolites testing is very show relief at lower doses, while results are accurate pattern. active (alpha) because of 1st- expand the difficult because Urine higherGiven thedoses elevated are needed salivary to values, and include metabolites. pass metabolism clinical picture. of 1st-pass increase serum or urine lab values. metabolites. that leads metabolism of serum/urine may under-represent Givensome tissuethe salivary exposure, elevations, and it to increased any hormone is likely that serum/urine testing levels from swallowed. providers should use caution to Accurate testing IDEAL OPTION Inactive Special method A very good mayavoid underestimate overdosing. tissue levels that includes Diurnal Free (beta) and hormone that removes free option. of hormones. Serum/urine levels has not been in metabolites with an Cortisol Pattern active (alpha) hormone Metabolites mayE2 increases increase urine/serummuch more levelswhen easy collection. AND Metabolized metabolites circulation as contamination. expand the using alcoholic gels. Urine testing “free” hormone. to a higher degree than Pg, while Cortisol along with tested for Some local phase clinical picture. Great for providesthe opposite valuable is true information in saliva. It onis more useful Great for II metabolism monitoring metabolismnot entirely clear patterns, what butPg/E2 no ratiotests information. monitoring may increase E2/ metabolism reliablyis needed help in inorder adjusting to protect HRT the metabolism. E3 levels. patterns. dosages.endometrium. Best Practices for HRT Monitoring Serum and urine are more Patch, Pellets consistently increased with some Oral Pg Oral Estrogen Vaginal/Anal Sublingual Injections application techniques, and we continue to research this topic. Most lab Serum is best Only offers Use caution Proceed with caution! testing is of for adjusting avoids the most when monitoring WATCHWhile adjusting THE VIDEO dosing FOR is marginal dosages. contamination information. dosing. Use DETAILS!complicated with any test, urine value. can be used and offers Any test can testing testing also allows the testing of metabolites can to include metabolites. be effective. for metabolites. metabolite patterns. offer insight metabolites. into dosing.

To access our video links, go to dutchtest.com and download our online interactive matrix.