Tests to assess your hormones

What testing can help you understand your acne or PCOS?

The below testing options will give a huge amount of information and may uncover your drivers and the root cause of your acne, PCOS or post pill acne. First things first, if you are on birth control or recently come off it <3 months, you are going to need to park getting your estrogen, progesterone, LH and FSH done. However, you can still test a lot of other markers of health.

WHEN SHOULD I LOOK AT TESTING?

If you are well, healthy, and feeling great, with no real ailments or things to complain about, once every two years is a good timeline for a check-up and to get some testing done to assess your health.

However, if something is up; you’re tired all the time, you have acne, your periods have gotten heavier, you have no libido, it warrants some further investigation. On top of blood work, there are some very insightful functional pathology testing as well. 

WHAT TESTS CAN HELP ME UNDERSTAND MY HEALTH BETTER?

See below some valuable markers, food sources and how they support health. Those marked with an * are of particular value if you eat a predominantly plant-based diet. 

VIT D*– SUNSHINE AND EGGS AND FATTY FISH.

• Immune function
• Bone mineral density
• Heart health

B12* – ANIMAL PRODUCTS

• Gut health
• Energy
• Nerve and brain
• The health of red blood cells

FOLATE – BEANS, EGGS, LEAFY VEGETABLES

• Energy
• Mood 
• DNA repair
• The health of red blood cells

IRON STUDIES* – ANIMAL PRODUCTS, BEANS, SEEDS

• It’s important to understand energy levels
• Thyroid health
• Bone homeostasis
• Growth
• Mood regulation
• Memory and concentration

– Iron, Zinc and Vit A all have a relationship helping or impacting each other’s absorption. If you have been taking the above as supplements, then this needs to be monitored. 

ZINC* – SEAFOOD 

• Numerous enzymatic processes in the body
• Hormones
• Insulin
• Wound healing
• Immunity
• Sensory functions – low impacts on our relationship with food

Zinc isn’t a mineral that is commonly tested, however, if you have a skin concern disordered eating or hormonal imbalances it is crucial to know your zinc status. Long term zinc supplementation can impact iron and copper, so understanding levels and only supplementing when needed is very important

RBC

Red blood cell count will give more of a complete picture to understand potential anemia, folate, B12 or iron deficiencies.

THYROID PANEL.

TSH, T3, T4, thyroid antibodies.

Standard practice is to test TSH and only test the other parameters if TSH is out of range. Unfortunately, we know sub clinic thyroid conditions are immensely common. It is shown that the other thyroid markers can be out of range for up to 5 years prior to it impacting TSH.

LIPID PROFILE

Important to understand the levels and breakdown of cholesterol and not just cholesterol. Looking at HDL, LDL and triglycerides can give information on the impact of the diets or if there is a genetic component at play. 

LIVER FUNCTION

The liver has a huge impact on skin health and hormone clearance. It is a large detox organ. Our diet and lifestyle have a huge impact on the liver. Markers can give us an indication if our liver is overworking with increasing enzymes. 

FASTING INSULIN/ HBA1C

Similar to cholesterol and lipid studies, insulin is hugely important for overall health. In particular PCOS it is very helpful to test for insulin resistance.

Measurement of insulin either in the fasting state or during an oral glucose tolerance test is not a clinically useful method (and maybe costly because of the insulin assay) to estimate insulin sensitivity. The hyperinsulinemic-euglycemic (HIEG) clamp is the gold standard for assessing insulin sensitivity as it is possible to assess tissue-specific sensitivity and can be used in all types of populations. This feature is important because a method of standardisation must be developed to control for various factors prior to any methods for measurement.

CORTISOL

High-stress periods, long chronic ongoing stress and fatigue not relieved by resting could be helpful to check cortisol. Cortisol and progesterone both require the precursor pregnenolone to make adequate, stress up often will impact ovulation and progesterone production negatively. Pregnenolone is a steroid hormone that plays a key role in the production of other steroid hormones, including progesterone, DHEA, and estrogen

DHEA

An androgen that is produced by the ovaries and adrenal glands and makes other hormones such as testosterone. A certain subset of PCOS is driven by stress and elevated DHEA levels, checking this can help PCOS understand what type and what drivers are behind their PCOS

FEMALE HORMONES, PROGESTERONE (DAY 21), LH, FSH, ESTRADIOL.

These tests are SO important for assessing hormonal health, PCOS and acne drivers.

Collectively they help us understand the health of our reproductive organs, our egg quality and reserves if we are ovulating and making quality progesterone if we have high or low estrogen. 

TESTOSTERONE, FAI & SHBG

Testosterone is important for energy, libido and bone health. Commonly both acne and PCOS see huge issues with excess androgens. 

PROLACTIN

Is made when women are lactating, levels can be disrupted outside these times. High prolactin can cause acne and look very similar to PCOS.

WHAT PREPARATION SHOULD I DO PRIOR?

For the most accurate results tests are best done,

• Fasted
• Calm
• No high intensity exercises the day prior
• No sex prior (prolactin)
• Stopping all supplements up to 7 days prior
• First thing in the morning

TESTING HORMONES?

• Ideally day 21 for estrogen, progesterone and FSH/LH.
• You can also test on day three for FSH/LH and oestrogen.

HORMONE TESTING, BLOOD, SALIVA OR URINE? WHAT ARE THE PROS AND CONS?

It’s important to realize the limitations of any test method before employing them and while blood and salivary testing are quick and convenient, they too have their own limitations.

SERUM (BLOOD) TESTING: 

Pro: Can be used to assess both free and total hormones

Cons: Doesn’t provide an accurate reflection hormone at work in the tissues (we call these bioavailable hormones).

Cost – can be free via a GPs referrals

Out of pocket costs can be $30 up to $170 depending on what you will test.

SALIVARY (SPIT) HORMONE TESTING: 

Pro: Assesses hormones (cortisol, DHEA, estrogen, progesterone and testosterone) available at the cellular level

Cons: Fails to give any information about how those hormones are processed and metabolized by the body.

Cost – Out of pocket costs can be $100 up to $500 depending on what you will test.

WHAT IS A DUTCH TEST?

The DUTCH test stands for Dried Urine Test for Comprehensive Hormones and is the gold standard in hormone testing. It tests hormone production, adrenal function, melatonin production, oxidative stress markers and a full breakdown of hormone metabolites. 

Cost – Out of pocket cost $380 – $500

Treating hormones isn’t just a matter of hormones being too low vs. too high. Together, we have to determine: Is there a production issue, a processing/metabolism issue and/or a detoxification/elimination issue? The DUTCH test gives me a complete picture of hormone production, metabolism and detoxification routes and helps direct treatment so you get full, lasting resolution of your skin and hormonal concerns once and for all!

WHERE TO GO FROM HERE?

Testing can sound simple but it also can get tricky as you delve into a deeper understanding of your health. As we know acne and PCOS is multifactorial, and some tests are crucial. If you are interested to do some testing or have questions regarding your currents tests, there are a few options when it comes to working together you can view appointment types on offer. 

Lindsay