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HORMONES: WHICH TEST IS BEST I'm sorry to disappoint you, but after 8 years in this field, I find no convincingly clear answer. I personally have done them all and will shortly do all of them on one day to see how the results compare. But I will give you the data to help you decide if you should do a blood, urine or saliva test. I have interviewed the directors of the best labs, who offer either blood, urine or saliva testing for hormones. And not surprisingly, each assured me without a doubt that their test was the best. Otherwise, they would offer the other tests in their lab as well. The hormones that you want to make sure to test for are: Estradiol, Estrone, Estriol, Progesterone, Testosterone, Dhea, and the ratio of 2-hydroxyestrone to 16-alpha hydroxyestrone. All you need to remember about this ratio is that there is possibly a decreased risk of breast cancer when the ratio of the "2" to the "16" is greater than 2. And if it is not, not to worry. You can increase the ratio by eating ground flax seeds in your yogurt or smoothie or on your cereal. However, keep the flax seeds in the fridge or freezer so that they don't become rancid. Soy in moderation, in the form of tofu, tempeh, soy, miso, soy milk etc. can also raise the ratio. Please make sure that the soy you ingest in any form is either organic or non-GMO(genetically modified) or you run the risk of ingesting more pesticides. Pesticides themselves can upset one's hormonal balance. The reason that you need to test for all three estrogens listed above is that one, estriol, is considered beneficial. And estradiol and estrone are considered possibly carcinogenic depending on how one's body converts and breaks down these hormones. So it is important to know the levels of all of the estrogens so that should a woman decide with her doctor to dose with bio-identical hormones (and not synthetic, I hope), that they are dosed in the most beneficial ratio. OK. Now the tests: 1) Blood or serum. This test is a "snapshot" of what hormones are available in what quantities to the tissues at that moment in time. This test looks at the "reservoir" of what is there to be used. To measure all of the hormones above, this test can get expensive. 2) Urine. This is usually a 24-hour urine collection. It has been the gold standard of some very astute scientists for many years. It measures the output in the urine of all of the above hormones over a period of 24 hours. So it is not a "snapshot " of a moment in time. The saliva experts will argue that it only measures what the body's tissues have not used. The urine experts argue that it measures the by-products of hormone metabolism, which can give a more accurate picture of how the body is using and converting the hormones that are being produced or given. It is easy to collect the 24-hour urine specimen, if one remembers to collect evey time one urinates. It can be an expensive test. 3) Saliva. This is usually the least expensive test. It is easy to collect. The saliva advocates believe that the saliva reflects directly the amounts of hormones which are found in the tissues, reflective of what is being used,not stored or excreted. There are some drawbacks to this test: hot beverages, certain foods and medications, taken before the test can interfere with results as well as chewing gum, sugar in gums, or blood in the saliva from periodontal disease. Taking sublingual hormones can give false high saliva hormone levels. If you do the saliva test, then you will have to do the 2:16 ratio test by blood or urine. When to do your first baseline hormone test? This varies based on the individual. When a woman feels or knows that something is not right is the time to do a hormone test. i.e. you can be 25 and not get your period due to low body weight or over-exercising. You can be estrogen dominant and have severe PMS and need a little natural progesterone, you can be perimenopausal or post menopausal or or have low libido, hot flashes or be moody, depressed, sleepless and anxious and know that the doctor and T.V. are wrong about needing Prozac, Paxil, or Xanax. Where to get tested? I would suggest working with a M.D., a D.O., or ARNP who is familiar with and has used all of the diffferent tests to see which is best for you and help you interpret the results of the test. And if you need supplemental bio-identical hormones, they can be ordered by that practitioner. I would not order the test over the internet and then try to dose myself or be dosed by an unlicensed individual. This can have harmful consequences. If the practitioner is schooled in nutrition and nutritional testing, it would be wise to have them test your minerals, fatty acids, protein status, adrenals, thyroid and gastointestinal system, because they can all influence the production of hormones. If testing the body's systems other than the hormones is not their speciality, find an N.D. or Chiropractor who does this type of testing. You can find a M.D. or D.O. in your area by going to www.acam.org. or www.brodabarnes.org. or www.aaem.com. Every woman can have physical well-being. Part of it is lifestyle, nutrition, exercise, fresh air, sun, pure food and water, adequate rest, and balanced hormones. Part of balanced hormones is to get knowledge on what they are and how they work, and then to find a practitioner to be a partner in that balance. Sue Minkoff R.N. BSN References Clinical Value of 24-hour Urine Hormone Evaluations by Alan Broughton, MD Saliva Hormone Testing by David Zava, PhD     Copyright © 2010 Optimum Health Report, All Rights Reserved. Disclaimer