What to test, when to test, and why to test are real questions to consider?

Guest Blog by Carol Petersen, RPh, CNP

What to test, when to test, and why to test are real questions to consider. Will the test provide actionable information? Can a test reveal the reason for physical signs and symptoms that have mysteriously showing up? When you get your test results, will you and your practitioner be able to understand them?

Hormone Testing

I have previously written about hormone testing in serum, urine, and saliva, and discussed the advantages and disadvantages of each. You can read more about that here: Testing for Steroid Hormones. Recommended tests are included.

In this blog, I want to shift the focus to what testing might supply the best information.

Importance of Testing Before Supplementing

Testing before supplementing hormones yields the most accurate information. Once you begin hormone therapy, interpreting test results becomes more complicated.

Common Scenario: Misdiagnosed Symptoms

A recurring scenario involves incapacitating symptoms such as panic attacks, anxiety, inability to sleep, and brain fog. These symptoms often lead individuals to emergency rooms, where doctors target the heart as the possible source, only to declare the cardiovascular system in good shape after extensive testing. The cause of the symptoms remains unknown, leaving the individual in distress. Some may receive benzodiazepine prescriptions to relieve anxiety, but these drugs introduce additional side effects.

Adrenaline Dominance and Insulin Resistance

Dr. Michael Platt’s book on Adrenaline Dominance links these symptoms to excess adrenaline. When blood glucose drops, adrenaline spikes, triggering a “flight or fright” reaction. This state of anxiety may persist. Evaluating insulin resistance can be helpful in such cases. Tests like serum levels of fasting glucose, fasting insulin, hemoglobin A1C, uric acid, and triglycerides can reveal insulin resistance. Continuous glucose monitoring is a new testing modality that can help identify high and low glucose levels.

Methylation and Anxiety

Those who are constantly anxious may have impaired liver detoxification, specifically in the methylation process. It is estimated that 40% of people have some level of impaired methylation. This process detoxifies adrenaline and plays a role in estrogen metabolism and histamine breakdown.
Methylation issues may also contribute to conditions like Mast Cell Activation Syndrome. Testing for impaired methylation can be done by DNA evaluations showing MTHFR and COMT snips, serum tests for homocysteine, or 24-hour urine tests indicating an accumulation of 4 OH estrone.

Supplementation for Methylation Support

Once you know there’s an issue with methylation, various supplements may help:

• B complex vitamins containing methylfolate and methylcobalamin
• Methionine or SamE
• Betaine (trimethylglycine)
• Phosphatidyl choline
• Creatine supplementation may also be beneficial, as low creatine diverts methyl groups from detoxification pathways.

Progesterone and Adrenaline

Dr. Platt advocates using progesterone to balance adrenaline. Progesterone can help regulate insulin and glucose swings while blocking excess adrenaline’s effects. For some women, progesterone deficiency may be lifelong, evidenced by symptoms like painful menstrual cycles, infertility, PCOS, heavy bleeding, or a history of hysterectomy or ovarian cysts. In such cases, higher doses of progesterone might be required.

Testing for Progesterone Deficiency

• Serum Testing: Serum tests during the follicular phase can reveal low progesterone produced by the adrenal glands. In the luteal phase (days 18 to 21), serum tests can show whether ovulation has occurred.
• Urine Testing: A 24-hour urine test can reveal if progesterone metabolites are produced efficiently.
• Saliva Testing: Saliva tests can be used, though the differences between follicular and luteal levels are less pronounced compared to serum.

Testing During Progesterone Supplementation

Oral progesterone can raise serum levels, but the timing of testing is crucial. A sample must be taken within 4 to 6 hours of the last dose for accurate results. Saliva and urine tests may also yield normal levels, but the form of progesterone (oral vs. cream) impacts these tests differently.

Evaluating Endometrial Health

While some organizations claim only oral progesterone is effective in preventing endometrial overgrowth, many clinicians successfully use progesterone creams. Vaginal ultrasounds can assess the thickness of the endometrium to ensure proper management.

Pitfalls in Hormone Testing

There are several pitfalls in hormone testing. For example, testosterone levels have been adjusted downward over time, reflecting population decline rather than optimal levels. Age-adjusted normal ranges sometimes overlook underlying causes of low hormone levels. Hormone levels fluctuate constantly, and test results only provide a snapshot of that moment, often without correlating symptoms to the time of testing.

Comprehensive Testing

Focusing solely on sex hormones or adrenal hormones during perimenopause neglects other important hormone systems. A complete assessment should include cholesterol and other lipids, vitamin D, pituitary hormones, blood differential, chemistry, inflammatory markers, and a complete thyroid panel to gather sufficient information.

Conclusion: The Real Test

Ultimately, the most reliable test is the resolution of symptoms associated with low or excessive hormone expression. Understanding hormone function and observing what works for your body puts you in control of your health. Remember, knowledge is power.

About Carol:

Carol is a colleague of Dr. Michael E. Platt has endorsed his books “Adrenaline Dominance” and “The Platt Protocol for Physicians.”

Carol Petersen is an accomplished compounding pharmacist with decades of experience helping patients improve their quality of life through bioidentical hormone replacement therapy. She graduated from the University of Wisconsin School of Pharmacy and is a Certified Nutritional Practitioner. Her passion to optimize health and commitment to compounding is evident in her involvement with organizations including the International College of Integrated Medicine and the American College of Apothecaries, American Pharmacists Association and the Alliance for Pharmacy Compounding She was also the founder and first chair for the Compounding Special Interest Group with the American Pharmacists Association. She is chair for the Integrated Medicine Consortium. She co-hosts a radio program “Take Charge of your Health” in the greater New York area. She is on the Medical Advisory Board for the Centre for Menstrual Cycle and Ovulation Research (CeMCOR.ca).