When I was practicing medicine, I had the option of suggesting a number of possible ways to test hormone levels in patients. Each had their own advantages and disadvantages. I will be discussing each, with no relationship to preference.

Saliva testing is a popular method utilized by many practitioners. After receiving the kit, it has the advantage of being a test done at home. Depending on the tests being ordered, up to four specimens are submitted obtained at various times during the day. My own feeling is that it may be a useful kind of test from hormone screening but may not be useful for people who are on hormone creams. I say this because levels obtained appear to be inordinately high. The cost is fairly comparable to laboratory testing and may be covered by some insurance companies.

There are blood testing kits available as well that can be done at home. One of the disadvantages is that there is little flexibility about the available testing. For example, it allows for PSA testing but not the free PSA that should always be ordered with it. It has screening for men and women but does not include progesterone levels for men. The cost is comparable to saliva test and may possibly be covered by insurance.

Personally, I have always felt more comfortable with blood drawn for hormone analysis. I had the advantage of having the blood drawn on site and received excellent rates from various labs for all the blood tests. I also had the advantage of being able to request the exact testing that I wanted done. For example, when I tested for a CA 125, a screening test for cancer of the ovary, the lab charged about $25 as opposed to the usual charge of $185 when people use insurance.

When it came to evaluating a person’s hormone levels, I always found that often they were best determined by sitting down and talking to a patient. Usually, one can never go wrong treating a patient, but one can go wrong treating a lab test. The reason for this is that hormone levels go up and down during the day, during the week, and during the month, so that blood drawn at a particular time may not correlate with true values. For example, in women that are still menstruating, blood drawn around the time of their periods will demonstrate extremely low levels of estradiol and progesterone. Blood obtained in the afternoon will have low levels of cortisol. Testosterone levels in men are usually low because it is released at 4 o’clock in the morning and descends throughout the day. Generally speaking, women in the menopause will have low levels of all the ovarian hormones. Unfortunately, the standard of care dictates that doctors obtain hormone levels before they treat which adds to the cost of getting hormones in balance. Obviously, it would make more sense to get the level done after they are started on their hormones.

Tip of the day: For those of you on thyroid, please remember to take it on the day of your testing even if the test was ordered fasting.