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Types of Hormone Testing

Written By: Jillian Foglesong Stabile MD, FAAFP, DABOM

Hormones are chemicals made by the organs of your endocrine system that play a vital role in most of the body's functions. They control your metabolism, development, and reproductive functions. The body maintains a delicate balance of hormones. [1] If you have signs of hormonal imbalance, it can have a profound effect on your body and how you feel.

Hormones Commonly Tested

There are many hormones in the body, but not all are commonly tested. The most commonly requested hormone tests are generally those that affect metabolism or reproductive health.

Thyroid

The thyroid gland lives on the front of your neck and is one of the primary metabolism-related hormones. The thyroid gland is part of a feedback system that includes the hypothalamus region in your brain and your pituitary gland. [2] Thyroid hormones that can be tested include thyroid stimulating hormone (TSH), thyroxine (T4), triiodothyronine (T3), thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb), and thyroid stimulating immunoglobulin (TSI), among others. TSH is the most commonly tested thyroid hormone and can be used to diagnose thyroid dysfunction or to monitor treatment in people already diagnosed with thyroid disease. A low TSH suggests hyperthyroidism or overtreatment while a high TSH indicates hypothyroidism.

Adrenal Glands

Adrenal hormones are produced in small glands on top of your kidneys, the adrenal glands. The pituitary gland is also involved in the regulation of adrenal hormones. [3] Like thyroid testing, there are several adrenal hormones that can be tested, though the most common are adrenocorticotropic hormone (ACTH) and cortisol. ACTH is released by the pituitary gland and triggers the adrenal gland to produce cortisol. These hormones affect your response to stress and influence inflammation, sleep cycles, blood pressure, blood sugar, and other metabolic responses.[4]

Testosterone

Testosterone is traditionally thought of as a male hormone, but it is produced in both the ovaries and testicles. This hormone is higher in males and people assigned male at birth (AMAB) than in females and people assigned female at birth (AFAB). Testosterone levels vary with age and are generally lower in people with obesity. [5] Testosterone is usually measured in both protein-bound and non-protein-bound forms. Non-protein-bound protein in the body is called free testosterone. [6] Testosterone may be evaluated for a number of symptoms, including erectile dysfunction, infertility, decreased muscle mass, and problems with sex drive.

Female Reproductive Hormones

There are several female reproductive hormones that are commonly tested. Estrogens and progesterone are all produced in the ovaries and testicles. These hormones are higher in women and people with AFAB. There are three types of estrogen that may be tested: estrone, estradiol, and estriol. [7] Other female reproductive hormones that may be tested include follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These hormones are produced in the pituitary gland and affect estrogen production, follicle production for ovulation, and the development of sperm. [8]

Types of Tests Used

Blood Tests

Blood testing is considered the gold standard for hormone testing. It can be collected through spot testing through finger prick or through venipuncture which involves inserting a needle into the vein to remove a blood sample in a vial. [9]

Blood testing can be used for most hormones. There are several methods by which hormones can be measured in the blood. Blood testing is the measure that researchers use to test other methods for hormone testing. [10]

Saliva Tests

Salivary hormone testing is generally considered to be reliable and can be used to test a number of reproductive hormones. [11] Salivary hormone testing is less invasive and less stressful for many people. It has been around for quite some time. The uses for salivary hormone testing are growing as researchers find more biomarkers that can be reliably tested in saliva. [12] Salivary testing has been shown to be a viable alternative to blood testing for both male and female reproductive hormone testing as well as cortisol testing. [9] That being said, blood testing is still used most commonly in the medical setting.

Urine Tests

Urine hormone testing has been used in the clinical and at-home settings for years. Urine pregnancy tests test for human chorionic gonadotropin (hCG). There are many ovulation prediction kits available that measure the levels of LH in the urine. Urine hormone testing can be done by 24-hour collection or through multiple dried urine samples.

Studies have shown that dried urine testing is as accurate as liquid urine testing. [13,14] There are many hormones that can be tested through urine testing, including reproductive hormones such as estrogens, progesterone and androgens, adrenal hormones, some thyroid hormones, and melatonin. [15]

If you're researching hormone testing, you've probably heard of the DUTCH (Dried Urine Test for Comprehensive Hormones) test. The DUTCH test is a functional hormone test that is available through a number of laboratories.

Hair Tests

Hair testing is another method being evaluated as a method for hormone testing. Studies demonstrate that hair testing is a reliable form of testing. [16,17] Hair is another noninvasive method of testing and may have some benefit for measuring hormones over months rather than a point in time. Hormones and other compounds are incorporated into hair follicles from the blood over time as hair grows. [18]

Comparing Hormone Testing Methods

There are many reasons to consider different types of hormone testing. Here are some of the pros and cons of each.

Pros Cons
Blood Accurate – gold standard
Wide range of tests available
Commonly used by healthcare providers so they are familiar with how to interpret results 		Requires a blood draw or finger poke
Can be more expensive than other types of testing
Measures a single point in time
Urine Less invasive
May be more affordable than blood testing 		Measures fewer hormones than blood testing
May be less accurate than blood testing
Saliva Non-invasive
Generally accurate
Convenient, doesn’t usually require specific timing 		Can be contaminated by food, drink, or toothpaste
May be less accurate for some hormones
Hair Non-invasive
Gives an average over a longer period of time 		Newer so not as validated as other forms of testing

Top At-Home Hormone Testing Kits

When considering which at-home hormone test kit to use, you should consider a number of factors. Some of these include:

  • Accuracy
  • Cost
  • What certifications and lab safety protocols a lab provides
  • Whether the lab offers FDA-approved testing
  • Support from medical professionals

According to testing.com, Quest and Everlywell are two of the top at-home testing kits for hormone testing. [19] Healthline recommends Everlywell, myLAB box, and Modern Fertility test as some of their top choices for at-home hormone testing. [20]

When to Choose Professional Hormone Testing

There are many reasons why at-home hormone testing is appealing, especially if you are experiencing signs of hormone imbalance. At-home hormone testing is convenient, faster, and, in many cases, less expensive. That being said, there are reasons why it may be important to have professional hormone testing.

People with complex or unusual symptoms may need the benefit of a professional guiding their evaluation. Not all hormone imbalance symptoms are actually due to hormone imbalance, especially since the symptoms of hormone imbalance are so varied and share similarities to other conditions. [21] Severe symptoms may also require a more detailed evaluation. Another reason to consider professional testing is if you have other medical conditions that could make the diagnosis or treatment of hormone imbalances more complicated.

Check Your Hormone Levels With Everlywell

If you have hormonal imbalance symptoms, you have many options for testing. Whether you're concerned about menopause, fertility, or metabolism, Everlywell has a solution for you. If you are concerned about hormone imbalances, you can schedule a virtual visit with one of our certified healthcare providers.

Everlywell offers a range of options for at-home hormone imbalance testing you need to screen for hormonal imbalances, no matter your gender. Consider our Women's Health Test for females and people AFAB to learn about 11 key reproductive hormones like estrogen, progesterone, cortisol, and more. Men and people with AMAB might opt for the Men's Health Test to review cortisol, DHEA-S, estradiol, and testosterone levels. We also offer a Metabolism Test that measures cortisol, free testosterone, and TSH levels.

References

  1. Campbell M, Jialal I. Physiology, endocrine hormones. StatPearls - NCBI Bookshelf. Published September 26, 2022. Accessed December 19, 2024. Medical Citation URL.
  2. Shahid MA, Ashraf MA, Sharma S. Physiology, thyroid hormone. StatPearls - NCBI Bookshelf. Published June 5, 2023. Accessed December 20, 2024. Medical Citation URL.
  3. Huecker, M. R., Bhutta, B. S., & Dominique, E. (2023, August 17). Adrenal insufficiency. StatPearls - NCBI Bookshelf. Accessed December 20, 2024. Medical Citation URL.
  4. Professional CCM. Adrenocorticotropic hormone (ACTH). Cleveland Clinic. Published July 18, 2024. Accessed December 20, 2024. Medical Citation URL.
  5. Sizar O, Leslie SW, Schwartz J. Male hypogonadism. StatPearls - NCBI Bookshelf. Published February 25, 2024. Accessed December 20, 2024. Medical Citation URL.
  6. Professional CCM. Testosterone test. Cleveland Clinic. Published September 17, 2024. Accessed December 20, 2024. Medical Citation URL.
  7. Estrogen levels test. Medline Plus. Accessed December 20, 2024. Medical Citation URL.
  8. Orlowski M, Sarao MS. Physiology, follicle-stimulating hormone. StatPearls - NCBI Bookshelf. Published May 1, 2023. Accessed December 20, 2024. Medical Citation URL.
  9. Huang T, Howse FM, Stachenfeld NS, Usselman CW. Correlations between salivary- and blood-derived gonadal hormone assessments and implications for inclusion of female participants in research studies. AJP Heart and Circulatory Physiology. 2022;324(1):H33-H46. Medical Citation URL.
  10. Sluss, P. M., & Hayes, F. J. Williams Textbook of Endocrinology. 14th ed. Elsevier-Health Sciences Division; 2020:77-107. Accessed December 20, 2024. Medical Citation URL.
  11. GröSchl M. Current status of salivary hormone analysis. Clinical Chemistry. 2008;54(11):1759-1769. Medical Citation URL.
  12. Song M, Bai H, Zhang P, Zhou X, Ying B. Promising applications of human-derived saliva biomarker testing in clinical diagnostics. International Journal of Oral Science. 2023;15(1). Medical Citation URL.
  13. Newman M, Curran DA. Reliability of a dried urine test for comprehensive assessment of urine hormones and metabolites. BMC Chemistry. 2021;15(1). Medical Citation URL.
  14. Widuri A, Fakhriani R, Agustin Q, Cahyarani A. DUTCH (Dried urine test for comprehensive hormones) in preventing diseases related to hormonal function. Qanun Medika - Medical Journal Faculty of Medicine Muhammadiyah Surabaya. 2022;6(2). Medical Citation URL.
  15. Precision Analytical (DUTCH TEST). Accessed December 20, 2024. Medical Citation URL.
  16. Stern J, Arslan RC, Penke L. Stability and validity of steroid hormones in hair and saliva across two ovulatory cycles. Comprehensive Psychoneuroendocrinology. 2022;9:100114. Medical Citation URL.
  17. Auer MK, Krumbholz A, Bidlingmaier M, Thieme D, Reisch N. Steroid 17-Hydroxyprogesterone in Hair Is a Potential Long-Term Biomarker of Androgen Control in Congenital Adrenal Hyperplasia due to 21-Hydroxylase Deficiency. Neuroendocrinology. 2019;110(11-12):938-949. Medical Citation URL.
  18. Peng FJ, Palazzi P, Mezzache S, Bourokba N, Soeur J, Appenzeller BMR. Profiling steroid and thyroid hormones with hair analysis in a cohort of women aged 25 to 45 years old. European Journal of Endocrinology. 2022;186(5):K9-K15. Medical Citation URL.
  19. Testing.com. Best At-Home Hormone Tests of 2023 - Testing.com. Testing.com. Published September 29, 2023. Accessed December 20, 2024. Medical Citation URL.
  20. Goltzman J. 5 Best At-Home Hormone Tests of 2024: Should you use them? Healthline. Published December 19, 2024. Medical Citation URL.
  21. Clinic C. Do you need hormone testing? Cleveland Clinic. Published June 28, 2024. Accessed December 20, 2024. Medical Citation URL.
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