Hormone Testing 101

I will keep it simple. 


Thanks for reading, it’s been fun!!

Ok, I realise that’s not very helpful, so let’s dive in.

Don’t just blame Sex Hormones

When we talk about hormones, and especially when it comes to us ladies, we tend to vilify and hyper-focus on the sex hormones. However, it’s important to remember that they are just one part of a cocktail; hormones all interact with each other. We have adrenal hormones such as cortisol, adrenaline, and energy metabolism hormones like thyroid, insulin, and there are others. The more information you can gather on ALL of these, the better you can understand your body. I also want to make something clear; in terms of symptoms, some hormone imbalances can look the same, so it’s important you guess.

Let’s start by evaluating the pros and cons of blood (serum) testing and collection. 


Has been around the longest and the most widely used and therefore the cheapest method. In general, I’m a huge advocate of blood testing for measuring many biomarkers.   For hormones such as thyroid & insulin, you can get a perfectly usable reading.  

However, for fat-soluble, sex hormone steroids like estrogen’s, (yes, it’s plural, there are three of them) progestogens, & androgen hormones such as testosterone, there are limitations. 

Hormones are potent signaling molecules that are incredibly effective at asserting action on target cells. Because they are so effective, the body regulates them tightly, by binding 95 – 98% of them to transport proteins.

Free v Bound

I like to use the analogy of commuting to work. It’s raining, so you (you being a steroid hormone) jump into a taxi, only to find yourself in the mother of all traffic jams, stuck along with hundreds of other people.  You gaze out of your misty taxi window and see a colleague who has decided to walk. It’s wet and windy, but you can see she doesn’t care.  In wonderment, you notice (annoyingly), she seems to be in her element, striding out with purpose and soaking up the fresh air.  She arrives to work on time, gets the job done, and is soon on the list for a promotion! She represents the free-hormones; they are the go-getters.

When you get a standard serum test, it measures the total level of circulating hormone, which is the sum of the bound (taxi) and the free (annoying work colleague) together. It can have its uses, particularly if you are monitoring over a long period over time. However, it can be misleading also. A person can have a ‘normal’ total hormone level, but,  if this is all bound and not enough free, they are going to feel like crap.

Diurnal Hormones

Where a serum test falls short is in measuring the adrenal hormones, such as cortisol.  Cortisol is a diurnal hormone, which means it has a circadian rhythm.  It SHOULD follow a natural slope across the day. Ideally high, but not too high, in the morning and low in the evening. If this is out of whack, it impacts on ALL other hormone production. To accurately know what your levels are at these points of the day you need to test at those times and it’s just not practical. Unless of course, you have a nurse with first thing in the morning and last thing at night to take the blood sample.

Blood tests DO NOT measure the metabolites of hormones, more of which I will cover later.

Saliva Tests 

Saliva tests can measure sex hormones & diurnal hormones, so they provide a good comprehensive profile. 

They can distinguish between bound and free-hormones, which is great!   

The downside is that it takes a fair bit of spit (yuck), and there are quite a lot of restrictions around what and when you can eat and drink, but it’s ok a relatively convenient method of collection.  It is quite a nice test if you need to make multiple collections to look at hormone patterns across the month.

Just like with serum, it also DOES NOT measure metabolites.

Dried Urine Test

Now, moving on to urine and it’s no spoiler alert that this is my favorite method. Firstly, it is ridiculously easy to take the samples.  You pee over a paper stick (a little bit like a keto or pH stick) at four, sometimes five points, across 24 hours, set them aside to dry, and THAT IS IT.  How simple is that?!  

You can see bound and free-bioavailable levels of the hormone, which we have established, is essential.

It measures sex and adrenal hormones, including the pattern across 24 hours – another win.


It’s the information on the metabolites of these hormones provided in urine analysis, which makes it the gold standard for me. 

The metabolites show you HOW THE BODY IS USING the hormones and which biological pathway they are being directed down. Some of the pathways are health-promoting, and others quite honestly are disease forming.  What you absolutely don’t want to do is add fuel to the fire. The aim is not always to increase/decrease the level of a given hormone. If it is going to keep getting shunted down a not so nice pathway, you are going to feel worse, not better. 

It is so important because it means that together, we can know where and how we need to intervene to get you back to feeling yourself again.

I’m going to cover the different pathways and their significance in a lot more detail over the coming month.

For now, I hope this was helpful.