What to test, when to test, why to test are real questions to consider. Will the test give you information that you can act on? Can a test reveal the reason for physical signs and symptoms that have mysteriously shown up?
When you get your test results, will you and your practitioner be able to understand the results?
I have previously written about hormone testing in serum, urine and saliva and discussed the advantages and disadvantages of each. In this blog I want to flip this around to what testing might supply the best information.
Testing before supplementing hormones yields the best information. Once you are using hormones, it starts to get messy.
Let me describe a scenario that repeats itself over and over. Symptoms of panic attacks, anxiety, inability to sleep, brain fog become incapacitating. The feeling that you may die from heart palpitations drives you to the emergency room. You spend thousands of dollars and days of fear because the doctors target the heart as the possible source of these incidents. You then get a “all clear” and your cardiovascular system is in good shape. But you still have no idea what is causing these terrible symptoms and what you can do about it. Some may get prescriptions for benzodiazepine drugs to relieve anxiety and now the side effects (not side effects but effects!) contribute to general unwellness.
Adrenaline Dominance
If you have read Dr. Michael Platt’s book on Adrenaline Dominance, you can recognize these symptoms as indications of excess adrenaline. Since adrenaline is provoked when blood glucose drops, your whole body goes into “flight or fright” reaction. Sometimes these symptoms persist leaving one in a constant state of anxiety.
Take Charge of Your Health : Corinne and Carol interview Dr. Michael Platt on his book ”Adrenaline Dominance”
We are well aware of adrenaline as our “fit or flight” hormone, however, we also experience health problems when adrenaline is turned on constantly. We never measure this hormone, yet it is fundamentally involved in our basic glucose and insulin balance, our most primitive and fundamental hormone system.
Since considering the impact of adrenaline, it would be good to evaluate for evidence of insulin resistance. Serum levels of fasting glucose, fasting insulin, hemoglobin A1C, uric acid, and triglycerides can reveal this. What you are eating, when you are eating, and other stressors may need to be addressed. A new testing modality of continuous glucose monitoring can be a valuable tool to discover high and low glucose levels.
Methylation
But what about those that are constantly anxious? The liver detoxification process called “methylation” may be impaired. It is estimated that 40% of us have some impaired methylation processes. Not only is it the major detoxification process for adrenaline, it is also important for estrogen metabolism and a secondary pathway for histamine. Note that many are getting diagnosed with Mast Cell Activation Syndrome suffering from too much histamine. DAO enzyme is a primary detoxifier but methylation is used too.
How do you test for impaired methylation? Some have submitted samples for DNA evaluation and find MTHFR and COMT snips that indicate poor methylation. A serum test for homocysteine that is high indicates that this molecule is not getting metabolized or methylated as it should. In a 24 hour urine test, you might find an accumulation of 4 OH estrone which should be getting metabolized to 4 methoxy estrone.
Supplementing Methyl Groups
What’s the action when you have this information? You can supplement with B complex vitamins containing methylfolate and methylcobalamin. You can use methionine or SamE. Betaine is actually trimethylglycine and is often used to help with stomach acid as betaine HCl. Phosphatidyl choline is a precursor to betaine. You can supplement creatine because if you have insufficient amounts then making creatine is a methyl sink diverting the methyl groups from detoxification pathways.
Enter Progesterone: To Test?
Dr. Platt advocates the use of progesterone to help balance adrenaline and indeed, it can be a powerful tool to help overcome insulin and glucose swings and blocking some of the effects of excess adrenaline. However, there can be a life long progesterone deficiency with some. These women will have had painful menstrual cycles, missing periods, infertility, PCOS, heavy bleeding, birth control or IUD use in their history, hysterectomies, fibroids, and ovarian cysts. Very generous progesterone dosing might be needed.
How do you test for progesterone deficiency? Serum tests during the follicular phase can reveal low progesterone that is mainly produced by the adrenal glands. Serum testing in the days 18 to 21 in the luteal phase can reveal if ovulation has occurred in this cycle or not. Low levels of progesterone in the serum would show that the lovely generous rise in progesterone from the corpus luteum has not occurred. Collections of urine over 24 hours can reveal if a progesterone metabolite has been produced efficiently or not. Saliva tests can also be used to evaluate progesterone, however, the difference between follicular and luteal levels in the saliva is not as marked as in serum.
Now for the messy part. Oral progesterone capsules can raise serum levels. However, it is crucial that a serum sample be taken within 4 to 6 hours of the last dose to see that rise. In 12 hours, there would be little change. Saliva testing can yield somewhat normal levels and so can urine testing. If you use progesterone in a cream, suddenly progesterone levels go off the charts with saliva while serum tests would reveal little change. Should we just use oral progesterone because it gives us better test results? Some of the medical organizations say just that. They claim that only oral progesterone which can raise serum levels confirm that the progesterone is sufficient to prevent overgrowth of the endometrium. However, many clinicians have used progesterone creams successful for many years without endometrial proliferation. To determine that answer, a vaginal ultrasound can be performed to evaluate the thickness of the endometrium.
Testing Pitfalls
There are so many pitfalls when evaluating test results. For example, the normal ranges of testosterone levels in both men and women have been lowered in recent years as a consequence of declining testosterone is frequent but certainly not optimal. Sometimes labs report age adjusted normal rather than lifetime ranges for hormones. This leads to the perception that declining hormones are normal rather than having underlying causes for low hormone levels. Some ranges are contrived like those for cholesterol. We have abandoned the ranges produced for other analytes in population evaluations for ranges determined by “expert” committees. Hormone levels vary constantly and tests reveal just a snapshot for that day for the moment. Very little attention is paid to what symptoms were evident on the particular day and time of testing.
It’s been very popular to test for sex hormones or sometimes for adrenal hormones during the perimenopausal period, but this leaves out all the other hormone systems that are contributing to the loss of wellbeing. To test for just a few hormones and leave out cholesterol and other lipids, vitamin D, pituitary hormones, blood differential and chemistry, inflammatory markers, complete thyroid panel yields insufficient information.
Finally, the real test is resolution of symptoms that are associated with low hormones or excessive expression of hormones. This requires understanding the functions of various hormones and taking charge of your own health by observing what works and what doesn’t. Knowledge is power.