Everything You Need To Know About Hormone Testing

Written By: Jillian Foglesong Stabile, MD FAAFP

What Is Hormone Testing?

Hormone testing is a very broad topic as there are multiple hormones affecting different body systems. Hormone testing is generally done through blood testing, sometimes as part of routine healthcare maintenance or in response to specific symptoms or health concerns. Some hormones can be drawn anytime, while others require specific timing.

While blood testing is the most common way hormones are tested, saliva and urine testing may sometimes be performed. Many hormone tests can be ordered by your primary care provider, but some types of hormone imbalances can benefit from management by a specialist such as an endocrinologist.

Common Reasons To Consider Hormone Testing

There are many reasons that hormone testing may be necessary. Sometimes, abnormal lab results may point to the need for testing. At other times, the need for labs may be indicated by your symptoms.[1] Hormone testing is generally done for one of three reasons.

• Screening: Determine if hormone levels are in normal range or track them over time
• Diagnosis: Determine if specific symptoms you are experiencing are related to hormone imbalance
• Monitoring: Monitor for effects of treatment

Types of Hormone Tests

Hormone testing can be done in several ways. Blood testing is most common, but hormones can also be tested through urine and saliva.

Urine hormone testing can be done on either liquid or dried urine. Studies have shown that dried urine testing is as accurate as liquid urine testing.[2] Some of the testing that can be performed on urine includes reproductive hormones such as estrogens, progesterone, androgens, adrenal hormones, some thyroid hormones, and melatonin.[3] Your healthcare provider can advise you on whether urine is the best testing option for you. Urine can be tested as a 24-hour collection or through dried spot testing.

Salivary hormone testing has been used for many years. Salivary hormone analysis is a noninvasive and less stressful option for testing for many people. It consists of spitting into a vial. It can be used to test many reproductive hormones.[4] It is generally considered to be reliable. Blood testing can evaluate many different hormones. Blood testing can either be done as blood spot testing or through venipuncture, which is done in a lab. Venipuncture usually consists of putting a tourniquet around your arm and introducing a needle into the vein to remove a blood sample. Blood testing is considered the gold standard for hormone testing.[5]

Hormones Commonly Tested

Many types of hormones can be tested, but some are more common than others.

Thyroid

The thyroid gland lives at the base of your neck and is part of the system that controls your metabolism. Other parts of this system include the hypothalamus (a region in your brain) and the pituitary gland.[6] There are many types of thyroid testing available. Some of these include thyroid stimulating hormone (TSH), thyroxine (T4), triiodothyronine (T3), thyroid antibodies such as thyroid peroxidase (TPOAb), thyroglobulin antibody (TgAb), and others. Thyroid testing can be used to diagnose thyroid disease or monitor treatment.

Thyroid hormone interpretation can be challenging. In general, a low TSH indicates too much thyroid hormone (hyperthyroidism) while a high TSH indicates too little thyroid hormone (hypothyroidism).[7,8]

Parathyroid

The parathyroid glands are four small glands that live on the back of your thyroid gland. Parathyroid testing is used to evaluate for potential causes of abnormal calcium or phosphate metabolism or to monitor people with kidney disease or osteoporosis. It can also be used for diagnosis or treatment.[9] Parathyroid hormone levels are interpreted in relation to the calcium levels in the blood.

Reproductive

Reproductive hormone testing includes estrogens, progesterone, follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, and prolactin.

Testosterone is produced in both the ovaries and testicles. Testosterone hormone levels are naturally higher in people assigned male at birth (AMAB) compared to those assigned female at birth (AFAB). Testosterone levels may be measured as free or total. Free testosterone is not protein-bound in the body. Total testosterone measures both the testosterone that is free and protein-bound.[10] Testosterone testing may be done for problems such as erectile dysfunction, low sex drive, decreased muscle mass, or infertility.

Estrogens and progesterone are produced in the ovaries and testicles. There are three types of estrogen: estrone, estradiol, and estriol.[11] Estrogen testing can be used to monitor for problems with puberty, unusual breast growth in males or people AMAB, infertility, menstrual problems, pregnancy, erectile dysfunction, or following treatment for some of these medical conditions. Progesterone levels may be drawn if someone is struggling to get pregnant, has abnormal menstrual bleeding, or is at risk of miscarriage.[12]

Adrenal

Adrenal hormone testing includes adrenocorticotropic hormone (ACTH) and cortisol. ACTH is produced in the pituitary gland and is involved in stress response. ACTH triggers your adrenal glands to produce cortisol and androgen hormones. Together, ACTH and cortisol control how the body responds to stress, metabolic response, inflammation, blood pressure, blood sugar, and the sleep-wake cycle.[13] Low ACTH can occur due to pituitary problems or Cushing’s syndrome. High ACTH levels can be caused by Cushing’s disease, tumors, or adrenal insufficiency.

Cortisol testing can be used to diagnose Addison’s disease, Cushing’s syndrome, and some types of tumors. Cortisol is made in the adrenal gland. Cortisol testing is generally done either as a timed test (with or without suppression) or a random test. It is normal for cortisol levels to rise and fall throughout the day. It can also be affected by other medical conditions such as thyroid disease, obesity, and pregnancy. Stress (physical or emotional), medications, infection, injury, exercise, or disease can also affect your cortisol levels.[14]

Signs You May Need Hormone Testing

There are many reasons you may need hormone testing. If you don’t have a condition that needs monitoring, you may benefit from hormone testing to evaluate for hormone imbalances. Some of the signs that you are experiencing hormone imbalances include[1]:

• Irregular menses
• Infertility
• Symptoms of menopause (hot flashes, vaginal dryness, night sweats, mood changes)
• Fatigue
• Unusual hair growth (loss of hair in places you expect it or hair where you don’t)
• Acne
• Unexplained weight changes
• Recurrent miscarriage
• Hair or skin changes
• Sleep problems
• Decreased sex drive
• Muscle loss
• Recurrent infections or illness
• Joint pain or stiffness
• Unusual stretch marks
• Puffiness of the face
• Intolerance to cold or heat
• Anxiety
• Depression

This is not an exhaustive list of symptoms that may indicate a hormone imbalance, nor is hormone imbalance the only thing that can cause these symptoms. Talking with your healthcare provider is the best way to determine what type of testing is right for you.

How At-Home Hormone Testing Works

Hormone testing at home is easy. When you receive your kit, there are instructions to walk you through the steps. You’ll generally need to register your kit online with the company you purchased it. After reviewing the instructions, collect the sample (blood, saliva, and/or urine). Pay attention to any timing for drawing tests recommended by the company. The testing may involve spitting into a container, poking your finger to draw blood, peeing into a cup, or collecting swabs.[15] After collecting your sample, package it according to the instructions and send it back to the lab. Within a few days of the lab receiving the sample, you should be able to access the results.

Comparing At-Home and In-Clinic Hormone Testing

At-home hormone testing is usually not used by clinic-based healthcare providers. The accuracy and quality of at-home lab testing can be variable. These tests rely on the patient to collect the tests according to the instructions and can potentially risk contamination. In-clinic-based laboratories adhere to strict quality standards and do regular quality control evaluations. At-home lab testing may not provide a full picture of what is going on and may not be subjected to the same approval processes through the Food and Drug Administration (FDA).[17] Labs ordered by a healthcare provider also come with the advantage of the healthcare provider’s guidance to interpret the labs. At-home labs can be considered a screening test rather than a diagnostic one.

How To Interpret Hormone Test Results

Interpreting hormone testing should be done with caution and preferably with the guidance of a healthcare provider. Many testing reports will come with a guide to the results. When evaluating your labs, compare the results to the normal range for the lab used. This will tell you whether the test level is low or high. Abnormalities in lab testing should prompt an appointment with a healthcare provider for further guidance.

Lifestyle Changes To Support Hormone Health

There are many ways that you can support your hormones and overall health through lifestyle changes. Some of these include[18]:

• Maintaining a healthy weight
• Managing stress
• Exercising regularly
• Maintaining a healthy, balanced diet
• Getting adequate quality sleep
• Avoiding or minimizing alcohol consumption
• Stopping smoking (or don’t start)
• Managing any other chronic health conditions you may have
• Staying current on your preventative health maintenance

If you’re wondering about supplements for hormone health, it’s important to remember that the FDA does not regulate supplements and may not have as much evidence to support their use, though they may be safe for use. Before starting any supplement, check with your healthcare provider.

Check Your Hormone Levels From the Convenience of Home

Hormone imbalance can be tricky, and not all imbalances have obvious symptoms. Many hormone imbalances can mimic other diseases, such as depression. 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 when 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 10 key reproductive hormones like estrogen, progesterone, cortisol, and more. Men and people AMAB might opt for the Men’s Health Test to review cortisol, DHEA-S, estradiol, and testosterone levels.

1. Cleveland Clinic. Do you need hormone testing? Published June 26, 2022. Accessed December 17, 2024. Medical Citation URL.
2. Newman M, Curran DA. Reliability of a dried urine test for comprehensive assessment of urine hormones and metabolites. BMC Chem. 2021;15(1):18. doi:10.1186/s13065-021-00744-3
3. Precision Analytical. DUTCH Complete. Accessed December 17, 2024. Medical Citation URL.
4. Gröschl M. Current status of salivary hormone analysis. Clin Chem. 2008;54(11):1759-1769. doi:10.1373/clinchem.2008.108910
5. Edelman A, Stouffer R, Zava DT, Jensen JT. A comparison of blood spot vs. plasma analysis of gonadotropin and ovarian steroid hormone levels in reproductive-age women. Fertil Steril. 2007;88(5):1404-1407. doi:10.1016/j.fertnstert.2006.12.016
6. Shahid MA, Ashraf MA, Sharma S. Physiology, Thyroid Hormone. In: StatPearls. Treasure Island (FL): StatPearls Publishing; June 5, 2023.
7. Mayo Clinic. Hypothyroidism (underactive thyroid). Published December 10, 2022. Accessed December 17, 2024. Medical Citation URL.
8. NHS UK. Overactive thyroid (hyperthyroidism). Last reviewed April 11, 2023. Accessed December 17, 2024. Medical Citation URL.
9. MedlinePlus. Parathyroid hormone (PTH) test. Updated December 4, 2023. Accessed December 17, 2024. Medical Citation URL.
10. Cleveland Clinic. Testosterone test. Last reviewed September 9, 2024. Accessed December 17, 2024. Medical Citation URL.
11. MedlinePlus. Estrogen levels test. Updated October 4, 2022. Accessed December 17, 2024. Medication Citation URL.
12. MedlinePlus. Progesterone test. Updated October 4, 2022. Accessed December 17, 2024. Medical Citation URL.
13. Cleveland Clinic. Adrenocorticotropic hormone (ACTH). Last reviewed June 1, 2022. Accessed December 17, 2024. Medical Citation URL.
14. Cleveland Clinic. Cortisol test. Last reviewed February 21, 2022. Accessed December 17, 2024. Medical Citation URL.
15. Everlywell. Everlywell at-home lab tests: how it works. Updated December 8, 2023. Accessed December 17, 2024. Medical Citation URL.
16. Leung AQ. The truth about at-home fertility tests. RMA Network. Accessed December 17, 2024. Medical Citation URL.
17. Visana Health. Are at-home hormone tests reliable? Published October 15, 2023. Accessed December 17, 2024. Medical Citation URL.
18. Cleveland Clinic. Hormonal imbalance. Last reviewed April 4, 2022. Accessed December 17, 2024. Medical Citation URL.