Many people ask me about self-testing for hormone imbalances. Doing these tests can be insightful and shed light on any particular issues. At-home testing is just one way to take the reins over your medical destiny, learn about the state of your general health, glean important information about how to alter your lifestyle to impact your physical and emotional wellbeing, as well as how you age. Hormones are the root of so many health issues, so testing your hormones at home gives you the power to see what’s going on inside and decide what to do with the golden ticket. I’ll answer some of the most common questions and refer you to some of the top clinical and at-home testing options available.
Where should I start?
Start with a conventional blood test. Speak with your doctor about testing your hormones in a standard blood test, and specifically request a morning cortisol test in blood. Depending on your doctor’s experience, he or she may be able to recommend at-home or lab tests. The gold standard for measuring adrenal hormones is a blood draw (i.e., sticking a needle in a vein to draw blood) and then run a serum test in a laboratory. If you’re stressed about it or have a needle phobia that can give you a false positive result. Additionally, the serum or plasma tells you total cortisol, not the free level of cortisol, which is biologically active. Finally, the serum cortisol test provides only a snapshot of total cortisol while the needle is in the vein, not over the course of the day like four-point dried urine testing or saliva testing.
I used to ask my patients to do at-home 24-hour urine tests, which average the cortisol level over the course of the day, but it don’t tell you about variations in the stress response control system, the hypothalamic-pituitary-adrenal axis.
Because of that, my favorite at-home test is dried urine for several reasons: It provides the cortisol level over the course of the day, at four points (usually upon awakening, before lunch and dinner, and before bed). Dried urine also provides free and metabolized cortisol, which I find to be clinically helpful, especially in patients with normal serum cortisol. Finally, I can measure cortisol awakening response in dried urine, which I use clinically for patients with mood disorders like depression.
The four-point urine test allows physicians to diagnose whether there is a flat diurnal pattern, which is considered worse than smoking according to the Whitehall Study, and may be a marker of greater mortality in those with breast cancer.
Once you cross into self-testing territory, there’s no perfect test and much confusion. You can consider the Complete Hormones profile test from Genova Diagnostics or the DUTCH test from Precision Analytics, which stands for Dried Urine Test for Comprehensive Hormones. Either will tell you about your adrenals (both short- and long-term function), and your estrogen metabolism, which can say if you have too much wear and tear from cortisol. It can shed light on things like whether you have a modifiable tendency toward breast cancer or a risk of osteoporosis. I suggest reviewing the results with an informed, functional medicine clinician.
Both the Complete Hormones and the DUTCH test provide cortisol metabolism and estrogen metabolism data, along with androgens like testosterone. Additionally, the DUTCH test provides urinary organic acids and neurotransmitters, which I again find to be helpful when I’m evaluating a patient in terms of the broader function of their body, including gut health, dysbiosis, and fungal overgrowth.
How reliable are at-home saliva stress tests to assess adrenal hormones?
At-home saliva stress tests that are then sent to the lab are valid for cortisol and probably DHEA for most people. Salivary cortisol has been studied extensively from a scientific perspective and can provide reliable information. However, if you have serious medical issues, it’s better to perform the gold standard, which is serum testing. So first choice is saliva, second choice is urine testing and the third is hair.
Are there tests that better diagnose stress disorders?
I start with a blood test, which you can get from your clinician. Then to look at HPA function over the course of the day, I perform a dried urine test. For other hormones, I measure fasting serum levels of DHEAS, testosterone (free and total), estradiol, progesterone, FSH, insulin, etc. Endocrinologists who are looking at the extremes of adrenal function, like Cushing’s disease or Addison’s disease, or enzymatic defects, typically order a combination of blood and twenty-four-hour urine testing.
Hair cortisol is another at-home test that has validity and reliability with the convenience of at-home testing. Hair cortisol can tell you the total cortisol load over the past three months, but you have to remove a chunk of hair near the nape of your neck.
Testing hormones can feel like unraveling a new part of yourself that you may have never explored. It can be overwhelming, especially with all the options and the potential for self-discovery. I recommend working with a trusted practitioner who can guide you and put you on course for balancing your hormones through proper lifestyle modifications.
 Kumari et al. “A nonlinear relationship of generalized and central obesity with diurnal cortisol secretion in the Whitehall II study.” J Clin Endocrinol Metab. 2010 Sep;95(9):4415-23. doi: 10.1210/jc.2009-2105. Kumari et al. J Clin Endocrinol Metab. 2009 Dec;94(12):4801-9. doi: 10.1210/jc.2009-0555. Epub 2009 Oct 22. Kumari et al. “Maternal separation in childhood and diurnal cortisol patterns in mid-life: findings from the Whitehall II study.” Psychol Med. 2013 Mar;43(3):633-43. doi: 10.1017/S0033291712001353. Epub 2012 Jul 11.))
 Sephton et al. “Diurnal cortisol rhythm as a predictor of breast cancer survival.” J Natl Cancer Inst. 2000 Jun 21;92(12):994-1000.