Hormone Testing: Do I Need It?

I'm a medical doctor specializing in the treatment of female diseases. Back in 1999, I used to want to see a woman's hormone test. However, now, I do not do hormone testing nor do I recommend hormone testing. I do not recommend hormone testing because for the vast majority of patients, the hormone test comes out normal for their age group and for their time of the month. Often a woman will call me and ask about estrogen dominance. She usually has bloating and breast tenderness, thinning hair, feel tired, have fat on the belly and hips, have water retention and weight gain before her period, have irritability, mood changes, and premenstrual syndrome. Yet, her hormones would always be normal for her age and the time of the month. What was going on? Well, if her hormones were normal, then some other chemicals or herbs that mimic her hormones or interfered with her hormones are active in her body. These chemicals and herbs are collectively known as endocrine disruptors, hormone disruptors, or xenoestrogens. Endocrine just means hormone. Xenoestrogens just means foreign estrogens.

These endocrine disruptors do not show up on the hormone test. The hormone test does not measure these endocrine disruptors. For instance, red clover is a potent estrogen mimic. Red clover looks like estrogen to the body. Red clover is a strange estrogen to the body. Red clover makes my endometriosis patients worse even in minute amounts. Yet, Red clover does not show up on the hormone test. [1] Why is this?

The reason why red clover does not show up on the hormone test is that the hormone test is extremely specific for measuring specific molecules. If I order a hormone test that measures it the molecule estradiol, only the molecule estradiol will be measured. Red clover will not measured because Red clover contains different molecules that mimic estrogen. The hormone test is not designed to measure Red clover.

I do not use a hormone tests now because the hormone test does not measure endocrine disruptors. The hormone test only measures your own estradiol. For most women their own estradiol is normal. The woman may say that her estrogen is abnormal. However, when I saw her actual estradiol levels and correlated it with her cycle, her estradiol's were actually normal. Her physician may tell her that she has high estradiol levels, but when I actually examined her lab report the estradiol was normal for that time of her cycle.

There are times when I have seen estradiol levels spike to 300 ng/dL. You must ask the question why estradiol levels had spiked. A Brigham Young University study showed that several cups of coffee can increase estradiol levels by 70%. Also, chocolate, cocoa butter, cocoa powder, and black African soap which contains cocoa powder has shown to increase estradiol levels. So, I used to take hormone levels and observe the estradiol levels as being high. Then I asked the patient to stop drinking coffee, eating chocolate, eating cocoa powder, eating cocoa butter, or using black African soap. After one or two months, the estradiol levels would come back to normal. And even without the application of topical progesterone cream, the patient would become normal. After several repeat experiences of the same clinical picture, I stopped doing the hormone test. I went directly and asked the patient whether they drank coffee, ate chocolate, cocoa butter, cocoa powder or use a black African soap. If the patient did use any of these foods that caused increase estradiol, then I asked him to stop. Then, the estradiol levels would revert to normal after several months. I found that this technique of asking the patient first whether they ate any estradiol elevating foods or drinks was much more efficient than measuring the hormone and then asking them. Why not just cut to the chase?

Case Study: Xenoestrogens

I had one patient that was a naturopath in Spain. For 10 years, her practice was made up of giving out natural progesterone. She herself had estrogen dominance and confidently told me she needed progesterone. She showed me her saliva hormone test, and pointed out that her estradiol was high.

I told her," No, she did not need progesterone. She needed find out what was causing the estradiol to be high."

She answered, "I am sure I do not have any xenoestrogens, I'm using all natural things."

So I took an hour over the phone and tried to find all the things that touched her skin. I found that she was using black African soap. Black African soap is soap that contains cocoa powder. I pointed out the cocoa powder would elevate her estradiol. She switched to a different bar of soap. A follow-up hormone test one or two months later showed a normalized estradiol. She did not need any progesterone. She is currently normal without the use of progesterone.

Do I Need To Use Progesterone?

I do not use hormone test now because the hormone test does not measure xenoestrogens. Xenoestrogens are making my patients sick. Progesterone can balance out weak xenoestrogens. After the age of 35, for the vast majority of cycles, the normal progesterone level is close to 1% of the progesterone levels before the age of 35. The problem is an anovulatory cycle. An anovulatory cycle is a cycle in which the women do not ovulate even though they continue to menstruate. If you do not ovulate, then no corpus luteum is produced. If no corpus luteum is produced, then no progesterone is produced. As a result, there is no progesterone to balance out the xenoestrogens in the woman's life. And increased estrogen dominance is a result of this unopposed estrogen. This is most commonly found in women over the age of 35. However, it is also known to occur in women undergoing strenuous physical training. These strenuous athletes may stop menstruating altogether. Dr. Peter Ellison of Harvard University using a hormone test in 18 athletic cyclers whose average age was 29 found seven anovulatory women. In non-athletic women, Dr. John Lee believes anovulation is the result of xenoestrogen exposure. Dr. Jerilynn Prior Prof. of endocrinology at the University of British Columbia in Vancouver, British Columbia, Canada found that anovulatory cycles among women from the mid-30s to 40s was quite common[2].

If I have a patient over the age of 35, I will assume that her progesterone level is close to zero because of anovulatory cycles. I usually do not have to do any hormone tests. All I have to do is listen to the litany of symptoms of tiredness, fatigue, hair loss, fat on the belly and hips, inability to lose weight, cold body temperature, weight gain before her period, and irritability.

Again, if xenoestrogens are completely removed from the environment, then even if the patient has close to zero progesterone, she still can be normal. For example, as of 2015, my wife is 53. She went through menopause last year. She had no hot flashes and no night sweats. She has not had any PMS in the last 12 years. She has had no thinning hair. She has had no weight gain around the belly and hips. She has no weight gain just before her period. She had no mood swings were irritability just before her period. She has taken no progesterone during the last 12 years. Why? She eliminated all xenoestrogens from your environment by changing the things that touch her skin.

What Are Hormone Tests Good For Then?

There is one clinical instance where I will recommend using a saliva hormone test. I will recommend using a saliva hormone test to test the hormones if and only if the absorption of progesterone the skin is in question. There are cases where the patient will use progesterone on the skin and there will be no clinical effect. After using progesterone, the patient does not feel anything bad or good. Either the patient is using something on the skin that is blocking progesterone or the patient has poor topical absorption of progesterone.

Patients that are heavy set and use progesterone over the fatty areas of the body have impaired absorption because the fat layers will absorb the progesterone before the body can "see" it.  This is an easy fix.  Wright, MD of the Tahoma Clinic found that these heavy set patients can simply apply the topical transdermal progesterone on the inside of the thighs and arms.  On the inside of the thighs and arms the fat layers are thinner and the patient can now properly absorb the progesterone cream.

There are some herbs that cause miscarriage. These herbs are traditionally used by folk medicine practitioners to cause miscarriage. They are called abortifacients. These abortifacients act sometimes by blocking the progesterone receptor. Progesterone is needed to go into the progesterone receptor to maintain the pregnancy. If there is not enough progesterone, or there is some kind of herb that is blocking the progesterone, then a miscarriage will occur. This is how the morning after pill works. RU486 or Plan B is a drug that goes into the progesterone receptor and does not stimulate. RU486 or Plan B blocks progesterone from going into the progesterone receptor. This is how the drug causes miscarriage.

If the patient takes an herb that causes miscarriage, then when the patient takes progesterone there will be no effect that are good. This is because the herb blocks progesterone receptor. Even though the patient is absorbing sufficient amounts progesterone the herb will block the progesterone receptor and the patient will feel no effect, bad or good.

A hormone test is also useful for post menopausal women that have adrenal exhaustion.  The patient is usually under high amounts of fear/stress/anxiety.  The body tries to produce cortisol to deal with the stress.  When the patient produces cortisol, the cortisol production steals away raw materials that is usually used to make estradiol.  Patients that have high fear/stress/anxiety in menopause usually have low estradiol levels.  A hormone test can be used to document low estradiol levels in anxious post menopausal women.  However, instead of doing a hormone test, I just usually ask the patient whether or not they are under stress.

Why Does The Progesterone Not Work?

So, if the patient is complaining of progesterone has no effect, then they are two possibilities. One, the patient is not absorbing progesterone. Two, the patient is taking an herb or chemical that blocks progesterone. Most commonly, the patient is taking an herb that's blocking progesterone. I had one patient that was using progesterone and she felt that the progesterone was making her sleepy. She was using progesterone as a sleeping pill. She decide to change all her products to healthy products. Then she use the progesterone again and found that there was no sleepiness. So she called me up to find a was going on. After a detailed questioning all of her new healthy products. I found that she was using mint toothpaste that had real mint in it. Mint is used as an abortifacient. Therefore, mint may be blocking the progesterone receptor. I advised her to change her toothpaste to the one that we recommended, wait a month until the mint washed out of the body, and then try the progesterone again.

If I cannot find an abortifacient herb, then it may be that that the patient is not absorbing progesterone sufficiently. Usually, the problem is found only in a heavy set woman. The heavy set woman needs to apply the topical progesterone on the inside of the thighs or the inside of the arms where the subcutaneous fat is the thinnest. If a heavy set woman applies the progesterone over thick areas of fat, then the progesterone will not be able to enter into the body. In this case of questionable progesterone absorption, the patient could do a saliva hormone test. I usually don't recommend this. I just look for the clinical effect of the progesterone.

Blood Test Versus Saliva Test

Topical progesterone cream does not appear in the blood test. I will repeat. You cannot measure the topical progesterone cream absorption by using a blood test. Why? Oil and water do not mix. If you use a progesterone blood test, then the progesterone blood test will not measure topical progesterone cream. The blood test is useless for measuring topical progesterone cream. Why? Oil and water do not mix. If you take oral progesterone in a pill, then the blood test will work to measure progesterone levels. The problem with oral progesterone is a pill is that it is 90% first pass inactivated by the liver. The liver will add binding proteins to the progesterone to make it water-soluble. Then, the blood tests will be able to measure oral progesterone pill levels.

Because oral progesterone is 90% first pass inactivated by liver, a normal dose for oral progesterone is 200 mg of progesterone in a pill. However, an equivalent dose of topical progesterone cream is only 20 mg of progesterone cream put on the skin.

However, when you use progesterone cream on the skin, the progesterone goes directly into the body through the skin. The progesterone is not 90% prefiltered by the liver. The progesterone goes directly into the body. Where does the progesterone travel? The progesterone travels in the chylomicrons in the blood. Chylomicrons are small bubbles of oil, or droplets of oil in the blood. Progesterone also travels around on the red blood cell membranes which are also lipids or fats. Again, not to belabor the point, a blood progesterone hormone test will not measure topical progesterone cream that is put on the skin. You must use a saliva test to measure topical progesterone levels.

I am sorry to be pedantic. Topical progesterone levels absorbed by the skin must be measured by saliva progesterone levels. Saliva progesterone levels are advocated by the World Health Organization or WHO. Again, I do not use saliva progesterone levels except if the patient thinks she is not absorbing progesterone well through the skin.

The lab that I like to use is ZRT labs run by David Zava, PhD. Call them up. They will send you a tube with a cap. You open the cap, spit in the tube, cap the tube, and then send the tube of saliva to ZRT labs. You should be able to get a result within two weeks.

John Lee, MD's Take on Testing Progesterone When taking Topical Transdermal Progesterone

“The best way to test your hormone levels is with a saliva test. You don’t need a prescription for a saliva test; you can order it yourself. You can find out how to order a saliva test at the end of the book under Resources. However, if the results of the test are confusing to you, it’s probably best to discuss them with a qualified health care professional and work in partnership with him or her to create a program for restoring hormonal balance. [ I suggest you start your journey to better health by looking at the first 10 videos on our website.]

Saliva tests are more useful than blood tests because they measure the bioavailable (free) hormone in the blood. After steroid hormones (progesterone, cortisols, estrogens, DHEA, testosterone) are manufactured by the ovaries, adrenal glands, or testes, they’re released into the bloodstream, where they attach or bind to very specific carrier proteins, and, to a lesser extent, to red blood cells. Progesterone and cortisol bind to cortisol binding globulin (CBG). The estrogens (estradiol, estrone, estriol) and testosterone bind to sex hormone binding globulin (SHBG). All of the steroids also bind to albumin, which is a protein present in very high concentrations in the blood. For every 100 steroid molecules bound to these carrier proteins, only about 1 to 5 percent escape the binding proteins and make it into the cells during circulation through the blood. The small 1 to 5 percent of steroids that escape the binding proteins are considered the free or bioavailable hormones, and these are what you want to measure, because they represent the amount of hormone that the tissue actually receives and responds to.

Some of these steroids also bind to the red blood cells. The more fat-loving a steroid hormone is, the more likely it is to hitch a ride on a red blood cell. Steroids hang on less tightly to red blood cells than they do to carrier proteins. This means that steroids bound to red blood cells will dissociate more easily and therefore are more bioavailable for use by your cells. Studies have shown that when red blood cells pass through the capillaries of tissues, the steroids bound to them can dissociate and enter tissues within milliseconds.

When steroid hormones are delivered through the skin with topical creams and gels, most of the steroid, as it enters the blood stream, is picked up by red blood cells and transported rapidly to tissues. Remember, it takes only about 20 seconds for the blood to circulate completely throughout the body. Those who have experienced almost an instantaneous response from sublingual hormone therapy will appreciate just how fast hormones can circulate in the body when they enter directly into the blood stream. We’ve heard from many women who were estrogen dominant for years and applied progesterone cream. They report, “It was as if my body immediately sighed a huge sigh of relief.” This is because the progesterone cream is entering the blood stream almost immediately and having a calming effect on the brain.

Now that you understand what happens in your body when you apply progesterone cream, you’ll be able to understand why blood tests don’t work to measure topically (skin) applied hormones—particularly the ones that are highly fat soluble like progesterone. When hormones are delivered topically, they enter the blood stream, bind to red blood cells, and are rapidly transported to tissues of the body, one of which is the salivary duct—which in turn delivers them to the saliva. This makes saliva testing an accurate measure of your free hormones. In contrast, when blood is first measured for hormones, what do you think is first removed to create the serum used for testing? You guessed it, the red blood cells. Thus, blood tests completely miss the free hormone bound to your red blood cells.

A group of French-Taiwanese researchers illustrated this testing discrepancy beautifully in one of their published studies. They were interested in determining if progesterone (25 mg) delivered topically in a gel to the breasts of women would result in progesterone intake into the breast tissue and change how fast the ductal cells were replicating or dividing. (A high replication rate increases the cancer risk.) What they found after only 10 to 13 days was that 25 mg of topical progesterone (the dose recommended by Dr. Lee) resulted in a 100 fold increase in progesterone in the breast tissue and significant reduction in cell division. What the researchers simultaneously discovered is that when they did blood tests of these women’s hormone levels, progesterone in serum did not increase. Had they known to measure progesterone levels in saliva before and after applying the progesterone gel, they would have found a dramatic increase in salivary progesterone levels. A number of subsequent studies have shown that topical application of progesterone increases saliva levels dramatically, whereas the serum levels show little or no change. Thus, by measuring hormones in saliva it’s possible to determine not only how much hormone is bioavailable but also how much is entering the tissues throughout the body.

If you already know that you’re progesterone deficient, then it doesn’t make sense to test our saliva hormone levels when you aren’t using progesterone; this will tell you only what you already know—you need progesterone. What you want to know is what your hormone levels are when you are using the cream. [I have found that when patients completely eliminate xenoestrogens, then they get well and in most cases find that they no longer need progesterone at all.]

The test will be the most helpful if you time it according to when you last used progesterone cream. Saliva testing has given us a picture of what happens to our hormone levels after you apply progesterone cream. When scientists measure the absorption of transdermal progesterone hour by hour after application of the cream, they find that saliva levels rise within two to three hours, achieving their peak levels about three hours after application. These peak levels begin to drop, indicating that the liver is processing the progesterone for excretion. This is a normal function of the liver. After 10-15 hours about 90 percent of the absorbed progesterone from a single application has been processed by the liver for excretion.

This teaches us several important lessons. The fall in progesterone 12-15 hours after application suggests that progesterone cream doses should be given in two smaller doses daily rather than a single bigger dose each day.

If the saliva sample is obtained two to three hours after application, the progesterone level will be at its peak. If the saliva sample is obtained 15 hours after application, over 90 percent of the absorbed progesterone will have passed through the body and the saliva levels will be lower. For this reason, it’s ideal to standardize saliva collection time at 8 to 10 hours after application to measure progesterone at the halfway point of the curve. Subsequent testing results will be meaningful only if the same collection time (relative to application time) is used at each testing.

In reality, many women use progesterone cream only in the morning, and if other hormones besides progesterone are being tested, they should be collected first thing in the morning. Thus, Dr. Zava’s lab tells women to collect their saliva sample at 8 to 24 hours following their last dose, in the morning, before applying the cream. Based on testing, his lab has established a range (500 to 3,000 pg/ml) that 80 percent of women should fall within if they use 10 to 30 mg of progesterone and take the test within 8 to 24 hours.

What’s most important is that the saliva testing laboratory establishes the ranges based on topical hormone delivery, because these ranges will be higher than normal. When levels fall below this range, then it’s possible that the progesterone just isn’t absorbing well or is cleared more rapidly than in the average individual. If symptoms of estrogen dominance persist in concert with low progesterone, despite dosing of 10 to 30 mg, then it will be important to consider the following:

* Check to make sure the progesterone product contains adequate levels of progesterone.

* Apply progesterone to parts of the body that blush (where capillaries are more numerous and closer to the surface) and apply it when your body is warm (as in after a warm bath or shower.)

* Increase the dose or apply the progesterone more than once a day.

[* Wright, MD of the Tahoma Washington Clinic has found that for heavy set patients, it is best to apply the topical transdermal progesterone where the subcutaneous fat is the thinnest. This happens to be on the inside of the arms and thighs. Otherwise, the fat is too thick and will absorb the progesterone before the body can “see” it.]

If progesterone testing show the level to be above the expected range, then a reduction in the dose is called for, especially if you’re having problems such as bloating or excessive sleepiness. [I have found that when xenoestrogens are completely eliminated from the environment the patient does NOT have bloating when using progesterone, high progesterone levels do NOT cause bloating. High progesterone levels taken with xenoestrogens WILL CAUSE Bloating. Bloating when taking progesterone means that there is a xenoestrogen in the environment.] Both saliva levels and symptoms should be used in concert to help you and your health care professional make educated decisions about whether to increase or to decrease your progesterone dosing, or leave it in the way it is.

Finally, the graph also recorded the progesterone serum levels during the hours when saliva progesterone was high. As you can see, the serum levels didn’t reflect the obvious rise of saliva progesterone. This is a clear example of why blood tests are irrelevant in this scenario.

Interpreting the Results of the Saliva Test

As we mentioned earlier, it’s ideal if you can interpret and analyze the results of your saliva hormone level test with a health care professional. However, as we know from mail we receive from women around the world, many of you don’t have access to a health care professional who is willing or qualified to help.

Here are some general guidelines to use. The normal physiologic luteal range of saliva progesterone in a woman who has ovulated is 0.1 to 0.5 ng/ml, which is equal to 100 to 500 pg/ml. Since topical progesterone creams create higher saliva levels, the expected range in women using 10-30 mg topical progesterone 8 to 24 hours after using it is 0.5 to 3 ng/ml, which is equivalent to 500 to 3,000 pg/ml. At the 3 hour peak, saliva levels in those using topical progesterone can range as high as 5 to 30 ng/ml, which is equal to 500 to 3,000 pg/ml.

For this reason, we can’t make it a general goal to reach “normal” luteal levels of progesterone when using progesterone cream, because topically applied progesterone has its own unique graph, which is different from the graph produced when endogenous (made-in-the-body) levels of progesterone are tested. The goal is to use physiologic levels of progesterone, and use the saliva test and symptoms to help adjust dosing if necessary .” [3]

I recommend that all my patients get and read John Lee, MD’s Book, “What Your Doctor May Not Tell You About Breast Cancer.”

Conclusion

1. I do not do hormone testing because the hormone test is usually normal for that patient for her age group. After the age of 35, most women have anovulatory cycles with close to zero progesterone levels for most cycles but not all cycles. This is normal.

2. Even though her hormone levels are normal the patient feels sick because of xenoestrogens. The usual mode of xenoestrogens entry into the body is through the skin. Xenoestrogens are causing the disease. Eliminate xenoestrogens and the disease goes away.

3. Women with high estradiol levels need to find out why they are estradiol levels are high. Usually, I find that coffee, chocolate, cocoa butter, cocoa powder, or black African soap will elevate the woman's estradiol levels abnormally high. Instead of doing the hormone test and then asking the women whether they are using these foods, I skip to the chase. I just ask whether or not they are using these foods. Usually, after they stop these foods, estradiol levels normalize one to two months later. The hormone test is not necessary.

4. Oral progesterone pills may be assessed using either a blood of progesterone test or saliva progesterone test. Topical progesterone can only be assessed using a saliva progesterone test. You cannot use a blood progesterone test to assess progesterone cream. The blood progesterone test used to test the progesterone cream will always test zero. The blood progesterone test is not good for testing progesterone cream levels in the body. Do not use a blood progesterone test to look at progesterone levels administered by topical progesterone cream.

5. The only time I advise using a hormone test is when the patient has a question about whether the progesterone cream is absorbing are not. Most of the time when progesterone is used and there's no effect, the patient is taking some kind of her that is blocking progesterone. As soon as the patient eliminates the blocking progesterone herb, then, the progesterone works. Herbs that cause miscarriage typically block progesterone.

Notes:

1. www.cancersupportivecare.com/estrogenherb.html, David Zava PhD, Charles Dolbaum, MD, PhD and Marilyn Blen, "Estrogen and Progestin Bioactivity of Foods, Herbs, and Spices", 1998, The Proceedings of the Society for Experimental Biology and Medicine, 1998, Mar;217(3): 269-78.

2. John Lee, MD with Virginia Hopkins, What Your Doctor May Not Tell You About Menopause, 1996, Time Warner Book Group, NY pages 120-121, 138-140.

3. John Lee, MD, David Zava, PhD, Virginia Hopkins, What Your Doctor May Not Tell You About Breast Cancer, Hachette Book Group USA, 2005, pages 279-283.