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.  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?
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.
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.
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.
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.
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. In this case of questionable progesterone absorption, I will recommend that the patient do a saliva hormone 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.
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.
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.