I’ve been getting questions from readers like “What hormones should I check, and when should I check them?” From my doctor readers, I have been hearing, “How do I get my patients to stop asking me for hormone panels?”
The ambiguity about hormone testing comes from a need for shared understanding regarding hormones and how to manage them (if at all). As a traditionally trained physician (at research-oriented academic institutions Stanford and Columbia), I learned that “proper” doctors save lives by stopping death at the door. We don’t check things like hormones because patients might ask questions about the results. Also, they might want to do something about the results, which is arduous and can we just refer them to an endocrinologist?
In this post (which is shorter — I promise), I will explain the basics of hormone testing and what is the right balance between exciting health data and confusing noise. Hopefully, this will be useful to laypeople and doctors alike!
The Big Debate
There are two main camps on the subject of hormone testing. Camp A is made of “Data Nerds,” who all want to know as much information as possible about their bodies and will analyze their test results as one might interpret tea leaves or the stock market. Camp B comprises “Reactive Minimalists,” who will only pursue hormone testing if there is a significant warning sign or symptom. Notably, both doctors and laypeople are split among the two camps.
I fall somewhere in the middle. I recognize that there are inherent costs to testing (and follow-up), including financial or labor costs and anxiety and anticipation about results. Not to mention, it is an effort for both patient and doctor to sit down, interpret the results against the backdrop of the patient’s symptoms, and choose an appropriate therapy, if anything, to pursue. That’s a lot to ask out of a 5–15 minute visit! But ultimately, I believe in empowering every human to be proactive about their health, which requires data to act upon.
So where I land is — if you have the money to pay (or are lucky enough to have a health plan with coverage) and the time and willingness to spend learning about the implications of your test results, I think you would benefit from getting hormone tests proactively and regularly, depending on health status and symptoms.
If the hormone panels are too expensive for you because your health plan does not cover them, I am wary of encouraging most people to pay out of pocket for “full” panels beyond the usual preventive care labs. The truth is, if you do happen to need intervention for something beyond hypothyroidism or diabetes, the likelihood of your health plan covering hormonal treatment, if they don’t even cover your hormone testing, is close to zero.
What Hormones DO I Test?
First of all, you don’t ever need a test for every hormone in your body. There are well over 50 types of hormones (hundreds are depending on how you categorize sub-types). We don’t even have appropriate ways to test for most of the body’s hormones.
But just in case you were curious, this is a list of the available hormone tests at major medical centers (list from Mount Sinai here in NYC — scroll down quickly!):
- 5-HIAA
- 24-hour urinary aldosterone excretion rate
- Adrenocorticotropic hormone (ACTH)
- ADH
- Follicle stimulating hormone (FSH)
- Renin
- T3
- T4
- Thyroid stimulating hormone (TSH)
Even most non-endocrinologist MDs must pull from the deep recesses of their medical school memory to recall some of these (remember congenital adrenal hyperplasia?). You would only test for most of these hormones based on prolonged and extreme symptoms.
Many doctors would argue that you don’t need any testing for hormones without a good reason (inexplicable symptoms). The problem is that many signs and symptoms that might indicate a hormonal dysfunction are pretty normal-seeming to most people. Fatigue, anxiety, constipation, diarrhea, obesity, depression, insomnia, dry skin and hair, hair loss, extreme thirst and frequent urination, palpitations or irregular heartbeat, weight fluctuations, infertility, sexual symptoms, irregular periods, and many more symptoms could be due to an underlying hormonal issue.
So you can tell why so many patients might ask their doctors for a hormone panel 😄.
Preventively, or in the absence of specifically alarming symptoms, a typical hormone panel would include the following:
So How Do I Get These Tests?
Most hormone panels will include some subset of these labs, and many doctors will resist ordering all of these tests for you (if for no other reason than it’s challenging to figure out which labs are already coded into the EHR lab ordering system). I’m not joking — if your clinic doesn’t have some ready defaults, it’s very annoying for a doctor to “find” the lab to order (and no one wants to use a paper form).
I took a quick look at Quest and Labcorp, which allow patients to self-order tests, and their “women’s” and “men’s” panels are pitifully slim. I would go as far as to say they’re probably not useful for most people who already get routine labs ordered by their primary care doctor. The Labcorp OnDemand Men’s Health Test is a basic panel (CBC, CMP, HbA1C, and basic lipid panel) plus total testosterone, which, as you can read in detail above, is mostly useless except perhaps as a signal for what your free testosterone level is. Their Women’s Health Test doesn’t even include any reproductive hormone testing (they literally do not include estradiol, FSH, LH, etc.). For some odd reason, they include TSH and call it a test panel for women’s health (strange, strange!). The Quest options are similarly bewildering, but I won’t waste space here going through them (know that they really don’t make sense to this physician and aren’t hormone panels). They do have funny test panels named things like “Menstrual Irregularities Test Panel” that will include more hormonal tests, but it still seems like an odd way to market and explain the things being tested.
A very motivated patient could probably figure out some combination of self-ordering that will result in the right combination of hormone tests. However, there are newer companies that essentially create lab panel “templates” and make it simpler for a patient to get these tests. One that I have tried is Function Health (that’s a link to my early access code), which is hilarious yet brilliant because all they really do is order sets of labs at Labcorp that you go and get (just like any other lab test). The nifty trick is that they order a lot of tests (like, every single one you could remotely want as a generally healthy human being) and generate a clinician report explaining everything. (Then they say go see your doctor because they’re not a clinic, so they don’t want to deal with any actual treatments you might need, haha.)
I think it’s not a bad price for two somewhat excessive numbers of lab tests a year at $499, but again, it won’t be helpful unless you want to follow up and do something about your results. There are far more tests on their general panel I’m excited to dive into for the Longevity/Healthspan enthusiasts in a future post.
A final note on testing — I don’t generally recommend at-home tests unless you are absolutely unable to get to a lab center. The reason is that capillary pricks are both painful and result in less than perfectly accurate results, which seems plain silly if you’re paying all the money these at-home companies tend to charge. If you’re burdened by your symptoms (depression, immobility) or by work or household demands (children), it might be that you would benefit from some at-home testing than none at all. But food for thought — some companies will send a phlebotomist (person who draws your blood) to your home or office for a win-win situation!
Anyways, this was a short post for the week. Next week, my goal is to be back on schedule! Please send me suggestions and questions — you are all the best!
Cheers to your health,
Hillary Lin, MD
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