Why Your Hormone Test Results Mean Sh!t
Part of the Functional Lab Testing guide
Doctors have three options for hormone testing: serum, saliva, or urine. Each is a viable method, but by itself, each is nearly useless for making solid clinical recommendations.
Certified in functional medicine, I am always looking for reliable tests to confirm or rule out a clinical suspicion and help patients reach a higher level of function. Nothing frustrates me more than someone arriving with a set of results that, on their own, tell us almost nothing about function. So here is an attempt to clear up salivary, serum, and urine hormone testing. As I always say, let’s test, not guess.
Each fluid has strengths and weaknesses, but none provides enough information alone. Running and analyzing just one panel is rarely comprehensive enough to know what is going on, much less to make a confident recommendation.
Blood hormone testing, advantages and disadvantages
Advantages: ideal for measuring hormone concentrations in blood or plasma, and accurate for circulating hormones. Disadvantages: it does not measure bioavailable hormone or how hormones are being metabolized, and it is only a snapshot in time.
Blood is the conventional standard, and it is genuinely ideal for peptide hormones such as FSH, LH, prolactin, fasting insulin, and thyroid hormones including Reverse T3 and thyroid antibodies, as well as Sex Hormone Binding Globulin.
For sex hormones, blood is accurate but limited. Serum usually does not distinguish bound from free hormone, so a level can look normal or high because of abundant bound hormone, even while your free, usable hormone is low, leaving you functionally deficient. Serum testosterone is an exception, commonly available as both total and free. And because hormones are secreted in a pulsatile rhythm across the day and night, a single draw may catch a peak, a valley, or something in between, which also makes it hard to compare one test to the next.
Saliva hormone testing, advantages and disadvantages
Advantages: non-invasive, easy to do at home, allows multiple data points across a day, and is a good way to measure free or bioavailable hormone. Disadvantages: accuracy is sensitive to many factors, including saliva production.
Saliva is a good way to evaluate the balance and flow of estrogens and progesterone in cycling women, and to map cortisol across a day with multiple samples. But there is a missing piece: it measures free cortisol, not metabolized cortisol, and to properly assess the adrenals you want both. Saliva only measures steroid hormones (peptide hormones like thyroid and growth hormone are not available), and it does not capture hormone metabolites, so it says little about how hormones are actually being processed.
Collection is also finicky, with restrictions on eating, drinking, gum, makeup, and brushing, and micro-damage from tooth brushing can falsely elevate salivary testosterone for up to an hour. Importantly, saliva is a poor way to monitor hormone therapy, since exogenous hormones, especially transdermal progesterone and testosterone, can distort results dramatically.
Urine hormone testing, advantages and disadvantages
Advantages: non-invasive, and good for monitoring circulating hormone levels and their metabolites. Disadvantages: accuracy depends heavily on the lab and method, and single-point collection has real limits.
A 24-hour urine collection is the preferred method for hormones secreted at night and in deep sleep, like growth hormone and melatonin, and it is an economical, reliable way to evaluate steroid hormone metabolites. But not all urine testing is equal: single-point collection misses individual variation, while 24-hour collection captures a full day and night. And the assay method matters, with gas chromatography paired with mass spectrometry emerging as the standard others are measured against.
So what is the best hormone test?
Honestly, all of them together give the most complete picture. But if I have to pick one for value, the DUTCH test by Precision Analytical is my preference. DUTCH stands for Dried Urine Test for Comprehensive Hormones, and it is currently the most comprehensive hormone panel on the market.
It offers the most extensive profile of sex and adrenal hormones along with their metabolites, plus the daily pattern of free cortisol and melatonin, a combination not available by any other single method. It was built to monitor most forms of hormone replacement effectively, and collection is simple: four or five dried urine samples over 24 hours, stable for weeks and easy to ship. In short, it gives you what you would get from blood, saliva, and 24-hour urine, and quite a bit more.
Now you know. Test, do not guess.
Your life is your medicine.
If something here rang true for you, the next step is a conversation. Start with a free consult, then we can work on your baseline together.
Reviewed by Dr. Daniel Gonzalez, DC.
