Hormones work as a communication system within our bodies. Hormones, glandules, and the endocrine system work together to meet basic physiologic functions such as growth and homeostasis, all the way to more complex ones like reproduction and metabolism. They also play an essential role in mental health, gut health, and the immune system. Basically, they control everything. Therefore in Functional Medicine, we believe that having an optimal hormonal balance and assessment is impactful for our health. If your hormones are off-balance, you might have felt these symptoms: your libido has decreased, your concentration is not the same as before, you feel like you can only function after you had your coffee in the morning? If you answer yes, we need to talk about hormone assessment step by step.
We mentioned that hormones have a large number of functions in our body, and since there are a lot of them, we are going to focus on sex hormones, thyroid hormones, and adrenal hormones. We will discuss how to test them, the right time to assess them, and the optimal numbers that we are looking for.
The most affordable way to run a preliminary hormone assessment is to run a blood test. Still, if you want to get a more in-depth examination of a hormone metabolite, then a urine test is the most suitable method.
Table of Contents
Testosterone: It is known as the principal sex hormone in males; testosterone is secreted by testicles and is associated with optimal levels of energy, motivation, brain heath. Low levels of testosterone are associated with decreased libido and sexual function. Nowadays, 39% of men over 45 have low testosterone levels. This is strongly associated with increased abdominal adiposity and insulin resistance.
Normal: 264-916 ng/dL
Optimal: >500 ng/dL
Free Testosterone: The amount of free testosterone acquired by the test determines the testosterone that is not bound to SHBG (sex hormone-binding globulin). Free testosterone tests will determine the quantity of testosterone that is active and available in our body. Most of the time, this measurement should parallel the levels of total testosterone.
ย Normal:
20-50 years old: 7.2-26.5 pg/mL
Optimal: >15-25 pg/mL
ย
Sex Hormone Binding Globulin: Most circulating testosterone is bound to this compound, while a small amount of testosterone travels through menโs body bound to albumin. SHBG works by transporting Testosterone around our body; if there is an abnormal amount of this transporter in our body, that would mean that testosterone is not available to be used since it is โboundโ to this protein.
Normal:
20-49 years: 16.5โ55.9 nmol/L
DHEA: The adrenal glands secrete dehydroepiandrosterone; it serves as a major precursor of several sex steroids; between them, we can find testosterone. If this hormone is too low, we can relate it to problems with our adrenal glands. Therefore the stress response would be compromised.
Normal: 71.6-530 ฮผg/dL
Optimal: 200-530 ฮผg/dL
Estrogen: When we talk about estrogen in men, we have to explain that balance plays a major factor in menโs health. Estrogen is liked with a healthy libido, sex function and has a protective effect on the brain. This hormone has been linked to gynecomastia in men, sexual dysfunction, and hair loss. Studies report that men with insulin resistance have a higher level of estradiol, a precursor of estrogen.
Normal: 7.6โ42.6 pg/mL
Optimal: 20-40 pg/mL
Luteinizing Hormone: Or LH is a hormone produced by our brain; it stimulates the synthesis of testosterone and sperm in the testicles.
Normal: 1.7โ8.6 mIU/mL
Follicle Stimulating Hormone: FSH, which is also a hormone produced by our brain and is responsible for the production of sperm.
Normal: 1.5โ12.4 mIU/mL
Hormone levels in women significantly contribute to their health; if there is an imbalance, this patientโs quality of life will be severely impacted. Most women think that having cramps, a heavy flow, PMS, low energy, irritability, bloating, mood swings, weight gain, brain fog, and irregular periods are normal. Still, a Functional Medicine practitioner would like to dig deeper into the patientโs medical and nutritional history.
A womanโs life stage plays an important role in hormonal balance and therefore is important to know if your patient is pre-menopausal or post-menopausal. Hormone levels can fluctuate depending on the different stages of the menstrual cycle; your healthcare provider should consider this to perform a test.
Progesterone: This hormone should be tested between days 18 to 21 of a womanโs cycle. The main factor to consider is the balance of this hormone and estrogen; the optimal ratio of estrogen to progesterone should be 10x the amount of estrogen to progesterone at this time of the cycle.
Normal: 1.8โ23.9 ng/mL
Optimal: >5 ng/mL
Estrogen: If a woman is experiencing anxiety, infertility, a heavy flow, fluid retention, or weight gain, these are signs that she is experiencing estrogen dominance.
Normal: 43.8-211.0 pg/mL
Normal post-menopausal: <6.0โ54.7 pg/mL
Optimal: 80-200 pg/mL (~10x the amount of progesterone)
FSH: the function of the follicle-stimulating hormone in women is developing follicles and stimulates the growth of eggs in the ovaries. It is an important hormone to measure when a woman has problems with infertility, irregular menstrual periods, or confirm the start of menopause.
Normal (d 19-21): 1.7-7.7 mIU/mL
Normal Post-menopausal: 25.8-134.8 mIU/mL
LH: The release of an egg from the ovaries is dependent on LH. Also, progesterone is controlled by LH.
Normal: 1.0-11.4 mIU/mL
Normal Post-menopausal: 7.7-58.5 mIU/mL
DHEA:
Normal: 41.2-432 ฮผg/dL
Optimal: 200-432 ฮผg/dL
Testosterone: Energy levels, motivation, and a healthy sex drive are associated with optimal levels of testosterone. Even if this hormone is an essential part of menโs health, it is important to have a balanced ratio of this component in women.
Normal:
20-49 years: 8โ48 ng/dL
+49 years: 3-41 ng/dL
Optimal: 60-80 ng/dL
Free testosterone
Normal: 0-4.2 pg/mL
Optimal: >0.5 pg/mL
SHBG
Normal:
20-49 years: 24.6โ122.0 nmol/L
+49 years: 17.3โ125.0 nmol/L
Optimal: 16.5-80 nmol/L
The thyroid is an endocrine gland located in the lower front of the neck, whose main role is to synthesize thyroid hormones. These hormones travel through our blood and have a special effect on how our body uses its energy; they help by keeping our body temperature in an optimal range. Almost every cell in our body has a receptor for these hormones.
Hormone | Function | Ranges |
TSH | Produced in the pituitary gland, it controls the production of T4. | Normal: .45-4.5 ฮผIU/mL
Optimal: 1.0-2.0 ฮผIU/mL |
Free T3 | The active form of thyroid hormone. | Normal: 1.81โ4.06 pg/mL
Optimal: 3.2-4.4 pg/mL |
Free T4 | Thyroxine, it contains 4 iodine atoms. T4 has to be converted to T3 to become active. | Normal: 0.82-1.77 ng/dL
Optimal: 1-1.5 ng/dL |
TPO antibodies | This marker is important to diagnose Hashimotoโs disease in people with hypothyroidism. | Normal: 0โ34 IU/mL Optimal:0IU/mL |
Anti-thyroglobulin antibodies | Not a measure of thyroid function, but important to monitor treatment after thyroid surgery. | Normal: 1-115 IU/mL
Optimal: 0 IU/mL |
Reverse T3 | An inactive protein very similar to T3, it can block the actions of the thyroid gland. | Normal: 9.2-24.1 ng/dL |
Testing is an essential part of Functional Medicine, and by reading this, you might want to try every test in the book. It is also very important to note that obesity and a high-calorie diet with saturated fats and sugar add to hormonal imbalance by affecting insulin resistance. If we start to make simple changes in patientโs diets and lifestyle, some of the symptoms related to hormonal imbalance will decrease, improving the patientโs quality of life.- Ana Paola Rodrรญguez Arciniega, Master in Clinical Nutrition
Jameson, J. Larry.ย โMechanisms of hormonal action.โย Harrison. Principles of Internal Medicine, 20eย Eds. J. Larry Jameson, et al.ย McGraw-Hill, 2018,ย accessmedicina.mhmedical.com/content.aspx?bookid=2461§ionid=197389421.
Li, Ji, et al. โInteraction of sex steroid hormones and obesity on insulin resistance and type 2 diabetes in men: The Third National Health and Nutrition Examination Survey.โย Journal of Diabetes and its Complicationsย 2.31 (2017): 318-327.
Mayo Foundation for Medical Education and Research. 2020. โTestosterone, Total, Bioavailable, and Free, Serum.โ www.mayocliniclabs.com/test-catalog/Clinical+and+Interpretive/83686
Mayo Foundation for Medical Education and Research. 2020.โDehydroepiandrosterone (DHEA), Serum.โ, www.mayocliniclabs.com/test-catalog/Clinical+and+Interpretive/81405.
Medline Plus.2020. โFollicle-Stimulating Hormone (FSH) Levels Test.โ medlineplus.gov/lab-tests/follicle-stimulating-hormone-fsh-levels-test/.
Medline Plus. 2020. โLuteinizing Hormone (LH) Levels Test.โ medlineplus.gov/lab-tests/luteinizing-hormone-lh-levels-test/
American Thyroid Association. 2020.โ Thyroid Function Tests.โ www.thyroid.org/thyroid-function-tests/
Professional Scope of Practice *
The information herein on "Hormone Assessment Step by Step." is not intended to replace a one-on-one relationship with a qualified health care professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional.
Blog Information & Scope Discussions
Our information scope is limited to Chiropractic, musculoskeletal, physical medicines, wellness, contributing etiological viscerosomatic disturbances within clinical presentations, associated somatovisceral reflex clinical dynamics, subluxation complexes, sensitive health issues, and/or functional medicine articles, topics, and discussions.
We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system.
Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.*
Our office has reasonably attempted to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.
We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez, DC, or contact us at 915-850-0900.
We are here to help you and your family.
Blessings
Dr. Alex Jimenez DC, MSACP, RN*, CCST, IFMCP*, CIFM*, ATN*
email: coach@elpasofunctionalmedicine.com
Licensed as a Doctor of Chiropractic (DC) in Texas & New Mexico*
Texas DC License # TX5807, New Mexico DC License # NM-DC2182
Licensed as a Registered Nurse (RN*) in Florida
Florida License RN License # RN9617241 (Control No. 3558029)
License Compact Status: Multi-State License: Authorized to Practice in 40 States*
Presently Matriculated: ICHS: MSN* FNP (Family Nurse Practitioner Program)
Dr. Alex Jimenez DC, MSACP, RN* CIFM*, IFMCP*, ATN*, CCST
My Digital Business Card
Stress on the lower back during pregnancy often leads to back (upper, middle, lower), sciatica,… Read More
Can melatonin help many individuals dealing with sleep issues and help them stay asleep longer… Read More
For older individuals looking for a workout that can help improve overall fitness, can kettlebell… Read More
Can choosing the right pillow help many individuals with neck pain get a full night's… Read More
What is the recommended way to choose a mattress for individuals with back pain? … Read More
Can non-surgical treatments help individuals with piriformis syndrome reduce referred sciatica pain and help restore… Read More