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.

Men’s hormones:

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.

 Normal:

20-50 years old: 7.2-26.5 pg/mL

• 50 years old: 6.6-24.0 pg/mL

Optimal: >15-25 pg/mL

 

Sex Hormone Binding Globulin: Most circulating testosterone is bound to this compound, while a small amount of testosterone travels through men’s 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 “bound” to this protein.

Normal:

20-49 years: 16.5?55.9 nmol/L

• 49 years: 19.3?76.4 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 ?g/dL

Optimal: 200-530 ?g/dL

Estrogen: When we talk about estrogen in men, we have to explain that balance plays a major factor in men’s 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: 7.6?42.6 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: 1.7?8.6 mIU/mL

Follicle Stimulating Hormone: FSH, which is also a hormone produced by our brain and is responsible for the production of sperm.

Normal: 1.5?12.4 mIU/mL

Women’s hormones:

Hormone levels in women significantly contribute to their health; if there is an imbalance, this patient’s 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 patient’s medical and nutritional history.

A woman’s 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 woman’s 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: 1.8?23.9 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: <6.0?54.7 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 ?g/dL

Optimal: 200-432 ?g/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 men’s health, it is important to have a balanced ratio of this component in women.

Normal:

20-49 years: 8?48 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: 24.6?122.0 nmol/L

+49 years: 17.3?125.0 nmol/L

Optimal: 16.5-80 nmol/L

Thyroid panel

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 ?IU/mL Optimal: 1.0-2.0 ?IU/mL
Free T3	The active form of thyroid hormone.	Normal: 1.81?4.06 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 Hashimoto’s disease in people with hypothyroidism.	Normal: 0?34 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 patient’s diets and lifestyle, some of the symptoms related to hormonal imbalance will decrease, improving the patient’s quality of life.- Ana Paola Rodríguez Arciniega, Master in Clinical Nutrition

Jameson, J. Larry. “Mechanisms of hormonal action.” Harrison. Principles of Internal Medicine, 20e Eds. J. Larry Jameson, et al. McGraw-Hill, 2018, accessmedicina.mhmedical.com/content.aspx?bookid=2461&sectionid=197389421.

Li, Ji, et al. “Interaction of sex steroid hormones and obesity on insulin resistance and type 2 diabetes in men: The Third National Health and Nutrition Examination Survey.” Journal of Diabetes and its Complications 2.31 (2017): 318-327.

Mayo Foundation for Medical Education and Research. 2020. “Testosterone, Total, Bioavailable, and Free, Serum.” www.mayocliniclabs.com/test-catalog/Clinical+and+Interpretive/83686

Mayo Foundation for Medical Education and Research. 2020.“Dehydroepiandrosterone (DHEA), Serum.”, www.mayocliniclabs.com/test-catalog/Clinical+and+Interpretive/81405.

Medline Plus.2020. “Follicle-Stimulating Hormone (FSH) Levels Test.” medlineplus.gov/lab-tests/follicle-stimulating-hormone-fsh-levels-test/.

Medline Plus. 2020. “Luteinizing Hormone (LH) Levels Test.” medlineplus.gov/lab-tests/luteinizing-hormone-lh-levels-test/

American Thyroid Association. 2020.” Thyroid Function Tests.” www.thyroid.org/thyroid-function-tests/