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Hormone and Metabolic Lab Testing Explained

Allara Explains Hormone and Metabolic Lab Testing with Funk It Wellness

Whether it’s the side effects of PMS, PCOS symptoms, or something just feels ‘off’ with your body, lab testing can be a clarifying way to get answers to some long-awaited questions. For instance, are you persistently tired due to stress, or do you perhaps have a vitamin deficiency? Is your thyroid working the way we expect it to, or is it wreaking havoc on your hormones and your emotions? And when we look at not just hormones, but your metabolic health, we gain even more insight into what is going on internally. From inflammation, to cholesterol levels, to your risk for insulin resistance: the more information you know about why your body is acting the way it is, the more you can do to protect your long-term wellbeing, as well as begin improving your ‘right now.’ 

So that being said, today we’re going to explore what metabolic and hormone testing typically entails, what tests to ask for when it comes to diagnosing PCOS (and why you should ask for them), as well as what the results may indicate. Let’s dive in. 

  • What Is Metabolic and Hormone Testing? 
  • What Tests To Ask For, Depending On Your Symptoms 
  • Translating Your Test Results 

What is metabolic and hormone testing? (And why you should bother with both) 

Hormone testing is not typically part and parcel of your annual wellness check up. While getting a CBC (complete blood count) test and blood pressure check are common, more in depth tests are not usually ordered without reason. Here are some reasons your doctor or dermatologist may suggest or advocate for hormone testing: 

  • If you display symptoms of PCOS 
  • If you experience an onset of notable, sudden physical changes (such as excessive hair loss) that can’t be explained by an external stressor or one-off event
    • In this case, a straight-forward testosterone test may be conducted, alongside a thyroid panel, to exclude hormonal causes
  • If you have a family history of hormone imbalances, and a physical symptom is bothering you (for instance, a particularly heavy period)  
  • If you have an irregular menstrual cycle, or you have had trouble trying to get pregnant for the past 12 months or longer

When people think of ‘hormone’ testing, they likely think of the most well-known hormones: testosterone and estrogen (spoiler: women and men have both of these, just at varying levels). However, hormone testing can encapsulate studying not just these internal markers of health, but others, such as: 

  • LH and FSH levels
    • LH stands for luteinizing hormone, and it is made by your pituitary gland. This hormone plays an important role in controlling your menstrual cycle (LH levels help trigger the release of an egg from the ovary), as well as in sexual development and functioning. LH levels rise before ovulation. 
    • For women, undesirable LH levels can indicate fertility problems and irregular periods.
    • FSH stands for follicle-stimulating hormone. FSH also helps control the menstrual cycle, and abnormal levels of FSH can indicate problems with infertility, as well as irregular ovulation. 
  • Testosterone levels
    • Though testosterone levels are low in women compared to men, testosterone plays a critical role in women’s health, too. Too high levels can lead to problems like acne, PCOS, irregular periods (or absent periods), excess hair growth (hirsutism), androgenic alopecia, infertility, and blood sugar problems. On the other hand, too low levels can also lead to fertility problems, as well as low sex drive, irregular periods, and vaginal dryness. 
  • AMH levels
    • AMH stands for anti-mullerian hormone, and this test measures the amount of AMH in your blood. AMH levels are thought to correspond to the number of eggs you have in your ovarian reserve: higher AMH correlates to a higher egg count, while the inverse correlates to a lower ovarian reserve. It’s worth noting that AMH also plays a key role in fetal development; AMH levels are higher in male babies, and stops them from developing female reproductive organs, while female babies only need a small amount of AMH for their development.  

Metabolic testing can be part of your annual wellness check up, though not always. We mentioned earlier that your doctor may order a CBC during your annual physical exam, and this will give you insights into your overall health; it is designed to raise red flags and spot a bunch of disorders and problems, from anemia, to infection, to leukemia, to heart disease. On the other hand, a comprehensive metabolic panel (CMP) is different, despite its similar-sounding acronym. A CMP measures a very different component of your wellness: it tests for 14 different substances in your blood, and lends insight into your body’s chemical balance and overall metabolism. It is critical in understanding liver function, kidney function, blood sugar levels, fluid and electrolyte imbalances, and your overall metabolism. 

Here is what a comprehensive metabolic panel measures

  • Glucose 
  • Calcium 
    • Calcium is present not only in your bones, but also your blood; it is essential for proper functioning of your nerves, muscles, and heart 
  • Sodium, potassium, carbon dioxide, and chloride 
    • All considered electrolytes, these are minerals that help control the amount of fluids in your body 
  • Albumin
    • This is a protein made by the liver; levels outside of normal range can signal inflammation, dehydration, and other problems, and warrants further investigation. Albumin levels can be affected by different medications, so as always it’s important to let your doctor know of any other drugs you may be taking. 
  • Total protein 
    • This measures the total amount of protein in the blood (essentially, this encompasses albumin and globulins
  • ALP, ALT, and AST 
    • The above are all different enzymes made by the liver, and all extremely important in indicating the health of your liver. These may be elevated due to ‘fatty liver,’ a by product of insulin resistance, high cholesterol, or excessive alcohol intake. 
  • Bilirubin 
    • Elevated bilirubin levels can suggest that your liver isn’t excreting waste the way it should, and is an orange flag for potentially deeper health problems. In occasional cases, elevated bilirubin levels are due to something called Gilbert’s syndrome, which is estimated to effect 3-7% of Americans: this is a mild, inherited condition that essentially means your body doesn’t produce enough enzymes to remove excess bilirubin from the body, and it can result in jaundice. This is an occasion where an elevated bilirubin level is not something to worry about, however all out of normal range results should be investigated, especially when it comes to your liver health. 
  • BUN 
    • Encompassing blood urea nitrogen and creatinine, these are waste products excreted from your blood thanks to your kidneys 

Another metabolic test, besides a CMP, may include a total cholesterol test. This, again, is not always part of a physical check up. This will indicate whether your cholesterol is too high, and can help proactively understand your risk of heart attacks (or other forms of heart disease), and take action early and accordingly, to lower your risk. 

A cholesterol test works by measuring four types of fat in your blood: 

  • Total cholesterol
    • This gives an overall view into your blood’s total cholesterol content
  • Low-density lipoprotein
    • Also known as ‘bad’ cholesterol
    • Too much LDL in your blood can accumulate over time into the buildup of plaque in your arteries, which in turn reduces blood flow. When these plaques rupture, it can lead to heart attack or stroke. 
  • High-density lipoprotein 
    • Also known as HDL cholesterol 
    • This is known as ‘good’ cholesterol. HDL can help reduce the amount of LDL cholesterol in your blood, which means your arteries are unobstructed, and your blood can flow freely through these pathways. 
  • Triglycerides
    • Ideally, you don’t want high triglyceride levels. High levels are associated with drinking too many sugary beverages, smoking, drinking too much, and being sedentary. They are also correlated with having diabetes and subsequently elevated blood sugar levels

What tests to ask for, depending on your symptoms 

Most of the time your doctor should order the tests you need, based on your symptoms, family history, medical records, and other relevant information. 

Understanding what tests to ask for and what the results can indicate can be incredibly useful when it comes to making informed health decisions, and using your knowledge to get the best health outcomes for your body. So with that being said: what tests should you consider asking for, when you’re consulting with your doctor? 

Well, the answer is: it depends on your symptoms, your concerns, and your family history. 

We’ve gone in depth on this topic before, so we’ll keep it short here: PCOS can encompass a range of symptoms, so if you suspect you have this condition, then it is extremely important to investigate what is going on, and of course consult with your healthcare provider. 

Physical symptoms of PCOS can include: hair loss on the scalp, acne, excess hair growth on the body (particularly the chest, stomach, breasts, neck, back, and backs of your thighs), irregular or absent menstrual periods, and unexplained weight gain. If you have experienced one or more of these symptoms, it may be useful to ask your doctor about ordering hormone tests, particularly ones that measure your testosterone and LH and FSH levels. These tests are best drawn within the first few days of your cycle. It’s worth noting PCOS can also affect your thyroid, or thyroid issues can crop up independent of PCOS: for that reason, if you have any symptoms of a thyroid problem, ask about what thyroid tests to look into to get to the root cause of your symptoms. 

On the other hand, if you display symptoms of type 2 diabetes (this can include increased thirst, frequent urination, fatigue, blurred vision, and more), or prediabetes (darkened skin on certain areas of the body, fatigue, skin tags), or you have unexplained weight gain, then you may want to consider asking for some metabolic tests, including a CMP and a total cholesterol test to find out what is going on internally. (Learn more about the relationship between PCOS and diabetes.)

Finally, family history and your own suspicions about what could be going on are also important to share with your healthcare provider. For instance, one study published in the Trends in Endocrinology and Metabolism found that: 1) PCOS is a “familiar disorder, with a single autosomal dominant gene effect”, 2) that family history is a risk factor for developing PCOS, and 3) that “preliminary data indicate a woman’s risk of developing PCOS is approximately 40%” if her sister is effected. They also conjectured that since only 19% of mothers were also affected with PCOS, the inheritance could be preferentially paternal, but they would need more data to support this theory. They go on to add that environmental influences likely also play a role in the development of PCOS. As such, if you have a family member diagnosed with PCOS, or you see physical symptoms in other female family members (for instance, you know your sibling has irregular periods), then consider sharing this with your healthcare provider. The more information they have, the better they can collaborate with you in your health outcomes, and order the most fitting tests from the start. 

To wrap up, keep in mind that your primary care physician (or Allara healthcare provider!) should order the right tests, in accordance with your symptoms, history, concerns, and risk factors. That being said, it is always good to be equipped with some basic understanding of what metabolic and hormone testing entails, and what kind of tests your physician may order, so that you can better advocate for yourself within the healthcare system. If you would like to learn more about hormone and metabolic testing, particularly in light of PCOS, periods, and nutritional health, learn more here.

Note here: this article is for informational purposes, and should not supersede or replace medical advice.  

Allara Health provides personalized treatment that takes the guesswork out of managing PCOS, and offers a customized, holistic plan of attack that merges nutrition, medication. supplementation, and ongoing, expert support to begin healing your body.