Hormone Testing: 8 Options + pros/cons of each

There are so many ways to test your hormones – we review 8 options and pros and cons of each to help you decide which test is best for you!

Note from Dena: This post was written by Meredith Sorensen, Dietetic Intern, as part of a research partnership between Back To The Book Nutrition and post-graduate nutrition students from the University of Houston.  

How can you know for sure if you have a hormone imbalance like estrogen dominance or low progesterone? Since many hormone imbalances have similar symptoms, testing your hormone levels is the only way to be certain. 

Below are 8 methods of hormone testing and pros/cons of each to help you and your provider pinpoint specific imbalances and determine the best ways to get you relief!

Just want to know which test is best? Scroll all the way to the end to find out what Dena’s favorite hormone test is for her clients!

Note: This article focus on testing for reproductive hormones (estrogen, progesterone, testosterone, LH, FSH, etc.) and stress hormones (cortisol, etc.), but does not address other hormones like thyroid, insulin, etc. 

8 Common Methods of Hormone Testing + Pros/Cons of Each

1. Blood/Serum

Blood/serum hormone testing requires a blood draw from your doctor’s office or another lab location.

Pros

• Widely available from conventional medical doctors
• Insurance will likely cover it
• Measures:
  • Estrogen
  • Progesterone
  • Testosterone
  • Luteinizing Hormone (LH)
  • Follicle Stimulating Hormone (FSH)
  • DHEA
  • SHBG
  • and more

Cons

• Will only show serum levels at the time of the blood draw, so it misses hormonal shifts across the day and throughout the month
• Practitioners must know what phase of her cycle the woman is in to interpret results correctly
• Does not provide information about hormone precursors or metabolites
• Most hormones in blood are bound to carrier proteins, so the results are not telling you the “free hormones” available for your body to use
• May not be accurate if you take oral progesterone or the birth control pill

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How to get tested

Most major labs like Quest, Lab Corp, etc. offer serum hormone panels. Can be ordered through a provider or you can order online here. 

Note: This post contains affiliate links. By making purchases through these links, you pay the same amount for products, but a portion of the sale will be sent my way to help with blog expenses. Thanks!

2. Blood Spot (Finger Prick)

With blood spot testing, you simply prick your finger with a lancet provided by the lab, place drops of blood on a card, and mail it back to them.

Pros

• Easily done at home
• Correlates to serum test results (1)
• If you use topical hormone creams, this test is more accurate than serum tests (2)
• Measures: 
  • Estrogen
  • Progesterone
  • Testosterone
  • DHEA-S
  • SHBG

Cons

• May not be covered by insurance
• Will only show serum levels at the time of the blood draw, so it misses hormonal shifts across the day and throughout the month
• Most hormones in blood are bound to carrier proteins, so the results are not telling you the “free hormones” available for your body to use
• Does not provide information about hormone precursors or metabolites

How to get tested

Order blood spot tests through a functional medicine/holistic provider like Dena, or you can order directly from specialty labs like ZRT Labs. 

3. Saliva

For saliva hormone tests, you simply spit into a collection tube provided by the lab and send it back to them for analysis.

Pros

• Easily done at home
• Reflects “free” hormone levels, which are available for use by the the body
• Measures: 
  • Estrogen
  • Progesterone
  • Testosterone
  • DHEA-S
  • Cortisol

Cons

• May not be covered by insurance 
• A salivary test only shows hormone levels on the day of collection and may miss hormonal shifts throughout the month
• Least accurate if using hormone therapy (i.e. birth control pills, patches, creams, pellets, etc.)
  1.  

How to get tested

Can be ordered through a functional medicine/holistic provider like Dena,  or you can order directly from specialty labs like ZRT Labs.  

4. Liquid Urine

Urine hormone testing requires you to collect and store all your urine over a 24-hour period in the provided container, which  must be kept cool the entire 24-hour period and until you return it to the lab.

Pros

• Well-established, reliable method
• Most comprehensive (similar to dried urine)
• Hormone levels vary from hour to hour. This test averages out the differences for the entire 24 hr collection period
• Accurate even if using hormone replacement administered via patches, pellets, or injections
• Measures:
  • Estrogen
  • Progesterone
  • Testosterone and other androgens
  • DHEA
  • Precursors and metabolites of above hormones, including 4-OH-E1, an estrogen metabolite linked to increased risk for hormone sensitive cancers (i.e., breast, endometrial, prostate, etc.)
  • Cortisol

Cons

• Insurance may not cover this type of test
• Only provides levels of the day of collection and misses hormonal shifts across the month
• 24-hour collection and storage is inconvenient and susceptible to user error
• More costly than dried urine test
• May not be accurate if you are taking oral progesterone, birth control pills, or vaginal hormone creams
• May not be accurate if you have compromised kidney function or kidney disease

How to get tested

A doctor can order this test for you from labs like Genova Diagnostics. Genova’s Complete Hormones 24 hr urine test also includes add-on options for testing for SNPs (“snips”) for COMT, MTHFR, VDR, CY1B1, all of which provide you further information on how your body detoxifies estrogen.

5. Dried Urine

For a dried urine hormone test, you’ll urinate directly onto test cares, allow them to dry, then mail them back to the lab. Some tests collect samples for just one day, while others have you collect daily for a full month.

Pros

• Easily collected at home
• You can opt to collect samples for an entire month to see a full hormone pattern, rather than just on a single day – especially helpful if you have hormone symptoms at various times of the month 
• Most comprehensive (similar to liquid urine)
• Hormone levels vary from hour to hour – this test averages out the differences for the entire collection period
• Usually cheaper than liquid urine
• Good correlation to results from blood/serum and liquid urine (3)
• Good option if you are on any type of hormone replacement (i.e. oral progesterone, hormone patches, vaginal creams/pellets, etc.) – oral estrogen must be discontinued the day(s) of testing
• Measures: 
  • Estrogen
  • Progesterone
  • Testosterone and other androgens
  • DHEA and DHEA-S
  • Hormone precursors and metabolites, including 4-OH-E1, a marker indicative of increased risk for hormone sensitive cancers (i.e., breast, endometrial, prostate, etc.)
  • Cortisol (free and total)

Cons

• Insurance may not cover this type of test since most conventional doctors don’t offer it
• Expensive
• If you opt to collect only on a single day, results will only show levels at the time of collection
• Samples must be collected at precise times, and it may be inconvenient to follow the schedule
• Results may not be indicative of “free hormones” available to the body’s tissues
• May not be accurate if you have compromised kidney function or kidney disease

How to get tested

• Order the DUTCH Complete single day dried urine test (for all markers listed above), a month-long DUTCH Cycle Mapping (for estrogen and progesterone only), or a combination of both of these two tests through a functional medicine/holistic provider like Dena, or directly from the lab.

6. Ovulation Predictor Kit (Urine test for Luteinizing Hormone only)

You’ll urinate directly on test stick. A positive test confirms an surge in Luteinizing Hormone (LH) and means ovulation is likely to occur within the next 12-36 hours.

Pros

• Easily done at home
• Very cheap and available over the counter
• Instant results
• Tells you if ovulation is likely to occur soon by detecting a rise in luteinizing hormone (LH), the hormone that tells the ovaries to release an egg
• Especially helpful for fertility awareness/family planning

Cons

• Does NOT test estrogen or progesterone levels. If you are wondering if you are ovulating, however, this test may be for you.

How to test

Test kits like Clearblue, Pregmate, Stix, etc. can be purchased online or over the counter in pharmacies.

7. Urine Progesterone Only Test

You collect your first morning urine 7-10 days after suspected ovulation and dip test strips into it. A positive result confirms ovulation occurred and peak progesterone levels were reached. A negative test may indicate an anovulatory cycle or low progesterone.

Pros

• Easily done at home
• Cheap and available over the counter
• Instant results
• Confirms whether your progesterone reached peak levels after ovulation, helping confirm whether ovulation occurred

Cons

• Only confirms progesterone peak, not an actual number value.
• Does not measure estrogen or other hormones. 

How to test

Proov and similar tests are available online and over the counter in pharmacies.

8. Cycle Tracking with Basal Body Temperature (BBT)

This requires taking your temperature at rest, before you get out of bed in the morning, and charting the temperatures daily to track hormone shifts throughout the month, including ovulation (4).

Pros

• Easily done at home
• 100% free if you already have a digital or basal thermometer
• Helps you to really get to know your body and identify valuable information about your cycles and related hormonal symptoms
• Critical component of fertility awareness method to help you get pregnant or prevent conception 

Cons

• Must collect data daily for about 3 months to truly identify patterns
• Body temperature can be affected by a variety of external factors like stress, sleep disruptions, and hyper or hypothyroidism
• This does NOT directly measure estrogen or progesterone levels, or their precursors and metabolites 

How to track

• Learn how to track your daily basal body temperatures here
• Use apps like Kindara and Natural Cycles keep track of your temperatures and other cycle patterns
• A holistic provider can help you interpret your monthly charts to see whether hormone imbalance is likely

What if I take Birth Control Pills or Hormone Replacement?

As indicated above, certain hormone tests will still accurately measure the hormones your own body is making even if you’re taking the pill or another form of hormone therapy. But remember, birth control pills and other forms of hormone replacement often suppress your own hormone production so your levels will be much lower while taking them.

Which Hormone Test is Best?

Of all the options listed above, the DUTCH Cycle Map + Complete Test Bundle is my (Dena’s) preferred test for clients. It is pricey but is truly the best return on investment in most cases. This dried urine test is the only method that collects samples for a full month and may be especially helpful if you fit any of these descriptions:

• Have hormone symptoms, but bloodwork from your doctor looks “normal”
• Symptoms occur at multiple times of the month (i.e., around PMS and ovulation)
• Irregular periods
• Are in the perimenopausal age range (late 30’s-40’s) where hormone shifts throughout the month can vary significantly
• Have already improved your nutrition, supplements, gut health, etc. and still have hormone symptoms
• Also have fatigue, low motivation, insomnia, or other symptoms that reflect cortisol imbalances/HPA-axis dysfunction, since these markers are tested as well

Watch a case study video of how the DUTCH Cycle Map + Complete Bundle Test helped us find this client’s hormone imbalance other testing missed!

Want help testing + fixing your hormones? 

If you are still unsure about which hormone test is right for you, and how to fix your hormone imbalance, working one-on-one with a functional medicine or holistic provider like Dena may be the best route.

Schedule your free, 10 minute Discovery Call here!

Check out these related articles!

How to Know if Your Period is Normal (7 signs it is + 12 signs it isn’t!)

How to Lower Estrogen Naturally

Thyroid Tests: Which Ones You Need + Where to Get Them

About the Author:

Meredith Sorensen is originally from northern Michigan, but moved to Houston to be a D1 cross-country and track runner for the University of Houston. She completed her B.S. and is currently pursuing her M.S. and completing the dietetic internship at the University of Houston. She is passionate about learning and working with female athletes to optimize health, performance, and longevity in sport.  

Disclaimer: Information on this site is intended only for informational purposes and is not a substitute for medical advice. Always consult with a trusted healthcare provider before implementing significant dietary change. Read additional disclaimer info here. 

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