🌿 Functional Testing for Hormone Insight

Understanding what your labs can (and can't) tell you about hormone balance.

Hormones are powerful chemical messengers that regulate nearly every process in the body, from energy and metabolism to mood, sleep, and reproductive function. When they fall out of rhythm, symptoms can range from subtle fatigue and low motivation to noticeable shifts in mood, skin, or cycle regularity.

That is where testing comes in, not to diagnose, but to help map out what is happening beneath the surface and identify the patterns that influence how you feel every day.

🧬 Why Functional Hormone Testing Matters

Traditional labs often look for disease states, values outside of a "normal" range.

Functional testing, on the other hand, takes a closer look at patterns, ratios, and relationships to understand how the body is functioning, not just whether it is broken.

This type of testing can help reveal:

• How your body is producing, metabolizing, and clearing hormones.

• Whether stress hormones like cortisol are following a healthy rhythm.

• The connection between sex hormones, thyroid function, and metabolism.

• How nutrients, inflammation, or detoxification might influence balance.

It is not about diagnosing or treating, it is about building a deeper understanding of your body's signals.

💉 Blood vs. Urine: What’s the Difference?

Different test types provide different kinds of information, and both have value.

🩸 Blood Testing

Blood draws are the most common type of hormone testing and measure hormones circulating in your bloodstream at a specific moment.

What blood testing shows:

• Levels of estrogen, progesterone, testosterone, DHEA-S, cortisol, and thyroid hormones.

• Binding proteins like SHBG that control hormone availability.

• Metabolic markers such as insulin, glucose, and cholesterol ratios.

• Inflammation markers like high-sensitivity CRP (Hs-CRP)

Limitations:

Blood tests show a snapshot in time and may miss daily rhythms or hormone fluctuations across a day.

💧 Urine Testing (e.g., DUTCH Test)

Urine-based testing, especially a test like the DUTCH (Dried Urine Test for Comprehensive Hormones), measures both parent hormones and their metabolites across the day.

What urine testing shows:

• Cortisol rhythm over 24 hours.

• Estrogen metabolism pathways (how estrogen is broken down and cleared).

• Progesterone, testosterone, and DHEA metabolites.

• Adrenal and melatonin patterns, sometimes with nutrient-related markers (like B12 or glutathione pathways).

💡Why it is useful: Urine gives a fuller picture of how your body is actually using and processing hormones, not just how much it makes.

🧪 What Markers Matter in a Comprehensive Hormone Analysis

A complete hormone panel looks beyond individual levels. It examines interactions between hormones, because one imbalance often creates ripple effects throughout the endocrine system.

Below are key markers commonly included and what they can reveal:

• 💗 Sex Hormones:

  • Estrogen (Estradiol, Estrone, Estriol):

    • Estradiol (E2): The most active estrogen; supports bone, mood, and reproductive health. In women, low E2 can correlate with irregular cycles, mood changes, or hot flashes. In men, small amounts are essential for bone and brain function, too high, though, can suppress testosterone.

    • Estrone (E1) and Estriol (E3): provide insight into estrogen metabolism, useful for understanding detoxification and balance between estrogenic effects.

  • Progesterone:

    • Produced after ovulation, progesterone calms the nervous system, supports sleep, and balances estrogen.

    • Testing during the luteal phase (about a week after ovulation) helps confirm ovulation and assess whether levels are sufficient for cycle stability.

    • In men, smaller amounts are made by the adrenals and support mood regulation.

  • Testosterone (Total & Free):

    • Total testosterone= all testosterone circulating in the blood (both bound and unbound)

    • Free testosterone= the active form available to tissues.

    • Testing both is essential because SHBG (sex hormone-binding globulin) can alter availability. A man may have normal testosterone but low free testosterone due to high SHBG (common with aging, thyroid imbalance, or low-calorie intake). In women, elevated free testosterone can lead to acne, unwanted hair growth, or irregular cycles.

  • DHEA-S (Dehydroepiandrosterone Sulfate):

    • A precursor to both estrogen and testosterone, made by the adrenal glands.

    • Reflects adrenal resilience and overall anabolic (building) capacity.

    • Low levels may accompany fatigue or low libido, while high levels can suggest chronic stress or excess androgen activity.

• 🦋 Thyroid Hormones:

  • TSH:

    • pituitary signal to the thyroid gland

  • Free T4 & Free T3:

    • circulating and active thyroid hormones

  • Reverse T3:

    • Inactive form that can increase during stress or inflammation

  • TPO & Tg Antibodies:

    • Help identify autoimmune thyroid involvement

• ⚡️ Adrenal & Stress Hormones:

  • Cortisol:

    • Follows a diurnal rhythm, highest in the morning, lowest at night.

    • Blood captures one point; urine or saliva show the pattern over 24 hours.

    • Flattened curves may suggest chronic stress adaptation; high evening cortisol can affect sleep and recovery.

  • Cortisone:

    • Measured in urine, these show how cortisol is being cleared and converted.

    • Valuable for understanding prolonged fatigue or sleep-wake dysregulation.

• 🔗 Metabolic & Binding Markers:

  • SHBG (Sex Hormone-Binding Globulin):

    • Regulates how much testosterone and estrogen are "free."

    • High SHBG = less bioavailable hormone

    • Low SHBG = more free hormone

  • Insulin & HOMA-IR:

    • Indicate metabolic and blood sugar control.

    • Elevated insulin can shift hormone balance toward more androgens in women.

  • Lipid Panel (Total Cholesterol, HDL, LDL, ApoB):

    • Cholesterol is the building-block for all steroid hormones.

    • Very low levels can impact hormone production.

• 🧠 Additional Functional Markers:

  • Ferritin:

    • Iron storage.

    • Impacts thyroid conversion and energy.

  • Homocysteine:

    • Reflects methylation and B-vitamin status.

    • Important for detox pathways.

  • Vitamin D:

    • Acts as a hormone influencing estrogen, testosterone, and immune health.

  • Albumin/Globulin Ratio:

    • Shows liver protein synthesis which affects hormone transport and detoxification.

🔍 Why Functional Patterns Matter More Than Individual Numbers

Hormones do not work in isolation. One number rarely tells the whole story.

• A normal cortisol level with a flat daily rhythm may still indicate stress dysregulation.

• Balanced estrogen paired with slow metabolite clearance might show detox inefficiency.

• Normal total testosterone but low free testosterone may reflect elevated SHBG or insulin imbalance.

Functional testing is about seeing the full system, not isolated results.

🧭 Interpreting Results Objectively

While these tests offer valuable insight, results must be viewed within context timing, symptoms, nutrition, sleep, stress, and even medication use all play roles.

Functional testing does not diagnose disease. Instead, it helps create a more complete picture of how the body is functioning, guiding collaborative discussions with a qualified healthcare professional.

⚠️ Disclaimer: This information is for educational purposes only and is not intended to diagnose, treat, cure, or prevent any disease. The content shared through Holistically Trained is based on research and holistic practice and should not replace medical advice from your healthcare provider. Always consult your qualified health professional before making changes to your diet, medications, or supplements.

📚 Resources:

1. Wheeler MJ et al. Assessment of dried urine as a sample matrix for measuring steroid hormones using LC–MS/MS.BMC Chemistry. 2021;15(1):1–12.→ Confirms the accuracy and reliability of dried urine testing (used in DUTCH panels) for reproductive and adrenal hormones.Read here

2. Handelsman DJ et al. Free testosterone: how to measure it and why. Clinical Endocrinology. 2018;88(6):754–765.→ Explains the importance of testing both total and free testosterone for accurate hormonal assessment.Read here

3. Rosner W et al. Sex hormone-binding globulin: physiology, molecular biology, and clinical significance. Endocrine Reviews. 2010;31(5):507–541.→ Discusses how SHBG regulates hormone bioavailability and impacts hormone interpretation.Read here

4. Bianco AC & Kim BW. Deiodinases: implications of the local control of thyroid hormone action. Endocrine Reviews.2006;27(2):168–184.→ Details how thyroid hormone conversion affects energy, metabolism, and hormone interactions.Read here

5. Wallace TM & Matthews DR. The assessment of insulin resistance: comparison of HOMA and QUICKI methods.Diabetologia. 2002;45(3):274–278.→ Outlines how HOMA-IR and insulin markers provide insight into metabolic health and hormone balance.Read here