Which is the best method for testing hormones?

There is no single ideal method for assessment of hormones. Blood, saliva, and urine each have their advantages. At Meridian Valley Lab, we specialize in urine testing (both 24-hour and dried urine) and specialty serum markers that will provide you with the most useful information in a given clinical scenario. Below, we have ranked each method based on clinical utility in assisting doctors in assessing hormonal health.


1. 24-Hour  Urine

Best used for:

  • Female hormone balance
  • Androgen balance
  • Breast and prostate cancer risk factors
  • Adrenal health
  • Adrenal reserves
  • Growth hormone
  • Oxytocin
  • 5α-reductase activity
  • Monitoring bioidentical hormone therapy

In addition to being a non-invasive, patient-controlled collection, a 24-hour urine sample is most accurate because it provides a stable indicator of output not susceptible to the hour-to-hour fluctuations seen in serum or salivary measurements. Urine hormone testing is well-established in medical literature as a reliable method of assessing physiological hormone levels. Meridian Valley’s 24-hour urine profile reference ranges have been validated over many years of clinical testing and correlate well with patient symptoms and with therapeutic interventions.

Urinary evaluations also allow the measurement of many estrogen metabolites. These metabolites provide critical information about a person’s relative risk for estrogen related cancer. A recent concept in hormone-related cancer prevention is the measurement of the ratio of two estrone metabolites: 2-hydroxyestrone and 16α-hydroxyestrone. A decrease in the 2/16α ratio is associated with an increased risk of breast and cervical cancer. This ratio is available only in a urine collection.

Urinary estrogens can be a sensitive monitor of liver detoxification capability. Elevated urinary estrogens in normally-cycling women may indicate a history of exposure to compounds that stress the liver such as environmental chemicals. This phenomenon has also been observed in peri- or post-menopausal women who have previously taken conjugated equine estrogens. Interventions intended to improve liver function result in a gradual normalization of the abnormal estrogen levels. Thus measurement of urinary estrogens can give insight into other aspects of physiology.

Similarly, the broad array of glucocorticoid and mineralocorticoid metabolites measured in a 24-hour urine hormone profile take adrenal assessment beyond simple cortisol measurements. The 24-hour urine profiles provide a comprehensive picture of long-term adrenal health, short term stress response and cortisol/cortisone balance.


2. Dried Urine

Best Used for:

  • Female hormone balance
  • Androgen balance
  • Breast and prostate cancer risk factors
  • Adrenal health
  • Adrenal reserves
  • Circadian Cortisol Pattern
  • 5α-reductase activity
  • Monitoring bioidentical hormone therapy

Dried Urine is a new testing method that combines the depth and breadth of 24-hour urine testing with the time-specific advantages previously available only in saliva testing, without the downsides and limitations of saliva testing. Dried urine hormone testing combines these two popular methods by giving you hormone metabolites, which were only available before in 24-hour urine testing, and offering cortisol and cortisone throughout the day (circadian rhythm), just like saliva testing; all this information is gathered from four simple urine markers throughout the day. This new and innovative method provides a more cost-effective, convenient, and complete assessment of hormonal health.


3. Blood

Best used for:

  • 5α-DHT
  • FSH
  • LH
  • ProlactinTSH
  • RT3
  • Insulin
  • IGF-1
  • 3β-Adiol

A blood (serum) test provides a direct assessment of circulating hormones.  Most reported hormone values are “total”, including both free and bound hormones.  Testosterone is the exception, being offered as “free” as well as total testosterone.  Serum tests offer relatively accurate values with well-established reference ranges. However, reference ranges are often broad, reducing their clinical utility.  Typically, serum estrogen measurements only include Estradiol (E2), although Estrone (E1) is also available.  In serum, Estriol (E3) is usually available only as a measurement of unconjugated Estriol.  This has limited usefulness as 90% of Estriol is conjugated. Free Estrone, free Estradiol, and free Progesterone are rarely measured. Serum measurements are a ‘snapshot’ look at sex hormones that may fluctuate greatly during day.

Meridian Valley Lab has pioneered clinical serum testing for 3β-Adiol, which holds great promise as a marker for the development of prostate cancer.  Click here for more information about 3β-Adiol and the Testosterone Metabolite Test.


4. Saliva

Best used for:

  • Circadian cortisol pattern
  • Menstrual cycle evaluation

Saliva is beneficial for monitoring cortisol according to the AM/PM circadian rhythm.  It can also be helpful to assess cyclical output of estrogen and progesterone throughout the month in a cycling or peri-menopausal woman.

Saliva tests results may be hindered in elderly patients with limited salivary output. Saliva testing can yield higher than physiological levels when using exogenous hormone replacement therapy; this can give a false impression of overdosing. Single point saliva tests also have the disadvantage of being a ‘snapshot’ look at hormones that ebb and flow throughout at 24-hour period.