Dawn Burnett swears by her at-home hormone tests. The 49-year old Florida wellness coach relies on them to inform her if certain hormones — such as the reproductive hormones estrogen, progesterone and testosterone — are in balance. Every few months, she does a variety of blood and saliva tests to determine various hormone levels, then works with her physician, who specializes in integrative medicine, to adjust her dose of bioidentical hormone replacement therapy. She is convinced her at home test regime is one of the reasons she feels so vibrant and healthy today. “For years, I felt like something was wrong with my body, but when I went from doctor to doctor, they told me it was all in my head,” she says. “But as we age, hormones become unbalanced and decline. My home testing regime lets me monitor all of them, and figure out ways to even them out again.”
There are many people who share Burnett’s philosophy, which is one reason at-home health tests such as hormone tests are exploding: they are expected to triple or even quadruple by 2022, according to a 2017 report from the market research company ReportLinker. When you feel like you are constantly running on empty, or are battling weight gain or awful PMS, it seems easy enough to order one of these tests online in an effort to find out what ails you. And as women pay more and more out of pocket, thanks to the rise in high-deductible plans — about 43 percent of adults with employer-based coverage were on one in 2017, up from around 14 percent a decade earlier — it is tempting to try to take your health into your own hands. “Many women are starting to blur the lines between being a patient and being a consumer,” says Marra Francis, M.D., an OB-GYN and executive medical director of home testing company Everly Well. “If they have to pay for the health care they’re purchasing, they want to do it on their terms: which may mean doing testing at home. It’s an inexpensive way to get the information they need to help manage their health.”
Companies like Everly Well do not diagnose, and they do not prescribe — they just provide consumers with their lab results, along with reference ranges for what is considered normal. But many medical professionals are still concerned. Most of these tests are not FDA approved, which means the agency has not reviewed them to make sure the kits are easy to use and that they do what they claim to do. There is no guarantee that the results you get are correct, and “if you get an abnormal result, you’ll have to see your doctor anyway, who will most likely want to redo the test, which will cost you more money and even more anxiety,” points out Rocio Salas-Whalen, M.D., an endocrinologist at New York Endocrinology. (Some of the at-home hormone testing companies also conveniently sell supplements to “treat” the conditions they screen for.)
If you do decide to use one of these home hormone tests, proceed with caution. Always make sure that the company you are buying the test kit from has the results analyzed in a CLIA-certified laboratory (that means the lab has had to undergo certifications with a federal agency and has agreed to voluntary periodic inspections). Make sure it is actually cheaper to do the test at home, rather than having it done through your doctor. And make sure you always let your primary care physician know what you are doing, and what the results are.
In the meantime, here is a look at six types of top at-home hormone tests on the market, and what you need to know about them.
Menopause/fertility tests
The most common and inexpensive type of test is a urine test, where you pee on a stick and then wait a few minutes for results. The test measures levels of follicle-stimulating hormone (FSH), a hormone secreted by your pituitary gland that stimulates the follicles inside your ovaries to develop an egg for ovulation. If it is positive, your FSH is high, which may potentially indicate you are starting to go through the change. (This is also why these tests are sometimes used by women trying to gauge their fertility.) Some of the more expensive tests are blood tests that also check levels of other female reproductive hormones such as estradiol and testosterone.
Cost: a basic urine test is only about $9.99, while a more extensive blood test can cost anywhere from $39 to $59.
The verdict: Unfortunately, high — or low — levels of all these hormones is not a reliable indication of whether or not you are going through menopause, says Salas-Whalen. “Once women start having irregular periods, their hormones can be all over the place,” she adds. “You can be in the midst of menopause, with terrible hot flashes, but still have a low FSH level or vice versa. That’s why we go by symptoms, rather than by hormones.” And do not assume that just because you have a high FSH level, you can’t get pregnant: A 2017 study published in the Journal of the American Medical Association, for example, found no link between high FSH levels and a woman’s ability to conceive.
Stress tests
These at-home tests claim to measure certain hormones to gauge your stress levels. These include cortisol, the main hormone your adrenal gland churns out when you are stressed, as well as other hormones such as DHEA, which helps to balance cortisol if it gets too high. Some are urine tests, while others are saliva. Most require you to take a sample four times a day.
Cost: these kits tend to start at about $99 and can go up to about $170
The verdict: Cortisol levels fluctuate throughout the day (they tend to be highest early in the morning and the lowest late at night), which is why you are supposed to collect four samples throughout the day, says Pamela Peeke, M.D., professor of medicine at the University of Maryland and author of “Body For Life For Women.” But the reality is unless your levels are very high or very low then the results are basically meaningless. “They’re not usually a good gauge of how stressed you are, since certain medications such as birth control pills or even a vigorous workout the day before can temporarily affect cortisol levels,” Peeke explains. “Even if you’re under a lot of stress, your cortisol levels will probably still fall within a normal range.” These tests are only traditionally done if your doctor suspects Cushing syndrome, a condition where your body churns out too much cortisol, leading to weight gain in strange places such as your face and in between your shoulders; or Addison syndrome, where your body produces too little. And in these cases, you are better off seeing an endocrinologist who specializes in the disorder, who can diagnose and treat these conditions.
Sleep tests
These types of kits measure your levels of melatonin, a sleep-promoting hormone that your body produces naturally. Some also measure the stress hormone cortisol. Like stress tests, you will need to take either urine or saliva samples four times a day.
Cost: anywhere from $119-$250
The verdict: If you are having trouble sleeping, you are much better off seeing your doctor rule out any medical conditions such as hypothyroidism, which has been linked to sleep apnea and hyperthyroidism, which can cause insomnia, says Peeke. You can also check your vitamin D levels since research shows low levels may also affect sleep.
Thyroid tests
One in eight women will develop a thyroid problem during her lifetime, according to the American Thyroid Association. These at-home blood tests purport to help you self-diagnose the problem by measuring certain thyroid hormones, including TSH, T3, T4, as well as TPOAbs, antibodies made by your immune system that suppress your thyroid function.
Cost: around $175
The verdict: The problem with these tests is that they are not so easy to interpret, says Mary Jane Minkin, M.D., an OB-GYN at Yale School of Medicine at Yale University. About five percent of all women have what is known as “subclinical hypothyroidism,” which means levels of one thyroid hormone, TSH, are slightly elevated, but their other thyroid hormones are normal and they are not showing symptoms of hypothyroidism such as irritability and weight gain. In these cases, most doctors do not even recommend treatment. But not surprisingly, some of the companies that sell these tests also sell supplements touted to boost thyroid function.
Genomics
These tests — which require both a blood and saliva sample — claim to go one step further than regular hormone tests by also analyzing your DNA. (For example, one test checks cortisol, thyroid hormones and the sex hormone testosterone, while also checking certain genes such as the FTO gene for mutations that are related to obesity.) They are significantly more expensive than at home tests that just claim to check your metabolism.
Cost: around $200
The verdict: Genetic testing is still in its infancy, stresses Peeke. (The companies themselves even acknowledge this, with one statement on its website “results do not determine or limit your ability to gain or lose weight.”) “You can have a mutation in one of the so-called obesity genes and not be at any risk for being overweight,” she says. “When it comes to obesity, we still don’t have a good grasp of how significant genetics is. Lifestyle is still the main factor when it comes to weight.” Save the money you will spend on the test and spend it on a gym membership.
Vitamin D
The so-called sunshine vitamin is not actually a vitamin — it is a hormone produced by your kidneys to control the concentration of calcium in your blood and help maintain strong bones. Low levels of vitamin D in the blood have been linked to conditions such as type 2 diabetes, depression, heart disease, high blood pressure and possibly even autoimmune conditions such as multiple sclerosis and certain types of cancer. These tests check your blood levels of vitamin D to help determine whether or not you are D-deficient.
Cost: around $39
The verdict: If you do have this test done, you probably will not know what to do with the results. There is controversy about how much vitamin D you need to stay healthy. The Endocrine Society, for example, recommends at least 30 ng/mL or higher, but some groups want your levels to be above 60 ng/mL. But taking too much vitamin D when you do not need it can be dangerous and cause side effects such as nausea, vomiting or even kidney problems. You are better off having your doctor check your vitamin D levels, advises Peeke, and if you are low, speak to them about how much you can safely take from supplements.
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