• Wendy Finkelstein

Why measuring urinary hormone metabolites can be more accurate that blood hormone levels.



If you are getting bio-identical hormone therapy and your practitioner or Dr. is only using blood or saliva levels, than you will want to read this blog.


While blood hormone levels are necessary and important, they do not give insight into the delicate  journey hormones take in the body. Blood is simply an end point or a measurement in time, taken  in the midst of processes that occur on a continuum.   That said, what is becoming increasingly important in my approach to hormone therapy, is understanding the hormone process in motion. This means, I look at hormone activity via the functionality of the enzymes and receptors involved, their  binding affinity, and their excretion and reabsorption. Blood can give some insight into possible hormone pathways, but to rely soley on them, prohibits the fine tuning  necessary to truly appreciate the benefits of hormone optimization.  To unravel the deeper reasons why urine testing in my opinion is more than necessary, we must first distill some important concepts. Concept 1 Estradiol vs Estrone and Progeterone  As we age, we transition from having  more estradiol to more estrone. This  presents an issue when measuring monitoring estrogen in the aging population. This is because many practitioners only use estradiol to monitor estrogen levels.  Aging women can falsely appear estrogen deficient when estradiol is the only estrogen measured. Measuring only estradiol is not advisable when deciding if premenopausal woman, or even postmenopausal woman, need estrogen therapy because many aging women with estrogen dominance or elevated estrogens can still have low estradiol levels. Placing this category of women on estrogen therapy could potentially lead to worsening symptoms and even endometrial cancer risk.2,6,7 Additionally, metabolites of estrone and estradiol can indicate certain risk factors and often have estrogenic strength as well, so it is important to know the total effect of all the estrogens and their metabolites  on the target tissues. Many women in their 30's and 40's become "estrogen dominant" due to either increasing estrone or hiccups in the elimination of estrogens, For this reason, progesterone is prescribesd to help balance the estrogen. The different reactions many women have to topical and oral progesterone  lies in the way it is metabolized.  Again, a blood or saliva hormone test will not give you this valuable  information. Concept 2 Aromatase Activity Aromatase activiity is responsible for converting testosterone  to estrone or  estradiol in men and women.  Monitoring testosterone in serum can show misleading  lower levels of  testosterone  when there is high aromatase activity. To complicate this,  tracking estrogen levels in serum can hide increased aromatase activity. In other words, practitioners justify increasing the dose  of testosterone due to falsly low testosterone levels in blood while not realizing that he  or she is just converting testosterone to estrogen. Both men and women  in this situation often exhibit declining benefits of testosterone therapy and are at risk for poor cortisol metabolism and hypothyroid as a result. If the urine was checked, the elevated testosterone would have been apparant, an aromatase inhibitor, such as anastrazole could have been started, and  no addittional testosterone would have be needed.  Concept 3 Cortisol Metabolism DHEA  and Thyroid When our adrenal gland make cortisol, it is important to know how long it takes for its metabolites to breakdown.  When cortisol metabolism is slow it can suggest hyporthyroid while  on the flip side, when it is accelerated it points toward insulin resistance.  When cortisol metabolism is increaseed the body leans towards a catabolic state, meaning its  inflamed. DHEA, another hormone is necessary to balance cortisol. DHEA can offset the energy storage and weight gain driven by excess cortisol. Looking at these metabolites in ratios to one another is another bonus of urine metabolites over blood. Interestingly, thyroid function in women is often driven by estrogen. Hypothyrroid is often the bodies way of slowing down esttrogen production in women who suffer from estrogen dominance. This is a common explanation of irregular periods in premenoupausal women.  Conclusions In men, estrogen is assessed vs testosterone, and in women, estrogen is assessed vs progesterone to identify estrogen dominance and uncover any imbalances between these metabolic pathways. By evaaluating our cortisol response alongside our sex hormones we can appreciate and  integrate how our hormones may be effecting our thyroid, blood sugar, and body composition. By measuring over a 24 hour time frame, urinary hormone testing PREVENTS false highs and lows that can show up when testing in more immediate, moment-in-time methods of detection like blood and saliva. Urinary hormone testing provides a more in-depth clinical picture due to the ability to measure hormone metabolites along their physiological pathway. These metabolites indicate how the primary hormones are affected by enzymes and cofactors between hormone synthesis and hormone elimination. Too many people are getting hormone treatment withouth this necessary insight and it is  my primary focus  to deliver the most accurate results with the highest amount of clinical information. To find out more or how you can test your urinary hormone metabolites plesase visit my website at Nephesh-Health.com  and schedule a consult.

With Love and Service Wendy FInkelstein PA-C,MMS,  FAAMFM

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