The How and Why of Hormone Testing, Explained

Things don’t feel right — and they haven’t for a while. It’s lots of little things: You’re extra tired, extra irritable and you seem to be losing extra hair in the shower.

You want answers. Could it be time to consider hormone testing?

We asked hormone and women’s health specialist Pelin Batur, MD, about common symptoms of a hormone imbalance, how they differ between men and women, and the different ways to test for them.

Common reasons for hormone testing

“We have at least 50 different hormones in our body, and when they’re out of balance, they can cause complex symptoms and health issues,” Dr. Batur says.

But experiencing symptoms of a hormonal imbalance doesn’t mean you have a hormonal imbalance. Nearly every symptom of an imbalance can have other causes, as well.

“It’s important not to lump everything together under hormones and instead, break down each symptom individually,” Dr. Batur advises. “We have to take a deep dive to make sure we’re not missing anything.”

Here are some symptoms Dr. Batur recommends discussing with your healthcare provider.

Acne

“When someone — male or female — complains of acne, it could be a sign that they have high levels of male hormones called androgens, such as testosterone,” Dr. Batur says. “That’s common in women with polyendocrine metabolic ovarian syndrome (PMOS).”

Thyroid hormone imbalances can also cause acne in both men and women.

Hair changes

If you notice differences in the hair on your head, face or body, it could be a sign of a hormone imbalance.

Increased testosterone can cause excessive hair growth in women (hirsutism). Hair growth can also be a symptom of PMOS or menopause, among other things.

On the flip side, hormonal imbalances — in both men and women — can cause the hair on your head, legs and pubic region to thin.

“Hair changes can be tough to figure out,” Dr. Batur says. “You might assume hair loss is hormonal, but it could be related to something else, like vitamin deficiency or high stress levels.”

Unexplained weight gain

Sometimes, weight gain is the result of a hormone imbalance or a hormonal shift. For example, changes in body composition are common during menopause. But if you don’t have other symptoms, chances are good that other factors are playing a role, like:

• A condition like depression, chronic kidney disease or sleep apnea
• Lifestyle factors, such as stress or a change in your routine
• Muscle loss that occurs with age

Unexplained weight loss

If you haven’t changed your behavior but have suddenly dropped 15 pounds, that could be a sign of an overactive thyroid (hyperthyroidism).

When your body produces too much thyroid hormone, your metabolism speeds up. This can cause weight loss, along with rapid heartbeat, an intolerance to heat and other symptoms.

Sexual changes

Sudden changes in the bedroom can also signal a hormone imbalance. Dr. Batur recommends talking to your provider about sudden changes in your level of:

• Desire
• Arousal
• Sexual performance

“But remember, what matters isn’t what’s ‘normal’ for most people. It’s about what’s normal for you,” she clarifies.

Energy and sleep issues

You may experience extreme swings in your energy levels and sleep patterns if your hormones are out of whack. But these fluctuations aren’t always due to hormones, so be sure to tell your provider about other symptoms, too.

Hot flashes and night sweats

Did you know that women aren’t the only ones who deal with hot flashes and night sweats?

We usually associate them with the drop in estrogen levels that comes with perimenopause or postmenopause. But Dr. Batur reports that hormone shifts and imbalances in men can have a similar effect.

Also, keep in mind that hormones may not be behind these symptoms. Hot flashes and night sweats are also common side effects of certain medications, for example.

Mood changes

If you’ve been riding an emotional rollercoaster recently, it could be down to hormones. But many conditions can affect your mood.

“Symptom tracking can help your provider find patterns — if there are any — and narrow the list of possible causes,” Dr. Batur says.

Difficulty focusing

Brain fog and difficulty concentrating can be distressing if you’re someone who can normally “lock in” without issue. Trouble focusing may be linked to a hormonal imbalance, especially if you’re also experiencing issues with energy and sleep. But stress, depression or vitamin B12 deficiency can also contribute.

Symptoms specific to women

Women’s hormones fluctuate more often than men’s, thanks to periods, pregnancy and menopause. Common symptoms of hormone imbalances that affect women include:

• Irregular periods: Changes to your menstrual cycle can signal pregnancy or perimenopause, but those aren’t the only possible causes. “If your menstrual cycles are disrupted, you should definitely come in to be seen,” Dr. Batur advises.
• Vaginal dryness: While it can be a sign of a few issues, vaginal dryness is one of the most common symptoms of menopause. “The vagina is quite sensitive to lack of estrogen,” Dr. Batur says. “At least 50% of women have vaginal dryness that may get in the way of intercourse, and it tends to get worse over time.”

Symptoms specific to men

In addition to the other symptoms we’ve mentioned, men with hormone imbalances may also experience:

• Gynecomastia: If you notice that your breasts (chest) are getting bigger or losing muscle tone, your balance of estrogen and testosterone may be off. Rest assured: This is a very common experience for men, and there are several treatment options.
• Testicular atrophy: If your testicles seem to be shrinking, it may be because of a hormone imbalance. This is also a common side effect of anabolic steroid use and testosterone replacement therapy (TRT).

How to get your hormones tested

The type of test that’s right for you depends on the type of hormone imbalance that’s suspected and the kinds of medical questions you’re trying to answer.

A hormone test ordered by a healthcare provider usually gets collected at the office or at a lab. These tests usually involve either a blood or a urine sample. Test results can take anywhere from a couple of days to a week to come back.

Some commercial home-testing services use saliva. But at-home tests can be tough to interpret, so the results can be misleading. Those findings also don’t get you any closer to a diagnosis or treatment plan.

“At best, retail tests are a conversation starter,” Dr. Batur says.

While it’s important to advocate for your health, try not to be swayed by broad, overarching claims that everyone needs hormone testing (looking at you, social media).

Which hormones are typically tested and why

There’s no one-size-fits-all hormone test. Healthcare providers order tests to check specific hormone levels based on your symptoms.

For example, a provider may check:

• Thyroid hormones, like your TSH, free T3 or free T4, are used if they suspect a thyroid condition.
• Reproductive hormones, like estrogen, progesterone, testosterone, luteinizing hormone (LH) or follicle-stimulating hormone (FSH), are used for issues revolving around sexual health or fertility.
• Stress hormones, like cortisol and adrenocorticotropic hormone (ACTH), to see how well your pituitary and adrenal glands are working.
• Metabolic hormones, such as hemoglobin A1C and glucose, are of concern if they’re concerned about insulin resistance or blood-sugar regulation issues.

Other things to consider

Here are a few other things Dr. Batur says to keep in mind about testing:

• Timing matters. Some hormones fluctuate throughout the day, which can affect test scheduling and results. (Side note: Ask your provider if you can eat and drink before hormone testing.)
• Medications and supplements can change results. Certain medications — like steroids, certain cancer treatments and birth control — can impact your hormone levels.
• Not all hormone shifts are meaningful. All sorts of things can cause your hormones to shift, from a bad night’s sleep to the common cold. So, changing hormone levels or an abnormal test result may not be reason to worry.

“Remember: Hormone testing can be a valuable part of the diagnostic process, but it’s not the first step,” Dr. Batur notes. “The first step is a conversation with your doctor.”

That discussion can set you on the path to getting the answers you need.