Hormones are responsible for crucial bodily functions as well as major changes that occur over your lifetime. They are essential for fertility, libido, muscle tone, skin tone, bone health, energy levels, and weight management, among other functions. Additionally, hormone levels shift at various points to induce life stages such as puberty, reproduction, pregnancy, and menopause. Imbalanced hormone levels are part of the reason why young people going through puberty often develop facial acne and why women going through menopause typically experience hot flashes just to point out a few issues.
Hormones are chemical messengers that manage many bodily functions. Balanced hormones help you maintain good health, but shifting or unbalanced hormones can negatively affect your health. Hormone testing can identify hormonal imbalances to provide insight as to whether hormone therapy to balance your hormone levels could improve your health, vitality, and quality of life.
The 24 hour urine test is one of the options available that many practitioners find useful.
Urine Hormone Test Pros
- The 24-hour urine hormone test has several positive qualities. It shows a good overall picture of hormone levels by providing the average hormone level over a 24-hour period, removing the variable of daily fluctuations in one’s hormone levels. It accounts for the full day and night of hormonal secretion. This eliminates the possibility of falsely elevated or depressed levels that may be obtained when a single point collection occurs at a peak or valley of an individual’s secretory cycle. Since higher amounts of hormones are secreted at different times during the day, this gives a picture of the average level of hormone secretion.
- Urine assays measure systemic, circulating, unbound hormone, reflecting that which is bio-available and ready for the body to use. Urine hormone tests shows hormones in their water-soluble form, meaning that the body has prepared it and made it ready for excretion.
- Although the test is more expensive than blood or saliva, it provides a more comprehensive hormone picture by testing a broader range of hormones, pro-hormones, and hormone metabolites than any blood or saliva panel, which results in a higher level of information that is especially helpful in difficult cases. Pro-hormones are the precursors or biochemical building blocks for hormones. Hormone metabolites are the biochemical by-products or end products of hormone metabolism.
- Measuring hormones in urine is quite common in research. A 24-hour urine collection is the preferred method for testing hormones that are secreted at night and during deep sleep, such as growth hormone and melatonin, and is the most economical and reliable way to evaluate steroid hormone metabolites. This method has been gaining in popularity among integrative practitioners since it was brought into clinical practice by Dr. Jonathan Wright in the early 1980s.
1. Urine Hormone Test For Estrogen
- Urine tests for all three estrogens (estrone, estradiol, and estriol) and provides additional helpful information, such as the levels of 2/16 hydroxyestrone ratio and 2-methoxyestradiol (suspected to have anticancer qualities).
- Other useful hormone tests are available using the urine, including different sub-types of estrogens such as 16 alpha (OH) estrone.
2. Urine Hormone Test for Cortisol
Twenty-four hour urine hormone panels are excellent for evaluating adrenal health and function. In addition to measuring DHEA and cortisol, a complete panel also measures cortisone (the storage form of cortisol) and several important cortisol and cortisone metabolites, as well as aldosterone and other mineralocorticoids. The importance of measuring these metabolites can be seen in the stressed patient with normal or high-normal cortisol. Cortisol and cortisone metabolites can point to decreasing daily cortisol production that signals adrenal deficiency. The ratio of cortisol and cortisone is another important indicator of adrenal function, as are the mineralocorticoids: low mineralocorticoids are a clear indicator of chronic adrenal fatigue and are an excellent marker to monitor adrenal recovery with treatment.
3. Urine Hormone Test for Metabolites
- An important advantage of a 24-hour urine hormone collection is the ability to measure hormone metabolites. This is most important when evaluating the adequacy and safety of exogenous estrogen supplementation and in assessing adrenal function. It is well established that certain estrogen metabolites are “good” estrogens, having a protective effect on estrogen-sensitive tissues. Other metabolites are known to have more carcinogenic effects.
- The utility of measuring estrogen metabolites has been the focus of much recent attention. Studies from 2012 and 2013 (a prospective case-control study and a retrospective case-control study) uncover new data that find a statistically significant association between 2-hydroxylation pathway estrogen metabolites and lower breast cancer risk. These studies focused on postmenopausal women not taking hormone replacement. While there are no studies to date that examine estrogen metabolite ratios in postmenopausal women while concurrently taking hormone replacement, it stands to reason that supplemented levels of parent estrogens will make estrogen metabolite analyses an important test in this population group.
- Thierry Hertoghe, M.D., from Belgium and the author of The Hormone Solution, proposes that urinary hormone studies provide the best overall picture of hormone metabolism. He says they are a critical component for evaluating age-related hormonal changes, one that blood studies do not provide, and he suggests a comprehensive 24- hour urinary hormone profile as the initial test to be used in hormone balancing therapy.
- Estrogen metabolism is also easily influenced, being easily altered with supplements such as diindolylmethane (DIM), indol-3-carbinol (I3C), methylated B vitamins, and magnesium. Being able to evaluate the relative balance of protective estrogens to potentially harmful estrogens and see the effects of treatment interventions is invaluable to the clinician working to maximize quality of life while also protecting against harmful effects. Because 24-hour urine hormone profiles measure both phase 1 and phase 2 liver metabolites of estrogen, these profiles also offer a peek into liver function and may suggest further avenues for treatment. It also shows urinary metabolites of steroid sex hormones, such as those involved in testosterone and pregnenolone metabolism.
Urine Hormone Test Cons
Even though it has so many benefits, the 24-hour urinary hormone panel has a few limitations as well.
- This method is considered inconvenient by some because it requires a person to collect all their urine over a 24-hour period.
- Older people are often unable to manage urine collection with accuracy, and for these individuals urine testing may be too cumbersome.
- Dehydration or excessive fluid intake can also affect the results.
- It only measures the hormones the body is excreting in the urine. And while excreted hormones often correlate with tissue and blood levels, this is not always the case.
- Not all urine hormone testing methods are equal. Serial single-point urine collection does not account for individual differences in hormone secretion, especially for patients with nontraditional schedules, such as shift workers.
- Just as single-point and 24-hour collection are different, not all technical methods of urine assay are equally accurate. Highly sophisticated gas chromatography (GC) run in tandem with mass spectrometry (MS) is emerging as the method against which all other methods are measured.
- People with kidney disease do not excrete urine or metabolic products normally, so a urine hormone test is not suitable in these cases as hormone results may be altered in people with significant liver or kidney disease.
- As with all other methods of testing, non bio-identical hormone substances are not measured.
- Urine testing cannot test both free (active) and total levels of testosterone.
- This test is complex and difficult to interpret, so you need to consult a physician who is an expert in this type of testing to tell you what it means.
- The 24-hour urine collection does not shed light on the diurnal cortisol pattern. It has been observed clinically, however, that an elevated cortisol and cortisone in the 24-hour urine panel may be related to nighttime cortisol spikes.
- Some practitioners have expressed a concern about the convenience of a 24-hour urine collection.
- To help ensure accuracy, some labs and their total testosterone hormone testing have been CDC-certified every year since the program’s inception in 2011. Unfortunately, there is no similar certification program for overall urine hormone testing at this time.
The 24 hour urine test has been elevated to a new level with the availability of the DUTCH test which is a dried urine test and more comprehensive than the above mentioned urine tests. You can find out more info about the more comprehensive urine test here.
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