Which Hormone and Vitamin Test?

Can someone please remind me of which hormone and Vitamin deficiency tests to have done? I recall Shannon mentioning that earlier but I can't find my notes.

All the best,
Que

I would be interested as well regarding any hormone/vitamin or general blood work that is recommended.

Bill

Typical testing done on routine checkups with allopathic physicians don’t often include the specialized testing required to evaluate specific nutrient levels or other markers which can signal trouble areas specific to the body’s metabolic requirements.

My long and extensive medical history includes medical negligence from never testing my iodine levels or a full thyroid panel. Had that been done when I was in my 20’s and complaining about various symptoms that were sloughed off as insignificant or worse, “normal,” I wouldn’t have been subjected to the misery and severe complications that could have been avoided with something as inexpensive as supplementing with iodine. Instead, I suffered and was subjected to many, totally-preventable surgeries.

Additionally, I treated for many years with a diagnosis of “fibromyalgia” by a Rheumatologist….a catchall term which means “we don’t know what it is you have, but here’s a drug for it”…. and I made no progress, was miserable on the drugs so I stopped and eventually learned from Vitamin D testing that my levels were 18 in spite of having lots of sun exposure in the summer with gardening and golfing. Aggressive supplementing year round and periodic testing took away all the fibromyalgia symptoms. Another fiasco.

Today, “modern” medicine is still remiss in not going through basic, fundamentals by evaluating the core nutrients and how each of the body’s systems rank for either deficiency or overload.

We have to advocate for ourselves and the best direction one can take is to be in the care of care of a naturopathic physician or one certified in the Functional Medicine approach, testing by specialty labs such as Genova Diagnostics (NutrEval ) or Metametrix (Comprehensive Metabolic Profile), Spectracell etc… Then, you’ll have an overview of very specific functional testing that should include thyroid, vitamin D (25 OH D) and specific sex hormone levels, blood viscosity markers, markers of inflammation, iodine, complete thyroid panel and not just TSH. and so on. (And Exatest).

These are not typically offered by your PCP or GP, unfortunately. Sometimes, you can get them to include some in your routine testing. I’ve found I need a Primary Care Physician just in case I need to be hospitalized but I rely on my FM MD for my care, testing and counsel although she doesn't accept insurance. Catch 22, but worth every dollar spent out of pocket. Fortunately, the specialized lab testing is covered; just not the office visit.

Be aware, there are many ‘holistic’ type practitioners who think they are knowledgeable but don’t really have the advanced training to be reliably useful and they tend to want to sell a lot of expensive supplements in a “try this – try that” approach without proper testing. I've seen a few of those over the years as well.

This link is a collection of a variety of posts on various types of testing and for what purpose… as discussed casually over time here on the forum. [www.afibbers.org]

Jackie

Thanks Jackie for sharing your personal experiences and the fruit of those experiences with us younger folks just beginning this journey. If there is any consolation at least your experience is helping a new generation of people hopefully avoid some of these problems. Of course traditionally MDs still resist any notion of vitamin of hormone deficiencies. I was at a sleep doctor the other day and asked if he had any idea about how a Vitamin D deficiency might affect my current sleep problems and he dismissed it. I get it. They weren't trained in any of this stuff and they are suppose to be experts. However, slowly there does seem to be a little progress. We have a few MDs that are willing to step outside of their comfort zone to help patients like Dr. Gominak and others.

My doc tests for most Vitamins. When I get the copy of the blood tests from him it is almost a small book. There are some hormone tests on there also.

The best screening for comprehensive hormone and nutritional status is done with a combination of serum and A complete 24hr urine steroid hormone and metabolite test protocol such as offered by Meridian Valley Labs (Washington) and Rhein Labs (Oregon) that use sophisticated GC/MS/MS (Gas Chromatography/Mass Spectrometry) methods. The new DUTCH (Dried Urine Testing of Circadian Hormone) test is also quite promising. Melatonin in urine testing (prior to starting Melatonin therapy for baseline)

In addition, combine the urine collections with next morning blood draws included a CBC (Complete Blood Count) with a Diff, CMP (Comprehensive Metabolic Profile), Iron panel including Ferritin, Complete Lipid profile (preferable with LDL particle size), Prolactin, PSA for men.

Serum Vitamins A, E, K2, D3, B6, B12 (complete B12 profile), folic acid, Selenium, Glutathione, SOD, RBC magnesium, Albumin

EXAtest epithelial electrolyte profile

Serum hormones: Total and Free Testosterone (LC/Ms-Ms), DHEA-Sulfate, Estradiol, Estrone, Progesterone, IGF-1 & IGF-BP3, 8am fasting Cortisol, Transcortin (Cortisol Binding Globulin) ACTH, Thyroid profile (TSH, Free T3, Free T4, Reverse T3, TPO, Anti-TG).

The tests Jackie noted have some real value too and some redundancy with some of the above, but the 24 hr uri e components of one or two of those profiles she mentioned are not as sophisticated and accurate as the first two 24hr urine tests noted above. But those tests Genova, Metametrics and Spectracell tests all have valuable additional components for those wishing to look into other areas as well.

But the list above is a very good starting point for a very comprehensive baseline Hormone/endocrine status and nutritional Eval to see what needs to be addressed most importantly.

The best BHRT (Bioidentical Hormone Replacement Therapy) physicians and Functional Medicine MDs will ask for a good portion of both. By cautious of those facts who rely mostly on saliva testing as their main tool for Hormone evaluation .. Especially those that rely on salute testing for follow up adjustment of hormone levels once you are on BHRT therapy... Saliva tends to be very unreliable for follow up screening for most anabolic hormones.

Circadian Saliva Cortisol testing is valuable to see intraday swings in adrenal response, but the DUTCH dried urine test does an even better job of showing that as well as. To

It is not cheap to do a full battery of initial Baseline tests, but the good news is that once that Initial comprehensive baseline is done most follow up testing to adjust treatment will only entail a portion of those I tests that need to be repeated periodically.

Shannon

Shannon - can you give an idea of the costs of the Meridian Valley, DUTCH and Rhein Labs? I presume those aren't typically covered by insurance or Medicare which cover the ones I've used. And I fully understand the importance of the more definitive tests... just that costs can be out of sight when you have to pay out of pocket.

Thanks,
Jackie

Meridian Valley and Rhein Labs I have Medicare pay for some of those tests, Not sure about DUTCH test Jackie as that is a new test.

It does get expensive for a full initial comprehensive serum and 24 hour urine full anabolic, adrenal, growth hormone, urinary thyroid and 6-Sulfatoxy-Melatonin hormone profile at around $1,200 to $1,500 max for all of those initial ideal list of baseline labs depending on which lab company you use for the serum tests I listed.

Many docs will pair down the list to the bare essentials when the person gets no help from insurance and thus help cut the cost considerably for that very important first baseline test to establish treatment protocol, but any subsequent testing will be much cheaper and a fair portion of those serum tests and an occasional 24 hour urine test will be picked up by most medicare plans.

Shannon

Thanks, Shannon... I should have also asked... do you order them yourself or does your local doctor cooperate and order them in for you. That's typically a problem here... as for instance, my PCP will not order those specialized tests. I can get them through my FM MD, but the office visit and results visit is not covered by insurance and that's pricey.

Jackie

Hi Jackie,

I called Rhein and they said they have CPT codes for the urine hormone test. They also state on their site under FAQ:

Will my insurance cover the hormone profile?

Most insurance companies reimburse fully for the Rhein Labs hormone profile. Of course, it’s wise to check with your insurer in advance.

I also spoke to Meridian Valley Labs and they have CPT codes for their tests.

Que



Edited 1 time(s). Last edit at 08/24/2015 08:01PM by Que.

Hi Jackie, for the 24 hour urine they ask for a participating physician, MD or ND, to order it as it requires a good deal of added training for proper interpretation.

Before the job of keeping this lights on here on our Afibbers forum and website landed in my lap two years ago, I did a good deal of patient coaching for a couple BHRT MDs in the Bay Area ( by phone or Skype) and in AZ to help set up such tests and instruct patients on how to properly prepare and conduct the urine and blood work collections, with proper timing of any hormone dosing with respect to blood, urine or saliva sample collections in order to get the most relevant results and studies extensively 24 hour urine lab test analysis as well to help explain what we found in the patients tests for the patient etc.

As such, its been easy for me to arrange for my own tests via these docs too. Some of the other Meridian Valley labs and other lab company tests though, can be ordered directly by patients, including many serum blood tests.

Shannon