What are the Best Hormone Imbalance Tests? – How to Test for Hormone Imbalance

Have you suddenly started experiencing physical symptoms like fatigue, hair loss, anxiety, insomnia, acne, menstrual irregularities, or weight gain/loss? You could be dealing with hormone imbalance with female hormone imbalance being the most common, and doing a hormone imbalance test could be the first place to start. 

Hormone imbalance tests are being used more than ever before, and new research demonstrates a link between hormones and physical abnormalities seen in women on a daily basis.  

Hormone Testing 101

Nowadays, more than ever, men and women are getting curious about testing their hormone levels, and for good reason. But why?

The stressful environment in which humans exist nowadays far exceeds those of our ancestors. Everything from inflammatory diets, long-term medication use, toxic exposure, excessive technology use, increased work, and family demands, and social responsibilities greatly influence our hormonal health as a society. A few questions to consider:

  • Do you feel overwhelming bouts of anxiousness?
  • Are you dealing with constant mid-day or morning fatigue?
  • Frustrated with menstrual irregularities? 
  • Having mood swings out of this world?
  • Are you waking up to pee multiple times/night?
  • Are you experiencing unexplained weight gain or inability to lose weight? 

Stop thinking you’re crazy; YOU’RE NOT! These are just a few of the many symptoms that your hormones may be a bit out of whack.

The above are just a few of the many symptoms that can be explained by hormonal imbalances. Hormonal imbalances can happen at any age and should not just be accepted as “normal” despite your doctor or society making you feel this way. 

We get it; we’ve been in your shoes and have experienced the above symptoms and more. But we don’t want that for you, which is why today we are talking all about hormone imbalance tests. You can learn how to identify the cause of your unwanted symptoms through hormone testing, so you don’t have to suffer for years the way we did. 

Not only can hormone imbalance tests help identify the root cause of your symptoms, but you’ll also develop the powerful knowledge needed to best treat the symptoms in a safe and healthy way. 

This post will map out the different types of hormone tests, their advantages and disadvantages, and guide you on how to test for specific hormones.

How To Test For Hormone Imbalance?

By knowing and understanding which hormones are imbalanced, you’ll no longer be shooting in the dark trying to fix the issue. 

Instead of self-treating your symptoms with social media-influenced products and diets, you can make informed decisions about diet protocols, supplements, and lifestyle interventions to properly address your concerns.  

Hormones are downright complex. Different doctors and healthcare professionals will have their own opinions and preferences with how and what they test and typically are based on a patient’s specific set of symptoms. 

Testing for hormones can be done in several ways, and there are pros and cons to these different types of tests. Here is everything you need to know about how to test for hormone imbalance:

1. Serum 

Serum testing is a hormone blood test measuring the hormones present in the liquid part of the blood known as serum.

Serum blood tests have been long accepted in the conventional medicine space for hormone imbalance tests and are the standard that your general practitioner or gynecologist will use. You can get a lot of great information and learn a lot about your health from them.

These labs are most commonly drawn from a vein in the arm and sent to the lab for analysis which measures hormone levels in the blood. 

Advantages of Serum Blood Tests for Hormones

  1. Relatively simple as the patient has little involvement
  1. Generally low cost, especially with insurance coverage
  1. Can identify blatant medical conditions or diseases
  1. Used to measure the effectiveness of mediation 
  1. Can accurately evaluate peptide-based hormones including [1]:
    1. Thyroid panel
      1. Thyroid-stimulating hormone (TSH)
      2. Free T4
      3. Free T3
      4. Reverse T3
      5. TPO and Tg antibodies
  1. Follicle Stimulating Hormone (FSH)
  2. Luteinizing Hormone (LH)
  3. Fasting insulin 
  4. Prolactin 
  5. Cortisol binding globulin (CBG)
  6. Sex Hormone Binding Globulin (SHBG)

Disadvantages of Serum Blood Tests for Hormones

  1. Can miss subclinical diagnoses such as hypothyroidism 
  1. Does not help in monitoring transdermal (patch) form of hormones 
  1. Provides “normal” ranges but does not provide “optimal ranges”
  1. Testing is just a “snapshot” in time of what hormones are doing. Hormones are secreted in a pulsatile manner over the course of the day and into the evening; therefore, we don’t know if these values represent a peak, a valley, or something in between.[1] 
    1. Ex: Cortisol follows a diurnal pattern throughout the day, and a one-time serum blood draw does not assess this pattern of fluctuation.
  1. Does not always explain unfavorable symptoms (i.e it isn’t always an accurate reflection of bioavailable hormones that are active in organs and tissues). 
    1. Sex hormones (estrogen, progesterone, testosterone) are found in blood but they are bound to a protein such as sex hormone-binding globulin to be excreted from the body. 
    2. More of the bioavailable (active) hormones reside in fatty tissue and organs, which serum doesn’t represent. For example, serum levels of estrogen or testosterone are typically reported as totals and it may appear normal or even high normal because there is an abundance of the bound hormone. But what if the free hormone (amount of hormone that is readily available for use in the body) is low? Then that person can be functionally deficient and serum wouldn’t reveal that. 

What we’re sayhing is that serum doesn’t always give us the whole picture with hormone testing for women. 

They are a great start, but many hormones like our sex hormones estrogen, progesterone, and testosterone like to hang out in the fatty tissues, which aren’t accounted for in serum blood draws that are measuring hormones attached to a carrier such as sex hormone-binding globulin. 

Serum hormone tests are useful to some degree, but they often fail to help women understand why she’s continuing to experience symptoms of hormone imbalance, which is where saliva and urine tests are valuable. 

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Functional Hormone Imbalance Tests

Hormone levels are continuously changing throughout the day; thus blood may not always be the perfect reflection of what’s going on.

You may be able to relate to this by being told “everything is normal” and “you’re good to go” from your doctor, yet you still feel like junk! 

It’s no fun leaving the doctor’s office confused, discouraged, and unheard because you’ve been told your lab work is “all normal” despite feeling the complete opposite.

This is where specialized functional lab testing can be useful.

2. Saliva Testing 

Saliva testing is a common form of hormone imbalance test that can measure the amount of free, unbound hormones that are available for use in the organs and tissues. 

This type of testing can better reflect how a person feels day-to-day and may explain unfavorable symptoms that serum blood tests cannot explain. 

Advantages of Saliva Tests for Hormones[1] 

  1. May give a more accurate measurement of “bioavailable”, free-floating/active steroid hormones including:
    1. Estrogen (E1, E2, E3)
    2. Progesterone
    3. Cortisol
    4. DHEA
    5. Testosterone
  2. Non-invasive and simple
    1. Unlike serum which often requires the person to travel to a lab at a specific time and be fasted beforehand, saliva testing can be done at home
  3. Stable for long periods of time, so can travel for some time without needing ice packs, etc.

Disadvantages of saliva tests for hormones

  1. Not helpful in monitoring women taking hormone replacement therapy (topicals/sublingual); leads to falsely higher levels than serum.
  2. Lack of familiarity in the medical community (serum is considered the gold-standard).
  3. Results impacted by food and beverages like coffee and gum, as well as medications
  4. Are not regulated as rigorously as serum testing. Therefore, reproducibility and accuracy have been questioned.

3.Urine Testing 

Urine hormone testing is another form of hormone imbalance testing that is less common than serum and saliva testing, though its efficacy is already established in the literature. 

There are a variety of different companies offering urine testing that is commonly used among functional medicine practitioners.

Are All Urine Hormone Tests the Same?

No. Urine testing may involve collecting multiple samples of urine at multiple times of day, collecting all of your urine for 24 hours in a jug, or using dried urine samples such as the Dried Urine Testing for Comprehensive Hormones (DUTCH) from Precision Analytical. 

The dried urine sampling is newer to the market (known for its great stability at room temperature) and though its validity has been questioned, there is emerging evidence that this testing is comparable to previously used methods. 

A 2021 study reported that the burden of urine collection could be reduced using the collection of four spot dried urines on filter paper without compromising comparability with hormone results from a 24-h urine collection.[2]

One study compared the results of both 24 hour and dried urine samples to serum samples from women throughout the menstrual cycle. The results showed that urine metabolite concentrations correlated to serum concentrations, and the 4-spot dried urine samples can be substituted for 24-h urine collections.[3] 

What Hormones Can Be Measured with Urine Testing?

Similar to saliva tests, urine tests can measure bioavailable hormones and metabolites, including:

  • Estrogen (E1, E2, and E3) 
  • Progesterone
  • Testosterone
  • DHEA and DHEA-S
  • Cortisol (free and total metabolized)
  • Melatonin

Now that we’ve discussed whether urine testing is legit, let’s discuss some of the advantages and disadvantages of testing hormone levels through urine.

Advantages of Urine Tests for Hormones 

  1. An economical and reliable way to evaluate steroid hormone metabolites as they give an in-depth picture of what overall hormones are doing
    1. Ex: Progesterone and cortisol levels are changing throughout the day, and a single snapshot in time done through serum is not be reflective of the overall production of these steroid hormones. 
    2. They can measure if the person needs to learn how to reduce cortisol, or if it’s too low.
    3. Can clue practitioner and patient in on what is causing specific symptoms 
  1. Can identify HPA axis dysfunction, potential sources of inflammation, thyroid dysfunction, or blood sugar/insulin issues. 
  1. Learn about the metabolism of steroid hormones that helps measure the different types of estrogen (protective vs high risk). 
    1. This can help identify disease/disorder risk (i.e. breast cancer, hypothalamic amenorrhea, diabetes, thyroid conditions, adrenal dysfunction)

Interestingly, a case-control study and a retrospective case-control study in 2012 and 2013, respectively, revealed a significant association between the 2-hydroxylation pathway estrogen metabolites and lower breast cancer risk.[4] 

  1. Identify sources of unfavorable symptoms like:
  • Fatigue
  • Weight gain
  • Hair loss
  • Infertility 
  • Heavy periods
  • Painful menstrual cramps 
  • Insomnia
  • Poor lean muscle mass development
  • Increase abdominal fat
  • Poor cognitive function
  • Anxiety and depression
  • Gut dysfunction
  1. Measures both phase 1 and phase 2 liver metabolites of estrogen, which offer insight into liver function
  1. Urine tests measure cortisol and cortisone metabolites which helps identify adrenal dysfunction in highly stressed individuals, especially those with chronic fatigue syndrome.[5] This helps identify whether cortisol dysfunction is there is the first step to reducing stress. 

Disadvantages of Urine Tests for Hormones 

  1. Not always financially practical for the patient as tests are often not billed through insurance.
  2. The methods  of collection may effect results (some methods used are not optimal, and quality may differ significantly from lab to lab)
  3. Testosterone can be falsely low in some individuals
  4. Not effective with oral estrogen replacement or sublingual hormones due to first-pass metabolism (it is greatly reduced before it reaches the systemic circulation)
  5. Dried urine testing is not appropriate for people with significant kidney issues
  6. Results may be altered with specific supplementation scenarios 

As you can now see, the options for hormone imbalance tests are quite advanced these days. There are strengths and limitations to serum, saliva, and urine testing, and when used together, can provide important information about your hormones if you expect imbalances. 

Frequently Asked Questions About Hormone Imbalance Tests

How often should I test hormone levels? 

Generally speaking, testing hormone levels every 3 months to measure whether diet and lifestyle changes are effective is advised. 

If you have the means to do so earlier, or if your practitioner suggests sooner testing, do it! 

When is the best time to test for hormone imbalance?

Testing sex hormones in a woman with regular menstrual cycles each month is best evaluated during the mid-luteal phase. This occurs about 1 week after ovulation, which typically occurs somewhere between days 19-22 of the menstrual cycle.

Should you look into further testing if your doctor says thyroid levels are “normal” yet symptoms are present?

YES! You should. YOU are the expert on you’re own body, and if something doesn’t feel right, you have the right to investigate it. 

Serum testing of thyroid levels by your doctor usually starts with TSH and maybe T4. 

The problem with this is that just measuring TSH clues us in on pituitary function rather than thyroid function. It does not evaluate how much active thyroid (T3) you’re making. 

Another caveat to conventional thyroid testing is that the ranges for “normal” are very large; therefore, many women can be experiencing subclinical symptoms of hypo/hyperthyroidism without being notified by their doctor. 

If possible, request a full thyroid panel as described earlier in this post and seek a functionally trained health professional to interpret whether your levels are “optimal.” 

How do you test for adrenal fatigue?

The best way to test for adrenal fatigue or adrenal dysfunction is with urine and saliva testing. We are able to assess steroid metabolites for DHEA, metabolized/free cortisol, and the cortisol awakening response (CAR), which are players in evaluating adrenal fatigue.

What is the most accurate way to test cortisol levels?

Serum is not found to be a very helpful measure for cortisol levels, and this is because cortisol follows a diurnal pattern. 

It rises when you get out of bed, hitting its peak about 30 minutes after waking, and then slowly falls as the day goes on. We aren’t able to see this pattern by performing a snapshot in time serum cortisol test. This is where salivary testing is thought to be the best option when testing free cortisol, especially when considering the cortisol awakening response (CAR). 

What are the costs of hormone tests?

The cost of hormone testing vary. Serum blood draws are typically the cheapest option. This type of testing is the standard of practice and is often covered (or partially covered) by insurance providers.

Saliva and urine testing, which are often done at home by the individual, can vary in price depending on the company. 

A full urine hormone panel including sex hormones (progesterone, estrogen), androgen hormones (testosterone, DHEA), cortisol, and all their metabolites can range from $200-500 depending on the company and which tests are being performed. 

Which hormone test is the easiest to get?

It depends. As mentioned, serum blood testing by your doctor is the standard of practice and typically easiest for most people to get if they have easy access to the doctor. You, as the patient, don’t have to do any work except drive yourself to the lab. 

Finding a qualified nutrition expert or physician that is functionally trained who will order saliva and urine testing and properly interpret the results may be less accessible, but it just takes a little research to see who is in your area.

You’ll have to read directions and complete the testing on your own with saliva and urine testing. There are benefits to having a combination of serum, saliva, and urine for a full picture of what’s going on with your hormones.  

We did it! Thanks for sticking through until the end!

As you can now see, the options for hormone imbalance tests are quite advanced these days. There are strengths and limitations to serum, saliva, and urine testing, and when used together, can provide important information about your hormones when you expect that things just “feel off”. You are more in touch with your body than anyone else. You know what does and does not feel right. So, if clear answers to your problems don’t show up on a standard lab test, investigate further! 

Sometimes the root of your symptoms is a result of food sensitivities or not following an anti-inflammatory diet. Embarking on an elimination diet could be instrumental in managing your hormonal imbalance symptoms

If you’re all jazzed up about hormone testing now and are interested in diving deep into your hormonal health, you may want to consider working one-on-one with one of our dietitians (including me) to get to the root of your fatigue, painful periods, anxiety, whatever it might be! 


  1. https://eds.a.ebscohost.com/eds/detail/detail?vid=0&sid=bd56ea5b-0715-48b8-8491-c9849adf7403%40sessionmgr4007&bdata=JkF1dGhUeXBlPWlwLHNoaWImc2l0ZT1lZHMtbGl2ZQ%3d%3d#AN=93353547&db=awh
  2. https://pubmed.ncbi.nlm.nih.gov/33722278/ 
  3. https://bmcchem.biomedcentral.com/articles/10.1186/s13065-019-0539-1
  4. https://pubmed.ncbi.nlm.nih.gov/22232133/, https://pubmed.ncbi.nlm.nih.gov/23607871/
  5. https://pubmed.ncbi.nlm.nih.gov/16868267/

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