Hormone Testing: What Women Really Need to Know

When evaluating hormone imbalances, patients often ask about the difference between serum hormone testing and the and whether they really need any testing at all. While there are many ways to go about evaluating hormones and there is no single best way to do it, I’ll share with you today my approach to hormone management at Well North Functional Medicine. 

First, the testing vs. no testing debate. Some providers will simply go off of symptoms when deciding on when to start hormones and then also go off of symptom resolution to figure out if the dosing is correct. This is often the approach for post-menopausal women when we know that all hormone levels are quite low. I do find that doing some testing and tracking is helpful especially when looking at and starting something like testosterone replacement therapy.

And now what about serum (aka blood) testing vs. the DUTCH test. They both can provide information about hormone health, but serve different purposes and are not equal in cost, validation, or clinical utility.

Serum Hormone Testing (Blood Tests)

Serum blood hormone testing measures hormone levels directly in the bloodstream. This method is well-validated, evidence-based, and widely used in conventional and functional medicine. It is also more affordable and accessible (often covered by insurance), making it the preferred first-line option for evaluating hormones such as estrogen, progesterone, testosterone, cortisol, and thyroid hormones.

For most patients, serum testing provides clear, actionable data to diagnose hormone imbalances and guide treatment decisions, including hormone replacement therapy (HRT). It is tricky in perimenopause because we try to time it at various parts of the menstrual cycle but I always tell patients, we are pairing the lab data with your symptoms to get the best clinical picture to start treatment. 

The DUTCH Test (Dried Urine Hormone Testing)

The DUTCH test (Dried Urine Test for Comprehensive Hormones) analyzes hormone metabolites collected over a longer period of time. It can offer insight into hormone metabolism and detoxification pathways, but it is more expensive and less clinically validated than blood testing. It is used often in functional medicine but not something that I use regularly. 

When the DUTCH Test May Be Helpful

In my practice, serum hormone testing is the foundation and this is almost always where I start with patients. However, I may use the DUTCH test selectively, most often in patients on hormone replacement therapy who continue to have symptoms that do not align with blood hormone levels, or when we are having difficulty fine-tuning hormone dosing.

If you’re wondering which hormone test is best, serum blood testing is the most reliable and cost-effective starting point. Specialty hormone tests like the DUTCH test should be used strategically, not routinely, and as a complement, not a replacement, for blood work and getting a good patient history.

If you are looking to do some hormone testing or curious to learn more, book a FREE 15 minute discovery call below!