🧪 The problem with frequent hormone testing
In clinic vs at home testing, making forever chemicals disappear, and manopause is real
Direct-to-consumer companies market AMH testing to women as often as every six months to “keep an eye on things.” Since they’re available to anyone who wants them and typically cost under $200, what’s the harm minus the expense, right? Turns out hormones aren’t that simple. And also PSA: AMH is *not* a good single indicator of the ability to conceive naturally. It tells us how many eggs are left in a woman’s ovarian reserve, and is predictive of how well stimulation drugs will work during egg freezing and IVF.
The word hormone is derived from the Greek word hormao, meaning “to excite.” And that is what hormones do: they are signaling molecules that flow through the body via the hormonal superhighway, aka the endocrine system, telling our cells and systems how to keep us alive while regulating physiology and behavior. They aren’t just made in the ovaries and testicles. The brain makes them. The gut makes them. Bones make them. And the body’s various glands make them too. Just like a key in a lock, each hormone docks onto a cell’s receptors and delivers instructions, like reminding the body to eat (ghrelin), moving sugar into the cells to be used as fuel (insulin), preparing the body for sleep (melatonin), or growing bone, brain, and muscle (thyroxine).
In-clinic vs at-home hormone testing
Hormone testing is an standard part of an infertility assessment and is done in a doctor’s office or lab with specific protocols and timing. In a medical setting, your care will be personalized, and you will receive strict instructions and show up for testing on a certain cycle day. Men can also have their hormones measured. And now, at-home versions are available too. They are easier to access but still require specific timing and are best for those who are just exploring their fertility. All it takes is ordering a test online, following the instructions, sending it back, and waiting for your results. When choosing a company, screen for tests that are reviewed by a board-certified physician and allow you to opt into a telemedicine appointment with a fertility specialist to interpret results.
Because hormone levels fluctuate so much, it’s crucial to time an at-home test appropriately to get an accurate result. Those on hormonal birth control or taking hormone replacement therapy must quit ideally for six weeks before testing as both impact hormone levels. In better news, one advantage for women who hate needles (and really, who doesn’t?) is that at-home versions take less blood (though the process is still painful). The most common collection method is a dried blood spot, which involves pricking your finger with a lancet, then squeezing a few drops of blood onto a card to mail back for analysis. Some more extensive at-home tests refer out to labs where you’ll do a normal draw in person with a phlebotomist or nurse. Men are even luckier: at-home testing can be done via saliva.
Why not hormone test frequently?
For one, it turns out that hormone levels fluctuate daily, cycle-to-cycle, and pending which cycle day the test is performed. Even AMH, which was thought to have minimal variation versus other markers of ovarian reserve like FSH, varies up to 20 percent throughout the menstrual cycle. If you talk to most reproductive endocrinologists, the ob-gyns who specialize in fertility, they will tell you that a frequent testing cadence is not useful for most people, with one exception. Hormone imbalances can be sneaky, and when new symptoms creep into your life, they can indicate there is an underlying condition in play. Symptoms to watch include new cystic acne, weight changes, gastrointestinal issues, excessive hair growth or loss, vaginal dryness, irregular or a full halt to periods, and breakthrough bleeding. These symptoms indicate one or several hormone levels are too low or too high. If you feel like something is off, ordering a test or doing several over time is an option if you’re not ready to see a doctor.
At-home testing is useful in helping you understand if you should seek medical care, but it doesn’t integrate into the bureaucratic world of healthcare yet
Most doctors do not know what to do with the results of at-home tests, or they will look at and then rerun them using their specific protocol. The accuracy of at-home tests can vary depending on the maker of the test, the environment in which the test was taken (e.g., did the box get hot or take too long to get to the test maker), and whether it was done on the correct cycle day or performed while on hormones. At-home tests do not test every single hormone or marker that a full workup in a medical office would, nor does it involve a physical exam, so they cannot diagnose every issue on their own. These tests are only appropriate for women between twenty-one and forty-five, as they are designed for the years when hormone levels are more stable—after menarche and before the onset of menopause. Clinic-based tests are still the gold standard because the reference lab instrument and hormone assay kit are that particular physician’s therapeutic decision-making tool set. The same assays on different machines can provide slightly different results.
So what’s the tl;dr?
The best reasons to do an at-home hormone test for men or women are curiosity and cost. Doing the same hormone panel in a doctor’s office costs upward of $1,000 and is not covered if it’s not diagnostic. Doctors aren’t into doing tests just because you’re curious; there must be a medical reason to order one and charge insurance. If you are looking for a baseline, general idea of your overall fertility, at-home tests are a great way to achieve that cheaply. If you’re looking for information beyond that or navigating infertility, it’s best to book an appointment with your doctor. And if you are a bodyhacker or data-driven person, remember that more isn’t always better, and testing every month is unlikely to be helpful since hormone levels naturally fluctuate.
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👀 What I’m reading
💨 Cessation of chronic THC use partially reverses impacts on male fertility At least in rhesus macaques, a breed of monkey that shares around 93% of its genome with humans. THC enthusiasts should know that it causes testicular atrophy, increased DNA fragmentation in sperm, and decreased serum sex steroid levels.
⚡️ New water treatment zaps forever chemicals for good Forever chemicals, or PFAS (per-and polyfluoroalkyl substances) make products like raingear, non-stick cookware, stain repellents, and firefighting foam non-stick or stain-resistant and are linked to hormone disruption, cardiovascular disease, developmental delays, and cancer. “Think Brita filter, but a thousand times better,” says University of British Columbia professor Dr. Madjid Mohseni.
👴 Male menopause is treated like a joke, but there’s nothing funny about this silent epidemic Male menopause, or andropause, is the period in an adult man’s life when his hormone levels crash, causing symptoms including erectile dysfunction, depression, anxiety, and rapid fat gain.
Fertility Rules 🚀 June 6
