Why Hormone Tests Can Sometimes Be Misleading

Typically, when we are talking about hair loss and hormones, we are only focused on the hormones themselves (or hopefully that plus what some potential root-causes of the imbalance may be).


Brunette woman sitting at outdoor cafe, working at her laptop


It’s much less common to hear about how our hormones are actually behaving – whether they are active, or inactive, whether they are free to bound to protein – factors that can have a dramatic impact on our health. Without this information, the results of our hormone tests may be misleading.

Our hormones play a very influential role on our hair growth and have the ability to increase or decrease the rate that new hairs grow and old hairs shed. This means that we may experience thinning hair as the result of hormonal imbalances.


Protein-Bound Hormones Are Inactivated


Because of how our hormones are transported, only a fraction of our total hormones are actually available to our cells. These hormones are called “bio-available” and the remainder of the hormones may not be as active or available to our tissues.

Often this is something that goes overlooked when we have our hormone levels assessed which can cause our lab values to paint a very different picture than how our hormones are actually behaving in our body.

Sex-hormone binding globulin (SHBG) is a protein that our liver makes to transport and store hormones. It can bind to dihydrotestosterone (DHT), testosterone, estradiol, and estrone; and when it does, they become inactive and unavailable, even if our total hormone levels are normal.


What If Your Levels of SHBG Are Higher (or Lower) Than Assumed?


When we have total hormone tests run (for example, total testosterone) there is an assumption made about how the level of SHBG binding. For women, it is typical to expect close to 65% of testosterone to be bound to SHBG. Remember, when a hormone is bound to SHBG it’s essentially inactivated. If the actual amount of testosterone bound to SHBG is higher or lower than 65% the lab test results won’t be as meaningful.

The major flaw in assuming that women’s SHBG levels will remain constant is that they don’t, and levels can fluctuate depending on a number of factors.


Factors Associated With Higher SHBG:

  • High estrogen
  • Hormonal birth control
  • Pregnancy
  • Hyperthyroid
  • Low protein intake
  • Low calorie intake
  • Weight loss
  • Anorexia
  • Liver issues

Factors Associated With Lower SHBG:

  • Low estrogen
  • Menopause
  • Insulin resistance
  • Obesity
  • Polycystic Ovarian Syndrome (PCOS)
  • Cardiovascular disease

Getting The Whole Picture


Understanding how much hormone is actually available to our cells should be every bit as important as measuring totals. When hormones are bound to SHBG, they are inactive and aren’t available to interact with our cells. Hormones can also be transported by the protein albumin, but these hormones are still considered active since they are only bound loosely. The remaining amount of hormone is unbound or free and it’s just a small fraction of the total.

Brunette woman doing abdominal workout at gym


When we have our “total” hormone measured (for example, total testosterone) it is including SHBG bound (unavailable) + albumin-bound (bioavailable) + free (bioavailable) all together. So, it can’t actually tell us how much hormone is available to our cells just based on that test alone.

Thankfully, there are ways to have our hormones assessed so that we can understand their levels and how they are behaving better.

First, I think that it’s important to test as many hormones as possible versus just testing one or two. Our hormones are all interrelated and know which are high or low (individually or related to each other) can provide better information about root-causes of hormone imbalance. The test that I prefer for hormones is the DUTCH Complete (Dried Urine Test for Comprehensive Hormones) because it looks at thirty-five different hormones and does a great job visually showing how they all interrelate.

Second, testing SHBG and albumin levels can help provide even more detail about how much of the hormones that your body is producing is actually available. Both of these are carrier proteins for hormones and their levels can vary. The higher they are, the less “free” hormones there are available to your cells (although, hormones only bind to albumin loosely as we talked about earlier).

If you are working with a doctor on blood testing for your total hormone levels it might be best to request that they also test your SHBG and albumin. You may also want to ask that they measure your bioavailable hormone levels, since this will show how much hormone is available to your cells (generally, albumin bound + free hormone).


When It Comes To Hormone Testing, Timing Is Key


One more important consideration is the timing of your testing if you are a menstruating pre-menopausal woman.

Levels of hormones in women between puberty and menopause fluctuate throughout the month depending on where they are at in their cycle. At certain points during our cycle, certain hormones can be low while others are high, and vice versa. It’s important that you have your hormones tested on the right day of your cycle so that they can provide an accurate picture of your levels.

For most women, testing hormones during the mid-luteal phase (days 17-21 of a normal cycle) provides the most accurate picture. You can calculate which day of the month to do the hormone assessment by counting forward from the first day of your period (Day 1 of your cycle).


Did you notice how many factors in the above lists can be related back to nutrition and lifestyle factors? This is just another example of how influential our habits are on our wellness (even our hormonal wellness).


Ready to reclaim your health and feel better than ever? Book your Introduction Consult with me today!








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