Let’s get one thing straight.
Hormone testing is not useless.
That myth needs to go sit in the corner and think about what it’s done.
What IS useless is doing random testing with no plan, then acting shocked when it doesn’t answer your real question.
Hormone testing is like using a flashlight. If you shine it in the wrong place, you won’t find what you’re looking for. That doesn’t mean flashlights don’t work.
So let’s talk about what each testing method does well, what it misses, and why the DUTCH test can give you clues you can’t get from most other methods.
Why test hormones at all?
Because symptoms matter, but symptoms aren’t always specific.
Hot flashes can mean low estrogen, or they can mean estrogen is swinging all over the place. Poor sleep can be hormones, stress hormones, blood sugar, or all three. Low libido can be testosterone, estrogen, vaginal tissue changes, stress, exhaustion, resentment, or a mix of everything.
Testing helps us stop throwing spaghetti at the wall.
And if you’re on hormone therapy, testing can help answer a very real question:
Is this actually working the way we want it to?
Because here’s another truth nobody loves to say out loud:
Not everyone absorbs hormones the same way. Two women can use the same estradiol patch dose and get totally different blood levels. Some women are poor absorbers. Some women do great. If you’re still symptomatic, we need to consider that.
The myth: “Hormone testing is useless”
Nope.
Here’s what IS true:
- Hormone levels don’t always match symptoms in perimenopause.
- Levels can change day to day.
- Timing of testing matters.
- You can’t treat a number instead of a person.
- Or your provider may not know what to do with the results
But this leads to the wrong conclusion. The conclusion shouldn’t be “don’t test.”
The conclusion should be: test smarter.
When you pick the right test for the right question, hormone testing can help you:
- spot poor absorption of estrogen therapy in some women
- check whether progesterone exposure looks adequate
- understand estrogen metabolism patterns
- map cortisol rhythm issues that wreck sleep and energy
- connect symptoms to what your body is actually doing, not what someone assumes it’s doing
So no, testing isn’t useless. Sloppy testing is.
The 3 main ways to test hormones
Let’s break it down: blood, saliva, and urine (like the DUTCH test).
1. Blood testing: great for big-picture health and some hormone questions
Bloodwork is useful. Period.
It’s especially helpful for:
- cholesterol and triglycerides (cardiovascular risk)
- A1c, glucose, insulin (metabolism)
- thyroid markers
- iron, B12, vitamin D
- inflammation markers
- testosterone and SHBG (important for understanding free testosterone)
Blood estradiol can also be useful in certain situations, especially when someone is on transdermal estrogen and symptoms aren’t improving and absorption is a concern.
Pros
- widely available
- familiar to medical providers
- strong for overall health markers
- helpful for androgens and SHBG
Cons
- it’s a snapshot
- timing matters a lot
- perimenopause can make one number look “fine” even when you feel awful
- it does not show hormone metabolites
- “normal” ranges are very wide
When I choose blood
- when I want a solid baseline medical picture
- when we’re assessing metabolic and cardiovascular risk
- when we’re evaluating testosterone and SHBG
- when someone on a patch or gel still feels terrible and I want to check estradiol levels as part of an absorption and dose discussion
2. Saliva testing: can help with cortisol rhythm, but has limits
Saliva testing is often marketed as “free hormones.” Sounds great, right?
But saliva can be tricky, especially if you’re using topical hormones. Contamination can happen, and results can be all over the place depending on collection.
Pros
- noninvasive
- can be useful for free hormone and cortisol patterns
Cons
- topical hormones can contaminate results or result in levels that can be misinterpreted
- collection issues can affect reliability
When I choose saliva
- when we’re focused on free cortisol rhythm and it makes sense for the situation
- when someone is not using topical hormones that could contaminate the sample
- when budget needs to be considered
3. Urine testing
Urine testing can show what your body does with hormones after it uses them.
And this is exactly where urine testing (such as DUTCH) stands out.
What the DUTCH test shows that most other tests don’t
DUTCH stands for Dried Urine Test for Comprehensive Hormones.
Depending on the version, DUTCH can show:
- estrogen metabolites (how your body breaks estrogen down)
- progesterone metabolites (overall exposure patterns)
- androgen metabolites
- cortisol and cortisone rhythm across the day
- cortisol metabolites (how much you produce and how you clear it)
- a selection of organic acids that complement hormone testing to provide insights into energy, mood, and metabolism.
This matters because your symptoms aren’t just about what hormone level you have. They’re also about:
- how you metabolize hormones
- how stress hormones behave over a full day
- how your body processes what you’re taking
Pros
- shows hormone metabolism, not just a single level
- helps connect symptoms to patterns, especially when “basic labs” look normal
- gives a fuller view of cortisol rhythm and cortisol production
- at-home testing that captures more than one moment in time
Cons
- it costs more than basic labs
- insurance usually doesn’t cover it
- interpretation matters, and people can spiral if they try to DIY it
- it does not replace medical labs like lipids, glucose, or thyroid
When I choose DUTCH
- when symptoms don’t match the story we’re getting from basic testing
- when I want to look at estrogen metabolism patterns
- when sleep, anxiety, and energy suggest cortisol issues
- when we’re troubleshooting hormone therapy response and I want more than a snapshot
Since the introduction of the DUTCH test, other companies now offer similar testing.
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How hormone levels connect to real-life concerns
Let’s connect this to what you actually care about.
Hormone absorption: “Is my therapy getting in?”
If you’re using transdermal estradiol and still having hot flashes, sleep disruption, or mood symptoms, we have to consider:
- dose too low
- inconsistent use
- absorption issues
- metabolism differences
- a missing piece like progesterone, thyroid, iron, blood sugar, or stress hormones
This is where the “don’t test” crowd gets it wrong.
If symptoms persist, you can’t confidently say therapy is optimized without checking data in the right context. You’re not “chasing numbers.” You’re troubleshooting.
Bone health: estrogen is not just about hot flashes
Menopause accelerates bone loss. Estrogen helps protect bone. Hormone therapy has been shown to prevent bone loss and reduce fracture risk in appropriate candidates.
If we’re serious about keeping you strong, steady, and not dealing with a hip fracture later, we don’t ignore estrogen. We want to see a blood level of at least 60 pg/mL.
Hot flashes: sometimes it’s not low, it’s unstable
Hot flashes are linked to hormone changes, and in perimenopause, it’s often the swings that cause the chaos.
That’s why one “normal” lab doesn’t mean your hormones aren’t part of the problem. It might mean your hormones are unpredictable, and your nervous system is paying the price.
Cardiovascular health: menopause changes the whole playing field
Menopause is a metabolic and cardiovascular shift for many women. Lipids often change. Insulin resistance can creep in. Vascular function changes across the transition.
This is why I don’t look at hormones in a vacuum. Bloodwork matters here, too.
So which test is “best”?
There isn’t one best test. There’s a best test for the question.
Choose blood testing when:
- you need cardiometabolic and cardiovascular markers
- you’re evaluating thyroid, iron, inflammation
- you need testosterone and SHBG
- you suspect poor absorption of transdermal estradiol and want a direct check
Choose saliva when:
- you’re focused on free cortisol rhythm and contamination isn’t a concern
- you want to know more about “free” levels of hormones
Choose urine when:
- you want hormone metabolism and cortisol rhythm patterns
- symptoms are stubborn and basic tests didn’t explain them
- you want a more complete picture of estrogen and progesterone exposure, breakdown and elimination
The bottom line
If you’re on hormone therapy and you still feel like a sweaty, tired, anxious stranger in your own body, you deserve better than “it’s normal.”
And you definitely deserve better than “testing is useless.”
Smart testing is one of the fastest ways to stop guessing.
Even though hormone tests alone can’t diagnose perimenopause or predict menopause, testing is still a powerful tool. When used correctly, it can:
- Rule out serious underlying conditions
- Help you connect the dots between symptoms and root causes
- Inform safer, more personalized treatment options
- Prevent you from being misdiagnosed or brushed off
If you want help choosing the right testing approach and making sense of your results, book a call. Let’s get you answers that actually move the needle.
Dr. Anna Garrett is a menopause expert and Doctor of Pharmacy. She helps women who are struggling with symptoms of perimenopause and menopause find natural hormone balancing solutions so they can rock their mojo through midlife and beyond. Dr. Anna is the author of Perimenopause: The Savvy Sister’s Guide to Hormone Harmony. Order your copy at www.perimenopausebook.com.
Dr. Anna is available for 1-1 consultations. Find out more at www.drannagarrett.com/lets-
