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Steroid Hormone Testing — Adrenal and Sex Hormone Metabolism

A blood test tells you how much of a hormone was in the circulation at the moment the needle went in. That is a useful thing to know, and for several clinical questions it is the right measure. But it does not tell you how much your body produced over the day, which route it took to break the hormone down afterwards, or whether the enzymes doing that work are running fast or slow. Those are frequently the questions that matter, and they are what this test is for.

Contents

Why urine, and why several samples · What is measured · Reading enzymes, not just hormones · Testing for women · Testing for men · When it changes what I do · How I read these results · What to expect · Key takeaways · FAQ · References

Why urine, and why several samples

Three things separate this method from a single blood draw.

It captures the metabolites, not only the parent hormone. Once a steroid hormone has done its work it is chemically modified and excreted, and the modified forms carry information the parent hormone does not. Measuring cortisol alone tells you what was free in the blood at one moment; measuring cortisol together with its downstream metabolites tells you roughly how much was produced across the day, which is a different and often more useful number.

It gives cortisol a shape. Cortisol is not a quantity, it is a rhythm — high shortly after waking, falling across the day, low at night. Four timed collections describe that curve. A single morning sample is one point on it, and two people with an identical 9 a.m. cortisol can have entirely different days behind them. The rise across the first thirty to forty-five minutes after waking, the cortisol awakening response, is measured separately and has its own published collection standards.³

It reduces the snapshot problem. Steroid hormones fluctuate within the individual, hour to hour and day to day. In men, repeated sampling of serum testosterone shows substantial within-person variation, which is why guidelines require repeated morning measurements rather than a single reading before a diagnosis is made.² Collecting across a day — or, in cycle mapping, across a month — averages some of that noise out.

What is measured

The panels are wide by design. Steroid hormones are built along one branching pathway from a single precursor, so reading one branch without the others tells you very little.

Adrenal. Free cortisol and free cortisone at four points across the day; total daily production estimated from the metabolised fraction; the major tetrahydro- metabolites; DHEA and DHEA-S.

Androgens. Testosterone and epi-testosterone; dihydrotestosterone; the 5α and 5β reduction products, androsterone and etiocholanolone; and the 5α-androstanediols.

Oestrogens. Oestrone, oestradiol and oestriol, together with the phase I hydroxylation products along the 2-, 4- and 16-hydroxy routes and the phase II methylated forms.⁹

Progesterone. Progesterone and its 5α and 5β reduced metabolites.

One oxidative stress marker. 8-hydroxy-2′-deoxyguanosine, an oxidised nucleoside used as a general marker of oxidative load. [Emerging]

Reading enzymes, not just hormones

This is the part that is difficult to get any other way, and it is the reason I order the test at all.

When you have both a hormone and its metabolites in the same sample, the ratio between them describes the enzyme that made the conversion. Four of these ratios do most of the clinical work.

Ratio	Enzyme it describes	Why it matters
Androsterone : etiocholanolone	5α-reductase	Sets how much testosterone is converted to the more potent dihydrotestosterone rather than down the 5β route5
Cortisol : cortisone	11β-hydroxysteroid dehydrogenase	Governs how much cortisol is active at the tissue rather than held in an inactive form4
Methylated : unmethylated catechol oestrogens	Catechol-O-methyltransferase	Describes how completely phase I oestrogen products are conjugated before excretion6
Androgen : oestrogen products	Aromatase	Sets how much androgen is converted to oestrogen, a conversion body composition influences directly

Testing for women

I use the DUTCH assay from Precision Analytical for women. Four configurations are available, and I select between them according to the clinical question.

Option	Sample	When to collect	Number of samples	Fee
Complete	Dried urine	Day 19–22 of the cycle	4–5	£375
Complete + cortisol awakening response	Dried urine + saliva	Day 19–22	4 urine + 5 saliva	£425
Complete + cycle mapping	Dried urine	Across the full cycle, plus one day	21 + 4	£536
Complete + cycle mapping + cortisol awakening response	Dried urine + saliva	Across the full cycle, plus one day	21 + 4 urine + 5 saliva	£642

Complete is the base configuration. Luteal-phase collection is used because that is when progesterone is at its most informative.

Cortisol awakening response adds five saliva samples across the first hour after waking. I add it when the presenting picture is dominated by early-morning symptoms, sleep-onset or waking difficulty, or a pattern of under-recovery that the four-point curve alone does not resolve.

Cycle mapping collects across the whole month rather than a single window, producing a curve for oestrogen and progesterone rather than one luteal point. It is the configuration to use when the cycle is irregular, when ovulation timing is in question, or when a single luteal sample has already produced a result that does not fit the history.

Testing for men

For men I use the HuMap profile from Doctor’s Data. One configuration, 51 markers, urine, no timing constraint, five to seven working days in the laboratory once the samples arrive.

Option	Sample	Markers	Laboratory time	Fee
HuMap base profile	Urine (frozen)	51	5–7 working days (excluding transit)	£375

The female assay also reports a small set of organic acids and melatonin alongside the steroid markers — among them markers of B-vitamin and glutathione status and of oxidative load. I read these as context for the metabolic picture, not as a standalone panel; a fuller organic-acid profile is a separate test.

When it changes what I do

I recommend testing when the result will change the plan, and not otherwise. In practice that means:

• A cycle that is irregular, short-luteal, or symptomatic in a pattern that a day-21 progesterone alone has not explained.
• A PMOS picture (recorded as PCOS on referral letters and search) where the androgen findings need to be separated into what is being produced and what is being converted.
• Persistent fatigue or under-recovery where the question is the shape of the cortisol day rather than whether cortisol is broadly normal.
• Perimenopausal symptoms that do not track with the cycle stage, where a curve across the month is more informative than a single point.
• Someone already taking replacement who does not feel as expected, where the question is how the administered hormone is being handled.
• Male presentations where a serum testosterone has been measured and reported as unremarkable, but the symptom picture has not resolved.

Testing follows assessment. I do not order from a list before I have taken a history.

How I read these results, and what happens next

Results come back to a consultation. I read the panel as one picture rather than marker by marker: how much of each hormone was produced across the collection window, which route carried the clearance, and whether the enzyme ratios account for something the history has already raised. A single value outside a reference range is rarely the finding. The finding is usually a shape — production adequate but clearance skewed down one branch, total cortisol unremarkable but the curve flat or front-loaded, a parent androgen in range with most of it converted onward.

What follows is a plan aimed at the parts that are modifiable: nutritional status, energy availability, insulin regulation, inflammatory load, sleep and training load, and where the assessment supports it, acupuncture or a herbal prescription. A repeat interval is set to the picture rather than to a default, because a metabolite panel is most useful as a before-and-after when something specific has been changed. Where a result needs a doctor’s attention, I say so plainly and write to your GP or specialist with the report.

Menopause is a clinical diagnosis in otherwise healthy women over 45, made on symptoms rather than on a hormone assay,⁸ and male hypogonadism rests on symptoms with repeated morning serum total testosterone.⁷ Where a serum measure is the validated one — thyroid function, prolactin, a diagnostic testosterone — I order serum and read this panel alongside it. What this panel adds is production and clearance: how much you made, and what you did with it. That is a description of how your endocrine regulation is running. It is not a risk score, and I do not present it as one.

What to expect

Samples are collected at home and returned directly to the laboratory — the kit includes everything needed, including the return instructions. Collection takes a few minutes at each timepoint; the awakening-response samples need you to stay upright and not eat, drink or brush your teeth until the last one is taken.

Both assays are laboratory-developed tests rather than regulator-cleared diagnostic devices — the normal regulatory status for this class of assay, and the reason a report is read against a history rather than off the page.

Every fee above is inclusive of VAT and covers both the laboratory fee and the interpretation consultation — 45 minutes, in person in Wimbledon or online. Fees for every other panel are on the functional lab testing page.

Key takeaways

• A single blood draw measures circulating hormone at one moment. This measures production and clearance across a day or a month, which is a different question.
• Metabolites carry information the parent hormone does not: the ratio between a hormone and its products describes the enzyme that made the conversion.
• Four timed collections give cortisol a shape. A morning cortisol is one point on a curve.
• Women: a dried-urine assay in four configurations, chosen by the clinical question.
• Men: one urine profile, selected for its more detailed androgen reporting.
• Enzyme-activity ratios explain variation between people. They are not diagnostic thresholds, and I read them alongside history and serum. [Clinical Heuristic]
• Results come back to a consultation with a plan attached, and where a finding belongs with your GP or specialist, I write to them with the report.

Frequently Asked Questions

References

1. Newman M, Pratt SM, Curran DA, Stanczyk FZ. Evaluating urinary estrogen and progesterone metabolites using dried filter paper samples and gas chromatography with tandem mass spectrometry (GC–MS/MS). BMC Chem. 2019;13:20. doi:10.1186/s13065-019-0539-1 [Established — method validation] ↩︎

2. Brambilla DJ, O’Donnell AB, Matsumoto AM, McKinlay JB. Intraindividual variation in levels of serum testosterone and other reproductive and adrenal hormones in men. Clin Endocrinol (Oxf). 2007;67(6):853–862. doi:10.1111/j.1365-2265.2007.02976.x [Established — human observational] ↩︎

3. Stalder T, Kirschbaum C, Kudielka BM, et al. Assessment of the cortisol awakening response: expert consensus guidelines. Psychoneuroendocrinology. 2016;63:414–432. doi:10.1016/j.psyneuen.2015.10.010 [Established — consensus methodology] ↩︎

4. Chapman K, Holmes M, Seckl J. 11β-hydroxysteroid dehydrogenases: intracellular gate-keepers of tissue glucocorticoid action. Physiol Rev. 2013;93(3):1139–1206. doi:10.1152/physrev.00020.2012 [Established — review] ↩︎

5. Russell DW, Wilson JD. Steroid 5α-reductase: two genes/two enzymes. Annu Rev Biochem. 1994;63:25–61. doi:10.1146/annurev.bi.63.070194.000325 [Established — review] ↩︎

6. Ball P, Knuppen R. Catecholoestrogens (2- and 4-hydroxyoestrogens): chemistry, biogenesis, metabolism, occurrence and physiological significance. Acta Endocrinol Suppl (Copenh). 1980;232:1–127. PMID: 6770572 [Established — review] ↩︎

7. Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;103(5):1715–1744. doi:10.1210/jc.2018-00229 [Established — clinical guideline] ↩︎

8. National Institute for Health and Care Excellence. Menopause: identification and management (NG23). Published 12 November 2015; updated 2026. Section: Diagnosis of perimenopause and menopause. https://www.nice.org.uk/guidance/ng23 [Established — clinical guideline] ↩︎

9. Badawi AF, Cavalieri EL, Rogan EG. Role of human cytochrome P450 1A1, 1A2, 1B1, and 3A4 in the 2-, 4-, and 16α-hydroxylation of 17β-estradiol. Metabolism. 2001;50(9):1001–1003. doi:10.1053/meta.2001.25592 [Established — in vitro] ↩︎

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Related reading

• Functional Lab Testing — every panel I use, with specifications and fees
• Hormone Optimisation — how the hormonal picture is read and what treatment involves

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Dr Ryu Natural Medicine is in Wimbledon, South West London. Testing is selected after assessment, so the place to start is a consultation rather than a kit.

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