Mr Mark Newman
Founder and President of Precision Analytical Laboratory, Inc.

2013 - Lab Testing For Monitoring (B)HRT Therapy - How to know when serum, saliva, or urine testing is right.

Objectives:

• Outline how expected lab results change for different routes of administration (ROA) of exogenous hormones.
• Share data to assist providers in avoiding common HRT-lab test combinations that can be clinically misleading.
• Discuss case-studies with serum, urine, and saliva results highlighting the above objectives.

Outline:

• Brief description of different methods for delivering hormones
• Defining the variables that make each ROA unique
• Absorption, pharmacokinetics, metabolism, contamination potential, etc.
• Brief, general overview of testing options (serum, urine, saliva)
• Description of situations where all tests work reasonably well
• Injections, oral DHEA, vaginal DHEA, etc.
• Description of situations where all tests have significant limitations
• Sublingual

• Pharmacokinetics limit serum testing
• First-pass potential limits urine testing
• Oral mucosa contamination limits saliva testing

• Oral progesterone (first-pass metabolism clouds serum, saliva, and urine results)
• Description of remaining options and which type of test might be best for each
• Oral estrogens
  • Potential pitfalls with urine testing
• Vaginal hormones
  • Potential pitfalls with serum, saliva, and urine testing
  • A new, better solution emerges
• Topical hormones
  • Clinical data to sort through contradictory lab results
• General conclusions on limitations and the need to heavily consider the route of administration when selecting lab testing for monitoring HRT

It has been the author’s repeated experience over the past several years of engaging providers on this topic to discover a significant deficiency in the education process.  The safety of BHRT practices can be significantly compromised when dosing habits are based off of misleading lab results.  The author’s unique perspective (having led testing efforts in labs monitoring BHRT in all major testing modalities and lecturing numerous times on related topics) allows him to offer up to providers with BHRT practices powerful examples of potential pitfalls and improved solutions for optimizing results.