A Dynamic Duo: When to Test Neurotransmitters with Sex Hormones

The nervous system and its communication with peripheral organs is under the continuous dynamic influence of hormones, neuroactive steroids, and neurotransmitters. This is why the underlying pathology of mood disorders can often be varied and complex.

The hormonal piece is critical to our understanding of the imbalances when it comes to the complete neurotransmitter assessment. Hormones regulate key processes pertaining to neurotransmitter biosynthesis, signaling, and degradation. It is important to recognize that disturbances in the relationships between hormones and neurotransmitters can shape normal physiology toward a maladaptive state leading to suboptimal psychological wellbeing.

HPA axis dysfunction, anxiety, depression, low libido, PCOS, lack of appetite, and menstrual cycle disorders are just a few examples of what happens when the equilibrium within the neuroendocrine system is disrupted. Without information yielded from objective clinical testing, selection of the most effective treatment for each particular patient with a mood disorder continues to be a challenge. Testing neurotransmitters together with hormones allows health care practitioners to enhance their neuroendocrine tool kit by delineating hormone-governed neurotransmitter dysregulation, and provides a deeper understanding of how individual biochemistry alters neurotransmitter homeostasis. 

Diurnal Urinary Hormones

What is measured: cortisol, cortisone, norepinephrine, epinephrine, melatonin

Sample type: dried urine

Diurnal rhythms of cortisol, norepinephrine, and epinephrine reflect HPA axis function; the addition of diurnal melatonin provides a useful measure of circadian rhythm regulation. Detailed characterization of these biochemical parameters may aid in identifying specific imbalances in an individual’s response to stress. This diurnal test uses the same urine cards on which the neurotransmitter sample was collected without any extra additional steps.

Saliva Hormones

What is measured: estradiol, progesterone, testosterone, DHEA-S, cortisol

Sample type: saliva

The saliva hormones add-on is an excellent way to assess the initial “big picture” of overall sex and adrenal hormone status in female and male patients. The test provides clinical information regarding the bioavailable fraction of hormones. For those Individuals who produce very little saliva or who use supplementary sublingual hormones, this test may not be appropriate.

Urinary Hormone Metabolites

What is measured: estradiol, testosterone, DHEA, pregnanediol, allopregnanolone, androstenedione, 5a-dihydrotestosterone (DHT), 5a,3a-androstanediol

Sample type: dried urine

The hormonal profile in dried urine features two main progesterone metabolites and five major androgens, along with estradiol. Assessment of sex steroids and metabolites in dried urine is a convenient option for those patient who are unable to collect sufficient saliva for the salivary test. While the salivary hormones add-on provides an overall glance at the major hormones, the metabolites add-on expands the evaluation to the major sex steroid metabolites and is specifically geared to those patients who present with low or high androgen symptoms or symptoms of estrogen dominance.

When to Test Neurotransmitters Alone When to Combine Neurotransmitters with Diurnal Urinary Hormones

When to Combine Neurotransmitters with Saliva Hormones

When to Combine Neurotransmitters with Urine Hormone Metabolites

  • Managing psychiatric interventions
  • Establish a baseline
  • Patients unable to use HRT
  • Children and Adolescents

  • Hormone levels recently tested
  • Suspected HPA axis dysfunction
  • Sleep problems
  • PCOS
  • Pre-menopause & Menopause
  • Andropause

  • ADHD
  • Symptoms of estrogen dominance
  • High or low androgen symptoms
  • Pre-menopause & menopause
  • Irregular cycles
  • PCOS

  • Suspected HPA axis dysfunction
  • Low androgen symptoms: fatigue, foggy thinking, decreased stamina
  • High androgen symptoms: acne, scalp hair loss, facial hair growth
  • PCOS
  • Symptoms of estrogen dominance
  • Suspected HPA axis dysfunction

Considerations Regarding Hormone Supplementation

Suitable for testing with any route of hormone administration Suitable for testing with any route of hormone administration Only suitable for oral, topical, vaginal, patch, injectable, pellet forms of hormone administration; Not suitable for troche/sublingual supplementation Only suitable for oral, topical, patch, injectable, pellet forms of hormone administration; Not suitable for vaginal supplementation

Within the neuroendocrine system, both hormones and neurotransmitters serve as key modulators of psychological wellbeing. The targeted neuroendocrine assessment provides clinicians with a focused individualized biochemical platform to guide treatment interventions.

Learn More about Neurotransmitter Testing