Beyond Replacement: Hormone Optimization | Part 3

Testing & Tracking

How to Measure What Matters

Posted in Hormones

Dr. Aaron Hartman

October 22, 2025

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You’ve optimized your sleep. You’re managing stress. You’ve cleaned up your diet and addressed gut health. Your primary hormones—cortisol, insulin, and thyroid—are finally stable.

Now comes the question every patient asks: “How do I know if it’s actually working?”

In our previous articles, Dr. Christian Jenski and I discussed the hormone hierarchy and the critical roles of gut health and the autonomic nervous system. But here’s what separates functional medicine from conventional approaches: we don’t guess, we test.

Today we’re diving into the practical side—what to test, when to test it, and how to interpret results in the context of your unique situation.

Why “Test, Don’t Guess” Matters

I’ve witnessed countless patients arrive at my practice after years of struggling with symptoms their previous doctors dismissed as “normal” or “just anxiety.” The difference? Their providers never looked beneath the surface.

Testing serves three critical purposes:

1. Establishes Your Baseline
You can’t measure progress without knowing where you started.

2. Identifies Root Causes
Symptoms overlap. Testing reveals whether your fatigue stems from thyroid dysfunction, adrenal insufficiency, nutrient deficiency, or something else entirely.

3. Guides Personalized Treatment
What works for one person may be completely wrong for another. Comprehensive testing ensures we’re addressing your unique biochemistry.

The Foundation: Adrenal Testing

Dr. Jenski emphasized this repeatedly in our conversation: “One of the things that I get on every single patient is an adrenal stress profile, which is a four-point salivary cortisol curve. And I also get something called a cortisol awakening response and a salivary DHEA.”

Why Saliva Over Blood?

Blood tests capture a single moment—your cortisol level at 8 AM on a Tuesday. But cortisol follows a diurnal rhythm. It should be highest in the morning, declining throughout the day to reach its lowest point at bedtime.

A four-point salivary cortisol curve maps this rhythm:

First morning (within 30 minutes of waking)
Mid-morning
Afternoon
Bedtime

The Cortisol Awakening Response (CAR)

Dr. Jenski explained the significance: “The CAR, or cortisol awakening response, kind of gives me an idea of light coming through their eyes, hitting a part of the brain called the suprachiasmatic nucleus to tell the pituitary to release ACTH to tell the adrenal to release cortisol.” This measures how effectively your body responds to waking. A healthy CAR shows a sharp spike within 30 minutes of waking, followed by a gradual decline.

Abnormal Patterns Reveal Different Issues:

Suppressed or Exaggerated CAR: HPA-axis dysfunction, often from chronic stress
Elevated and Flat Throughout the Day: Active stress response, sympathetic dominance
Low Throughout the Day: Advanced HPA-axis dysfunction, sometimes called “adrenal fatigue” (though this is technically an HPA-axis issue, not adrenal failure)

When Serum Testing Matters

While I prefer salivary testing for cortisol rhythm, some situations warrant serum cortisol and DHEA-S:

First morning serum cortisol: Useful for ruling out Addison’s disease or Cushing’s syndrome
DHEA-S: More stable in blood; provides insight into adrenal reserve

For more on interpreting cortisol patterns and treatment strategies, see our article: Cortisol: The King of All Hormones.

Thyroid Testing: Beyond TSH

This is where conventional medicine consistently fails patients.

As Dr. Jenski put it: “If the person has any thyroid condition, I’m gonna assess that. If they don’t have a diagnosis, but I suspect it, I’m gonna assess that.”

A complete thyroid panel includes:

Essential Tests

TSH (Thyroid Stimulating Hormone)
The messenger from your pituitary telling your thyroid to produce hormones. Conventional range: 0.5–5.0 mIU/L. Optimal functional range: 1.0–2.0 mIU/L.

Free T4 (Thyroxine)
The storage form of thyroid hormone. Your body must convert this to the active form.

Free T3 (Triiodothyronine)
The active thyroid hormone that does the work at cellular level.

Reverse T3 (rT3)
An inactive form of T3. When elevated, it blocks thyroid receptors, creating functional hypothyroidism despite “normal” labs.

Thyroid Antibodies (anti-TPO and anti-TG)
Detect Hashimoto’s thyroiditis—the most common cause of hypothyroidism. Many patients have elevated antibodies years before TSH becomes abnormal.

The T3/rT3 Ratio

Dr. Jenski expanded on testing beyond standard panels: “I take it a step further and look at their nutrition: iodine, zinc, selenium, copper, vitamin D, vitamin A, tyrosine—the nutrients that go along with thyroid support.”

He explained why this matters: “Say the thyroid’s off just a little. Am I gonna put ’em on medicine right off the bat? No, I’m gonna give ’em some nutritional support, work on other things.”

This is the functional medicine difference. Rather than immediately prescribing levothyroxine, we ask: Why isn’t your body producing or converting thyroid hormones effectively?

Our article: Thyroid: The Conductor explores optimal ranges and botanical support. For overlapping symptoms, see CIRS vs Hypothyroid, which details how environmental toxins can mimic or cause thyroid dysfunction.

Metabolic Testing: The Missing Piece

Dr. Jenski’s comments on this topic were sobering: “Half of the country is overweight and diabetic, and then up to 88% at this point in time are metabolically inflexible. So that means 12%, maybe less, are proper weight, metabolically flexible.”

Beyond Fasting Glucose

Most doctors check fasting glucose. Some check A1C. Almost none check what truly matters: fasting insulin.

The Gold Standard Panel:

Fasting Insulin
Reveals insulin resistance years before glucose becomes abnormal. Optimal: <5 ?IU/mL.

Fasting Glucose
Should be 70–85 mg/dL. Anything over 90 suggests early metabolic dysfunction.

Hemoglobin A1C
Reflects average blood sugar over 3–4 months. Optimal: <5.0%. Conventional medicine doesn’t flag concern until 5.7%—by which point significant damage has occurred.

As Dr. Jenski explained: “There is a paucity of fasting insulins being tested on individuals… how do they know you have proper insulin resistance? They don’t.”

He described a patient who illustrated this perfectly: “The guy is fit as a fiddle. He eats incredibly well… his A1C is 5.5, but his insulin is three, which is optimal. His glucose is 82, which is optimal… This is related to biotoxin.”

This demonstrates why comprehensive testing matters—symptoms and single markers don’t tell the whole story.

Advanced Metabolic Markers

Leptin
Should be low (generally <10 ng/mL for women, <5 ng/mL for men). Elevated leptin indicates leptin resistance—your body can store fat but can’t release it for energy.

Adiponectin
Should be high (>10 ?g/mL). Low adiponectin correlates with insulin resistance and cardiovascular risk.

Our Insulin: Our Sticky Problem article provides detailed guidance on improving metabolic markers through diet, exercise, and targeted supplementation.

For women with PCOS, metabolic testing is non-negotiable. The PCOS in Young Women article explains how to interpret these markers in the context of elevated androgens.

Sex Hormone Testing: Timing and Context Matter

This is where testing becomes more nuanced.

Dr. Jenski explained his comprehensive approach: “Depending on where they’re at and what they need, I might look at a sex hormone panel. If it’s a female that has predominant sex hormone issues, I’m gonna expand out and either get a 28-day salivary rhythm kit, or I’m gonna get salivary hormones if they’re already on hormone replacement therapy, or an estrogen detox kit.”

For Menstruating Women

Day 3 Testing (Follicular Phase):

Estradiol
FSH (follicle-stimulating hormone)
LH (luteinizing hormone)
Total and free testosterone
DHEA-S

Day 19–21 Testing (Luteal Phase):

Progesterone (should peak 7 days after ovulation)
Estradiol

This dual approach reveals whether you’re ovulating and producing adequate progesterone—critical for fertility, mood stability, and healthy cycles.

For Perimenopausal Women

Dr. Jenski called perimenopause “a moving target,” explaining that “you’re just kind of supporting that area and when it’s high, really ramp up detox and then catch it right as it’s on its way out.”

During perimenopause, hormones fluctuate wildly. Single-point testing may miss the bigger picture. Consider:

Multiple testing cycles to capture patterns
Symptom tracking alongside labs
DUTCH testing (Dried Urine Test for Comprehensive Hormones) for detailed metabolite analysis

Our Hormones After 40 article provides specific guidance for this life stage.

For Postmenopausal Women

Testing becomes more straightforward—levels should be consistently low. If on hormone replacement:

Serum testing for overall hormone levels
Saliva testing to assess tissue-level hormone delivery
DUTCH Complete to evaluate hormone metabolites and methylation

The Estrogen Metabolism Question

Dr. Jenski emphasized checking how you metabolize estrogen, not just total levels: “If you have a COMT SNP, that methylation is not happening well. Unfortunately, preferentially the 2-hydroxy becomes methylated. So you make the 4-hydroxy, it stockpiles, it’s not being neutralized… it becomes a problem.”

This matters because different estrogen metabolites carry different risks:

2-hydroxy estrogen: Generally protective
4-hydroxy estrogen: Potentially carcinogenic if not properly methylated
16-alpha-hydroxy estrogen: Associated with increased cancer risk

DUTCH testing or estrogen metabolite panels reveal these pathways.

For Men

Yes, men need hormone testing too. Our Our Silent Crisis article details the alarming decline in male testosterone levels.

Essential Tests:

Total and free testosterone
SHBG (sex hormone-binding globulin)
Estradiol (elevated in many men)
DHT (dihydrotestosterone)
PSA (prostate-specific antigen)
DHEA-S

Our Testosterone in Women’s Health article discusses testosterone’s role in female physiology, while Elevated Testosterone covers testing and treatment for women with PCOS and hyperandrogenism.

Nutrient Testing: The Foundation Nobody Checks

I was struck by Dr. Jenski’s comment during our conversation: “My D levels were 16 when we started. 16. And I started taking D and I was like, I’m gonna fix this. 10,000 IU, 25,000 IU a day. 45. Like I was taking huge amounts of D and could barely get above 60.”

He explained why: “I also have a VDR receptor snip, a homozygous one, so I don’t really convert sunlight into D. I don’t utilize it appropriately. So I gotta really take super physiologic levels to keep my levels where they need to be.”

This illustrates why testing—and genetic understanding—matters.

Critical Nutrients for Hormone Function

Vitamin D
Required for insulin receptor function and thyroid hormone utilization. Optimal: 60–80 ng/mL (not the 30 ng/mL conventional labs call “sufficient”).

Magnesium
As Dr. Jenski noted: “Insulin receptors don’t work without magnesium.” And when stressed, “you renally waste magnesium. When your cortisol’s high, you just pee mag out.”

Test RBC magnesium, not serum—it’s more accurate. Optimal: >5.0 mg/dL.

B Vitamins
I emphasized this point: “Just one single B vitamin deficiency… if 40–60% of Americans have at least one, you know, will have 25% have a heterozygous MTHFR… people are gonna have B vitamin deficiencies.”

Test:

B12 (optimal >500 pg/mL, not the 250 pg/mL lab range)
Folate (especially important with MTHFR polymorphisms)
B6 (watch for toxicity with high-dose pyridoxine)

Thyroid Nutrients
Dr. Jenski tests: “Iodine, zinc, selenium, copper, vitamin D, vitamin A, tyrosine, the nutrients that go along with thyroid support.”

Thiamine (B1)
Dr. Jenski brought up an often-overlooked connection: thiamine deficiency can cause dysautonomia symptoms. In Japan during the early 1900s, populations eating primarily white rice developed subclinical beriberi from B1 deficiency.

I’ve seen this clinically: “Thiamine, B1, particularly with patients with dysautonomia and neurological issues. There is amazing literature on low-level wet and dry beriberi.”

Nutrient Testing for Hypermobile Patients

I noted an interesting pattern: “If you’re hypermobile, you’re gonna have a tendency towards deficiencies in a lot of amino acids, vitamin C, trace minerals, and you tend to have low vitamin D levels.”

Approximately 20% of the population has some degree of hypermobility—far more than most doctors recognize. These patients often need higher nutrient levels to function optimally.

For nutrient recommendations specific to each hormone, see:

Progesterone: The Elder Sister for vitamin A, B6, C, and zinc
Thyroid: The Conductor for iodine, selenium, and tyrosine

CIRS & Mold Testing: When Environmental Illness Mimics Hormone Dysfunction

Sometimes what looks like hormone imbalance is actually environmental illness.

Our CIRS vs Hypothyroid article explores this overlap in detail. Key tests include:

Visual Contrast Sensitivity (VCS) Test
A screening tool for biotoxin-related neurological inflammation. Abnormal results warrant further investigation.

Biotoxin Markers:

MSH (melanocyte-stimulating hormone)
C4a (complement component)
TGF-beta1 (transforming growth factor)
MMP-9 (matrix metalloproteinase-9)
VEGF (vascular endothelial growth factor)
Leptin (often elevated in CIRS)

Environmental Testing:

ERMI (Environmental Relative Moldiness Index)
HERTSMI-2 (for post-remediation verification)

As Dr. Jenski’s patient demonstrated, you can have perfect metabolic markers except A1C—and the culprit can be biotoxin illness rather than metabolic dysfunction.

Wearable Technology: Real-Time Hormone Feedback

One of the most exciting developments in functional medicine is continuous monitoring technology.

Continuous Glucose Monitors (CGMs)

Even if you’re not diabetic, CGMs provide invaluable data about how your body responds to:

Different foods and meal timing
Exercise and movement
Sleep quality
Stress

I’ve seen patients completely transform their metabolic health by identifying hidden glucose spikes from “healthy” foods.

Oura Ring and HRV Tracking

I shared a personal example during our conversation: “Our family… we were kind of lazy bums. We sat outside for an hour and talked… went out and did some yard work… I was looking at my ring at the end of the day and it was like, ‘You were amazing. You had one hour of restoration time today.’”

That hour of family time showed up as measurably improved heart rate variability—quantifiable stress reduction.

What to Track:

Heart rate variability (HRV)
Resting heart rate
Sleep stages and efficiency
Body temperature (tracks ovulation in women)
Activity and recovery balance

Wearables and the Autonomic Nervous System

For patients with dysautonomia, POTS, or hypermobility, wearable technology can reveal patterns invisible to standard testing:

Orthostatic intolerance
Exercise intolerance
Sleep architecture disruption
Autonomic nervous system dysregulation

The Clinical Correlation Principle

Dr. Jenski emphasized throughout our conversation: “Optimization always has to be personalized and it depends on parameters, clinical correlation and where you are within normal.” This means testing must be interpreted in the context of:

Your Symptoms
Labs that look “normal” may not be optimal for you.

Your History
Past trauma, infections, environmental exposures, and life stage all influence interpretation.

Your Response to Treatment
Sometimes we learn more from how you respond to intervention than from the initial labs.

Your Genetics
Polymorphisms in MTHFR, COMT, VDR, and other genes influence optimal ranges and treatment approaches.

As I noted during our discussion: “The way I practice medicine now is a little different than it was three months ago. A little different than it was six months ago.”

Medicine is an art as much as a science. Testing provides the data, but clinical judgment and personalized application make the difference between good and transformational outcomes.

Dr. Jenski also acknowledged: “We are different people. We practice differently. We have similar training, we have similar certifications. We have different lives, different experiences, different exposures, different patient encounters.”

There’s no single “perfect” testing protocol. What matters is:

Thoroughness in assessment
Not missing critical pieces of the puzzle.

Appropriate interpretation
Understanding optimal versus “normal” ranges.

Personalized application
Tailoring recommendations to your unique biochemistry and life circumstances.

Clinical correlation
Integrating symptoms, history, and lab data into a coherent treatment plan.

A Note on Testing Philosophy

Some practitioners test extensively upfront. Others start with history, physical exam, and basic labs, adding complexity as needed.

As I explained: “If someone comes in, their diet is horrible… I’m not gonna do a GI test on them because I want you to eat real food first. Now, if it’s someone who needs data to convince them to eat real food, then we test.”

Dr. Jenski takes a different approach: “I find comfort in testing and I find that my population likes that as well, so I test more.”

Both approaches work when applied thoughtfully. The key is having a practitioner who:

Understands comprehensive testing
Can interpret results in functional ranges
Personalizes recommendations
Adjusts protocols based on your response

Taking Action: Your Next Steps

Based on everything we’ve discussed:

1. Find a Qualified Practitioner

Look for providers trained in functional or integrative medicine who understand:

Comprehensive hormone testing
Optimal versus standard lab ranges
Root-cause investigation
Personalized treatment protocols

2. Gather Your History

Before your first visit, compile:

Complete symptom timeline
Previous lab results
Current medications and supplements
Family history
Environmental and lifestyle factors

3. Prioritize Testing Based on Your Situation

If you’re just starting out: Begin with adrenal stress profile, complete thyroid panel, and metabolic markers.
If you’ve addressed basics but hit a plateau: Add comprehensive stool testing, hormone metabolite analysis, and genetic testing.
If environmental illness is suspected: Start with VCS screening and consider ERMI testing of your home.

4. Track Your Symptoms

Keep a detailed journal noting:

Energy levels throughout the day
Sleep quality and patterns
Mood and mental clarity
Digestive function
Menstrual cycle characteristics (for women)
Response to interventions

5. Retest Strategically

Most hormones stabilize within 3–6 months of intervention. Retest to:

Confirm improvements
Adjust protocols
Identify remaining obstacles
Monitor long-term optimization

The Bigger Picture

Testing isn’t about collecting data for its own sake. It’s about understanding your unique biochemistry so we can support your body’s natural healing capacity.

Comprehensive testing reveals:

Where your body needs support
Which systems are struggling
How to prioritize interventions
Whether treatments are working

Most importantly, it transforms you from passive recipient of care to informed participant in your healing journey.

In our final article in this series, we’ll translate everything we’ve discussed into actionable lifestyle interventions—the “low-hanging fruit” that every person can implement to support hormone balance, regardless of where they are in their journey.

Read Next: Lifestyle & Nutrition: Low-Hanging Fruit for Hormone Balance (Coming Soon)

Continue exploring hormone optimization:

This is the third article in a four-part series based on conversations between Dr. Aaron Hartman and Dr. Christian Jenski about hormone optimization. The information provided is for educational purposes and should not replace personalized medical advice from your healthcare provider.