Why you keep being told your hormones are “normal” despite having symptoms
It’s because your provider wasn’t assessing your hormones in the necessary depth using the correct tools
I work with a lot of women who tell me they are a lot of symptoms of hormone issues, yet their provider told them “their hormones looked fine”. Prior to our initial intake they often send me the bloodwork their previous providers have run and there’s almost always a list of hormones on there. I’ve very easily able to identify why “their hormones came back normal”: their hormones were not tested properly using the correct tools. Testing hormones for premenopausal women is tricky!
The immediate red flag is when I see ALL the sex hormones tested on the same blood draw or only using ONE tool (like only bloodwork).
Here’s the thing nobody tells you: hormones are not a single snapshot you can capture on any random day. They’re a moving, rhythmic, deeply individual conversation happening in your body all day, every day, across your whole cycle
Let me walk you through what’s actually going on - the reason bloodwork alone keeps missing things, the three main ways to test hormones (and the honest pros and cons of each), and the upstream stuff you want to rule out first, because it’s usually driving the hormone chaos in the first place.
IMPORTANT NOTE
While I will be sharing important information on HOW to test your hormones, we always have to remember, the lab data is completely irrelevant without proper interpretation. Interpreting hormones is very complex and requires a very trained eye of someone with deep knowledge of physiology and someone who is very familiar with these tools. Hormones should never be DIY or AI interpreted!
*****And most importantly, we need to not only test your hormones properly, we need to understand WHY your hormones are not optimal in the first place. Hormones are responders. If you don’t dive deep to understand the WHY behind it, that DIM, progesterone, testosterone shots you’re taking - you’ll be taking those forever and you won’t be addressing the underlying drivers of your hormone dysfunction.
First: why bloodwork alone can’t give you the whole picture
Now, if you’ve followed me awhile, you know how crucial bloodwork is. No tool or lab has the science backing as bloodwork does (not stool tests, not the organic acids test, NOTHING has the validity of bloodwork).. BUT for sex hormones, for premenopausal women, ONLY testing your hormones with bloodwork will not give you the full picture.
Here’s why one blood draw misses so much:
Hormones move in rhythms, and blood only captures a single second. Your cortisol is supposed to be high in the morning and taper down by night. Your estrogen and progesterone rise and fall across your cycle in a very specific dance. LH spikes for a matter of hours around ovulation. A single blood draw can’t see a rhythm - it can only see one dot on a graph that’s supposed to have hundreds of dots.
Blood doesn’t easily show you what your body is doing with a hormone. This is the big one. Your total estrogen could look “normal,” but the real question is how your body is processing it - which pathways it’s sending it down, whether it’s clearing it efficiently, or whether it’s recirculating in a way that’s making you feel awful. Standard blood almost never shows you this.
Reference ranges are not the same as optimal. Lab ranges are built around the average of everyone who walked into that lab - including a lot of people who don’t feel great. “Normal” often just means “not yet in disease territory.” There’s a huge gap between “not diseased” and “actually thriving,” and that gap is exactly where most of my moms are living.
Timing gets ignored. If a progesterone level gets drawn on the wrong day of your cycle, the number is meaningless - but it still gets stamped “normal” and you get sent home. So much of hormone testing is when you test, not just what you test. With progesterone, you MUST confirm ovulation. Not guesstimate, but CONFIRM. Then you count a certain number of days later and test your progesterone. Women don’t ovulate in the same window and progesterone is the RESULT of ovulation, so confirm ovulation first, then test progesterone.
So no, you can’t just test your hormones with one blood draw. You need the right method, at the right time, looking at the right markers. Let’s get into the three main routes.
The three main ways to actually test hormones
Each of these tests shows you something the others can't. The key is knowing which one to use for which question and where to start.
1. Blood (serum) testing
What it is: The classic blood draw. Measures hormone levels circulating in your blood at the moment of the draw.
What it’s genuinely great at:
Thyroid. A full thyroid picture - TSH, Free T4, Free T3, Reverse T3, T3 Uptake, Total T3, Total T3, plus thyroid antibodies - is best captured in blood. If a practitioner only ran your TSH and called it a day, you have not had your thyroid properly looked at. We want the full panel to see whether your thyroid may be functioning below its optimal range and why. The why requires more markers.
Baseline sex hormones and pituitary signals. FSH, LH, estradiol, testosterone (total and free), Sex Hormone Binding Globulin (MUST be run with testosterone!!), ACTH, PTH, DHEA-S, leptin and prolactin all show up well in blood but FSH, LH and estradiol need to be run on the right cycle day.
Other hormones. Fasting insulin, growth hormones, etc. are all run via bloodwork only.
Where blood falls short:
It’s a single snapshot, so it can’t show rhythms (especially cortisol’s daily curve).
Standard blood doesn’t show you how you’re metabolizing estrogen - which is often the missing piece and crucial information.
It does not tell you the length of your luteal phase (VERY crucial information. This is more important than knowing your progesterone levels).
It does not tell you how long your hormones are sustaining or when they are falling (like the Mira and Inito).
It requires precise cycle-day timing.
It’s not a great assessment of your progesterone.
The progesterone problem nobody warns you about (and what “pulse” testing actually means)
I have a post on how progesterone is tricky, and rightfully so because testing progesterone via blood on one occasion is one of the biggest reasons “normal” progesterone results are so unreliable.
Here’s the key fact: progesterone is not released in a steady, even stream. After you ovulate, your body forms a temporary little gland called the corpus luteum (it’s made from the follicle that just released your egg), and that gland pumps out progesterone in pulses - short bursts, roughly every 90 minutes, mostly in rhythm with pulses of LH coming from your brain.
And these pulses are not subtle. In the same woman, on the same day, progesterone can swing from around 2 all the way up to 40 (ng/mL) within a matter of hours. Researchers have actually confirmed it fluctuating up to eight-fold in about 90 minutes. So your level at 9:00am and your level at 9:45am can genuinely look like they belong to two different people.
Now really sit with what that means for a single blood draw. If your blood happens to get taken at the bottom of a pulse, you can look “low” or “deficient” - even if your corpus luteum is doing a beautiful job. If it’s taken at the top of a pulse, you look amazing. Same body, same day, wildly different number, decided entirely by the minute the needle went in. That isn’t really a measurement of your hormones. It’s a coin flip with a lab stamp on it.
This is the part that makes me a little crazy, because so many women are told their progesterone is “fine” - or scarily “low” - off one single draw, and then a whole plan gets built on a number that was, functionally, random most likely, inaccurate.
So how do we actually get around the pulses? Two ways:
1. “Pulse” (pooled) blood testing. Instead of one draw, you take several blood samples spaced out across an interval - classically three draws about 15 to 20 minutes apart - and the lab pools them into one combined sample (or runs them and averages them). By catching several points across the pulse rhythm, you get a value that reflects your true average instead of one lucky peak or unlucky valley. It’s far more accurate than a single stick. The catch: it means multiple needle sticks in one sitting, it’s a bit of a production, and most conventional labs simply don’t offer it. This is “pulse testing” - and now you know why it exists.
2. Urine PdG. This is exactly why I love the at-home urine monitors so much. PdG is the metabolite your body makes as it breaks progesterone down, and it shows up in your urine. Your first-morning urine PdG reflects the average of all the progesterone your body made the day before. Your kidneys have basically done the pooling for you - quietly collecting and integrating all those pulses overnight into one smoothed-out number. So a single morning PdG strip sidesteps the entire pulse problem that wrecks single blood draws. You get the averaged signal without having to get a blood draw three times.
That’s the whole reason measuring PdG is often smarter than chasing a serum progesterone number: you’re reading the integrated, real-life signal instead of one frame of a jumpy, pulsing hormone. It’s also exactly what makes Mira and Inito so powerful for confirming ovulation and luteal strength - which brings us to them.
2. At-home urine hormone monitors: Mira and Inito
These two have completely changed the game for understanding your unique cycle, because they let you test frequently and cheaply at home and actually map the pattern instead of guessing. For my 1:1 clients I prefer Mira because they have a nice PDF you can send your practitioner with all of your data! Makes it a lot easier for me to read and interpret versus 25 screenshots.
What they are: Small devices that read test strips or wands you dip in your urine. They measure real, quantitative hormone metabolite levels (not just a “yes/no” line like a drugstore ovulation test) and plot them on a chart in an app so you can see your cycle unfold.
What they measure:
Mira (Ultra4 wands) and Inito both measure LH, E3G (the urine marker of estrogen), PdG (the urine marker that reflects progesterone after ovulation), and FSH. It gives you actual concentration numbers.
Functionally they’re very similar tools. Both let you watch estrogen rise toward ovulation, catch your LH surge, and then - this is the part I love - confirm whether you actually ovulated and whether your body produced enough progesterone in the back half of your cycle (the luteal phase and how long your luteal phase is, which is crucial). That PdG rise after ovulation is evidence that ovulation truly happened.
Pros:
You see the whole picture, not just one snap shot. Testing daily (or close to it) shows the rhythm of your cycle - the rise, the surge, the luteal response - which a single blood draw could never capture.
It confirms ovulation and luteal strength. So many women are told everything’s “normal,” but their PdG never rises the way we’d want, it doesn’t SUSTAIN the way we want it to, and her luteal phase is short - a pattern that can point to ovulation not happening, or happening weakly. That’s the kind of insight that explains short cycles, spotting, anxiety in the second half of the cycle, trouble conceiving, and many more!
It’s at-home, affordable per test, and repeatable. You can run it cycle after cycle to see if a protocol is actually shifting your pattern.
Incredible for timing. Tracking across a full cycle tells us the exact right days to run confirmatory bloodwork or run the Dutch test (like a peak-luteal progesterone). The monitor and the blood draw/Dutch test work as a team.
Cons:
It’s cycle-focused, not whole-body. These tools shine for the estrogen/progesterone/ovulation story. They do not tell you about cortisol, your stress rhythm, thyroid, androgens like testosterone, or how you’re metabolizing/detoxifying estrogen. This is important!
There’s a learning curve and some daily commitment. First-morning urine, consistent timing, not over-hydrating before you test - it takes a little discipline to get clean data.
It reflects metabolites, not the exact serum number. E3G and PdG track estrogen and progesterone beautifully for pattern, but they’re proxies, not identical to a blood value. For pattern, that’s exactly what we want. For an exact number, we confirm with blood.
Not easy to interpret the data - need to be working with a practitioner, though you should always be working with a practitioner when it comes to any lab interpretation.
Bottom line: If your question is “What is my cycle actually doing, am I ovulating, how long is my luteal phase? and how long are my hormones staying up or down?” - Mira or Inito is the most powerful, real-world tool you can put in your own hands. I often have women map 1-3 cycles. The clarity is unreal.
3. The DUTCH test (dried urine)
If Mira and Inito show you the rhythm of your cycle, the DUTCH test shows you the story behind the hormones - especially what your body is doing with them.
What it is: You collect a few dried urine samples on filter paper across one day. It measures sex and adrenal hormones plus their metabolites - the breakdown products that tell us which pathways your body is using.
What it measures:
Estrogen and its metabolites. Not just “how much estrogen and exactly what type of estrogen,” but which direction your body sends it - including whether you’re favoring the optimal pathway or the oxidative stress pathway that can lead to more serious conditions like cancer,, and whether you’re clearing (methylating) it well. This is the insight standard blood won’t be able to give you.
Progesterone metabolites to reflect your luteal phase.
Androgens like testosterone and DHEA and their downstream metabolites - The Dutch does a FABULOUS job of assessing your androgen pathways and 5-alpha reductase activity. DUTCH shows not just testosterone and DHEA but which pathway androgens are traveling - specifically whether they're being converted into the more potent DHT via 5-alpha reductase. This is why a woman can have "normal" testosterone on blood but still have acne, hair loss, or unwanted hair growth - her androgens are being shunted to the more active form. Blood misses this entirely.
The full daily cortisol rhythm - Saliva measures free (unbound, active) cortisol - the fraction that's actually doing something at the tissue level. Its biggest strength is that it's not thrown off by binding proteins, and you can collect multiple points across the day to see the rhythm.
Often melatonin, an oxidative-stress marker, and organic acid markers that hint at B-vitamin needs and neurotransmitter activity.
Pros:
It answers “what is my body DOING with my hormones (how are my hormones being metabolized),” not just “how much do I have.” Metabolites are where the real, niche, root-cause insight lives. It can tell you if your estrogen, for example, is being metabolized down the carcinogenic pathway (4-OH), or if it’s being metabolized by the protective pathway (2-OH).
One collection gives you a wide, connected picture - sex hormones, adrenals, and detox patterns all in one report, so we can see how they’re influencing each other.
Complete androgen picture that bloodwork will miss!!
At-home, no needle.
Cons:
It’s the most expensive option and it’s usually a once-in-a-while deep dive look rather than a daily tracker.
It’s a snapshot of a single day (or cycle point), so timing still matters - you collect during a specific window of your cycle, and it won’t map the day-by-day rise and fall the way a Mira/Inito can. I typically have my 1:1 clients confirm ovulation first with the Mira and IF necessary, run the Dutch alongside for a complete picture.
It needs VERY skilled interpretation. A DUTCH report is dense. In the wrong hands it gets either ignored or wildly over-interpreted. This is exactly where deep physiology knowledge matters - the report is only as good as the interpretation.
It doesn’t tell you the length of your luteal phase, how long your hormones are rising or falling, so I use Mira for that information.
Bottom line: DUTCH is a big deep-dive tool for your hormones. When we need to understand how you’re processing estrogen, a deep dive into DHEA, androgens - nothing else gives us that deep dive.
If I'm running the Dutch test for my 1:1 clients, I will have them do the Mira as well. Both together provide the most useful information.
So how do you get the super clear, niche insight?
Here’s the part most people miss: no single test is “the best.” The clarity comes from stacking the right tools in the right order, at the right time. This is the actual art - and it’s where bioindividuality stops being a buzzword and starts being a real strategy.
Here’s roughly how I think about layering it:
Start with the foundation in blood. A thorough panel - full thyroid (TSH, Free T4, Free T3, Reverse T3, Total T3 and Total T4, T3 Uptake, & all your thyroid antibodies), fasting insulin, and a baseline of sex hormones drawn on the correct cycle day. This rules out the big foundational players and tells us if your thyroid may be running below optimal or if there are patterns of blood sugar dysregulation underneath everything. **You’ll also want to run a lot more expensive blood work in addition to these markers to have a full picture of things that can be going on that CAUSE hormone imbalances.
Address foundations and other critical areas that can cause hormone imbalances FIRST, before diving into the Mira/Dutch test.
Map your actual cycle with Mira or Inito. Run a cycle or two (or three) at home. Now we can see whether you’re ovulating, when, how strong your estrogen rise is, and whether your progesterone marker actually shows up in the luteal phase. This also tells us the precise days to time any confirmatory bloodwork and the Dutch test. The data is hard to interpret, but my clients send me the data!
Go deep with DUTCH when the question is “how am I processing this?” When the cycle map and the foundational labs raise questions about estrogen metabolism, androgen patterns, or your stress/cortisol rhythm, DUTCH connects those dots in a way nothing else can.
When you layer it like this, you stop guessing and getting little to no insight each time when you test your hormones. You go from “my labs were normal but I feel terrible” to “oh - that’s the pattern, and that’s why.” That’s the difference between band-aiding symptoms and actually understanding your physiology.
The foundations: what I almost always explore FIRST
Now for the part I really need you to hear, because it’s the thing the wellness internet skips over while it’s busy selling you supplements you do not need and jumping straight to bioidentical hormone replacement.
Here’s the reframe that changes everything: your hormones are not typically in charge. They’re responders. Estrogen, progesterone, testosterone, thyroid hormone - they’re messengers carrying out instructions based on what your body senses is happening in your environment, your plate, your stress load, your sleep, your energy availability. Your endocrine system is essentially asking one question, over and over, every single day: “Based on everything coming in right now, is it safe and resourced enough to run a full, fertile, energetic, calm version of this body?”
When the answer keeps coming back “no,” your hormones shift - not because they’re broken, but because they’re doing exactly what they’re designed to do given the inputs. So when a mom’s hormones are a mess, I’m not rushing to “fix the hormones.” I’m asking what is the body sensing that’s making it respond this way? Nine times out of ten, the answer is hiding in one of these foundations.
Blood sugar - the one I start with almost every time. Here’s the WOW: insulin doesn’t just manage your blood sugar, it directly reaches into your sex hormones. When you’re riding spikes and crashes - coffee and a granola bar, skipping protein, grazing on carbs - your insulin runs high, and high insulin lowers a carrier protein called SHBG (sex hormone binding globulin). SHBG is the “leash” that keeps your free testosterone in check. Less leash, more free androgens floating around - which is a huge part of the skin, hair, and ovulation patterns women get told are “just their hormones.” Meanwhile, every blood sugar crash is registered by your body as a stress event, triggering cortisol to rescue you. So a day of blood sugar chaos is, to your physiology, a day of repeated tiny emergencies. That’s why this isn’t sexy but it’s foundational - it’s quietly steering insulin, cortisol, AND your androgens at the same time.
Your stress response - and the survival math your body is always running. Your body will always prioritize getting you through today over making a baby next month. Here’s the genuinely mind-blowing part: chronic stress doesn’t just “use up” your hormones - it sends a signal up to the command center in your brain (the hypothalamus) that essentially says “conditions are dangerous, downshift reproduction.” That command center then quiets the pulses that tell your ovaries to ovulate. Your reproductive system gets dialed down from the top, on purpose, as a protective decision. (And no, it’s not the cartoon “your body steals progesterone to make cortisol” story you’ve heard a hundred times - the real mechanism is this brain-level prioritization, which is far more elegant and a lot harder to out-supplement.) This is why a dysregulated cortisol rhythm is one of the most common upstream drivers I see in women, and exactly why the DUTCH cortisol curve is so revealing.
Sleep and your inner clock. A huge share of your reproductive signaling and growth-and-repair hormone is released in specific windows while you sleep. Cortisol is supposed to surge in the morning to wake you and taper to almost nothing at night. Melatonin, your darkness hormone, also acts as a powerful antioxidant that protects your developing eggs. When sleep is short or fragmented, you don’t just feel tired - even one rough night measurably nudges your cells toward patterns of blood sugar dysregulation the next day, and chronic disruption scrambles cortisol, hunger hormones, and your cycle. Sometimes the single highest-leverage “hormone protocol” I give someone is genuinely just protecting their sleep with a solid sleep hygiene routine and getting morning light in their eyes.
Nutrient status - because hormones are built, not summoned. You physically cannot make or clear a hormone without raw materials, and this is where it gets wild: every steroid hormone you have - estrogen, progesterone, testosterone, cortisol - is built from cholesterol. The same molecule demonized for decades is the literal backbone of your entire hormonal system, which is why chronically low-fat eating can quietly starve hormone production. Then come the cofactors: your thyroid needs iodine, selenium, and zinc to make and activate its hormone; your liver needs certain B vitamins to package estrogen for removal; magnesium is a cofactor in hundreds of reactions and most of us are running low. And your iron stores - especially for us menstruating, often-depleted moms - can tank your energy, thyroid, and cycle, and it gets missed constantly because regular iron looks “fine.” You can’t supplement your way past a missing foundation; you have to actually rebuild the supply.
Gut health - and the estrogen recycling system. This is one of my favorite “whoa” facts to teach. You have a specific collection of gut bacteria - researchers literally call it the estrobolome - whose job touches how you clear estrogen. Here’s the cycle: your liver carefully packages used estrogen for disposal (think of it as bagging up the trash and tying the bag shut). But certain gut bacteria produce an enzyme that can untie the bag - snipping that packaging open so the estrogen gets reabsorbed back into circulation instead of leaving in the trash. So when your gut is inflamed, imbalanced, or you’re not having a daily bowel movement, estrogen that was supposed to leave gets recycled right back into you. You genuinely cannot have settled hormones with an angry, constipated gut. (Bonus: most of your serotonin is made in your gut, too - so this terrain shapes your mood as much as your cycle.)
Liver and detox capacity. Your liver is the packaging plant in that story above - it does the heavy lifting of breaking hormones down in two phases so they can be safely escorted out. If it’s overwhelmed (alcohol, a sluggish system, a high overall toxic load) or short on the exact B vitamins and nutrients it needs, that processing backs up and used hormones linger. This whole pathway - how you’re metabolizing estrogen, which route you’re sending it down, how well you’re clearing it - is exactly what the DUTCH test lets us actually see.
Thyroid - the metabolic conductor. Your thyroid sets the tempo for every cell, including the ones that make and listen to your sex hormones. And here’s a nuance most people miss: your thyroid mostly releases a storage form (T4) that has to be converted into the active form (T3) - and a lot of that conversion happens in your liver and gut, using selenium and zinc. So a stressed, undernourished, inflamed system can be making “enough” thyroid hormone and still not be activating it well. When your thyroid is running below optimal, everything downstream gets sluggish - cycles get weird, progesterone struggles, energy bottoms out. This is why I want the full panel, never just aTSH.
Energy availability - the question under all the questions. Tying it together: more than any single nutrient, your body is constantly tallying “am I getting enough fuel for everything I’m asking of it?” Under-eating, over-exercising, or chronic dieting (often dressed up as “wellness”) tells your brain resources are scarce - and a scarce body downshifts the non-essential stuff first, which to your physiology means your cycle, your libido, your fertility. So many “hormone problems” are really an energy-availability conversation in disguise. Sometimes eating more, and more consistently, is the most powerful hormonal intervention there is.
Inflammation and total load. Underneath all of it, low-grade inflammation - from food sensitivities, hidden infections, chronic stress, or blood sugar swings - is static on the line. Even when a hormone level is “fine,” inflammation can make your cells hard of hearing its message (this is the part that blows people’s minds: it’s not only how much hormone you have, it’s whether the receptor can even hear it). Calming the system down is often what finally lets everything else start working.
See the pattern? Every one of these sits upstream of your hormones. Your endocrine system is the most exquisitely responsive feedback network in your body - it’s not malfunctioning at random, it’s reacting intelligently to the terrain it’s living in. This is why chasing hormone numbers in isolation - or grabbing a supplement because an influencer with great lighting swore by it - so often fails. Change the inputs, and the messengers very often follow.
And this is the whole reason two moms with the exact same lab values can need completely different things. Your body isn’t a protocol you found on Instagram. It’s a unique, intelligent system responding to your specific life - and it deserves to be read like one.
The real takeaway
You can’t “just test your hormones” with one blood draw and gain any real insight. Real clarity comes from understanding that hormones move in rhythms, that how you process them matters as much as how much you have, and that the answer is almost always hiding upstream.
Blood gives you the foundation - especially thyroid, iron, and blood sugar. Mira or Inito let you map your actual cycle and confirm whether you’re truly ovulating. DUTCH shows you the deeper story of how you’re metabolizing your hormones and what your stress rhythm is really doing. And underneath all of it, your blood sugar, stress, thyroid, gut, liver, nutrients, and sleep are quietly moving and shifting your hormones.
The reason you haven’t gotten answers isn’t that the answers don’t exist. It’s that nobody has connected the dots across all of these layers for you, specifically. That’s the whole game. That’s the difference between collecting more data and actually understanding it.
If you’re the mom who’s been DIY-ing this, bouncing between practitioners, and feeling like your provider isn’t looking deep enough- this is exactly the work I do. The Investigating the Root program is a deep dive into your health. It starts with a thorough initial deep dive to map your whole story, then strategic, properly-timed testing, a lab review, and effective, custom solutions based on YOUR physiology - not a template. If you’re ready to gain clarity and effective solutions, this is your invitation to work together.
