Why Hormone Testing Matters Before Starting BHRT (It’s Not Optional)
Don’t Guess, Test
If you’re a woman in midlife navigating the hormone rollercoaster, bioidentical hormone replacement therapy (BHRT) can be a game-changer—but only when it’s done right. That means testing first. Skipping this step? It's like throwing darts in the dark and hoping for balance. Hormone testing is your GPS—helping you avoid side effects, monitor progress, and actually feel better, not worse.
What Is BHRT, and Why It Needs to Be PersonalizedWhy You Can’t Skip Hormone Testing Before BHRT
You’ve probably been there: talking to friends, reading wellness blogs, trying this or that supplement hoping it’ll be the one. But here’s the thing—your body is bioindividual. What worked for your best friend could make you feel worse.
Take it from me: I thought I was estrogen-deficient and almost started estrogen therapy. But after testing, I discovered my estrogen was fine—it was low progesterone making me estrogen dominant. Taking more estrogen? That would’ve poured fuel on the fire.
This is common in perimenopause, when estrogen can fluctuate wildly, but progesterone steadily declines. It’s also why symptom-matching alone is risky. You can feel “off” and still have labs that look “normal” by conventional standards—but functional medicine asks, what’s optimal?
BHRT (Bioidentical Hormone Replacement Therapy) uses hormones that are structurally identical to what your body makes. It’s used to relieve symptoms like:
Hot flashes
Night sweats
Mood swings
Sleep issues
Brain fog
Low libido
But BHRT is not plug-and-play. It requires custom dosing and delivery methods (creams, patches, pellets, oral, etc.), and that customization starts with proper lab testing.
Want to track your symptoms? Take the hormone self assessment.
Start with These Foundational Hormone Tests
Here’s what to ask your provider for before starting therapy:
✅ Blood Tests
Hormone
Optimal Range (not just “normal”)
Estradiol
100–150+ pg/mL (for symptom relief & bone health)
Progesterone
5–10+ ng/mL (or 100–150 ng/dL via LC/MS)
Total Testosterone
50–60 ng/dL
Free Testosterone
~5 pg/mL
DHEA-S
200–430 ug/dL
FSH
Under 25 mIU/mL (if on BHRT)
Note: These are functional/optimal ranges. Lab reference ranges often just show what’s "common"—not what’s ideal.
🧠 The DUTCH Test (Dried Urine)
This advanced test shows not only your hormone levels, but how your body metabolizes and detoxifies them, including:
Estrogen and its potentially harmful pathways
Cortisol (stress hormone)
Androgens like testosterone and DHEA
Knowing this helps you and your provider adjust dosing and spot risks (like estrogen dominance or poor detox pathways).
Additional Testing You Shouldn’t Skip
Before starting BHRT, functional providers also look at:
Thyroid function: Low thyroid can mimic hormone imbalance symptoms.
Gut health: A stool test helps uncover inflammation, poor absorption, and detox issues. Your gut influences hormone metabolism more than you’d think.
Testing Isn’t a One-Time Thing—Here’s the Schedule
Test Type & Frequency
Bloodwork- Every 3–6 months, then annually
DUTCH Test- Every 6–12 months
Stool Testing- Every 2 years or as needed
Think of testing as your hormone check-in. It ensures you’re not just taking hormones—you’re actually benefiting from them.
Real Talk: Common Symptoms When Starting BHRT
Even with proper testing, your body may need time to adjust. Here’s what’s normal at the beginning:
Estrogen-related
Bloating
Breast tenderness
Mood swings
Headaches
Progesterone-related
Drowsiness
Brain fog
Anxiety (yes, even with progesterone)
Testosterone-related
Acne
Hair changes
Libido shifts
📝 Pro Tip: Oral progesterone can be sedating, and each woman’s estrogen sensitivity is unique. Symptoms often resolve as your dose gets fine-tuned.
Perimenopause vs. Post-Menopause: Different Bodies, Different Needs
Perimenopausal women still have fluctuating cycles. Hormone levels can spike unpredictably, increasing risk for estrogen dominance or irregular bleeding.
Post-menopausal women are more sensitive to small doses but typically stabilize quicker once the right balance is found.
Signs You May Need to Adjust Your Hormones
If any of these apply, talk to your provider:
No symptom relief after 2–3 months
Persistent bleeding post-menopause
Mood instability
Severe breast tenderness
Worsening acne or hair thinning
This doesn’t mean BHRT isn’t working—it likely means your dose or delivery method needs adjusting, or your detox pathways need support.
Functional Truth: One Size Does Not Fit All
In my practice and personal experience, I’ve seen too many women go the DIY route—cherry-picking supplements, guessing based on symptoms, or borrowing someone else's protocol.
But here’s the truth: What your body needs is unique.
Testing gives you data, and that data saves you time, money, frustration—and protects your health.
Final Takeaways: What to Remember
✅ Testing before BHRT isn’t optional—it’s essential
✅ Functional ranges matter more than “normal” labs
✅ Bioindividuality means your protocol should be yours
✅ Testing is ongoing, not one-and-done
✅ BHRT is powerful—but only when it’s monitored, personalized, and supported
Ready to Get Rooted in Hormone Balance?
Let’s make sure your body is heard, not guessed at. At Nurturing Roots Healing, we don’t slap a protocol on symptoms—we partner with your body to support the whole system.
FAQs: Hormone Testing & BHRT
Do I really need hormone testing before BHRT?
Yes. It’s how you personalize your plan and avoid guesswork. Skipping testing is like driving cross-country without GPS.
How often should I test my hormones?
Blood every 3–6 months initially, DUTCH every 6–12 months, and stool testing every 1–2 years.
Is it normal to feel worse at first?
Sometimes. It’s often your body adjusting. With good testing and symptom tracking, that window is short.
Can I use symptom tracking alone to adjust my hormones?
You can, but there is may be a lot of trial and error in your tracking, so it can be risky. Symptoms can overlap and be misleading—testing helps to show the root cause.