The Midlife Labs to Ask For, and How to Ask Your Doctor

From the video captions, as spoken.

You also want to get a full iron panel, not ferritin alone. That means serum iron, ferritin, TIBC, and iron saturation. You want vitamin D, 25-OH form. You want to test B12, folate, magnesium red blood cell, not serum magnesium. So it's magnesium RBC on the lab order. You want a CBC and a CMP run. You want CRP run, which is the high sensitivity inflammation marker, can tell you how much inflammation you have.

We want to have your fasting glucose, fasting insulin, and A1c, which is your 3-month blood sugar average. You want your morning cortisol tested, drawn before 9am. You also can do a 4-point saliva cortisol test. Many insurances will cover that, okay? Because if you only do the blood test version in the morning, it doesn't show you what your pattern is.

Now, low cortisol can have very serious medical issues, okay? So it does, if you're feeling consistent exhaustion, we want to see what your cortisol levels are. All right.

Now let's talk about labs for your sex hormones. All righty. It's all about when you get your labs done for your sex hormones if you're still cycling. So there's 2 draws. If you're still bleeding, there's 2 different lab draws you would ask for to get your sex hormones checked. The first lab draw happens day 2 to 5 of your cycle. Right, so consider day one the first day of your full flow.

On this first draw, day 2 to 5 of your cycle, you get FSH, LH, estradiol, SHBG, you get total testosterone, free testosterone, and DHEA. This is all in the list and I spell all these out for you in your guide and what each one is and what it's measuring. The second draw you ask for is 7 days after you ovulate, which is on a typical 28 day cycle right around day 21 of your cycle. This is where you get your progesterone and your estradiol again so that we see what's happening in the luteal picture. So if your cycle runs longer or shorter than 28 days, you subtract 7 from your usual cycle length to find the ideal day to test. So for example, on a 32 day cycle, that's day 25, not day 21, okay? So you're gonna have that mathematical equation in your guide.

Here's why you do 2 different draws for your sex hormones. See progesterone surges after you ovulate. If you draw it earlier, it reads low, even a completely healthy cycle, so it doesn't tell you anything useful. Drawn 7 days after ovulation, it tells you whether you ovulated and whether you produced enough afterward. So everything else reads cleanest at the start of the cycle when your system has reset. Now if your cycles have stopped all together, draw whenever you can and then you repeat in anywhere from 6 to 12 weeks. So you're building a trend rather than just relying on one set of labs.

Okay. I would do that at least 3 times in 6 to 12 weeks. And now you look at the patterns. Things to know about any of your blood draws. This is crucial. Do all your labs fasting first thing in the morning, water only. So that means the day before, like 9 PM, don't eat anymore.

Get your labs done around 8 AM in the morning. You can drink water. You can drink tons of water.

If you're getting labs done, stop taking multivitamins for a week. Stop taking anything with biotin in it, okay? Biotin will skew the results of your thyroid testing. It doesn't impact your thyroid. It just skews the results. Now, if you already take any kind of thyroid medication, don't take it the morning of your labs. Okay? Take it after you get your labs done.

Now, there are spit tests, saliva tests, and blood tests. Both will show you lots of valuable information. Okay? I happen to do both, my functional medicine practitioners, and I recommend to my clients, you really want to understand your sex hormones and your cortisol levels. You do your blood work and then you do a saliva kit that will read your cortisol patterns and it'll give you a different view on your sex hormones. So this is giving you very, very complete data. I think how we walk into our appointments asking for these labs matters as much as what we're asking for.

All right? So we don't want to brace for a fight or arrive armored. Bring your handouts and you know, in whatever way that you really care for and appreciate your physician, acknowledge them. You know, I think we can't ever acknowledge people enough in life, you know. So starting your appointments with some acknowledgement for the care you've been receiving is a really good starting point. Then make your clear and specific request. Something like, I would like to run a full thyroid panel, including free T3, reverse T3 and free T4. I would also like my antibodies tested along with ferritin.

I'd like to know my D levels and my sex hormones, okay? And if you need a reason, you can say things like, what's true, I've been experiencing fatigue and weight gain and I went to a workshop all about the things that can be happening in a Midlife Woman's body and physiology. There could be things running in my family that I'm unaware of. So I've just never had this complete of a baseline done and I'd really like to be able to collaborate with you on my health care. I'm taking my Midlife health very seriously and I know that it's an investment in my future, okay? So you know if you find your appointments are rushed or they say no you don't need reverse T3 or TSH is plenty. That's information that this is not a practitioner I would stay with, okay?

Get copies of everything, friends. Get copies of your lab, your lab results. Start to make an archive so that you can start to see patterns and trending. And you keep asking, keep looking for the right help until you get the right help.