Monday, March 21, 2016

In-Depth Hormone Testing and The Value of Monitoring BBT Every Day

Health updates and why I want you to start monitoring your BBT!

Honing in on Hormones! 
It's one thing to get back to a normal period, it's another to get a deeper look inside to see assess hormone levels and the progression of a menstrual cycle. In January I decided it was time to some deeper hormonal investigation to see where I’m at, especially with pregnancy goals in the horizon (but don't hold your breath on that). I’ve had my period again for a while now—it came back January 2014 and was spotty for a while until August 2014 when it returned for good on a monthly basis, minus that few-month hiccup last fall from which I quickly recovered and learned my lesson that I’m still very sensitive to my type of “extreme” living and stress. 

So anyways, the month-long hormonal panel is called the BioHealth 208, that gives 17 readings of progesterone and estradiol levels throughout an entire menstrual cycle (basically a month-long test), as well as two measures of testosterone levels. I highly recommend getting this test from your practitioner if you’re on a similar path as me in regaining and/or balancing out hormones. If you haven't regained a period yet, however, wait off on this test and there are others that are more helpful (inquire in comments).

It starts on Day 2 of a new cycle every other day first thing in the morning before food or drink you spit saliva into a tube. This process continues until the start of the next period. I’m so used to the saliva tests by now, having done my first back in 2013. They’re awkward, but saliva is a much better way to monitor hormones than blood, and obviously the saliva is very DIY efficient. Some new tests like the DUTCH Test to measure hormones might even be a better way to gauge production and metabolism of hormonesand more bang for your buckbut that’s another topic for another day. 

Basal Body Temperature (BBT) 
As part of the test’s requirements and also for my own data collection, in conjunction to the saliva collections I measured basal body temperature (BBT) daily. BBT is your core temperature at complete rest, and it can tell you a lot about your fertility, hormones, health status, or any underlying issues like thyroid problems. Like HRV, our BBT is a direct window into our body, and it is a super easy and low-cost mechanism to assess your current state, health and overall well-being—and also figure when to make changes if needed. Also like HRV, measuring BBT in itself will do nothing to affect health, it's on you to go the next step to support what you need if indeed additional support is needed. It’s important to take BBT immediately upon rising before going pee, before hanging out in bed having a chat, before anything, for accuracy. Eyes open = thermometer in. 

You can use apps to record BBT instead of old-fashioned pen and paper. I use Kindara and love it.

It’s surprising to me how many women aren’t really familiar with BBT, what the numbers mean, why it’s important to measure it, or even ovulation and the menstrual cycle for that matter. So I’ll explain a bit and why I think it’s so valuable to understand these things if you want to own your health—as you should. And even if you think nothing is wrong right now, it's also good to measure BBT anyway so in case you have an issue in the future you have data from when things were "normal" with you.

BBT: Normal vs. Abnormal Readings 
 Waking temperature should be pretty static, ideally not below 97 degrees nor too high, i.e. not over over 98.9 degrees. A temp of roughly 97.2 to 98.5 degrees upon waking—depending where you’re at in a cycle, which we’ll get to—is considered normal. I don't like to see girls below 97.2. A low BBT in the 96s, 95s is not normal and associated with some problematic issues like hypothyroidism, a state of chronic caloric deficit, eating disorders, increased risk of fungal infection, etc. If your BBT is chronically low, i.e. below 97 degrees for 5-10 days or more then it’s definitely worth looking into to find out why. 

BBT and the Menstrual Cycle 
Basal body temp and the menstrual cycle are directly related so you can learn a lot about your female situation simply by taking your temperature upon waking. In the follicular phase, the first half of the cycle, BBT ranges from 97.0 to 97.7 degrees. Upon ovulation and into the luteal phase, the second half of the cycle, BBT increases to roughly 97.8 to 98.3 degrees or more. At the end of a cycle your BBT on a chart should look something like this: 

This is my BBT chart from the Kindara app. You see the overall trend in BBT readings, which pretty much line up with what you want to see in normal functioning. You may take note that my cycle is a tad long still, we're hoping it will normalize over time as cycles of 32 days or less are ideal for conception.

Notice lower temps in the first half, a very clear spike in temp (ovulation) and higher temps in the second half before the start of another period in which temperature drops back down and the cycle continues. 

For a woman, there’s really no excuse to not get in the habit of monitoring BBT as much as possible, ideally every day. I know it’s hard to form new habits, but set yourself up for success by having your thermometer and phone app to record BBT right next to your bed, and just get into the routine—as mentioned, you must measure BBT before you sit up or get up and especially measure before your first morning pee, even laying in bed and chatting or rolling around will increase temperature and it’s crucial to get that core resting temp for accurate information. It took me a few days to remember to measure BBT, but once I got in the habit it was an automatic response as soon as my eyes opened. Even since the month-long hormone test, I’m still measuring BBT daily. 

BioHealth Test Results
So my BioHealth 208 panel showed amazingly rad results that seriously had me fist-pumping and feeling very proud like hard work is paying off. I have normal and near-perfect levels of progesterone and estradiol—and the progression of each throughout my cycle look spot-on for a healthy female who has a healthy normal menstrual cycle. In fact my functional doc said my hormone levels and the curves they form when charted out (i.e. the spikes and drops over the course of a month) look better than 90 percent of patients she sees! No longer is low/no progesterone a problem of mine, oh ya!

In terms of the progression of my cycle, my chart showed a clear spike in estrogen, a very clear and strong ovulation midway, and a clear spike in progesterone—each hormone forming a "beautiful curve" as my doc put it. See the graphic below for a visual of this. Of course, ovulation is also key to getting pregnant. 

The menstrual cycle. Note how the BBT readings line up.

Comparing Present and Past
These results are a far stretch from where I was at in 2013. A saliva test I did in June 2013 showed no signs of a menstrual cycle (no surprise) and pretty much no signs of sex hormones either. My progesterone levels were literally measured at 1 (the range on this test was 80-270 pg/ml)—and that might as well have been none. Estradiol, DHEA, testosterone were also scarily low for female norms, as was my PG/E2 ratio (i.e. progesterone to estradiol ratio), which was reflective of what you’d see in perimenopause and postmenopausal womenat age 28. 

Everything was bottomed out, except for cortisol—not surprising at all actually. My cortisol wasn’t off the charts, but it was on the high end in the morning and afternoon, and I’m sure I was in some phase of adrenal fatigue. As this relates to sex hormones, it’s very likely that I was deep into the pregnenalone steal—more cortisol production was taking priority over production of all other hormones to support my high-stress go-go-go lifestyle, and my body saw no need to push for sex hormone production given the environment I created… and as the story goes this can only go on for so long before you tank, which I did later that fall in ’13. 

Since then, as I’ve shared openly, I’ve worked incredibly hard to adopt a lifestyle that supports a healthy period and healthy hormones—and doing so while not having to totally give up my love for endurance sports and an active lifestyle. It hasn’t been easy, and there have been slip-ups, but I think I’m getting used to what I need for steady rockin' hormones. Supplements have certainly been involved along the way, but really it's more about lifestyle and your mental state that fosters the best results.

Finding A Normal BBT Over Time, and Tie-In With Thyroid
Going back to the BBT, interestingly, in 2013 I tracked BBT for a while in July and August of that year (after the hormone test showing I was bottomed out), and my numbers were consistently 96.5 to 97.1 degrees, never over that. A red flag for sure, and this lined up with the other health issues I was exhibiting and lifestyle choices I was making—training for 70.3 worlds and a tough-ass Ironman.

BBT got back to being more normal in 2014 and 2015, but I’ll be honest I rarely measured it—just hadn’t adopted the habit. 

Then, when I was going through a bit of a hiccup lat fall I started measuring my BBT again and saw it dropping into the 96’s several times. Uh oh. At that point, we also saw that my thyroid was acting up—or should I say down—I was definitely exhibiting some hypothyroid issues. (I now have a clue as to why thyroid function decreased; more on that to come.)

I got back on track quickly in December '15 by taking a few simple steps to re-balance out my life, rest, etc, and put a halt to being in that chronic high-stress state. My BBT, hormones and period followed suite. As of this year my BBT is solidly in the 97’s to 98’s every day and never once below 97 degrees. Most days in the first phase of my cycle it’s high 97’s, and into the second phase it stays in the 98 range. 

Interestingly, in January/February my thyroid was still wonky, including symptoms of fatigue and quick weight gain, which I didn't freak out about but I was still a bit shocked since I hadn't changed anything in my diet or exercising habits. We tested with a full thyroid panel and got answers, at which point I started thyroid support including lifestyle and nutrition “hacks” and taking an all-natural non-synthetic supplement for thyroid—just one!—called GTA Forte II. By late February a third blood test showed my thyroid numbers—TSH, T3, T4—were all back to normal. And my weight also returned to normal, in the 133-135lb range.

Pretty cool what you can do to by taking charge of your health and understanding what’s really going, then implementing the right lifestyle and nutrition/supplemental support for healthy living. 

Take Action
Go buy a thermometer now if you don't have one. And get Kindara too. And if you really are curious to know more or figure out that reason why you're not functioning optimally right now (i.e. can't lose weight, tired, amenorrhea, etc) it might be time for not only new blood labs but some more detailed hormone testing too. Don't put it off, invest in YOU!


  1. Hey I know you mentioned other tests for those who have not regained their period. I was wondering which ones you suggest. I've been off birth control for about 6 months and have been resting a lot as well as eating more healthy fats. If you have any tips or suggestions, it will be much appreciated!

    1. I like the DUTCH test or a functional adrenal stress profile (saliva) test. If you don't have your period chances are these tests will show low levels of both progesterone and estrogen which requires action to heal. But you'll also want to investigate cortisol, DHEA, and so on. Sometimes it also just takes time to regain normal cycles after being on BC assuming all other factors are healthy (training status, weight, diet, etc).

  2. hi! are the tests you received available only through functional practitioners or could they be done thought a regular MD?

    1. Some regular MD's may be willing to order but we're talking about different methodologies here in many cases. If your MD takes an integrative/functional health approach that is great and I would ask, but otherwise you may need to order testing else where through a functional practitioner (locally or remote options). Could be covered by insurance, but often not. Depends.