Labs are Overrated!

Written by Dr. Amy Bratteli - February 2026

Labs Are Overrated

Labs are an important part of hormone care at Harmony HRT, but they are only a part of the process. At Harmony HRT, we treat the patient’s symptoms first. Labs are a tool to help us manage symptoms and improve health outcomes. We’re focusing on labs and some of the caveats of using them in today’s post. 

Labs are useful for determining if someone’s baseline hormones are low. We also use them to ensure levels are where research shows maximum helpful benefits occur. They can also help us figure out the problem – is it estrogen dominance? Perimenopause? Menopause? Thyroid deficiency? Low testosterone? Vitamin D deficiency?

Basic things to know about labs:

• Lab Process:

• In the laboratory, there a different chemicals and machines used to read levels in a patient’s blood sample. Some times there are shortages in the chemicals or problems discovered with certain machines. Different methods, and even different labs, have different “normal values”. When there are reagent shortages, labs will “batch” test results, meaning they will wait until their trays are full before running a test. If your sample is at the beginning of a tray, it will take longer (sometimes 2 weeks for testosterone and estradiol). If your sample is lucky enough to be at the end of a try, it will be run within a few days. 

• Normal Ranges:

• “Normal Values” are statistical and determined by sampling a large number of folks to get the average normal values. These become the low and high levels (Remember the bell curve from school?). Unless specified, these normal values are from folks not on the meds we prescribe in our clinic. So, their “normal” and our “optimal” can be very different. Different labs in different parts of the country have different levels. For example, folks in Colorado tend to have higher hemoglobin levels because a lot of us live at altitude. So labs drawn in Boulder will have different normal values than labs drawn in the plains. 

• Things that Affect Lab Results: 

• Testosterone: Right now, the reagent used to measure testosterone has changed and it seems to be a bit wonky. We are seeing crazy high levels that don’t make sense, particularly with testosterone but sometimes with estradiol as well. I’ve discussed this with other physicians across the country and they are experiencing the same thing. Even the organization I trained under, doesn’t really use testosterone levels except to show an increase in levels. We can’t rely on levels. What do we do? Look at other factors. If a patient feels well without side effects of too much testosterone (acne, mood irritability, unwanted hair growth, clitoromegaly), if their SHBG (Sex Hormone Binding Globulin) is low, if their hemoglobin and hematocrit levels are normal, we can infer that this is not an accurate level. These are all the things our physician and providers will use to determine the validity of the testosterone result. This highlights how important it is for a patient to be aware of what is happening with their body on the HRT and medications we provide. It is also important to have a provider who understands the nuances. 

  
  

• Thyroid Labs:

• Thyroid results can be affected by supplements, particularly B vitamins, and most specifically biotin. These mainly affect the TSH levels. Usually by holding these 1-2 weeks before lab draws that effect can be negated. Timing of the labs doesn’t really matter. Some clinics will have a patient fast before a thyroid blood draw. At Harmony HRT, that doesn’t matter as much as being consistent with what you do before blood draws. If your thyroid is always checked on an empty stomach, then make sure to get all your labs drawn like that. If you have always eaten then make sure that is the same every time. Consistency is more important than being fasting or not. 

  
  

• Other Factors:

• Stress, lack of sleep, illness, hard work-outs, recent intercourse, can have effects on the hormone levels we monitor. Try not to have labs drawn during these times that can increase cortisol levels which compete with hormones at the same receptor types, causing levels to go down. At minimum, let us know if any of these are at play when we look at your labs. 

  
  

• Bottom-line:

•  What can help you the most, is to pay attention to how you feel and how your body responds to the prescriptions we have given you. That will give us far more assistance in managing your care than the labs themselves. Make note of timing of your last meds, if you ate, if anything unusual is happening prior to your lab tests, and how you feel. We will use this information along with any lab results to determine the right course for each person. 

Schedule a consult today to discuss symptoms and start making a plan towards feeling better with Harmony HRT.