the optimal

lab guide
healing made simple.
01 introduction 3
the importance of hormone testing

02 chapter I 6
what labs to order and PCOS specific labs

03 chapter II 10
explaining each lab marker

04 chapter III 15
the problem with “normal” ranges

05 chapter IV 19
advocating for yourself and finding proper care

06 conclusion 20
 t to expe
ha c
w

t
Did you know that 80% of women experience hormonal
imbalances, but it often takes 6-7 years to get a
proper diagnosis?

I personally experienced this struggle for six long

years. That's why I've created this guide - to help
you avoid the same hardship that I and countless
other women have faced.

In this guide you will learn:

º Why to test your hormones

º How to order lab work
º When to test your hormones
º The importance of advocating for yourself
º The importance of optimal ranges
º Understand lab markers
Get ready to embark on a fitness journey that
celebrates your uniqueness and empowers you to
achieve your fitness goals.

Let's unlock your body's full potential together.

©2023 Mila Mend. All rights reserved. intro | 03

 Hormone Testing
Hormonal testing gives a clear insight of where your
hormones are at, and can put an end to a long and
difficult guessing game.

Here are some common symptoms of hormonal imbalances:

º Irregular periods, heavy & painful periods, or a

complete absence of periods.
º Infertility or difficulty conceiving.
Menopause.
º Polycystic ovary syndrome (PCOS).
º Thyroid disorders: such as hypothyroidism or
hyperthyroidism.
º Mood swings, depression, anxiety, and irritability.
º Low libido, fatigue, decreased sex drive, or difficulty
achieving orgasm.
º Weight gain or difficulty losing weight even with diet
and exercise.
º Insomnia, sleep quality, and cause difficulty falling
asleep or staying asleep.

It is important to note that not all women will experience

the same symptoms.

However, if you are experiencing any of the symptoms above

or suspect a hormonal imbalance, it is important to talk
to a healthcare provider to determine which hormonal test
is appropriate and if treatment is needed.

©2023 Mila Mend. All rights reserved. intro | 04

 Hormone Testing
How to get lab tests:
To request a lab test, you can ask a general doctor, an
OBGYN, or purchase your own at home lab test. Preferably an
OBGYN, Endocrinologist, or a naturopath (functional
medicine doctor) will be the best fit to interpret your
results.

When to test:
Fasted, in the morning (8:00am), during the first
3 days of your menstrual cycle. Sex hormones should be checked
on day 19, 20, 21, or 22 after ovulation.
* Stop taking Biotin at least 72 hours before testing
since it can affect insulin, thyroid
* Your hormones fluctuate throughout the month, therefore
depending on what hormones you want to test, the timing
of you draw can influence the results.

What if I don't have a period?

If you don't have a menstrual cycle, any day works.

What if I'm on birth control?

You will not be able to test FSH, LH, estradiol or
progesterone accurately.

Types of testing:
Blood testa re most commonly used but you can ask for a
urine test, saliva test, or a DUTCH test.

Additional Thyroid test:

Having a doctor feel your thyroid is very important.
If your insurance covers it, I highly recommend getting an
ultrasound of your thyroid if you have any thyroid issues.

©2023 Mila Mend. All rights reserved. intro | 05

 What lab tests to order

General Health Markers

CBC* - complete blood count
CMP* - complete metabolic panel

Inflammation
Cortisol*, Free Cortisol
HS-CRP

Hormones
Estrogen (Total), Estriadol* (E2)
Progesterone*
Testosterone*, Free Testosterone
SHGB, FSH*, LH

Thyroid
TSH*,
Free T4*,
Free T3*, Reverse T3,
Thyroid Peroxidase*, Thyroglobulin Antibodies*

Blood Sugar
Fasting Insulin*, Fasting Glucose,
Hemoglobin A1C*,

Other
Ferritin*,
Vitamin D*, Vitamin B12,
Magnesium, Melatonin

* starred markers are essential to order. The other ones are

not necessary, but ordering both will give a clearer picture
of where your health is at.

©2023 Mila Mend. All rights reserved. Chapter I | 06

 PCOS specific lab tests

LH:FSH
LH and FSH are gonadotropin hormones that regulate
the menstrual cycle and ovarian function.

In PCOS, there is often an imbalance between LH and

FSH, with elevated LH levels relative to FSH.

This imbalance can disrupt ovulation and contribute

to irregular menstrual cycles.

Testosterone
Elevated levels of testosterone are
a common feature of PCOS.

High testosterone levels can lead to symptoms like

hirsutism, acne, and male-pattern baldness.
The test measures both total testosterone and free
testosterone

In addition to testosterone, other androgen

hormones like DHEA-S and androstenedione may be
measured to assess hyperandrogenism.

Progesterone & Estradiol

Estradiol: Estradiol is the main type of estrogen
in your body. In PCOS, irregular menstrual cycles
can happen when estrogen levels are higher than
progesterone due to a lack of ovulation

Progesterone: Low progesterone levels can result in

irregular periods or amenorrhea (absence of
menstruation).

©2023 Mila Mend. All rights reserved. Chapter I | 07

 PCOS specific lab tests

Sex Hormone-Binding Globulin (SHBG)

SHBG is a protein that binds to sex hormones,
including testosterone.

When you have high insulin levels (common in PCOS

due to insulin resistance), SHBG levels drop.

This means more testosterone is free to act in your

body, which can lead to symptoms like excess hair
or acne

Insulin and Glucose Levels

Elevated fasting insulin levels and impaired
glucose tolerance can indicate insulin resistance,
which can lead to weight gain and other metabolic
issues.

HbA1c Test: This blood test provides an average of

your blood sugar levels over the past two to three
months. It can help assess long-term glucose
control and is useful in detecting insulin
resistance, pre diabetes, or diabetes.

Thyroid Hormones
Thyroid function tests (TSH, T3, T4, free T3 and
free T4) may be performed to rule out thyroid
disorders, as symptoms of thyroid issues can
overlap with PCOS symptoms.

©2023 Mila Mend. All rights reserved. Chapter I | 08

 PCOS specific lab tests
Ultrasound
In PCOS, the ultrasound may reveal enlarged ovaries
with small cysts or follicles arranged around the
outer edge (often referred to as the "string of
pearls" appearance).

Rotterdam criteria
To be diagnosed with PCOS, you typically need to
have the presence of two out of the following three
conditions:
Irregular or absent menstrual cycles.
Signs of hyperandrogenism such as hirsutism or acne.
Polycystic ovaries observed via ultrasound.

©2023 Mila Mend. All rights reserved. Chapter I | 09

 The science behind each marker

CBC (Complete Blood Count),

provides information about an individual's blood
cells and overall health status and measures the
volume of blood cells that make up your blood.

CMP (Comprehensive Metabolic Panel),

is a blood test that provides information about
an individual's overall metabolic health.

Cortisol
is a hormone produced in the adrenal glands that
helps you manage stress, regulate blood sugar,
regulate metabolism, fight infection, and
maintain blood pressure.

Free Cortisol
measures of the amount of cortisol that is not
bound to proteins in the blood. Measuring free
cortisol levels can help diagnose conditions
like Cushing's syndrome or adrenal
insufficiency.

HS-CRP (C-reactive protein)

is produced by the liver. The level of CRP rises
when there is inflammation throughout the body.
It is a marker of inflammation in the body.

DHEA-S
is a hormone produced by the adrenal glands.
It can help find out if your adrenal glands are
working right.

©2023 Mila Mend. All rights reserved. Chapter II | 10

 The science behind each marker

Estrogens (Total)
measures the total amount of estrogen in the body,
including both active and inactive forms. Estrogen
regulates the menstrual cycle, development of the
breasts and uterus, and many other functions in the
body. Levels can provide info about menopause,
menstrual irregularities, infertility, hot flashes,
and endometriosis.

Estradiol (E2)
is the main estrogen in non-pregnant females of
childbearing age. It's mostly made in the ovaries
and is important for fertility. It also helps
support brain and bone health.

Progesterone
plays a key role in regulating the menstrual cycle
and preparing the uterus for pregnancy. Progesterone
is used to identify whether ovulation has occurred
and is used in the investigation of infertility.

Testosterone
promotes muscle and bone strength, brain function,
fat distribution, heart function, blood vessels
production, energy levels and sex drive. Levels can
provide information about symptoms such as low sex
drive, fatigue, and decreased muscle mass, irregular
menstrual cycles, acne, and hirsutism.

SHGB (Sex hormone-binding globulin)

is a protein that binds to sex hormones. SHBG
testing is most often used to gather information
about how testosterone is working in the body.

©2023 Mila Mend. All rights reserved. Chapter II | 11

 The science behind each marker

FSH
helps control menstruation and triggers the release of
eggs from the ovaries. Imbalances with FSH can cause
infertility and can also have an effect on puberty,
periods, and sex drive.

LH
is a hormone that helps regulate the menstrual cycle
and triggers the ovaries to release eggs. Imbalances
in LH can result in fertility problems. Testing can
help prediction of ovulation (by LH surge).

FSH : LH Ratio
The FSH and LH ratio can provide information on
ovarian function. It can help determine infertility
and if you have PCOS (LH higher than FSH)

TSH
stimulates the thyroid gland and reflects thyroid
function. It is used to screen for all causes of
primary hypothyroidism and hyperthyroidism.

Free T3
the most active form of thyroid hormone that plays an
important role in regulating metabolism. Measuring
levels of free T3 can help diagnose thyroid disorders.

Free T4
is a hormone produced by the thyroid gland that plays
an important role in regulating metabolism and growth
and development. Commonly used to diagnose and manage
hypothyroidism and hyperthyroidism.

©2023 Mila Mend. All rights reserved. Chapter II | 12

 The science behind each marker

Thyroid Peroxidase (TPO)

is an enzyme found in the thyroid gland. TPO antibodies
attack and damage TPO, which can lead to inflammation
and damage to the thyroid gland. It is used to diagnose
autoimmune thyroid disorders, such as Hashimoto's
thyroiditis and Graves' disease.

Thyroglobulin antibodies (TgAb)

are antibodies that attack thyroglobulin, a protein
produced by the thyroid gland that is involved in the
production of thyroid hormones. Levels evaluate thyroid
function and diagnose autoimmune thyroid disorders, such
as Hashimoto's thyroiditis and Graves' disease.

Fasting Insulin
measures the level of insulin in the bloodstream after a
period of fasting, usually for 8-12 hours. Measuring
levels is useful in the diagnosis and management of
diabetes, PCOS, and insulin resistance.

Hemoglobin A1C
measures average blood sugar levels over the past 2-3
months. It is used to monitor and diagnose diabetes and
can provide valuable information about long-term blood
sugar control.

Ferritin
is a protein that helps store iron in the body.
Measuring ferritin levels in the blood is useful in the
diagnosis and management of conditions related to iron
metabolism, such as iron deficiency anemia and
hemochromatosis, leading to fatigue, weakness, and other
symptoms.

©2023 Mila Mend. All rights reserved. Chapter II | 13

 The science behind each marker
Vitamin D
is essential for many important functions in the body,
including bone health and immune function. Vitamin D
deficiency has been linked to insulin resistance, and
has been shown to have a role in regulating the
production and secretion of thyroid hormones.

Vitamin B12
is a vitamin that is important for nervous system
function and the production of red blood cells.
Vitamin B12 deficiency can lead to various health
problems, including anemia, fatigue, weakness, and
neurological problems such as numbness and tingling in
the hands and feet.

Magnesium
is an essential mineral that is involved in a wide
range of biological processes in the body, including
energy production, protein synthesis, and muscle and
nerve function. Magnesium deficiency can include muscle
weakness and cramps, fatigue, and mood changes.

Melatonin
is a hormone that helps regulate sleep-wake cycles.
Measuring levels of melatonin may help diagnose sleep
disorders. There is also evidence to suggest that
melatonin may play a role in the regulation of other
hormones, such as cortisol and growth hormone.

©2023 Mila Mend. All rights reserved. Chapter II | 14

 The problem with “normal”

I got my results back, but they are "normal"

Normal lab reference ranges, used to assess our health, can
be problematic for us with symptoms because they're based on
averages and may not fit everyone.

These ranges may miss early health issues, not consider our
individual differences, and not address our personal health
goals.

Also, the averages used to establish normal lab reference

ranges are derived from testing a broad population, but this
population might not necessarily represent the epitome of
health.

The Standard Reference Range

2.5% 95% of the TESTED population will fall in here 2.5%

abnormal
low “Normal” Abnormal
high

If you fall in this range, you are considered to be

healthy regardless of your symptoms.

This means that the reference ranges can encompass a wide

range of health statuses, including some individuals who may
not be entirely healthy.

As a result, the "normal" range is essentially a statistical

snapshot of the tested population and may not necessarily
reflect what is optimal or ideal for an individual's health.

©2023 Mila Mend. All rights reserved. Chapter III | 16

 The problem with “normal”

On the other hand, optimal lab testing is a true

representation of health.

It can offer a more accurate reflection of where you

stand and can help explain any symptoms you may be
experiencing.

The Functional “Optimal” Range

We are able to know much more about your health
looking at where you fall within the “normal” range.

Abnormal Functional Abnormal

functionally functionally
low low
Physiological high high
Range

We know that small imbalances in hormone levels can

have a significant impact on an our health and
wellbeing. Therefore, it's essential to have optimal
lab testing to ensure that hormone levels are within
the range that is best for our individual needs.

Furthermore, ideal hormone levels can vary depending

on factors such as our age, gender, genetics, and
lifestyle.

By further customizing our healthcare approach, we can

aim for optimal health and wellness that goes beyond
what might be considered "normal." This tailored
approach provides a clearer understanding of our
health status and how to address any issues we face.

©2023 Mila Mend. All rights reserved. Chapter III | 15

 Let’s take a closer look

The Functional Optimal Range

still in the still in the normal

normal range but peak performance range but on the
on the low end scores higher side

room room
very very
low to optimal to high
low high
improve improve
slightly below slightly above
speak to your speak to your
peak performance peak performance
doctor ASAP doctor ASAP
levels levels

Sometimes, health conditions can manifest with mild or

early symptoms, even when standard lab results appear
normal.

Detecting these subtle deviations from the optimal

range early on, before they extend beyond the "normal"
reference range, empowers you to take timely action and
prevent the worsening of potential health problems.

Hormonal imbalances, a common concern among women, can

give rise to various symptoms. Optimal hormone testing
takes into account your specific hormonal requirements
and has the potential to identify imbalances that
conventional testing may overlook.

By addressing these subtle imbalances and optimizing

your health markers, optimal lab testing not only helps
you feel your best but also plays a role in preventing
diseases. This proactive approach can significantly
contribute to an enhanced quality of life.

©2023 Mila Mend. All rights reserved. Chapter III | 17

 Optimal reference ranges

STANDARD REFERENCE OPTIMAL

TEST
RANGE REFERENCE RANGE

TSH 0.45-4.12 mlU/L 0.5-2.5 mlU/L

T3 2.8-4.0 mlU/L 2.8-4.0 mlU/L

T4 0.93-1.70 mlU/L 1-1.70 mlU/L

FREE T3 3 -7 pmol/L 5 - 7 pmol/L

FREE T4 9 - 23 pmol/L 15 - 23 pmol/L

REVERSE T3 8-25 ng/dl < 15 ng/dl

ANTI- TPO <35 IU/mL <2 IU/mL

ANTI- TG <35 IU/mL <2 IU/mL

VITAMIN D 30-100 ng/mL 50-80 ng/mL

FASTING GLUCOSE 70 – 125 mg/dL 70- 85 mg/dL

FASTING INSULIN 2.6-24.9 mcIU/ml 4.6 – 5.5 mcIU/ml

HGBA1C Under 5.7 4.6-5.5

©2023 Mila Mend. All rights reserved. Chapter III | 18

 Advocating for yourself

My doctor won't order my labs:

If your doctor refuses to test you, then please

consider switching doctors.
Your care team is part of your health success.
If you are unable to switch doctors, ask them to write
down in your chart they refused to test your
hormones... they hate that and will usually go ahead
and order them.

Here is a link to a letter you can send to your

stubborn doctor, made by Dr. Iszabella Wentz.

How can I find a Doctor who works with

these ranges and aims for optimal health?

Finding a doctor who uses optimal lab testing may

take some research and effort, but there are a few
strategies you can use to increase your chances of
finding one:

Here is an incredible international database of

functional doctors.

I also highly recommend Lark Swofford, who has guided

me in optimizing my labs.
Here is the link for booking a consultation with
her.

©2023 Mila Mend. All rights reserved. Chapter IV | 19

 My experience
Since I first began experiencing symptoms of hormonal
imbalance, I've consulted more than 20 medical
professionals, including specialists, OBGYNs,
endocrinologists, naturopaths, generalists, internists,
gastroenterologists, ENTs, neurologists, and more.

Despite numerous visits, my lab results consistently came

back as "normal," and I was repeatedly prescribed birth
control pills, spironolactone, metformin,
antidepressants, and ADHD medication to alleviate my
symptoms.

Some doctors even attributed my issues to genetics or

suggested that my symptoms were imaginary. This left me
feeling utterly helpless and defeated.

However, after enduring six long years of worsening

symptoms, I finally took matters into my own hands and
insisted on thorough testing.

That appointment, where I stood up for myself despite my

discomfort with confrontation, turned out to be an act of
self-care. Ultimately, after years of being told that my
blood work was normal and that nothing was wrong, I
received a diagnosis of hypothyroidism and polycystic
ovarian syndrome.

Remember that you are your own best advocate.

You’ve got this, and I’m rooting for you.

All my love,

©2023 Mila Mend. All rights reserved. conclusion | 20

 Medical Disclaimer
Information provided in this document is for
informational purposes only and are not intended
to diagnose, treat, cure, or prevent any disease.

This information is NOT intended as a substitute

for the advice provided by your physician or
other healthcare professional.

Do not use the information provided in this

document for diagnosing or treating a health
problem or disease, or prescribing medication or
other treatment.

If you have or suspect that you have a medical

problem, contact your health care provider
promptly. Do not disregard professional medical
advice or delay in seeking professional advice
because of something you have read in this
document.

©2023 Mila Mend. All rights reserved. conclusion | 21