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Fertility specialist Oluyemisi Famuyiwa discusses her KevinMD article, “The rise of at-home hormone tests: a double-edged sword for patients.” In this episode, Yemi explores the surge in popularity of at-home hormone testing kits and the complexities they introduce to patient health care. She highlights how these tests can lead to confusion, unnecessary stress, and harmful interventions due to the lack of medical oversight and the nuanced understanding required for hormone fluctuations and synthetic hormones. Yemi emphasizes the responsibility of testing companies to educate consumers about the limitations of their products and advocates for a focus on holistic wellness strategies such as stress reduction, adequate sleep, balanced nutrition, and seeking professional medical guidance. Listeners will gain insights into the potential pitfalls of at-home hormone tests and discover actionable strategies for achieving accurate hormone health monitoring and overall well-being.
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Oluyemisi Famuyiwa. She’s a fertility specialist, and today’s KevinMD article is “The rise of at-home hormone tests, a double-edged sword for patients.” Yemi, welcome back to the show.
Oluyemisi Famuyiwa: Hello, Kevin, nice to be here.
Kevin Pho: All right, so tell us what your latest article is about.
Oluyemisi Famuyiwa: All right, so my latest article is about trying to decipher the confusion that patients sometimes have when they use a lot of at-home testing. So it really came about because I had—I’ve had a run of patients who had different tests done, and then they don’t get any directions on what the tests mean, and then they come to you and they want a thorough explanation of what they should do with this test, what it means. I’m like, hang on a second. Who gave you this test? Who made this test? Maybe we need to go back to them first.
Kevin Pho: All right, so tell us the type of tests that you’re talking about.
Oluyemisi Famuyiwa: So, so there are some at-home monitoring things that are very, very useful—don’t get me wrong—such as the glucose continuous monitoring. That’s very good. I also recommend some ovulation apps for my patients. Those are good if used in conjunction with things like a urine LH surge, right? That’s a valid, tried-and-true test. But the one that got my attention was tests that are coming out measuring urine hormones or salivary hormones, and some of them will plot different graphs for patients and tell them, “Oh, your hormone looks like this, and it’s got this wave pattern, it’s got that wave pattern,” and that’s it. Now the patient’s saying, “Oh my gosh. What do I do? What does this mean? Does it mean I’m not going to get pregnant? I can’t respond?” They are confused. And the advice from some of these—not all of them—but some of these manufacturers is now, “Well, go to your doctor and let them explain it to you.”
Kevin Pho: So what are these hormone tests supposed to measure and predict? They’re marketing that if you monitor your hormone levels with a saliva or urinary test, that can predict potential periods of fertility. What are they trying to sell?
Oluyemisi Famuyiwa: They’re trying to sell periods of fertility. Or maybe they’ll say, “We’re doing a better LH surge measurement,” or indeed they’re saying, “Well, we have a better measure of your estradiol,” or, “We can tell if your progesterone level is within range.” The question is, within range of what? And the particular patient I had also had an IUD in place. So then, what are the standards that these tests are measured against? If you’re measuring the urine metabolites, not the blood level of the hormone itself—the metabolites—what table are you using to convert that into real data to say, “Oh, X amount of metabolite is equal to Y amount of blood level,” right? Do we have that standardized? And what happens to someone who’s already on a hormonal regimen? I had someone who was taking birth control pills and was also doing this at-home test and saying, “Well, you know, it’s not looking like the graph.” I’m like, well, hang on, you know you’re already on some hormonal manipulation, so when you test these things, it even throws more confusion into the issue. So I don’t think the directions are clear. And if they are, you are performing a test that may normally be done, say, in a lab, like LabCorp or Quest, with a physician who’s going to interpret it in light of where you are in your menstrual cycle. Now the patient has this test. It’s not necessarily standardized. They’re on hormonal treatment, or sometimes they may have different metabolic conditions going on, such as PCO, which also throws more confusion into the whole equation. And now they’re super confused, and they’re told, “Go to your doctor.”
Kevin Pho: So for these at-home tests, they don’t give any direction for the patient to interpret the results? There’s no color-coded chart? It’s simply, “Just see your doctor.”
Oluyemisi Famuyiwa: Right. Some of them may have color-coded charts, but let’s be clear. The patients using this are not medical people; they’re just the lay audience. So you draw a graph or a bar chart or a color code—what does it mean to them? What are they supposed to figure out? Now, fertility by itself is super anxiety-provoking. These patients are anxious; they’re going through a lot. So when they do this, it further drives up their anxiety level. They’ll come in fixated on some urine result and want you to say, “How does that tie in if I have a cyst?” And they’ll fixate on some of these things instead of saying, “OK, let’s step back a little. Let’s look at the whole picture. Let my doctor interpret what’s going on. Was it done in the luteal phase or in the follicular phase?” Let somebody who’s actually familiar with what these numbers should be order and interpret some of this. And if you’re going to market it and sell it to patients, then you need to also set up a virtual consultation where you can tell them what it is they’re measuring, how they can use it. And if you’re not, then are you really practicing medicine in an unregulated fashion? Because that’s what medicine is. That’s what you and I do, right? You order a test, you sit a patient down, and you try to make sense of that test. But now, the patient gets a test, and nobody’s making sense of it, and the conclusion is, “Go talk to your doctor,” right? So now, when you get blood tests that don’t match what they’re looking at, they’re further confused. So you need to make some head or tail of it for the patients. So I think that some of these tests may cause more confusion. I think they need to be standardized. They’re not all bad, but they need to be standardized, and if the patient’s going to use it, then let it be in conjunction with a physician, right? And some of these tests also—another thing I noticed—because they’re mostly out of pocket, they’re not covered by insurance, but when you look at what they’re measuring, I can get the same data more accurately from a blood test for a whole lot cheaper, right? You can send a blood lab to LabCorp or Quest, and they’ll charge you under ten dollars or under fifteen dollars for a test that some of these people are charging two hundred or three hundred. I saw one—I wouldn’t mention any names—that if a patient used it in the window that they’re supposed to do, they would be spending almost three to four hundred dollars every month that they use it. It doesn’t cost that much to do a blood test, if I need to—if I need to.
Kevin Pho: So it sounds like, especially with fertility and our hormones, there’s so much variability in terms of these cycles, so it’s very difficult to have these at-home tests that can measure something accurately with everything else—the variability that goes around it.
Oluyemisi Famuyiwa: Right, right. So, you know, hopefully we will—if they were standardized where I could say, “OK, if I get this much salivary result of this metabolite, I can directly correlate it to this much of the blood result and take X, Y, Z action,” right? But then, if I’m ordering it, I know exactly what time of the month I’m ordering it—is it in the menstrual phase, is it in the follicular phase, is it in the luteal phase? Then what am I going to do with the result? How am I going to use it? Am I using it to monitor response to treatment, or am I using it to check what their baseline is? I don’t think that that’s necessarily clear, and what that results in is almost punishment for the patient who’s already suffering from the agony of going through fertility.
Kevin Pho: Now, you’re speaking through the lens of, of course, a fertility specialist, and you practice in a metropolitan area. What about those patients who don’t have access to fertility specialists, and they live in a rural area, perhaps, and may not have a fertility specialist for hundreds of miles around them? Is there any utility for these at-home—like ballpark ranges? Is there any utility at all?
Oluyemisi Famuyiwa: Right, I think there is some utility there. I think that if you are going to use this test, I think you want to use it in conjunction with a physician, right? So, you know, you can use the test in different phases, but I want to be able to have a physician monitor whatever response is being watched, right?
Kevin Pho: Any red flags they should look out for to determine whether an at-home test is purely fraudulent? Is there anything that they should not purchase, or any warnings that they should look out for whenever they’re looking for a potential at-home test?
Oluyemisi Famuyiwa: The way I would look at it is, if I’m going to send—because I do have patients who are flying from Arizona or wherever—I think that the patient can be monitored again in conjunction with a physician. So yeah, you can send a patient to go get this test done out somewhere in rural, but you’re watching it, you’re looking at their response, you’re making head or tail of it. I think that would be the best way to use it.
Kevin Pho: And in terms of these hormone tests, are you seeing at-home tests in any other areas? Anything else that you’re seeing, perhaps other than hormones?
Oluyemisi Famuyiwa: I think that mostly for fertility purposes is where I see it the most. But if it’s not being standardized correctly, I think the manufacturers need to give a disclaimer. They need to give a disclaimer to the public using it and say, “OK, if you want to use this test, you have to say what the limitations are. What are the limitations of the test?” I think that patients need to be aware of the limitations of that; otherwise, you’ll be practicing unregulated medicine.
Kevin Pho: So you mentioned the cost earlier, so just give me a sense of how much these tests cost whenever patients choose to purchase them.
Oluyemisi Famuyiwa: Right. The one I looked at, I think it cost about three hundred dollars per cycle, and what they were measuring, if I ordered a blood test—or I think this particular one looked at LH released during ovulation—the urinary ovulation kit is a fairly useful test to get, but if you’re going to check it in some of these other kits, you would be spending up to two, three, five hundred. I wonder if it’s worth it to do that.
Kevin Pho: We are talking to Yemi Famuyiwa. She’s a fertility specialist, and today’s KevinMD article is “The rise of at-home hormone tests, a double-edged sword for patients.” Yemi, let’s end again with some take-home messages that you want to leave with the KevinMD audience.
Oluyemisi Famuyiwa: I think my take-home message for most people would be not to over perseverate on these hormone tests. Understand that it has some limitations, read carefully, and if you’re in doubt, check with your doctor instead of getting one test or the other or the other. It leads to massive confusion, and that confusion can further drive up people’s cortisol levels, which also drives up their anxiety and everything, and it’s not a good thing for patients.
Kevin Pho: Yemi, as always, thank you so much for sharing your perspective and insight, and thanks again for coming back on the show.
Oluyemisi Famuyiwa: Thank you very much.
