January RX: the bloodwork and tests I do annually
Your cheat sheet to blood testing for women's health
This post will be different in that I’m going to recommend only one thing: my protocol for testing all the relevant biomarkers for women’s health.
Before you proceed: please note that I am not a medical professional and this is for information purposes only. Many of these recommendations might not apply to you, so always discuss with your physician to decide what’s best for your unique needs. My hope is that this guide will help you figure out where to start and help you advocate for yourself if you are being dismissed by a medical provider.
In my late 20s I started to experience bothersome symptoms like debilitating PMS, gut issues, skin problems, uterine polyps and more frequent episodes of depression and anxiety. I was very fortunate to stumble upon Parsley Health who had opened just around the time I moved to NYC, and was among the first to sign up. I will always remember my first appointment where my Parsley doctor spent one hour (the average medical visit in the US is less than 20 minutes) going over my whole health history and then sending me off with a long list of tests to do.
I became diligent about regular bloodwork (twice a year, sometimes quarterly) and tracking my results in a spreadsheet. You can use my template here.
The Parsley doctors, however, are an exception. Many physicians will try to dissuade you from extensive testing because a) it’s expensive, b) the medical establishment has an aversion to “incidental findings”, c) if you’re a woman, your symptoms might not be taken seriously. I’m not the only one among my female friends to have been told by a provider that PMS or debilitating menopause symptoms are “normal” and that you just need to suck it up. And here’s the thing: many people believe that feeling “blah” on a daily basis is normal, especially as we age. But living with pain, persistent symptoms, or lacking energy and vitality is not normal. Everyone deserves to be in good health for as long as possible.
Health testing is expensive and you definitely don’t need every test under the sun. But given that in the US nearly half of the population lives with a chronic condition, the benefits of getting a baseline of your health and tracking your progress every year far outweigh the risks. The first step is to find a primary care physician who will order a baseline set of blood tests annually and who will interpret them for you. Based on your health insurance, you should not have to pay for these out-of-pocket. If you don’t have a primary care physician, or insurance, you can purchase these tests here or here.
Start here
CBC - Red and white blood cell counts
Comprehensive Metabolic Panel to assess kidney and liver health (including GGTP, AST, ALT, Albumin and electrolytes)
Comprehensive Lipid Panel (Total cholesterol, LDL, HDL, Triglycerides) and importantly, Apo-B and Lpa.
Inflammation markers (hsCRP, ESR, Homocysteine)
Micronutrients including: Vitamin D3 (as Vitamin D, 0H-25) Vitamin B12, Folate, Magnesium, Selenium, Zinc, Copper, Ferritin, Iron
Blood sugar markers (Fasting glucose, Fasting insulin, Hemoglobin A1C)
Full thyroid panel including THS, Free T3, Free T4, and Thyroid autoimmune antibodies (TPO)
Metals (toxicity): Mercury, Lead
Sex hormones: Free and Total Testosterone, DHEA-S, Estrogen and Estrogen metabolites, Progesterone, LH
Routine Urinalysis
Hormone health
If you experience any symptoms of hormone imbalances (PMS, heavy or irregular periods, spotting, acne, hair loss, excess hair on your face, hot flashes, and others), a more comprehensive hormone test could be very useful. I highly recommend the DUTCH test which I’ve done a couple of times to identify the cause of my symptoms. This is a dry urine test, you need a provider to order it for you and it costs $400 out-of-—pocket. It’s an expensive test, but it can help you identify many hormone imbalances related to PCOS, infertility and more. Depending on your situation, you might not need this every year, or at all.
If you are going to test hormones with just a blood draw, note that Estradiol and FSH should be tested on day 3 of the menstrual cycle, and progesterone usually days 19-22 (assuming an average 28-day cycle). This is a great in-depth guide for testing hormones.
Cancer screening
Even though new guidelines recommend women to have a PAP smear every 3 years, I prefer to do mine annually. This choice is influenced in part by previous results, but it also reflects my strong bias toward prevention. At a very minimum, make sure to adhere to the cervical cancer screening guidelines.
If you’re over 40, you can start having a mammogram every year. Decades of research have demonstrated that regular mammograms are the most effective way to ensure early detection for breast cancer. You can book your free mammogram here.
If you have a family history of breast cancer, taking a genetic test to see whether you carry the BRCA gene mutation is also important. I took the Color test and highly recommend it. It analyzes over 30 genes to identify variants associated with breast, colorectal, melanoma, ovarian, pancreatic, stomach, or uterine cancers. The Color test costs $249.00 and you only need to do this test once.
I also encourage you to take this free, 5-minute cancer risk quiz to assess your personal risk for various types of cancer. The best cure for cancer is early detection and Ezra can find cancer and over 500 other conditions in up to 13 organs. Even if Ezra had not been started by my husband, Emi, I would still do my scan every year because of the immense peace of mind it gives me and my family. You can get a full-body scan for $1350 and Ezra are working toward a 15-minute scan priced at $500.
Other tests
Two other tests I do yearly are a DEXA scan and a VO2 max assessment. The DEXA scan measures bone density (which is very important for women, especially as we age) and body composition (lean muscle and fat mass). The one metric I pay most attention to is visceral fat (the fat that wraps around your abdominal organs). You can have a normal weight and even look lean, but still have visceral fat which increases your risk for developing high blood pressure, heart disease, diabetes and some cancers. If you’re in NYC, you can do a DEXA scan here.
As for VO2 max, this test measures the maximal oxygen you can consume during exercise. Cardiorespiratory fitness has been shown to be a strong predictor of all-cause and disease-specific mortality. In plain English, having the highest VO2 max you can for your age group is essential for longevity. In NYC, you can do a VO2 max assessment here.
Most direct-to-consumer and at-home test kits that you see promoted on social media are scams. But there are some trustworthy, evidence-backed tests that if you have the financial means and curiosity to try, I think you can gain some interesting insights from. One such test is 3X4 Genetics which looks at how your individual gene SNPs influence many functions such as inflammation, metabolism, detoxification and more. Doing this test was useful in helping me adjust certain lifestyle behaviors, particularly around nutrition, supplementation and training.
If you struggle with unexplained digestive issues, GI Effects by Geneva Diagnostics can be useful. This is a test that has helped me identify problems stemming from dysbiosis and maldigestion. Similarly to the DUTCH test, you’ll need a provider to order this for you and it will cost around $400 out-of-pocket. Please note that there are probably more affordable (albeit not as comprehensive) ways to asess gut health. Both GI Effects and 3X4 are tests I only did once.
Other routine tests I do include a yearly full-body skin check with my dermatologist, a yearly eye exam, and one teeth cleaning every six months.
If you have questions about any of this, feel free to email me at sabina@kahla.com.