Endocrine Abstracts

Hormones are key regulators of numerous physiological processes. While most hormones are produced in select organs, their effects are felt throughout the body. Hormonal exposure is not only mediated by hormone production, but also by circulating binding proteins, and by local metabolism. Although we still heavily rely on total serum levels for the diagnosis of endocrine disorders and abnormalities, it is increasingly clear that total serum hormone levels do not always accurately reflect true exposure. Patients with binding protein defects presenting with low total hormone levels - but no profound clinical features - are a key example of this. Free serum hormone levels, the minor fractions of circulating non-protein bound (steroid) hormones, are recognized as superior markers of hormonal exposure and are increasingly used in the clinic. For example, using free testosterone is now recommended in the diagnosis of male hypogonadism and female hyperandrogenism. However, free serum hormone levels are mostly estimated using calculators, as access to direct measurements is limited because it is technically demanding and laborious. Also, alternative measurements in different matrices such as saliva and hair are being explored. Advantages of these measurements include more accurate reflections of hormonal exposure, over longer periods of time, minimizing patient discomfort, and the ability to collect samples ambulatory. Despite recent advances, further insight is necessary for a broader adaption of these new markers. In the BEED-ED project, we want to improve the clinical applicability of free steroid hormone concentrations in patients with specific conditions. As the number of available tests increases, so too does the need to educate both healthcare providers and patients. Increasing public awareness about the importance, implication and interpretation of these new measures of hormonal exposure is key to advancing both the immediate care for patients and the utility of these novel estimates of hormonal exposure.