Assessment of the hormonal milieu

The hormonal milieu has been hypothesized to play a role in a range of human diseases, and therefore has been a topic of much epidemiologic investigation. Hormones of particular interest include: sex steroids; growth hormones; insulin-like growth factors; stress hormones, such as cortisol; and hormones produced by the adipose tissue, termed adipokines. Depending on the hormone, levels may be measured in plasma or serum, urine, saliva, tissue, or by assessing genetic variation in the hormone or hormone metabolizing genes. Sample collection, processing, and storage requirements vary according to the type of sample collected (e.g. blood or urine) and the hormone of interest. Laboratory analysis of hormones is frequently complex, and the technology used to conduct the assays is constantly evolving. For example, direct or indirect radioimmunoassay, bioassay or mass spectrometry can be used to measure sex steroids, each having advantages and disadvantages. Careful attention to laboratory issues, including close collaboration with laboratory colleagues and ongoing quality control assessments, is critical. Whether a single hormone measurement, as is frequently collected in epidemiologic studies, is sufficient to characterize the hormonal environment of interest (e.g. long-term adult hormone exposure) is also an important issue. While the assessment of hormones in epidemiologic studies is complex, these efforts have, and will continue to, add importantly to our knowledge of the role of hormones in human health.