You’ve seen on page one the total of the estrogens and then the progesterone is a serum equivalent for female patients so as we dig in to page three we can see the detailed breakdown of all these hormones so starting with progesterone we can see there are two primary metabolites here so the reason there’s no number listed here for progesterone is because again it’s
Not in urine it has to get turned into these other metabolites before you see it in urine so these metabolites have been shown both by us and in research studies that to correlate really well with serum progesterone each one of them represents about half of the progesterone that’s produced so we measure beta pregnant dial and alpha pregnant dial so if the beta
Pregnant dial is on the higher side and the alpha is on the lower side then we’re plotting here for progesterone basically a weighted average of the two and then again we can extrapolate a serum equivalent for that that you see on the summary page for female patients now we want to look at these numbers relative to of course the reference range so if we’re looking
At a female patient that is in the pre menopausal phase of life and is collecting this in the luteal phase that’s that latter third of the cycle day 1920-21 we should expect to see her if there’s good strong ovulation and progesterone production we should see you’re up between these two stars so a good strong progesterone will put a woman up in this upper part of
The range so we can evaluate that and as we get then to women who are not cycling say they’re on birth control or they’re past the menopausal phase so they’re postmenopausal then we expect to see their levels not up in here because they’re not ovulating we expect to see them down in this little purple band once they’re in that phase of life because again they’re
Not ovulating and what’s left is really just residual progesterone that’s being made not by the ovaries but primarily from the adrenal glands so we want to look at those values the two different values but really just the overall values that we’re looking at and keeping in mind when you start supplementing with progesterone then the interpretation can change a
Little bit particularly if you’re taking oral or sublingual progesterone i would encourage you to watch the specific videos to those situations because it does change the interpretation quite a bit as we move on to the estrogens we can see that we have a lot of estrogens here we have e1 e2 e3 those we consider the primary estrogens but especially estradiol that’s
The most potent estrogen then we have the three phase one metabolites two hydroxy e 1 4 hydroxy e1 and 16 hydroxy e1 and then we’ve got the methylated product 2 methoxy e1 so we want to consider first what are our overall levels of estrogen so we can look at that total on page one and we can also look at these individual estrogens and see how that breaks down and
Look at that relative to again the reference range so the pre menopausal range is up higher that’s where we expect to find women who are menstruating when they’re collecting in that luteal phase that latter third of the cycle we expect to find them in this range so if they end up a bit lower say the estradiol is at one point six one point five one point three those
Levels would be considered a modest efficiency for those estrogens when we get down into that little purple band now we’re talking about levels that are expected for postmenopausal women so if a woman is 65 and not cycling anymore and not supplementing that’s where we expect to find her however if a pre menopausal woman who’s not on birth control and collects at
The right time of the cycle if she finds herself in this range then the ovaries are really not making the hormones that we expect them to at this phase so we want to look at those levels each of them as they compared to the reference range for e1 for e2 for e3 and then now we move on to the downstream metabolism how is that phase 1 metabolism going so what we can
Do here is look at the absolute values again as they compared to the reference ranges but we can also look at this pie chart to look at the different ratios so the ratios that we typically see for these 3 is a 70% 10% and 20% distribution the 16 hydroxy is a more potent estrogen so if that one’s predominating we may see things like estrogen dominance but we also
Want to put that in the context of the overall results so we’re looking at the distribution if you or distribution is significantly lower than 70% then you can do things to address that oftentimes providers will use things like dim i 3c dim stands for dye indle methane i 3c is indole-3 carbinol that’s something that’s in cruciferous vegetables that’s been shown to
Increase to hydroxylation and it can improve those ratios if they’re way off and the two hydroxy is much less than 70% then we can improve those likewise we can also look at these metabolites relative to the primary metabolites so as an example if you have a woman whose estrogen dominant and those estrogens are high so we’re aster owns up around 30 and our estradiol
Is maybe at five six seven and our estriol is elevated and the two hydroxy estrogens are not elevated that would be a picture of that phase one metabolism really not clearing the way that it’s supposed to and again there are things that we can do to look at that so you can look at the relative distribution of these 3 metabolites but you can also look at the the total
Of those 3 just as it compares to the upstream metabolites to see if that phase 1 metabolism seems to be going the way that it’s supposed to as we move on to methylation which is a part of phase 2 metabolism we’re simply looking at the conversion of two hydroxy e12 to methoxy one that methylating step is thought to be protective as it relates to the estrogens but
It’s also very important elsewhere it helps you get rid of catecholamines and other compounds so it’s an important step as it relates to overall health what are we looking at here we’re simply looking at the ratio the average woman turns a two hydroxy of say 10 into a 2 methoxy of around 5 so it’s usually a two-to-one relationship there so we’re looking at that
Ratio and we’re gonna simply plot that as an index so if you’re a very good methylate er you’ll see this index up on the higher side whereas if the methylation is not very efficient it’s gonna be down on the bottom here and then you can start investigating whether that’s nutrient deficiency or maybe a genetic defect so people have been testing a lot recently with
Mthfr comt these are some of the genes that are actually involved in methylation and you can act test those for genetic defects and when we see people with those genetic defects you can definitely see an impact on the methylation so again we’re looking at the overall levels of the estrogens phase 1 metabolism and phase 2 metabolism or the methylation step we want
To look at those properly in terms of the context of the reference range the other thing that we want to be careful of and noting is as those levels get very low so let’s say a two hydroxy estrogen of 0.4 and a two methoxy of you know 0.2 0.3 we’re getting closer to the detection limit of the assay we want to look at those ratios as a little bit more approximate
Because the reproducibility of the assay is going to get a little bit worse as you approach the detection limit of the assay so look at those ratios a little bit more approximate as you get into the bottom part of the postmenopausal range with respect to the ratios so we want to look at the absolute levels and the metabolism and then we should be able to properly
Understand the overall picture of the estrogens and the progesterone for our patients
Transcribed from video
DUTCH Estrogen Tutorial By Precision Analytical
