Additional DUTCH and Hormone Wisdom (R.2) · transdermal progesterone. These testing methods are...
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www.schoolAFM.com ◄ 1 Additional DUTCH and Hormone Pearls (R.2) Follow-Up Q&A from Dr. Carrie Jones and Additional Pearls re: DUTCH Testing Hormones are powerful, interactive, and tend to fluctuate in the body – within a given day based on the body’s natural rhythms but also our diversity of experiences. It’s important to always remember that hormone testing is only one puzzle piece, and no type of hormone testing is fully comprehensive for showcasing the level and effect of hormones in the body. Be careful not to make mistake of over-relying on test data in your assessment of what is at play with a unique individual. At a bare minimum, we recommend you review ALL of these videos carefully – as well as the posted DUTCH bonus webinar – before attempting to assess any DUTCH data, including your own. These are likely best reviewed after completing the entire Deep Dive clinical course. • Overall introduction: https://dutchtest.com/video/introduction/ • Comparing types of hormone testing: https://dutchtest.com/video/1-hormone-tutorial-introduction/ • Specifics about adrenal hormones: https://dutchtest.com/video/2-testing-adrenal-hormones-with-dutch/ • Overall tour of a DUTCH data report: https://dutchtest.com/video/dutch-complete-overview-2 / Follow-on Q&A with Dr. Carrie Jones and further exploration of the innate limitations of various types of hormone testing reveals some key pearls for you to consider: • Urinary and salivary free cortisol levels are comparable in accuracy, but with the latter, (1) you lose the ability to distinguish between free cortisol and total metabolized cortisol and (2) you don’t have the ability to understand the coincident cortisol and cortisone levels (to gauge how the body is using – or not using! - this protective conversion). • Neither urine, nor serum, no saliva samples can be used to effectively monitor via testing the effect of transdermal progesterone. These testing methods are not reflective of tissue levels (e.g. urine underestimates tissue levels and oral progesterone supplementation will not increase serum progesterone levels because metabolites are what is being increased). The last page of this file includes a chart from Precision Analytical that summarizes the efficacy of various testing methods for monitoring various types of hormone supplementation therapy. • There can be a dramatic difference between DHEA and DHEA-S because the sulfation cycle is either overloaded or blocked (e.g. nutrient insufficiency) or due to increased inflammation (which impairs sulfation). Thus measuring DHEA-S on its own can be misleading. High inflammation may also drive the production of higher levels of cortisol as a protective mechanism to balance the inflammation with the immunosuppressive effects of high cortisol. • Obesity will often drive low levels of free cortisol yet very high levels of total metabolized cortisol. Fat tissue is endocrine tissue! And body fat will store and metabolize cortisol – stimulating the adrenals to keep churning out production at a high level. • In hypothyroid individuals, total metabolized cortisol tends to be lower while free cortisol is higher. This reflects poor cortisol clearance. • 5a-pregnanediol is the metabolite of oral progesterone that can promote sleep. Our natural metabolic balance between 5a and 5b can vary. • Testosterone can be falsely low due to impaired glucuronidation clearance (UGT – also bilirubin may be elevated re: Gilbert’s). This may also lead 5a-DHT to be falsely low. Look at Epi-testosterone (which doesn’t use this pathway). Sulfation is the other pathway used for clearance. Use Total and Free Testosterone blood test to confirm levels. • Use of 5-HTP or tryptophan supplements (especially for sleep) can dramatically increase melatonin levels and render this marker unusable relative to the published reference range.
Transcript of Additional DUTCH and Hormone Wisdom (R.2) · transdermal progesterone. These testing methods are...
www.schoolAFM.com ◄ 1
Additional DUTCH and Hormone Pearls (R.2)
Follow-Up Q&A from Dr. Carrie Jones and Additional Pearls re: DUTCH Testing Hormones are powerful, interactive, and tend to fluctuate in the body – within a given day based on the body’s natural rhythms but also our diversity of experiences. It’s important to always remember that hormone testing is only one puzzle piece, and no type of hormone testing is fully comprehensive for showcasing the level and effect of hormones in the body. Be careful not to make mistake of over-relying on test data in your assessment of what is at play with a unique individual.
At a bare minimum, we recommend you review ALL of these videos carefully – as well as the posted DUTCH bonus webinar – before attempting to assess any DUTCH data, including your own. These are likely best reviewed after completing the entire Deep Dive clinical course.
• Overall introduction: https://dutchtest.com/video/introduction/ • Comparing types of hormone testing: https://dutchtest.com/video/1-hormone-tutorial-introduction/ • Specifics about adrenal hormones: https://dutchtest.com/video/2-testing-adrenal-hormones-with-dutch/ • Overall tour of a DUTCH data report: https://dutchtest.com/video/dutch-complete-overview-2 /
Follow-on Q&A with Dr. Carrie Jones and further exploration of the innate limitations of various types of hormone testing reveals some key pearls for you to consider:
• Urinary and salivary free cortisol levels are comparable in accuracy, but with the latter, (1) you lose the ability to distinguish between free cortisol and total metabolized cortisol and (2) you don’t have the ability to understand the coincident cortisol and cortisone levels (to gauge how the body is using – or not using! - this protective conversion).
• Neither urine, nor serum, no saliva samples can be used to effectively monitor via testing the effect of transdermal progesterone. These testing methods are not reflective of tissue levels (e.g. urine underestimates tissue levels and oral progesterone supplementation will not increase serum progesterone levels because metabolites are what is being increased). The last page of this file includes a chart from Precision Analytical that summarizes the efficacy of various testing methods for monitoring various types of hormone supplementation therapy.
• There can be a dramatic difference between DHEA and DHEA-S because the sulfation cycle is either overloaded or blocked (e.g. nutrient insufficiency) or due to increased inflammation (which impairs sulfation). Thus measuring DHEA-S on its own can be misleading. High inflammation may also drive the production of higher levels of cortisol as a protective mechanism to balance the inflammation with the immunosuppressive effects of high cortisol.
• Obesity will often drive low levels of free cortisol yet very high levels of total metabolized cortisol. Fat tissue is endocrine tissue! And body fat will store and metabolize cortisol – stimulating the adrenals to keep churning out production at a high level.
• In hypothyroid individuals, total metabolized cortisol tends to be lower while free cortisol is higher. This reflects poor cortisol clearance.
• 5a-pregnanediol is the metabolite of oral progesterone that can promote sleep. Our natural metabolic balance between 5a and 5b can vary.
• Testosterone can be falsely low due to impaired glucuronidation clearance (UGT – also bilirubin may be elevated re: Gilbert’s). This may also lead 5a-DHT to be falsely low. Look at Epi-testosterone (which doesn’t use this pathway). Sulfation is the other pathway used for clearance. Use Total and Free Testosterone blood test to confirm levels.
• Use of 5-HTP or tryptophan supplements (especially for sleep) can dramatically increase melatonin levels and render this marker unusable relative to the published reference range.
www.schoolAFM.com ◄ 2
A special note for perimenopausal women or others with irregular menstrual cycles. Indeed, for these women it can be challenging to pinpoint the exact right date for sample collection (ideally, the luteal peak). We recommend you experience this video first: https://dutchtest.com/video/irregular-cycle-collection/ . Then, there are perhaps three choices to discuss and consider with your patient:
1. You may just do the best you can to estimate and count and aim for the mid-luteal point (day 19-21). This target is based on a 26-28 day cycle. Of course, the risk is that your timing is off, and your data may not be as applicable as you wish.
2. You may also take your morning basal body temperature each day and wait to see the typical
ovulatory temperature jump - and then count forward about 6 days. This is a small but noticeable temperature jump and might give some confidence to the timing. This choice assumes ovulation is still happening - and is also appropriate for women who've had an ablation but who are still cycling.
3. You may also use an ovulation predictor kit which measures luteinizing hormone and is an even more
reliable marker that ovulation has taken place. These are available at pretty much any drugstore (and are commonly used by women in their fertility quest or to assist in natural birth control). Again, this choice assumes ovulation is still happening (appropriate for post-ablation too).
