#339 Urine Hormone Testing Reveals Information to Guide Women to Health with Dr. Jaclyn Smeaton

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Hi, and welcome to How Humans Heal. I'm Dr. Doni Wilson. In today's episode, I'm going to be talking with Dr. Jacqueline Smeaton about testing for hormones, women's hormones, with urine testing. Jacqueline— Dr. Jacqueline Smeaton is the Chief Medical Officer for Precision Analytical, and she is a naturopathic physician specializing in fertility, reproductive health, and genital urinary health in general. She's been in practice for over 20 years. And so I'm so glad you're here with us today, Jacqueline. Thank you for joining me.

Thanks for having me, Dr. Doni. It's great to see you and great to be here.

Oh my gosh. I mean, and it just brings back— you and I have been knowing about each other over the decades. And I feel like we're in this parallel path of helping in women's health and transforming women's health. And so I'm really excited for you to be in this position as Chief Medical Officer at Precision Analytical because Precision Analytical offers urine hormone testing that really changed things for us as naturopathic doctors. Because a couple decades ago when we first trained as naturopathic doctors, that wasn't available. We had to do a lot of work looking at symptoms and menstrual cycles and temperatures, and we still do that. But now we can also use urine hormone testing which a woman can do at home to finally get a lot more information than we can get from blood work about what's happening with estrogen, progesterone, testosterone, DHEA. And we're gonna talk about all of that today because—

Yes.

I feel like I want all women to know that this testing is available. And for those women who already know it is available, I want them to understand all the different ways it could help. Whether you're still having your menstrual cycle, maybe you're having menstrual-related symptoms like PMS or painful cramps, Maybe you're working on fertility and how this could help you with fertility. And then maybe you're perimenopausal or even postmenopausal, or maybe using hormone replacement therapy, and how could this testing help you in that part of your life? So it's really— what would you say? I mean, just as an opening up about urine hormone testing, like, is that what you find? Is that this is a test that just opens all kinds of information and avenues for women's health?

It absolutely is. And I think, you know, we— it's colloquially called the DUTCH test, and that stands for dried urine test for comprehensive hormones. And really, that comprehensive piece is so critically important when we look at hormones. And there's a couple areas where I think that that expanded comprehensive look really makes a difference. The first is what hormones we look at. So, um, it looks at estrogen and progesterone, which we think about typically for a woman's reproductive system, but then it also looks at metabolites of those hormones. It looks at androgens and their metabolites, and then it looks at cortisol in the HPA axis and their metabolites. And really, when we're looking at hormones, you can't just single one out because you have to get the complete story. So that's one thing is what hormone systems it looks at. But the second piece is looking at metabolites. And I think the easiest way I'd explain this at a 50-foot level, and we can get into it more, is that when we look at hormones, we tend to focus on the hormones made by a gland. So it would be like estrogen made by the ovary, estradiol made by the ovary. But if estradiol is off or you're having symptoms of high or low estradiol, sometimes the issue is upstream at the brain, which is why we look at LH and FSH, like in blood work. And sometimes the issue is actually down at the tissue where you make the right amount of estrogen, but then when it reaches your tissue, which is where it has activity, there's a problem with how your tissue uses the hormones. And that's what we really can see when we look at metabolites. So you're looking at a whole system across brain, organ, and tissue. And you're looking at a wider array of hormones when you're looking at a Dutch test. And that's really the reason why I think it's so informational for people.

Such a good point. And so just to be clear, because so many women will say to me, well, can't I just do this blood work under my insurance to check estrogen or progesterone? And I want to hear your answer to that. How do you answer that for women?

So I think, yes, it's always a great place to start with serum testing. I do that too in my practice. So this is oftentimes not meant to just replace that or add an out-of-pocket cost to the blood testing. But I think as a clinician, I'm sure you've seen this too, there's a lot of times where you run labs and you're like, wow, this looks really normal, but the patient's obviously not feeling normal. And there's a lot of other explanations for that. The gland can be making enough hormone. This is like thyroid. Cortisol. Like, you could name so many different examples of this where when you look at blood work, it actually is in the normal range, but the patient's not feeling good. And so the Dutch test adds that added layer to go a level deeper to really better understand what's happening with that hormone. Because measuring in blood is just telling you how much is made. It's not telling you how it's used by the body. And oftentimes that's where our problem comes up, is you're not metabolizing it or excreting it properly.

And that's the key, is to understand Where we're testing it. So if you're measuring— if you have your blood drawn, you're also getting it right at the time the blood is drawn, and you're, you're getting just what's floating through your bloodstream. Whereas when we do this urine testing, we can see— so we can see hormone levels in the urine, and we can also see the metabolites, and we can piece together the puzzle to say, oh, this is how you're— how it's not just in your bloodstream, but how your body is metabolizing it and making its way through.

And Absolutely right. And actually, you're making me think of another really important point that I'm glad you raised, which is when you do a blood test, it's a single snapshot in time. So whatever you're measuring in your blood— this is the same with saliva— it is a single snapshot. So a lot of hormones— we think about hormones in a menstrual cycle undergoing a lot of change, like estrogen. If you look at the normal range for estradiol, it's so big on a blood test because there's times where it should be low and times where it should be high. And the reference range is so big that most providers don't know what to do with that on any given day. Now, when we look at a Dutch test, it's 4 time points in 1 day. So rather than a snapshot, you're getting all of the hormone made during the course of that day, which also helps to capture the highs and lows that happen within a day. Because believe it or not, like progesterone as an example, it's a 20 to 30% variation across the course of a day. Testosterone is similar for men. So you might have— when you do a blood test, you don't know if you're catching the average for the day or the low or the high. And then we make clinical decisions based upon that when it might not represent what's happening over the whole day. So 4 time points in 24 hours, which is easy because we're doing it at home— can you imagine doing 4 blood draws in a day? It allows us to really see what's being made over the course of a day and get a more accurate assessment.

So in terms of the collection, which I've collected this for myself many times because I, I submit for myself, um, tests for the DUTCH Panel and have found it to be— you know, I always do that as a clinician, by the way. Whenever I come across a test, I'm like, let me do this on myself so I can see and understand what the patient's going through. And so when we— the reason it's called, as you said, a Dutch test is because it's a dried urine, meaning you pee on this little strip of paper or you pee in a cup and dip the strip in the urine and then you let it dry before you send it to the lab. So how does that work? What, like, when that means that hormones, when you pee on a strip and you let it dry, they can survive on there and then—

Yeah.

Even if a week or two goes by, the lab can still measure it.

Yeah, it's pretty amazing. So with the saliva, we want to freeze it between collection and shipping. If it's not happening right away, we recommend you freeze it before you send. But that's one thing that's so nice about the dried urine collection compared to liquid urine tests, which there's ones in the market that look at urine, but you have to collect liquid urine, which is pretty picky. It's pretty hard to do. But if you've ever taken a pregnancy test or you've ever taken an ovulation predictor kit test where you just pee on a stick, it's very much like that. You pee on this piece of paper, it dries for 24 hours, you fold it up, You stick them in a bag and you send them off. So they're so easy to collect at home. And it's really an amazing technology because what happens in the lab is that when we receive the samples, the paper gets cut and rolled and then put into a 96-well plate. Water gets added to it, a liquid that reconstitutes the urine, and then they measure the urine. So the dried paper is there to make it very easy for patients to collect, but it's complicated to reconstitute it because— Urine is a different dilution depending on the day. When you first wake up, it's more concentrated, and then maybe you drink things through the day and you have a more dilute urine. You can see that if it's like clear versus yellow through the day. So the lab has to account for all that with their calculations, and they've really nailed it. You know, we published in peer-reviewed journals about the accuracy of measuring off the dried paper compared to just liquid urine. So it's a really amazing method. Our lab techs are— I mean, our founder's a chemist. So he's the one that came up with the methodology. But we have amazing chemists and method development team in the lab that makes sure that everything is spot on.

And just— I'm thinking of it from someone who may just be hearing about this for the first time and thinking, well, why isn't this in, like, say, standard labs like Quest or LabCorp? Why can't we just— and why isn't this happening in the gynecology office or the endocrinology office? I don't know if you have any thoughts on those things.

Well, I wish it was. I'll just say that to start with. I mean, I think this is something that provides information that should be available to everyone. There's a couple of challenges. I think first of all is that when you look at standard practice guidelines, they're really focused around just very few hormones in our testing workup. And I think that's one of the gaps in women's health that led to this product being developed because so many women were tested and told they were normal and sent on their way. And I think many of us have had that experience as clinicians or patients where you feel like you're at the end of the road. And I think with conventional medicine, And especially gynecology. One of the reasons why I became so passionate about doing women's health at all as a naturopathic doctor is that there are so little tools in the toolkit of a standard gynecologist. It's mostly birth control pills, right? So if you have irregular cycles or PMS or acne or heavy bleeding or spotty bleeding, the solution is normally an oral contraceptive. That's one of the first-line therapies, and that overrides our hormonal system, and you don't really need to know what's happening. To go on the pill because the pill is going to override our natural physiology and kind of shut down the system so you're regulated on a drug. And so I think there's also a little bit of a gap in need when we're looking at it through a conventional medical lens versus through a functional lens where we really want to get to the root of the problem and solve the problem. And we know with hormones, sometimes hormone imbalance can be caused by gut dysbiosis or by stress or by something that is really unrelated to the ovary.

Absolutely. And that's why I'm glad you mentioned cortisol as well. As you know, I research and specialize in stress and helping people to recover from stress and to understand how stress can affect all these different systems in our bodies, including our other hormones, everything from ovarian hormones, thyroid hormone, insulin. And so to me, absolutely, I want to know a patient's cortisol levels at the same time that I'm looking at their their estrogen and progesterone, because if, if there's any imbalance anywhere in those hormones, I'm going to want to address it. So I'm glad— that's why I'm glad that Precision Analytical, or the DUTCH Test, also allows for testing cortisol levels at different times a day. Maybe, you know, just to clarify about that, just like you were saying, when you send in these samples that are at least 4 different— morning, midday, evening, bedtime— and with that, you can measure all these hormones, including cortisol. And so you can see what was their cortisol When they first wake up? What about their cortisol awakening response? Maybe let's talk about that a little bit and how that can be so helpful.

Well, first I'll tell you, I learned so much about cortisol from you and from all the work you've done. You're like legendary and a teacher and a mentor of mine in that area. So grateful for all of your work in that space. When it comes to Dutch testing, I remember when I first was interviewing for a role and it was interesting to me, a couple of the questions I asked that were obviously so not well informed. And one of them was around cortisol on every single report. And I think that's a fundamental piece of the DUTCH Test, of the comprehensiveness of the DUTCH Test. And you probably understand it more than most people or your patients, because when we think about hormones, they really work in a hierarchy where the base of that pyramid, if it's a pyramid, and if reproductive hormones are at the top, there's so much that's below that that needs to be in balance for our reproductive hormones to function properly. The base of that pyramid is like insulin and metabolic health and cortisol balance. And then you have thyroid, and it kind of works up to estrogen and progesterone and testosterone, which are the tippity top of that pyramid. So I'm sure if you're a clinician that's listening, you've probably had times where you've tried to address estrogen and progesterone balance and you feel like you're just not getting it. Maybe the patient gets a little better but then regresses, or the treatments aren't working. And part of the reason why is that if stress is a factor, It's really difficult to make lasting change. And that's because cortisol has an impact everywhere in the body. And when it comes to reproductive hormones, it's so impactful. I mean, even if you look at the main reason why women's hormonal systems shut down, hypothalamic amenorrhea, where the communication just stops between the brain and ovary, stress is the most recognized factor, even in conventional medicine. So That happens on a scale. Of course, it's not just black and white like a light switch. There's dysregulation in between, and so many women are caught in that space. I've been caught in that space. I think that's when we think about the menstrual cycle as a vital sign, is one of the things that has been coined that I love because it is a little bit like the canary in the coal mine. Fertility is the same way. When things are off, we start to see our hormones change for the worse. Sometimes again, it starts at the tissue. It may not start at the gland. You might have changes in how your cells use the hormones, and we can talk about that because that's where metabolites come in, but the cortisol plays a really critical role. So yeah, the 4 points, the 4 urine collections, or if you're doing a DUTCH+ with saliva, we measure cortisol in saliva. That allows us to give us the diurnal pattern for cortisol. And then we also look at metabolites and the conversion to cortisone, which is kind of a stored form of cortisol, in order to get that full story of what's happening with your stress axis.

And it's so important, as you know and as listeners have heard me talk about, it's so important to know that because the treatment is different. If, if your cortisol is too high at certain points in time, we're going to use a different treatment approach than if your cortisol is too low at certain points in time. And so as a naturopathic doctor or functional practitioner, that makes all the difference. We're not going to just assume that everybody has high cortisol or that everybody needs ashwagandha. We're going to need— we're going to want to know exactly what's going on so that we can be precise about our treatment. And that means you're going to be more likely to get a positive outcome, to feel better. And so And so it really does make a difference to have all that information. And I love the way that Precision Analytical does the reports, by the way, because it really helps both clinicians and patients to understand the connection and the metabolites of these hormones, as you were mentioning. And that's one of the key differentiators that I emphasize, especially when I'm helping women with whether it's fibroids, menstrual cramps, Or other, let's say, breast cysts or breast risk or HPV and abnormal Pap smears, I want to see the metabolites. Totally. And so, because sometimes the actual estrogen and progesterone level might be completely optimal, and yet when we look at the metabolites, that's where we see, okay, how is the liver metabolizing estrogen? Is there an issue there? And you can't see that in blood work. Your doctor, your gynecologist is never going to notice that.

Right. The

only way you're going to know is to do a urine panel that shows those metabolites to be able to say to you, oh, actually— and this might be because of genetics or because of stress or the combination of the two. But once we can see, oh, your body could use some help metabolizing estrogen down a more beneficial pathway, we can use natural substances to do that. It's so cool, I think, actually. It's like, now you don't want to just add supplements for no reason, but if we see it on the test, Now we have a reason. Now we know it's going to help your body.

Definitely. And you don't really want to add them without testing. And I'll give you just a classic example. This is a case we see oftentimes coming through, which is a case of what is— it's not a scientific term or a medical term, but we call it estrogen dominance. So it's a relatively high amount of estrogen compared to progesterone in the body, and it tends to result in women having things like breast tenderness, Bloating, heavy periods, things like that. They can feel pretty crummy. So oftentimes when we look, estrogen and progesterone look normal. This is on blood tests and on the Dutch test. They might look okay. But then when we look at the metabolites, we see a couple of things. One is that there is one type of metabolite called a 16-hydroxy estrogen, which actually binds to the estrogen receptor and stimulates it a lot like estradiol. It's not the strongest estrogen like estradiol is. But it still binds and it still has activity. When you look only at the parent estradiol, you don't see the total load of estrogens. And 16-OH is one, but there's others too that bind to the receptor. Similarly with androgens, and we can talk about that next with testosterone and metabolites. But sometimes women make too many of a certain kind of androgen— I'm sorry, estrogenic metabolite that kind of contributes to the feeling of how much estrogen is in your system. So that's number one. So you're right, shifting that can make a difference. The next thing is that sometimes women are told literally not clearing it. So with estrogen, we think about phase 1 clearance, phase 2 clearance, which is methylation, and then phase 3, which is elimination in the gut. So if a woman has poor methylation, that requires really different nutrients to fix compared to your phase 1 going down the wrong pathway. So you might be not making— you might be making a lot of 16, but you need to improve methylation, and you have to fix that first. You have to fix the gut first and methylation first. So knowing what's happening is really important. Because if you treat step 1, you're going to just have even more of a backup behind the dam at step 2 because you're going to have more coming through step 1 and not enough clearance in phase 2. So that's where knowing where every step lies is really critically important. And I think one of the biggest values of that part of the DUTCH Test.

And to me, it's also such a value of working with a practitioner or provider who understands how to help you with this. Because sometimes I know as women, we kind of tend to be independent and trying to figure things out on our own. And yet some of these details like you're talking about now, and which supplement and which dose and what order, those are the kinds of things that, that we've learned in either in our training or through years of practice to be able to understand, okay, here's, here's the product and the dose and the sequence that's going to help you the most versus just guessing, right? Because I know a lot of times women are just like, okay, let me just try DIM, for example. Or let me just try something that helps with methylation. But actually, definitely, if you feel worse, it's time to see a practitioner. But I would say work with a practitioner before that and have help with getting this test and interpreting the results and getting the right treatment.

I couldn't agree more. And I think as doctors ourselves, we're the worst patients of all. We try to do it ourselves. But this is definitely a time where if you're a clinician and a woman and you're trying to figure it all out yourself, Trade with a friend, hire somebody, be bossed around. It's a good time to just submit and be bossed around and do what you're told. Yeah,

it's worth it because then you have less bias and you're going to feel better faster. You mentioned the testosterone, which I love that we can also see testosterone. That helps in so many cases. I'm especially thinking of, let's say, PCOS. I look for those patterns. or hair loss or other androgenic symptoms. It also comes into play with peri and postmenopause when oftentimes women have testosterone levels dropping. So tell us more about how we can use the DUTCH Test to understand our testosterone levels and androgens in general.

Now, I've actually been kind of obsessed with this part of the DUTCH Test in this last year because I think there's been just some really interesting studies that have come out. We reformulated the look of the report to highlight one metabolite that is like the best marker for androgen activity in the body, in the cells. And I'm just really excited about where that's at. So women, we think about testosterone predominantly as a male hormone, but it's critically important for female health as well. It's important for fertility. It's important for ovarian health. We make it. We actually have more testosterone than estrogen in our body. So it is really important. So with the Dutch test, you can measure testosterone and also DHEA. Because when we think about testosterone, that's an androgen, the category of hormones called an androgen. And we make androgens in the ovary and we make it in the adrenal gland through DHEA production. So it's connected to cortisol in that way, because sometimes if cortisol is high and stress is high, you make more DHEA, which converts to androgens. And we see this a lot in women with PCOS or PMOS. And you can have that just general overproduction or low testosterone. So again, with DUTCH, you can see those parent hormones. But one thing that's really interesting, there's a marker in urine called 5-alpha-androstenediol, which we call 5-alpha-andro just for short. And it actually is the best distinguisher for women who do or don't have PMOS or PCOS. So what I mean by that is when you have testosterone in the body, of course, like I said, it goes to the cells, and then when it gets inside the cell, it gets converted to a metabolite called DHT. And there's many metabolites; the strongest one is DHT, and a lot of clinicians have heard of it because it's also associated with benign prostatic hyperplasia in men, or BPH, and male pattern baldness. So we do talk about it in other areas of medicine, but it is the strongest binder to the androgen receptor. It's actually three times stronger. Than testosterone in the cell. But DHT doesn't leave the cell very well. It gets kind of stuck inside the cell membrane. But when it converts to 5-alpha-andro, it leaves, and then we can measure it in urine. So what we see, and this is especially true for women with PMOS, is oftentimes women come in with acne and hirsutism and hair loss, and it's like, I must have high androgens. And then you test their testosterone in blood and it's fine. Maybe it's high normal or the upper third, but you're like, this doesn't really explain it. When we see their Dutch test, the metabolites are Screaming high. And that can be genetics. It can be other factors like metabolic dysfunction that can push things down that pathway. So we really see it more in the metabolism of testosterone than the problem is not with manufacturing the right amount of testosterone. And again, like you said, that's a very different treatment plan. So it allows us to get very specific very quickly on how we can really help a woman. And I think PMOS is one of the best use cases for Dutch, particularly on the androgen side, because you really get to understand how much of it is the ovaries, how much of it is the adrenals, how much is metabolism. And from there, you can craft a really specific treatment plan.

Yes, I definitely found that too. So it could be so clarifying because 2 people with PMOS could have a completely different situation with their hormones. So we can't— and like you were saying before, if you go to a gynecologist, they might give both of those people a birth control pill, but But when she wants to come off the birth control pill or say she doesn't want to use a birth control pill, we need these details to say, okay, is it that we need to help with the testosterone metabolism and/or is it that we need to help with cortisol, insulin, thyroid, all the other factors that may be playing a role?

Absolutely. And you mentioned peri and postmenopausal women as well. And that's another reason why I love using the Dutch test, particularly perimenopausal women. The reason why is that we assume you need estrogen and progesterone. I mean, postmenopausally, we can talk about hormone therapy next. But perimenopause is so tricky because women have these vague symptoms. And when you think about the pool of diagnoses that could be under there, estrogen and progesterone could be part of the picture, but sometimes it's testosterone or androgens, or sometimes all of their reproductive hormones are fine and it's cortisol. So it really allows you to see the whole picture. Particularly for women who are in that transition period, and figure out well why are you fatigued or why are you gaining weight or why are you having mood changes? You know that you can really start to get an insight on what factors might be at play, so you don't just assume and treat with progesterone when the problem's really testosterone, for example.

And it really can in perimenopause. There's so many also variables, like some women have this situation where estrogen goes way up high right before the ovaries decrease in function, and and so. So this can really help. In fact, I started telling patients, I really recommend doing a Dutch panel even in your 40s before you really hit into what might be menopause or kind of feeling like, oh my gosh, now I haven't had my period in a year. Yes, then do a Dutch test too. But even if we can catch it before that, so we can— because when I've been able to follow women from, let's say, 5 years before, And we do a Dutch test even, let's say, every year along the way, then I can really help them navigate the menopause transition so much more smoothly because I can catch the timeframe when maybe their estrogen was too high and help with that. And then as it starts to drop, help them a completely different way as it starts to come down and then be able to help them transition onto hormone therapy much more smoothly. So yeah, talk us through that. What do you see?

Same thing. So I'm actually doing a Dutch test right now. I'm doing a cycle map plus a Dutch plus. So I'm 46. My cycles are still regular, but I'm definitely starting to get those early symptoms of perimenopause, like changes in my bleeding or feeling a little more edgy premenstrually, where that's never been a problem for me. So I know that things are starting to change a little bit. I love that test, the full cycle map, which is you collect time points throughout the whole menstrual cycle, and then on cycle day 21-ish, you do the full panel collection, 4 points in the day. And what I like about that is you just get this wealth of information. And I actually have a colleague at the Dutch test, Dr. Smith. She wouldn't mind if I said this, where she was sharing with me her tests year after year because she does exactly what you said, the Dutch cycle map plus Dutch plus every single year. And what's really interesting is that cycle to cycle and perimenopause hormones can change. Your estrogen can be high one cycle and low the next. But when we look at them year over year, you can see the trends and patterns where now progesterone is lower. You're just making less of it. The ovaries are making less per cycle, and you might think, okay, now I should add progesterone, but the estrogen is still robust. But then you start to see the estrogen come down and think, okay, now I want to add estrogen into the picture. And that whole time, you can make sure that your androgens and your cortisol are in good balance. Because what we know is that when women are under less stress and their HPA axis is more balanced, they tend to experience less symptoms of perimenopause and menopause. So all the while, like you said, you're able to work on those fundamental building blocks, and then that does make that hormone management so much easier. So you get that picture over time. I completely agree with you. It's one of my favorite reasons to order the Dutch test, and it's something that I, like, am working with even with myself right now.

If you've recently received an abnormal Pap smear result or told that you test positive for high-risk HPV virus, I'm here to empower you. Your body is powerful, and it's designed to heal You can heal even from HPV. I'm Dr. Doni, and I've spent years helping women to tap into their natural healing potential. The Say Goodbye to HPV program provides you with a personalized, natural approach to support your immune system and clear HPV. This is about giving your body the boost it needs to do what it's made to do. Join Join thousands of women who've taken this journey with me and start your own path to healing. Yeah, it really helps to understand. Mine completely shifted from year to year. And so let's transition into talking about hormone therapy and how it can be used for that. Because, of course, this has been opening up. I mean, as naturopathic doctors, we were trained in hormone therapy a long time ago. But now that this information came out that That actually, what the researchers were saying, estrogen was causing breast cancer. Now we know that those same researchers came out and said, actually, no, it wasn't that estrogen was causing breast cancer. It was that the synthetic progestins were increasing risk very slightly. Well, we can stay away from those synthetic progestins. We can use bioidentical natural estradiol and bioidentical progesterone. Mm-hmm. And now studies are showing how beneficial that can be for women. And so we're seeing now that even gynecologists are going back to training and learning how to use these natural hormones for women in menopause. And yet there's still a lot of learning about how do we get women to the right dose because it's not a one-size-fits-all. As much as it would be tempting to say, oh, let's just give every woman the same amount of estradiol and progesterone. Right. It's not going to work that way. We need to individualize it is what I find. And so that's where I see that the DUTCH test can help us. Talk us through that. How does that work and what do you suggest?

So I see things exactly the same way that you just described, and I think things are really changing. So I think you're totally right. There's one, there's an openness to menopausal hormone therapy. And I would say that the traction that the research is gaining now to show us that not only is it about managing our quality of life through this transition with hot flashes predominantly, maybe vaginal dryness as well, or genitourinary syndrome of menopause, we call it GSM. But also now we're recognizing that there is clear prevention benefits. So the biggest area of this is bone health, the bone protection. There are guidelines for using estrogen therapy to prevent bone loss over time. So that's really great for women who might be osteopenic or at risk of osteoporosis. Estrogen can really help. But we also have emerging research, particularly in cardiovascular health, and I would say very early data on brain health and cognitive health. Not as much there; that's still a little bit in a gray zone. But definitely with cardiovascular health, there seems to be pretty good consensus around estrogen therapy being protective. So now we're starting to think about hormone therapy as a really important prevention strategy for women postmenopausally. And so there's a couple of questions. One is when to start, which I think we just talked a little bit about. The second is how much to give. Now, I was really surprised to learn this. There was this study that came out by a researcher named Jarviden back in 2001. He had 24 women in the study, and he put them on an estrogen patch for a period of time, and then they had a washout, and then they put them on estrogen gel. So these were FDA-approved products. And what they found in that study, and this was very small, only 24 women, was that 30% of the women did not absorb enough estrogen from one formulation or the other or both. But it was completely unpredictable. So some women just didn't absorb anything. Other women did fine on the patch but didn't absorb the gel. And some women did great on the gel but didn't absorb from the patch. And it was just totally unpredictable. But 30% is like 3 out of 10. So if you're prescribing the same dose of estrogen therapy to women, And you're expecting them all to get the same levels of estradiol in their blood and the same benefit for protective benefit from that amount of estradiol, we're missing the boat clinically. And right now, what we tend our guidelines tell us to prescribe based upon symptoms. So let's talk about that piece next. So one is that there's this huge variability. That Jarvinan study got kind of repeated on a larger scale in 2025 with about 1,500 women out of the UK. It saw about the same thing, and you can even see this in FDA. Literature, like in the package inserts. Like if you look at the mean amount of estradiol, the deviations bar that goes up and down from that mean is huge. You can see the variability in absorption. So that's pretty well recognized in the literature at this point. So then let's talk about how much do you need. So when you get benefits from hot flashes, what we tend to see is women get that benefit anywhere from five to twenty-five picograms per mil in serum. Okay, so 5 to 25. Most women have hot flash resolution. Bone protection really starts about 60 picograms per mL. And some women, if you need to build bone because you're actually osteoporotic, you may need to go up to 250 or 300 in serum. And similarly, when we look at cardiovascular health, you're looking at like 60 to 120. In cognitive, we don't really have the data yet to pinpoint a dose. But bottom line is that if you're using hot flashes, As a marker for this is enough, you might have a woman at 5, 10, 15, 20 when she needs to be at 60 to get the bone benefits. So as we change the conversation, I know this gets kind of scientifically complex, but as we change the conversation to prevention, we really need to start to think about achieving a certain level in serum. And the data is all in serum. So then let's talk about serum testing. In serum is really tricky when you're on hormones because they come up and down really fast in your body. And this is where the utility of the Dutch test comes in. For estradiol, because again, you're looking at 4 points in a day. So you actually get an average and you capture, you know, the whole thing rather than a single snapshot, which we know based upon research is basically flipping a coin type of a guess. So it's kind of a long story, but I think Dutch has such an important place when it comes to monitoring dose of estrogen therapy for postmenopausal women and really can help us tailor the dosing to make sure you're in a sweet spot where it's just enough, not too much, but you're going to get all the benefits.

It makes sense. So essentially, just to summarize what you're saying, is that if you say you're now taking— you're using estradiol, let's say, as a patch or a gel or a cream for that matter, and maybe oral progesterone, and maybe your doctor's ordering blood work for estradiol and progesterone. And I'm seeing that more and more gynecologists are doing that and maybe trying to aim for, you know, okay, what level of estradiol are we trying to get to? But what you're saying is that just measuring those levels in the blood may not really give us an accurate number and may not really help us to see, are you at the right dose? Whereas if we instead do, or in addition do, a Dutch urine panel, we're more— you can— it's an equivalency. We can look at the Dutch urine and see, oh, are you actually getting to a level that's gonna help you not only prevent hot flashes and night sweats, but also help you prevent bone loss?

Exactly. And we have that equivalency data. We actually published some of it in Menopause, like one of the leading journals in the field on urine hormone metabolites and urine testing for women who are on estrogen therapy of all different kinds— creams, patches, and gels. Creams are hard to find literature on because they're compounded, so there's not a lot, but we've published there too. So I think that's great. If serum is the only tool available to you as a patient or in your practice, patches can be tested on serum. So because you get about— you get steady state for a few days, so testing the midpoint of the patch is generally pretty good. But for any topical that you're applying every day, like a gel or a cream, capturing the amount correctly in serum is extremely difficult. So that's where the 4-point's really great. And so that, that's talking mostly about estrogen and estradiol. When you look at progesterone, we actually don't recommend that you test progesterone, period, from a hormone replacement perspective. We just recommend that you use the amount that's required in research to show endometrial protection, which is 100 or 200 milligrams of oral micronized progesterone if you're using bioidentical. Testing, it's not accurate, it doesn't really help. There's not a great way to test for progesterone. But for estradiol, as long as it's not oral, Dutch is a great option for you. And most people are using some kind of transdermal form now.

Yes, I agree. And it's— I think it's important for women to understand this, that, that, like, to some degree, there's still a lack of information and a lack of, you know, we can use the tools and information we have to this point in time. I really, because we've, we've so much has become known even in the past 5 years, I'm sure in the next 5 years, we're going to have even more information available. And this could shift again, right? Yeah. I think as providers, we have to be constantly learning and constantly prepared for things to shift. And for more, like, because that would be wonderful to be able to know, hey, Does this person really need to be on 200 milligrams of progesterone, or actually maybe 100 is enough? And right now, we can't know that. We have to— like you were saying, if you're on, let's say you're on an equivalent of 1 milligram of estradiol, either orally or transdermally, then you're going to need 100 milligrams of progesterone. And that's how we go based on. Mm-hmm. It's, it's, you know, it's just based on that. We don't have a tool that says, oh, you have exactly, you know, the right amount of progesterone. And sometimes it comes down to women having sometimes some vaginal bleeding, and then we have to problem solve from there to figure it out. And so for women to just know that it's— it can be a process when you start on hormone therapy. What I tend to do, and I'm looking forward to your thoughts too, It's start at a lower level or a base level, see how you feel, see how you do, and see— sometimes we can perceive, hey, is this person doing well on a patch or they're not feeling better or they're allergic to the patch? Okay, let's switch to a gel or a cream. Let's find the one that matches best for your body and then be able to— I recommend for my patients on hormone therapy to do a DUTCH panel. So at least once a year, but sometimes you may have to do it a couple of times at the beginning to get your doses at a good place and to know that your body could change. Like we've talked about, if you're under a lot of stress, things could change and your dose might change.

Yeah, absolutely. I mean, I see things the same way. I like testing before getting on therapy because you also are able to correct any testosterone or androgen issue and cortisol. And I think that's important to get hormone therapy right. Otherwise, sometimes Sometimes the hormone therapy just doesn't work as effectively. So I like to do that full panel. And then once a woman is on a hormone therapy protocol, I like to retest 6 to 8 weeks later. Dutch also offers one called a sex hormone panel, which eliminates the cortisol. It's a little bit less expensive. So that's great for that kind of dose check-in. And then do a full panel once a year after that. But you're right, sometimes you need to shift. And this is where the art of medicine comes in. Not only do you have to find a type of hormone therapy that works for the patient, like some women don't like a patch or don't like a cream, so they might need to take oral, right? So that may not be the safest form or the preferred form of the provider, but you have to make it work for the patient, and it has to absorb, and you have to be flexible because what might work for a little while might change over time because we all change. Our our you know environment within our body can change with time. So that flexibility, and I just encourage women to stick with it because it can get. frustrating if you're not doing as well as you wish you would be straight away. And it's not always the provider's fault. It's just a matter of finding the right puzzle piece that fits your health situation.

And I love this. I completely agree that it's— you got to be knowing that your body is unique. And it brings me to thinking about really women prioritizing themselves and their healthcare, you know, to say, hey, my Health is a priority. I'm a priority. And even if this is something that's not covered under my insurance, it's worth the investment because it's an investment in my health. It's an investment in how I feel each day. 'Cause say if this could make the difference of you getting the right dose so you can sleep better and not have joint pain and maybe be in a better mood with better energy all day long, that's worth it. But it's also worth it if it can, some of these other benefits we talked about, like preventing bone loss and heart disease. And even dementia. This is a huge value. So I think that it's really showing that women are realizing that and saying, hey, I'm important and my health is important, so I want to do this testing and I want to get the best information for hormone therapy that I can.

Yeah. The amount of research that's come out just in the last 5 years, like you said, on hormone therapy and menopause has been tremendous. And I think we're just at the tip of the iceberg. And thank goodness. Because I think there's so much opportunity here to really have a positive impact on women's lives. And of course, estrogen is not the be-all end-all only thing that matters for our health. But there's interesting things like GLP-1s work better in women who are also on estrogen, right? So there's other things, there's other synergies with your weight, with the way you feel, with your energy production. There's so many reasons why getting that right is protective and healthful and can help you live your best life. I actually today got asked on social media by Deanna Minnick, a colleague of ours, to say like what I thought exceptional health was. And when I really got down to it, it's like, okay, it's a matter of like having a life that's filled with joy and purpose and knowing what that is, but then living with the freedom to pursue that, right? You're not bounded by physical disability or by mental disability. Social, you know, your social structure is strong. You can live the life you want with freedom to kind of do what brings you joy and what brings you purpose. And that's where I think when I think about hormone therapy and the role that it can play, I don't mean to sound existential, but I think it's so important about how can we live our longest, best life. And I think this is a really amazing piece for women that is low risk and really beneficial for many women.

Absolutely. I mean, to me, it's like information just gives you clarity, it takes away the confusion. So then you can actually— you and your provider can actually make decisions to benefit you. Otherwise, we're just dealing with guessing and, and, and/or a woman being placed on a dose or a medication or a hormone that may not be actually the best fit for her, and she's just dealing with an incorrect dose for years, if not decades. So it's It's, it's like, yeah, let's get women some clarity so they can actually feel better, and then see what happens from there. And I love that you keep emphasizing that it's not like you're just going to rely on whether your menstrual cycle or in peri and post-menopause, you're not going to just rely on hormones to make you feel better. We, we see it as naturopathic doctors, we see it as a whole picture that this is one piece of Of the puzzle of your whole body, physically, emotionally, and even spiritually and energetically. Right. It's like this is just one piece of it, which is reminding me that on your complete panel, on the Dutch Complete Panel, it also gives some organic acid levels. So we get even a little more detail than just about ovaries and adrenal glands.

Totally. So organic acids, I think about them as like the sprinkles on the sundae. That's what I tell people. It's like, because we care a lot. Organic acids are compounds we can measure in urine, and we include the ones on the report report that are, one, trustworthy, because there's a lot of really broad organic acid panels. But when you read the literature, you can measure them accurately. But the question is, are they really meaningful? Do they really matter to your health? And both of those things have to be true for them to make the test, the DUTCH test. And the second thing is, do they have a relationship or add to the story of understanding what's happening hormonally? And those are the ones that we put on there. But there's some really great ones. There's markers for vitamin deficiencies like vitamin B12, vitamin B6, B6, glutathione, biotin. Biotin is on there because a lot of people use a DUTCH test to test for hair, like hair loss. You can see androgens, but now you can get a little bit of that nutritional picture too. We also have ones that look at different neurotransmitters like dopamine that can contribute to mood. And we have ones that show a little bit about oxidative stress, which oxidative stress is really interesting because it can make it hard for our hormones to be manufactured properly and to work properly in the body and can be one of the reasons why we get DNA damage. We also have melatonin on there. So you get a marker of whether melatonin is contributing to poor sleep. But also melatonin is an oxidative stress marker. So there are some really cool benefits to looking at that OAT panel as well. It's like a lot of great sprinkles.

I'm so glad that the 8-OH-DG, the one that measures oxidative stress, is on there because the 8-OH-DG is one that otherwise it'd be hard to get that. You'd have to do a separate urine test to get that. You're not going to get it in blood work. I've actually learned a lot from you about how oxidative stress relates to fertility. Mm-hmm. And so to me, I get excited when I'm able to see that level. And if I see it climbing up, even if it's still in the range, but it's climbing up, that has helped me many times clinically to be like, you know what? I think we got to figure out what you're getting exposed to that's toxic. And from there, we might uncover mold toxicity or glyphosate exposure or other kinds of toxicity. Or say just need to support their body to detoxify better. Methylation issues, for example, that maybe weren't showing up anywhere else, whether it's fertility related or general health related.

I'm so glad you fell in love with that marker because I have always really appreciated having that on the Dutch test. This is back before I even worked with Dutch because I did a lot of Dutch tests for patients who were trying to conceive. And oxidative stress is such a big part of egg health and sperm health. But we now know just ovarian health in general. Like having your ovaries produce hormones later in life, which we want you to have the latest menopause possible. That's a good sign of health. So it's really critically important and you can measure it in urine. So it is something that particularly with fertility, I always liked to see that because it's almost a marker of like an overall generalized marker of is your lifestyle healthy enough to keep your cells healthy? Like if you're a smoker, it's probably going to be elevated. Or if there's an imbalance where you're exposed to more toxins but you don't get enough fruits and vegetables, or it can be a little amorphous, but it tells me kind of the overall balance in your body. And if it's high, that is definitely concerning and something we want to fix. And like you said, it can point to some kind of underlying issue that you might not have even thought about before.

And this is reminding me of how just recognizing how much this particular— a lot of times I refer to it as the urine hormone panel, but it's the Dutch panel from Precision Analytical that it has It helps so many women to clear HPV to negative and clear abnormal cells on a Pap smear to negative. And so I want to say thank you to Precision Analytical for making this available and to make it out there and acknowledge that it's helping women in that way. Because I think it's not something— usually when women get diagnosed with high-risk HPV or an abnormal Pap, it's not like they're hearing this at the gynecology office. Right. You know, oh, we should be looking at your estrogen or progesterone or your estrogen detoxification. They're not hearing that, and yet it absolutely can play a role. And I'm not saying that every single woman who has HPV should do this test, but I do find that many cases it has been very helpful where we can finally see, hey, is this part of it? I mean, there's— in my eyes, there's There's— I identify 8 common susceptibilities to high-risk HPV, and ovarian hormone imbalance is one of those 8. Mm-hmm. And, you know, sometimes we can see based on symptoms, like say if a woman has, you know, let's say painful menstrual cramps or history of fibroids or endometriosis, or they're going through peri or postmenopause, then it kind of flags, okay, we better go look under that susceptibility. Even then, there may be times where women say, "Hey, I feel just fine," and they do the test, and we, lo and behold, find that they're they have an issue with with their methylation and metabolism of estrogen. So to me, I would say that I'm really got my eyes on this as as an opportunity for women who, especially if you've been testing positive for high-risk HPV and it's not going away, and you've tried a lot of other things, I would and you haven't done this. I would say we need to do this because we might see our oxidative stress levels that we weren't aware of. We might see methylation issues we weren't aware of, or even some of these other hormones that we've been talking about that are just not being measured anywhere else. And so we can get information that's going to help you to heal.

I love hearing how you're using it in that way, and I love getting to talk with other clinicians like you who have so much experience to understand how you're applying it in practice. It's awesome.

Yes, absolutely. It's really cool. And it's so empowering for women. Because, again, back to that, to say, when you've been just in this unknown, like, all, you know, all you've heard at the gynecology office is you have this virus that is associated with cancer risk. And you're just, you're sent out the door into the world. And you're like, what am I supposed to do now? And, and to be able to— it can be that impetus, it can be that pivot point, that moment where women start to go, oh, I can actually get information about my health that's not only going to help me and my body clear HPV to negative, but it could also help me with my whole health now. And it could help with fertility for women who are wanting to have a pregnancy, or it can help with menopausal symptoms for women who are in menopause. It's like life-changing. Yeah. So that's why I get so excited about being able to offer this test. As you've said, it's a test. And we— I have patients I'm helping from around the world, women from around the world We can, we can ship this test kit and they can collect their urine and ship it back to, to the United States to be analyzed. It's not— you don't have— we don't have to be limited by location, even for the most part, to be able to do this test.

Yeah, the test is available around the world. And like you said, it's like easy to ship, easy to send. So we have distributors that serve the UK and Europe and the Middle East and kind of all over the place to Australia, New Zealand, to really make sure that it's available. The only lab that tests is in Okay. So all the samples come back to us in Oregon because I think the last thing to talk about is that testing hormones is really difficult because they're very low concentration anywhere in our blood, in our saliva, in our urine. And so we have to use a method. There's kind of 2 methods available in blood. One of them is an immunoassay, and the other one is called LC-MS, liquid chromatography paired with mass spectrometry. It's more expensive to do LC-MS, but it's far more accurate when hormones are at low levels. So really, we recommend that type of testing even in blood. That's like a great little clinician takeaway, particularly when you expect hormones to be low, like testosterone in women or postmenopausal women. You're looking at estrogen and progesterone. That more specific method is great even in serum. And you can order both like Quest and LabCorp. You just have to select the right one. But with Dutch test, it's also LC-MS. That's what we use for the testing. And most labs don't use that. They use immunoassay. So you get a much more specific result, but the equipment is very finicky. It's really hard to work with. You need lab technicians and chemists who are really experienced with it. And so we've talked about, do we need a second lab somewhere? And in the end, it's so hard to get the instrumentation correct and the precision down that really all the samples come to us in Oregon still.

Amazing. You know, I'm originally from the West Coast, from Oregon and Washington. So I, I in some ways love hearing when there's a lab in Oregon that's like that, that makes me proud to be I guess a partial Oregonian, although now I've been living in New York for a while.

So New Yorker, it's a great story. Our founder, Mark Newman, founded Dutchess with Andy Tison and his wife, Katie Newman. And it's in McMinnville, Oregon, which is about an hour and a half outside of Portland. It's in the wine region, and it's really a homegrown business. They take really great care of their employees. And it's still run like a small town business, even though it's quite a large company now. So it's a really nice place to work. And I would say, Doni, if you're ever visiting back, you should swing by the lab. They would love to have you and give you a tour.

Aw, thank you so much. I definitely will. That would be so awesome. Thank you again so much, Jacqueline, for coming to talk this through with me. This has been so much fun, and I know it's been so informative for everyone listening. So thank you again for joining us here Thanks

for having me.

I wanted to add to this episode that I, Dr. Doni Wilson, do offer the precision analytical testing through my office for patients and for program participants. So if you would like to learn more about how you can access the precision analytical testing, the urine hormone testing that we've been discussing, then please feel free to reach out to my office. I'll put the contact information down below. You can go right to drdoni.com and Yeah. And find our contact email and phone number. You can reach out to set up an initial appointment to meet with me one-on-one, and then we can set up a program, whatever your health goal is, whether it's for regulating your menstrual cycle naturally or for fertility or for peri- and postmenopause and hormone therapy. Those are all things that I help with in my practice, and so I would be happy to help you. I can work with patients either in person or virtually, and of course, this is a test you do from home, so it could be from wherever you are located. And also, if you are dealing with high-risk HPV and an abnormal Pap smear, you can choose to work with me one-on-one, or you could choose to work with me through a group online program called Say Goodbye to HPV program. And that— in that program, you also have access to order various different tests through my office, including the Precision Analytical Dutch test. So just so you know, if you're thinking, wow, this conversation is really helping you to see that you would like to get this test and you would like to get help to implement whatever your results reveal, then please know that I could be a resource to help you with that. And my team in my office would be happy to, to guide you on your path to balance and improving your health and wellness by getting information about what's going on in your body and what it needs that I know is difficult to find out there if you don't have access to this kind of information and and the expertise that I've developed over 26 years in practice. So please feel free to reach out if this is something that you'd like my help with. And again, feel free to subscribe so you don't miss the next episode of How Humans Heal. I look forward to seeing you there.

Thanks for listening to How Humans Heal. If you liked this episode, leave a rating and a review. And for more resources, visit drdoni.com.