#110: How We Can Test Hormones?

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Hi, I'm Dr. Tabatha, the Gutsy Gynecologist. I'm a triple board-certified OB-GYN and functional medicine physician. I've embraced the world of functional medicine and wellness through my own personal health journey, and I'm super excited to share my wisdom and unique perspective as it pertains to women's health. After caring for thousands of women, I've come to realize that your gut health determines your gyn health and your overall And it's a super gutsy thing for me to go against conventional gynecology practice to bring you the truth. No more Band-Aid medicine, ladies.

We're talking root cause resolution on this show. So if you're struggling with hormone imbalance, weight gain, period issues, anxiety, insomnia, you name it, then you've come to the right place.

And I want to be your gutsy gynecologist. So welcome. Welcome back.

Today we're going to talk about testing hormone levels because even if your doctor tells you you can't or there's no point in it or they don't know how to interpret it, that's just not the case. There are amazing ways to test your hormones and gather so much information about what's going on in your body. So that's what I want to talk about. So conventionally, we would do bloodwork to check your hormone levels and drawing your blood Say cycles day 3 or 10, you can get a good idea if you made enough estrogen or too much estrogen. It can tell you your FSH level, which is follicle stimulating hormone. That's coming from your brain talking to your ovaries and telling your ovaries how much estrogen to make. Follicle stimulating hormone is sometimes checked to see if you're going into menopause because As your body starts to no longer make as much estrogen, the FSH levels increase because your brain and your ovaries are always talking. And if your ovary isn't responding to what the brain says, the brain says make more estrogen, the ovary doesn't make more estrogen, then the brain starts screaming. It starts saying it louder and louder by producing more and more FSH. And so this FSH level gets higher when your ovaries are no longer producing enough estrogen. And so that's why FSH is elevated in menopause. It's also elevated in premature ovarian insufficiency and diminished ovarian reserve when you're dealing with fertility issues. So checking those levels on cycle day 3 or 10 can be very beneficial. On cycle day 21, if you're having a normal 28-day period, We can measure your progesterone level because your progesterone level will start to increase during the luteal phase if you have ovulated. Progesterone is actually produced in the ovary from the little cyst that released the egg and let you ovulate. So that corpus luteum, that cyst, releases the progesterone, and that level can get measured on day 21. So we can measure how much your body makes of a certain hormone. We can also measure free and total testosterone and sex hormone binding globulin. Sex hormone binding globulin is what transports your hormones around your body so that you can send those signals. So I like to think of sex hormone binding globulin as like a bus. The hormones get on the bus. They ride the bus around to different places, and then the bus drops the hormones off to do their work and send their signals. But sometimes the bus is really big, and so a lot of hormones get on the bus and nobody gets off. Sometimes the bus is really small and none of the hormones can get on and go to where they need to go. And so your sex hormone binding globulin level is important to know if Are your hormones all stuck and bound to this globulin, or are they free and available to send signals? And so that can impact whether or not the level of hormones you do have is actually able to do its job. So that's an important piece as well. So all that can look— be looked at in blood work. And an important piece here is to understand that The ranges on the lab reports are not optimal. They are very wide and they are to determine outright disease. So if your levels are outside of those ranges, you definitely have a diagnosable disease. But you could be inside of that range and still not be optimal and therefore have a hormone imbalance, especially, say, your estradiol or estrone are a little bit high and your progesterone's a little bit low. That little bit on both ends makes a big ratio difference and feels like a major hormone imbalance. So it's really important that the practitioner that's ordering these hormones understands how to interpret the results. That's where a lot of conventional gynecologists fail women because they don't understand the nuances of optimization and And all the details that go along with hormone balance. And so that's just one caveat that I want you to understand. The bigger piece is, what is your body doing with these hormones? So we can find out if your sex hormone binding globulin is holding all these hormones and they're not even available to send their signals, but we also need to know Once the signal has been sent, what is your body doing with that hormone? It should normally be getting deactivated, aka metabolized in the liver and sent to the urine and stool for excretion and removal. But that doesn't always happen. And there are amazing functional medicine tests in the urine and saliva that can show us How your hormones are being metabolized and handled through your body, and are they being appropriately deactivated and removed? So there's so much testing that we can do in the functional medicine space that will give you so many more answers to what's going on. So I do want to share with you an example of a Dutch test, which stands for dried urine testing for comprehensive hormones. So you get a kit. You pee on these pieces of paper, they dry, you send them in, and then they test not only the levels of your hormones, but what your body's doing with them. So if you're watching on YouTube, you get to see the picture. And if you're listening, you could go hop over to YouTube, or you can just use your imagination. So first, I want you to understand that all of our sex hormones and our stress hormones come from a cholesterol backbone. So we need healthy cholesterol fats to even make our hormones. That's key number one. You need enough healthy fats in your diet. And that looks like at least 3 to 4 servings every day of grass-fed butter or ghee, avocado, avocado oil, healthy animal fats from grass-fed beef, pasture-raised chicken, you know, that type of thing, organic. Free-range eggs. You need healthy fats. Nuts and seeds are a great source as well, coconut and coconut oil. So you have a cholesterol backbone, and then your ovaries and your adrenal glands make sex hormones. And so they start out, they make pregnenolone, as you can see up here on the top. Pregnenolone gets made into progesterone. Progesterone is our calming, balancing hormone. It is what's needed to keep the lining of your uterus stable and not overgrow. It keeps estrogen in check. Estrogen is a growth hormone. It makes things grow. It makes your uterus grow. It makes your boobs grow. It makes your hips grow. And progesterone keeps all that from overgrowing. It also can be very calming because, as you can see, progesterone gets metabolized on 2 different pathways. It can go down the 5-beta pathway or the 5-alpha pathway. The 5-alpha— that's hard to say— that is more of a neurotransmitter, and it can cross the blood-brain barrier and actually affect your mood. And it has to do with GABA, one of our main calming neurotransmitters. And so having enough progesterone and having it metabolized on the 5-alpha pathway can be like your natural anti-anxiety. It's like nature's Valium. It helps you sleep and feel balanced and good. So these— Important information about progesterone is like, what are— are you making enough of it? from ovulating and how are you metabolizing it? So that's really helpful. Pregnenolone goes also to DHEA and androstenedione. Those can be turned into testosterone, and testosterone can go down a 5-beta or 5-alpha pathway as well. As opposite of progesterone, 5-alpha down that testosterone pathway is more androgenic, meaning more manly. We don't want too much 5-alpha metabolism of testosterone that makes DHT. And this looks like hair loss on your head, acne, abnormal chin hair growth, belly hair growth, all of that too much testosterone type symptoms. So you don't want your testosterone to be metabolized down this 5-alpha the way this sample test is showing. And I should explain, on this sample test, the green in the middle is, you know, where things are optimal. The stars are kind of the edges of too low on the left and too high on the right. And for this sample, they are making way too much dihydrotestosterone, and that person is most likely having symptoms from that. So From there, you can make your estrogens. So you have 3 main forms: estrone, E1, estradiol, E2, and estriol, E3. Those are the 3 main hormones that are running our bodies. Estradiol is that growth hormone that's responsible for reproduction, so it grows the lining of your uterus every month, and hopefully you have progesterone to keep that in check. But as you can see, it can go in, turn into estriol or estrone. Estrone is also not only made by your ovaries but also by your fat cells, and too much estrone is a bad thing. So we want to make sure that we don't have too much estrone around because that can go down to increase our risk of breast and uterine cancer, as I'm going to explain in a minute. And if you notice on this picture here, testosterone can get aromatized to estradiol or estrone, and in fat cells it almost always gets aromatized into estrone. So women who carry extra fat cells on their body and can't release that weight, they are more prone to having too much bad estrone, and that is why obesity is a risk factor for uterine cancer and breast cancer. It's this situation right here. So you're making these levels. In this sample case, it's way too much. You should not be all the way far to the right. If you look all the way far to the left, you see this purple area that is a menopausal level. And so that would be super low. So what happens is estradiol, our main reproductive hormone, gets turned into estrone. Estrone goes down one of 3 pathways. And that's what we're going to talk about. Or estradiol gets made into estriol and can go down this intermediate pathway of 16-hydroxyestrone. So things are always shifting and changing your hormones. So when you do blood work, oftentimes a doctor will just measure an estrogen level. For the lab that you get drawn at, that could mean they're measuring all 3 of these estrogens, Or it might be just the estradiol. It's sometimes hard to know. You can specifically ask for estradiol, estrone, and estriol, and those will give you the levels. So what we see here is estrone gets metabolized down this 2-hydroxyestrone pathway, which is the most protective pathway. That means it went through phase 1 of the liver detoxification process appropriately and your body inactivated it so that you can hopefully remove it from the body. It can go down this blue pathway, which causes this intermediate of 16-hydroxyestrone. This intermediate can be a bad carcinogenic intermediate form. And so we don't like it to be too high in this case because then it can get reabsorbed. So we don't want too much reabsorption. Either. And we don't want to go down the red pathway, which causes 4-hydroxyestrone. 4-hydroxyestrone can damage the DNA in our cells and increase our risk of cancer. So this Dutch test shows a nice pie chart with the different percentages of how your estrogen got metabolized during the phase 1 process of your liver. And you do not want more than 11% of that going down the red pathway. If that is the case, we need to get you on some major antioxidants. We need to be eating brightly colored vegetables and fruit and taking NAC and helping glutathione production. Glutathione is our major antioxidant that goes around and cleans house, gets rid of all that broken DNA and damaged cells so they can't go rogue and cause cancer. So if this quinone reaction is happening down this toxic pathway, it's really important to know and take action. You can also support this green pathway, this phase 1 detoxification through the liver, by pushing this 4-hydroxyestrone over to the green pathway. And you do that by making sure that the 4-hydroxy— I'm sorry, you make sure by making sure the liver detox pathway is functioning well. And that looks like eating enough cruciferous vegetables like broccoli, Brussels sprouts, cauliflower, cabbage, bok choy, because they have compounds in them called diindolylmethane and indole-3-carbinol. Those compounds help phase 1 of the liver so that you can get your estrogens through that process to get deactivated. So I encourage women, if you have too much of this 4-hydroxy or too much estrogen overall with symptoms of estrogen dominance, to take DIM and indole-3-carbinol. DIM, diindolylmethane, can be found in supplement form, and it can be very effective at pushing more estrogens down the green pathway so that fewer are going down the red pathway. This part of the test, if you can see it on here, is the second phase of detoxification in the liver. And so once it comes down to 2-hydroxyestrone, it has to get methylated. So it has to get a methyl group put on it to completely deactivate it. For the liver to be able to excrete it out of your body. Methylation donors are B vitamins mostly, and so it requires enough B12, B6, and folate, which is B9, and also magnesium to be able for this process to proceed. And so a lot of times we'll see B vitamin deficiencies back up this process. And this is a good example. If you see, we're way over here on the left with the methylation activity, meaning things are not getting methylated. So we're getting a backup. It's like the garbage got taken out to the curb through phase 1 detox, but then the garbage man didn't come by and pick it up off the road. So now you have garbage stacked up in front of your house, and that is not good. So the other component of this is that you can have genetic mutations that make you not methylate things as easily or as well. MTHFR is a very common mutation that you can have, and COMT is another one. I have both, actually, and so I don't think— I don't methylate things very well. And so I need extra activated methylated B vitamins as a supplement, as well as magnesium, to complete this process to get my estrogens deactivated and cleared out of my system. So if you did this test, you would be able to see, is your liver doing their detox processes appropriately, or do I need more support on that front?

Yeah.

So that can be super helpful. The 3rd phase of your hormones is elimination. So that is getting them out in the urine and in the stool. And having them back up in the stool is a major problem. So say you are sending your estrogens down the good green pathway, your liver is hydroxylating and methylating them, everything's working well, the things get to your stool. But if you have the wrong bacteria in there, then that methyl group can be cut off and you can reabsorb your estrogens. And if you're constipated, then there's more time to reabsorb those. So all of these factors can affect how much circulating levels of estrogen you have in your body. So that is why I love this Dutch test, because you can see all these intricate details that you can't see in blood work and you can't get from just talking about symptoms, you know, with your doctor. You can't find out this information. And the cool thing is there's so many things that you can do to intervene and change this situation. So, it's super important to get yourself evaluated if you are having symptoms, if you are feeling imbalanced in Figure out exactly what is going on. You know, let's get all the pieces of the puzzle and figure that out. So I hope that was helpful in understanding how you really can test your hormones and get so much valuable information. And that was only one little piece. There's other tests. There's a Dutch cycle mapping test where you test for an entire month to see how your hormones are being made and produced to Create your menstrual cycle. So if you are having fertility issues, irregular periods, question anything about your like cycle all month long, the cycle mapping test is really amazing as well. I mean, there are just so many ways to get answers to what's going on. You do not have to rely on the couple blood work tests that are covered by insurance that your doctor has not been trained to really interpret. Interpret and deal with. So seek more answers. You can always reach out and work with me one-on-one, or you can go, you know, to ifm.org and find a functional practitioner in your area because there are trained providers that know how to balance your hormones. So I hope this was helpful. Please follow me on Instagram and TikTok at The Gutsy Gynecologist, on Facebook at Dr. Tabatha. Please, I would just love it if you'd hit the subscribe button and share this with all your girlfriends. And if you're feeling like you got something out of this, a 5-star review would be so amazing. So thank you so much. Go have an amazing week, ladies.