What You Don't Know About Hormone Tests (Wish I'd Known Sooner!)

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Welcome to my appointment with Dr.

Sharon Stills, who is here to—

we are really pulling back the curtain, or I am, and allowing this to be recorded, but for, for every reason, so that you too can discover, you know, what have we been missing So this is from a wet urine test, and, um, many of you attended Dr. Sharon Still's Menopause Summit and realized that this was one of the things she was talking about. There's a YouTube video, some of you may have seen it from that, and you've gained some curiosity.

I'm Debra Atkinson. You're listening to Flipping 50. I started this podcast over a decade ago to answer questions about fitness in menopause and beyond before you knew to ask them. The goal: to help accelerate your results with science and the practical application of proven protocols while living your best life. There's no more powerful health influencer in the world than a midlife woman. And it's not just about you, but the 3 generations that you influence. My unique 40-year career, including being a university senior lecturer in kinesiology and industry subject matter expert expert and an international speaker to founder of the first and the only exclusively made for menopause and beyond fitness membership in the world. Every week I interview experts behind the scenes and the science of optimal hormone balancing fitness and longevity and share answers to our community's questions so you can have the vitality and the energy that you want, need, and deserve.

So first of all, in terms of hormone testing, why the wet urine test?

So this is fun, and I appreciate you for being so vulnerable and sharing your results, because this is— if anyone, the action step is going to be, if you want to do what I just did with you, to purchase a test plus consult, which is basically what we're filming. And I've done so many of these and I've never filmed one. So this is fun and exciting. And so the reason why, when we're looking at hormones, the gold standard and the way we really need to test is a 24-hour wet urine. Now, some of you may just be tested in your blood or in your saliva, and there's a lot of problems with that. First of all, neither of those give you the metabolites, and the metabolites are just as important as the actual estrogens, for example. So you don't see that in blood or saliva. You can't accurately see estriol in those kind of tests. Saliva often falsely elevates once you're on hormones. It will falsely elevate your levels. So a lot of women who have been monitored on saliva that come into me, they're like, they took me off my hormones, I was feeling okay, and now I feel horrible, but they said I can't take the dose because my levels are high. So there's a lot of stuff that gets misled and you end up suffering. So you've also maybe heard of a dried urine test, and that's moving in the right direction because now we're looking more globally, we're looking at the metabolites. But the truth is a lot of mistakes are made with dry urine testing just on the user side, and you can't get an accurate read. To get an accurate read, we really need to see the whole circadian rhythm of hormone production. And when you just take 4 random samples, you just get 4 random samples. So it's like reading a book with 10 chapters and you read part of chapter 5 and that's it.

I'm going to ask you to go back to, go back to square one, because we've said a word several times that in case anybody is not sure exactly what does that mean, what is, what is metabolites?

So metabolites are, so we have estrogen, and the truth is estrogen is just a word. We have different types of estrogens, and the main ones that we know about and we study and we treat with E1, E2, and E3, although we don't treat with E1. But those estrogens then metabolize and they become 4-hydroxyestrone and 2-methoxyestradiol, and we're going to see them on your results. And those metabolites are like their own being. So some of them are amazing. They're anti-cancer, they're anti-inflammatory. Some of them not so amazing. Some of them cause DNA damage. Some of them are considered carcinogenic. So we need to know it's not enough to just give you estrogen and stop your hot flashes. That's like the tip of the iceberg. And yes, we, we're going for zero hot flashes. We want to be symptom-free. We want to have clear thinking. We want to have— be sleeping like a baby, have energy, no hot flashes, no vaginal dryness, healthy hair, healthy skin, all the things. And so if we don't, we know the hormones are not dialed in perfectly. Now, of course, there's other things, but we can't say balanced hormones are going to fix everything. But they're going to fix a lot of things because my extensive experience at this point, 23 years, which still blows my mind when I say that, but it's like if you're throwing a dart, when you throw the hormones at the body, it comes pretty close to the bullseye. Sometimes it does hit the bullseye and that was all you needed. But other times we need to look at more in-depth the adrenals, the thyroid, toxicity levels, the gut microbiome, your lifestyle, your movement, your diet, your hydration, your community, your relationships, your passions, and things of that nature, nutrient deficiencies. But the hormones— hot flashes is a hormone issue. So there are certain things that we know when your hormones are dialed in, we should be at a big fat zero as far as symptoms. If it's okay with you, I'm going to share my screen. Absolutely. Welcome to the doctor's office, everyone. And so here we have your results, which I'm going to go over in depth. You also have— you get a symptom tracker, and we can see you have a lot of zeros, which doesn't surprise me because you're pretty supercalifragilistic, you know, I know that you're healthy. And so a little bit of morning fatigue, some headaches, some neck or back pain, some joint pain. These, the symptoms. So hormones are interesting because there's a lot of overlap. So joint or muscle pain, and you only have a 1, you know, a lot of people I see are at 4, at 5. This can be estrogen. It can also be thyroid. So there are some things, insomnia is usually a progesterone issue. Morning fatigue can be an adrenal issue. This is more the thyroid issue. And so they're sort of grouped together, but there's definitely overlap. And so you're interesting because you don't have a lot of symptoms and you're just smart because you want to prevent, you wanna age gracefully. And like you said, you wanna be 85, still doing what you're doing today. We're still going to go out and go hiking. We're going to do all the things. There's no reason we can't. When we're looking at your reference ranges, there is a section that says postmenopausal. Now you are on hormones, right? When you are on hormones, we're not looking at postmenopausal. And to give you an example, okay, postmenopausal ranges are low because our hormones are expected to be low. So your total estrogens postmenopausally, they say, should be between 1 and 17. And you're the black diamond. The black diamonds are your results. The green is typically the optimal range, but you'll see I have some differences in what I say is optimal than the lab sometimes. So when you look at this, you go, look at me, I'm off the chart. I'm amazing. My estrogens are great, but When you're on hormones, or even if you're not on hormones, we want to optimize in the luteal phase. Now, the luteal phase is when you are a cycling woman, you ovulate, and then you go from your follicular phase to your luteal phase. It's the second half of your cycle. So this is really where we're looking. We want to be optimized here. Now, your estrone, E1, is the more inflammatory estrogen. So we don't prescribe it, and we don't like it high. We like it right right where yours is. That's perfect. And estradiol is— everyone talks about estradiol. Estradiol is an important estrogen, and yours is good. Yours is optimized. The range is 2 to 7.8, and yours is at 4.5. The problem is your estriol is super low, and if I am correct, you take a patch.

Correct.

So this is one of the reasons why I'm— I mean, there's a few reasons I'm not a fan of the patch. Yeah, but this is the main reason, because the patch is only estradiol. So there's a lot of noise out there saying that all you need is estradiol, and that's false. And there's a lot of noise saying estriol isn't important. The only time we have high estriol is when we're pregnant. But that's because they're looking in the blood where it's really hard to see estriol. And there was some research done by a colleague using 24-hour wet urine on healthy 20-something-year-olds. They're a bunch of nurses and showed that estriol was actually a predominant estrogen in a healthy woman. So we've got that the word on the street is not correct. And so estriol is like a supermodel. Estriol is anti-cancer. I use estriol to treat breast cancer, to treat colon cancer, to treat glioblastomas. Estriol helps seal the leaky gut. Estriol hits places in the brain like oxytocin. Estriol is anti-inflammatory. So when we take estrogen, it hits a receptor site. There's either an alpha receptor site which says step on the gas, let's get going. That is what estrone does and that is what estradiol does. So what does that mean in the body? That means proliferation. That means growth. That means potentially it can be a contributing factor to a tumor growing. It can mean fibroids growing, cysts growing, endometrial tissue growing. Now, estriol hits the beta receptor, which says slow down. It's anti-proliferative, it's anti-inflammatory, it supports against autoimmune disease. It has so many powerful mechanisms, all beneficial in the body. And estradiol, I said it says hit the gas. It does also say slow down. It's like bipolar. It can't decide. It hits depending what's needed. It can hit proliferation or it can hit the beta receptors, the anti. So estradiol is important, but estriol is equally important. So normally I like to see estradiol where yours is, and then I like to see estriol way up at the high end of normal to give you that protective benefit. And when you do that, we get your total estrogens into the green.

Yeah.

Onto the playing field. Because right now yours are pretty low. So I know you— I know we can talk about the caffeine thing. I'm having my own caffeine issues. Maybe we should go to Caffeine Anonymous together. But that's only if you admit you have a problem, right? I, I know that you, you know, obviously you're in amazing shape. You live a healthy lifestyle. So you feel really good. Most women who I would see with a low testosterone, I mean a low estrogen like this, they're probably going to be a lot more symptomatic than you are. So you're a unicorn in that way.

So, okay, and you just answered my question, which was, because of course it's all immediate gratification, is if I were to do something to bring that up, and of course I want to know what that something would be, if the patch is out or if you do something in addition to the patch. What, what is that? But the more immediate result would be I'm going to feel more energetic, or a level of stable energy that elevates. Is that potentially—

it may just be more on the inside. You may just be getting more protection on the inside from all the physiological things it does, because estriol is a weaker estrogen, but it still helps with brain health. Still helps with bone health. It still helps with vaginal dryness. It does all the same thing as estradiol.

Okay.

And so some— once in a rare while, like 1 out of every 500 women I see results on, her estrogen patch will be converting down to estriol. And I'll say, you know, you can stay on it. So in a case like this, you know, obviously I didn't prescribe your estradiol patch for you, right? You could stay on it and add some estriol in a cream, or you could go— I don't prescribe patches. I also don't like the sticky chemical patch stuff that's like dripping into your body all day long because I'm a, you know, I get like fanatical about stuff like that. It feels like something you're doing once in a while, I'm okay, but it's all the time and there's chemicals in there. So I prescribe Biast. It's a cream. It's compounded. We put in estradiol and estriol. We apply it to the external labia. That's another big faux pas. When you're taking creams, a lot of times they don't work because your doctor's like, put them to your wrist, put them to your, to your chest, put them to your abdomen. And those— that's all dermis. That's all skin., and we get a downregulation of receptor sites and the hormones don't work. They can get stuck in the fat cells. So when I apply creams, I don't apply them transdermally. I apply them transmucosally. Where is mucosal tissue? The external labia or the area around the rectum. So most of us choose the external labia.

Okay.

So you apply them there and you can get better absorption and potentially use lower doses.. And we're not trying to get you to take high doses. You should not be having a period every month. That's too inflammatory. There's no need for that. You can take, you know, the physiological, subphysiological doses you need to get rid of symptoms if you're having them and to know you're getting the protection you need. So then we look at the phase 1 and phase 2 metabolites. So one of the things that I do like about your estradiol is that you are metabolizing down to 2-methoxyestradiol, 2-methoxyestrone. 2-methoxyestradiol in particular, I compound this as its own compound and use it to treat cancer. So this is a very anti-cancer metabolite. And so I'm very happy to see yours is there. So you're getting protection. So when people tell you, can't take hormones, they cause cancer, it's like, that is such a 30,000 feet. I don't really know what I'm talking about because when you get into the nitty gritty, you go, oh wow, this estrogen actually is a— the pharmaceutical companies are trying to figure out how to patent it. Well, they want to make money on it. Wow. Then we look at your phase 1 metabolites. You have a very high 2:16 ratio. So this data is depicted in pretty little pie charts here. So we're going to look at them here. So first, going back to your estrogens, this is a formula that has been shown anything over 1 is thought to be breast cancer protective. So you can see the reference range. They have it half green, half purple. You can see your purple's gotten a little— aggressive, it's turning into a Pac-Man and eating up your green. What this simply is, is your E3, your estriol, the anti-inflammatory, the one that I love, divided by your estrone and estradiol added together. And so we want to have a good source of estriol to, to balance the more inflammatory estrogens to give you that layer of protection. So if you go on estriol, that will automatically change. That's not, you know, too difficult to move. Okay. Then we look here. So the 4-hydroxyestrone, this is one I was talking about before. This is thought to be carcinogenic. This causes DNA damage. This can contribute to breast cancer. It doesn't— now, yours is fine. The range is 7%, the reference range, and that's where you are. So I wouldn't want to see you go higher. But even if you were— came in at like 18%, doesn't mean you're going to have breast cancer or have breast cancer. It's a risk factor. And we want to mitigate as many risk factors as possible. There are certain risk factors out there, you know, EMFs and pollution that we don't have a lot of say over, but we can mitigate what we can mitigate. And so if this was elevated, there are different things that I use, like sulforaphanes, glutathione, magnesium to bring the levels down. So even if yours was elevated, it doesn't mean you can't take hormones or you're not a candidate or you have to stop your hormones. Just means we have to encourage your pathways to metabolize down different, different roads. Got it. Then we look at your 2:16 ratio, which I pointed out here was high. So do you take DIM? Is that— did you write it on your—

I was taking DIM for a while. I haven't taken it probably for over 8 months.

Okay, so you— so DIM is poorly understood, and a lot of people think it's estrogen. A lot of people think it does a lot of things. What DIM does— DIM is a concentration of cruciferous vegetables. So DIM is like the equivalent of going to a food semi-truck that's carrying broccoli and like saying, I'll eat half the semi-truck. It's a lot of concentrated veggies. There's no way you're going to eat all those in a day. Yeah. And DIM raises the ratio and the ratio is between your 2-hydroxyestrone and your 16-alpha hydroxyestrone. So your ratio is on the higher side. You can see the 2 Reference is 73. The 2— yours is 84. The 16-alpha, yours is 8. The reference is 20. Now your 2-hydroxyestrone is anti-inflammatory, so we like having that high. The 16-alpha makes things grow. So again, like endometrial tissue, a cyst, a fibroid, but it also makes your bones grow. So if you drive it down too low, it puts you at a risk for osteoporosis. So if you were taking DIM, I would say stop it. You don't need it. You're not taking it. And some women just metabolize this way. Now, I know you got some good bones because I know what you do for a living and I know how you work out. So I'm not so concerned about that with you that yours is only 8%. So this also puts you into a more anti-inflammatory protective state. Then we look at a methylation ratio, and methylation is a look into your phase 1, phase 2, how your liver is clearing hormones. So your result is 0.21, and the range is between 0.2 and 0.65. So you just eked into the green. We like the reference ranges the 3/4 of a tank full. And this has to do with liver, and I always give liver support when I have someone on hormones, just so we're supporting detoxification and processing. Okay, so you could use a little help there. Do you— have you ever had a homocysteine run?

Um, I have, and I have run high before.

Yeah, so you probably need a good— like, I have a Homocysteine Supreme formula. You probably need a good source of methylated Bs and 5-methyltetrahydrofolate acid, you know, methylated folate, some betaine to help you methylate. Because homocysteine, the range is very large in the blood. My range is like between 6 and 7. So if you're at a 9, the lab's not going to flag you, but I'm going to flag you. Got it. If you support that, you'll fill your, you'll fill your gas tank a little. Great. So then we look at progesterone and you are taking, I believe, a 160 milligram capsule and you sleep wonderfully. So sleep's not an issue. Yeah. So progesterone is an interesting one. Progesterone, when you take the capsule, muscle always metabolizes high. So you're at 12,000, I expect to see you. I have some patients who are at 20,000 or 25,000. I expect to see it high. If you only come in on their green range, you probably don't have enough progesterone. Now I will say, me personally, for my patients, I don't just do capsules. I do capsule and cream because I have experienced different mechanisms of action from the different forms. So estrogen I do as a cream, but progesterone I do as a capsule. And I also usually put like 50 milligrams of cream in because the cream goes more systemic. The capsules cross the blood-brain barrier. The capsules Capsules are more like if you weren't sleeping, I'd be like, let's raise your capsules, let's raise your dose. I titrate women up. Some women need 400, even really severe cases can you need 600 milligrams to help them sleep or to take away anxiety. Okay. So I would consider adding a little bit of progesterone cream just to help the bones and the breasts and the blood sugar and, you know, all the body parts, uterus. Um, so then we look at your androgens. And are you not taking— you are taking testosterone? Yep. So where do you apply your testosterone?

Um, inner thighs, glutes, rotation.

And so how many milligrams is it? Because you wrote down 4 clicks, which is 1 gram, but how many milligrams per gram is it?

Do you want me to get it and tell you?

Okay.

Moses, you talk to her.

So all it's— okay, testosterone 2 mg/gm.

Okay, so it's 2 milligrams per gram. Okay, so you're getting 2 milligrams. Are you doing it every day? Yeah, so you can see your testosterone is low. Yeah, so 2 milligrams— I dose typically anywhere from 1 to 5 milligrams a day, but I also put it to the external labia. So you're putting it on places that you're not getting optimal absorption. So it could be that 2 milligrams is fine for you. Okay, you just need to move it to the labia. Got it. It could be that you need a higher dose, so it's something that needs to be played around with a little. Now, testosterone, although is a very important hormone for women, and when we're cycling we actually have more testosterone relative to our estrogen and progesterone, but it doesn't need to be like— I just finished telling you progesterone could be way off the charts. I want it there, expect it there, the way it metabolizes. Even just going from a 3.3 to getting on the low end of optimal, a 6, 7, 8, could make a big difference. Okay. And testosterone, yes, we know, we think testosterone, we think of our sex drive. Testosterone is related to dopamine production. Testosterone builds bones. Testosterone supports the cardiovascular system. Testosterone builds muscle. Testosterone is anti-breast cancer. It's another one I use actively to treat. So testosterone has a lot more that it does. It's definitely energy. It can be— low testosterone can be related to anxiety. So you are definitely, again, a unicorn because you're not symptomatic. So I just want everyone listening to not compare themselves to Deb, right? Because, because you're a superstar.

Okay, so let's come back to what would be symptomatic. I was tanking, I have no libido, I can't build muscle.

Is that symptomatic? Yeah, if we look in here, it could be joint pain, headaches, neck pain, decreased strength, numbness, decreased flexibility, decreased muscle size, Decreased stamina, apathy is a big one, anxiety, cardiovascular issues, osteoporosis. So all sorts of things, a very wide range. So, you know, you're not wanting to optimize to get rid of anxiety or to build muscle, but you're optimizing for, I'm going to say, your 105-year-old you. 'cause I have a feeling at 85, you'll still, like, if we did nothing, you'd still be fine at 85. We'd have to start planning, working on it then. So, and then we'd look at your DHEA. So, DHEA is another all-around superstar. I call it the Ponce de León hormone. So, that's one of the explorers I remember from grade school who discovered, like, right, the Fountain of Youth in Florida. So, DHEA, anti-cancer, anti-diabetic, supportive against autoimmune disease, regulates the immune system, does all the things like testosterone, you know, the bones and the muscles, good for memory. So it just does everything. It's like easier to say what it doesn't do because it pretty much does everything. And so you're not taking it.

I'm not. In fact, I was taking it for a while, and at some point I was told stop taking that. Why? Don't know. Some association with numbers was, you know, you don't need it.

So a lot of times it's measured in the blood, and, and if you are measuring it in the blood, it should be measured as a DHEA- S for sulfate. It's a more accurate read. But if you're taking it, it'll usually be high in the blood. And I think a lot of people go, oh my God, it's too high. And you, like I was saying before about like progesterone or hormones being measured wrongly, and be— so if I see it high in the blood and I know you're taking it, then I'm like, woohoo, you're absorbing it, you're using it. On the urine, I like to see it mid, like at 1,000 in the middle of the range, I'm like, woohoo. And if we can get it higher and higher and higher, I do a happy dance as high as we go. Okay. So, um, so DHEA is a real easy one. It's surprisingly— I'm not sure why, but it's over-the-counter. Yeah, I like to use it as an oral liposomal and moderate doses for women. If you're dealing with an autoimmune disease, and of course I'm not telling you what to do because I'm not your doctor who's listening. I'm not even Deb's doctor. She's just doing a second opinion with me. But I, in my practice, if a woman has autoimmune disease, I will do a higher dose. I'll do like 25 milligrams. But if we don't have autoimmune disease and we're just looking to optimize, I do anywhere from 5 to 10 milligrams. You don't need to take high doses DHEA and testosterone are androgens. If you're taking too much, your body will let you know. You might get some acne breakout on your back or on your chin. You might get a little cantankerous, you know, angry. So you will know. You might get some extra chin hairs, start growing, working on your beard. So your body will give you feedback. But my experience, because I've been through the barrel with all of these is oral liposomal is the best absorbed. Don't do it in a cream. It doesn't absorb with the— yeah, you mean. Yeah. Okay. And testosterone, you could do cream, but you move it to the external labia. And I actually think that some women can tolerate injections of testosterone, you know, maybe just 5mg, 10mg a week, not a lot. But if you're taking testosterone, this is really important. Your doctor must monitor your DHT in your blood, which is your dihydrotestosterone. Please do not do pellets. Pellets always overdose. They stress the liver, they stress the body. No good comes from pellets. It is not a good way to replace your hormones. But DHT is a metabolite of testosterone. It can make your hair fall out.. So I've seen many women who were put on testosterone and no one's monitoring their DHT, and they come into me and I look at their DHT and it's sky high. Now again, there are ways with herbs, you know, you could do it pharmaceutically, but I do it herbally where you can stop the conversion to DHT, but it has to be monitored. So if you're on testosterone, you should monitor DHT. You should monitor SHBG, which is your hormone binding globulin. I monitor a CBC to watch the hemoglobin and hematocrit and the red blood cells, make sure they're not increasing too high. So you just want to be watching these things if you're on testosterone. And women need to be on testosterone. There's a few rare birds who are like still cranking it out and don't need it supplementally, But for the most part, you know, 95% of my practice is on testosterone.

Quick clarifying point. So something interesting you said that I want to make sure everybody absorbs, you know, doing a testosterone shot sometimes works. And you said like 5 milligrams, is that the measure? 5 milligrams a week. And, you know, I can tell you that I was doing shots for a period of time, but I was doing them like once a month. And that's is it not the same issue as with pellets? Like, all of a sudden, boom, I get a surge, and then at the end of the month it's low. And so it's never optimal, right? Yeah.

Yeah. I'm not a huge— I always go to cream first because for the most part, but I just— my son does testosterone shots with some women, and when he first told me that, I think I was interviewing him for my summit. And I was like, why'd you say that? That's not the way I do it. And he's like, well, that's the way I do it. And I was like, fine, whatever. But then I started thinking about it and I was like, all right, maybe he's got a point. And then I had some women who don't seem to do that great with the cream or they're not absorbing it or they don't feel the results. And I'm like, all right, I have an open mind. We're not gonna overdose. We might do a shot once a week or even twice a week if you're losing it. And, you know, not maintaining it and starting to crash. Because for men, I do testosterone shots all the time, and some of my men either take it weekly or some of them need that second shot during the week. Um, so, you know, it's, it's the art and practice of medicine, right? So finding what's right for you, but not— I've seen women come in on these mega high doses of testosterone and shoots them up and they come crashing down. And yeah, so, you know, we can do with cream and you can get the impulse of the testosterone every day, that's optimal. But if you've really tried it, you've put it to the external labia, it's not working, you've tried upping the dose, you're making sure you're applying it— because I do a lot of times the estrogen and the testosterone applied in the morning. And so some women, they're— it's like there's there's competition at the labia. So I have them separate their estrogen and testosterone by like an hour. That seems to work for women. So, you know, no one is exactly the same. You have to find a doctor who can dance with you and find what's going to work for you. Got it. So then we look at your glucocorticoids and your mineralocorticoids. These are stress hormones, adrenal hormones, the mineralocorticoids. Come out of the adrenal medulla, the inner part of the adrenal gland. The glucocorticoids come out from the cortex, the outer part. We've all heard, probably all heard of our cortisol, right? And so I'll start by saying my number one gold standard way, if I really want to know what's going on with cortisol, is to do a 4-point saliva test because cortisol is very bioavailable in the saliva. And you can see the rhythm. This unfortunately doesn't show the rhythm or the circadian cycle, it just shows output. So I can see you're outputting cortisol, you've got some storage, the cortisone. What I can see here is that your metabolites are really low, and this is your adrenal reserves, and You're 60 years old. It's, you know, you've lived, right? We all— our adrenals take the brunt of a lot of things. And by the time you're 60, I mean, heck, by the time you're 30 in this life, right, you've been through some major stressors. You've had life changes, sorrows. And so the adrenals, you know, get the brunt of that. And so doing some things to boost these metabolites to give you more reserve could be very beneficial because it's not like your adrenals have shut down. They're still producing. But if something like major happens, they may be like, yeah, we don't really have it in us to sustain you. So I often say to follow this up with a 4-point saliva test just to get the whole picture. I have to go look at your oxytocin as you're petting Moses. So oxytocin, I'm jumping down. I'll come back up in a second. Okay. Oxytocin, as we know, is the cuddle hormone, the love hormone, the bonding hormone, the orgasm hormone, the happy hormone. It's the jam, right? We love some oxytocin.. And yours is, you know, although yours is not sky high, we don't really produce oxytocin when we're not ovulating. And when we're 60 and we're postmenopausal, we're not ovulating. So this is a good level to me because a lot of times, you know, unfortunately I can't take like another person's results and compare, but usually most women I see in your age range, which is my age range, you know, on— they come in at like 50, 60, like they're very low. So a lot of times if I'm gonna supplement oxytocin, which I do, we do it as a nasal spray because oxytocin is a very unstable molecule and the best way to absorb it is— so like I do every hormone in the best way it's absorbed. So you got capsules, you got creams, you got drops, you got nasal sprays, because I want you to get the best treatment and the best effects and the best benefits. So a lot of times if I do the nasal spray with someone and we can get them to a 351, we have a little oxytocin celebration. You've always been love people and all of a sudden you're like, yeah, I just want to stay home. You know, that's a sign that low oxytocin is really affecting you. Low sex drive, very anxious, very stressed. Sometimes I'm like, well, you know, if that's going on, like I have women say that they're like, I used to love my husband and now I want to kill him. You know, he, he breathes the wrong way. He chews the wrong way. So in that situation, I'm like, let's mainline the oxytocin. We need to get you much higher. How do you build oxytocin other than squirting it up your nose? You play with puppies, you play with babies, you get massaged, you garden, you lie in the sun, you do things that bring you joy. And whether your oxytocin is low or not, that's one of the best prescriptions I can give you is to find what brings you joy and chase the heck out of it. So that's your cortisol, your aldosterone. Yeah, so your mineralocorticoids are a little on the low side. This has to do with our sodium potassium regulation. I'm assuming you take electrolytes, but I do. Yeah, so these are some ratios. These are about your androgens and your testosterone, so they're towards the lower side because we saw your DHEA and your testosterone were on the lower side. This is your cortisol-cortisone ratio, which is in the range, which looks good, which I had said, right? You have cortisol, you have cortisone production. It's just the metabolites, the storage, the reserves look a little low. Then we come to your peptide hormones. So of course, Deb has a perfect growth hormone, which is, you know, reflective of working out and eating right and living well. So there it is. She, she does walk her talk. You know, you're right at the high, you know, it's perfect. We talked about your oxytocin. Your melatonin is a little high, which— do you take melatonin? I don't. All right. So you're just a melatonin producer, which also is like double thumbs up. So, what I always say to patients, and I'll say to you, say you were taking melatonin, I would not tell you your levels are too high, you need to decrease your dose. Melatonin is— I always see it high when someone's taking it. And melatonin is a superstar from supporting bone health. I mean, obviously it helps with sleep and circadian rhythm, jet lag. That's what we all know about it. But melatonin is support for our mitochondria, for our immune system. I use high doses of it to treat cancer. That's what I was gonna ask.

Yeah.

I was told breast cancer reduction actually once.

Yes. Thyroid, maybe your morning fatigue, maybe your headaches, maybe a little bit of the pain, um, could be thyroid. What I'll say about your thyroid is usually— so your free T3 is the active thyroid hormone. Your free T4 is higher than your free T3, which we really want the free T3 to be higher. Most women do not feel good at a low-end range of free T3. They feel good way up here, sometimes higher than up here. Now, the full story needs to be finished in the blood work because we need to see a reverse T3. If your reverse T3 is high, then that means the T4 that you're taking is not going to T3. It's going more to reverse T3, which blocks free T3. We need to make sure, and I don't know if you know, like, do you have antibodies? Um, yes, but not high. Okay, just critical mass. Yeah. Okay, you know, it's nice— in a perfect world, we have zero antibodies. Um, it would be nice to know what your TSH is. When you're taking thyroid hormone, your TSH should be suppressed, which will often freak a bunch of endocrinologists or doctors out. Oh my God, you're hyperthyroid, blah blah, blah, blah, but your body will let you know if you're hyperthyroid. You will have heart palpitations, you will be sweating, you will have diarrhea, you will want to jump out of your skin. So just because your TSH is suppressed does not mean you're hyperthyroid. I would recommend getting the full story in your blood work, and you may need more thyroid. Thyroid is one of the misdiagnosed, misinterpreted mismanaged hormone conditions out there. Because on a blood panel, a free T3 will be 2 to 4.4 approximately as a reference range. And if you come in at a 3.2, a lot of times you're told it's perfect, you're right in the middle of the range. But again, my extensive experience is most women's thyroid is not functioning and they don't feel as good as they could until they're at a 4 or higher. I run my own free T3 at like 5-something. I run over the range because it's just a range. It's not like the be-all end-all. It's a range and I'm an individual. My range is different than the lab range.

Hmm. So question about maybe your comment about maybe I need to take more thyroid. So if— is that the answer? If, say, if my T4 is not converting, then is the answer taking more?

The answer is taking T3 only. Okay, got it. Yeah, my experience is it's a lot easier and quicker to balance the sex hormones with thyroid. I like to titrate, like I'm not just going to be like You know, you're taking a grain of thyroid. Well, it's low. Let's give you 4 grains. You know, it's like, let's take a grain and a half and see how you do. Let's step it up a little. So it's a little bit of a slower dance. And there's a huge wide range. Take-home message is you really need someone who knows how to do like the thyroid cha-cha and is going to do— because when you get it, when your thyroid is optimized, it's It's like the lever is lifted, the lights come on, the weight comes off, the bowels start moving, the hair is better, the energy is better, the sleep is better, the muscle pain is better. It all gets better. So that would be something I would look into in the blood and just see, you know, and you can trial run it, right? Because, you know, I keep saying this, but you have great lifestyle, so it doesn't affect you as much. Um, so you trial run it. Maybe you raise the dose and you're like, I feel absolutely the same, and maybe you don't really need as much a high raised dose. I, you know, it would be important to see like what your reverse T3 is. That's an important marker that a lot of people don't run, but it really is the guiding factor for what kind of thyroid replacement you need. But this is a marker, urine nitrates, which a lot of women get confused. They think it means they have a urinary tract infection because there's a nitrite marker in the urine. This is nitrates. This is a marker for nitric oxide. And then we have, this is a chronic disease risk factor screen, emphasis on screen. They're doing research. This is not something, this would not be my first way to check, but we're looking at metabolites of tryptophan metabolism. Tryptophan is an amino acid. Acid, and kynurenic and xanthurinic acid are metabolites. If your levels are really high, it means you're at risk. It's a warning risk sign for cardiovascular disease, for dementia, for B6 deficiency, could be for insulin resistance. It's, it's a very general screen. If your levels are really low, I often find you're not eating enough protein, or if you are eating enough protein, you're not absorbing the protein you're eating. Your levels are fine, and I always just caveat that with, don't walk away thinking I have zero inflammation. This is a screen. You might have zero inflammation, but it is important to go to the blood, check a D-dimer, check an insulin, check a fibrinogen, check a homocysteine, Check, um, a C-reactive protein, check your sed rate, check your interleukins, check your amylase, your lipase, you know, check the liver enzymes, LDH, creatinine kinase, check the markers of inflammation in the blood because I have seen where this screen is low and then we do find inflammation in the blood. So I just like everyone to be thoroughly thoroughly checked. I don't want anyone to think they're fine when they might not be. And that, my dear, concludes your, your review of results.

So thorough. This was amazing. So much insight and connecting the dots, really. Um, but you've explained so very well why you prefer and why you, you go to— here's, here's what's going to optimize it best. So that was also super rich for anybody who's taking another form maybe and still feel— doesn't feel like they're right in that sweet spot where they need to be. That's something to look at and questions to ask. And so if they— somebody else wanted to sit down with you, you're still open to taking people as a test and consult package, correct? Those of you that want to do that, we're going to send you right here to a specific link so that you can get started, flipping50.com/drsharon, and we'll make sure that you've got that as a follow-up as well. But any words of wisdom? I mean, you've given so many, but to somebody who's thinking about this. Is there anybody who's not a good candidate to do a test like this, to kind of sit down and go through? Second opinions are so very important, and I think sometimes we take the easy way out and, and don't want another appointment, another doctor's appointment, or another—

will this confuse me? So what I would say is if you're currently on hormones and you feel great, it's still important to do because you may see like some of the things we see that we're looking at, the metabolites, like Deb's 4-hydroxyestrone was not elevated, but yours can be elevated while you still feel great. And it's so, it's like a silent risk factor that you don't know about. So it's worth checking to see like, does my DHEA need to be adjusted? You know, So if you're on hormones and you're happy, you're a good candidate. So if you're on hormones and you don't feel good, you could either do the test and then we can see from what you're on why you don't feel good and make adjustments. Or if you're like, I'm on hormones and I really don't feel good and I want to take these, I'm on the wrong form, then I recommend going off them for like at least— and this kind of stinks, but for like 8 weeks. To make sure everything's cleared and we're getting a true baseline so we can see what you actually need. If you're not on hormones and you want to go on hormones, it's great to get a baseline so we know what you need, what maybe, you know, so that's good. If you are a cycling woman and you have a regular cycle, but you're perimenopausal or you just want to know, you're just curious, you're preventative, you can do the test on day 19 to 21 if you have like a 28-day cycle. If you are in the madness and the throes and the mystery of perimenopause and you do not get a regular period, you can do the test, but we recommend after you purchase it to contact our office and kind of give us a little snippet of how irregular you are, and I will then tell you when I think you should test. Test because we don't want you to spend money and test and then I'm like, oh, this is not a, you know, you shouldn't have done it then. So we want to, so otherwise, you know, if you're, you know, postmenopausal, you can test any day. If you're on hormones, just make sure if you're on vaginal hormones, you're not applying vaginally, you're applying rectally so you don't contaminate the sample. If you take internal estriol for vaginal dryness anything that you're sticking up there for vaginal dryness, you want to stop that for a couple of weeks so it doesn't contaminate the sample. Um, once you purchase the opportunity, you will then get a kit mailed to you. You collect the kit at home in your house. It is a complete 24-hour urine sample. So just a word of wisdom, like, do it on a day preferably where you don't have to leave the house. Write notes on your bathrooms. You're doing a 24-hour urine test. Don't forget to collect because it's very easy in the heat of the moment. Oh my God, I gotta pee. And then you're like, oh shit, I forgot to collect. And then you gotta start all over. Once you collect your urine, you send it off. It comes with a prepaid UPS bag. Then you can let our office know that you've sent off your test. It takes anywhere from 2 to 4 weeks. To get the results. And then so you can let us know, we will schedule you for a 45-minute Zoom appointment. When we have your results, we'll do exactly pretty much what I just did with Deb. I'll put them up on the Zoom and I'll talk you through everything, and then I'll write you a report of what you need.

So good and so worth it, really. I learned so much and I've got a few actionable things.

You noticed I said like different forms and different testing. Everything has optimals for how we test it or how we prescribe it. And then you put in the art, the who is this person in front of me, what are they experiencing, and what kind of unicorn are they? 'Cause we're all sorts of unicorns, right? It's different and it's across the board and it can be different at different times in your life. Depending upon where you are in your hormonal journey and also just stress, illness, not illness, not stress. So it, it definitely, you know, we're, we're fluid creatures.

It fluctuates. So good. Dr. Sharon Stills, thanks so much for being here.

Oh my God. Thank you for letting me do this and just being so brave and sharing your results.

It is what it is. So everybody who's interested in also getting the opportunity, you don't have to do yours on camera. Flipping50.com/DrSharon, just D-R Sharon, we'll get you there.

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