Up-to-date, comprehensive hormone testing in clinical practice.
Steroid Hormone Pathway Testing.
I recently learned that urine steroid hormone pathway testing is not a test that is ordered very frequently here in the UK, and I was genuinely surprised to hear that.
Steroid hormone pathway testing is one of my favourite functional tests, and I use it more than any other hormone test by far.
One of the core concepts of functional medicine is that if we understand why a problem is occurring, we can effectively intervene at the root, making specific, personalised recommendations to address the underlying issue.
With hormones then, it seems obvious to me that just knowing a hormone is high or low, is not enough. We need to understand why this is happening in order to know how best to address it.
Understanding Steroid Hormone Pathways
Steroid hormones synthesis is a fascinating, complex symphony of hormone conversions and the enzymes that govern them.
With diet and lifestyle measures and targeted supplementation when it’s appropriate we have a large scope for influence on the enzymes, and therefore on the metabolic pathways.
Looking at the pathway also helps us to gauge exactly what effect such factors as exercise, stress, obesity or inflammation are having on hormonal health.
When we are working with hormones in clinic, we need to consider 4 important factors.
- Production / Synthesis / Secretion of the hormone.
- Transport / Conversion of the hormone around the body, and Interaction of the hormone with other hormones.
- Sensitivity of the target tissue and receptor sites to the hormone signal.
- Detoxification / Excretion of the hormone.
Urine steroid hormone pathway testing gives us insight into three of these four points.
It allows us to see if hormones are being made adequately, and if not we may be able to see where the problem originates.
We can see conversion of the hormones as they flow down the pathway from cholesterol/pregnenalone, and we can see if there are problems with both phase 1 (CYP enzyme mediated) or phase 2 (sulphation and methylation) detoxification processes involving the hormones.
That is a lot of useful, practical information that we can then translate into action to improve and support these critical functions.
How we metabolise and break down our oestrogens is very important for both men and women. Unhealthy oestrogen metabolism relates to Lupus, oestrogen-sensitive cancers, prostate cancer and other serious health concerns. It makes sense then that we investigate oestrogen metabolism, in both men and women, in those with oestrogen dominant signs and symptoms or those in high-risk groups.
How many of you are aware that all estrogens are made from androgens. There is no de-novo synthesis of oestrogen. In every tissue that oestrogen is made it is made from an androgen. Therefore, when we are considering a problem with oestrogen, it is prudent to also assess androgens to see if that is where the problem originates, or if there is a roadblock or upregulation regarding the production of oestrogen from androgens.
In a woman with low oestrogen, she may have reduced aromatase activity, leading to elevated androgens and low oestrogens, this is an important piece of information clinically and it’s also useful for informing accurate protocols, as we know that we specifically need to influence the aromatase enzyme with lifestyle and dietary advice.
This advice would obviously differ if the upstream problem was low DHEA leading to low androgens and therefore low oestrogens casued by upregulated cortisol production.
And the advice would differ again if the problem was low cholesterol leading to reduced steroid hormone synthesis across the board.
You can see how just focusing on oestrogen levels or even delving into oestrogen metabolism would not help you to understand the upstream issues involved.
Let’s move away from oestrogen for a moment, and consider cortisol.
I know that we are all very familiar, confident and comfortable with using salivary tests to assess free cortisol and making clinical decisions about adrenal function based on these results.
However, it turns out that solely measuring free cortisol is only giving us part of the picture and for some patients it may be painting an inaccurate picture.
When we measure cortisol in urine, it gives us the free cortisol picture as saliva does, but importantly it also gives us cortisol metabolites. This extra information provides a more complete picture.
In this case we may see elevated cortisol production that is being metabolised very efficiently, meaning free cortisol is low. It is likely in this case that you could be treating someone with normal or even elevated cortisol as though they have low cortisol, which at best is not helpful.
In more complex cases, you need to look at the free circulating cortisol and also at the cortisol metabolites to get a complete clinical picture
Some of the primary reasons to run this test on your clients and patients include:
- Assess hormone metabolism
- Assess steroid hormone enzyme activity
- Assess hormone replacement therapy
Simply put, urine steroid hormone pathway testing gives you more information, so that you can make better clinical decisions and have better clinical outcomes for your patients.
Let’s look at some case studies, as they demonstrate more eloquently how steroid hormone pathway testing can illuminate your understanding of hormone function in clinical practice.
Obese female. Free cortisol levels are low, but when we look at her corticol metabolites (THE and THF) we see that her cortisol production is actually high.
Male with classic patterns of inflammation disrupted hormone health. DHEA metabolites are high, but sulphated DHEA (DHEAs) is low indicating suppressed sulphation. Aromatase is upregulated, leading to elevated oestrogens and oestrogen metabolism is also unhealthy leading to excess 4-OH-E1 compared to 2-OH-E1.
In this case, we can use diet and lifestyle to reduce inflammation, support oestrogen metabolism with a product such as DIM and consider a product such as Chrysin to reduce aromatase activity.
(Disclaimer: Specific products mentioned are for illustration, individual recommendations must be made per patient/client in clinic)
Regenerus Laboratories are very proud to partner with Precision Analytical to bring you DUTCH (Dried Urine Test for Comprehensive Hormones) testing. We believe they provide excellent quality laboratory testing, with the most information available to date in a single test, at extremely reasonable pricing.
For more information on Steroid Hormone Pathway Testing and to see what makes DUTCH so different, click here.