Chris had mentioned he didn’t mind answering questions about sex hormones and DUTCH results, so I’m seeing all these markers specifically with the metabolites that I have questions about. So we have three different questions about the sex hormone portion of the DUTCH complete hormone profile. If 16-OHE1 is in the low range, would you be concerned to do anything specific about it? What about 4-OHE1? What about 2-OHE1? Is it more the levels or the ratios that we’re concerned with?

Dr. Amy Nett: Okay. So what I’m most concerned with is, what are the estrogen levels? So there are a couple of pieces here. My number one concern is going to be, what are the total estrogen levels? E1, E2, and E3. Do they fit with the patient’s age? So I’m going to assume because here you’re asking about the metabolites, I’m going to assume we’re looking at a patient. He or she has completely normal levels of those three estrogens.

So, if I see normal levels of estrogens, a low 16 or low 4-OHE1, no I’m not worried. 16-OHE1, which is associated more with hormone-sensitive cancers, and 4-OHE1, which is associated more with oxidative stress DNA damage, I’m concerned about those if they’re high. I’m not as concerned about them if they’re low. 2-OHE1 is the most favorable pathway for estrogen metabolism, so I want to see most of the estrogens going down the 2-OHE1 pathway. If 2-OHE1 is low, that might just be because the patient’s effectively clearing estrogens out of the body or because estrogens are relatively low. The only time I would really be concerned about a low 2-OHE1 is if that’s because the 16-OHE1 and 4-OHE1 are high. So I think, yes, what you’re asking, “Should I be concerned with the ratios?” Yes. As long as you’re seeing most of the estrogen metabolites going down the 2-OHE1 pathway, that’s what you want. I’m not as concerned about the absolute number. So, 2-OHE1 being low only of concern if it’s because the estrogens are going down the 16 or 4-hydroxy pathway.