Homocysteine of 11, TPO, or thyroid peroxidase, antibodies at 245. She has been diagnosed with Hashimoto’s and is on 100 mg of Synthroid. Her thyroid markers are all in the functional ranges. Her vitamin D is low at 29.5, She also has low-normal iron stores, trying to focus on organ meats. Her chief complaints are are fatigue, body aches, weight. She had an ablation. She believes she’s still premenopausal which make sense since the estrogen markers are normal, sort of high normal. Progesterone is low normal. Testosterone is below normal. DHEA is low normal, with DHEA-S in range at the lowest. She has High 5-alpha-reductase activity.

Dr. Amy Nett: Interesting. Because DHEA actually upregulates 5-alpha-reductase activity. So I would’ve expected with low DHEA that she would have low 5-alpha-reductase activity. Sometimes I wonder though, I don’t know that I read anything about this, but I sometimes think if people have low androgens that the body may upregulate 5-alpha-reductase to at least have the more potent forms available. I’m not sure, but I feel like that’s a pattern I often see. With lower androgens, sometimes it almost seems like there’s an upregulation of 5-alpha-reductase. But, trying to think, yeah, there are a few other things that upregulate 5-alpha-reductase. So we can come back to that, and then she has low methylation activity. Specifically, you’re saying low 2-hydroxy, so it might just be that she has normal methylation activity but just fewer metabolites going down that 2-hydroxy pathway. That’d be the other possibility. Yeah, okay, so she has fewer estrogen metabolites going down the 2-hydroxy pathway. And then 24-hour free cortisol is low normal and metabolites—it looks like you got cut off there. I don’t know. We have a limit for the number of characters you get. So I don’t know what the metabolites are.

So what you’re saying is she certainly could be perimenopausal. If she’s having—okay, so just the additional information, your 24-hour free cortisol is low normal, metabolites cortisol is in mid range, trends towards more cortisone metabolites. Cortisol pattern is normal except for morning sample, which is low on cortisone and low normal on cortisol. Okay. Right. Trend towards cortisol. Okay.

So, I mean, a lot of this is sort of nonspecific. I think, given that vitamin D level, you have the full blood panel, so I would look at her calcium, I’m guessing, she would benefit from some cod liver oil, so she probably is going to benefit from getting that vitamin D up there a little bit. I agree with you that she is premenopausal, probably perimenopausal, so you could ask her if her cycles are regular. If she’s still having regular cycles and you’re seeing a true picture of estrogen dominance with fewer estrogen metabolites going down the 2-hydroxy pathway. I might think about using maybe DIM Detox and maybe Calcium-D-Glucarate if her 16 and 4-hydroxy-E1 are high just to help her clear out the estrogens and shift the estrogen metabolism down that 2-hydroxy pathway.

If she is still having normal cycles, you could also do some Vitex or chaste tree berry, which helps increase progesterone—ovarian production of progesterone. But again at 51, I’m not sure where her cycles are and so I’m a little bit less convinced that that’s a good one. So Brent says that “4-hydroxy-E1 is above range and 16-hydroxy is within range,” but Brent you’re saying both of those are higher than the 2-hydroxy-E1 at least in that relative scale in terms of where that needle is pointing. And so, her cycles are irregular. Okay. So she’s perimenopausal.

So with a high 4-hydroxy-E1 above range and low 2-hydroxy-E1, I would think about doing the DIM Detox, and you could do it at a slightly lower dose but I might just—and Calcium-D-Glucarate just to help her to clear out some of those estrogens and shift that production. And then, sorry, going back—oh, 2-OHE1 is at the high end of the range. Okay. And then you’re saying she just has low methylation activity, I see, so low COMT-dependent methylation.

Okay. So then I would think about getting her on some B vitamin support, and you might want to do functional methylation testing, and that’s an option. You could also just, if she’s not too sensitive to supplements, maybe get her started on an active form of B12, folate, because based on that homocysteine of 11, based on the low COMT-dependent methylation that you’re seeing there, she almost certainly has some degree of impaired methylation, so I would consider doing that if you’re comfortable with it, at least B vitamin support. You could also do something like Liver Nutrients from Seeking Health just because methylation is involved in detox. And since you’re saying, like, her 4-OEH1 and 2-OEH1 are kind of high and high-normal, I’m not sure how well she’s clearing estrogen, so maybe do a little bit of detox support there, especially while you’re waiting for other test results to come in if you want to get started somewhere.

Fatigue and body aches, I don’t know too if you’ve started her, depending on what the other blood markers look like, I would think about curcumin. I’m thinking, I’m looking at the TPO antibodies. Low-dose naltrexone something to consider. Chronic pain, I will consider low-dose naltrexone, and then she’s got those high TPO antibodies, so autoimmune condition, that’s another option to consider. But immune support, so even something like glutathione, curcumin bringing the immune system into better balance because of the TPO antibodies. Okay.