I recently did a DUTCH test, and no previous experience with Precision Analytics, so trying to learn how to interpret results. Generally, it’s normal but wondering if you could explain one more time the swing between the cortisol and cortisone spectrum? I understand cortisol is the more available, so if someone tends to have normal levels of both but favors cortisone, does it mean that the body has directed some of the extra cortisol into cortisone because it’s not needed at that time? Is this flow back and forth constantly changing? Additionally, I know we’re not covering hormones specifically in this course, but the DHEA-S was normal. Testosterone was low. Could you briefly address some of the causes of low testosterone if there is no obvious HPA axis dysregulation, and progesterone is normal?

Chris Kresser:  Regarding cortisol and cortisone, cortisol is the more active form. It’s not the more available form, a slight difference there, but I just wanted to clarify that. So, if someone has normal cortisol, and he has high cortisone, what is likely happening is the body is deactivating excess cortisol that is produced into cortisone in an attempt to protect itself from the effects of high cortisol. As you recall, when we look at cortisone, it kinds of biases our perception of cortisol either upward or downward. So, if you see normal cortisol or high-normal cortisol, but then cortisone is really high, then that would make me actually think of that person as being a high cortisol person, or at least at that point in time. Likewise, if you see normal or low-normal cortisol, and cortisone is really low, then I would think of that as more of a low cortisol presentation. So, that’s how you use cortisol and cortisone. Then there are the specific conditions that I mentioned, drugs, substances, and hormones that affect that cortisol-to-cortisone balance.

In terms of low testosterone, if there is no obvious HPA-D, and estrogen and progesterone are both normal, the first thing I would do is do a serum total and free testosterone to see if they are all consistent and in line. That is what we will often do as a follow-up because testosterone in the urine can sometimes vary from serum testosterone, which I think is a little bit more accurate. If, indeed, the serum testosterone is low, then again the question is, is it low because it’s the time of life when testosterone is starting to drop for a woman, if she’s approaching menopause, and is it pathologically low? We all have some different set points for sex hormones, I believe, and some people, for example, may always have testosterone that is a little bit on the lower end compared to other people, but it’s not pathological for them.