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Fmv) 0.11 0.10-1.40 Physician Copy Completed: July 09, 2018 Received: June 28, 2018 Collected: June 27, 2018 ACHF.1 Steroidogenic Pathway At-A-Glance 27.4 RR : 11.0-76.3 444 113 RR : 13-370 RR : 46-269 <dl RR : 10-48 640 RR : 121-1,209 539 <dl 11,196 RR : 117-939 RR : <=23 RR : 522-6,529 315 RR : 57-370 1,293 RR : 142-595 18.1 5.7 RR : 2.0-26.2 RR : 0.6-11.2 (Luteal range) (Luteal range) 11.5 3.2 RR : 1.3-36.3 RR : 0.2-8.6 15.3 17.1 RR : 0.5-8.9 RR : 0.6-19.9 (Luteal range) 14.3 <dl RR : <=5.9 RR : <=1.0 © Genova Diagnostics · A. L. Peace-Brewer, PhD, D(ABMLI), Lab Director · CLIA Lic. #34D0655571 · Medicare Lic. #34-8475 Interpretation At-A-Glance Anabolic/Catabolic Balance 17-Ketosteroids/17-Hydroxysteroids Ratio Anabolic/Catabolic Balance (FMV) 0.11 0.10-1.40 Catabolic (Wear & Tear) Anabolic (Growth & Healing) Catabolic Anabolic 17 - Hydroxysteroids 17 - Ketosteroids 12,960 859-9,018 nmol/dl (SG) 1,472 576-3,142 nmol/dL (SG) Total* (FMV urine) Total* (FMV urine) * Total values equal the sum of all measurable parts Enzymatic Activity Estrogen Metabolism Phase 1 Phase 2 Estrogen Metabolism ) 2 2-OH (E1+E2) / 16α-OHE1 E + 2- 1 O E ( 0.8 H Lower 2/16 Ratio Higher 2/16 Ratio (E O 1+ e RR : 0.3-13.7 E M 2 - ) 2 Methylation Activity 16 α-OH 2-OH (E1+E2) / 2-MeO (E1+E2) E1 ) 2 E More Methylation 3.6 Less Methylation + 1 E RR : 1.6-10.7 ( H O - 4 5α-Reductase Activity Etiocholanolone/Androsterone (E/A) Ratio Estrogen metabolite values <DL cannot be depicted in the pie-chart. More 5α-Reductase 1.19 Less 5α-Reductase RR : 0.34-1.76 This sample pie-chart reflects current scientific understanding of the association of specific estrogen metabolites with disease risk for hormone related cancers. Metabolites in green have been associated in the literature with decreased risk; those in red, with increased risk. 16-OHE1 (in yellow) has mixed findings, some studies showing an association and many finding no association. The dark line separates Phase 1 and Phase 2 detoxification pathways. Key © Genova Diagnostics · A. L. Peace-Brewer, PhD, D(ABMLI), Lab Director · CLIA Lic. #34D0655571 · Medicare Lic. #34-8475 Complete Hormones (FMV) Completed: July 09, 2018 Received: June 28, 2018 Collected: June 27, 2018 Methodology: GC-MS and LC-MS/MS; Specimen: FMV urine; Results SG = specific gravity Progesterone Reference Range Pregnanediol (FMV urine) 444 13-370 nmol/dL (SG) Androgens 17-Ketosteroids Reference Range DHEA (FMV urine) 27.4 11.0-76.3 nmol/dL (SG) Androsterone (FMV urine) 539 117-939 nmol/dL (SG) Etiocholanolone (FMV urine) 640 121-1,209 nmol/dL (SG) 11-Keto-androsterone (FMV urine) <dl 37-236 nmol/dL (SG) 11-Keto-etiocholanolone (FMV urine) 24 57-315 nmol/dL (SG) 11-Hydroxy-androsterone (FMV urine) 209 71-496 nmol/dL (SG) 11-Hydroxy-etiocholanolone (FMV urine) 25 64-363 nmol/dL (SG) 17-Ketosteroids, Total* (FMV urine) 1,472 576-3,142 nmol/dL (SG) * Total values equal the sum of all measurable parts Testosterone (FMV urine) <dl 10-48 nmol/dL (SG) Androstanediol (FMV urine) <dl <= 23 nmol/dL (SG) Glucocorticoids 17-Hydroxysteroids Reference Range Pregnanetriol (FMV urine) 113 46-269 nmol/dL (SG) allo-Tetrahydrocortisol, a-THF (FMV urine) 315 57-370 nmol/dL (SG) Tetrahydrodeoxycortisol (FMV urine) 43.4 <= 9.4 nmol/dL (SG) Tetrahydrocortisone, THE (FMV urine) 11,196 522-6,529 nmol/dL (SG) Tetrahydrocortisol, THF (FMV urine) 1,293 142-595 nmol/dL (SG) 17-Hydroxysteroids, Total* 12,960 859-9,018 nmol/dl (SG) * Total values equal the sum of all measurable parts © Genova Diagnostics · A. L. Peace-Brewer, PhD, D(ABMLI), Lab Director · CLIA Lic. #34D0655571 · Medicare Lic. #34-8475 Page 2 Estrogens Estrogens Reference Range Estrone (E1)* 18.1 2.0-26.2 mcg/g Creat. * Premenopause (luteal) reference range shown Reference Ranges Premenopause 2.0-26.2 mcg/g Creat. Menopause 1.1-26.2 mcg/g Creat. Male 1.6-8.6 mcg/g Creat. Estradiol (E2) * 5.7 0.6-11.2 mcg/g Creat. * Premenopause (luteal) reference range shown Reference Ranges Premenopause 0.6-11.2 mcg/g Creat. Menopause 0.6-15.4 mcg/g Creat. Male 0.8-4.3 mcg/g Creat. Estriol (E3) * 17.1 0.6-19.9 mcg/g Creat. * Premenopause (luteal) reference range shown Reference Ranges Premenopause 0.6-19.9 mcg/g Creat. Menopause 0.7-30.8 mcg/g Creat. Male 0.3-5.1 mcg/g Creat. Estrogen Metabolites 2-Hydroxyestrone + 2-Hydroxyestradiol [2-OH(E1+E2)] * 11.5 1.3-36.3 mcg/g Creat. * Premenopause (luteal) reference range shown Reference Ranges Premenopause 1.3-36.3 mcg/g Creat. Menopause 0.9-43.8 mcg/g Creat. Male 0.7-12.5 mcg/g Creat. 16α-Hydroxyestrone (16α-OH E1)* 15.3 0.5-8.9 mcg/g Creat. * Premenopause (luteal) reference range shown Reference Ranges Premenopause 0.5-8.9 mcg/g Creat. Menopause 0.4-7.7 mcg/g Creat. Male <=2.0 mcg/g Creat. 4-Hydroxyestrone+4-Hydroxyestradiol [4-OH(E1+E2)] * 14.3 <= 5.9 mcg/g Creat. * Premenopause (luteal) reference range shown Reference Ranges Premenopause <=5.9 mcg/g Creat. Menopause <=8.8 mcg/g Creat. Male <=1.6 mcg/g Creat. 2-Methoxyestrone+2-Methoxyestradiol [2MeO(E1+E2)] * 3.2 0.2-8.6 mcg/g Creat. * Premenopause (luteal) reference range shown Reference Ranges Premenopause 0.2-8.6 mcg/g Creat. Menopause 0.3-5.9 mcg/g Creat. Male 0.2-2.5 mcg/g Creat. 4-Methoxyestrone+4-Methoxyestradiol [4MeO(E1+E2)] * <dl <= 1.0 mcg/g Creat. * Premenopause (luteal) reference range shown Reference Ranges Premenopause <=1.0 mcg/g Creat. Menopause <=1.0 mcg/g Creat. Male <=1.0 mcg/g Creat. © Genova Diagnostics · A. L. Peace-Brewer, PhD, D(ABMLI), Lab Director · CLIA Lic. #34D0655571 · Medicare Lic. #34-8475 Page 3 Estrogens Ratios Reference Range Anabolic/Catabolic Balance (FMV) 0.11 0.10-1.40 E/A: 5β/5α Ratio (FMV urine) 1.19 0.34-1.76 2-OH(E1+E2) / 16α-OHE1* 0.8 0.3-13.7 * Premenopause(luteal) reference range shown Reference Ranges Premenopause 0.3-13.7 Menopause 0.3-15.1 Male 0.8-12.9 2-OH(E1+E2) / 2-MeO(E1+E2)* 3.6 1.6-10.7 * Premenopause (luteal) reference range shown Reference Ranges Premenopause 1.6-10.7 Menopause 0.4-11.6 Male 1.0-8.8 Lab Comments The performance characteristics of all assays have been verified by Genova Diagnostics, Inc. Unless otherwise noted with , the assay has not been cleared by the U.S. Food and Drug Administration. <dl = Unable to calculate results due to less than detectable levels of analyte. © Genova Diagnostics · A. L. Peace-Brewer, PhD, D(ABMLI), Lab Director · CLIA Lic. #34D0655571 · Medicare Lic. #34-8475 Page 4 Commentary Commentary is provided to the practitioner for educational purposes, and should not be interpreted as diagnostic or as treatment recommendations. Diagnosis and treatment decisions are the practitioner's responsibility. Pregnanediol Progesterone rapidly metabolizes by the time it reaches the urine, and its direct metabolite, pregnanediol, is a reflection of circulating progesterone concentrations. Progesterone is important for normal reproductive and menstrual function, and influences the health of bone, blood vessels, heart, brain, skin, and many other tissues and organs. As a precursor, progesterone is used by the body to make other steroid hormones, including DHEA, cortisol, estrogen and testosterone. In addition, progesterone plays an important role in mood, blood sugar balance, libido, and thyroid function, as well as adrenal gland health. Progesterone is primarily produced in the ovaries in premenopausal women and in the adrenal cortex in postmenopausal women. Although progesterone is found in both women and men, the physiologic role in men is poorly understood. •In women, lower levels of progesterone have been associated with dysfunctional uterine bleeding, and may play a role in osteoporosis and impaired neurological function. Excessive amounts can result in problems such as dysglycemia, alopecia, acne, and breast tenderness. •The clinical significance of elevated or low levels in men is poorly understood. Low progesterone levels may be involved in male infertility. Increased levels of progesterone have been found in states of stress and anxiety in men and women: this may relate to its sedative or stress-countering effects. Glucocorticoids & Cortisol The glucocorticoids, or 17-hydroxysteroids, are cortisol-related metabolites that have traditionally been assessed to provide insight into catabolic activity in the body. Assessment of total 17-hydroxysteroid metabolites gives a better sense of overall glucocorticoid production compared to cortisol alone. Cortisol (optional add-on) is the main glucocorticoid produced by the adrenal cortex and plays a central role in glucose metabolism and the body’s response to stress. In addition, cortisol has significant effects on protein, carbohydrate, and lipid metabolism, muscle tissue maintenance, myocardial integrity, and suppression of inflammatory responses. •An elevated 17-hydroxysteroids total and/or cortisol total may be caused by stress, strenuous exercise, inflammation, hypoglycemia, insulin resistance, hypothyroidism, or licorice ingestion. Indicated therapeutics include stress management, adequate sleep, reducing stimulants such as caffeine, reducing high glycemic load foods, as well as considering adrenal nutritional and botanical (adaptogenic) support. •A low 17-hydroxysteroids total and/or cortisol may be a result of endogenous suppression from exogenous glucocorticoid supplementation or adrenal or pituitary insufficiency.
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