TM with specialized hormone testing Discover Essential Insights the GDX-7-144 Cholesterol Steroidogenic Pathways © 2018 Genova Diagnostics Pregnenolone 17-OH-Pregnenolone DHEAAndrostenediol Essence_trifold_030718 Pregnanediol Pregnanetriol Progesterone 17-OH-Progesterone Androstenedione Testosterone Etiocholanolone 11-Deoxycortisol DHT Corticosterone THS 11β-OH-Androstenedione Androsterone Androstanediol Mineralocorticoids Cortisol Cortisone 11-OH-Androsterone Estrone (E1) Estradiol (E2) Aldosterone* a-THFTHF THE 11-OH-Etiocholanolone Adrenosterone 2-OH (E1+E2) 2-MeO (E1+E2) 17-Hydroxysteroids 800.522.4762 • www.gdx.net 16a-OH(E1) Estriol (E3) ENZYMATIC STEPS: 11-Keto-Androsterone 11-Keto-Etiocholanolone 3βHSD = 3beta-Hydroxysteroid dehydrogenase 4-OH (E1+E2) 5α = 5alpha-Reductase 17-Ketosteroids 4-MeO (E1+E2) 5β = 5beta-Reductase CYP11b1 = 11beta-Hydroxylase Hormones measurable 11βHSD = 11beta-Hydroxysteroid dehydrogenase Estrogen Metabolites 17βHSD = 17beta-Hydroxysteroid dehydrogenase by Genova Diagnostics: 17,20 Lyase = 17,20 Desmolase CYPc17 = 17alpha-Hydroxylase Measurable in Urine CYP19 = Aromatase CYP21 = 21-Hydroxylase ESTROGEN METABOLISM: Measurable in Blood 1A1 = Cytochrome p450 1A1 (CYP1A1) 3A4 = Cytochrome p450 3A4 (CYP3A4) 1B1 = Cytochrome p450 1B1 (CYP1B1) Measurable in Saliva COMT = Catechol-O-Methyl-transferase © 2016 Genova Diagnostics • e,po,steropath,031016 *Serum Testosterone Melatonin (x3) Progesterone (x3) Estrogens (x3) (E1, E2, E3) Testosterone Progesterone Melatonin (x3) Peri/Menopausal Females Estrogens (E1, E2, E3) *Serum Saliva Profiles Testosterone Melatonin (x3) Estradiol (x11) Progesterone (x11) for Cycling Females *Saliva www.gdx.net Cortisol Metabolites Genetic SNPs (add-on) 24 Hour or FMV Urine Profiles HORMONE TESTING COMPREHENSIVE-TO-SPECIFIC TESTING HORMONE Not sure where to start? Androgens & Metabolites Progesterone Metabolites Additional Tests additional product information. Please visit SALIVARY HORMONES URINARY HORMONES SERUM HORMONES Adrenocortex Estrogen Male Hormonal Estrogen Comprehensive Cortisol Awakening Adrenocortex Stress Profile with Menopause Check One Day Hormone Male Hormones Comprehensive Complete Essential Estrogens™ BIOMARKERS Menopause™ * Menopause Plus™ * Rhythm Plus™ * Rhythm™ * Cortisol, Salivary Metabolism Estronex® Profile * Hormonal Health™ Health™ * Metabolism Thyroid Response Stress Profile Cortisol Awakening Plus™ Check™ * Plus™ Melatonin Profile * Hormones™ * FMV/24Hr What sample type should I use? Response Assessment Assessment Assessment ‡ 11-Hydroxy-androsterone 11-Hydroxy-etiocholanolone 11-Keto-androsterone 11-Keto-etiocholanolone 2-Hydroxyestrone + 2-Hydroxyestradiol [2-OH(E1+E2)] also reported separately 16α-Hydroxyestrone (16α-OH E1) 4-Hydroxyestrone + 4-Hydroxyestradiol [4-OH(E1+E2)] 4-OHE1 only 2-Methoxyestrone + 2-Methoxyestradiol [2MeO(E1+E2) 2-MeOE1 only Serum 4-Methoxyestrone + 4-Methoxyestradiol [4MeO(E1+E2)] 4-MeOE1 only • Measures bound circulating hormones Anabolic/Catabolic Balance • In-office collection E/A: 5β/5α Ratio • Useful to evaluate baseline primary sex hormone levels 2-OH (E1+E2) / 16α-OHE1 • Useful to monitor bioidentical hormone therapy (oral, pellets, injectables) 2-OH (E1+E2) / 2-MeO (E1+E2) 2-OHE1 / 2-MeOE1 Anti-TG Anti-TPO Saliva Androstanediol Androsterone • Measures unbound, bioavailable hormones Cortisol x4 x4 x6 + • At-home collection Creatinine • Optimal choice to evaluate diurnal cortisol and melatonin levels Dihydrotestosterone (DHT) • Useful to evaluate baseline primary sex hormone levels • Useful to monitor bioidentical hormone therapy (oral, topical) DHEA Estradiol (E2) Estriol (E3) Estrone (E1) Urine Estrone Sulfate • Measures unbound, bioavailable hormones Etiocholanolone • Evaluates hormone metabolites Free T3 + • At-home collection Free T4 • 24-hour collection for patients on hormone therapy or First Morning Void (FMV) Insulin-Like Growth Factor 1 (IGF-1) for non-supplemented patients Melatonin Progesterone Patients with hormonal imbalance may present with: Pregnanediol • Fatigue Pregnanetriol • Weight loss or gain Prostate Specific Antigen (PSA) • Menstrual irregularities Reverse T3* • GI complaints INDIVIDUAL COMPONENTS INDIVIDUAL Sex Hormone Binding Globulin (SHBG) • Memory decline Testosterone • Low libido Tetrahydrocortisol, THF • Insomnia Tetrahydrocortisone, THE • Change in hair and skin Tetrahydrodeoxycortisol • Hot flashes allo-Tetrahydrocortisol, a-THF Using hormone testing, clinicians can customize hormone TSH and/or nutritional therapies. Add-On Androstenedione Add-on Bone Resorption Add-On Follicle Stimulating Hormone Add-On Luteinizing Hormone Add-On Prolactin Add-On Vitamin D * NOT AVAILABLE IN NEW YORK + Add-On for this test only.