698814 COMPREHENSIVE HORMONE INSIGHTS™ TEST REPORT Dr. Maximus, N.D. E: [email protected] Date of Collection: P: 403-241-4500 Time of Collection: F: 403-241-4501 Date of Receipt: www.rmalab.com Reported On: CHI Accession: 698814 Healthcare Professional Patient Age: Dr. Maximus, N.D. Date of Birth: Gender: Male F: Relevant Medications Biometrics Curcumin Height (in) : 73 Weight (lb) : 180 BMI : 24 Waist (in) : 35 Hip (in) : 41 CHI Accession: 698814 SUMMARY HMUS01 How to read the graphs LEGEND: 50 66 Sex Steroid Hormones 50 66 Middle third of 33 33 84 reference population Hormone Start of 83 100 80 100 highest 16 Percentile Precursors 16 Percentile third of Sum of Androgens Sum of Estrogens 50 66 reference 0 0 population (T, DHT, α+β androstanediol) Listed in Interp Guide 33 84 End of 100 16 lowest Percentile00 50 66 50 66 third of 33 33 84 reference 0 population Patient’s percentile rank 81 100 95 100 compared to reference 16 Percentile 16 Percentile population (see summary) DHEA + Metabolites Sum of Progesterone Metabolites 0 (DHEA + A + E) 0 α+β Pregnanediol Cortisol Melatonin Oxidative Stress Free Cortisol Profile (ng/mg) 100 50 66 50 66 33 84 33 84 80 64 100 0 100 16 Percentile 16 Percentile 60 6-sulfatoxy 8-Hydroxy-2- 0 Melatonin 0 deoxyguanosine 40 (Overnight) (Overnight) 20 6-sulfatoxymelatonin provides 8-hydroxy-2-deoxyguanosine is Cortisol/Creatinine (ng/mg) insight into melatonin levels. a marker of oxidative stress 0 Morning Dinner Bedtime A B C 50 66 Free cortisol Cortisol Metabolites 33 84 profile is used to provides a general Testosterone Cortisol assess diurnal assessment of 16 100 cortisol rhythm adrenal cortisol 16 Percentile Cortisol production Cortisol Metabolites 0 (α+β THF + THE) Testosterone Cortisol/Testosterone provides insight into relative catabolic (cortisol) and anabolic (testosterone) states. Accession Number: 698814 Page 3 of 25 CHI Accession: 698814 MARKERS REFLECTING THYROID HORMONE ACTIVITY There are multiple ratios and patterns measured in this test that can potentially inform on the overall activity of thyroid hormones. The interpretation is “tuned” to comment on thyroid hormone activity only when there is sufficient alignment amongst all the various indicators. If alignment is not sufficient, various individual comments about thyroid hormone activity may appear but there will be no overall “verdict” regarding thyroid hormone activity. When multiple indicators are measured simultaneously, chance variations can decrease the likelihood that all of the indicators will align perfectly, even in the face of a bona fide thyroid hormone issue. Accession Number: 698814 Page 4 of 25 CHI Accession: 698814 STEROID HORMONE OVERVIEW LEGEND Hormone Heat Map Not Reported HMUS02 <DET or NA Aldosterone 0 - 16 17 - 33 18-OH Corticosterone THA 34 - 66 Percentile 67 - 84 Corticosterone THB Glucocorticoids β-Cortolone 85 - 100 Progesterone Reductase Cholesterol 11-Deoxycorticosterone β-Pregnanediol Cortisone 5β-THE α-Cortolone 11βHSD 3βHSD Pregnenolone Progesterone α-Pregnanediol Cortisol 5β-THF α-Cortol 17 Hydroxylase 17 Hydroxylase Reductase 3βHSD 17 OH-Pregnenolone 17 OH-Progesterone 11-Deoxycortisol 5α-THF β-Cortol 17,20 Lyase 17,20 Lyase 3βHSD Aromatase cyp19 DHEAS DHEA Androstenedione 2-MeOE1 4-MeOE1 epi-Testosterone DHEA Glucuronide 17βHSD Type 3 17βHSD Type 3 Testosterone Glucuronide 2-OHE1 4-OHE1 3βHSD Aromatase cyp19 Androstenediol Testosterone E1 16α-OHE1 5β Reductase 5β 5α Reductase 5α 5β-DHT 5α-DHT E1S 3βHSD 17 OH-Progesterone 3βHSD 5β-Androstanediol Progesterone 5α-Androstanediol E2 E3 17βHSD backdoor pathway 17βHSD Etiocholanolone Androsterone 2OHE2 4-OHE2 11KE 11HE 11KA 11HA 2-MeOE2 4-MeOE2 Androgens 5β Reductase 5α Reductase Estrogens The Rocky Mountain Analytical Hormone HeatMap provides an overview of sex steroid hormone and hormone metabolite results. For each of the Hormone HeatMap pathways, the colour that frames the named hormone or metabolite corresponds to the percentile found in the Legend (top left). This makes deficiencies or excesses in the major hormone groups easy to identify and patterns easier to discern. Note: Hormones bordered in gray are either not tested or not reported. They are included for completeness. HORMONE ABBREVIATIONS 5ß-THE: 5ß-tetrahydrocortisone E1: estrone 2OHE2: 2-hydroxyestradiol 5α-THF: 5α-tetrahydrocortisol E2: estradiol 4OHE2: 4-hydroxyestradiol 5ß-THF: 5ß-tetrahydrocortisol E3: estriol 16α-ΟΗE1: 16α-hydroxyestrone 11HA: 11-hydroxyandrosterone 2-MeOE1: 2- methoxyestrone 11HE: 11-hydroxyetiocholanolone 2-MeOE2: 2-methoxyestradiol 11KA: 11-ketoandrosterone 2-OHE1: 2-hydroxyestrone 11KE: 11-ketoetiocholanolone 4OHE1: 4-hydroxyestrone DHEAS: dehydroepiandrosterone sulfate DHEA: dehydroepiandrosterone Accession Number: 698814 Page 5 of 25 CHI Accession: 698814 CORTISOL & CORTISOL METABOLITES Hormone Heat Map HMUS03 CORTISOL CONJUGATION PATTERN Cortisol (free) Cortisol sulfate Cortisol glucuronide 18.2 - 32.8 % 20.7 - 34.7 % 40 - 53.1 % Reference Population (Male) Patient Result 50.9% 35.2% 13.9% 11βHSD2 Cortisol-Cortisone Metabolite Balance Cortisol Cortisone 11βHSD1 5α-THF 5β-THF 5β-THE Cortisol Clearance Ratio Activity of 11-β HSD2 The ratio (aTHF+ βTHF + βTHE) / (Cortisol + Cortisone) This marker informs on the nature of the activity of 11-β HSD2 enzyme. 11-β HSD2 provides insight into the overall “speed” of reduction or converts cortisol to inactive cortisone in kidneys, distal colon and saliva glands. When this hydrogenation of cortisol and cortisone. enzyme is markedly inhibited free cortisol will be much greater than free cortisone. When the enzyme is upregulated free cortisone will typically be much greater than free cortisol. Activity of 11-β HSD2 0 Percentile 100% Inhibited Active Upregulated (More Cortisol) (More Cortisone) Cortisol Metabolites Alpha Reductase Preference 50 66 αTHF / βTHF Insight into adrenal 33 84 Alpha reductase production of cortisol preference may be metabolites. 16 100 influenced by thyroid 16 Percentile 0 Percentile 100% status. Cortisol Metabolites 0 (αTHF + βTHF + βTHE) Free Cortisol Profile Free Cortisol Profile (ng/mg) 100 The Free Cortisol Profile provides insight into the diurnal rhythm of cortisol. 80 60 The dotted lines Two ratios are calculated: represent the 20th and 40 - Overnight Cortisol Response (D/C) 80th percentiles for each cortisol point. - Morning Cortisol Response (A/D) 20 Neither ratio is graphed, but both are commented on in Cortisol/Creatinine (ng/mg) 0 the interpretation. Morning Dinner Bedtime Overnight A B C D Accession Number: 698814 Page 6 of 25 CHI Accession: 698814 CORTISOL RATIOS AND SUMS CORTISOL & METABOLITES Range Analyte Result Range Units 0% 16% 33% 66% 84% 100% %ile Applied Cortisol (GCMSMS) 100 40 - 78 ng/mg 0.94 94% Male Cortisone (GCMSMS) 110 63 - 120 ng/mg 0.78 78% Male a-Tetrahydrocortisol (aTHF) 200 170 - 430 ng/mg 0.29 29% Male ß-Tetrahydrocortisol (ßTHF) 890 860 - 1,500 ng/mg 0.23 23% Male ß-Tetrahydrocortisone (ßTHE) 1,400 1,500 - 2,500 ng/mg 0.11 11% Male aTHF+ßTHF+ßTHE 2,500 2,700 - 4,400 ng/mg 0.16 16% Male Cortisol Clearance Ratio 12 18 - 31 0.03 3.1% Male a-THF/ß-THF 0.23 0.16 - 0.36 0.47 47% Male Cortisol/Testosterone 0.31 0.20 - 0.85 0.39 39% Male Morning Free Cortisol (Specimen A) 83 11 - 49 ng/mg 0.94 94% Male Dinnertime Free Cortisol (Specimen B) 23 3.6 - 16 ng/mg 0.90 90% Male Bedtime Free Cortisol (Specimen C) 8.7 1.2 - 5.2 ng/mg 0.90 90% Male Overnight Free Cortisol (specimen D) 14 4.5 - 19 ng/mg 0.69 69% Male Free Cortisol (pooled specimen) 53 10 - 28 ng/mL 0.97 97% Male Free Cortisone (pooled specimen) 90 34 - 58 ng/mL 0.95 95% Male 11-beta HSD2 Activity Ratio 1.0 0.42 - 1.8 0.54 All DETERMINANTS OF FREE CORTISOL The amount of free cortisol relative to overall cortisol production is determined by five main factors: 1. The overall extent of production of cortisol, influenced by various factors including sleep (quantity, quality, OSA), allostatic load (stress), inflammation, thyroid hormone activity, body fat burden, calorie intake. 2. The combined rates at which alpha- and beta-reductase irreversibly convert cortisol and cortisone to hydrogenated metabolites-influenced by presence or absence of biliary stasis, hepatic inflammation, thyroid hormone activity, intake of lipotrophic nutrients and foods. 3. The tendency to preserve cortisol as cortisol or shift it to cortisone-which is subject to bile acids, insulin, exercise, % body fat, supplements 4. The extent to which conjugation (Phase II) enzymes are active-which is subject to genetics, exposure to external toxins, diet, hormones and supplements taken. 5. General nutrient intake including nutrients relevant for adrenal health (e.g. Vitamin C, B Vitamins, Mg, K, adequate Na intake). It is difficult to identify any one factor that will be dominant: thyroid support, liver support, identification and removal/mitigation of sources of inflammation, and normalization of the insulin-glucose axis all play some role. Here the result for free cortisol (ng/mg) in the pooled specimen lies at 95 % in the reference population. ***NOTE: The percentile for the pooled free cortisol cannot be estimated by taking the average of the percentiles for each of the four point free cortisols !! Accession Number: 698814 Page 7 of 25 CHI Accession: 698814 RESULT FOR SUM OF MAJOR CORTISOL METABOLITES IS LOW; LOW CORTISOL SYMPTOMS ARE NOT PROMINENT OR NOT LISTED The result for the sum of the major cortisol metabolites, reflective of overall cortisol production, lies at or below the 33rd percentile; however, symptoms of low cortisol are not prominent or the symptom inventory was not filled out. Symptoms of low cortisol secretion can include anxiety, increased tendency to allergies, morning sluggishness, low blood pressure, low blood sugar between meals, irritability, muscle aches and pains as well as problems with memory. It's possible that the patient has many of these symptoms but may be downplaying their severity.