Accession # 00216506 Female Sample Report 123 A Street Sometown, CA 90266 Sex Hormones and Metabolites Last Menstrual Period: 2015-10-12 Ordering Physician: DOB: 1976-01-01 Collection Times: Dr. Dutch Age: 39 2015-11-10 04:00AM 2015-11-10 06:00AM Gender: Female 2015-11-10 03:00PM 2015-11-10 09:00PM Test Result Units Luteal* Postmenopausal Progesterone Metabolites (Urine) Range Range b-Pregnanediol Below luteal range 196.0 ng/mg 600 - 2000 60-200 a-Pregnanediol Below luteal range 112.0 ng/mg 200 - 740 15-50 Estrogens and Metabolites (Urine) Estrone(E1) Above luteal range 28.2 ng/mg 12 - 26 3.0-7.0 Estradiol(E2) Above luteal range 5.1 ng/mg 1.8 - 4.5 0.2-0.7 Estriol(E3) Above luteal range 22.5 ng/mg 5 - 18 0.6-4.0 2-OH-E1 Below luteal range 4.8 ng/mg 5.1 - 13.1 0.3-2.0 4-OH-E1 Within luteal range 0.8 ng/mg 0 - 1.8 0-0.3 16-OH-E1 Above luteal range 4.7 ng/mg 0.7 - 2.6 0.2-0.6 2-Methoxy-E1 Below luteal range 0.8 ng/mg 2.5 - 6.5 0.3-1.4 2-OH-E2 Low end of luteal range 0.19 ng/mg 0 - 1.2 0-0.3 4-OH-E2 Within luteal range 0.3 ng/mg 0 - 0.5 0-0.1 2-Methoxy-E2 Within luteal range 0.5 ng/mg 0 - 0.7 0-0.4 Total Estrogen High end of range 67.1 ng/mg 35 - 70 4.0-15 Androgens and Metabolites (Urine) DHEA-S Low end of range 26.0 ng/mg 20 - 750 Androsterone Above range 1810.0 ng/mg 200 - 1650 Etiocholanolone Within range 680.0 ng/mg 200 - 1000 Testosterone Within range 7.7 ng/mg 2.3 - 14 5a-DHT Above range 7.2 ng/mg 0 - 6.6 5a-Androstanediol Above range 42.0 ng/mg 12 - 30 5b-Androstanediol Within range 32.0 ng/mg 20 - 75 Epi-Testosterone Within range 8.8 ng/mg 2.3 - 14 *the Luteal Range is the premenopausal range. When patients are taking oral progesterone this range for progesterone metabolites is not luteal and reflects the higher levels expected when patients take oral progesterone. This test is intended to be taken in the luteal phase of the menstrual cycle (days 19-22 of a 28 day cycle) for premenopausal women. The ranges in the table below may be used when samples are taken during the first few days (follicular) of the cycle, during ovulation (days 11-14) or when patients are on oral progesterone. See the following pages for age-dependent ranges for androgen metabolites. Additional Normal Ranges Follicular Ovulatory Oral Pg (100mg) b-Pregnanediol 100-300 100-300 2000-9000 a-Pregnanediol 25-100 25-100 580-3000 Estrone (E1) 4.0-12.0 22-68 N/A Estradiol (E2) 1.0-2.0 4.0-12.0 N/A Precision Analytical (Dawn Huo, Ph.D., Lab Director) Female Sample Report Page 1 of 10 3138 Rivergate Street #301C FINAL REPORT CLIA Lic. #38D2047310 McMinnville, OR 97128 11/25/2020 DutchTest.com Hormone metabolite results from the previous page are presented here as they are found in the steroid cascade. See the Provider Comments for more information on how to read the results. Pregnenolone This result is a e s weighted average n n of two progesterone o e 20 metabolites (below). r g 26 Progesterone is e Postmenopausal o measured indirectly 750 t range r s in urine. d DHEA DHEA-S e Progesterone n 5 g ß α 5 A o r 2.3 14.0 P 7.7 600 196 200 112 2000 740 60-200 15-50 ar b-Pregnanediol a-Pregnanediol Androstenedione Testosterone om at as ar e om 5 a ß α ta 5 se 200 680 1000 200 1810 1650 12 26 1.8 4.5 28 5.1 5.0 22.5 18.0 3.0-7.0 0.2-0.7 0.6-4.0 Etiocholanolone Androsterone CYP3A4 Estrone(E1) Estradiol(E2) Estriol(E3) primary estrogens (E1, E2, E3) C Y P 3 A 5ß preference 5α Preference 4 (androgenic) 5α-Reductase Activity s n 0.7 4.7 2.6 e 5α-metabolism makes androgens more potent, most g 0.2-0.6 notably 5α-DHT is the most potent testosterone metabolite o C 16-OH-E1 Y ) Phase 1 Estrogen Metabolism Ratios r P y 1 a t Age-Dependent Ranges B w 1 s h t Age DHEA-S Age Androsterone a E p 20-39 60-750 20-39 650-1650 e v 40-60 30-350 40-60 360-1000 i t >60 20-150 >60 200-600 c e Patient t 2-OH 4-OH 16-OH o Percentages r 46.4% 8.2% 45.4% p Age Testosterone Age Etiocholanolone ( Expected 60-80% 7.5-11% 13-30% 20-39 4-14 20-39 450-1000 1 40-60 3-8 40-60 300-800 A 1.8 Percentages (2-OH) (4-OH) (16-OH) 1 0.8 >60 2.3-6.3 >60 200-500 P Y 0.0-0.3 C 0.04-OH-E1 Glutathione detox Low High COMT QUINONE 2.5 0.8 6.5 5.1 4.8 13.1 (reactive) methylation 0.3-1.4 0.3-2.0 Methylation-activity 2-Methoxy-E1 2-OH-E1 2-Methoxy/2-OH Methylation detox 4-OH-E1 If not detoxified, 4-OH-E1 can bind to and damage DNA Precision Analytical (Dawn Huo, Ph.D., Lab Director) Female Sample Report Page 2 of 10 3138 Rivergate Street #301C FINAL REPORT CLIA Lic. #38D2047310 McMinnville, OR 97128 11/25/2020 DutchTest.com Clinical Support Overview Thank you for choosing DUTCH for your functional endocrinology testing needs! We know you have many options to choose from when it comes to functional endocrinology evaluation, and we strive to offer the best value, the most up-to-date testing parameters and reference ranges, and the greatest clinical support to ensure the most accurate results. Please take a moment to read through the Clinical Support Overview below. These comments are specific to the patient’s lab results. They detail the most recent research pertaining to the hormone metabolites, treatment considerations, and follow-up recommendations. These comments are intended for educational purposes only. Specific treatment should be managed by a healthcare provider. As an ordering provider, we encourage you to schedule a complimentary clinical consult with one of our expert DUTCH clinicians. Please schedule via our online scheduler, email [email protected] or call at 503.687.2050 to schedule a 15-minute or 30-minute consultation. Precision Analytical (Dawn Huo, Ph.D., Lab Director) Female Sample Report Page 3 of 10 3138 Rivergate Street #301C FINAL REPORT CLIA Lic. #38D2047310 McMinnville, OR 97128 11/25/2020 DutchTest.com How to read the DUTCH report This report is not intended to treat, cure or diagnose any specific diseases. The graphic dutch dials in this report are intended for quick and easy evaluation of which hormones are out of range. Results below the left star are shaded yellow and are below range (left). Results between the stars and shaded green are within the reference range (middle). Results beyond the second star and shaded red are above the reference range (right). Some of these hormones also change with age, and the age-dependent ranges provided should also be considered. For female reproductive hormones, a purple band is present on the dutch dials. This band represents the expected levels (reference range) for postmenopausal (or non-cycling) women. In a few places on the graphical pages, you will see fan-style gauges. For sex hormones, you will see one for the balance between 5a/5b metabolism as well as methylation. For adrenal hormones, you will see one to represent the balance between cortisol and cortisone metabolites. These indexes simply look at the ratio of hormones for a preference. An average or "normal" ratio between the two metabolites (or groups of metabolites) will give a result in the middle (as shown here). If the ratio between the metabolites measured is "low" the gauge will lean to the left and similarly to the right if the ratio is higher than normal. Patient or Sample Comments Throughout the provider comments you may find some comments specific to your situation or results. These comments will be found in this section or within another section as appropriate. Comments in other sections that are specific to your case will be in bold. The following video link(s) may help those new to dutch testing to understand the results. If you only have a hardcopy of the results, the video names can be easily found in our video library at www.DutchTest.com. Be aware that our reporting format has recently undergone some cosmetic changes, so the results on the video may look slightly different. These results and videos are NOT intended to diagnose or treat specific disease states. The following video may assist with the interpretation of the Progesterone and Estrogen results: Estrogen tutorial video This video may assist with the interpretation of the Androgen results: Androgen tutorial video The patient reports regular menstrual cycles. The patient reported symptoms of excess estrogen. This can be caused by excess estrogen or progesterone deficiency. Results should be carefully reviewed. We do not report a progesterone to estrogen ratio.