This report tutorial is to assist you as you interpret results with our dried urine test for comprehensive hormones for patients taking estrogens in their mouth sublingually under their tongue or somewhere where it’s absorbed in the mouth not intended to be swallowed the issue with this type of router administration is that inevitably most people are going to
Swallow some and when you swallow it you get a lot of first pass metabolism what is that that’s a hormone that’s gonna go down into the gut and essentially it’s gonna end up in the urine without having gotten into systemic circulation and then another fraction of that is going to get into if you will systemic circulation and then also find its way into the urine
You can’t tell which is which so you don’t know how much is swallowed but the amount that gets swallowed gives basically a disproportionate amount into the urine so you can end up with these very high results and it doesn’t necessarily mean you’re takin too much estrogen it may just mean that you swallowed a great deal of it so if patients are very careful you
Know go to extremes of collecting their saliva while they’re administering the hormone you can be fairly sure that you’re not swallowing any but under normal supplementation scenarios people swallow them and they end up getting these types of results where there’s just a pan elevation there all high it’s more common to get this sort of a result where e1 e2 and
E3 are elevated and then the metabolites downstream they’re not as subjected to the first pass metabolites so when i see this type of a profile i think the metabolites in aggregate reflect probably pretty well what’s going on in systemic circulation so the way to get good numbers on all these is is either one to go to great extremes to not swallow it or two you
Can skip it the day of the test and when you skip it the day of the test you’re going to avoid the first pass but the numbers you get are to some degree potentially an underestimation of what’s going on the day of testing so it’s a limited scenario but what we want to look at are you know how much do we have of each of these estrogen you’re probably gonna see a
Little bit higher s drone relative to the other compounds because when you take estrogens orally which you sort of are with sublingual hormones you get a lot of ester own sulphate in the urine typically that’s gonna bump those numbers up but in this particular case you know you’re getting a lot of ester own sulphate you get a decent amount of estradiol so up in
The upper end of the range and then we can evaluate the metabolites and that’s probably the most valuable piece of this with sublingual hormones is looking at how the metabolism pattern ends up and you can see for this particular patient the only metabolite that’s elevated is the four hydroxy estrogen and that could be somewhat problematic most people want to see
The two hydroxy be preferred and so we can look at that and evaluate that the pie charts are helpful for that you know in this patient you normally you get a seventy ten and twenty sort of split with those three and here you’re closer to eighty 13 and eight so there’s an under production of the sixteen hydroxy estrogens a slight overproduction of the four and a
Significant over production also of the two hydroxy estrogen so that’s decent phase one metabolism but you do have this high level of four hydroxy estrogens how are you gonna get rid of those methylation and that’s why we want to always look at methylation as well so you’ll want to evaluate that we’re not looking at necessarily are the results low are the results
High we’re looking at the relative conversion so for these two patients there are two hydroxy ones about the same but the tomb ethoxy is very different so there’s a lot of methylation going on here as we look at the ratio between the two and not very much going on here so in those cases you might want to look for genetic defects for methylation most notably mthfr or
You might want to look at potentially some of the cofactors that are involved in methylation so but you want to look carefully at the estrogen levels and the metabolites but you just want to be really careful when you’re looking at the absolute levels that you put it in the right context especially if the patient has swallowed a high degree of the hormone because
That can be a little bit confusing and you want to make sure that you put that in the proper context
Transcribed from video
Interpreting Estrogen Sublingual 06 By Precision Analytical