Lab Comments
Salivary cortisol is fluctuating from high to normal throughout the day suggesting stressors causing adrenal exhaustion and/or
poor regulation of blood sugar levels (dysglycemia-common in individuals with insulin resistance/metabolic syndrome). Acute
situational stressors (e.g., anxiety over unresolved situations, travel, work-related problems, wedding, holiday season, etc.) can
raise cortisol levels, which is a normal response to the stressor. Symptoms commonly associated with high cortisol include sugar
craving, fatigue, sleep disturbances, anxiety, and depression. If cortisol remains elevated throughout the day (usually associated
with a high night cortisol) and over a prolonged period of time (months/years) excessive breakdown of normal tissues (muscle
wasting, thinning of skin, bone loss) and immune suppression can eventually result. Adequate sleep, gentle exercise, naps,
meditation, proper diet (adequate protein), natural progesterone, adrenal extracts, herbs such as licorice, and nutritional
supplements (vitamins C and B5) are some of the natural ways to help support adrenal function (consult with a health care
provider for proper dosing). For additional information about strategies for supporting adrenal health and reducing stress(ors),
the following books are worth reading: "Adrenal Fatigue", by James L. Wilson, N.D., D.C., Ph.D.; "The Cortisol Connection", by
Shawn Talbott, Ph.D.; "The End of Stress As We Know It" by Bruce McEwen; "Awakening Athena" by Kenna Stephenson, MD.
Estradiol (blood spot) is within expected range for a premenopausal woman. Self-reported symptoms/signs of estrogen
imbalance are not problematic at this time. During the second half of the menstrual cycle (luteal phase) estradiol should be well
balanced with progesterone (optimal Pg/E2 ratio: 100-500).
Progesterone (blood spot) is within expected mid-range for a premenopausal woman during mid-luteal phase of the menstrual
cycle. Progesterone should be well balanced with estradiol (optimal Pg/E2 ratio 100-500, when estradiol is within
mid-physiological range).
Testosterone (blood spot) is within normal range for a premenopausal woman. Testosterone is an anabolic hormone essential
for creating energy, maintaining optimal brain function (memory), regulating the immune system, and building and maintaining the
integrity of structural tissues such as skin, muscles, and bone.
DHEAS (blood spot) is much higher than the reference range. DHEAS is a precursor to more potent androgens such as
testosterone and DHT and is often associated with symptoms of androgen excess (loss of scalp hair, increased facial/body hair,
acne). DHEAS rises during the early teens and peaks in the early twenties; thereafter DHEAS levels drop steadily with age to
the lower end of the range by age 70-80. A very high DHEAS could result from DHEA/adrenal supplements, acute adrenal gland
stressors, insulin resistance (a pre-diabetic condition) and in rare cases congenital adrenal hyperplasia (CAH-usually
co-associated with very low cortisol) or an adrenal adenoma. DHEA supplementation can cause a very significant increase in
DHEAS and about a 50-100% increase in testosterone levels. High DHEAS, particularly when coupled with high testosterone,
excessive weight in the waist, obesity, high triglycerides, and/or high blood pressure, is a strong indication of insulin
resistance/metabolic syndrome. Insulin resistance is strongly associated with polycystic ovaries. High levels of insulin, caused
by insulin resistance or exogenous insulin supplementation (diabetes) may stimulate the adrenal glands to produce high levels of
DHEAS. For more information, see:
http://www.ovarian-cysts-pcos.com/index.html;
http://www.pcosupport.org or "PCOS, the Hidden
Epidemic" by Samuel Thatcher, MD.
SHBG is within normal range. The SHBG level is a relative index of overall exposure to all forms of estrogens (endogenous,
pharmaceutical, xeno-estrogens). As the estrogen levels increase in the bloodstream there is a proportional increase in hepatic
production of SHBG. Thyroid hormone and insulin also play a role in regulating hepatic SHBG synthesis. Thyroid hormone
synergizes with estrogen to increase SHGB production while insulin, in excess (caused by insulin resistance) decreases SHGB
synthesis. Thus, in individuals with thyroid deficiency and insulin resistance the SHBG level is usually low. SHBG is an important
estradiol and testosterone binding globulin that help increase the half life of these hormones in the bloodstream, and also limit
their bioavailability to target tissues. SHBG binds tightly to testosterone and its more potent metabolite dihydrotestosterone
(DHT). It also binds tightly to estradiol, the most potent of the endogenous estrogens, but about 5 times weaker than to
testosterone and DHT. Thus an increase in SHBG results in proportionately less bioavailable testosterone than estradiol.
Free T4 is within normal range. If symptoms of thyroid deficiency are problematic it would be worthwhile to consider thyroid
therapy.
Free T3 is within normal range. If symptoms of thyroid deficiency are problematic this may be due to a "functional" thyroid
deficiency, meaning that the thyroid hormone is not functioning normally at the tissue level.
TSH is within high-normal range. Although most laboratories have a TSH range of 0.35-5.50, new studies are finding that the
mean and median values are 1.0-1.5mU/l . Some experts believe that TSH should be kept near the median value of healthy
individuals. TSH levels >3.0 are now considered abnormal due to changes by the endocrinology association - see
http://www.aace.com for more information. Thyroid therapy may be worthwhile considering if T4 and/or T3 are low and symptoms of thyroid deficiency are problematic.
Good luck!