Poor hormone metabolism can be a bigger driver of unwanted symptoms than hormone production. That means that the way our bodies metabolise and detoxify our hormones after they’ve been used, can determine a huge amount about the way we feel.
This is one of the main reasons we test hormones in urine – aside from being more accurate than blood testing for hormones, it allows us to assess this vital piece of the hormonal puzzle when getting to the root cause of your symptoms.
So let’s look at 5 examples of when hormone levels are ‘normal’ but poor hormone metabolism is the root cause of symptoms.
- Period pains, heavy periods or fibroids
- Acne and body hair growth
- Anxiety and insomnia
- Weight gain
- Breast cancer or high breast cancer risk
1. You’ve got period pains, heavy periods or fibroids (but estrogen is normal)
More often than not, symptoms like period pains, heavy periods and fibroids are a result of poor hormone detoxification, specifically poor estrogen detoxification.
This is particularly true if we have issues with our Phase 1 estrogen metabolism, and favour the 16-OH pathway.
What is the 16-OH pathway?
Our estrogen is metabolised and detoxified in two phases by the liver, and then excreted via the gut and urine.
In the first phase of detoxification, our estrogen travels down 3 different pathways: the 2-OH (favourable), the 16-OH (less favourable) and 4-OH (least favourable).
We want around 70% of our estrogen going down the more favourable 2-OH pathway, with the remainder going down the 4-OH or 16-OH.
If more than 30% of estrogen goes down the 16-OH pathway (you can see an example below), it can cause a lot of problems. This is because the 16-OH pathway is more proliferative, meaning it accelerates the impact of estrogen inside the body. It can cause tissue proliferation in endometrial tissue (hello cramps and heavy bleeding), breast tissue (tender or lumpy breasts) and also ovarian tissues (ovarian cysts).
It is important to test your phase 1 (and 2) estrogen metabolism before starting any estrogen hormone therapy.
An example of poor Phase 1 estrogen metabolism and a preference for the 16-OH pathway, taken from a FUTURE WOMAN hormone test report.
How do I know if I have a 16-OH preference?
I have tested and I have a preference for 16-OH, what can I do about it?
Examples of support for 16-OH pathway preference include:
- Antioxidant support in the form of diet and specific supplementation, for example NAC
- Anti-inflammatory support via the diet and supplements, for example turmeric
- DIM (only if high overall oestrogen and low 2OH preference)
- B6 in therapeutic dose
2. You’ve got acne or body hair growth (but testosterone is normal)
Have you tried everything, and nothing will get rid of your acne? Or maybe you’re dealing with unwanted hair growth along your jaw line or chest? Suspecting high testosterone levels, you may have even had your hormones tested in blood serum and everything has come back ‘normal’.
There’s another hormone metabolite that can cause these unwanted symptoms, even when testosterone is within range – and that’s 5a-DHT, which gets converted from our androgens via the 5 alpha reductase pathway.
5a-DHT is at least THREE TIMES more potent than testosterone. So when you have a preference for the 5a pathway, it can lead to symptoms associated with too much testosterone, including head hair loss, body hair growth, acne and oily skin.
An example of low androgens, but a preference for the 5a reductase pathway, taken from a FUTURE WOMAN hormone test report.
How do I know if I favour the 5a pathway?
I’ve tested and I favour the 5a pathway, what can I do about it?
Examples of support for favouring the 5a reductase pathway include:
- High therapeutic dose of zinc to move preference from 5a to 5b pathway
- Herbs such as Reishi, stinging nettle and saw palmetto
- Implement stress management such as daily breath work
- Ensure adequate vitamin D levels
- Increase flavonoids in the diet
3. You have insomnia or anxiety (but progesterone is normal)
Progesterone is one of our favourite hormones because it helps us feel cool, calm and collected. Made as a result of ovulation, progesterone helps to support sleep, reduces anxiety and lightens our period.
But if we’re getting regular menstrual cycles, and we know we’re ovulating every month (tracking through basal body temperatures or cervical mucus), or perhaps we’ve tested progesterone levels and they’ve come back normal, then why are we still feeling anxious and struggling with sleep?
It could be your progesterone metabolism. If you’re feeling the wonderful effects of progesterone after ovulation, you likely favour the 5a-pregnanediol pathway. This metabolite can cross the blood-brain barrier and up-regulate GABA, our calming neurotransmitter. But if you favour the 5b-pregnanediol pathway you’re less likely to feel the soothing effects of progesterone, meaning more anxiety and poor sleep.
If you’re taking progesterone HRT and aren’t noticing any of the benefits, you may want to check your progesterone metabolism to see if you’re favouring the 5b-pregnanediol pathway.
An example of a client who strongly favoured the 5-b pregnanediol pathway and struggled with anxiety and poor sleep.
How do I know if I favour the 5b-pregnanediol pathway?
I’ve tested and I favour the 5b-pregnanediol, what can I do about it?
Examples of support for a 5b preference include:
- Herbs such as chaste tree (vitex) to upregulate progesterone
- Specific nutrients such as B6
- Adequate magnesium in the diet and proper supplementation
- Specific adaptogens to support the HPO and HPA axis
- Specific supplementation to support sleep such as passionflower, L-theanine and more.
4. You’re struggling to lose weight (but cortisol is normal)
For women, weight loss is a lot more complicated than calories in, calories out. And the main reason for this is our hormones! In particular cortisol, our main stress hormone, plays a key role in helping us to maintain a healthy weight. When cortisol is out of balance, it can cause us to gain weight or have difficulty shifting weight.
While stress can cause us to gain weight, assessing high free cortisol levels (the amount of cortisol in circulation) on their own is not sufficient to identify cortisol as a root driver.
However, looking at cortisol metabolism can provide more answers. For example, if free cortisol is high, but metabolised cortisol is low, this is indicative of possible slow thyroid function and therefore slow overall metabolism, which may be contributing to your weight gain.
An example of a client who had higher levels of free cortisol and lower metabolised cortisol.
How do I know if I have slow cortisol metabolism?
I’ve tested and I have slow cortisol metabolism, what can I do about it?
Examples of support for cortisol metabolism include:
- Herbal medicine such as skullcap (to increase active cortisol to inactive cortisone)
- Ashwagandha or other adaptogens to support overall stress response
- Magnesium to lower total cortisol levels and increase metabolism of cortisol
- Balance blood sugar
- Increase Omega 3s in the diet and decrease Omega 6s
5. You are at high risk for breast cancer (but your estrogen is normal)
There are many risk factors for breast cancer including genetics, age of puberty/menopause, alcohol consumption, even height. Research shows that poor phase 1 estrogen metabolism also increases the risk.
In particular, there is a known correlation between a high preference for the 4-OH pathway in phase 1 estrogen detoxification and breast cancer. This is because the 4-OH metabolites can create reactive products that damage DNA. Damaged DNA disrupts the signalling in our cells and impairs the body’s ability to repair itself or stop abnormal cell growth.
This is one of the reasons it’s so important to test your estrogen metabolism before starting estrogen hormone therapy.
An example of a client who strongly favoured the 4-OH estrogen pathway in Phase 1.
How do I know if I have a 4-OH preference?
I’ve tested and I have a preference for 4-OH, what can I do about it?
Examples of support for reducing the 4-OH pathway preference include:
- Specific supplementation support to such as DIM/ I3C (if high overall estrogen)
- Sulforaphane to move from the 4-OH to the 2-OH pathway
- Ensure adequate antioxidant support such as glutathione (tested in our Advanced and Advanced+ Hormone Tests)
- Specific methylation support for phase 2 estrogen detoxifications