I’ve been getting these tested when I do my sex hormones.
Then I read something about DHEA and wondered - shouldn’t I always get DHEA too? Is that even a sex hormone ?
Then I thought I’d ask you guys … am I missing anything that I should add to my core list of tests to get every time I check sex hormones? I’m about to consider HRT so want a baseline and the right repeating tests as I go along,
* Oestradiol
* Progesterone
* Follicle-Stimulating Hormone
* Luteinising Hormone
* Prolactin
* Testosterone
* Sex Hormone Binding Globulin
* Free Androgen Index
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DHEA-S(ulphate) is a blood test and apparently my levels were good but when I take a saliva test my free levels were low, ideally free levels are what you need to know
Yes, a blood serum test measures both DHEA and its sulphated form DHEA-S, and is usually accepted even by functional practitioners. This is because DHEA-S is the majority hormone by a long way and the lesser amounts of DHEA follows DHEA-S patterns. Therefore, by testing the DHEA-S you can glean the overall levels and also a good picture of DHEA.
The idea of measuring saliva DHEA or DHEA-S against saliva cortisol is to assess the ratio. Best outcomes for patients is a balanced ratio no matter what the levels as these can be (hopefully) reduced or increased. Unbalanced ratios means there is likely a load of other hormonal imbalances, etc, and a more complex approach to rectify.
I haven't heard of a DHEA:DHEA-S ratio, only with cortisol, and you can usually find the result on your saliva stress test.
'1-DHEA and 4-DHEA'
Haha, is the rower looking to become a body builder? 🚣♀️ 🏋️♀️.
These are just two of the types of modified DHEA supplemented for more anabolic effects, but how or why is way beyond my knowledge although I know they are manipulated to convert more to testosterone and less to oestrogen, whilst reducing symptoms such as water retention and rage 😳.
As a yogi🧘♀️ and cyclist 🚴♀️, I don’t usually read body builders forums but do follow the info concerning hormones and the immune system. Where did you find these?
I interpreted this bit (Therefore, by testing the DHEA-S you can glean the overall levels and also a good picture of DHEA.) as meaning you could get an idea of DHEA levels based on DHEA-S results
I went off in search of what the ratio was meant to be between the two.... we did the DHEA-cortisol ratio for my last homework 😅 I came across some mention of DHEA-S being 250-500 higher but couldn't really pin that to any science 🤷♀️
I'll have to look at the history on the other computer to see where 1-DHEA and 40-DHEA cropped up but certainly had an athletic bent to it so I gave up
'I interpreted this bit (Therefore, by testing the DHEA-S you can glean the overall levels and also a good picture of DHEA.) as meaning you could get an idea of DHEA levels based on DHEA-S results'
Exactly, because supposedly DHEA always follows the pattern of DHEA-S, although the later is in much larger supply. Hope this makes sense now.
Will your link teach me anything? Say anything different?
Nah, the link is just a good explanation of DHEA/S
So I don't really understand why my DHEA-S level is considered high at 7.5 umol/L(0.51-5.51) range changed age 55 from (0.51-11) but my DHEA at 0.46nmol/L (0.23-1.38)... not correspondingly high, which suggests to me DHEA-S doesn't give a clear guide to free levels?
I had to have a think about your question and as I see it .....
DHEA is the unconjugated (free un-metabilised) hormone that is transformed into DHEA-S that is sulphated and stored in the adrenal cortex, and then circulated in the blood as a reservoir for DHEA.
DHEA has a short half life so DHEA-S which has hugely higher levels keeps it topped up by reverting back to DHEA in peripheral tissues, and this process is also bidirectional as required.
Therefore, you can not compare DHEA to DHEA-S as you are doing as each measurement is the desired result in its own right and not to be used further. It will also be variable each time it is measured and especially DHEA which follows cortisols circadian rhythm.
However, if you measured saliva DHEA or DHEA-S with cortisol then you can see the ratio with cortisol which gives functional practitioners a good picture of your adrenal function. I seem to remember previously working yours out and it was good 👍.
Regarding your elevated results I wouldn’t worry. The range decreases according to age and I’m guessing you are about 60? ... So range could easily be extended a little so you wouldn't then be high in range ... simples! ... particularly as you have been supplementing DHEA and recently recovered good adrenal health. Remember these hormones are much more in abundance, not like strictly controlled thyroid hormones.
Just short hand for feeling incredulous at how silly and broken healthcare is.
Perhaps a 🤦♀️ or a 🤯 or a 🫠 instead !
Why on earth, indeed.
It’s like when you see anyone share a T3-uptake test… it’s a sure tell they are in the US. Completely useless and outdated, yet still part of an “thyroid panel”. When I told my daughters doctor once to do FreeT3, then they did T3-uptake… so I told them they have to do “Free T3.”
They point to t3-uptake and say “ we did that already.”
That looks good to me, presumably you are also getting a full panel of thyroid results as well? I would definitely encourage baseline tests before starting HRT. I hear what medics say about the lack of relevance in perimenopausal women as levels fluctuate but some don't fluctuate hugely (SHBG/Testosterone) and they will give you an idea of your starting point.
I didn't get any of these or thyroid hormones before I started and I'm now nearly 7 months in, feeling rubbish and unsure what had triggered what. Was I like this before HRT which is why I felt unwell or has the addition of HRT triggered these issues I'm experiencing.
For me, my SHBG is really high which means they my free levels of oestrogen and Testosterone are being effected. I now don't know if it was like it previously because of a potentially subclinical thyroid issue or is it the addition of oestrogen that has increased the SHBG. Is high SHBG also effecting my T3 or is my T3 effecting my SHBG 🤷♀️
There may be few answers but I really wish I'd had baseline bloods to compare.
Hi there OBAMS,I hope you can find a decent endo to help answer these questions for you - I appreciate that decent (knowledgeable) endo's are hard to find, especially as so many only seem to understand diabetes!
Maybe you can Google a good private Endo in your area, at least for your first appointment.
I don't know if you're taking Esteogen and Progesterone, you should not be on only one of them (well, so I have been told (by a doc).
Thanks Shield-Maiden, I'm hoping I've found a decent Endo but I can't get to see them until the middle of March! I'm hoping that's a good sign. I'm on the cancellation list though so I'm hoping something might come up earlier.
I am taking Progesterone and Oestrogen together as well as the Testosterone.
The mix of sex hormones and thyroid seems complex and finding someone who understands is tricky
The DHEA-S blood test seems a sensible thing to include.
As a nice to have, if the extra cost is ok - before starting HRT, I would also suggest an early morning (8-9am) cortisol blood test so that you can get an idea of how much difference HRT makes to your levels once you have been on it a while. But that's just a nice to have unless you have a specific reason to check it - actually, as I typed that I just noticed that you tagged your post with the addison's disease tag, so maybe you should.
Thank you! I do get serum cortisol with my usual thyroid batch, but actually yes, will add if only getting the sex hormones batch.
Also - no idea where those tags come from on posts, they automatically populate. So I’m not concerned about Addisons in particular but I definitely am watching adrenals overall as my Free Ts adjust - the adrenaline rushes, the insomnia, the sluggish mornings with heavy eyes - some getting better some getting worse as I go along : ) Have some one 6-point saliva, should do another at some point for comparison. I’m sure I’ve got a ways to go.
What stage of meno are you at? Post- menopausal, the LH & FSH become meaningless.
DHEA isn’t a sex hormone but is a precursor for sex hormones, and therefore can be useful to test in cases of adrenal fatigue when all hormones because low. Also useful to view in context with cortisol levels as they should oppose each other.
Prolactin will show a problem within the pituitary or if TSH is high.
SHBG is useful if you medicating large amounts of T3, and free sex hormones are low.
I’m on HRT and first tested O, P & T six monthly but now yearly. These are the three hormones I’m supplementing.
Thank you for this info… I’m on the beginning of my learning curve so this illuminates a lot.
I am right now very perimenopause. Monthly periods still happening but not quite the same number of days each cycle. A few years ago went from reliable 28 to reliable 25. Then within the last year have been more like 25-35~ ish.
Pretty sure I’m still ovulating. Taking Basel temp every morning and see a recognizable trend of the surge sometime between 9-18 days, and then the temp drops back down . Patterned and still predictable.
Have self-assessed with a few blood tests recently and think it’s estrogen dominance late cycle but still need to validate with a couple more tests at the right time of post-ovulation in my cycle. Rosacea has returned, sore boobs, some hot flashes, and … a return of soft, warm fatigue that I haven’t felt since I first diagnosed hashi. Kinda cool as it’s dampened my insomnia : ) but still seeking that equilibrium !
Had a sweet spot of my Free Ts recently for at least a week or more, then fatigue returned. Next steps include reducing my top range ft3, adding B vitamins, and getting an HRT plan so I can pull the trigger on that when I’m ready.
Also started NAC last week and have stopped today and it’s no joke - my guess is that my already top of range ft3 has just kicked a little higher. Anyway - stopping til I get more bloods and pretty sure I’ll be reducing t3 in the next step. And I think I’ll finally add my b12 and b complex. I’ve been bottom of optimal for folate (varies 10-20) and b12 (varies from 450-800 all without supplementing).
But at the ready for HRT sometime in the next few 6-8 week periods - and will use this time to gather info on my sex hormones so I can make the right decision .
Started after reading Dippys sinus infection post. I spent most of my undiagnosed years trying to fix what I thought were chronic sinus infections. MRIs, Neti pots, Sudafed, allergy medicine, garlic, etc.
I hit a sweet spot with my Ts about a month ago, and so started thinking what next.
Did a deep dive on NAC specifically and in addition to the benefits for sinus/mucous/lungs and stuff… long story even longer - touched on a part of my history regards to brain clock (vs body clock) that I e been researching a while, and the overlap of sinus stuff and the neurotransmitter stuff / and the relative low risk of NAC and the short time frame one could determine “it’s working” or not…. Made me think - why not! Let’s squeeze it in before my next move (likely/maybe HRT.)
Well. After a few days with the expected slight headache, it was pretty obvious my nose and lungs felt great. I also began to feel shifts in my body/brain clock, slept better. It was fascinating and great.
Then about a week ish into it - yesterday and the day before my heart rate jumped from about 68-78…. All the way up to 75-95… the first day I was like - what the heck.
The second day I carefully sequenced my morning, and coffee, and when I took the NAC it was a clear boost on the heart rate again. Lasted 5 hours.
I then hypothesized that it’s possible the impact of the NAC in all its glory … might have started to make my t3 more effective. Hypothesized that my already just-over range T3 may have went too-far-over.
Just a guess. But reminded me before I go taking something that theoretically is know to make thyroid hormones work better (like NAC) AND considering starting HRT MAY also lead to a reduction. I have to think about it more - but decided for the sake of my heart rate, to just stop and go back to my Ts, possible HRT, and maybe I take a minute to start supplementing B.
Short question long answer radd
I’m on an HRT and amino acid learning curve and appreciate your asking and would love your opinion !
The medical profession use NAC as a mucolytic agent, whereas the functional medicine side view it not only for its antioxidant properties but also because it is a precursor of glutathione (positive double whammy).
I initially used it under a practitioners c guidance for quelling thyroid antibodies and the chronic inflammation created by the numerous variables in Hashi, and since used it in a nasal spray as part of a mould detox regime.
NAC used to be very fashionable on the forum years ago. I haven’t heard of it directly increasing free thyroid hormones but I guess theoretically it indirectly could because it really is a multifunctional support, eg people take it for leaky gut, to improve liver function, balancing blood sugars, etc.
Over range T3 doses are never good long term. If you found NAC so beneficial you could always reduce your T3 meds.
I am definitely down the rabbit hole on NAC. I did not expect it to be so noticeable so quickly (whether it was impacting t3, I’m not sure but with a resting heart rate 85+ for two days, I’ll take a step back and rethink!)
So I think now, actually… start Bs finally, reduce t3 slightly… simultaneously get a late cycle sex hormone blood test, figure out what I want to do with HRT (love the Calcium D-Glucarate suggestion) and one day NAC will be back!
Izabella Wentz says if you have a CBS mutation , don't take NAC. I have a double CBS mutation. You talk about intending supplementing B vits and B12. If have CBS mutations folate, B12 and B6 are especially important. I wish she explained more fully re. CBS. She mentions that if have CBS you lose B12 too quickly. It gives you problems with the Methylation and Transsulfuration pathways. If you have this you probably can't tolerate cruciferous veg, onions, garlic etc. and will have a definite leaky gut. I don't know if this applies to you or not. I really wish I understood it better!
Hi Wua! Thank you and Merry Christmas 🎄! My next post should be “the ultimate genetic test wishlist”!
I googled Wentz and NAC (thyroidpharmacist.com/artic... and didn’t see where she said not to take with that mutation - did I miss it? I don’t think I lose B too quickly… but not sure how I could tell definitively. But since as noted above my Bs without supplementing have not been horrible (folate (varies 10-20) and b12 (varies from 450-800)) . But obviously a boost is needed.
Transsulfuration I need to Google. I only learned after I started taking it that it has sulfur in it … and in the past I’ve been allergic to sulfur : / But my allergies seem to go in the “7 year cycle” and I’m not anymore on any daily basis.
I have no issues with onions or garlic - I eat them regularly and love them!
But leaky gut is on my very long list to understand and investigate. I know nothing about it!
Re the Calcium D-Glucarate - is it an “and” or an “or” when it comes to HRT (for me, I think I will do bioidentical micronized progesteron specifically ).
If I get the HRT, would I do this also?
Or is the Calcium D-Glucarate a stand alone when not taking prescription HRT?
Just reading your convo with Wua13262348 regarding a CBS SNP. I usually like Isabella Wentz but will say on this occasion that the tolerance of sulphur will be dependant upon whether the genetic SNP up-regulates or down-regulates the trans-sulfuration pathway.
These training videos given by Lifecode GX are for practitioners but you do not have to be a practitioner to sign up for access to the group. lifecodegx.com/training Scroll through until you see The Trans-Sulfuration Pathway which shows sulphur tolerance/intolerance is also influenced by surrounding genetic SNP’s within the pathway.
Merry Xmas to you too! Izabella Wentz , when she mentions CBS mutation, is usually a one or two line comment within a lengthy article about various different things. An example of this is towards the end of her article on Selenium , where she says "Those with a CBS gene mutation have difficulty breaking down selenium (Research has found that selenomethionine needs to be converted into its active form via the CBS gene)." Selenomethionine contains sulfur, and if have a CBS mutation you are sulfur-sensitive.
If you put "Izabella Wentz and CBS mutation "in the Google search box , it will offer you an "Nac for thyroid health" article, which states , without even hitting on the link that "Moreover,NAC is not recommended if you have an expressed CBS mutation or a sulfur sensitivity." Nac is sulfur based. In the actual article it is hard to find anything explaining this.
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