Adrenal Stress Profile (Saliva)

Abdul R. Khan, MD

LABORATORY DIRECTOR

18173 S. Pioneer Blvd

Artesia, CA 90701

Ph: 562-924-2299

Fax: 562-924-7830

Salivary Cortisol and DHEA

Hormone Test In Range Elevated Units Reference Range

Cortisol Morning 1.062 ug/dl 0.200 - 1.200 ug/dl

DHEA 3 pg/ml 137 - 336 pg/ml Males

632* 106 - 300 pg/ml Females

DHEA:Cortisol Ratio/10,000 595 115 - 1000

The Performance characteristic of this assay is determined by Bioanalysis Diagnostic Laboratories. The FDA has determined that such approval and clearance is not necessary. This test is for investigational purposes only.

CLIA Lic #: 0 5 D 2 0 6 5 1 6 2

Client ID:

Accession No.

Physician/Doctor:

Patient Info: Name: DOB: Age: Gender: Phone No: Menopausal Status: Collection Date: Received Date: Report Date:

Hormone Reference Range Reference Range

DHEA

106-300 pg/ml

DHEA:Cortisol Ratio/10,000

115 - 1000

0

0.2

0.4

0.6

0.8

1

1.2

1.4

0 10 20 30

ug/dl

Time of Day (Hour)

Cortisol AM

Patient Hormone Level

Low

Elevated

Average

Commentary

Commentary is provided to the patient and practitioner for educational purposes, and should

not be interpreted as diagnostic or treatment recommendations. Diagnosis and treatment deci-

sions are the responsibility of the practitioner.

This saliva profile measures the levels of cortisol and DHEA to provide an evaluation of fluctuating changes in cortisol levels throughout the day. Cortisol levels primarily are at their highest in the morning shortly after rising and are at their lowest after the onset of sleep. Cortisol plays many important biological functions in the body. It is extremely important to evaluate cortisol levels because of the role it plays in the metabolism and utilization of proteins, carbohydrates, and fats, the body’s ability to respond to psychological and physiological stress, and the control of inflammation and proper blood sugar levels. Other biological functions dependent on healthy cortisol levels include maintenance of proper blood pres-sure, optimal nerve and brain activity and normal heart and immune functions. DHEA also has specific and im-portant biological functions in the human body. DHEA assists in the metabolism of protein, carbohydrates, and fats, aids in regulation of body weight, blood pressure and immune function, and is an important metabolic intermediate for the synthesis of testosterone and estradiol. DHEA works in conjunction with cortisol to maintain proper blood sugar. Extremely elevated or low levels of cortisol and DHEA, as well as the balance between the two, may be a cause for concern because suboptimal levels of these hormones can lead to illness. The results of this profile indicate that the patient is within the optimal reference range for cortisol during the morning hours. Cortisol levels are primarily higher during the hours after awakening and can be indicative of peak adrenal gland function. During the hours of 10pm – 12am cortisol levels are typically at their lowest. DHEA concen-tration is elevated and not within the provided reference range. Possible causes can be attributed to adrenal and androgen dysfunction. Consider re-evaluation after stopping DHEA supplementation for a minimum of 24 hours (if such supplements are taken). Consider life style and dietary options along with weight loss as a natural treatment for lowering DHEA concentration. Please consult your physician before making any changes to supplement usage and for further recommendations. Cortisol:DHEA Ratio:

Cortisol and DHEA have opposing effects. DHEA levels get lowered with the release of cortisol, which in turn is released during stressful situations or depression. Studies show that low DHEA and depression go hand in hand. So, by increasing DHEA levels, you can get rid of the symptoms of depression. Increased levels of DHEA help cancel the adverse effects of stress hormones. The ratio of DHEA to cortisol is normal. The ratio indicates a relative balance of the adrenal output of androgens and cortisol.

Laboratory Report

Hormone Test In Range Elevated/Low Units Reference Range

Estradiol (E2) pg/ml 0.56 - 4.39 pg/ml Postmenopausal

5.03 1.29 - 7.76 pg/ml Follicular phase

3.79 - 16.05 pg/ml Mid Cycle

1.22 - 8.43 pg/ml Luteal phase

0.88 - 4.75 pg/ml Males

5.0 - 20.0 pg/ml Oral/Patch: Supplemented

10.0 - 50.0 pg/ml Cream/Gel: Supplemented

Progesterone (P4) pg/ml 6.0 - 56.4 pg/ml Postmenopausal

77.3 19.6 - 86.5 pg/ml Follicular phase

99.1 - 332.6 pg/ml Luteal Phase

12.7 - 57.4 pg/ml Males

100 - 600 pg/ml Oral: Supplemented

500 - 2000 pg/ml Cream/Gel: Supplemented

Ratio P4/E2 15.4* pg/ml 200 - 500 optimal when

E2 1.3-3.3 pg/ml

Females

200 - 300 Males

Testosterone pg/ml 2 - 142.5 pg/ml Males (Age Dependent)

20.4 pg/ml 2 - 59.1 pg/ml Females (Age Dependent)

The Performance characteristic of this assay is determined by Bioanalysis Diagnostic

Laboratories. The FDA has determined that such approval and clearance is not

necessary. This test is for investigational purposes only. CLIA Lic #: 0 5 D 2 0 6 5 1 6 2

Hormone Replacement Therapy

Monitoring Patient Info: Name: DOB: Age: Gender: Phone No: Menopausal Status: Collection Date: Received Date: Report Date:

Client ID:

Accession No.

Physician/Doctor:

Abdul R. Khan, MD

LABORATORY DIRECTOR

18173 S. Pioneer Blvd

Artesia, CA 90701

Ph: 562-924-2299

Fax: 562-924-7830

Medication Use:

Sample A: 7:15 am Sample B: 12:15 pm Sample C: 5:00 pm Sample D: 8:00 pm

Commentary

Commentary is provided to the practitioner for educational purposes, and should not be

interpreted as diagnostic or treatment recommendations. Diagnosis and treatment deci-

sions are the responsibility of the practitioner.

Estrogens play a critical role in female sexual development, menstrual function, protein synthesis, cardiovascu-

lar function, bone formation and remodeling, cognitive function, emotional balance and other important health

factors. The estrogenic potency of estradiol is 12 times that of estrone and 80 times that of estriol. Estradiol is

the primary estrogen in premenopausal women. Estone is the second most potent estrogen compared to estra-

diol. After menopause, estrone becomes the primary estrogen as the ovary loses its ability to manufacture es-

tradiol, and it is synthesized in the adrenal glands and fat cells. Estriol is considered to be the mildest and brief-

est-acting of the three estrogens. Estrogen metabolism and synthesis in men appear to remain relatively stable

across the life course.

• In men, low levels of estrogen may be associated with decreased bone density, cognitive decline and cardio-

vascular disease. Excessive estradiol levels have been associated with greater risk of stroke and cardiovascular

disease, as well as BPH, gynecomastia, decreased sexual function and weight gain. A source of elevated estrogen

in men may be associated with men who have a higher body fat percentage, as increased aromatization of tes-

tosterone to estradiol can occur in adipose tissue.

• In a large, population based study of salivary sex hormone levels in older adults researchers found: Older men

and women had similar estradiol concentrations. Estradiol concentrations have been associated with cognition,

mood, and memory in women and, in combination with testosterone and other factors, preservation of memory

and cognitive function in men.

Progesterone is important for normal reproductive and menstrual function, and influences the health of bone,

blood vessels, heart, brain, skin, and many other tissues and organs. As a precursor, progesterone is used by the

body to make other steroid hormones, including DHEA, cortisol, estrogen and testosterone. In addition, proges-

terone plays an important role in mood, blood sugar balance, libido, and thyroid function, as well as adrenal

gland health. Progesterone is primarily produced in the ovaries in premenopausal women and in the adrenal

cortex in postmenopausal women. Although progesterone is found in both women and men, the physiologic role

in men is poorly understood.

• The clinical significance of elevated or low levels in men is poorly understood. Low progesterone levels may

be involved in male infertility. Increased levels of progesterone have been found in states of stress and anxiety

in men and women: this may relate to its sedative or stress countering effects.

Testosterone is an androgenic sex steroid/hormone that helps maintain libido, influences muscle mass and

weight loss, and plays a role in the production of several other hormones. During the aging process, testos-

terone levels gradually decline in both sexes, which can lead to loss of bone density. Testosterone concentra-

tions tend to be higher in men versus women.

• In men, lower levels of testosterone are associated with aortic, peripheral vascular, and cardiovascular dis-

ease in middle-aged and older men. In some but not all studies, lower levels of testosterone predict increased

incidence of cardiovascular events and mortality. Additionally, elevated testosterone can be associated with

CVD risk. Men with excessive testosterone may exhibit aggressive behavior or increased irritability, and hair

loss (scalp).

Taking testosterone cream or gel or other may lead to excessive increase of salivary testosterone . Re-evaluate

after adjusting the dosage.

Progestrone: Estradiol Ratio (P4:E2): The levels of both progesterone and estradiol are important and equally so is

the delicate ratio between them. The ratio must be in the range of 200-300:1 (P4:E2), meaning for every 200-300 units

of progesterone there must be 1 unit of estradiol.