Follow-up from last Q&A, recent Q&A where he asked about a DUTCH result with high cortisol and cortisone with severely blunted cortisol awakening response that he hacked from the saliva kit,” which is really cool. Congrats for doing that. “I know sex hormones are not covered in this level. I’m just wondering if you could briefly help to interpret this result. Total DHEA normal, etiocholanolone normal, androsterone high normal at 2,391, testosterone high at 221, total estrogen high at 41.7. All estrogen metabolites high with methylation activity marker in the center of the gauge. Patient is not on a prescription. I’m curious of differential diagnosis for high sex hormones. Patient is a 32 year old male.

Chris Kresser:  Let me go here and look at something. So when etiocholanolone is low or normal and DHEA is normal, the 5-alpha testosterone is high and androsterone is high, that means there’s an upregulation of the 5-alpha pathway. And one of the things that can cause that, which it’s not really in the scientific literature, but I’ve seen this anecdotally in DUTCH tests, and I’ve talked with Mark Newman about it, it is probably inflammation. I see this in patients that are dealing with inflammation. So with high testosterone and if that’s being aromatized into estrogens and high-estrogen metabolites, particularly 16 OH-E1 and 4 OH-E-1, which are proliferative and can increase the risk of prostate cancer in men or breast cancer in women, I might be inclined to use something like DIM to reduce the aromatization of testosterone into those estrogen metabolites. Something like DIM Detox from Pure Encapsulations, for example. And I would go looking at other potential causes of inflammation or upregulation of that 5-alpha pathway. It’s a good question and it’s that’s something we’ll definitely be covering later.