← The Thyroid (and Hormone) Fixer Podcast: Thyropause, Menopause, Metabolism and How to Fix It
The Thyroid (and Hormone) Fixer Podcast: Thyropause, Menopause, Metabolism and How to Fix It
530. My Cancer Diagnosis and The DUTCH Test: How It Helps to Customize Hormone Protocols
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- [00:00]
Dr. Amy
Welcome to the Thyroid Fixer Podcast. I'm your host, Dr. Amy, and we're diving deep into the world of hormones, especially for all you fierce women in perimenopause and menopause and everyone struggling with hypothyroidism. So if you are battling weight gain, you're feeling like shedding those pounds is an impossible feat. If you're dealing with plummeting energy levels, gut wrenching fatigue, or a libido that seems to have left town, then you're in the right place. And let's not even start on the hair loss if these symptoms are sounding all too familiar you have felt around your tribe. My goal is to educate, empower, and shake up your world. Remember, I want you to embrace every inch of that badass woman that you truly are. So if you're ready to dive in and fix things, let's go. Let's talk about the power of berberine for blood sugar control and for moving you into a state of insulin sensitivity. Now, what does that mean? So when you are insulin resistant, we can look at your fasting insulin number on labs and see that's above a six. You can look at your glucose, your fasting glucose on your labs is that above an 85. Is your continuous glucose monitor that you're slapping on the back of your arm consistently reading above an 85? Is your hemoglobin A1c above a 5.2? If you answered yes to any of those. Oh, wait, let me also add in. Do you crave carbohydrates and sugar through the day? Literally, where your. Your body is screaming at you to go get something from a vending machine or eat something sweet, then that points back to your blood sugar and your blood sugar being out of whack and being on this roller coaster. Now, what this means for you is inflammation. It means weight gain. It means an increased risk of dementia and Alzheimer's. Now, if you're carrying around an extra 20 pounds, you're not really thinking about your brain and the health of your brain when you're 70 and 80. But I'm here to tell you the fastest way to age is to keep your blood sugar on that roller coaster and keep it high. To get control over our cravings, to get control over our weight, to be able to tap into our fat stores for fuel, we need to have steady, regulated glucose. And this is where Blood Sugar Fixer comes in. Blood Sugar Fixer was one of the O G supplements in the Fixer line. And I designed this because I kept seeing over and over Again with the patients we were working with. Elevated insulin, elevated A1C, elevated glucose, inability to lose weight, carbohydrate and sugar cravings. And this is where Blood Sugar Fixer comes in. It takes that one wild ride, that roller coaster of blood sugar and it squishes it together to a nice wave like pattern. Steady, balanced, even. So that your cravings, you no longer get those cravings screaming at you. It allows your body to literally tap into the fat that you're grabbing on your stomach or your thighs, saying, gee, I really wish that this was gone. This big chunk, yes, it taps into those fat stores and uses that to burn as fuel for energy. But you can't do that if you're a sugar burner. You can't do that if you're insulin resistant. You can't do that if your blood sugar is dysregulated. So what you want to do is bring in Blood Sugar Fixer. Now, I made it more economical. There's a lot of companies on the market that they only have their Berberine at 400 milligrams. Well, then you have to take three per day. The therapeutic dose is 1200 milligrams. I've also seen it at 1000 or 1200 milligrams. If you take that all at once in one capsule, you might get some loose stool that becomes a little unpleasant to deal with. So 600 milligrams per capsule is what's in Blood Sugar Fixer. You take it twice a day, one with each main meal, and you will start to notice a difference, really, within a couple weeks of your cravings. And then as you are testing, you're going to see those numbers come into alignment. You're going to see the numbers come down on your CGM, your A1C will come into that beautiful optimal range. Below a 5.2, your insulin will become beautiful once again, below a 6. And the bottom line is you will feel better, you will decrease inflammation, you will lose weight, you will gain control of your carbohydrate and sugar cravings and you will protect your brain. So that's Blood Sugar Fixer. Twice a day, one cap twice a day. That's it. The struggle is real when it comes to losing weight. Listen, I know because I've been there. You're trying all the things. You're doing the diet, you're tracking your macros, you're getting to the gym, you're going to the Pilates, you're doing all the things, but it's not working. It's not working. And this is independent of a thyroid problem. Maybe you have a thyroid problem. Maybe you have low hormones or maybe you don't, and you're just like, I just have a really crappy metabolism that I am putting on weight or I can't lose weight no matter what I do. Then you need some help. But what you don't need is a stimulant fat burner of the old days where you literally thought you were having a heart attack. You need something that is actually going to work to increase your metabolism without jacking up your heart rate. Enter Thyroid Fixer. Yes, I know it's called Thyroid Fixer, but I named it after myself and the brand because it's my baby, it's my child. It's a product that I have been studying for 15 years and using it on patients for 15 years before I brought it to you. Thyroid fixer contains T2. And what this does, I call it the forgotten thyroid hormone. No, there's no tests for T2, but your body does produce T2 in small amounts. T2 will increase your basal metabolic rate, literally the amount of fat that you're burning at rest. It's also browning white adipose tissue. So this is why you jump into cold plunges. Or maybe you're like, I don't want to jump in a cold plunge to brown your white adipose tissue. That helps with insulin resistance, it helps with metabolism, it helps with inflammation, helps with overall health. So that's a good thing as well. And here's the other thing. With T2, it's not going to affect your thyroid. So many of you know, if you take T3, if we give you T3, or if you abuse T3 when you're not supposed to, it will have a feedback loop, a negative feedback loop on your thyroid. And you're going to either look like you're hyperthyroid or you're going to shut down your own Thyroid Production. T2 doesn't do that. It's working at the cell level to just simply increase your metabolism. That's a win all the way around, because now you're going to burn fat, now you're going to lose those extra LBs, and that's ultimately what we want. It also bonus, helps with ATP production at the mitochondrial level. This means steady energy through the day. No highs, no lows, no caffeinated Red Bull spikes, just really nice, steady energy through the day to keep you going. So you want to add in Thyroid Fixer and just literally watch your body change over the next couple months. Because, listen, I mean, it's it's time. Well, it's time all year long. I mean, there's no good time of year. Lose body fat. We want to be in shape. We want to look, feel, and perform our best. Add in thyroid fixer and your body will absolutely thank you. And then you'll come back and you'll thank me. I wasn't planning on telling you this yet, actually, but this podcast was so powerful when we recorded it. I knew I had to get this out. And therefore, because of that, I need to tell all of you that I have cancer. I was diagnosed with uterine cancer about a month ago, and I will be sharing how the journey has gone. I will be sharing how it's impacted me, the things that I've uncovered and discovered and the rabbit holes. I've gone down to figure this out. Because if you have ever heard the big C told to you, it rocks your world a little bit and you realize that you're going to do whatever you have to do to get through it, get your family through it, and then you're going to do everything that you have to do to never hear that word again. And that is my goal on both fronts. So in this exploration of what the hell caused my uterine cancer, there are so many different things that could have occurred, from me never having children to having polycystic ovarian syndrome when I was younger, to possibly two high doses of estrogen when I started hormone replacement therapy. I'll share all of this as I move along in this journey, I promise you. For now, we are going to start with the Dutch test. So Betty Murray and I unpack my Dutch test results. And I actually completely forget whether or not I said this in our recording, but I did have a Dutch test done in 2022, and at that point in time, it showed me that I don't metabolize estrogen very well, that I push down certain pathways that we're going to talk about today. And I didn't take that data and apply it to my hormone treatment. And this really is where I truly believe that some practitioners are better at treating everyone else but themselves. I didn't apply my own data to my own decisions. Could that be it? I don't know. I'm still unpacking, I'm still uncovering. But what I will tell you is this episode and my journey will be for good. It will be to help one, if not multiple other women out there avoid this and avoid ever hearing this word cancer. And I don't mean to leave the guys out, but I'm talking about a female cancer right now, and I'm talking about how our hormones drive that or protect us. So that's what I want to uncover in this episode with Betty. What do I need to know now as I walk this journey, as I decide what path to take, looking like a hysterectomy, as I walk this journey, what am I going to do after to replace my hormones again? And a lot of this is uncovered in this episode. But your takeaway, your takeaway from listening to this episode is to apply the knowledge that you can receive from the Dutch test to your hormone replacement. Hormone replacement gives us life. I will never, ever, ever stop it. Bioidentical hormone replacement protects us from cancer. I will never, ever, ever stop it. But I am now more passionate than ever at tailoring and customizing treatment to each individual woman. And I won't go down too far of a, of a tangent right now, but I could absolutely get on my soapbox at this moment and say that no one, not a single woman listening to the sound of my voice should ever be using a cookie cutter telehealth, doggy mill, puppy mill, hormone mill, clinic for their hormones. You are not an algorithm. You are a human being with cells that are constantly and rapidly dividing. And the last thing we want to do is go to someone who's plugging us into a computer or looking at a chart. And if this, then this. Okay, here's what you're going to be prescribed, hormone wise. Absolutely not. I will save that rant for another day. But if you are going to one of those online cookie cutter telehealth clinics for your hormones, and most of them, by the way, don't do thyroid. And then the thyroid ones don't do hormones. It's ridiculous. They all go together. If you are, then you better listen to this because you might be doing more harm than good. If they don't know what they're doing, especially if they are giving you pellets, if they are giving you large doses of estrogen, you need to listen to this episode. This episode is also going to uncover what the Dutch test can tell us, even as it ties back to testosterone and progesterone and your cortisol and your cortisone, it's really interesting. And Betty Murray is going to unpack this in a way like no one else can. She is absolutely genius at looking at Dutch tests. So we're going to unpack it together. And my goal is for you to walk away with more information that can help you look, feel and perform the best, as well as protect you from ever hearing the C word or from ever hearing it again. If you're on the same journey with me, and if you are, we're going to get through it. We're going to get through it together. If you're not, you are going to learn and be empowered as to what you need to do in your life and all the different crazy things I'm trying right now what you need to do in your life to prevent and never hear that word in your world ever again or ever. Period. So please do enjoy this episode and you will be hearing much more from me on this topic. Follow me on Instagram. Join the just fix your thyroid Facebook group. This is where I will be posting all about my journey and I hope to help each and every one of you with my story. So in this episode, we are doing something a little bit different. And I'm going to say it's unexpected, too. I did not expect to announce for the first time to all y' all that I have uterine cancer, so we're just going to drop that bomb right off the bat. But the reason I'm leading with that is so that you understand the purpose of this episode. Since my diagnosis and I've always been planning on releasing these episodes along with my deep dive of all the different rabbit holes I've been going down. Just wasn't planning on doing it so soon. But what happened was my Dutch test came back, reached out to my dear friend and colleague Betty Murray, and I said, okay, interpret this for me. And, and, and what do you have to say? And she came back with, well, you're going to be shocked and pissed, and I've uncovered a whole lot of shit. So that's why we are recording this soon. You are going to hear this very soon because I feel like this information is vital to get out there as soon as possible. So there's no marketing plan for me announcing that I have cancer. It just is. Here's what it is. Here's what I'm dealing with. And what I'm learning along the way of this journey is that it is so important for all of us, especially women, to know your risk. And even when you're going into bioidentical hormone replacement. And I'm going to talk to Betty about this, but my opinion is static dosing. Okay, you're pretty safe, but it's really a good idea to have a Dutch test and to go a little bit deeper and look into how you metabolize your hormones, maybe go down the genetic pathway as well. But especially if you're doing something like I was doing, which is the Wiley protocol, requiring higher doses of hormones, you know what? I'm going to die on this hill and say, you damn well better know how you metabolize your hormones if you're putting those levels of hormones in your body. And I don't care that it matches the rhythm to what you used to do. You want to know how your body takes and metabolizes and deals with, detoxifies, processes, whatever name you want to give it, how it deals with those hormones. So that's what we're going to unpack today as it relates to me, because I got to tell you, after I go through the treatment and get the hysterectomy and do all the things, I want to go back on hormones that are exactly right for my body. No more guessing, no more throwing darts. I want to dial in the exact hormone protocol that is right for me. So, Betty, thank you so much for jumping on on a Sunday to go through my Dutch test to educate these people out there. I know you're going to be releasing this to your audience as well, because we're both passionate about women getting the help that they need and being educated themselves about their own body.
- [16:29]
Betty Murray
No, you're absolutely right. It hurts me that you're going through this, but I also have to look at it and go, you know, there were two people that are probably the best people to go through this. You have a level head. You understand a lot about all of this and can take very sort of measured approach without running in fear, which is most. What most people do is they run in fear. And I think a couple things that I want to clarify while we're going through this conversation today is, number one, bioidentical hormones are not really the cause of cancer. Right? They aren't. But how you metabolize hormones and all of the estrogenic sort of materials out there, the xenoestrogens, can drive a risk whether you have hormones or not. My scientific argument is without hormones, we, you know, we don't have our protective estradiol and estriol. We actually might be stimulating these pathways heavily with other crap from our environment, like fragrances and phthalates and all that other stuff. And that's why we see these cancers more in a menopausal woman than we do in a 25 year old. So, you know, what we're going to walk through today is one of a couple of the major pathways that research is kind of pointing to. And just to give some people qualifications, like, why am I uniquely qualified to have this conversation? I spent three years of a PhD immersed in hormone metabolites. I am one of the world's experts on how these move through the body, what they do, particularly in the gut and elsewhere. And we've been capturing this data in my clinic as long as we've been able to test for this. So well over 12 years. And so I have a unique perspective that we don't see in conventional care, we don't see from the menopause society, we don't see in any current treatment, because there are major gaps in how we test for these things. And so I'm going to explain how I look at it and what we see, you know, because it is. I don't want people to walk away and be, oh, I'm terrified of hormones. It's more. So you need hormones. And most people deserve and should have hormones. But we have to be educated on what we need to do to do hormones safely. And even if you're not doing hormones, it would be valuable to know these things because they also increase your risk for cancer, even if you don't have a damn hormone in your body.
- [18:41]
Dr. Amy
Oh, yeah, absolutely. And, yeah, let me clarify, too. Every single conventional doctor I saw, including my oncologist, said, stop hormones immediately. And then they wanted to put me on a synthetic progestin, which made me laugh. I'm like, do you understand that I am on large amounts of bioidentical progesterone? Right. So they wanted me to stop everything. I have not stopped everything. I've reduced my dose of estradiol, kept the progesterone high, and I'm basically riding out static therapy until the time of my surgery. And then we'll discuss probably on this show, what I'm going to be doing afterwards. But I love the hormones. I mean, I do love hormones. I love currently and loved my higher doses of hormones. I felt amazing. So there's no way in hell I'm going to give them up. And to your point, oh, my God, please do not, anyone listen to this, think that we are saying that hormones cause cancer. That is not the point. That is not the point at all. In fact, the hormones that I'm going to be putting back in, in my personalized, precise dosing regimen ultimately will protect me against cancer. Because we know that about hormones as well, that they provide way more protection when done right and done in the right combinations and doses for our body.
- [19:53]
Betty Murray
Absolutely, absolutely. So if you're. Are you okay with me, like throwing your report up here and showing everybody, you're like, yeah, you know, let me.
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Dr. Amy
That's why we're doing it.
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Betty Murray
That's why we're doing it. All right, let me scroll through here and I'm just going to get the big picture up here and then I'm going to share my screen.
- [20:08]
Dr. Amy
So, yeah, this is my second Dutch test that I've ever done in comparing this one to the other one. Very, very similar in, in the pathways that I push down.
- [20:19]
Betty Murray
Yeah. So I'm going to give a couple pieces of context here first. Right. So tell me a little bit just to make sure that we're on the same page. So while you were on this test. So anybody that's never looked at this test before, these are speed dials, right? So these are speed dials that basically say if you're in the green, that means that you're in an expected level of physiological dose, particularly if you're on hormones or if it's. Before you go on hormones, your physiological dose is appropriate. And then if it falls below on the left side, that means it's under physiological dose. And if it's in that little purple field, it's a post menopausal range. And then if it's in the red over here, it's considerably higher than what's expected. And it's breaking down into basically your estrogens and your testosterone and your. And your progesterones. Right. So while you were on here, you were on, you were on rhythmic dosing, is that correct?
- [21:10]
Dr. Amy
When I did this test, which was literally done probably about two weeks ago, I had changed over. So the beginning of April, my diagnosis at that point of time, I changed over to static dosing of 2.1 milligram patches twice a week.
- [21:29]
Betty Murray
All right. So, and then you were not. You were said you were inconsistent with your testosterone, but you had been doing testosterone kind of on and off or at least some androgens, right?
- [21:37]
Dr. Amy
Definitely, yeah. About 10 milligrams a week of testipianate, plus the oxanderlone. So there's no test out there yet that can show us that that's what basically you want to develop.
- [21:48]
Betty Murray
Okay. Okay. And then obviously you were doing physiological doses of progesterone. Right. Okay. So there's a couple things that stand out to me here, and I'm going to kind of walk through this and I'm going to throw a bunch of other diagrams up. So first and foremost, obviously, if we look at your results and we look at your testosterone it's incredibly low. Right. And even DHEA is relatively low. And your other androgens, which are all in the little green area right here. And androgens are a recovery hormone. They rebalance things, they're protective against breast cancer in most cases. You do have a little bit of a preference for the 5 alpha reductase pathway, which I'm surprised because I know you don't lose hair a lot, even, even though you do. Right. But what's interesting to me is there's a, there's a huge gap in these tests whether it's Dutch Humap, the hormone Zoomer, by Vibrant, any of the companies that do urinary hormone metabolites. There's a gap and it's how the test gets run because you were on, probably you should have at least some testosterone. It might have been at the lower end of your dose or later on. Right. But your testosterone is, it looks almost Non existent at 1.3. Right. Now I'm going to point out a couple other things and I'm going to start wrapping this together. The aromatase enzyme can take testosterone and make estradiol, and it also can take androstenedione and make it into estrone. Right. So, and if we look at your genetics, if we were just to look at your genetics, you have a high propensity for aromatase to make estrogens. Right. And we'll go back to that genetics in a few minutes. Right. So that, what that means is, is your, your androgens have a strong commitment to making estrogens. Right. So if we look at your estrone, it's on the high side of normal. If we look at your estradiol, it's very, very high. And then your estriol is relatively high. So there's some very important caveats here. First and foremost, estradiol can go back and forth between this 17 hydroxy steroid pathway and get made into estrone. So these two can get made back and forth to each other and then aromatase also makes estrone. So if you are on testosterone, it doesn't make sense for it to be very, very low with a normal estrone and a relatively high estradiol. Now, when we look at how our body metabolizes estrogens and toxins, I'm going to use an example. So I'm going to use this. I think it's a lip, you know, a lip balm. So when your body goes to prep this to get rid of it genetically, it's going to move it from either estradiol estrone or estriol down one of these three pathways. So it's either going to go down the two hydroxy pathway, the 16 alpha hydroxy pathway, or the CYP1 pathway down to four hydroxy estrone. So I like to think of that. It's kind of like Goldilocks and the three little bears. The first pathway is the porridge is just right. That's that green pathway. So it's going to wrap a wrapper around that estrogen molecule because it's got to get the green wrapper around it, because it has to be done in order, in order for it to get thrown out. So your preference for that two hydroxy pathway is pretty strong, right? It's pretty strong. Then let's look at the blue pathway. Like, I like to consider that the sort of in between in the pathway, that's a blue wrapper and that wrapper is made by the CYP3A4 pathway, which you have a slight preference for, which makes 16 hydroxy estrone and also makes estriol, which is a very weak estrogen, but becomes very important later on. And you genetically make quite a bit of estriol, but not a lot. And if we look at your little pie chart down here, there's a very low amount of basically estriol production. And then estradiol, which is our protective estrogen made by our ovaries, that peters out when we're in menopause because the egg carton is empty, it no longer gets made. So when we put estradiol back, estradiol can go back and forth and make estrone, but it can also go down through these pathways. And then the last One is that CYP1B1 pathway. So this is the one most associated with cancer risk. Based on if you're looking at Dutch or Humap or the hormone Zoomer, all of those companies will point this one out, because if you make a lot of that metabolite, 4 hydroxy, it makes a metabolite that can damage DNA. And when you damage DNA, it creates spelling errors and then you can get cells that don't realize they need to die, apoptosis. So the 4 hydroxy pathway is considered damaging. And you make quite a bit of it. It's not your highest, but you make quite a bit of it. So where does the testosterone come in? All right, so all of these tests, because of the mechanism of how they perform these tests, have a huge gap. And basically what that gap is whether they're using urinary hormone out of a tube or you're peeing on a strip and then you're using it later. In order for them to perform the action, it has to go through a thing called hydrolysis. When that happens, it destroys a sulfate bond. So one of the major pathways of estrogen and testosterone detox is no longer visible on any of these tests. Here's where it becomes important. So if the process of the test actually destroys the bond for the most primary way that estradiol and testosterone get detoxified, I have no real visibility to it. It is using a glucuronidation technology to see it. So here's the way to think about it. The very last step of detoxifying all of your hormones and basically most of the crap coming out of your body. Honestly, it gets to. I like to describe this as, okay, I'm going clean out my house. So I start in the attic, which is going to be up here in these very first steps, right? The CYP1A1, the 1B1, or 3A4. I'm going to get all that junk out of my attic, and so I drag it into the kitchen. That's step one. That's your phase one liver detoxification. None of that stuff is getting out of the body until it gets to phase two. And phase two is where we do glucuronidation, we do methylation, and we also do sulfation. So phase two is getting it to the garage and the dumpster. So the challenge is, because of the mechanisms in which they use this test, we see half of the distance of phase two and we never see if it makes it to the dumpster. Right, yeah.
- [28:02]
Dr. Amy
No, that makes sense. While you're on. Before you go on with that, while you're on that methylation activity, where does someone want that? Is it best to be that dial all the way to the red like it is with mine, or do you want it more halfway?
- [28:17]
Betty Murray
Yeah, exactly, exactly. So here's the thing. So I either have it wrapped in green, red, or blue, right? So your green is pretty heavily promoted. Your blue's small. Right. And your red's relatively small. So if we were to look at this, we would say your estrogen metabolism pathway looks excellent, would we not? We would. But the testosterone points to something that is awkward and odd because testosterone is almost always mostly sulfated. So it goes through the sulfation pathway, which is not visible. To have somebody taking testosterone with an absolutely low level of testosterone on a Dutch and an adequate level in the blood is a sort of proxy for a sulfation problem because we can't see it on these tests. So I know this is like people are going to go, holy crap, what is she talking about? Right. It's hard, right? So we've got that very first step. We're upping the green, the red or the blue wrapper. Right. So if we get to the methylation down here, all right, we get to the very bottom here, that methylation wrapper, everybody say, oh, my God, you're methylating. Great. Because you're taking methylfolate and B12 and B6 and B2. Right. Think of that as the pink wrapper.
- [29:22]
Dr. Amy
Yep.
- [29:22]
Betty Murray
Well, methylation isn't the final step. It either goes glucuronidation, which is estradiol primary fate, or it goes sulfation, which is estrone's primary fate. Now, estrone is very, very important because estrone is pro inflammatory. We don't want a lot of that. And estrone is what we make mostly when we go through menopause because our fat cells can make it. That's why we gain weight during menopause. And so estrone, whether it's being made by our fat cells or aromatized by a testosterone or androstenedione, or being converted from estradiol, if it's estrone on its own, it's damaging. If it doesn't get out of the body, it has to go through one more step called sulfation that has several other genes that are either good or bad. Does that kind of make sense?
- [30:13]
Dr. Amy
Yep.
- [30:13]
Betty Murray
You know, here's the thing. I am, I am of the mindset that we want to be in those ideal ranges and not really high because more is not necessarily better.
- [30:21]
Dr. Amy
Yes.
- [30:22]
Betty Murray
I mean, there is, there is science seeing overly methylated vitamin utilization and like colon cancer risk increased. And the reason is, is we've never ever been able to give super physiological dosing of vitamins until recently. It would never be seen in human experience. And so I think adequate and not too much and not too little is really, really important, which is why I'm such an advocate for testing because then we can kind of stick with the science that we do know. So let me, I'm going to show another picture. This is actually from Genova. They do, you know, I didn't really ask them, but I do use their picture quite a bit because. All right, if you can see this window. So again, this shows that diagram and a little bit of amplification. So here's where it becomes important. So your testosterone, again, it was really, really low. So that's Your testosterone right over here. All right, so the 17 hydroxy pathway is right here and right here. Here's the first thing that I think is happening. You're aromatizing some of your androstenedione to estrone. You've got plenty of estrogen, you had testosterone. But estrone isn't going to just get to 4 hydroxy. And it isn't just gonna make it here. It has to get sent to sulfation, which is what we don't see. You look like you methylated qu, but that's not the preferred pathway. And glucuronidation through the gut is the preferred pathway for estradiol. So where this becomes more important is, is this final metabolism pathway that is actually controlled by a different, basically a different set of genes. Right? And this is even hard because this is something I've talked with all the genetic companies too. So the reality is at the very end of that diagram. So imagine at the end of that hormone diagram, you've either methylated your estrogen or you've left four hydroxy hanging. Most of your estrone must get a sulfate bond on it. And it takes two major genes. One is called suox. And suox basically takes sulfites to sulfates, making them non toxic. And we produce those in the body and they're made from the cysteine pathway of amino acids. And so this is very, very dependent on. Do you have sulfur donors? Sulfur donors. So suox is the first step. And then the last gene is a gene called SULT1A1S U L T1A1. That is the gene responsible for testosterone and estrogen, and particularly estrone going through the sulfate pathway. So it says, hey, I'm moving estrone, which is fat loving, to a water soluble form of estrone sulfate that then gets peed out. So this is the last step that is not visible on any labs, anywhere at all. And it makes me absolutely batshit crazy, you know, because I mean, I've been in conferences and held my hand up while they were doing a presentation about how wonderful these tests were. And I said, what happens when I have a blood level of 150 on a testosterone and I see a testosterone of 2? Because I know you use hydrolysis. So is my assumption that you cannot see sulfation? So if I see that that's a proxy for a sulfate problem, they're like, well, yeah, maybe. I'm like, okay, thank you, thank you. And a bunch of other people were like, what'd you just say? I, I was flabbergasted because we take these tests and they are good and they are super helpful, but they are missing an entire gap here that may be really, really important. And for somebody like yourself or somebody like me that has less than favorable pathways here, we're running under an assumption that everything's normal. And the reality is I would say it's not great anyway, regardless of whether you do hormones or not. And if I were to show you my genetics, you would see an even worst case scenario. This is the reason why I do what I do because my genetics were so, so poor. Right. Because we see here like your propensity for estrogen dominance. You're going to make a lot of estrone out of androstenedione. You're going to have more estrogen toxicity because you have an upregulation in some of those pathways and a downregulation and two hydroxy. Your comped isn't bad. So compt helps methylate basically the, the estrogen glutathione. Not awesome. But the problem is, is we need salt, we need ugt here, which is the, which is the glucuronidase pathway and we need the salt pathway to identify. Because my bet is if we looked at your genetics and we were able to identify your salt pathway, you have mutations there.
- [34:45]
Dr. Amy
Okay, interesting. So now when you have. Let me ask you, this is my profile and what you're seeing more on the rare side or more on the comm.
- [34:54]
Betty Murray
Common.
- [34:55]
Dr. Amy
Oh, okay. So what practicality wise, what does a person do when they get their Dutch test back and they're seeing some not correlating with the blood markers? How do they know how like. Or is this just a step that we are going to be missing until one of the companies steps up and listens to you?
- [35:17]
Betty Murray
Yeah. So I extrapolate it from a bunch of different data. So I would say your genetics that we see here aren't necessarily radically off. Right. You know they're not. The likelihood of everybody having a green and all of those pathways are, is nil. Again, we have to remember that these pathways were not problematic. Methylation was not problematic until industrialization. Right. When we started loading the environment with toxins. So your body has a normal pathway here. So when I look at these and I see something like a free testosterone on a Dutch really low. Despite I, you know, despite knowing that they're on it, the first thing I do is I get a total and a free testosterone on blood. Right. To correlate. Because sometimes it could be the pharmacy screwing stuff up. I know you've seen that when I'm like, okay, you're on it, but there's nothing in it. Right?
- [36:08]
Dr. Amy
There's nothing in it. Right, Right.
- [36:10]
Betty Murray
The other thing I will do is I will have somebody run an estrone serum which is going to show you the fat soluble form and estrone sulfate.
- [36:19]
Dr. Amy
Okay.
- [36:20]
Betty Murray
Right. And what I remember you, you and I were going back and forth yesterday, and the last time you had it done, what were your numbers?
- [36:26]
Dr. Amy
So the, the estrone, not the estrogen sulfate, the estrone alone, well, the hot, it's always been high. So the last marker was 188. The one before that, I think it was in 2023 was a 409. So yeah, I, I pushed to estrone.
- [36:45]
Betty Murray
Yes. Okay, so, so here's the numbers. Normally we would see that like below 30 and in the teens in somebody menopausal. Right?
- [36:53]
Dr. Amy
Yeah.
- [36:53]
Betty Murray
And even in a woman cycling on a normal basis, it's going to, you know, roughly average out around 60. It'll, it'll peak around 200 as estrogen comes up during ovulation. And so an estrone level in 188 or 409 isn't, is a sort of identifier of like, hey, I make a lot of that first step of estrone. The problem is, is if we don't have an estrone sulfate, if we don't have that, we don't know how much of it you get into the water soluble form that you can excrete. And that one was the one you didn't have. So what we don't know is, is when it was 409, was your estrogen sulfate low? Because that would indicate you were, you were unable to get rid of it. It was not the 4 hydroxy one, it was not the 16 alpha hydroxy. It was estrone, estrone on its own that was unable to get out of.
- [37:43]
Dr. Amy
Okay, and that would make sense because for, for the diagnostics, it started off with atypical hyperplasia.
- [37:52]
Betty Murray
Yep.
- [37:53]
Dr. Amy
And it was at the time, and I don't know how much this plays into the direct correlation of the estrone, but it was an estrogen positive receptor cancer that was found on the biopsy in April where those atypical cells basically flipped a switch and now we're actually picking up cancerous cells. And then they take those cancerous cells and they do further testing on them and see, you know, what, what does this look like? So it's a stage one estrogen positive and it does have a genetic mutation that is not Full blown Lynch syndrome. But that does show kind of back to what you said about some genes not being able to properly detoxify or properly repair. So I do have some repair mechanisms that are damaged on my DNA where my body can't actually see that a cell is damaged and go out and, and fix it up. It just kind of leaves it as a damaged cell, thus turning into cancer.
- [38:56]
Betty Murray
Yeah, yeah. And I think, you know, because people don't understand that whether it's. So lynch syndrome is a set of genes that, that clean up and repair and tell cells to die. They're like, you no longer function. Get out of here. And that doesn't work. And so you usually see a host of cancer risk in that family. And same thing with brca. People think BRCA has to do with estrogen. I'm like, it doesn't have a damn thing to do with estrogen. It has everything to do with a cleanup gene that is broken and can't clean up, you know, and so, you know, and we could never really know for sure. Like, I can't say this is absolutely what happened. But we can extrapolate from the data we have. You had sulfate metabolites stuck in the body. You were taking what we would have seen or assumed to be adequate levels of progesterone because you were on quite a. But in that rhythmic dose, maybe it wasn't enough because you weren't able to clear the metabolites properly. And then because your cell cleanup genes aren't as efficient as they could be, it wasn't able to get rid of, you know, those early cells that were kind of mutating as they go.
- [39:54]
Dr. Amy
I feel so much stronger in my workouts and I legit feel like I recover quicker from my workouts because I am now using every single day Mito pure. So when I dive into what does Mitopure do? How is this actually helping me? And sometimes I won't even look at what a supplement does. I'll just use it because I want to actually experience the results and then go back and say, okay, here's when I feel, here's what I notice. How is it doing it? So after feeling stronger, noticing that I'm recovering so much faster, and especially with Hashimoto's hypothyroidism, you know, your recovery is much lower than everyone else's with regular use. I started to see and feel the difference in my energy levels and in my workouts. So I was stronger. I had more endurance where I would normally, let's say, poop out. At burpee number 10, I was actually able to do burpee number 20 and not feel like I was dying. So the endurance is up. And the other thing I noticed when I dove into the literature on my TO pure is that it really does deliver double digit increases in muscle strength. And guess what? Endurance without actually changing your exercise. So total win, complete and total win. It's working at cellular renewal, it's working on your mitochondrial health. But most of all for me, what I noticed immediately, better energy, steady through the day, strength, power, resiliency, better workouts, better recovery, Absolutely amazing. So if you want the most out of your workout, because it's hard enough to get to the gym, so if you actually want the most out of your workout and you want your muscles to get the most out of your workout, then you gotta go and grab some Mitre pure. So, timeline, that makes Mitre pure, they're offering a 10% off your order. So you're gonna go to timeline.com forward/drammy D R A M I E and you're gonna use the code Dr. Amy. And that's it, 10% off. You got to try it. So again, timeline T I M E l I n e.com forward/d r A M I E. That's going to get you 10% off your order. Write me after, let me know how your workouts are. You are going to thank me. So the fact that I was not bleeding on rhythmic dosing would absolutely tie back to possibly not enough progesterone to produce that shedding of the uterine lining. And maybe it wouldn't have even mattered. I could have gone up, up, up, up, up in the progesterone. But if my body literally can't get rid of the estrone, I don't know that that would necessarily have mattered.
- [42:53]
Betty Murray
Yeah, yeah. I mean, it was unique that you didn't necessarily have any breakthrough bleeding despite having that, because you would expect it. And the truth is, you may have had plenty of a physiological dose of progesterone to manage the dose of estradiol you were on. You know, so one of your other questions to me yesterday was how do I feel about biased and estradiol? Because again, we have to look at the entirety of the pathways and what really happens in the body. Right.
- [43:22]
Dr. Amy
Yeah. So that is the next question then, based on what you see in the Dutch and the information that we now have, what would the hormonal protocol be for someone like myself?
- [43:35]
Betty Murray
Yeah. So here's where it gets interesting. So on all our cells Particularly, particularly breast cells and uterine cells. We have estrogen receptors and we actually have estrogen receptors on every cell other than two in the body. And there's two types of receptors. There's estrogen receptor A and estrogen receptor B. And they, they both do things, right? So like both of them help stimulate bone growth by stimulating osteoblasts and decreasing osteoclasts. They both stimulate, you know, the estrogen kind of activities in cells. And however, estrogen receptor A, if it is overly amplified, it's overly amplified, it's cancer prolific.
- [44:12]
Dr. Amy
And you know what? Most people do not realize that tamoxifen is an estrogen. They, well, they were told that it's an estrogen blocker, but it is an estrogen being used in tamoxifen.
- [44:24]
Betty Murray
Yeah, yeah. It basically binds to estrogen receptor B strongly and never breaks the bind. Right. Kind of like your ethyl estradiol that's used in birth control binds irreversibly. Right? So it binds irreversibly. So here's the thing. So your estrogens all bind to these two receptors slightly differently, right? So estradiol has the most protective binding right now, estrone. Guess what it likes to hang on to the most Estrogen receptor A.
- [44:51]
Dr. Amy
Okay.
- [44:52]
Betty Murray
Right. So cancer proliferative. It has a negative. You want some, but you don't want like, you know, think of it as a seesaw. I don't want most of it going there.
- [45:01]
Dr. Amy
Right.
- [45:02]
Betty Murray
So estradiol, if it has the capacity to also hit that receptor and also get made into estrone. If I do estradiol alone, I might be overstimulating again. This is extrapolating from the research. I might be overstimulating that estrogen receptor A receptor. Now estriol, which is a much weaker estrogen, binds almost exclusively to estrogen receptor B. And it's protective. So I know a lot of people out there are like, you know, because they look, we look at things in this very isolated mechanism. Estradiol is the physiological thing that makes us have all the beautiful stuff like good skin and all the, all the wonderful things of still being a cycling woman. So we just need estradiol because that's the physiological equivalent to the most important hormone. But I'm like, but it's not alone for a reason. It's not alone for a reason. If I also put it estriol, right? Estriol is a one way route. It goes through that CYP3A4 pathway. So, you know, so if I make it, it's that pathway it doesn't go backwards, so it never gets made into estrone. And if I give a little bit of estriol, I get a preferential tapping on that estrogen receptor B, that is making sure that I'm not taking estradiol and making estrone and possibly overstimulating the estrogen receptor A. Yeah, right. This is me extrapolating from the data. We don't study this stuff because none of the drugs work that way. Right. You know, I just loved. I had a really heated conversation with the ex president of the Menopause Society about these pathways and she said really hot of me, we believe in evidence based medicine. And I said, what, you mean placebo controlled double blind studies? Yes. And I go, well, no, nobody's going to produce a drug here because all the drugs mess up these pathways. And I said, so you're willing to let millennials and Gen X women die from something that we absolutely know is true, that these hormone pathways, whether stimulated with bioidentical hormones or hormones at all, are damaging, but you're not willing to even possibly contribute to the research because you want a drug trial? And she's like, well, we just do evidence based medicine. I was like, okay, I'm just, I had an opinion about you and I thought I was right. You just confirmed it. Thank you.
- [47:15]
Dr. Amy
Yeah, that's just the answer on repeat. She doesn't even know how to, to reply.
- [47:18]
Betty Murray
Yeah, it's like you don't even. Yeah, it's like there is evidence, actually there's a lot of evidence that SALT1A1 is associated with breast cancer. Several studies coming out of China. Right. Because there's a lot of mutations in the Chinese population on salt 1A1.
- [47:31]
Dr. Amy
You know, so the bias debate is, is really huge amongst our. And it's, it's amongst people that I very much love and respect. And I will hear opinions on both sides that, that bias, bias, biased. You got to add in that Estriol to have that protection. Dr. Lindsay Berksen, I absolutely love her. Felice Gersh, I love her. But then on the other side, you will have oncologists like Julie Taguchi, who. I love her as well. And I've been consulting with her as well since my diagnosis going, you know what, I think you'll be okay with just estradiol. It's confusing out there for us, let alone for the average woman to make the decision as to which route she wants to go. Now my whole thought on this, and I'm going to give this to you and you can unpack it. And you said this to me yesterday in a message. You know, with estradiol and estriol, it doesn't have to be 80, 20, it doesn't have to be 80% estriol, 20% estradiol. We can compound that to give you that little bit of Estriol because maybe, God knows, maybe it's providing some protection based on the literature, but I'll still have the estradiol coming in. So that's, I think, sounding really good to me. And so based on what you see in my Dutch, what percentage would you do and what is your opinion on, on that idea?
- [48:52]
Betty Murray
Yeah, so. So yes, I mean, if you look at. Because again, they're looking at I. The way we study stuff in, in the United States in particular, but in all of science is a very reductionist way we go, okay, we got this one, this one little variable that we want to look at in this one intervention, and we ignore everything around it, despite the fact the body never is a one for one relationship. So, yes, if you look at estradiol, it has the most research showing efficacy, protection and all that stuff. And like your oncologist said, it has also the most protective studies for use vaginally or, you know, being, being safe and okay, but like you said, we have medicine 3.0 today where we get genetics, where we can get hormone metabolites. Like I would run a Dutch test run, estrone and estrone sulfate at the same time, because then I have all the data right there at the best level I could because then I would see it pretty clearly and that would say, okay, yeah, this person is a candidate for biased and standard disclaimer. I happen to be a nutrition professional and a researcher. I don't prescribe, which makes it great for me because I can look at this very, very scientifically because I don't have any vested interest in what I say. So the reality is, is we have the ability to look at that data. So in your case, I'm going to throw your, your genetics back up here. So in your genetics, this is where it becomes important, right? So we know that you have a preference for estrone. We know you have a, have a preference for aromatization from androstenedione and testosterone to make estrogens. So you're estrogen dominant and you've got more estrogen toxicity, but your CYP3A4 is slow. It is a slow enzyme, which is, means you're making less of the 16 hydroxy and everybody goes, cool. That's also Cancer proliferative. So it proliferates where 4 hydroxy increases DNA damage. The problem is, is it goes from there to make estriol. So you don't have a natural propensity to make estriol out of that byproduct. So the first thing I look at and go, okay, I see sort of the sulfate pathway over amplified. If you were to get a bias that has estradiol in a physiological dose and some estriol to preferentially hit that estrogen receptor 2B, that B receptor, I'm still going to get physiological support, but I'm going to make sure that I hit that estrogen B receptor a little harder. And you might be more of like a 5050 biased instead of an 80 20.
- [51:16]
Dr. Amy
Yep.
- [51:17]
Betty Murray
You know, instead of an 80 20.
- [51:19]
Dr. Amy
Yeah. Well, that's my thought is like, why can't we all just get along and find a middle ground?
- [51:24]
Betty Murray
Yeah.
- [51:24]
Dr. Amy
Like that just makes sense to me is like throwing in a little bit of the estriol. Why not? And you're still getting the physiological doses of the estradiol for the benefit, Right?
- [51:35]
Betty Murray
Exactly. And this is where testing comes in. And it's why in my clinic we've done testing and it's why on the Minerva Project, our telemedicine company, we test all of this. And you know, it's funny, I'll sit down with our medical, you know, medical group and they're like, do we have to have that? And I was like, yes, you know, we have to have all of that. We have to see all of that.
- [51:55]
Dr. Amy
Yeah. Yep. Yeah. Beautiful. Now, what else do you see on a Dutch that you really like to look at that is beneficial to the listener so that they know, oh, if they've never had a Dutch test done before, what else it's showing us outside of just those dials?
- [52:12]
Betty Murray
Yeah. All right, so. So obviously the dials are a great. Just visual, visual view of what's going on. So again, I kind of talked a little bit about this, but. But like I said, I was very surprised that you don't experience hair loss because most women, we have to be very careful of their testosterone dosing because they will overproduce your five go down your five alpha reductase pathway, which is right here and make a lot of dht, right. Which is the little barometer right here, which often results in androgenic hair loss. So hair loss on the head, chin hairs, mustache, peach fuzzy. You happen to be very lucky there. Mine, even if it's in the middle. I'll start Losing hair.
- [52:54]
Dr. Amy
Well, here's my theory. I've had this for a couple years now because I do have elevated dht. My hair will go through thinning processes, but not loss. You know, I'm, I'm 51, so of course I have some dark hairs, but nothing major. My theory is that because my SHBG is high and it preferentiates DHT first, that I have my SHBG binding to my dht, saving me.
- [53:19]
Betty Murray
Okay, yeah, that's probably true because my SHBG is never high. And for everybody that's listening, SHBG is. Think of that as the taxicab that drives your testosterone and dihydrotestosterone and estrogen around. And if it has low binding, it's going to leave a lot of dht, more hair loss. And if it's got high binding, it'll. It'll. It'll kind of attach to it. Right. So I always look at that and I look at that just because I, I like to catch that before it starts happening. Because when you start a shed, it's very difficult. Also your progesterone. Right. So if we look at. The other thing is I look at the relative ratio between your progesterone to estradiol. Based on looking at this, you probably still need more progesterone. Right. Because I always think of the speed dials need to be going the same direction.
- [54:03]
Dr. Amy
Yeah.
- [54:03]
Betty Murray
Right. Now you make a lot of the alpha pregnitol, which has the most relaxing effect of progesterone, which sort of relaxes you and gives you sort of that GABA effect, which is positive. Your overall. When we. Again, when we look at your Dutch test, you got this and you're probably like, rock on. I don't have a problem detoxing.
- [54:22]
Dr. Amy
Right, exactly.
- [54:24]
Betty Murray
Because. Because the first phase one and half of phase two looked fine. Because your pie chart looks great here. Right. You had a lot going through your two hydroxy pathway, which is considered protective, although it does have a little bit of extra risk for, for osteoporosis and somebody not doing all the things like weight loss training and all those other things. You have a preference for 4 hydroxy, but it's not wildly high. And again, that 16 hydroxy is low because you have a slow enzyme, which means you make a lot less estriol.
- [54:52]
Dr. Amy
Now someone does. If someone does push down the 16 or the 4oh pathway. On my last Dutch test, the 4oh was a bigger piece of the pie chart and I was pushing down that more. So I incorporated in N acetylcysteine, calcium D glucarate, dim here and there. Endo3 carbinol, psyllium husk here and there. And that seemed to have brought that, that red down a little bit. Is that what you would tell a woman who does tend to push down those pathways?
- [55:25]
Betty Murray
So that's really, really interesting. So I'm going to bring up, I love these questions, like, why is she grinning like a madman? Like, because I am. Okay, so I'm going to bring back up this picture because I think it does a better job of that. So, so you're dim.
- [55:39]
Dr. Amy
Sorry I totally derailed you from the Dutch, but we'll get back to that.
- [55:42]
Betty Murray
That's okay. No, no, I, I like, I, I do add. All right, so, so, okay, so dim end all three carbinol. Your things like calcium deglucarate, all reduce circulating levels of estradiol.
- [55:56]
Dr. Amy
Okay?
- [55:57]
Betty Murray
So we have to be careful not to do too much of that because a lot of times people will super dose that and their E2 is low and they're like, why? And then they keep raising the dose. I'm like, like, quit making it go down that pathway. Right. And then if you do calcium deglucarate, it helps make it get out of the stool. Right? So it moves all the estradiol pathway, but it doesn't really move the sulfate pathway very much. Okay, so all the things you see right here, so cruciferous berries, indole, three carbonyl dim, soy genistein, flaxseed, caffeine, rosemary. It also affects your thyroid hormone. So we can even get into that wild game. All of those things will improve, basically two hydroxy pathway and push it a little bit towards that. Now the four hydroxy are more affected by the citrus bioflavonoids, like grapefruit and, and the citrus bioflavonoids, hops is actually a really good thing here. The catechins, also your curcumin is actually somewhat favorable here too, but they don't help you sulfate. So the other thing that I often see when we look at the Dutch, right, when we look at this, these pathways, regardless of which ones we're looking at, is everybody sort of starts at the top of the pyramid, right? I'm going to start with phase one detox and then I'm going to make sure I methylate and I'm going to take some glutathione. But remember that's. You got all the trash out of your attic, you got it all out of your closets, but your garage door is empty. You can't get it to the dumpster, and that is the ultimate problem. So you have to go to the dumpster first. Now, salt is dependent on sulfate opportunities, sulfur metabolism. So things like MSM, NAC, B6, your Epsom salt baths, sulfate, Right. I need to have sulfate there and available, so I can then take that dumpster and open it up and raise the garage door. So when you work on detoxification, you start at the end and work your way backwards. So I would put in sulfate donors first. I'd say, okay, do some magnesium salt, foot. Foot baths, you know, do some, you know, Epsom salt baths. If you want, take MSM, take NAC, take a significant amount of B6, because it gets chewed up in this pathway. Molybdenum is also really important. Molybdenum is the door opener for Suox to allow sulfates to be available. I would get those things in first. Then I would go to citrus bioflavonoids, hops, maybe a little bit of dim, and calcium deglucarate, because that's a nice combo. Like, I have combos that have a little bit of all these things in it to sort of help all the pathways. And then I would worry about things above stream, right? Because I think what was happening is you got, like, everything to the garage door, but the garage door was closed and your. Your.
- [58:31]
Dr. Amy
Your.
- [58:31]
Betty Murray
Your garage was getting full of trash.
- [58:33]
Dr. Amy
Yeah, yeah. Just can't get it to the dumpster. Okay.
- [58:36]
Betty Murray
Yeah, exactly. Exactly. Yeah. And what's really crazy here's the other thing, is that same salt pathway, right, affects thyroid metabolism, it affects. Affects testosterone metabolism, it affects catecholamine clearance. So. And because catecholamines go through glucuronidation and also sulfation, right? So often where these things are happening, they're ha. It's not. It's not exclusive to the estrogen. It's everywhere. It's everywhere.
- [59:03]
Dr. Amy
Yeah. No, that makes sense. Okay, so let's flip back to the Dutch. Keep going with that hit on a couple of the other pieces of information that we receive when we do a Dutch test.
- [59:14]
Betty Murray
All right, so if we do the Dutch test. All right, so that's what we look at, right? So on this page, we're really looking at the relative ratio between progesterone and estradiol in particular. And then all the estrogens, whether testosterone is adequate when somebody. When somebody's on it, you know, or that we have an amplification here, because that could be a sign sulfation is wrong. And then these early metabolites. And again, yours look really clean, Right. And you're actually kind of maybe a little bit overmethylated here. I will often look also at, like, what's the total dht? Because it's not on the. It's not on the diagram. And then again, the 5 alpha reductase pathway. And then I always look at the adrenal situation, too, because a lot of people, yours actually looks really good overall. But a lot of women, when they're in the kind of menopause or perimenopausal state, they've got an amplification of metabolized cortisol. Right. Which is what we see up in this quadrant right here. You don't. But what we know is when that metabolized cortisol starts to get in that 6500 range, that will block metabolites and activities of the thyroid receptor, you know, and so that's super common. You know, your actual rhythm here is a little bit low from a cortisol standpoint. Yeah, it is.
- [60:27]
Dr. Amy
It kind of surprised me because I don't feel that, you know, it's interesting.
- [60:31]
Betty Murray
Because it could have reflected that day, right. Like, maybe that wasn't super stressful, you know, because most of the time they would say, oh, you probably need cortisol. But I would say your metabolized cortisol is adequate. So I would say it was more reflective of that day. But this pattern, outside of that low range in the middle of the day looks fine. You have compensatory mechanism that looks normal. I don't necessarily ascribe to. If somebody feels fine and they're low here, that may actually reflect. I don't know. I also think as entrepreneurs, you get anesthetized to the stress response and you just, you know, you're like, yeah, you've had it for so long, the body's like, got it. I'm cool.
- [61:07]
Dr. Amy
Well, even when I was talking with Cash on my DNA, he was going over the brain component, and he's like, you. You really are a warrior, not a worrier. You have the warrior gene. You run on adrenaline, you run on cortisol, and you probably don't even feel it, do you? I go, no, I'm totally fine. I'm good.
- [61:25]
Betty Murray
Yeah, you and me both.
- [61:29]
Dr. Amy
I knew you would get that.
- [61:30]
Betty Murray
Yeah.
- [61:30]
Dr. Amy
We probably have very similar DNA profiles. So. Yeah.
- [61:34]
Betty Murray
So this pattern, you know, now if you were dragging, right. So this would be a place if you were dragging here, if you were really like, no, I feel really, really tired. You know, medically that might be like Cortef. Right. Low dose cortisol or even things like licorice root short term can help metabolize, you know, and even maybe some adrenal glandular right in the middle of the day to sort of help that boost over a couple months. But, but I also sometimes I call it the retirement pattern because I see these women that are finally retired and like the kids are gone and nobody's bugging them and they're starting to live their best life and they're always really low. And I'm like, I think this just reflects the body finally going, thank God.
- [62:11]
Dr. Amy
I guess I'm far from retirement, but I'm just going to roll with it because I feel good. It always goes back to how do you feel and whether we're looking at blood, the Dutch, any test, if you don't feel what that showing, we're not going to overcompensate and treat that because we don't want to throw you to the other direction.
- [62:29]
Betty Murray
Right, right. Yeah. You have to use it all together. It's a, it's a practice of medicine, not this, not the absolute of medicine. You know. And, and so what's interesting here is we, we saw your methylation marker. Right. So your methylation marker your for comped was high. Right. However, methylmate or methylmalonic acid is a little bit higher than expected, which usually means B12 might be slightly insufficient.
- [62:53]
Dr. Amy
Yeah.
- [62:54]
Betty Murray
You know, and probably hydroxy B12, your B6 marks are actually looked pretty good. But I would say with the potential sulfation problem, I would probably support that Anyway. And all your other metabolites here are in range. Your melatonin. Oh, here's another good one. Right. So what do we see here? 6 hydroxy melatonin sulfate above range. Check that. Now you probably. Do you take melatonin?
- [63:16]
Dr. Amy
I do.
- [63:17]
Betty Murray
Okay.
- [63:18]
Dr. Amy
Yep.
- [63:18]
Betty Murray
We're going to see this really crazy high result if somebody's taking melatonin. But this is a sulfated melatonin.
- [63:24]
Dr. Amy
Okay.
- [63:25]
Betty Murray
Again kind of pointing to hey, there's a sulfate thing going on.
- [63:29]
Dr. Amy
Interesting.
- [63:30]
Betty Murray
Yeah. So that's, that's how I would look at the, at the overall report. And it overall, you know, especially reflects kind of your DNA as a, as a whole. But you had some support in there for like dim and indole 3 carbinol and all those other metabolites to help the 2 hydroxy pathway look cleaner.
- [63:47]
Dr. Amy
So no, my view of the Dutch test have, definitely, has definitely changed throughout the years. I no longer poo poo it. I don't look at it sideways. I look at it as a valuable piece of information. And honestly, my opinion has changed as well. And that every woman, whether you're on static dosing, but especially if you're on a higher dosing or arrhythmic dosing, you gotta have this done like once a year, maybe twice a year, you gotta have it done and just get that information. Yes, it will change a little bit. Like I said, my Last Dutch from 2022 looks very, very similar to this one. However, I have reduced, you know, pushing down that 4oh pathway through the interventions that I've implemented. But would you say you want to see a Dutch on a woman at least once a year, if not twice?
- [64:34]
Betty Murray
Yeah, I mean, we do. You know, here's the thing is 24 hour urine, right? A 24 hour urine capture, that has been kind of a gold standard of free levels for a long time. But not everybody wants to do a 24 hour urine. And we do do that as well. You know, when we're really looking. The Dutch test has made it easier by having and, or the Hue map or the Vibrant hormone zoomer. They're all the same, right? And, and I've looked at all of them, I've consulted with, I've consulted with, you know, Vibrant about the, the construction of theirs. They have some drawbacks, right? You know, you're getting a single measure onto a, onto a, basically a lab paper that then gets, gets hydrolyzed and they have to pull things out so there could be some variability there. And all of them lack some of this deeper dive into just that last kind of step of what biotransformation really looks like. And the reality is, even if we're not talking about hormones, these same pathways metabolize drugs like lipid lowering drugs, pain medications, SSRIs. All of these pathways metabolize a ton of stuff. And so they all have, I would say they have their credit and their limitations. So I think, think all of those have at least some of the best stuff we can look at today. You know, I really honestly, this could be done with liquid chromography, mass spec, with frozen samples of urine in a single single morning study. You know, if you just wanted to see the hormone metabolites, maybe you're not looking for that diurnal cortisol where they haven't gone through that reagent activity. You know, it's just hard to get people in the lab world to think differently because they're just thinking about competing with each other.
- [66:08]
Dr. Amy
Yeah, yeah, exactly. And Nobody wants to take that extra step. And to your point, about the 24 hour urine. Yeah, it's. It's a pain in the ass. And it's more expensive.
- [66:16]
Betty Murray
Yep.
- [66:16]
Dr. Amy
So when you're looking at your, your average person and what they can do in a day, the Dutch test is, is really good and gives us a lot of information and stays within an affordable realm as well.
- [66:28]
Betty Murray
Yeah. And we generally, we generally get blood work around the same time, so we can see, we can see some comparison things like I'd want the estrone and the estrogen sulfate. And so if we have all of that and then we know how you're metabolizing it, then we're like, okay, we can make some modifications. And you want to look at it again to see if the modifications that you made are working because that helps tailor your prescription to what you really need.
- [66:49]
Dr. Amy
Well, and just a clarification too, you don't dose based on the Dutch test. You always want to know that level in the blood. But the Dutch tells us how you are methylating your hormones, metabolizing your hormones, not necessarily the dosing of your hormonal protocol right now.
- [67:07]
Betty Murray
Right, Right. Yeah. The gold standard today is still blood levels in blood. Recognizing that we can't tell the difference between a free hormone and a bound hormone, but it at least is sort of the standard of where we look at, you know, along with symptoms and other data to identify, yes, this is the right pathway, you know. Yeah. You know, and. Yeah, and so I think it's all part of a bigger picture, you know, because then you could back up and go, what's going on with your gut health? And are you hydrated? Do you drink alcohol every day? That trashes these pathways. Like, there's so many. You have medications that go through these pathways, that CYP3A4 that metabolizes a ton of stuff, you know.
- [67:47]
Dr. Amy
Yeah. So just more data on your body to go a little bit deeper and to get more, more precise with whatever you're doing.
- [67:54]
Betty Murray
Right, right. You know, and so as you look at kind of your future and what you choose to do after your surgery, you know, you could look at it and go, okay, yes, biased is probably a better route at a, whatever level your doctor would prescribe just so you could raise that estriol. So get to more estrogen receptor B binding. Whether you chose to choose to do static or some rhythmic dose, I would say if you're rhythmic dosing, I would probably rhythmic dose progesterone at a much higher level just to sort of counterbalance it. Although you don't have your uterus anymore, I think it's just still sort of protective.
- [68:28]
Dr. Amy
Oh, yeah. I mean, it's. It's protected and that. Oh, gosh. Yeah. Let's just touch on that false premise that docs like to throw out. Oh, you don't have a uterus. You don't need progesterone. Progesterone does so much, from protection of our bones to protection of our breasts to being anti prolific to helping with T4 to T3 conversion and insulin resistance and insomnia and mood. My God, why wouldn't we all be on progesterone whether you have a uterus or not?
- [68:53]
Betty Murray
Not. Yeah. And that's my argument for Estriol. Like, you can. You don't ignore progesterone. Like, it's, like, not magically necessary. Same thing with Estriol. It's there for a reason. And just because we haven't studied it heavily doesn't mean it's not there for a reason.
- [69:07]
Dr. Amy
Yeah. I love it.
- [69:09]
Betty Murray
I love it.
- [69:10]
Dr. Amy
Well, Betty, you're amazing. You're so brilliant. You're so amazing. You're taking time on a Sunday to review my Dutch test. And we did all this live. I knew nothing until I sat down with you except my knowledge of the Dutch. But I wanted to just like, we can't think for ourselves. I don't want to have to sit and try to interpret my own Dutch. I want to sit back and have somebody else do it. Because that's the beauty of having a practitioner look at your Dutch test. So thank you so much for unpacking this and sharing this experience with me as I share it to my audience. And I will continue going down these rabbit holes. I've gone down so many that I'm going to be sharing that journey with my audience as well. But thank you for being a part of it.
- [69:52]
Betty Murray
Absolutely. Thank you for having me. And I think for the people that are listening to this, go and watch it on screen. There's no way to, like, understand all of this conversation without having the visuals. It's just, we need pictures. So if you're listening to it and you're like, I don't know what the hell just happened. Go take some time, watch it on YouTube because that will be very, very helpful at helping you understand what we just kind of went through and.
- [70:14]
Dr. Amy
Exactly. Exactly. Well, amazing. Betty, thank you once again for your time today. Love it.
- [70:19]
Betty Murray
I love it. I love it. Thank you, everybody.
- [70:28]
Dr. Amy
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