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Hot Springs' Nutrition and
Natural Healing Center

Dr. Roger Trubey, Dr.PH, MPH and Doctor of Integrative Medicine
Call 501-624-1248
455 Broadway St
Hot Springs, AR 71901



Adrenal and Sex Hormone Assessment


Hormones exert a powerful influence over all physical, intellectual and emotional behavior. Problems with weight, memory, sleep, digestion, blood pressure, high cholesterol, cravings, addictions, sexual dysfunctions, and problems associated with the immune system, are all influenced by the endocrine system. Endocrine problems lead to a wide spectrum of symptoms that in most cases can be reversed using natural methods.

A primary marker of the aging process in both men and women is a reduction in normal hormone levels which is responsible in large part for infertility, decreased energy and muscle strength, loss of libido, depression, mood swings, inability to cope, and an increase in the symptoms of PMS and menopause.  Research has shown that the use of natural hormone replacement can provide benefits for both men and women.

Estrogen dominance is a primary cause of almost all female health problems, including fibrocystic breast disease, PMS, mood swings, excessive bleeding, endometriosis, fibroids, infertility, and ovarian cysts. Perimenopause is the time when hormone levels begin to shift in preparation for menopause. It is not so much the decrease in hormones that produces the uncomfortable symptoms associated with perimenopause, but rather the changing ratio between estrogen and progesterone. Chronic or episodic depression, severe mood swings, and anxiety are frequent manifestations of these midlife fluctuations.

But estrogen can also be found deficient in the female body as well.  Signs of estrogen deficiency include: hot flashes, night sweats, dry eyes, vaginal dryness, sagging breasts and loss of breast fullness, mental fogginess, depression, changes in mood, decreased sense of sensuality and sexuality.

Progesterone is another female "sex" hormone, produced in the ovaries, that prepares the uterus for a fertilized egg. Its sudden withdrawal causes the uterus to shed its lining if pregnancy does not occur. While estrogen is high (during days 7-14 of the menstrual cycle), progesterone is at its lowest level. Its levels climb to a peak between days 14 - 24, and then dramatically drop off again just before the start of menstruation. Ideally, women should have five to ten times more progesterone than estrogen in the blood and 40 to 150 times more in the saliva. The lower the ratio of progesterone to estrogen, the higher the risk of health problems. Progesterone has the unique ability to change its structural form to become other hormones, allowing it to be converted and utilized by the body to the point of depletion.

Testosterone is responsible for much more than defining sexual characteristics in men or influencing sex drive. Testosterone is essential for life since it helps to regulate basic metabolism. Testosterone also facilitates protein synthesis and the building of body and bone tissues. Testosterone is produced by small groups of specialized cells within the testicles and is also secreted, to a lesser extent, by the ovaries. The production of testosterone is triggered by luteinizing hormone (LH), produced in the pituitary gland. In the absence of LH, testosterone production ceases. With age, blood levels of testosterone slowly decrease. Research conducted by the National Institute of Health has shown a 2% reduction per year from age 30 to age 70.

Endocrine problems may be the result of stress. Simply put, stress is the sum total of all mental and physical input over a given period of time. The marker used to measure stress is the adrenal steroid hormone, cortisol. Stress, whether physical or emotional in origin, provokes a response by the adrenal glands. Many hormonal imbalances are the direct result of adrenal insufficiency. When the adrenal glands become exhausted due to overwork, adequate levels of the stress hormones, DHEA and cortisol cannot be produced, this in turn plays a major role in the usage, or the misappropriation of all the other steroid hormones.  In other words with undue, long-term stress the body will use sex hormones to make stress hormones.  This is never an efficient system and was only designed by the creator for emergencies.  The trouble is that when this process continues for long periods of time, a maladaption takes place that depletes both progesterone and testosterone leading to estrogen dominance and all the problems associated with that in both men and women.

The adrenal glands produce two primary hormones, DHEA and cortisol. Both are considered the major shock absorber hormones in the body. They buffer us to stress and the negative impact it can have on both mental and physical function. Long-term stress can have a serious impact on the adrenal glands and cause them to shrink and reduce production. This causes cellular damage, which sets off a chain reaction affecting all parts of the body, as well as accelerating the aging process.

The adrenal glands hold the key to the hierarchy of hormones. It is necessary to establish the proper foundation first which means you must determine the cause of the hormonal dysfunction and treat the cause first. Our research has shown that to cause a positive hormonal change you must normalize adrenal activity first. It is the mainspring in the hormonal mechanism. When the adrenals malfunction, all other associated systems will as well. The symptoms associated with adrenal dysfunction are diverse and can involve the digestive, circulatory, respiratory, as well as the brain and nervous systems. In addition, the adrenals can impact the growth and repair of bones, muscles, hair and nails.

Knowing your adrenal and sex hormone levels is an important first step in assessing where your hormones may be out of balance and determining whether your current natural hormone regimen is working for you. If you are wondering whether certain symptoms may be due to a hormone imbalance, this is a quick, easy, and accurate way to find out.

There are three primary ways of assessing hormone levels - blood, saliva and urine. While each some advantages and disadvantages, it is my opinion that overall the best method is urine. But some testing will combine the saliva and urine and some parameters are only assessed via blood.

Saliva testing – While the free cortisol pattern in saliva has clinical value, there is a significant missing piece to surveying a patient’s HPA-Axis function with saliva testing – measuring metabolized cortisol. To properly characterize a patient’s cortisol status, free and metabolized cortisol should be measured to avoid misleading results when cortisol clearance is abnormally high or low. Likewise with sex hormones, measuring estrogen and androgen metabolites gives a fuller picture for more precise clinical diagnosis of hormonal imbalances and HRT monitoring.

Serum testing – While the most universally accepted testing method (due to the availability of FDA-cleared analyzers that are reliable and inexpensive), serum testing is lacking in some areas. Adrenal hormones cannot be effectively tested in serum because free cortisol cannot be tested throughout the day. There is also a lack of extensive metabolite testing (especially for cortisol and estrogens).

24-Hour Urine Testing – There are two primary drawbacks to urine testing of hormones. First, the collection is cumbersome, and as many as 40% of those who collect, do so in error. Secondly, dysfunction in the diurnal pattern of cortisol cannot be ascertained from a 24-hour collection. The daily free cortisol pattern was formerly only available with salivary testing.

The Dried Urine Test for Comprehensive Hormones (DUTCH) offers some distinct advantages.

· This advanced hormone testing was developed to improve on the available hormone testing options. DUTCH offers the most extensive profile of sex and adrenal hormones along with their metabolites. Additionally, the daily (diurnal) pattern of free cortisol is included along with melatonin. This unique combination of clinical information is not available by any other method.

· Effective HRT Monitoring: DUTCH testing was specifically made to be optimally effective for most forms of hormone replacement therapy. Unique methods are used for improved monitoring of oral progesterone and vaginal hormones.

· The Easiest Patient Collection: Patients collect just four or five dried urine samples over a 24-hour period. Dried specimen shipments are convenient worldwide. Dried samples are stable for several weeks.

· Analytical and Clinical Validation: Precision Analytical testing methods go through a rigorous validation process to verify accuracy, precision, recovery, linearity, etc.

In a separate test the lab providing the DUTCH assessment also combines the regular DUTCH urine assessment with saliva testing as a means of assessing a Cortisol Awakening Response (CAR). CAR is the natural rise in cortisol that is seen 30 to 40 minutes after awakening followed by a noticeable drop by 60 minutes. This activity is influenced by brain activity (hypothalamus/pituitary) and by adrenal function. Stress of all types will have a major influence on the CAR response.

Lower than normal CAR is often seen in individuals with:

· A high amount of psychosocial burnout

· Chronic fatigue

· PTSD

· Seasonal affective disorder (during winter)

· Nightshift work schedules

· Sleep apnea

· Short sleep cycles

· Chronic inflammation

· Adrenal insufficiency

· Lack of morning sunlight exposure

· Hippocampal damage or atrophy

· Amnesia (due to temporal lobe damage)


Factors associated with an elevated CAR include:

· Immediate access to light upon awakening

· Depression

· Ovulation phase of the menstrual cycle

· Sleep issues

· Older age

· Ongoing job-related and perceived stress (CAR is significantly higher on work days)


Hormone testing provides clues about menstrual irregularities, infertility, erectile dysfunction, endometriosis and osteoporosis. A hormone test can determine some of the reasons for hot flashes, night sweats, decreased libido, as well as monitor bio-identical and natural hormone therapy. In addition The DUTCH assessment also provides you a number of other very important clinical health parameters including:

· Methylation activity on hormones

· Vitamin B6 and B12 markers

· Glutathione marker

· Neurotransmitter metabolites

· Melatonin levels

· 8-OHdG Oxidative stress level

· Phase I and II detox function


Saliva contains the free fraction of the hormones which reflects the bioactive tissue levels. Free Fractions in saliva correlate more closely with clinical symptoms than total blood serum hormone levels (which mostly reflect the bound fraction). But dried urine testing has been shown to be extremely well correlated with saliva levels while at the same time providing us with many additional parameters that are unavailable with either saliva or blood.

Adrenal and sex hormone assessment is an accurate and simple way for you to know your current status of both the adrenals and sex hormones giving you information you will find highly valuable to improving your overall health.


Call Dr. Trubey at 501-624-1248 and make an appointment for a comprehensive health evaluation today.


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