ZRT Laboratory (Salivary Steroids)

an adrenal hormone

produced by the adrenal glands

7-keto DHEA (also known as 7-oxo DHEA) is a steroid produced by metabolism of DHEA. It is not directly converted to testosterone or estrogen. 7-keto DHEA is rapidly absorbed when given as a supplement and converted to its sulfate derivative. It is commonly used to produce the metabolic effects of DHEA while avoiding metabolism into estrogens or androgens, and clinical research supports its role in benefiting metabolism and weight management. Endogenous 7-keto DHEA may have some anticortisol activity through enzyme competition which in the case of hypercortisolism may be beneficial to the adverse effects of cortisol on metabolic syndrome. Most studies on 7-keto DHEA are on improving the metabolic rate where there appears to be improvement in metabolism despite being on a low caloric diet. There is also limited information that 7-keto DHEA may act to increase levels of T3 while patients are on a caloric restricted diet.

Steroid 5-beta reductase

the main metabolite of progesterone

a medication that inhibits the enzyme aromatase

DHEA and androstenedione are androgen precursors

also known as 17-deoxycortisol

A stress hormone produced by the adrenal glandsa

Under the direction of the hypothalamus and pituitary, and controlled by a negative feedback loop, the zona fasciculata of the adrenal cortex is stimulated to produce cortisol in response to circadian peaks and troughs in ACTH synthesis in addition to various types of stressors such as emotional/psychological, physical (injury, exercise), chemical, pathological (viruses, bacteria, etc.). The feedback loop is commonly referred to as the hypothalamic-pituitary-adrenal (HPA) axis. In a normal nonstressed state cortisol production is at its highest upon waking and declines steadily during the day, reaching its lowest point at bedtime. Cortisol has a wide range of effects on mind and body and interacts with the reproductive, thyroid and immunological systems. As part of the stress response, it prepares the body for “fight or flight” by regulating epinephrine (adrenaline) biosynthesis, and in doing so it can suppress the production of other hormones, including those involved with reproduction, and some immune functions. Salivary cortisol measurements are considered the gold standard in testing stress, in screening for Cushing’s disease, and in evaluations of adrenal insufficiency, such as Addison’s disease.

A stress hormone produced by the adrenal glandsa

A stress hormone produced by the adrenal glands

an inert form of cortisol

Dehydroepiandrosterone (DHEA), a hormone produced by the adrenal glands, is the precursor for estrogens and testosterone, and is therefore normally present in significantly greater quantities than all the other steroid hormones. It is mostly found in the circulation in the form of its sulfate ester, DHEA sulfate (DHEA-S), levels of which in saliva are higher and more stable than those of DHEA. Its production is highest in the late teens to early 20s and declines gradually with age in both men and women. Levels of DHEA-S reflect adrenal gland function. Low DHEA-S indicates adrenal insufficiency and/or androgen deficiency and can be associated with reduced libido and general malaise. High DHEA-S levels are seen in hyper-adrenal states such as CAH, and in polycystic ovarian syndrome; high levels in women are associated with masculinizing effects because of its local metabolism to testosterone. DHEA supplementation has been successfully used to treat adrenal insufficiency and can restore normal levels of testosterone in women with androgen deficiency, particularly as a consequence of ovary removal. Because of its conversion to potent estrogens and androgens, levels should be closely monitored during supplementation to avoid excess. DHEA is a supplement commonly used topically and orally. It is marketed as a dietary supplement for weight loss, increased metabolism, and memory enhancement.

Dehydroepiandrosterone (DHEA), a hormone produced by the adrenal glands, is the precursor for estrogens and testosterone, and is therefore normally present in significantly greater quantities than all the other steroid hormones. It is mostly found in the circulation in the form of its sulfate ester, DHEA sulfate (DHEA-S), levels of which in saliva are higher and more stable than those of DHEA. Its production is highest in the late teens to early 20s and declines gradually with age in both men and women. Levels of DHEA-S reflect adrenal gland function. Low DHEA-S indicates adrenal insufficiency and/or androgen deficiency and can be associated with reduced libido and general malaise. High DHEA-S levels are seen in hyper-adrenal states such as CAH, and in polycystic ovarian syndrome; high levels in women are associated with masculinizing effects because of its local metabolism to testosterone. DHEA supplementation has been successfully used to treat adrenal insufficiency and can restore normal levels of testosterone in women with androgen deficiency, particularly as a consequence of ovary removal. Because of its conversion to potent estrogens and androgens, levels should be closely monitored during supplementation to avoid excess. DHEA is a supplement commonly used topically and orally. It is marketed as a dietary supplement for weight loss, increased metabolism, and memory enhancement.

the precursor for estrogens and testosterone

an endogenous androgen

the most potent of the three primary estrogens

the predominant, and the most potent, circulating estrogen

the weakest of the three major naturally-occurring estrogens in women

the weakest of the three major naturally-occurring estrogens in women

one of three main circulating estrogens in humans

Estrogen metabolite

an estrogen receptor agonist

a 5a-reductase inhibitor

an aromatase inhibitor

produced from the pineal gland in a circadian pattern

a neurosteroid

a hormone released by the corpus luteum in the ovary

Progesterone’s primary function during the menstrual cycle is to induce a secretory endometrium ready for implantation of a fertilized egg. Levels therefore increase during the luteal phase of the cycle after ovulation. If no implantation occurs, progesterone returns to follicular phase levels. If a pregnancy results, progesterone continues to rise to very high levels and carries out a variety of functions necessary to sustain the pregnancy. In some patients with infertility, ovulation may occur but luteal phase levels of progesterone are inadequate. Luteal phase deficiency is a result of inadequate progesterone production by the corpus luteum. During menopause, ovarian progesterone production dwindles, resulting in postmenopausal levels similar to those seen in men. Progesterone has wide-ranging physiological effects, including neuroprotection, maintenance of skin elasticity, and development of bone tissue. Progesterone also counteracts the proliferative effects of estrogen on the endometrium. When samples are collected after transdermal application of progesterone, saliva progesterone levels are higher than serum, indicating distribution of progesterone to tissues.

Progesterone’s primary function during the menstrual cycle is to induce a secretory endometrium ready for implantation of a fertilized egg. Levels therefore increase during the luteal phase of the cycle after ovulation. If no implantation occurs, progesterone returns to follicular phase levels. If a pregnancy results, progesterone continues to rise to very high levels and carries out a variety of functions necessary to sustain the pregnancy. In some patients with infertility, ovulation may occur but luteal phase levels of progesterone are inadequate. Luteal phase deficiency is a result of inadequate progesterone production by the corpus luteum. During menopause, ovarian progesterone production dwindles, resulting in postmenopausal levels similar to those seen in men. Progesterone has wide-ranging physiological effects, including neuroprotection, maintenance of skin elasticity, and development of bone tissue. Progesterone also counteracts the proliferative effects of estrogen on the endometrium. When samples are collected after transdermal application of progesterone, saliva progesterone levels are higher than serum, indicating distribution of progesterone to tissues.

Optimal: 100-500 when E2 1.3-3.3 pg/mL

This ratio is helpful when both E2 and Pg are within range, yet the patient continues to have symptoms. It is not expected to be normal or used clinically when either E2 and/or Pg are outside of their expected ranges or if the patient does not have clinical symptoms. Is the ratio relevant in women using hormone therapy? With some types of hormone therapy such as topical progesterone, Pg levels in saliva are much higher than endogenous luteal phase levels, ranging from 200-3000 pg/mL at 12-24 hours after dosing, and so the ratio can appear high. However, because symptoms of both estrogen dominance and progesterone dominance can look the same, testing and assessing the ratio along with clinical symptoms can help determine the next step for treatment.

Hormone

Testosterone levels in saliva are an accepted method for assessment of hypogonadism in men. In women, high testosterone, often caused by ovarian cysts, leads to conditions such as excessive facial and body hair, acne, and oily skin and hair. Low testosterone in postmenopausal women, seen particularly after surgical removal of the ovaries, leads to female symptoms of androgen deficiency including loss of libido, thinning skin, vaginal dryness, and loss of bone and muscle mass.