Estradiol is lower than the observed range for a premenopausal woman. Lower estradiol is common in pre-menopausal women who may be experiencing fluctuating hormone levels, anovulatory (no ovulation), irregular cycles or in women using hormonal contraception (none noted). Symptoms of low estrogen include: hot flashes, night sweats, vaginal dryness, low libido, bone loss and/or mood swings. In general, supplementation with estrogen is not needed, but ovulation support (e.g. vitex agnes-castus) may be beneficial if symptoms are problematic.

Progesterone is higher than expected for a woman not using supplementation (no indication). High progesterone may be due to endogenous production, recent/current supplementation to progesterone, or exposure to progesterone from family members or anti-aging cosmetic facial creams. With “active” daily supplementation of 10-30 mg topical progesterone, salivary levels are expected to be in the 200-3000 pg/ml range 12-24 hr post supplementation.

Testosterone is within the high-normal range. High testosterone could indicate high production by the ovaries (common at early menopause and in women with cystic ovaries), supplementation with testosterone or other androgens (DHEA or 7-keto-DHEA. Note, DHEAS would also be high with these supplements), or exposure to someone using topical testosterone (usually a partner). Chronic high testosterone may be associated with high androgen symptoms (e.g. increased facial/body hair, acne, loss of scalp hair), particularly when estradiol and progesterone are low (both are antiandrogens). Correction of estrogen and progesterone imbalances often helps correct high androgen levels and symptoms. Chronic low DHEAS may suggest HPA axis dysfunction, particularly if cortisol is also low and symptoms are indicative of low adrenal function. DHEAS is highest during the late teens to early twenties (10-20 ng/ml) and drops steadily with age to the lower end of range by age 70-80. Consider adrenal adaptogens or DHEA supplements if symptoms of androgen deficiency are problematic.

Cortisol is low in the morning, normal during mid day, and high at night. This flattened circadian profile indicates adrenal dysfunction. In a normal individual without significant stressors, cortisol is highest in the morning shortly after awakening (optimal level 4-6 ng/ml) and steadily drops throughout the day, reaching the lowest level during sleep in the very early morning about 2 am (optimal level 0.7-1.0 ng/ml just before bed). The abnormal pattern seen in these test results indicates some loss of negative feedback control of cortisol to the brain (hypothalamic-pituitaryadrenal axis/HPA). Desensitization of the brain to cortisol often is related to excessive and chronic stressors (emotional, dietary, physical), nutrient imbalances/deficiencies, or the inability to regulate glucose levels (dysglycemia). Adrenal dysfunction, particularly high night cortisol, is associated with symptoms of sleep disturbances, anxiety, memory lapses, fatigue, bone loss, and depression. A high night cortisol may contribute to sleep disturbances and immune dysfunction. Adequate rest and sleep, gentle exercise, proper diet (adequate protein), nutritional (vitamins C and B5) and herbal supplements are some of the natural ways to support adrenal function. For additional information about strategies for supporting adrenal health and reducing stress(ors), the following books are worth reading: “Adrenal Fatigue.”