In our last episode we talked about the differences between PCOS and Adrenal Dysfunction, which is often called Adrenal Fatigue.  Adrenal Fatigue or Adrenal Dysfunction is not a ICD10 diagnosis. There is an actual ICD10 billable code called: unspecified adrenocortical insufficiency (E27.40).  But there is controversy in using this code for patients. It is technically meant for conditions where the adrenal glands do not produce enough steroid hormones such as cortisol and aldosterone.  You might be saying, but this sounds exactly like Adrenal Fatigue/Dysfunction! Most people with Adrenal Dysfunction have normal labs, so their doctor cannot code for Adrenocortical Insufficiency (E27.4).  And because their labs and testing look normal people are told they are fine and dismissed.

In this episode, we are going to talk about the testing for Adrenal Dysfunction.  There are some testing that can show Adrenal Dysfunction such as saliva and urine testing.  But most conventional docs are mainly familiar with blood testing. Typical blood testing for adrenals usually will show that a person doesn’t have adrenal dysfunction, when in reality, they do. 

We are going to talk about the different methods for testing Adrenal Dysfunction. 

 Let’s start by talking about the most common testing method that most docs use, blood testing.

Adrenal Blood Testing:

Cortisol: Blood testing for cortisol is not accurate.  Most, if not all people with Adrenal Dysfunction will test normal for cortisol blood testing.  The reference ranges are vast and a blood test is only done once or twice in one day. And when you have a needle coming to stab you, automatically the body raises the stress hormones.  So cortisol can be falsely elevated in a blood test.

DHEA: DHEA is secreted mainly from the adrenal glands.  In adrenal dysfunction, you will see lower levels of DHEA.  DHEA reference ranges are vast and everyone falls in normal when doing a DHEA total blood test.  But a DHEA-sulfate blood test is fairly accurate for evaluating levels of DHEA in the body. But again, those lab reference ranges are still pretty broad.  But in general, terms, if the DHEA is low or low normal range then you can start to consider that a person has Adrenal Dysfunction.

Testosterone: DHEA is secreted mainly from the adrenal glands and will convert to testosterone for females.  In adrenal dysfunction, you will see lower levels of testosterone in women because of the reduced DHEA levels.  In men with adrenal dysfunction, you will also see lower levels of total testosterone. Testosterone reference ranges are very vast.  Quest has a reference of 2-45 for females and for males the reference range is 250-1100 ng/dL. These are pretty big reference ranges.  But if someone has a low normal testosterone level you can consider that person has Adrenal Dysfunction. 

Pregnenolone: Pregnenolone is secreted from the adrenal glands and there is a small amount made in the spinal cord and brain making it very neuroprotective.  Pregnenolone is accurate as a blood test. But like DHEA and Testosterone, the reference ranges for pregnenolone is huge. For Labcorp the reference range is anything less than 150 is normal and Quest has a range is 22-237 ng/dL.  Usually, any level under 80 will be considered for Adrenal Dysfunction.

Saliva test:

Saliva tests are much more accurate for cortisol than a simple blood test.  Doing a series of 3-4 specimen samples of saliva throughout the day can really reflect the cortisol diurnal curve.  

There are four samples of saliva taken.  Morning, noon, afternoon late evening. Often in Adrenal Dysfunction, you will see low cortisol in the morning and elevated cortisol at night.  It is much more accurate to see this in a salivary test.

There are several companies that do saliva testing.  We have used ZRT and Diagnos-techs mostly with patients on testing adrenals using saliva.

DUTCH test:

This leads us to the next testing, A DUTCH test.  A DUTCH test is a urine test. It is one of the most comprehensive hormone tests and adrenal testing available.  It can check all the hormones with urine testing. And there is an add on or extended test that can also check the cortisol diurnal curve accurately.  

If you are interested in getting tests done for Adrenal Dysfunction, we have all the testing available for purchase from our store. Because you are a Progress Your Health podcast listener, use the codePYH67 for 20% off. 

PYHP 067 Full Transcript: 

Download PYHP 067 Transcript

Dr. Maki: Hello, everyone. Thanks for joining us for another episode of the Progress Your Health Podcast. I’m Dr. Maki. 

Dr. Davidson: And I’m Dr. Davidson. 

Dr. Maki: So, in this episode, we’re going to continue our series on adrenals. The last one, we talked about the kind of transitioning from concealed type of PCOS to adrenal fatigue, or if you would like to use the term adrenal dysfunction. This one we’re going to talk about testing.

Dr. Davidson: Sorry, I’m a little distracted. If any of you hear like a little like chomping noise throughout the entire episode, I apologize. We have our dog with us because we always bring him to our office, and he’s going to town on this bone. 

Dr. Maki: Yeah, he’s sitting at our feet enjoying a bone of some sort.

Dr. Davidson: It won’t be a bone much longer, I think it’s gonna be eaten. 

Dr. Maki: Yeah.

Dr. Davidson: But yes, we’re going to talk about–we’re going to continue talking about adrenal fatigue or as we like to call it more adrenal dysfunction. One of the main things that, you know, we’ve been dealing with adrenal fatigue, adrenal dysfunction for years, I mean, since we started practice in 2003, 2004. But what we’ve always run up against and even now in 2019, is you know, patients aren’t really technically being diagnosed with adrenal fatigue, because technically, it’s not a diagnosis.

Dr. Maki: Yeah, right. We touched on this in the last episode too; how cortisol is such a major hormone, you know, like you said, we can’t live without it. Our body– we wouldn’t survive without that major hormone. But yet, when it comes to a diagnosis, there’s these two rare things. What was the one– What was the diagnosis, the ICD 10 code that you actually found? What was the name of that?

Dr. Davidson: Well, throughout the years, I’ve always been looking for some kind of ICD–you know, ICD-10 code to be able to diagnose, you know, there’s Dr. Maki will talk a little bit about Addison’s and Cushing’s disease, but there is one that has been around not that long called an Unspecified Adrenal Cortical Insufficiency. Now, that is also a little bit vague, and a lot of doctors don’t use it because the whole kind of controversy behind it is the diagnosis is meant for people, you know, patients that don’t produce enough cortisol and aldosterone or cortisol or aldosterone. And you might say, “Hey, that sounds just like adrenal fatigue, adrenal dysfunction.” But everybody that does the typical normal lab testing that their conventional doctors do always come out in the normal range. So, they can’t diagnose them with that E27.4 ICD-10 diagnosis code because their labs look normal when in reality, we know you know, that they’re not normal; that they have adrenal dysfunction. But they’re told that they’re normal, they’re dismissed and sent on their way.

Dr. Maki: Yeah, right. S, that’s really a kind of a drawback from doing a Blood Cortisol test. And most functional medicine doctors are aware that. Most functional doctors do not test cortisol through blood precisely for that reason because everybody, as you said, is going to fall within that reference range. And it’s a fairly wide reference range. You might be low normal, but technically, if the numbers low normal, using that objective information for that for– to be able to build that diagnosis code, you wouldn’t be able to do it if the number– if the cortisol level comes back within that reference range, you wouldn’t be able to use that, that diagnosis code. So, it really leaves doctors and patients with really no other options. That’s why a lot of people that we work with, they don’t really have a diagnosis. They have this kind of pseudo functional medicine ideas or concepts or theories that are not an actual real diagnosis.

Dr. Davidson: And that’s a good, you know, kind of segue into, you know, blood testing. So typically, when you’re looking at testing for any diagnosis for any condition is, “Hey, let’s do some lab testing. Let’s do some blood testing.” That’s what pretty much most conventional doctors will do. And Dr. Maki’s right, if you do a cortisol blood test, everybody– I would say probably most, if not all, of the people with adrenal dysfunction, come back with a normal Blood Cortisol level on that test. And of course, you know, we had talked about the diurnal curve of cortisol, the adrenals secrete cortisol; high in the morning, it comes down slowly with time, and then it’s very low at night so that we can go back to sleep. So, when you’re doing a blood test, it’s just one second, one minute of your day. Let’s say you go in at 10:00 in the morning, it’s not– and the reference ranges are huge, everybody just falls in those normal reference ranges. And some doctors trying to be a little bit more progressive might have somebody go in at 8:00 o’clock in the morning and then go back at 4:00 in the afternoon. But they’re still gonna– nine times out of 10, you know, if not 10 times out of 10, fall in that normal range.

Dr. Maki: Yeah, because the range is so wide. So, everybody falls within that range. When you do a morning cortisol, you have to be at the lab by 9:00 o’clock. But when you’re trying to assess someone’s adrenal function– so, think about it, you got to get up, you got to shower, you got to put in your clothes, you got to drive to the lab, and have to be there before 9:00 o’clock, depending on what time you woke up. Of course, your cortisol is going to be a little bit higher by the time you get there. So, because you’re awake and you’re moving and you’re driving your car, you know, on your way to the lab, it may still below normal, but it’s more than likely can still be a normal test.

Dr. Davidson: And you think, you’re sitting in the lab, you have a needle coming at your arm to be stabbed. No matter how calm and cool and collected you are, your cortisol levels are still going to spike up a little bit as a stress response to a needle coming to stab you in the arm. That’s why I’m– on a side note, a lot of times when you run someone’s fasting glucose, it might be high normal or a little over the edge normal. And that’s usually because I’ll ask them, “Hey, how was that draw?” And they’ll say, “Oh, it was awful. They had to poke me twice. And they were moving the needle around. And I had this huge bruise.” And I’ll say, “Yeah, no wonder, you know, your cortisol went up, and that automatically mobilizes glucose. So, that’s why your glucose is a little bit over the edge normal.” So, definitely blood testing and with cortisol to determine cortisol levels for adrenal dysfunction is a no go.

Dr. Maki: Yeah. And that’s even why like coffee is not, you’re not really supposed to drink coffee in the morning because coffee raises cortisol. Cortisol will have an effect on your blood sugar, and it can throw off pretty much everything: throw off your blood sugar and throw up your cholesterol control of all those numbers. So, you know, that’s why they usually only recommend water in the morning because you’re already going to get a skewed result. But based on we just talked about, the needle driving to the, you know– If you’re driving they’re before 9:00 o’clock, you’re probably going to be stuck in at least a little bit of traffic or some kind of rush hour. Those are all kind of stressful things that’s going to give you an artificially inflated number anyways, so back to your point, then everyone’s going to have a normal number. Now, I’ve seen over the course of the years, I’ve never seen a low cortisol on a blood. Have you ever seen a low one?

Dr. Davidson: I’ve seen. Definitely seen low normal, but not actually out of their huge humongous vast reference ranges. But I have seen high. 

Dr. Maki: Yeah. I’ve seen a few high. They were kind of borderline like Cushing’s, like the patients didn’t end up having to have Cushing’s because again, Cushing’s is a fairly rare problem. But they were definitely, you know, high– an elevated number that was, you know, certainly got our attention for sure.

Dr. Davidson: And also too LCM high if people are on certain medications, of course.

Dr. Maki: Yeah.

Dr. Davidson: You know, steroids, prednisone, that kind of thing.

Dr. Maki: Yeah. Right. Right. Right. And that wouldn’t– that doesn’t really– I mean that doesn’t really count. 

Dr. Davidson: No.

Dr. Maki: Because like you said, they’re on such a, you know, powerful medication. But there are a couple of ways that you can infer what’s happening with the adrenals, right? And especially for women, you know, somewhat for men, but really for women, that gives a little glimpse, you know, because we’re going to do blood work anyways because we’re looking at thyroid, we’re looking at some other inflammatory markers, we’re looking at insulin, we’re looking at a few other things. So, it just makes some sense to look at these adrenal hormones at the same time.

Dr. Davidson: Exactly. So, we’ll go into some other testing. But let’s continue talking about some of the common blood testing that you can do for the adrenals. Like we said, we kind of, you know, put cortisol, blood testing to the side, but you can also test for DHEA which– DHEA is a hormone that’s secreted from the adrenal glands. So, that’s another blood test that you can do trying to infer or look for that adrenal dysfunction.

Dr. Maki: Yeah, right. Another one that we both do quite often is pregnenolone. Now all of those hormones are, you know, technically would be classified as steroid hormones because they’re all made from cholesterol. So, cholesterol– if you go down the little steroids tree and a lot of these labs and you know, different things will have these little pathways; cholesterol then gets turned into pregnenolone. Pregnenolone gets turned to DHEA, and then DHEA will branch into the other sex hormones: estrogen, progesterone, testosterone, including cortisol. Alright, so they’re all fairly similar with their cholesterol backbone. And as we just said, testing directly for cortisol doesn’t really tell you a lot. But testing for the other ones can tell you quite a bit.

Dr. Davidson: Exactly. So, with the DHEA, you don’t want to test blood levels of DHEA total because usually has such a broad number is we like to– if you’re going to do a blood test is do the DHEA sulfate, which is a metabolite of DHEA. But it’s a little bit more specific or accurate in evaluating the levels of DHEA in the body. Now, DHEA in men is– it’s an androgen. Men have more DHEA than us females. And also we have more DHEA when we’re younger, and it slowly goes down with time. So, that’s why it’s a little bit of a double-edged sword because the lab reference ranges are pretty broad even for DHEA sulfate.

Dr. Maki: Yeah, right. It’ll range for a woman in her 20’s, it’ll range anywhere from 40 to 300, 350, something like that. And then as the decades go on that, you know, that the bottom number– the bottom end of the reference range stays pretty consistent with the top in the range, but the time a woman’s in her you know, 50’s or 60’s, I think it goes up down to like 188. I mean, it goes pretty low. So, it drops, you know, quite a bit over about a 30-year period.

Dr. Davidson: But you can pretty much on generalize terms. To tell you is, you know, a DHEA sulfate that’s under 100 are on that, you know, that low end of normal range, you definitely should consider that that person has adrenal dysfunction. So, if you’re seeing that DHEA sulfate on that low normal range, regardless of the age, you’re going to have to infer like, “Hey, we need to look into this adrenal dysfunction”, because that’s typically what you will see.

Dr. Maki: Yeah, right. Yeah. So, even for us, we’d like to see a DHEA sulfate for women at least at 100. And now granted, as we talk about PCOS in the last series that we did, we don’t want that number to be too high. Somewhere between, let’s say, 125– would you say 125 to 175 would be kind of appropriate. Once you get above 175, that’s kind of where you start getting into that PCOS range. 

Dr. Davidson: Yeah, over 180 you start– They could be having a, you know, sensitivity to those androgens or to the DHEA. And then, you know, as we’re gonna talk now about the testosterone because testosterone isn’t an adrenal hormone, but for– especially for females, is DHEA converts into testosterone. So, when you see that DHEA sulfate, you know, over 180 you know that that could also be converting into testosterone and creating high levels of testosterone. But like we were saying, in adrenal dysfunction, you’re going to see the DHEA sulfate on that low end of normal.

Dr. Maki: Yeah, right. Yeah, the DHEA is going to be, you know, less than 100, less than 75. In some cases, it’s going to be less than 50. And then, of course, you would almost expect the testosterone to follow suit, and the testosterone is going to be probably more than likely, like in the single digits can be less than 10. That is definitely an indication that that person, whoever that person is, has had, you know, chronic stress, you know, for quite a long time to make those numbers to be so low.

Dr. Davidson: Yes. So, you know, we– You know, I know, it seems like we’re talking a lot about the ladies, but you know, we see a lot of ladies as our patients, but– So, you will see in the females with adrenal dysfunction, their DHEA sulfate is low, their testosterone, you know, low normal, and then that testosterone as a blood test as well for the females, you will see that on the low normal range too. Now, the Quest to reference range for testosterone is 2 to 45. What is it, nanograms per deciliter. It’s huge. I mean, you could be at 2 and you can be at 45. And that’s normal. But typically, with adrenal dysfunction for females, you’ll see that that number somewhere, you know, anywhere below 15. Usually, if you see it below 15, you know, 8,9,7– I’ve seen 3, that’s definitely pointing to some kind of adrenal dysfunction that you want to look into. Now men, because men have adrenal fatigue, adrenal dysfunction as well, I mean, just as much as females do, is the reference range for testosterone in men is 250 to like 1100 nanograms per deciliter. That’s huge, 250 to 1100.

Dr. Maki: Yeah, right. Now, if you’re a man, you know, and your testosterone is 8 or 900, you’re gonna feel pretty good. If your testosterone is 250 or 251 in the normal range, you’re going to feel a little bit different than– Again, there needs to be – and this is what we work with, there needs to be kind of a– you take the patient’s case or their situation into consideration, you look at the numbers. And honestly, if there’s a clinical presentation, and those numbers are low normal, even though they’re still normal, that is, you know, that’s a positive test right there.

Dr. Davidson: Exactly. See, a male, if, with adrenal dysfunction, you will definitely see their testosterone down at 250. I’ve even seen men, which– like I said, that a vast reference range of men at 100, 180 for their testosterone. So, that and even in young men, you know, they’re 45, 48, 53, they’re, you know, they’re young that they should have a testosterone of at least, you know, 500 or 600. So, definitely– Fellas, if your testosterone testing low and you’re not sure why or low normal, definitely we want to work on the adrenals, not just the testosterone.

Dr. Maki: Yeah, right. Yeah. And now granted, we do obviously, a hormone replacement for men. We do prescribe testosterone quite often. But we do have somewhat of an age limit. Like we’re not going to give a 20-year-old or 25-year-old, we’re not going to give them testosterone, we’re not even probably going to give an early 30-year-old testosterone. Some situations where that might applies that they’ve already been given testosterone by another doctor, which does happen, we do a little bit of a different way that can hack–actually help restore their testosterone rhythm. But almost in all those cases of men, whether they’re in their 20’s, 30’s, 40’s or beyond, if they have low testosterone or low normal testosterone, usually their stress level’s really high. Right? So, the cortisol is just a testosterone killer, you know, for men, and it just pulls their numbers down so significantly. You know, so in some ways, you’re right, a low normal testosterone for a male or a female is a really good indication that they have been under stress for a long time. You can even look at the labs; you don’t even have to hear anything from them. You just look at your lab and say, “Oh, yeah, this person’s really stressed out.” And then usually you ask them, and they’re like, “Oh, yeah, it’s been– it’s been a rough couple of years”, or you know, something and they confirm that your suspicions were right based on what the numbers say.

Dr. Davidson: Now, Dr. Maki had mentioned earlier about pregnenolone. And pregnenolone is a hormone that comes from the adrenal glands. There’s also a little bit made in the spinal cord and the brain which is why pregnenolone is so amazingly like neuroprotective. It’s great for memory. It’s what helps you learn things. When you’re, you know, your kids, you know, when you’re 20, you have such high levels of pregnenolone which is why you remember everything. You don’t even have to take notes in a meeting. But you will definitely see with pregnenolone, with adrenal dysfunction, it drops. Pregnenolone probably is more – I’ve noticed over the years, more sensitive to the adrenal stress or as Dr. Maki was mentioning, you know, lifestyle, external stress that’s putting stress on those adrenal, you’ll see that pregnenolone plummet. And I’ll see it plummet in all ages. I’ve seen girls in their early 20’s. And it’s nothing because of something, you know, something bad that had happened, or you know, you’ll see, you know, somebody in their 40’s and it’s like it, you know, what, eight. Now, this is another little bit of a– as again, we’re going to test pregnenolone in the blood, which is very accurate doing it blood wise, the reference range, you’ve got to take into consideration because even for Quest, the reference ranges, 22 to 237 nanograms per deciliter. That’s huge, 22 to 237. Lab Corp doesn’t really have a reference range. They just say anything less than 150 is normal. But we will tell you, anybody that has a pregnenolone level of under 80 is definitely going to be considered for adrenal dysfunction. I always kind of make 80 sort of my creme de la creme number that we’re working towards to bring their pregnenolone up to.

Dr. Maki: Yeah, right. Yeah. And those are– DHEA sulfate I think has been done for a long time. Pregnenolone isn’t done– it’s never done in primary care settings. It’s never done by endocrinologists. Certainly, you know, functional medicine minded doctors are certainly going to test a pregnenolone. But this is a very simple way between those three tests: the testosterone, the pregnenolone, the DHEA. It gives you a little glimpse of what’s going on. Now, we’re gonna go into– if we do need more information, right? If there’s something going on, or they’re not responding to our initial treatment or something, or there’s just something weird going on with their symptom picture, then we might actually go into a little bit more adrenal– specifically, more adrenal testing.

Dr. Davidson: Yes, honestly, the saliva testing for adrenal dysfunction in particular for cortisol is so accurate and so amazing. So, we’re talking about the blood tests because that’s what generally everybody in this country has access to. They have access to their primary care, who has access to doing, you know, send you over to Quest. So, we’re giving you some background or some insight into saying, “Hey, you know what, I don’t have the availability to do a saliva test, which you’re going to talk about, or urine test, which we’re going to talk about, I only have the availability to do a blood test.” So, we’re kind of giving you a little background on that. But definitely, if you have the option for– and we’re suspicious of having adrenal fatigue/adrenal dysfunction is you– doing a saliva test is going to tell you everything you need to know about your cortisol.

Dr. Maki: Yeah, right. It gives a really good baseline. You know, granted, now, if someone comes in, you can just tell by asking some questions where it, kind of, where they are, but the saliva test– And the reason why the saliva test is different one, now granted, like you said, it’s a different expenses, it’s a little more complicated. Where the lab test, the blood testing is just all done in one shot. Makes it really easy, really simple. It’s convenient. And a lot of times covered by insurance. So, like you said, people have access to it. The saliva testing is done at home, right? So, you can’t go to your doctor and request them to do a test because they won’t know what they’re– they won’t really know what you’re talking about. So, you get a test into your home, you provide four samples over the course of the day and evening, so, morning, noon, afternoon, evening. Usually, evening is probably close to bedtime. And then when you get the report back wherein your– when the practitioner gets to report back, there’ll be a little graph that shows up on the report. And it’s very easy to see where your cortisol is mapped out compared to what the reference ranges, and we see them kind of all over the place. Sometimes they’re like a flat line, sometimes it’s– Again, most people low in the morning, you’re tired, can’t get out of bed, and it starts peaking in the evening which is why people can’t fall asleep. That’s probably one of the most common.

Dr. Davidson: And well, like Dr. Maki said, you can talk to someone, you can get their symptoms. We kind of already know that they probably have that reverse diurnal curve with cortisol. But when somebody can see that on paper, it can be pretty powerful. I mean, people will cry saying, you know, “My doctor’s think I’m crazy.” You know, “They say I’m normal but I’m like–” you know, look at your cortisol. No wonder you can’t wake up in the morning. And no wonder you can’t go to sleep at night. You know, it can’t, you know, having that objective data can be really powerful.

Dr. Maki: Yeah, right. And it does give a certain level of severity, like, you said, how significant is the dysfunction. And then for, you know, from a practitioner perspective, it helps us to kind of determine what the treatments going to be. Because when you’re talking adrenals, everyone is going to get the same treatment, right? You’re talking all the way from prescriptions, like hydrocortisone, down to lifestyle and, you know, nutrients like vitamins and minerals. And there’s a few things in between, you know, having that extra little bit of information, whether it’s a blood test and/or the saliva test or we’re to talk about the Dutch test here in a second, having a little bit of extra information is going to help the practitioner be able to make those decisions. And now hopefully getting that person back to a functional state fairly soon.

Dr. Davidson: And saliva tests have been around for a really long time. And they’ve come a long way since we’ve been in practice, you know, not even that long. Since 2003, you know, you’ve seen the saliva tests really change. There’s two companies– there’s lots of companies that do it, but there’s two companies that we like the best; Diagnostics, we’ve used for years, they’ve been around, oh my gosh, since the ’90s, doing saliva testing for cortisol? I want to say, yeah.

Dr. Maki: I think the late ’80s, I think. I think they are already– yeah, late ’80s.

Dr. Davidson: Yeah, they are the leaders in that. And like I said, the saliva testing really has changed even over the last decade. And ZRT is another lab that’s been around, I guess, longer now. I still think of them as being new, but they’re probably more like what? 12 years?

Dr. Maki: I think is probably even longer than that. But yeah, and they’re both, you know, Pacific Northwest companies. So, Diagnostics is in Tukwila, or Kent, which is basically South Seattle. And ZRT is in Oregon, you know, so that’s great.

Dr. Davidson: Yeah, they’re great companies to use and work with.

Dr. Maki: Yeah, so those are– I think ZRT is probably a little more popular as far as what the public or what people are aware of. But both of them, you’re still going to get a four saliva sample, you know, it’s going to give you that. That’s why doing a blood test at 9:00 o’clock in the morning, that one blood draw, that’s why that is not necessarily the best way to do it. Because you’re literally, you know, for whatever it takes the time for that blood to go into that vial, that’s really the only information you have over the course of the entire day. And that diurnal curve; cortisol basically helps us regulate our circadian rhythms, so supposed to be high in the morning, supposed to be low at night. So, it’s going to rise and fall over the course of that, you know, light-dark cycle. Doing one blood test isn’t going to tell you that. It’s just not going to give you really any useful information. Not to mention, like we said earlier, everyone’s going to come back within the normal range anyways. So, what does that tell you?

Dr. Davidson: Exactly. So, the saliva tests will look– We like the saliva test for the cortisol. It will do DHEA and insulin and you know, testosterone saliva. I kind of prefer doing the blood test for that just because I’ve always done that. So, I do compare it to the blood test for the DHEA sulfate, the testosterone. Pregnenolone isn’t on a saliva test yet, so I’m sure it will be soon, but it isn’t. So, it’s having both of those, you know, the DHEA sulfate, the testosterone, the pregnenolone, blood wise, and then doing the saliva test for the cortisol is really comprehensive. But if you want to get really like ultra comprehensive is doing what’s been out for the last couple of years, is doing a dried urine test called a Dutch test. Now, that’s probably one of the most comprehensive hormone and adrenal testing that you can probably find, even now. 

Dr. Maki: Yeah, right. Yeah, I think it’s good because it gives you a metabolite. It shows you where things are converting and where things are, you know, kind of really the metabolites that never get tested, the [inaudible(23:32)], and all the things in between, and, you know, cortisol, free cortisol, cortisone, there’s a lot of–

Dr. Davidson: The estrogen metabolites that– yeah.

Dr. Maki: Yeah.

Dr. Davidson: Those are really cool to look at on that urine test that you can’t get, you definitely can’t do that on a blood test. I know they haven’t done that yet on a saliva test. But on the urine test, you can definitely see those estrogen metabolites which we could go on and on and on. But those are really important especially for females that might be at risk for breast cancer. So, it gives us a little bit of an idea. So, the Dutch test is super cool.

Dr. Maki: Yeah. So, you’re looking at the androgens, so DHEA, testosterone, all those metabolites. You’re looking at the stress hormones. So, cortisol, cortisone, and all those metabolites. You can’t do progesterone through the Dutch test. So, you look at a couple of specific progesterone metabolites. And then of course, like you said, about the estrogen. So, you really get a wealth of information that you can’t get through a traditional– a typical blood test. So, that definitely from an adrenal perspective, that is really valuable. There’s a lot of really good information there that, you know, that can really help someone kind of get going in the right direction.

Dr. Davidson: Yep. And you don’t have to do a blood draw, you just collect your urine. And it does have the cortisol diurnal curve on there too. So, if you kind of want, you know, the Full Monty, a Dutch test will provide that. But like I said, I still like to get that pregnenolone with the blood definitely. And then, you know, a couple other things just to match up, you know, just to match things up. And then of course, like Dr. Maki said, is most importantly, is getting your subjective information on what your symptoms and what your lifestyle and what’s going on with you and put it all together.

Dr. Maki: Now, we do run into situations a lot. We do sell direct to, you know, the public, we do sell lab testing just because we want people to be able to have access. And we come across situations all the time where people’s doctors, they just refuse to run certain tests. They just will not. So, we’ll be working with the patient. Patient wants– we’re of course, not covered by insurance. They want to go back to their doctor to have their labs covered by insurance. We give them a list of labs to be requested. And the doctors won’t right now– We understand why doctors don’t want to do that, they’re doing labs for some other doctor, I understand that part. But there still needs to– the information still needs to be gathered, you know, so we provide to our patients. We provide them cash pricing on labs; both blood testing and functional testing labs. So, the ZRT in the diagnostics and the Dutch testing, we provide that direct because we want people to be able to get access to the information. We don’t want it to be kind of held hostage necessarily. Because nowadays, there’s enough information out there. If you have those things, you can kind of help yourself in some respects. And that’s why we’re doing these podcasts is to be able to educate and to help people to be able to do just that. Kind of take responsibility and take control. And in some ways, in this day and age, you know, back in the ’50s, the doctor was the center of the healthcare team. Right now, it has to be the person or the patient has to be the center of the health healthcare team. And they have to kind of direct people the way they want. Otherwise, things don’t really get done. There’s just too many people. And you know, healthcare has changed quite a bit since then. So, you have to kind of be your own advocate. And we’re trying to enable people to be as much of their own advocate as possible.

Dr. Davidson: Yeah. We want to make this available to you. So, if you might not have the availability to do a DHEA sulfate test or a pregnenolone which, you know, it’s kind of like I think the unsung hero of the adrenals but isn’t tested very often from your conventional doctor, if you don’t have access to that or, you know, you want to do a saliva test because you’re sure your cortisol is low in the morning or the Dutch test is really amazing. “Hey, I want the Full Monty”, is we know we have that available for you because you’re one of our Progress Your Health Podcast listeners.

Dr. Maki: Yeah. So, if you’d like to, you can always go to our website progressyourhealth.com, click on the shop to go to our online store. You can use the code PYHP promotion. 

Dr. Davidson: 67 

Dr. Maki: Yeah, PYHP67. So, that is progressyourhealthpodcast67. So, PYHP to get a 20% discount on adrenal lab testing. Now, we do pretty much all types of lab testing. And we can even put together a custom panel. If there’s something that you want that we don’t have listed on our website. So, you can just reach out, either send an email or give us a phone call. Our assistant Erica will take care of whatever details, questions you might have and fill in any details that we didn’t talk about on this podcast.

Dr. Davidson: And the reason the code is PYHP67, is this is our 67th podcast which I’m kind of stunned because we were talking about yesterday, I was like, “Oh, I’m still kind of nervous when it comes to podcasting.” You know, like we’ve done 66 of them. I’m like, “No, we haven’t.” 

Dr. Maki: This is 66, 67.

Dr. Davidson: I should be more comfortable. But I’m getting there.

Dr. Maki: Yeah, no, this is PYHP67, 20% discount on adrenal testing. And we’re going to continue this series where we have the next three coming up, we’re going to talk about the– it’s getting close to Halloween. We did this before, but we’re going to do it again just because it’s appropriate based on this series and the time of the year. So, we’re going to talk about the three types of– it’s not really adrenal fatigue, but that’s kind of what we call it. So, the three types of adrenal fatigue that we see. That will be the next three episodes. 

Dr. Davidson: And like he’s mentioning about Halloween, the three types that we see, that we talked about a lot is the vampire, the ghost, and the zombie. So, when you listen to those, you can see if maybe you fit into one of those types.

Dr. Maki: Yeah, right. So, I think this wraps up the adrenal testing for now. Dr. Davidson anything else to add?

Dr. Davidson: Nope. We’ll see you at the next podcast. 

Dr. Maki: Alright. Until next time, I’m Dr. Maki. 

Dr. Davidson: And I’m Dr. Davidson. 

Dr. Maki: Take care. Bye-bye.