Key Topics & Timestamps
00:00 Why Hormone Testing Matters
00:17 Blood, Saliva, and Urine—What Each Test Really Shows
06:11 Postmenopausal Hormones and Hormone Therapy Insights
09:04 The Adrenal, Ovarian, and Fat Tissue Hormone Shift
12:23 How Your Hormone Delivery Route Changes Your Labs
17:18 The Truth About Cholesterol and Hormone Creation
25:01 Decoding Estrogen Detox and Cancer Risk
32:52 Understanding DUTCH Test Results Live
38:15 How Stress and Cortisol Patterns Affect Your Hormones
45:02 Herbal and Lifestyle Strategies for Hormone & Adrenal Recovery
48:45 Deep Dive: DHEA, Testosterone & Metabolites
54:45 Optimizing Detox, Methylation, and Gut Health for Healthy Estrogen
1:11:10 Practical Tips: Waking Up Hormone Receptors & Avoiding Pitfalls
1:15:21 Real-Life Cases, Supplement Cautions, and Listener Questions
1:19:13 Why Comprehensive Testing Matters—And Finding Your Next Step
Cracking the Code of Hormone Health: Why It’s Time to Go Deeper
Have you ever wondered why you still feel “off” even when your hormone bloodwork looks “normal?” Or maybe you’ve tried different therapies, supplements, or lifestyle changes but can’t seem to crack the code for lasting hormone balance.
If you’re nodding your head, you’re not alone. After decades as a gynecologist and hormone expert, and after walking through my own early menopause journey, I know that hormone health isn’t just about a number on a lab sheet. It’s about how your body actually uses those hormones—and that’s the story that’s been missing for far too long.
In this episode of The Girlfriend Doctor Show, I sat down with Dr. Liz Bartman, a brilliant naturopathic doctor and hormone metabolite expert, to dig into the science, the “aha!” moments, and the real-world strategies for reading your own hormone map. If you want to understand why you feel the way you do—and what to do next—you’re in the right place.
What’s Included in This Article
Why comprehensive hormone testing is essential for women in every stage of life
The differences between blood, saliva, and urine hormone tests—and when to use each
Why hormone metabolites are the missing link in your health puzzle
How stress, menopause, and lifestyle can shift your hormone balance
The science behind estrogen detox, cancer risk, and methylation
Real-life examples from advanced DUTCH test reports
Actionable steps to optimize hormone health and longevity
Key questions answered about testing, detox, and supplementation
Resources for taking your next right step
Why Comprehensive Hormone Testing Matters
As women, we’re often told our symptoms are just “part of aging,” or we’re handed a single blood test and told everything is fine. But your body is a living, breathing story. Every fluid—blood, saliva, urine, even stool—tells a different chapter.
If you only look at your hormones in the blood, you’re missing how they behave at the cellular level, how they get metabolized, and how stress, gut health, and detox pathways affect your entire health journey.
As I always say: Treat the patient, not just the labs. But don’t ignore the labs, either!
Blood, Saliva, or Urine? What Each Test Really Shows
Not all hormone tests are created equal. Here’s what Dr. Bartman and I discussed:
Blood (Serum) Testing
Shows what’s in circulation right now
Mostly measures protein-bound hormones (not always what’s actually “active” in your tissues)
Useful for monitoring some therapies, but can miss the bigger picture
Saliva Testing
Measures “free” hormone that can pass into tissues and be used by your cells
Great for seeing what’s available to your body, not just what’s floating in your blood
Urine Hormone Metabolite Testing
Reveals what was actually used at the receptor level and how your body broke it down
Let's you see hormone pathways, detox, and hidden imbalances that blood and saliva simply can’t show
Bottom line: Each method gives you a piece of the puzzle. Understanding all three helps you and your doctor make smarter, more personalized decisions.
The Postmenopausal Hormone Shift: It’s Not Just “Low Hormones”
After menopause, your ovarian “factory” shuts down. You lose up to two-thirds of your natural estrogen and most of your progesterone almost overnight. What’s left comes from your adrenals and—surprise—your fat tissue! That’s why stress, weight gain, and hormonal symptoms often feel so unpredictable in this stage of life.
FSH (follicle-stimulating hormone) rises, signaling your body to make estrogen wherever it can—often from fat stores. Aromatase, the enzyme that converts androgens (like testosterone and DHEA) into estrogen, kicks in. This is why changes in body composition, metabolism, and even cancer risk can emerge in midlife.
Key takeaway:
It’s not just about “low” hormones. It’s about how your body is adapting, and whether those adaptations are supporting your best health.
How Hormone Therapies Show Up in Testing
Are you on hormone therapy or considering it? It’s crucial to know that how you take your hormones—oral, topical, sublingual, vaginal, or injectable—can completely change what shows up on your labs.
Oral hormones: Often show up as high in urine (because so much is metabolized and excreted right away) but may not reflect what’s actually used by your body.
Topical hormones: Can show up high in saliva but may not appear in blood or urine the same way.
Vaginal/transdermal (patch, cream): These often reflect more accurately in urine, especially for estrogen.
Pro tip:
Always let your provider know exactly how and when you last took hormones before any testing!
Cholesterol: The Unsung Hero of Hormones
Cholesterol has gotten a bad rap, but it’s actually the building block of every steroid hormone in your body—including estrogen, progesterone, testosterone, and cortisol.
Most of your cholesterol is made in your liver, not absorbed from food. Special enzymes in your ovaries, adrenals, and other tissues turn cholesterol into pregnenolone—the “mother hormone” that then branches off into all your other hormones.
If you’re struggling with hormone health, don’t be afraid of healthy fats and cholesterol-rich foods—in fact, you need them!
The “Hormone Steal” Myth—And What’s Really Happening Under Stress
You may have heard that stress “steals” your progesterone to make cortisol. The truth is more nuanced: under chronic stress, your adrenals prioritize cortisol production, shifting resources away from sex hormone production. This is why chronic stress can suppress ovulation, lower progesterone, and worsen menopause symptoms.
Key insight:
Your body is always prioritizing survival. If you’re under ongoing stress, hormone balance will always be harder—no matter what supplements or therapies you use.
Estrogen Detox Pathways: Why They Matter for Cancer Risk & Wellness
One of the most eye-opening takeaways from urine hormone metabolite testing is how your body breaks down estrogen. There are three main “paths” (2, 4, and 16 hydroxyestrone), and each has different health implications:
2-hydroxyestrone: The “Goldilocks” pathway—generally safest and most easily detoxed
4-hydroxyestrone: Can become a “quinone”—a damaging free radical that raises cancer risk if not methylated and cleared effectively
16-hydroxyestrone: Promotes tissue growth and can speed tumor growth if cancer is present, but also helps protect bone
You want a healthy bias toward the 2-pathway, robust methylation (phase 2 detox), and a balanced gut to clear hormones effectively.
Decoding Real DUTCH Test Results: What to Look For
In this episode, Dr. Bartman and I walked through actual DUTCH test reports. Here’s what we look for:
Are your parent hormones (estrogen, progesterone, testosterone) in range for your age and stage?
Do your metabolite ratios show a safe, balanced detox pathway?
Is your methylation (COMT activity) robust, or do you need more B vitamins, magnesium, or protein?
Are your cortisol and DHEA patterns reflecting healthy stress adaptation—or burnout?
Are your gut and oxidative stress markers showing a need for deeper support?
This kind of testing lets you connect the dots between symptoms, lifestyle, and biochemistry—so you can take targeted action.
Stress, Cortisol, and Your “Wired and Tired” Patterns
Chronic stress leaves its fingerprints all over your hormone metabolites.
Urine testing can show whether you’re making enough cortisol, how quickly you burn through it, and whether your stress response is balanced or “fried.”
Low free and metabolized cortisol: Adrenal suppression (think fatigue, low motivation)
High free, low metabolized cortisol: Possible hypothyroid or sluggish liver
High metabolized, low free cortisol: “Burning through” cortisol rapidly—often seen in PTSD, chronic stress, or inflammation
Adrenal recovery isn’t just about supplements—it’s about lifestyle, healing trauma, and supporting your body’s natural rhythms.
Herbal and Lifestyle Strategies for Hormone & Adrenal Recovery
Dr. Bartman and I are both passionate about combining science with natural medicine. Here are some of our top recommendations:
Adaptogens: Maca, rhodiola, schisandra, and ashwagandha can help restore resilience and balance stress hormones
Mitochondrial nutrients: Acetyl-l-carnitine, coQ10, B vitamins, and antioxidants support energy and hormone synthesis
Red light therapy & sauna: Boost mitochondrial function, lower inflammation, and support hormone balance
Diet: Focus on high-quality proteins, healthy fats, colorful vegetables, and fiber to support hormone and gut health
Movement & sleep: Non-negotiable for hormone harmony and longevity
Optimizing Detox, Methylation, and Gut Health
If your estrogen metabolites or oxidative stress markers are off, here’s where to focus:
Support methylation: Magnesium, B6, TMG (trimethylglycine), and SAMe, plus protein-rich foods
Boost glutathione: NAC, liposomal glutathione, vitamin C, and selenium
Enhance gut health: Fiber, probiotics, and regular bowel movements (if you’re not pooping daily, your estrogen isn’t detoxing!)
Cruciferous veggies: Broccoli sprouts, cauliflower, and DIM for safe estrogen metabolism (but only if your methylation and gut are strong)
Check beta-glucuronidase: High levels (in stool testing) may mean your gut is recirculating estrogen—address with calcium d-glucarate and gut healing
When to Use (or Avoid) DIM and Calcium D-Glucarate
DIM (diindolylmethane) and calcium d-glucarate are popular for estrogen dominance, but be strategic:
DIM: Promotes phase 1 detox (2-hydroxy pathway). Only use if methylation is healthy and the gut is clear.
Calcium d-glucarate: Reduces recirculation of estrogen in the gut. Best for estrogen dominance with gut dysbiosis.
Caution: In postmenopausal women, overuse can lower needed estrogen and worsen symptoms.
Always address gut and methylation first, then support healthy estrogen clearance.
Your Most-Asked Hormone Health Questions—Answered
Q: What’s the best way to test hormone levels?
A: Use a combination of blood, saliva, and especially urine metabolite testing for a full picture.
Q: How does hormone metabolite testing help with cancer prevention?
A: It reveals if your detox pathways are safe or risky, and helps you take action to reduce risk.
Q: What supplements help optimize hormone detox and methylation?
A: B vitamins, magnesium, TMG, protein, NAC, glutathione, and targeted herbs (like maca and rhodiola).
Q: How does stress really affect hormone balance?
A: Chronic stress shifts resources to cortisol, lowering sex hormones and worsening symptoms.
Q: Can you change your hormone pathways with diet and lifestyle?
A: Absolutely! Nutrition, stress management, movement, and targeted supplementation are powerful tools.
Q: What is hormone metabolite testing?
A: It’s advanced urine testing that shows how your body uses and detoxes hormones—giving you a 360° view.
Q: Why do I need more than a blood test?
A: Blood shows what’s circulating, but not how hormones are used or cleared. Urine and saliva show the rest of the story.
Q: How can I optimize hormone detox?
A: Support methylation (magnesium, B6, TMG), boost glutathione, eat cruciferous veggies, and heal your gut.
Q: Should I worry about taking DIM or calcium d-glucarate?
A: Only use if your methylation and gut are healthy; otherwise, address those first to avoid making symptoms worse.
Ready to Crack Your Own Hormone Code?
You deserve real answers, not just “normal” labs or generic advice.
If you’re ready to go deeper—whether you’re facing menopause, hormone therapy questions, or mysterious symptoms—explore advanced hormone metabolite testing with a skilled practitioner.
Listen to the full podcast episode with Dr. Liz Bartman for in-depth science, case studies, and practical tips you can use right now.
And remember: the most important part of hormone health is YOU—your story, your intuition, your next right step.
If you have questions, email me at team@drannacabeca.com. And don’t forget to like, share, and subscribe for more empowering conversations!
