Your Hormones Aren’t Broken, Your Pathways Are

Your labs can look “normal” and you can still feel like a mess and that isn’t you being dramatic. I’m walking you through the missing link: hormone metabolism. When we only measure estrogen and progesterone in blood, we get a single photo. When we use a DUTCH test, we can watch the whole movie of what your body is doing with hormones behind the scenes.

We dig into estrogen metabolism pathways in plain English, including the 2OH pathway (often more protective), the 4OH pathway (where methylation and detox capacity matter most), and the 16OH pathway (the one that can drive heavy periods, bloating, fibroids, endometriosis, breast tenderness, and stubborn weight gain). If you’ve ever wondered why two women can have the same estrogen level yet feel completely different, this is the explanation.

Then we connect the dots to the real-life patterns I see all the time: the estrogen-dominant type, the wired-and-tired high-stress cortisol pattern, flat-lined burnout, and the detox disaster profile where symptoms don’t improve with standard approaches. We also talk about why “just adding hormones” through birth control or BHRT can backfire when your liver detox, methylation, glutathione, minerals, and gut elimination are overwhelmed.

If this hits home, subscribe, share this with a friend who keeps getting told “everything is fine,” and leave a review so more people can find a better path forward.

Transcript

Why Pathways Beat Bloodwork

SPEAKER_00 0:00

Welcome to Harmony Hub Health, where my mission is to provide comprehensive, affordable, integrative care that addresses the root cause of health issues. At the Hub, the focus is on individual patient journeys. I strive to optimize health, vitality, and longevity, fostering a community where each person can thrive in body, mind, and spirit. What if I told you that two women can have the exact same estrogen levels and one feels amazing while the other is dealing with PMS, weight gain, anxiety, and fatigue? That's where hormone metabolism comes in. I just returned from the BHRT symposium at C, and one of the biggest takeaways was this. If you're not looking at hormone pathways, you're missing the full picture. And we do run the Dutch test here at Harmony Hub Health, and this kind of brought it back to the front of my mind. So today we're gonna dive into the Dutch test and break down estrogen metabolism in a way that actually makes sense. I feel a lot of people don't like this test because to them the results are confusing and the test itself can be a little pricey. Um, but I'm gonna explain it so it does make sense, and more importantly, how it can explain your symptoms, okay? Because most of you, you've had your blood work done. That is something I do for all of my patients, and most of you, you've been told that everything looks pretty normal, right? But the problem is traditional blood labs give us a snapshot. The Dutch test gives us a metabolic movie, and they're not the same thing. Think of blood work like taking a single photo. It tells me what your hormone levels are at that exact moment, what's circulating in your bloodstream, a quick glance at estrogen, progesterone, testosterone, maybe even cortisol, even though for that you know I like my four-point saliva test. But that's it. It does not tell me what your body is doing with the hormones or how you're breaking them down, whether they're being detoxed or recycled or just causing chaos. It's like looking at one frame of a movie and trying to guess the entire plot. But the Dutch test, this is where things do get a little fun. I love this test. I have many of them, different types, because now we're watching the entire process unfold. We're not just asking, hey, how much estrogen do you have? We're asking, what is your body doing with that estrogen after you make it? So is it going down a protective pathway? Is it turning into something inflammatory? Is it getting stuck and just being recirculated? Is your detox system overwhelmed? This is the difference between seeing the ingredients versus watching the recipe play out. And here's the part that most people and honestly a lot of providers miss. Hormones are not static, they are constantly being converted. Estrogen doesn't just sit there looking pretty, it gets metabolized into different forms. Some are protective, some are neutral, and some are straight up problematic. So you can have normal estrogen levels and still feel like an absolute mess. Why is that? Because your body might be turning that estrogen into more inflammatory metabolites. It could be more proliferative forms that are growth stimulating, or it can be a form that is super hard to detox. And this is what I tell my patients all the time. I don't care how much estrogen you have, I care what it's turning into, because two people can have the exact same level of estrogen. One feels amazing, okay? One has PMS, anxiety, weight gain, breast tenderness, migraines. The difference really is just the pathways. Um, and I'm trying to think of a good way to um think of estrogen like traffic, okay. Blood levels tell me how many cars there are on the road. Sorry, my husband works in the car business. Um, if you need a Porsche, let us know. But the Dutch test tells me where those cars are going. Is there a traffic jam? Has there been an accident? Or if everything is just flowing nice and smooth. And if you have a hormone traffic jam, you are going to feel it. Okay. This is why just adding hormones or throwing birth control at symptoms or even doing BHRT without looking at the pathways sometimes can really backfire. Because if your detox pathways are not working, you're just adding more cars to an already congested highway. Does that make sense? Um, so now that you understand why how your body processes hormones matters more than just how much you have, I want to talk about the different estrogen pathways because this is where we start to see exactly why you feel the way that you do. And now that we understand it's not just about how much estrogen you have, let's talk about really matters. And that's what your body is turning it into. Estrogen doesn't just exist as one thing. Once your body makes estrogen, it has to process it through pathways. And there are three main ones we look at on the Dutch test. And I like to think of them as three different personalities. First, we have the good girl. This is the 2OH pathway. This is the pathway we love. This is the one we're rooting for, the overachiever, the one who follows directions. This pathway converts estrogen into a weaker, more protective form, less stimulating to tissues, easier for your body to safely eliminate. This pathway is anti-proliferative. That means it does not overly stimulate growth in tissues like breath, tissue, or uterine lining. And that's important because too much stimulation in what this is what leads to things like fibroids, endometriosis, estrogen-sensitive cancers. Clinically, when this pathway is dominant, symptoms tend to be more mild, cycles are more balanced, and there's less inflammation. This is what we want to see. Think of the 2OH pathway as the detox-friendly, the low drama estrogen. She shows up, she does her job, and she leaves without causing a scene. Now, the 4OH pathway, this is the risky one. Um, she's a little bit more chaotic. She creates metabolites that can interact with your DNA. And if your body cannot properly detox these metabolites, it can cause oxidative stress, it can lead to DNA damage, it can increase long-term risk for cellular mutations. This is the pathway most associated with cancer risk, especially breast cancer, or, you know, poor detox and methylation capacity. The 4OH pathway itself is not the enemy. It's the handling of it that matters. If your body has good methylation and adequate glutathione and strong liver detox pathways, you can process that pathway safely. But if you don't, that's when things become a problem. Um, this is the estrogen that's fine until your detox system drops the ball. Then we have the 16OH pathway. This is the aggressive one. This is the one that your estrogen does the most. It creates a very strong, highly active form of estrogen. This is the one that really stimulates tissue growth. So this can really lead to, or it's strongly associated with fibroids, endometriosis, heavy periods, breast tenderness, bloating, um, stubborn weight gain, and those classic estrogen dominance symptoms. This form of estrogen binds more strongly to estrogen receptors, and that's why it feels so intense. So it hits harder in your body. So even if your total estrogen isn't that high, if a lot of it is going down that 16OH pathway, you are gonna feel it. This is the estrogen that walks in, turns the volume all the way up, and then just doesn't want to leave. So now you can see why just being told you have high estrogen or even normal estrogen is incomplete information. The question is, which pathway is your estrogen choosing? Um, are you making the protective estrogen? Are you potentially damaging estrogen or highly stimulating aggressive estrogen? It's not just estrogen dominance, it's which estrogen is dominating. Does that make sense? Once you understand your pathways, we can actually do something about it because this is where targeted functional medicine treatment completely changes the game. And this is where it gets real because when I look at Dutch tests, I don't see numbers. I see patterns, I see types. And once you understand those types, you're probably gonna hear one and go, oh my gosh, that's me. So let's break down the most common hormone patterns that I see in practice with my Dutch tests. Um, type one, I'm gonna call this one the estrogen dominant queen. She's the one who walks in and says, I'm so emotional. My cycles are a disaster. I feel so puffy. So what is happening inside? Estrogen is being pushed down that 16 OH aggressive pathway. Detox pathways are sluggish. Um, estrogen is not clearing efficiently. It's often paired with poor gut elimination. These people tell me they're constipated, liver congestion, and just a high toxic burden. What this type feels is PMS and you know, the bad kind, breast tenderness, heavy, sometimes clotty cycles, bloating, um fluid retention, mood swings, irritability, weight that loves to hang on the hips and thighs. And behind the scenes, what we find is low fiber intake, um, sluggish bowels do cause um estrogen recirculation, um, and then overload from plastics, from skincare, from environmental estrogens. So you're not lacking estrogen, this type, it's drowning in the wrong kind of it. So see if that sounds like you. The second type is my wired and tired cortisol queen. This is your high-functioning, stressed-out, get it all done woman who can't sleep and feels like she's running on fumes. What is happening inside? The cortisol rhythm is dysregulated, either too high at night, or it's spiking at the wrong times. Progesterone is low because stress steals it. This is called the cortisol steal. And your nervous system is always on. This type feels anxious. They have insomnia where they're tired, but the brain can't shut off. Heart races with minor stress, um, less resilience. They're very irritable, they get that midsection weight gain. Periods are irregular, shorter, or maybe they're not getting one at all anymore. And what I see behind the scenes is chronic stress. You know, all of the life of the woman, the kids, the work, the caregiving. I talked to a lot of people this last week that was in the sandwich generation. They're taking care of mom and dad, they're taking care of the kids. Sometimes they're taking care of mom and dad, their kids, and the grandchildren. Um, I usually see blood sugar instability with this type. These are the people that are dependent on caffeine and they have just very poor recovery. So this person is not just tired. You're tired and overstimulated at the same time, okay? That is very common. The third type I call the flat-lined burnout. Um, this is actually something that um I've noticed a lot over the winter. This is when you were in that type two, but you just keep going for way too long, and your body finally just says it's done. This is when cortisol is just lobe across the board. So they have their four-point cortisol test, and um, it is just flat. There's no curve, it is flat. Your adrenals are no longer responding because they are done. Sex hormones drop because you're in survival mode. Okay, you don't need to reproduce, you're trying to survive. So this person feels exhaustion that even when they sleep, it doesn't fix zero motivation, a lot of brain fog, weight that won't budge no matter what you do, low libido, and that numb feeling disconnected type of feeling. And what usually I'll find behind the scenes is long-term stress, burnout, nutrient depletion, thyroid is struggling as well. And either this person is over-exercising or they're under-recovering. So this person is not lazy, their system is in full-on energy conservation mode. Okay. The next type is type number four. This is the detox disaster. Um, this one is my functional medicine deep dive patient. And honestly, it's one of the most important to catch and the most important that I treat. What is happening inside? Estrogen is going down that 4OH pathway, the risky one. Detox and methylation pathways cannot keep up. The body cannot safely neutralize estrogen metabolites. This is where we start thinking about long-term hormone imbalance, cellular stress, and increased disease risk if you ignore it. So this patient will look like any of the types we talked about, and they have headaches, chemical sensitivities, they're sensitive to medications and supplements, and their hormone symptoms don't improve with standard treatment. These are the ladies that I get after they've already seen other hormone providers and they are in desperation mode. So this is where I start looking deeper. This is where I look at methylation. Um, this is why I have a huge population of MTHFR, because they never knew until we do this deep dive. We look at liver detox pathways with phase one and phase two. We look at glutathione status because that is your body's master antioxidant and minerals. Your minerals, if they're off your detox pathways, they don't work properly. And I will drop this HTMA. This is the HTMA tie in or the hair tissue mineral analysis. When you have low zinc, when you have low magnesium, when you have copper imbalances, this is my specialty. That is not a hormone problem. That is a detox and cellular function problem. And here's what I want you to understand: most people aren't just one of those types, they're a combination. You can be estrogen dominant and wired and tired. You can be burned out and a detox disaster. That was me. And if you don't identify with your specific pattern, you end up on genetic protocols that just don't work. This is why personalized testing, like the Dutch test, matters, because once we know your type, we can start targeting and we don't have to really guess. So now you might a little bit understand estrogen pathways. You might be understanding your type. Hopefully, in your mind, you already said which one you think you are. Let's talk about why this matters, because this is where most women get stuck. Sometimes they can definitely identify that is me, but you go to the doctor and this is what happens. And I'm gonna say something that might ruffle a few feathers. But if you're giving hormones without looking at pathways, you are guessing. Okay. And sometimes you're adding fuel to a fire. Um, and when I say when you give hormones, this is because the number one thing I see is young women, they go to their OBGYN or they go to their PCP and they're identifying with one of these types. And what happens? They're given birth control. That is now the standard therapy, and it is hormones. So um birth control can add or suppress hormones, and you know, it can adjust levels in the bloodstream, but they don't do anything to address how your body's metabolizing the hormones, whether you're pushing more estrogen down that 16OH pathway, or whether your 4OH pathway is being safely detoxed. If your pathways are already dysfunctional, you're not fixing the problem. Okay, you're just adding layers on top of it. Um, one example I see all the time is a patient may go on birth control. The symptoms temporarily do improve. Temporarily. Then they come back to me with worse bloating, mood swings, stubborn weight. Sometimes people will start BHRT and get that initial boost, but then they become irritable, they don't feel right, and they have breast tenderness. So you can't out-prescribe a clogged pathway. This is the part that frustrates patients the most because they've done their blood work, they've done their labs, they've seen the doctor, they've seen their provider, they've been told, everything is looking quite normal. But here's the truth: normal ranges do not mean optimal function, and normal levels do not mean healthy metabolism. You can have normal estrogen and you can have normal progesterone. But if your body is favoring that 16OH pathway, if you're not detoxing the 4OH properly, um, if your body is recirculating estrogen through your gut, ugh, you can have so many problems. This is why I hear my patients say, I feel crazy, but they said my labs are fine. Nothing is working, or I've tried everything. They kind of give me that snarky look like what you got, girl. But I tell them, your labs might look good on paper. Most of the time they don't, but they might look good on paper, but your pathways are telling a completely different story. Um, and that's where functional medicine flips the script. Okay, your body has one job with hormones. Make them, use them, break them down, get them out. If any part of that process is off, you get symptoms. So let's break that down a little more simple. I always start with the liver, okay? Liver is your processing center. Um, I don't know if you guys have listened to the podcast for a while. You know that I used to work liver transplant. That was my first nurse practitioner job. What was that, 16 years ago? But your liver is what converts estrogen into those pathways to four or 16. If your liver is sluggish, more aggressive metabolites build up. Then we have the detox system. This is the cleanup crew. This is your methylation, your glutathione, these are your nutrients like the B vitamins, magnesium, and zinc. If any of those are low, which 100% most people are, detox really stalls. You don't have a cleanup crew. Then it goes to our gut. This is our exit route. This is where most people ignore things and it's huge. If your gut is off, if you have dysbiosis or poor microbiome, or if you're not pooping. I know people look at me crazy. I ask everybody, are you pooping every day? Are you pooping at all? How often do you poop? If you are constipated and you're a woman, estrogen can get reabsorbed instead of eliminated. All right. You don't want that. Um, that causes estrogen dominance that won't resolve. Um, it's patients that are doing all the right things, but stuck, literally, literally, literally stuck. Um, but they're doing everything else right. Maybe their lifestyle is good, maybe they're taking the proper supplements, but if you cannot eliminate that causes chronic inflammation and all the right things don't matter because everything is stuck. If you're not pooping, you're not detoxing, and your hormones, they know it. So when we look at hormones differently through the functional lens, we don't ask anymore, what are your hormone levels? We start asking, what is your body doing with them and can I clear them properly? You can't out-prescribe a clogged pathway. So now you're probably wondering, okay, Michelle, I get it. My pathways matter, my hormones aren't the problem. So what do I actually do about it? And this is where I geek out a little bit. This is where functional medicine is completely different. We're not trying to change your hormone levels. You ever hear that? Your hormones are low, let's just give you some more. We're trying to fix the system that can process them. I talk about methylation, detox elimination with every single one of my patients. The first step is going to be supporting that methylation. I call that methylation cycle the unsung hero. This is one of the biggest missing pieces, especially for my patients with MTHFR or who can't detox. Okay. Um, what methylation does, it helps your body neutralize harmful estrogen. Metabolites, especially that 4OH pathway. So it can support your DNA protection, your detoxification, and your neurotransmitter balance. Um, this is why I get into the talks with ADHD symptoms with all of my patients that have a problem with methylation. When your methylation is off, you do see anxiety, you see poor detox, you see hormone sensitivity, and symptoms that don't improve even when you try to treat them. And I support this. I'm just gonna give a little teaser. I'm not giving you my full protocol because then no one will come to see me. But we have to support methyl donors. We have to support targeted B vitamins, not cheap vitamins, but targeted B vitamins and personalized dosing based on testing. You can't detox estrogen if your methylation pathways are asleep. Number two, the liver support. That's remember that processing center. Your liver is literally where hormone metabolism happens. So if your liver is overwhelmed, your estrogen pathways are going to reflect that. Okay. The liver processes estrogen into those pathways, the two, four, and sixteen, and then it prepares it for elimination. When that liver support is low and it's sluggish, more estrogen is going to go down that 16 aggressive pathway. Um, detox gets backed up, symptoms get much worse. They intensify. And what contributes to liver overload? This is if you have toxins around you in your environment, in your skincare, in your food, um, the plastics, the metals. Um, if you have a poor diet, if you're taking a lot of chemical prescription medications, or maybe you drink a lot of alcohol, um, this can all contribute to your liver being overloaded. We can support it with nutrients and enhance detox pathways. We can give antioxidant support. This is why I love glutathione. Um, and we do strategic supplements, you know, not a trendy thing at all. But if your liver is overwhelmed, your hormones are going to be overwhelmed as well. And then the next step is your gut repair, which is their exit strategy. This one is non-negotiable. The gut matters so much. After your liver processes estrogen, it has to leave your body, right? And where does it go? It comes out through your stool. If your gut is off because you're not pooping, or you have that really poor microbiome balance, estrogen gets reabsorbed and you don't poop it out. This just recirculates that estrogen. You have persistent estrogen dominance, you have chronic inflammation. So we have to address it, whether we're improving motility or supporting your microbiome or reducing the inflammation and the gut lining. Because if it's not leaving your body, it's staying in your system and it's causing problems. A lot of people think you get estrogen, it kind of has a half-life like a medicine, and then it just dies away. No, you have to get rid of it. Um, and then, you know, the minerals. This is the foundation. Um, if you're one of my patients, you're probably tired of hearing about minerals, but this is where I really geek out. Because one of my favorite tools are minerals. They're required cofactors. You need them to detox, you need them to even make your hormones, you need them to balance your nervous system. Um not for, you know, changing the subject, but you guys know how I feel about the nervous system. This is why I have a float pod in my practice. But the key players with these minerals are magnesium. It supports stress and detox. Almost everybody I talk to, they're like, yeah, I take a magnesium supplement. They don't know what it does, they don't know what kind they're on, and they don't understand how to really target that. Um, then we have zinc, which is critical for hormone balance and immune function, and our copper balance. This is huge for estrogen metabolism. This is what I went through copper balancing when I was crazy. When your minerals are off, your detox slows down, your hormones become very dysregulated, your nervous system becomes very reactive. I think I remember at one point my husband called me Snappy Turtle. Um, and this is why I love using tools like hair tissue mineral analysis. If your minerals are off, nothing downstream is gonna work properly. You can take all the supplements in the world, and usually you're taking a lot of expensive ones and ones that have fillers or pretty colors, or you can even take the best that are the most expensive. But if your minerals are off, your body can't use them. Like it's just really expensive urine, is what you probably hear people say. And then, you know, one of the steps is lifestyle. This is the root driver. Um, and it's the one that nobody wants to talk about, nobody wants to hear, and people downright want to argue when you try to bring it in. But your lifestyle really does matter, especially stress. Stress hormones and sex hormones are directly connected. So, what happens under chronic stress? Your cortisol goes up, your progesterone gets stolen to make more cortisol, and your hormone balance shifts. This is called progesterone steel. Um, this is what happens, and you are anxious, you can't sleep, you have irregular cycles, you are having these estrogen dominant symptoms. So this is when I focus on nervous system regulation, sleep optimization, blood sugar balance, and realistic lifestyle shifts. I'm not looking for perfection. You cannot heal your hormones in a body that feels like it's constantly under attack. So when we look at fixing hormones the right way, we're not just throwing estrogen or progesterone at the problem. We're asking: can your body process hormones? Can it detox them? Um, can you eliminate them? And is your system calm enough to even allow balance to happen? And this is exactly why at Harmony Hub Health, I don't do cookie cutter hormone protocols. I like to test. You don't have to do the Dutch, um, but the Dutch does show these pathways. Um, whether or not we do a Dutch, everything I talked about today, I kind of streamline with everybody, whether we're doing BHRT or just serum labs or cortisol, saliva testing or the Dutch. With the Dutch, we can look at those pathways and you can have an even more personalized plan. Um, because once you fix the foundation, your hormones finally start working with you and not against you. So if you ever have been told, ah, your labs are normal and you feel like a mess, trust me, I understand I've been there. If you're exhausted, inflamed, anxious, if you're gaining weight and have no idea why, this is your sign. Because your body is not broken, your hormones are not crazy, um, you're just not getting the full picture. And that's exactly what I do differently at Harmony Hub Health. Um, I don't throw band-aids at symptoms. I test, I look at pathways, I like to build a plan that actually makes sense for your body. Um, and that's what I love to do. So if this episode resonated with you, you know, you can run a Dutch test and finally see what your hormones are actually doing behind the scenes. I do have every category of Dutch tests. I love them all. You can book a one-on-one um hormone consultation with me where we can break down your results and create a personalized plan. Or if you're ready to go all in, you can come and see me for a consultation and we can start one of our Harmony Hub Health Hormone memberships. Um, they're designed to walk you through step-by-step testing, treatment, and real support because once you understand your pathways, everything changes. So visit me at www.harmonyhubhealth.com. You can even shoot me an email at M I-C-H-E-L-E at harmonyhubhealth.com. Come and visit me in Westminster, Maryland. We can talk virtually or come and see me in person. I would love to meet you. This podcast is for educational purposes only. It's not medical advice and it's not meant to replace a one-on-one relationship with your healthcare provider. Everything we talk about here is meant to empower you with knowledge not to diagnose or treat on your own. Because you've probably learned by now hormones are not one size fits all. If you're dealing with symptoms or looking for answers, make sure you're working with a qualified provider who can personalize this for you.