00:00:00:05 - 00:00:18:08 

Noah Reed 

Welcome back to the DUTCH podcast, where integrative medicine providers can expand their understanding of functional endocrinology and testing. And everyone, no matter who you are, can learn more about their body’s most complex communication system. I'm Noah Reed, vice president of sales and marketing for the DUTCH Test. 

 

00:00:18:12 - 00:00:33:01 

Noah Reed 

And coming up on this week's episode, we bring you endocrine essentials, the female androgens edition. This week, Dr. Kelly Ruef is on the show discussing how the hormones that are most commonly thought of as male hormones present symptoms in female patients. 

 

00:00:33:09 - 00:00:50:01 

Noah Reed 

You'll learn more about what to look for on the DUTCH test when assessing testosterone, DHEAS androsterone and other androgens. Dr. Ruef is a licensed naturopathic doctor who completed her medical education at the National University of Natural Medicine in Portland, Oregon. 

 

00:00:50:08 - 00:01:10:14 

Noah Reed 

She also completed a residency at Pearl Natural Health in downtown Portland, where she specialized in inflammatory bowel diseases and women's health. For her undergraduate education, Dr. Ruef received a Bachelor of Science degree in biochemistry and cell biology with a minor in cognitive neuroscience from University of California, San Diego. 

 

00:01:10:22 - 00:01:25:13 

Noah Reed 

Dr. Ruef strategy is to give thorough, clear explanations to her patients, and she always encourages questions to help lead her patients to better help. We're honored and welcomed to have Dr. Kelly on the show. Let's get started. 

 

00:01:26:05 - 00:01:29:03 

Mark Newman 

Thanks, Noah, and thanks to Dr. Kelly for joining us today. 

 

00:01:29:08 - 00:01:30:07 

Kelly Ruef 

Yeah, thanks for having me. 

 

00:01:30:21 - 00:01:44:16 

Mark Newman 

So we talk about all things comprehensive when it comes to DUTCH. It's sort of central to what we do is lots of information, which means when we talk about male hormones, female hormones, there's a little bit more to talk about than, say, a blood test or a saliva test. 

 

00:01:44:17 - 00:01:58:17 

Mark Newman 

So you're here today to help illuminate to us the story about these male related hormones, as we typically think of them. But we're going to talk about them, obviously, for men and women. But today, the female picture on androgens. 

 

00:01:59:00 - 00:02:03:13 

Mark Newman 

So start with just defining what that even is like. What is an androgen? 

 

00:02:04:04 - 00:02:16:14 

Kelly Ruef 

Yeah. So, if you look up the term androgen, if you Google it, a lot of times you'll see male sex hormone. And the common example they give is testosterone. And it's true that men tend to have more androgens than women. 

 

00:02:16:14 - 00:02:31:19 

Kelly Ruef 

I mean, I have seen some older men with very low androgens have lower androgens than a woman in her twenties with PCOS. But in general, men tend to have low, higher androgens than women. But androgens and women like testosterone. 

 

00:02:31:19 - 00:02:36:07 

Kelly Ruef 

DHEA, are very present and very important for women's health. 

 

00:02:37:11 - 00:02:45:01 

Mark Newman 

Okay. So, tell us some of the functions of androgens as it relates specifically to female patients. Like what are they there for? What are they doing? 

 

00:02:45:09 - 00:03:04:22 

Kelly Ruef 

Yeah. Yeah. So, androgens do a lot. A lot of people think about or know about how they help with libido. They help with women's bone mineral density. But a lot of people don't realize that it helps with women's mood, with their sense of well-being, with their memory, with their ability to put on muscle mass and exercise and 

 

00:03:04:22 - 00:03:12:15 

Kelly Ruef 

maintain their weight with their hair and their skin and even their cardiovascular health and their immune health. 

 

00:03:13:12 - 00:03:22:00 

Mark Newman 

So sounds like if we don't have enough of them, we might be in trouble with the female population. What happens to females when they have too much of a good thing? 

 

00:03:22:08 - 00:03:36:19 

Kelly Ruef 

Yeah. So, if you have to, you know, too high of testosterone, too high of DHEA women tend to get acne, which I suffered with acne for like 15 years, and no one ever tested my testosterone. That's actually how I got in and go to integrative medicine. 

 

00:03:37:15 - 00:03:50:14 

Kelly Ruef 

But besides that, you get acne hirsutism. So, facial hair growth, scalp hair loss, you know, women's hair tends to fall out. And then women can have some mood issues, sometimes irritability or anger, for example. 

00:03:51:08 - 00:04:09:01 

Mark Newman 

Okay. And when we when we think about men with these hormones, it seems like there's this clean split of testosterone coming from our testes. And then the other androgens DHEA androstenedione are predominantly coming from our adrenal glands. Obviously, the female patients, no testes. 

 

00:04:09:03 - 00:04:13:16 

Mark Newman 

Where are these hormones coming from? DHEA. Testosterone. Where are they coming from? In our female patients? 

 

00:04:13:17 - 00:04:30:16 

Kelly Ruef 

Yeah, that's a good question. So, it's very different than what you get with men. In women 25% of their testosterone comes from their ovaries and 25% comes from their adrenal glands. And then 50% of testosterone is converted from androstenedione in the fat tissue. 

 

00:04:31:05 - 00:04:51:20 

Kelly Ruef 

But then you, you know, you get the question, well, where does androstenedione come from? And 50% of it comes from the ovaries and 50% comes from the adrenal glands. But this is pre-menopausal women. So, women before they hit menopause, after you know, when you hit menopause, your ovaries can still make some testosterone, but primarily comes from 

 

00:04:51:20 - 00:05:07:05 

Kelly Ruef 

DHEA, gets converted from DHEA. And then when it comes to DHEA. About 80% of it comes from the adrenal glands. 100% of DHEAS comes from the adrenal glands and a little bit from the ovaries. 

 

00:05:07:07 - 00:05:23:10 

Mark Newman 

So if you've got this mix of adrenal and ovarian production and then, of course, the ovaries sort of give away as we get through menopause than are you expecting then overall to have lower levels in postmenopausal women compared to a premenopausal woman? 

 

00:05:24:02 - 00:05:38:23 

Kelly Ruef 

Yeah. I mean, our androgens tend to drop, you know, once we hit our thirties, especially, you know, the DHEA testosterone tends to drop over time. But there's still healthy levels for every age. So, sometimes women's androgens come back really low and they're 55. 

 

00:05:39:06 - 00:05:45:02 

Kelly Ruef 

And I have a practitioner ask me was pretty normal, right? And I'm like, no, that's even low for their age. So. 

 

00:05:45:17 - 00:06:02:18 

Mark Newman 

OK, and if we've got an issue of in terms of like wanting to know if our DHEA and testosterone together and independently are within range or low or high, then on a DUTCH test, we've got a whole bunch of other things that we're measuring the metabolites of those hormones. 

 

00:06:02:18 - 00:06:06:17 

Mark Newman 

Like what value to the metabolites of those bring to you as a clinician? 

 

00:06:07:08 - 00:06:22:11 

Kelly Ruef 

Yes. Okay. So, the metabolites bring a lot of value. When you look at testosterone and DHEAS in the serum, you you get just part of the picture. And some women can have normal DHEA, normal testosterone in the serum. 

 

00:06:22:11 - 00:06:42:17 

Kelly Ruef 

But when you look at the metabolites in the urine, you can see that they're actually metabolizing their androgens or their testosterone in such a way which can lead to androgen excess symptoms. So, if they push their androgens more down the five-alpha pathway, they tend to be more androgenic. 

 

00:06:43:06 - 00:06:57:14 

Kelly Ruef 

So anything that goes down five alpha reductase into, for example, five-alpha dihydrotestosterone or DHT tends to be more androgenic. And DHT is the potent form. You know, we know it's a potent form of testosterone. 

 

00:06:58:03 - 00:07:08:10 

Mark Newman 

So too much of testosterone, you explain the symptoms. But if testosterone is pushing to DHT, then even more so because it's even more potent than testosterone itself. Yes. 

 

00:07:08:16 - 00:07:18:01 

Kelly Ruef 

Yeah. It's like they think around three times more potent than testosterone. So, DHT is the active form. DHT is what's causing that acne in the jawline. 

 

00:07:19:00 - 00:07:37:19 

Mark Newman 

Okay. So, so when you're talking about DHEA, you're talking about testosterone and their metabolites, which then ends up being a lot of different things that we're measuring. So, as you approach a DUTCH test on a female patient, what are the big like primary questions that you're trying to ask of those numbers? 

 

00:07:37:19 - 00:07:42:18 

Mark Newman 

Like what are the one of the things that you're you're looking at sort of in a hierarchy of like information? What are you looking for? 

 

00:07:43:03 - 00:07:56:17 

Kelly Ruef 

Yeah. So, the first things that I look at are the testosterone and then the total DHEA, which we also call the total adrenal androgen production. Okay. Of those I look at first to see, you know, are they above range? 

00:07:56:17 - 00:08:11:17 

Kelly Ruef 

Are they within range? Are they low? So that can kind of give you an overall idea of the apparent androgens, but then you want to see how they're being metabolized. So, then you look down at especially the five-alpha five-beta reductase activity, right? 

 

00:08:12:00 - 00:08:29:02 

Kelly Ruef 

So if they're favoring more of the five-alpha reductase, then you can expect possibly some symptoms of androgen excess like the acne and the hair loss. If they're favoring the five-beta, you know, five-beta reductase tends to turn androgens into these less potent forms. 

 

00:08:29:15 - 00:08:35:04 

Kelly Ruef 

So they might not be that much of a risk for these symptoms of androgen excess. 

 

00:08:35:12 - 00:08:48:19 

Mark Newman 

So explain to me how you'd put that together in the sense of if I have two people who are shoving down, let's say, the alpha pathway, so I'm heavy alpha, right, in terms of the pattern. And one of those is like a higher producer overall. 

 

00:08:48:19 - 00:08:59:14 

Mark Newman 

How is that going to present itself in terms of I have a lot of hormone in terms of androgens and I'm pushing down the alpha pathway or maybe I don't have very much at all, and yet I'm pushing down the alpha pathway. 

 

00:08:59:14 - 00:09:05:02 

Mark Newman 

Like how would you expect that to differentiate in terms of how the the patient's going to present clinically? 

 

00:09:05:19 - 00:09:21:01 

Kelly Ruef 

Yeah. So, I get that question a lot. Sometimes we'll see really low testosterone, really low DHEA, all the metabolites are low, but they're pushing the alpha pathway. And I have practitioners say, okay, is it the alpha pathway preference that's causing the hair loss or the acne? 

 

00:09:21:16 - 00:09:35:07 

Kelly Ruef 

And I usually say, no, no, not really. I mean, she's got low androgens, so even though she's favoring the alpha pathway, she doesn't really have that many androgens to push down that pathway. So, that particular patient probably won't have the acne. 

 

00:09:35:22 - 00:09:53:13 

Kelly Ruef 

They might have the hair loss there. Some research around hair loss and low androgens. But if you have a woman, let's say she has PCOS, she's got high testosterone, high DHEA, and she's pushing down the alpha pathway. Then, you know, she's going to have a lot of five-alpha DHT in her tissues, you know, causing the acne, 

 

00:09:53:13 - 00:09:55:18 

Kelly Ruef 

causing the hair loss or the facial hair growth. 

 

00:09:56:07 - 00:10:11:00 

Mark Newman 

So. So, then could you have a situation where somebody has low testosterone, low DHEA? So, in your mind, you're thinking low androgen symptoms and they happen to push in that alpha pathway, which means what they have is then getting more potent. 

 

00:10:11:00 - 00:10:27:18 

Mark Newman 

So in that sense, because in women we almost always think about DHT production as being a bad thing. But if you have low overall concentrations, then in some of those cases, can that save you from those low androgen symptoms by making the androgens you have more androgenic? 

 

00:10:28:02 - 00:10:42:03 

Kelly Ruef 

I would think so. Yeah. Sometimes when people have low androgens overall, but they're favoring the alpha pathway, I say, well, you know that that might actually be a good thing. Maybe the body's trying to get more potency out of the little amount of hormone they have. 

 

00:10:42:08 - 00:10:59:17 

Mark Newman 

So, we don't want to just look at a ratio in a vacuum. You want to put it in context. So, you said you're looking at total DHEA production of those those androgens that are produced from the adrenal gland, the testosterone, and then the metabolism, sort of all as one big collage of what's going on with the patient 

 

00:11:00:16 - 00:11:04:07 

Mark Newman 

and then overlaying the clinical symptoms to see to see what makes sense. 

 

00:11:04:14 - 00:11:05:19 

Kelly Ruef 

Yes, exactly. 

 

00:11:06:10 - 00:11:20:09 

Mark Newman 

So then if we find that woman who's struggling on the high end of things, either she has too much testosterone or she is a five-alpha metabolizer, what are the types of tools as a clinician that you're reaching for to help overcome that? 

 

00:11:20:17 - 00:11:21:11 

Mark Newman 

How do you approach her? 

 

00:11:22:06 - 00:11:42:18 

Kelly Ruef 

So we know with women who tend to favor that alpha pathway, right? We know there's a few things that tend to push that pathway. First of all, in the research, you see it associated with PCOS, but you also see it associated with high inflammation in the body, blood sugar, insulin dysregulation, stress and obesity. 

 

00:11:43:01 - 00:11:59:09 

Kelly Ruef 

So, you know, I'm a big fan of treating the cause, so a lot of times I'll go after those, you know, test their fasting glucose, their hemoglobin, even see their fasting insulin, their CRP HS just to get an idea of some of the blood sugar issues and inflammatory issues if there are any. 

00:11:59:21 - 00:12:17:22 

Kelly Ruef 

So usually people will go after it's kind of diet and lifestyle and, you know, working on those big things first. But there are some other tools in our toolbox that we can use. There's some herbs, they're called five-alpha reductase blockers, and you can see mild to moderate improvements. 

 

00:12:18:08 - 00:12:41:11 

Kelly Ruef 

So let's say someone takes saw palmetto or pi-GM, or nettles or there's another one, reishi mushroom. So, those to some extent can block five-alpha reductase activity. So, your testosterone and your DHEA, instead of going into these more potent forms like DHT, go down five-beta reductase instead. 

 

00:12:41:14 - 00:12:44:04 

Kelly Ruef 

So they they go down towards the less potent forms. 

 

00:12:44:20 - 00:13:05:10 

Mark Newman 

So you talked about the bits of information rate, how much DHEA, how much testosterone, how does the metabolism look in terms of five-alpha or not five-alpha? So we've got all these different metabolites. Which ones are the first place you look when you want to draw a conclusion about their metabolic preference of pushing down the alpha 

 

00:13:05:10 - 00:13:10:20 

Mark Newman 

pathway, you're looking at DHT itself or which metabolites are primary for that question. 

 

00:13:11:00 - 00:13:25:05 

Kelly Ruef 

So the literature says we should look at etiocholanolone and androsterone, which are primarily downstream of DHEA, but there's a lot of them around, more so than the DHT that we see in the serum, more so than some of the other metabolites. 

 

00:13:25:12 - 00:13:37:08 

Kelly Ruef 

So that's what we primarily focus on is that etiocholanolone and androsterone just to see you know is are they favoring more androsterone because that could be an alpha preference, right. 

 

00:13:37:08 - 00:13:55:01 

Mark Newman 

And we're talking indirect here. I mean, those two are monsters in our chromatograms. We get these two huge peaks. And then the question is, which where you pushing it? Not because that alpha metabolite is itself so important, but what it implies about what's going on at the tissue level. 

 

00:13:55:01 - 00:14:12:08 

Mark Newman 

When testosterone enters, in which way is it heading towards alpha or towards the beta metabolite? So we look at those and what I like nerding out on a little bit with our reports is when you then see that is we have actually three other pairs of five-alpha five-beta metabolites. 

 

00:14:12:08 - 00:14:27:22 

Mark Newman 

We have we talked about DHT downstream from that is the five-alpha androstanediol, so five-alpha five-beta and you can look at the balance of those two, but they're not as reliable according to the literature, at telling the overall story as those two great big ones. 

 

00:14:28:02 - 00:14:45:21 

Mark Newman 

But you can also look at non-androgens, right? Progesterone. We look at the five-alpha, which we call alpha or alpha-pregnanediol, and then we have the beta-pregnanediol. Now those aren't that important directly in terms of androgens, but it's the same or similar enzymes that push in one direction or the other. 

 

00:14:46:01 - 00:14:59:05 

Mark Newman 

And then cortisol does the same thing. It goes down five-alpha, it goes down five-beta, and when you see all four of those like slammed in a particular direction, then you know, somebody is a five-alpha or a five-beta metabolizer. 

 

00:14:59:14 - 00:15:12:21 

Mark Newman 

An example of that. I've always shoved all my hormones down the five-beta pathway and there's, you know, there's a story with that, but, but four or five-alpha of androgens which so we start with those two with the big, long, hairy names that are hard to pronounce. 

 

00:15:13:09 - 00:15:25:09 

Mark Newman 

But that's what the literature says tells us overall which way we're pushing. And then we can look at the DHT metabolism to sort of confirm if you're pushing in that direction or not. Is that is that right? 

 

00:15:25:16 - 00:15:38:22 

Kelly Ruef 

Yeah. Yeah, that makes sense. A lot of times when I see someone who's obese, who has blood sugar issues, they're really stressed out. You'll see them favoring alpha with their androgens and with their progesterone and with their cortisol. 

 

00:15:38:23 - 00:15:44:11 

Kelly Ruef 

And then, you know, okay, this person's really inflamed or this person, you know, might really have some blood sugar issues. Right. 

 

00:15:44:17 - 00:15:55:15 

Mark Newman 

Right. Because insulin actually upregulates that enzymatic engine to push all of our hormones down that five-alpha pathway. And then we see the consequences and then they come to your office to get fixed. 

 

00:15:55:16 - 00:15:56:10 

Kelly Ruef 

Yeah, exactly. 

00:15:57:12 - 00:16:10:06 

Mark Newman 

Then what about the overall just load of androgens? Like, what are the things that you're looking at in terms of the patient that you would describe as just making too much DHEA, making too much testosterone, sort of regardless of the metabolism pattern? 

 

00:16:10:06 - 00:16:13:06 

Mark Newman 

How do you how do you address high androgen production? 

 

00:16:13:18 - 00:16:31:12 

Kelly Ruef 

High androgen production? Okay. So, if it's coming from the adrenals, you want to do a lot of stress reduction. Of course, you can do some overall adrenal support, you know, B-complex, vitamin C, some adaptogenic herbs, but trying to figure out what is causing this higher adrenal output. 

 

00:16:31:12 - 00:16:46:00 

Kelly Ruef 

Is it stress? Is it pain? Is it inflammation? So, there's you know, there's various things that can lead to high adrenal output that often leads to higher DHEA. With testosterone in the ovaries, you tend to see that with blood sugar issues. 

 

00:16:46:05 - 00:16:53:13 

Kelly Ruef 

So, when there's higher insulin, you tend to see the ovaries overproducing testosterone. Gotcha. Yeah. So, working on those can be helpful. 

 

00:16:54:05 - 00:17:08:09 

Mark Newman 

Okay. And digging into the metabolites in terms of the specific patterns that you might see. I mean, one of the nice things about testing that's not so comprehensive is you don't have to worry about contradictory messages between two things that relate to the same thing. 

 

00:17:08:10 - 00:17:21:14 

Mark Newman 

One of the things I love as a chemist in terms of trying to draw a conclusion about something, is I'm I'm kind of a natural cynic. So, as soon as I see a result that's high or low, the first thought in my mind is really like, is that is that really the picture I'm looking at? 

 

00:17:21:14 - 00:17:37:03 

Mark Newman 

And so having those downstream metabolites I think helped complement that story, right when testosterone is high and I have three metabolites of testosterone and they're also high, like I'm super confident in my interpretation. Right? Similarly, if they're all low, I've got a nice, clean picture. 

 

00:17:37:14 - 00:17:49:15 

Mark Newman 

So, what do you do in the cases where I guess I'll give you a specific one, maybe a little easier. Testosterone is elevated, right? And then you have three downstream metabolites and they're not. So, maybe they're even low when they tell a contradictory story. 

 

00:17:50:10 - 00:17:53:03 

Mark Newman 

How do you wrestle through that in terms of what it really means for your patient? 

 

00:17:53:18 - 00:18:06:19 

Kelly Ruef 

Yeah, that's a good question because I mean, definitely comes up and we see it and sometimes the picture is not very clear. So, I always go, I always like always related back to the symptoms and the clinical picture of the patient to see if it makes sense. 

 

00:18:06:19 - 00:18:28:10 

Kelly Ruef 

Like, does she have acne on her jawline? You know, is she getting irritable? Does she have hair loss? Sometimes you can look at certain metabolites to get a clear picture of what's happening in the tissues. So, we know that the research is showing that DHT, which remember, that's our most potent androgen, it's a peripheral hormone, so it 

 

00:18:28:11 - 00:18:42:22 

Kelly Ruef 

likes to hang out in the tissues. So, let's pretend, let's just imagine it hanging out in the jawline, causing acne. It doesn't really like to circulate. So, sometimes we kind of miss it or we don't see the true levels in the serum or the urine. 

 

00:18:43:08 - 00:18:58:01 

Kelly Ruef 

So, the research is showing that the downstream metabolite, the five-alpha androstanediol might be a better marker of DHT activity in the tissues than actual DHT in the serum itself. 

 

00:18:58:22 - 00:19:16:08 

Mark Newman 

Yeah, that was kind of a I think an aha moment for me. You know, we're playing around with these metabolites and then at the same point, you know, try to survey the literature for and there's some, there's some really nice papers are actually relatively old that say that that's the DHT that pops into your into your vein 

 

00:19:16:08 - 00:19:28:21 

Mark Newman 

and then into your serum test is actually not a very good marker for itself, which is a weird concept that within within that tissue, it's hitting the receptor harder than the testosterone. But before it escapes, it turns into androstanediol. 

 

00:19:29:03 - 00:19:46:21 

Mark Newman 

And so for me, it was almost like blind luck that we're testing these metabolites. And then you're reading the papers and going, Oh, wow. Like, we have this marker and there's, there's a fairly recent study. Maybe we can pop it up in the notes or something where they measured all these antigen metabolites and looking at PCOS women 

 

00:19:46:21 - 00:19:56:20 

Mark Newman 

which is, is, it's great to be on a treat PCOS women. But it also, I think for me acts as a surrogate of just saying this is what high androgen women look like metabolically in terms of the markers that 

00:19:56:21 - 00:20:18:08 

Mark Newman 

Are strong for picking up high androgens and measuring all these metabolites, some of which are hard to even pronounce. But there's a whole bunch of them, right? And that one five-alpha androstanediol which is the sort of last the next step in that DHT biochemistry chain when they looked at PCOS, women and women without PCOS 

 

00:20:18:12 - 00:20:39:13 

Mark Newman 

that they created actually separate non-overlapping reference ranges, which was the only thing of all these metabolites that they're measuring that that was true. Right. Testosterone was off shifted a little bit. PCOS women had more. All of these androgens were a little bit higher for the PCOS women, but that one in particular, like it's screaming at you that 

 

00:20:39:13 - 00:20:56:18 

Mark Newman 

like this is a marker for high androgenic activity. So, do you find that to be like a uniquely valuable tool then in terms of, of kind of picking up when, when there really is like high androgenic activity in women? 

 

00:20:57:05 - 00:21:11:05 

Kelly Ruef 

Oh yeah, definitely. Yeah, I see it a lot, especially with PCOS. You'll see the the higher five-alpha androstanediol. But yeah, sometimes it can kind of clarify the picture for you when you're a little confused about the testosterone and the DHEA levels. 

 

00:21:11:11 - 00:21:17:18 

Kelly Ruef 

When you look down at how it's been metabolized and you look at the five-alpha androstanediol levels and they're elevated, then it makes more sense. 

 

00:21:17:22 - 00:21:26:07 

Mark Newman 

Yeah, yeah. I think those those are the most challenging things of why you guys are on the phone all the time. Talking to people is, again, when you get everything's high, it's like, yeah, we know what that means. 

 

00:21:26:07 - 00:21:46:19 

Mark Newman 

We know what to do. And but when they tell a different story, you know, for example, if testosterone is low, but these end metabolites are high, it's this picture of like metabolism, like flowing through that, that channel. But the other thing it might be a picture of is much as we like laboratory testing to think of it 

 

00:21:47:00 - 00:22:05:05 

Mark Newman 

as this perfect holy grail of information, you know, you have a biochemistry reality that some people like spill things into their urine differently than other people, which is rare. But you see those types of patterns and then you have analytical issues of what if there's an interference with a particular hormone or whatever. 

 

00:22:05:06 - 00:22:27:20 

Mark Newman 

And that's where I find the value of urine, of having multiple things to tell a particular story, and then also points to the importance of doing that work of overlaying the clinical picture and not blindly treating test results, but putting that whole story together before you get to the, you know, the solution of what you actually want 

 

00:22:27:20 - 00:22:29:15 

Mark Newman 

to try, you know, with a patient. 

 

00:22:29:23 - 00:22:44:18 

Kelly Ruef 

Yeah, definitely. I mean, I'm always telling practitioners, I think with the urine testing, the DUTCH Test is kind of some of the more advanced testing we have available to us today to look at the androgens. And, you know, we'll see where it goes from here. 

 

00:22:44:18 - 00:22:52:08 

Kelly Ruef 

But for now, like, this is a great tool to use. And once you can really understand it, it can take your practice to a whole new level. 

 

00:22:52:22 - 00:23:03:10 

Mark Newman 

Well, we appreciate you making that a little bit clearer for us today, because it is one of the more complicated pieces to the the puzzles that we're trying to look at with the DUTCH Test. So, thanks for joining us today. 

 

00:23:03:10 - 00:23:03:20 

Mark Newman 

We appreciate. 

 

00:23:03:20 - 00:23:05:16 

Kelly Ruef 

It. Yeah, you're welcome. Thanks for having me. 

00:23:06:05 - 00:23:24:21 

Noah Reed 

It's been great having you on the show, Dr. Ruef, to discuss the role of androgens in female biology. And a big thank you to all of our listeners who joined us this week. Stay tuned for next week's episode with another very special guest, Dr. Doreen Saltiel, the expert on men's health and testosterone. 

 

00:23:25:03 - 00:23:34:19 

Noah Reed 

You won't want to miss this conversation. So, like and subscribe so you can be notified when new episodes drop. I’m Noah Reed. Thanks for joining us today. Until next time.