Clinical Utility of Urine Hormone Metabolite Testing in Personalized Medicine: A Case Report of a Male Patient with Low Testosterone.

Introduction: Customizing dietary supplementation for each patient based on biomarker testing could maximize a supplement's health benefits and minimize safety-related issues. This case report demonstrates an integrative provider's use of hormone testing to guide personalized supplement recommendations for their patient. Case Presentation: The patient was a healthy 47-yearold man who expressed interest in obtaining information about his testosterone levels. He underwent sex hormone testing using baseline serum measurement, as well as an at-home four-spot dried urine collection kit (DUTCH Test, Precision Analytical, Inc.) at baseline and before and after each intervention. Baseline serum free testosterone and urinary testosterone levels were at the low end of the age-dependent male reference range. Available genetic results also showed a catechol-O-methyltransferase (COMT) V158M polymorphism. The provider recommended human chorionic gonadotropin (HCG) to address low testosterone. Outcome: After HCG treatment, testosterone increased as desired. A simultaneous above-range increase in estradiol prompted the provider to recommend a supplement containing calcium D-glucarate (CDG) and diindolylmethane (DIM). While CDG+DIM normalized estradiol, it elevated 2-hydroxyestrone (2-OH-E1) and 4-hydroxyestradiol (4-OH-E2) above range. In addition, the ratio of 2-methoxyestrone (phase-2 estrogen metabolite) to 2-OH-E1 (phase-1 estrogen metabolite) continued to decline further with each intervention, indicating a reduced capacity for estrogen detoxification, possibly related to the patient's COMT variant. To improve methylation activity, trimethylglycine was added, which normalized the 2-methoxyestrone/2- OH-E1 ratio. Finally, sex hormone and metabolite levels were within range, without any adverse events. Discussion: Sex hormone and hormone metabolite testing before and after each intervention enabled careful step-by-step additions of supplements, which helped to improve testosterone levels while maintaining healthy estrogen metabolism. Given the patient's genetic background, this approach also ensured that any unintended effects on methylation were minimized. The convenience of the at-home dried urinary sampling method facilitated before-and-after testing.