OESTROGEN METABOLISM PATHWAYS
WHAT BLOOD TESTS MISS — AND WHAT THE DUTCH PLUS REVEALS
OESTRADIOL (E2)
Primary circulating oestrogen
Blood test shows level only — not fate
CYP1A2/1B1
2-hydroxylation
CYP1B1
4-hydroxylation
CYP3A4
16-hydroxylation
2-OH PATHWAY
✓ PROTECTIVE · PREFERRED
2-methoxyoestrone
(inactive metabolite)
✓
Cleared efficiently via methylation
✓
Anti-proliferative properties
✓
Associated with reduced cancer risk
Requires COMT enzyme + B vitamins
DIM · Broccoli family vegetables
✓ Eliminated safely
via liver → bile → stool
4-OH PATHWAY
⚠ GENOTOXIC POTENTIAL
4-catechol oestrogens
(reactive quinones if not cleared)
⚠
Can form DNA adducts
⚠
Elevated if COMT variant (MTHFR)
⚠
Requires glutathione for clearance
NAC · Glutathione support · Methylation
cofactors (B2, B6, B12, folate)
⚠ Cleared IF methylation
sufficient — tested on OAT / DUTCH
16-OH PATHWAY
✗ PROLIFERATIVE · AVOID
16α-hydroxyoestrone (E3-like)
(strongly oestrogenic metabolite)
✗
Strongly binds oestrogen receptors
✗
Drives breast tenderness, weight gain
✗
Elevated by obesity, gut dysbiosis
I3C · Calcium-D-Glucarate · GI-MAP
beta-glucuronidase reduction
✗ Recirculates if not cleared
gut bacteria reactivate via ß-glucuronidase
WHAT THE DUTCH PLUS MEASURES — AND WHAT IT CHANGES
Woman A: Same blood oestrogen. Feels well.
Metabolising via 2-OH → safe metabolites → efficient clearance
2:16 ratio: HIGH (protective) · DUTCH Plus confirms
Intervention: maintain · continue methylation support
Woman B: Same blood oestrogen. Symptomatic.
Metabolising via 16-OH → proliferative → gut recirculating
2:16 ratio: LOW · DUTCH Plus + GI-MAP required
Intervention: DIM · I3C · gut protocol · methylation support
DETECTIVE HEALTH · STEPHEN DUNCAN MSC FDN-P · DUTCH PLUS HORMONE TESTING · DETECTIVE-HEALTH.COM