Private summary for Jeanie
A plain-language read of your DUTCH hormone test and your Quest blood panel, plus what is worth testing next and what it is likely to cost around Dallas.
Start here
Nothing on either report is alarming. There is no marker suggesting disease, no organ problem, and nothing needing urgent attention. Your liver, kidneys, blood count, blood sugar and electrolytes are all normal.
Your hormone levels are very low across the board. Not because anything is malfunctioning, but because your ovaries were removed in 2013 and nothing has replaced what they used to make. Thirteen years of that adds up.
Your fatigue and brain fog have a plausible explanation. The picture is best described as running on low fuel rather than broken. The machinery works properly; there is just very little coming through it.
The most useful tests have not been done yet. Thyroid, ferritin and an inflammation marker are all missing, and any one of them could change the picture. They are inexpensive.
Your endometriosis history matters a great deal for any conversation about hormone replacement. Make sure it is on the record before anything is prescribed. There is more on this below.
Reassurance first
It is worth being specific about this, because a list of low numbers can look worse than it is.
Your oxidative stress and DNA damage marker is low, and your neuroinflammation marker is normal. On the blood count, the ratio of neutrophils to lymphocytes is 1.09, which is low. That ratio is a rough gauge of whole-body inflammation, and yours suggests your system is not in an inflamed state overall. Whatever is happening in your gut appears to be local rather than systemic, which is good news.
The main finding
Because both ovaries were removed in 2013, your body lost its main hormone source abruptly at around 44, rather than gradually in your early fifties. Since then your adrenal glands have been the only source, and they are producing modestly.
Testosterone matters more here than people expect. It is not only a male hormone; in women it contributes to energy, mental clarity, muscle maintenance and libido. Yours is at the floor, and that fits what you described.
One useful detail: the DUTCH report prints a red warning suggesting urine testosterone might be under-reading your true level. In your case that is unlikely, because several independent androgen markers all agree that the level is genuinely low. A simple blood test would confirm it either way.
Page 8 of the DUTCH says you reported "significant symptoms of excess androgen levels." That is an automated response to the scalp hair loss box on the form, which the questionnaire files under androgen excess. Your actual androgens are low, not high. Hair loss with low androgens points somewhere else entirely, most likely thyroid or iron stores, which is why both are on the testing list below.
Please read before any prescription
Important
Ordinarily, a woman with no uterus who takes hormone replacement can take oestrogen on its own, because progesterone's main job in HRT is protecting the womb lining. With a history of endometriosis, that reasoning does not apply to you.
Microscopic endometriosis deposits can survive surgery, and oestrogen given without progesterone alongside it can reactivate them. The specialist guidance is that women with an endometriosis history should be offered combined oestrogen and progestogen therapy, or tibolone, even after a hysterectomy with both ovaries removed. Reported recurrence on oestrogen-only therapy after that surgery runs at roughly 3.5 to 6 per cent, and in the small number of documented cases where residual endometriosis turned malignant, around three quarters had been on unopposed oestrogen.
This does not mean HRT is off the table for you. It means the prescription needs to be the right kind, and your doctor needs to know about the endometriosis before writing it. Please make sure it is explicitly on your record.
Separately, the timing question is a genuine judgement call rather than a settled answer. Current guidance favours starting HRT under 60 or within ten years of menopause. You are 56, so under 60, but thirteen years out from surgery. The counterweight is that guidelines also recommend replacement after early or surgical menopause at least until the natural age of menopause, around 51, which you did not receive. That is a real conversation to have with Kirk, not something to decide from a report.
Adrenal picture
Your total cortisol output is fine and your daily rhythm is healthy, so this is not "adrenal fatigue." But two findings sit alongside each other: your free cortisol is at the low end at every time point, and your body is shifting strongly toward cortisone, the inactive storage form. On the DUTCH scale, only 15 per cent of women shift as far in that direction as you do.
In plain terms, you are making enough cortisol but converting more of it than usual into the inactive form. That may contribute to the afternoon and evening flatness you described. Combined with your DHEA-S sitting at the floor, it is the clearest hint on the panel of low-grade inflammation somewhere, which is exactly why an inflammation blood marker is the top priority on the testing list.
Gut
You have endometriosis, a hysterectomy and four pregnancies behind you. That combination carries a real likelihood of pelvic adhesions, and endometriosis frequently involves the bowel. Adhesions change how the gut moves, and altered gut movement is one of the leading causes of SIBO, or small intestinal bacterial overgrowth.
SIBO presents almost exactly as you describe it: swelling and distension that gets worse after certain foods, particularly fibre. It has a well-documented association with endometriosis. If that is what is happening, it is a different problem from "leaky gut" and needs a different approach, starting with a breath test rather than another supplement.
Thorne Leaky Gut Support contains L-glutamine 2.5g, partially hydrolysed guar gum 1g, aloe vera gel 250mg, curcumin 250mg and boswellia 250mg per scoop.
The likely culprit is the partially hydrolysed guar gum. It is a prebiotic fibre, and prebiotic means gut bacteria ferment it and produce gas. It is normally considered one of the gentler fibres, but the standard instruction is to begin at a quarter or even an eighth of a scoop and build up over several weeks. Starting at a full scoop, especially while already inflamed from the gluten exposure, is a well-recognised way to feel considerably worse.
The aloe vera is a secondary possibility, since it can be irritating to an already reactive gut. The curcumin and boswellia are anti-inflammatory and are unlikely to be the problem.
Your instinct here looks sound. The practical step is to stop it while the current flare settles. If you want to try again later, start at a fraction of a scoop and increase slowly over a month. If the bloating tracks the dose, you have your answer.
It is not clear from these reports whether coeliac disease was ever formally ruled out, and no coeliac test appears on the Quest panel. The difficulty is that the standard blood test is unreliable in someone already avoiding gluten, and a single exposure a month ago does not count as a challenge; that requires weeks of daily gluten, which is not something to put yourself through.
There is a way around it. HLA-DQ2 and DQ8 genetic testing is unaffected by what you eat and can be done at any time. If you carry neither gene, coeliac disease is effectively ruled out for life and you can stop wondering. If you do carry one, it does not confirm anything on its own, since roughly a third of people carry them, but it tells you the question is worth pursuing properly. Either way it closes an open loop without you eating gluten again.
Sleep
Your waking melatonin marker came back at 8.7 against a range of 10 to 85, which reflects low production overnight and fits the mild trouble falling and staying asleep you reported. Melatonin does decline naturally with age, so this is common rather than worrying.
Because your cortisol rhythm is intact, the underlying clock is working. That usually means light habits help more than supplements do: bright daylight in your eyes within an hour of waking, and dim, warm light in the evening. If you do try melatonin, the physiological dose is far smaller than what is typically sold, in the region of 0.3 to 1mg rather than 5 or 10mg.
Next steps
These are grouped by how much they would actually change what happens next, not by price. The costs below are typical Dallas-area cash prices as of August 2026, gathered from public price listings. They move around, so treat them as a guide and confirm when booking.
Your labs were ordered through Fullscript by Kirk Roberts, which means the simplest route is to ask him to add these to a single requisition. One draw, one visit, no duplicated phlebotomy fees, and the results go straight to the person interpreting them. Practitioner pricing through Fullscript or Rupa often matches or beats the retail figures above.
If you would rather order directly, services such as Ulta Lab Tests, Walk-In Lab and RequestATest let you buy tests online and have blood drawn at any Quest patient service centre, of which there are many across Dallas and Denton. They tend to be the cheapest option, though most add a small physician authorisation fee of roughly $6 to $10. For the DEXA scan, MDsave lets you prepay online at a fixed cash price before you book.
For the appointment