HPA-Axis Dysregulation (often called "adrenal fatigue")

• I · Estrogen & Endocrine Disruption

  Endocrine-active chemicals are widely measurable in the population; their health effects must be evaluated exposure by exposure.

• II · Obesity & Metabolic Dysfunction

  Obesity is a signaling and exposure problem, not a number on a scale.

• IV · Anxiety, Depression & Neurobehavioral Health

  Mood symptoms are assessed responsibly — never automatically attributed to toxins or hormones.

• HbA1c (4.0–5.6 %) — Average glycemia over roughly three months; central to Pandemic II. Discuss any value of 6.5% or higher with a clinician promptly.
• Fasting insulin (2.0–8.0 µIU/mL) — Insulin signaling load; pairs with glucose for HOMA-IR. Marked elevation with symptoms warrants clinician review.
• ApoB (< 90 (lower if high risk) mg/dL) — Atherogenic particle count; better risk discrimination than LDL-C alone. Persistently high values deserve a cardiovascular risk discussion.
• TSH (0.4–4.0 mIU/L) — First-line thyroid signaling test. Any abnormal result should be confirmed and reviewed clinically.
• Estradiol (Cycle- and sex-dependent pg/mL) — Central to Pandemic I assessment, interpreted with cycle timing. Interpretation requires a clinician who knows your cycle and medication context.
• Free T4 (0.8–1.8 ng/dL) — Circulating thyroid hormone; confirms whether an abnormal TSH reflects true thyroid under- or over-function. Low free T4 with symptoms, or any high value with palpitations, needs clinician review promptly.
• Free T3 (2.3–4.2 pg/mL) — Active thyroid hormone, formed mostly by conversion of T4 in tissues. High free T3 with low TSH suggests hyperthyroidism — see a clinician.
• Reverse T3 (9–24 ng/dL) — Inactive T4 metabolite that rises in stress, illness and calorie restriction. Do not change thyroid medication on rT3 alone; discuss with a clinician.
• Total cholesterol (< 200 mg/dL) — Sum of cholesterol in all lipoproteins. Values ≥300 mg/dL suggest a genetic lipid disorder — see a clinician.
• LDL cholesterol (< 100 mg/dL) — Cholesterol carried in LDL; main treatment target in guidelines. LDL-C ≥190 mg/dL warrants clinician evaluation for familial hypercholesterolemia.
• Non-HDL cholesterol (< 130 mg/dL) — Total minus HDL cholesterol — captures all atherogenic particles' cholesterol. Discuss persistently high values with a clinician.
• LDL particle number (LDL-P) (< 1000 nmol/L) — NMR count of LDL particles (Labcorp NMR LipoProfile); particle number drives arterial entry. High LDL-P with other risk factors deserves a cardiovascular risk discussion.
• Small LDL-P (≤ 527 nmol/L) — Number of small, dense LDL particles — an insulin-resistance lipid pattern. Review with a clinician as part of overall risk.
• LDL particle size (> 20.5 nm) — Average LDL size; ≤20.5 nm is called pattern B (small, dense). Interpret with particle number rather than alone.
• HDL particle number (HDL-P) (≥ 30.5 µmol/L) — Number of HDL particles; may reflect protective capacity better than HDL-C. Interpret in a clinician-led risk assessment.
• Lp(a) (< 75 (risk-enhancing ≥ 125) nmol/L) — Genetically determined lipoprotein; independent cause of atherosclerosis and aortic stenosis. Lp(a) ≥125 nmol/L warrants clinician review of overall cardiovascular risk.
• sdLDL-C (small dense LDL) (< 30 (lab-specific) mg/dL) — Cholesterol in small dense LDL (Quest Cardio IQ, Boston Heart). Review with a clinician as part of overall risk.
• Oxidized LDL (< 60 (lab-specific) U/L) — LDL damaged by oxidation; marker of oxidative stress on lipids. Interpret with a clinician; do not use alone for decisions.

Score cutoffs used

• HbA1c ADA Standards of Care: 5.7–6.4% prediabetes, ≥6.5% diabetes range
• Fasting glucose ADA: 100–125 mg/dL impaired fasting glucose, ≥126 diabetes range
• Fasting insulin Common functional reference; interpret only with a true fasting sample
• ApoB ACC/AHA & ESC: ApoB ≥130 mg/dL is a risk-enhancing factor
• Triglycerides NCEP ATP III: 150–199 borderline, 200–499 high, ≥500 very high
• HDL cholesterol NCEP ATP III: <40 mg/dL low (men), <50 (women)
• ALT ACG: upper limit of normal ≈ 29–33 U/L (men), 19–25 (women)
• GGT Typical laboratory upper limit ≈ 50 U/L
• TSH ATA/Endocrine Society: 0.4–4.5 mIU/L; >10 overt range
• Homocysteine >15 µmol/L elevated in most laboratory references
• Free T4 Typical reference 0.8–1.8 ng/dL (assay-specific); interpret with TSH (ATA)
• Free T3 Typical reference 2.3–4.2 pg/mL; low T3 also occurs in illness and calorie restriction
• Reverse T3 Typical reference 9–24 ng/dL; guidelines (ATA) do not recommend rT3 for routine diagnosis — grade D
• Anti-TPO antibodies Common cutoff >34–35 IU/mL (assay-specific); marks Hashimoto's risk (ATA)
• Thyroglobulin antibodies Common cutoff ≤4 IU/mL (Roche) — assay-specific; positive in ~60–80% of Hashimoto's
• Total cholesterol NCEP ATP III: <200 desirable, 200–239 borderline, ≥240 high
• LDL cholesterol ACC/AHA 2018: ≥190 mg/dL severe; 160–189 high; optimal <100
• Non-HDL cholesterol NLA: non-HDL <130 mg/dL desirable
• LDL particle number (LDL-P) NMR LipoProfile (Labcorp): <1000 optimal, 1300–1599 borderline-high, ≥1600 high; MESA
• Small LDL-P NMR LipoProfile: ≤527 nmol/L reference
• LDL particle size NMR: >20.5 nm pattern A, ≤20.5 pattern B
• HDL particle number (HDL-P) NMR LipoProfile: ≥30.5 µmol/L reference
• Lp(a) ACC/AHA & EAS 2022: ≥125 nmol/L (≥50 mg/dL) risk-enhancing; measure once in lifetime
• sdLDL-C (small dense LDL) Denka assay (Quest Cardio IQ, Boston Heart): <30 mg/dL optimal (lab-specific)
• Lp-PLA2 activity PLAC Activity test (FDA-cleared): >123 nmol/min/mL higher risk
• Oxidized LDL Lab-specific (Cleveland HeartLab ~<60 U/L); research-grade, grade C