Estrogen metabolism balance ratio
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About 2-OH (E1 + E2) / 16α-OH E1
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About 2-OH (E1 + E2) / 16α-OH E1
Overview and History
The 2-OH (E1+E2)/16α-OH E1 ratio is a biochemical marker derived from urinary estrogen metabolites. It reflects Phase I hydroxylation at the 2- and 16α-positions of estrone and estradiol — reactions mediated by cytochrome P450 enzymes — and downstream Phase II processes such as methylation and conjugation that alter metabolite fate.
Historically used in research to characterize estrogen metabolism patterns, this ratio captures a functional balance between pathways that produce relatively weaker versus relatively stronger estrogenic metabolites. As a metabolic readout, it helps describe how the body processes and clears estrogens rather than measuring circulating hormone production alone.
Interpreting Highs and Lows
Higher ratio values indicate relatively more 2-hydroxylation compared with 16α-hydroxylation, suggesting a metabolic shift toward the 2-hydroxy pathway and increased formation of 2-hydroxylated metabolites. Lower ratio values indicate relatively more 16α-hydroxylation, meaning a greater proportion of 16α-hydroxyestrone relative to 2-hydroxylated forms. Interpretation depends on the full Hormone Zoomer profile — absolute estrogen levels, other metabolite ratios, liver enzyme activity, methylation markers, and environmental exposures all affect meaning and clinical relevance.
Featured Test
This ratio is included in the Hormone Zoomer to evaluate estrogen metabolism and clearance at the metabolite level. It helps providers see whether estrogen is being routed toward 2-hydroxylation or 16α-hydroxylation, adding specificity to assessments of hormonal balance and informing personalized interpretation when combined with cortisol timing, toxin screens, and other hormone metabolites.
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Mary Beth Augustine
DCN, RDN, FAND- Lead Clinical Educator
Suzanne Barker
MS, RDN, LD, CTTS, CGP- Clinical Educator
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MSc- MHNE- Clinical Educator
Brooke Mader Ganev
MS, CNS, LDN, FDN- Clinical Educator
Adair Anderson
MS, RDN, LDN- Clinical Educator
Lillie Luu Nguyen
DCN, CNS, LDN- Clinical Educator
Jason Barker
ND- Clinical Educator
Emaline Brown
ND- Clinical Educator
Dana Filatova
DCN, CNS, LDN- Clinical Educator
Jessy Dhanjal
ND- Clinical Educator
Nour Amri
MS, LDN, CNS, CKNS- Clinical Educator
