FNA Clinical Vault
Six DUTCH and hormone case reviews from FNA office hours, led by Rachel — FNA's lead clinical mentor. Watch how FNA students work through real patient cases, from lab results to clinical plan.
Case 01 · DUTCH · PCOS · Mitochondria
The Mitochondrial Missing Link in PCOS
27-year-old · PCOS, irregular cycles, acne, anxiety, severe irritability, breast tenderness, orthorexia history
A student brings her first DUTCH case — a patient she hasn't yet met. The results raise immediate questions: mismatched cortisol dials, low testosterone relative to DHEA, estrogen dominance with low progesterone, and glutathione below range. Rachel works through what's driving each marker and how to prioritize care without overwhelming a patient who already has a complicated relationship with supplements.
What Rachel covers
Mismatched free vs. metabolized cortisol — what it means and why you can't answer the "why" without a full thyroid panel first
DHEA → testosterone conversion happens in the mitochondria — and why that changes your treatment priority for PCOS
Reading estrogen + progesterone together (not just individual markers) to explain this patient's irritability, breast tenderness, and cramps
Vitex dosing, timing, and the 750mg formulation Rachel prefers
NAC as a double-whammy: glutathione support and estrogen metabolism pathway support at the same time
Why Rachel wouldn't use MACA for this patient despite low testosterone
Case 02 · DUTCH · GI Map · SIBO · Perimenopause
When SIBO Makes Everything Else Impossible to Treat
46-year-old · Endometriosis, perimenopause, on thyroid meds + HRT, constipation + loose stools, became intolerant to supplements
The student had been working this case for months — building up the gut, clear plan in place — until the patient stopped tolerating every supplement she was put on. The SIBO test wasn't in the original plan. But the supplement intolerance turned out to be the most important clinical clue. Rachel explains why the DUTCH results have to wait, and how to sequence care when multiple systems are dysregulated at once.
What Rachel covers
Why supplement intolerance — not GI symptoms — was the flag pointing to SIBO
Reading SIBO breath test results when they're incomplete, and when to treat anyway
Candibactin AR + BR: Rachel's dosing protocol and why she chose it over berberine here
How to explain to a patient why her hormone results have to wait
The difference between always-intolerant vs. became-intolerant — and what that tells you about biofilms
Amino detox approach for patients who can't tolerate standard interventions
Case 03 · DUTCH · Thyroid · T3 Conversion
T4 Is Fine. T3 Is Not. Here's Why That Matters.
58-year-old · Perimenopause, anxiety, dry skin, nighttime waking, hypothyroid pattern — wants to avoid medication
This patient's T4 is optimal. Her T3 is low and her TSH is elevated. She's producing plenty of thyroid hormone — she's just not converting it. Rachel walks through the full thyroid panel, explains exactly where the breakdown is, and models how to have an honest conversation with a patient who wants to avoid medication without dismissing that option.
What Rachel covers
How to read T4, free T4, total T3, and free T3 together — and what elevated TSH is actually telling you
Why T4→T3 under-conversion is a liver and gut problem, not a thyroid production problem
The medication conversation: what T4-only meds do and don't fix, and how to present it without being prescriptive
Selenium (two Brazil nuts), zinc, and iodine — what to prioritize and when to test before supplementing iodine
ZRT urinary iodine test: when to use it and what it tells you that topical assessment doesn't
Thyroid antibodies: when a mild elevation warrants attention and when treating root causes (liver + gut) brings them down anyway
Case 04 · DUTCH · Birth Control · Estrogen Dominance
Reading DUTCH When a Patient Is on the Pill
28-year-old · PCOS, on hormonal birth control for 8 years, weight gain, insulin resistance, low energy, thinning hair
When someone is on hormonal birth control, their DUTCH results should show suppressed hormones. This patient's don't — her estrogen is robust despite being on the pill. Rachel explains why that's happening, what it tells you about the underlying clinical picture, and how to approach a case where the labs don't match what you'd expect from the chart.
What Rachel covers
What DUTCH should look like on hormonal birth control — and what it means when it doesn't
Why the estrogen is still showing up and what that tells you about what the pill has (and hasn't) been doing
Reading estrogen metabolite ratios when a marker is flagged — when to be concerned vs. when the ratio is proportionate
DIM and calcium D-glucarate: what they're doing mechanistically and when to reach for each
B6 and B12 deficiencies on DUTCH — when to investigate absorption rather than assume it's the pill or diet
The quinolinate marker: what it signals, when it matters clinically, and how to explain it without alarming a patient
Case 05 · DUTCH · High Cortisol · AdrenalReading DUTCH When a Patient Is on the Pill
High Cortisol, DGL, and the Body That Won't Slow Down
43-year-old · Anxiety, low energy, weight loss resistance, alternating bowel movements, elevated cortisol + cortisol awakening response
A naturopath recommended DGL for this patient's GI symptoms, but the practitioner wasn't sure if licorice root was safe with elevated cortisol. Rachel answers that clearly, then works through the full picture: a cortisol deactivation pattern that tells a specific story about what this patient's body is doing, and how to communicate that to a patient in a way that actually changes her behavior.
What Rachel covers
DGL vs. licorice root — why they're different and why DGL is appropriate even with high cortisol
What it means when the body is rapidly deactivating cortisol into cortisone — and how Rachel explains this to patients
Phosphatidylserine and melatonin timing for a high-cortisol, poor-sleep pattern
Low progesterone + estrogen dominance in the context of adrenal dysregulation
When DHEA and testosterone dials don't line up and what the mitochondrial connection looks like in practice
Managing care when a patient has multiple practitioners — and how to have that conversation
Case 05 · DUTCH · High Cortisol · AdrenalReading DUTCH When a Patient Is on the Pill
High Cortisol, DGL, and the Body That Won't Slow Down
43-year-old · Anxiety, low energy, weight loss resistance, alternating bowel movements, elevated cortisol + cortisol awakening response
A naturopath recommended DGL for this patient's GI symptoms, but the practitioner wasn't sure if licorice root was safe with elevated cortisol. Rachel answers that clearly, then works through the full picture: a cortisol deactivation pattern that tells a specific story about what this patient's body is doing, and how to communicate that to a patient in a way that actually changes her behavior.
What Rachel covers
DGL vs. licorice root — why they're different and why DGL is appropriate even with high cortisol
What it means when the body is rapidly deactivating cortisol into cortisone — and how Rachel explains this to patients
Phosphatidylserine and melatonin timing for a high-cortisol, poor-sleep pattern
Low progesterone + estrogen dominance in the context of adrenal dysregulation
When DHEA and testosterone dials don't line up and what the mitochondrial connection looks like in practice
Managing care when a patient has multiple practitioners — and how to have that conversation