It’s all about balance. You will hear us continually talking about that very topic over and over and over again. The main reason is that so many of today’s physicians do not fully understand the delicate balance required by each hormone and simply do not have the time to spend with each patient to really drill down on the specifics of what those relationships mean to your overall health. It is no secret that women are much more complex than men, especially when it comes to hormone balancing. As intricate as these pathways and interconnections are, I will only scratch the surface on each to provide a general overview of just how delicate we must approach this balancing act. Don’t fall into the trap of thinking that if a little is great, a lot must be better. And please take a breath…this is going to sound a bit like a science class, but you need to know some of the pathways and relationships to get a feel for the hormone web.
So, why consider hormone replacement therapy? For women, this translates to relief of menopausal symptoms, prevention of memory loss, heart health, weight loss, bone production and general growth and repair of tissue. Let’s begin with the one we think we all know, but likely only have a small overview of – estrogen. There are three types of natural estrogens – E1, or estrone; E2, or estradiol; and E3, or estriol. Generally speaking, estrogens are responsible for the following functions:
- Decreases blood pressure;
- Decreases LDL and prevents its oxidation;
- Helps maintain memory;
- Helps with fine motor skills;
- Increases water content of the skin;
- Stimulates production of choline acetyltransferase, an enzyme which prevents Alzheimer’s Disease;
- Increases metabolic rate;
- Improves insulin sensitivity;
- Improves sleep;
- Decreases wrinkles;
- Protects against macular degeneration;
- Aids in the formation of neurotransmitters in the brain, such as serotonin which decreases depression, irritability, anxiety and pain sensitivity;
- And so on……
Excess estrogen can cause cervical dysplasia, depression, increased risk of uterine cancer, weight gain, water retention, poor sleep, headaches, etc.
Estrone (E1) is the main estrogen the body makes post-menopausally. Estradiol (E2) is responsible for many of the beneficial effects of estrogen on the body, including heart health, maintaining bone structure, working as an antioxidant and enhancing memory. Estriol (E3) is 80 times weaker than E2 so it has less of a stimulatory effect. There is considerable evidence showing that E3 protects AGAINST breast cancer. It does this by blocking E1 and occupying estrogen receptor sites on the cells of the breasts. Further, after menopause, the metabolism of estrogen can change which means that these women may respond differently to estrogen replacement. We won’t get too much into the metabolism of estrogen, but effectively there are 2 major competing pathways (2-OH estrone and 16-OH estrone) and one minor pathway (4-OH estrone). The bottom line is that the 2-OH estrone is good. We can easily support this metabolism and methylation with diet and our exclusive line of nutraceuticals, including Omega 3’s, or a homocysteine modulator (both of which we can provide based upon your specific needs).
Next, we can look at progesterone. Symptoms resulting from progesterone loss include anxiety, depression, irritability, mood swings, insomnia, pain, excessive menstruation, weight gain and decreased libido, among others. Natural progesterone supplementation effects (not to be confused with synthetic progesterone called progestins – which are bad) can help balance estrogen, improve sleep, have a calming effect, lower cholesterol, lower blood pressure, serve as an anti-inflammatory and help the body burn fat. Studies have shown that progesterone does NOT induce estrogen-stimulated breast cell proliferation. In fact, natural progesterone has been shown to DECREASE the risk of developing breast cancer, as seen in a study which looked at 80,000 postmenopausal women for 8 years using hormone replacement therapy. Additionally, another study measured blood levels of progesterone in 6,000 women that were premenopausal. Women with the balanced levels of progesterone who had regular cycles had an 88% REDUCTION in the risk of developing breast cancer.
The delicate estrogen/progesterone ratio is critical. Progesterone without adequate estrogen results in weight gain, higher cholesterol, depression, fatigue and insulin resistance. Too much progesterone, even with adequate estrogen, still elevates cortisol, increases insulin resistance, causes incontinence, decreases growth hormone and suppresses the immune system. Once again, balance is key.
Believe it or not, women have and need balanced testosterone. Testosterone is responsible for increasing sexual interest, increasing a sense of emotional well-being, increasing strength, maintaining memory, prevent sagging skin, decreasing body fat and increasing norepinephrine in the brain. Many, many women also suffer from sub-optimal testosterone levels. Contrary to popular Starbucks discussions, the common misconception is that by supplementing this critical hormone, women will grow unwanted hair, and have male-patterned responses. FALSE! In order for testosterone to work well, estradiol levels must also be optimized. Without enough estrogen, testosterone cannot bind to brain receptors. Additionally, SHBG is a carrier protein for testosterone. If this level is high, then there is less E2 and testosterone for the body to use. If it is low, then more estrogen and testosterone are available for the body to use. Hopefully, that makes sense and helps to dispel the notion that testosterone is the evil step-brother. The reality is that our medical team sees so many cases of suboptimal testosterone levels in women that once this is balanced, so many pieces of their daily lives become exponentially enhanced.
DHEA is a hormone made by the adrenal glands, with a small amount also being made in the brain and skin. DHEA production declines beginning in the late 20’s and is responsible for making estrogen and testosterone in women and men. Women are definitely more sensitive to DHEA than men, which further stresses the need to carefully monitor and regulate levels. In addition to age, stress and menopause can really impact DHEA levels which, when balanced, have a significantly positive effect on decreasing LDL cholesterol and triglycerides, preventing blood clots, promoting weight loss, increasing brain function, decreasing allergic reactions, enhancing the immune system and assisting the body in repairing tissues. However, just as we have seen with the other hormones, excessive DHEA has significantly adverse reactions such as fatigue, anger, depression, weight gain, sugar cravings, restless sleep, acne, etc. Balance is critical.
Cortisol is the only hormone in the body that increases with age. It is made by the adrenal glands and is elevated in times of stress. But what if you live in a state of continual stress like many of us do? Consistently elevated cortisol levels can result in a decreased immune system, fatigue, irritability, fuzzy memory, sugar cravings, muscle weakness, increased infections, increased cholesterol/triglycerides/blood pressure/blood sugar, etc. It’s not pretty. Stress is not the only contributing factor. Menopause, fibromyalgia, depression, IBS, PMS, heart disease, etc. can also result in abnormal cortisol levels. Adrenal burnout, or Hypoadrenalism, could also result from abnormal levels which forces cortisol and DHEA levels to decline. Cortisol is a critical component of the hormone web. If it is increased, it decreases the making of progesterone and thyroid hormone becomes more bound and less active. We always take a hard look at cortisol to make sure we do whatever we can to keep this balanced.
Pregnenolone is the precursor to DHEA, estrogen, testosterone and progesterone which is, get this, made from cholesterol. If your total cholesterol is below 140, you CANNOT make pregnenolone effectively. Most primary care physicians do not understand this relationship. They think that when they see a total cholesterol of 135, then you should be commended and to keep doing what you are doing. Not so fast. It might benefit the prevention of arterial plaque formation, but your hormones will be in a state of panic and destruction. Then the wheels come off. Pregnenolone is so critical to nervous system responses, anti-inflammation, modulating neurotransmitters, regulating pain, learning, memory and alertness. It is just one more cog in a very complex and delicate wheel.
Finally, let’s touch on insulin. We know that estrogen, progesterone, DHEA and thyroid hormones are all important for the regulation of glucose. Estrogen lowers blood sugar in women. Testosterone decreases blood glucose in a male. Progesterone raises blood sugar if not balanced with estrogen. Because insulin is so vital with its role in serotonin production, converting blood sugar into triglycerides, countering the actions of adrenaline and cortisol, it is imperative that insulin be balanced. Low insulin is a pre-diabetic condition which can be caused by eliminating carbohydrates from the body (say goodbye to that ketogenic diet you thought was healthy), not eating enough, or over-exercising, among other factors. Excess insulin accelerates the aging process, promotes cancer growths and many other nasty health issues. Causes of excess insulin levels are attributed to high carbohydrate diets, soft drinks, artificial sweeteners, elevated DHEA, excessive progesterone, low estrogen, skipping meals, etc. Regulation of insulin is not just for diabetics. We all need to make sure that levels are optimally balanced at all times.
Whew…that was quite a bit of information, but I am really only touching on the highlights of each…and yet, it still probably felt like a class in endocrinology! The point to all this detailed information is to illustrate just how granular our medical team looks at your levels. It’s never just as easy as you may think, which is why so many doctors get it wrong in the first place. Our team understands the intricacies of all the hormone players and that means that we can help each one of you reset the levels back to when you were in your 20’s. You will be healthier, have more energy, sleep better, lose dangerous visceral body fat and have a recharged outlook on each new day. It sounds almost surreal, but when all levels are optimized, it is a beautiful symphony…because it is all about balance!