How do you know if you are Hormonal?
There is the cynical, but often accurate adage that you should beware of a female when it is her time of the month. “Look out, Jane is PMS-ing. If you push her she will snap at the slightest thing.” We have all heard these types of sayings. PMS, or premenstrual syndrome, is a real consideration for many women. It is often defined by irritability, mood changes, bloating, cramping, and increased cravings. The manifestation has become so common, and severe in some females, that traditional medicine has further labeled it as PMDD, or premenstrual depressive disorder. PMS, or PMDD, is often what has been simply called being “hormonal”.
What does it mean to be hormonal? This is a common presentation. Women in my clinic often tell me that they are hormonal for at least part of every menstrual cycle that they have, and if they are not, then they have dealt with it in the past. Yet, if being hormonal is so common, then there must be a common reason. Indeed there is. This reason is often related to progesterone. However, progesterone is just one hormone deficiency that manifests when you are hormonal. The bigger picture is that numerous hormones are deficient, and until these hormones are properly addressed, you are going to likely remain hormonal.
Many causes exist to create hormone deficiencies and imbalances that lead to becoming hormonal. Some of the more common causes are the chronic secretion of stress hormones, poor dietary choices, and lack of exercise. The typical picture is low progesterone and low or marginal levels of estrogen. Sometimes, the estrogen is elevated, but it is more often the imbalance between estrogen and progesterone.
Estrogen and progesterone have a unique balance that they must maintain to prevent you from becoming hormonal. It is a checks and balances system. Simply stated, estrogen stimulates. It stimulates the female brain and the estrogen sensitive tissues to change. A good example would be the breast. Many women begin to notice breast tenderness prior to menses. This is a good indication of low progesterone leaving the estrogen unchecked. Estrogen also serves the role of promoting fat and water retention. Think back to the PMS symptoms; irritability, moodiness, bloating, cramping and cravings. When you think about these classic symptoms of being hormonal as related to over stimulation or increasing water retention, it becomes easy to see the connection to estrogen. Regaining control over estrogen also means correcting the progesterone deficiency that you likely have.
It is likely that if you are suffering from hormone deficiencies contributing to being hormonal, you are also dealing with the effects of stress hormones. The stress hormone cortisol is notorious for stealing from progesterone to maintain its production. Much of the demand for cortisol comes from our lifestyle, but this is by no means the only source. We must also consider sources of inflammation for which there is a need for cortisol. One of the most common sources of inflammation is the diet. Fortunately however, just as a poor diet creates inflammation and leads to hormone deficiencies and becoming hormonal, so to can an adequate diet such as the Paleo Diet help correct some of the causes of hormone deficiencies.
Being hormonal is not a way of life. You are not cursed with it. It is simply the manifestation of dysfunction in the body secondary to a hormone deficiency. Our bodies depend on hormones. They are the chemical messengers that tell our body what to do throughout the day. If they provide the wrong message, you end up dealing with the wrong outcome. Thus, identifying your hormone deficiencies and working to correct them is key to overcoming being hormonal.
Have you ever asked someone how they are doing today, only to hear the response, “I’m tired.” Unfortunately, the person that answered this way is in the majority. Many people are going throughout their lives living in a state of constant fatigue. Fatigue is more than just a simple annoyance. Rather, it suggests that the overall state of the body is less than optimal. However, rarely is anything done about it. Many just keep trying to push through. Eventually fatigue becomes a way of life. However, this is no way to live life.
In talking with healthcare providers across the country, one of the most common complaints that enter their clinics is fatigue. This problem is not isolated to Houston. Rather it is concern throughout the entire United States. Fatigue can seem illusive. It is correlated with many different states of dysfunction and disease. However, it is not specific to any one condition. When dealing with fatigue, finding answers can seem challenging. The likelihood of finding an answer can seem daunting if you have been dealing with if for some time. After all, there is no medication to take for fatigue. Occasionally approaches such as B12 injections are recommended, but while useful, they rarely get to the underlying reason for fatigue.
Fatigue can present many ways. It can be noticed as lack of energy upon rising in the morning after sleeping, decreased production during the day, a lull in motivation in the afternoon or even mental fog and gut dysfunction. However, of the many presentations of fatigue, the one that I see repetitively is hormone deficiency. Hormone deficiencies that cause fatigue tend to manifest as a result of the increased demand for the stress hormone cortisol. As more cortisol is needed to aid in accommodation to stress, the result is a state of hormone deficiency is created since a limited amount of hormone can be produced each day. Once this threshold is exceeded, hormone deficiencies begin to manifest.
This should come as no surprise. Ask yourself if you are dealing with more dealing with fatigue. Now, also be honest and ask if you are also dealing with more stress than what is considered ideal for your body. If the answer to both of these is yes, you are not by yourself. There are many others out there just like you. The difference however, is that you know see the connection between hormones and fatigue. If your fatigue feels more chronic and unrelenting, your hormone deficiencies are likely more severe and need immediate attention to help alleviate your symptoms. If you feel fatigued when your stress levels increase, this is speaking directly to you.
However, as with many things in healthcare, the cause provides us a solution when approached in a restorative manner. If a hormone deficiency is a primary cause of fatigue in today’s high stress environment, then identifying the cause of the production of the stress hormone cortisol is a must. To build levels back up, commonsense hormone restoration should be a consideration. However, this alone will not help keep your energy levels up. In addition, hormone deficiency related fatigue also occurs secondary to lack of exercise, a diet devoid of the right nutrients and cofactors, reduced ability to remove toxins from our body, and not taking the time to enjoy life.
One thing you should absolutely know about fatigue is that it does not have to be a way of life. You can overcome fatigue, but it takes knowing the more common causes. One of the most common is hormone deficiency. Deficiencies in multiple hormones can be associated with fatigue, but much of it can be linked back to the stress hormone cortisol. Therefore, a diligent approach to conquering fatigue means not only addressing the stress hormone cortisol, but also knowing how all of your hormones are being affected. Take this step and you will soon be on the path to improved health and wellness and fatigue will be a thing of the past.
“Low T Syndrome?”
You cannot turn on the television anymore without seeing an ad discussing male hormones. This has become big business. There is even the catchy name “low T syndrome”. We are not just talking about a state of health anymore. No! We have gone on to label this as a syndrome or condition. And what is being proposed to deal with it. Well, depending on the commercial, it is the masculine named hormone gel or the cleverly named natural product that is guaranteed to improve your sex life and help you lose the spare tire around your waist. They all sound amazing? But is it too good to be true? Well if we have to ask the question, then you have your answer.
Estrogen in men
Numerous men are dealing with hormone deficiencies and the related symptoms. Otherwise the commercials offering options for male hormone replacement would not be so prolific. While male hormone replacement therapy is likely part of the solution, it is not the entire answer. You need to truly establish your need. I have seen numerous male patients that have been told their male hormone testosterone is low. When I ask if the male hormone estrogen was checked, I often get a puzzled look. But wait, isn’t estrogen a female hormone? It is predominant in the female, but males have it also, just as females have testosterone. The increased conversion of testosterone to estrogen in males is a common problem, but one that is not often addressed. If you add testosterone to a male that is converting testosterone to estrogen, he continues to feel like less of a man. He might feel better short term, but not long term.
There are some real considerations that should be made when it comes to dealing with hormone deficiencies in males. First, do you have symptoms? Symptoms of male hormone deficiency, specifically, but not exclusively low testosterone, would include low motivation, low libido or sex drive, increased fat deposition, low muscle tone, loss of muscle strength, decreased morning erection, decreased fullness of erection and lack of stamina. Clearly from this list, there are reasons outside of sexual function. Unquestionably those are important, but they are not the only reason that males should pay attention to the hormone levels. Just consider the unmotivated, apathetic male in our society. They are not held with as much regard by peers as the male that is energetic and of a “go-getter” attitude.
Correcting male hormone deficiencies also means asking the basic question, why? Why have the male hormones started to become deficient? Is it solely a manifestation of age? While an 80 year old man should not have the testosterone of a 20 year old, they should be able to maintain a realistic amount to support normal bodily functions. However, what I too often see is the 30 year old starting to manifest male hormone levels that reflect what you might expect in a 70 year old. The creation of these hormone deficiencies is driven by increased demand for stress hormones to support our lifestyle choices. The wrong foods, lack of exercise, the wrong type of exercise, and lack of sleep are just a few.
Addressing male hormones is not difficult, but it is not as simple as popping a single pill or lathering up in cream. Recreating a balanced hormonal environment means balancing all the male hormones and their subsequent interactions and conversions to hormones like estrogen. After all, I don’t know many men volunteering for more estrogen. If you suffer from some of the symptoms that were noted, you obviously realize a hormone deficiency exists. The key is managing and correcting that deficiency such that you can have complete balance of all of your male hormones.
As women move towards menopause, many of them begin to ponder the need for hormone replacement therapy. This time in a woman’s life is associated with hormonal change. Women are often instructed to initiate estrogen therapy to restore levels and alleviate symptoms. The most common of these symptoms is hot flashes, but this is by no means the only. Other annoying symptoms are vaginal dryness, mental fog, wrinkles and alterations in body composition. So many of these symptoms are blamed on lack of estrogen, but is estrogen the only problem?
A critical, yet rarely considered point is that women’s transition to menopause is influenced by far more than estrogen. Estrogen is under the influence of many other hormones. However, the hormone group that seems to have the most impact on the estrogens are stress hormones. Stress hormones play a vital role in making the transition into menopause smoother. The fluctuation of symptoms commonly associated with menopause suggests a bigger problem. It emphasizes the need to support the systems that are dependent on stress hormones.
Hormone Trade Off
Under an ideal situation, there is a trade off between the ovaries and the adrenal glands. Just as the ovaries are responsible for estrogen production, the adrenal glands secrete the stress hormone cortisol, as well as others, in a pre-menopause state. As a female continues to move closer to menopause, the function of the ovaries continues to decline. This production is replaced by the adrenal glands. Thus as estrogen production continues to decrease from the ovaries, the adrenal glands replace it making the net amount of available estrogen consistent. There is only one problem with this picture. Most women do not have adequate function of the adrenal glands. Therefore when it comes time to transition, there is already limited function of the gland the production of estrogen is being shifted to. As less estrogen is produced from the ovaries, levels continue to fall. With limited of no support from the adrenal glands, estrogen deficiency symptoms are only a matter of time.
If the symptoms that I noted initially sound like you, considering your stress hormones as part of hormone replacement therapy during peri-menopause and into menopause should be a consideration for you. By addressing the stress hormones, especially cortisol, you provide support to the adrenal glands. As these glands get the support they need, they not only are able to produce cortisol, but also a multitude of other important hormones, including estrogen.
Replacing estrogen has merit, but doing so alone only serves to further imbalance the body’s delicate chemistry. Hormones are chemical messengers and when the wrong message is given the outcome is negative. Women often experience this as hormone deficiency symptoms. Supporting a demand for estrogen also means promoting balance. This is best done by supporting the stress hormone cortisol as well as its direct precursor progesterone. Progesterone maintains balance over estrogen and keeps it from acting uncontrollably. Estrogen replacement therapy without sufficient progesterone further imbalances their ratio and worsen symptoms.
Taking a complete approach to the demand for estrogen means not just replacement, but also considering the stress hormone cortisol. The stress hormone cortisol robs from other hormones to maintain its production. Yet pushing more hormone toward this problem to attempt to support the adrenal glands is not the issue. The bigger picture is that one must address the basics of life and minimize stress. This includes adequate, restful sleep, a diet based on unprocessed, living foods, adequate nutrition, and the proper balance of exercise. Once these are addressed, then the demand for estrogen can be met and maintained.
Do you suffer from stress? If you are like nearly every other person living in Houston, Texas, or even the United States at large, you are dealing with stress. I bet if I asked you to list the stressors in your life you could immediately name several. In contrast, if I asked you to tell me what you do for fun, I bet at a minimum you would hesitate prior to answering. Interestingly this is something that I ask all my new patients when we are first beginning to work together. You might think this a little odd, but it speaks volumes about the lack of balance in most people’s lives. Some of my patients are not even able to provide me with a single example of what they enjoy. This can only result in dire consequences.
As I have been witness to, stress robs us of good health. The problem with stress is that it often disguises itself. We often think about stress as being mental or emotional, but the tentacles of stress reach far deeper than this. Stress is looming everywhere and depending on how we react to it makes a difference in our long term health.
An ironic point about stress is that regardless of the source of stress, your body is going to react the same. There is only one inherent response to stress. This is through the production of the stress hormone cortisol. Cortisol carries out some very necessary functions in our body, but when increased demand is placed on this stress hormone, ill effects begin to accumulate. In contrast, the secret to good health is keeping the stress hormones, especially cortisol, balanced.
Keeping the stress hormones balanced requires returning to some of the basic ideas that appear to have been eroded from our society. These include getting adequate rest and relaxation, eating a diet that limits inflammation and the demand for stress hormones, getting the proper amount of exercise and finding time to enjoy life. You may look at this list and think how am I going to ever tackle each of these areas? The answer lies in consistency. You may be the one percent that is going to make the jump and change your lifestyle habits immediately, but this is the exception rather than the rule. Rather you want to pick a particular area to work on in your life and once you have mastered it, then you can proceed to the next area. Becoming healthy cannot be about making yourself stressed out over becoming healthy.
Diet & Sleep
Start with you diet and sleep. These two items are going to have a profound impact on controlling your stress hormones. The demand for cortisol is increased when a diet of refined foods that have no living qualities is consumed. The repetitive consumption of these foods weakens the immune system and increases inflammation, leading to the need to produce cortisol to compensate. Add to this a lack of sleep and you have a recipe for poor health. Sleep is restorative. When you lack it, the demand for the stress hormone cortisol is raised leading to reduced healing and the breakdown of the body. Without sleep, you inhibit your body’s ability to control stress hormones and keep them in check.
Life is stressful enough without engaging in activities that further imbalance the stress hormones. Maintaining their balance is crucial to each aspect of our lives if good health is what you desire. When you get right down to it, the secret to good health is really not a secret at all. We know how to inherently achieve good health, it is just that many are overwhelmed with the stress of their life. In an attempt to manage their stress, many lose focus on the basics. To avoid falling victim to this paradigm, stay focused on the basics, one at a time, find something in life that you enjoy that you can routinely engage in and your stress hormones will better maintain balance, a key to good health.