Incorrect Hormone Diagnosis
One of the medical buzz words out now is hormones. This has been the case for the last several years. In talking with my patients, I have come to learn that while many are interested in the concept of maintaining their hormone levels, few really understand what that means. More shockingly, I am also noticing that some of the clinicians that my patients have been working with, are fixated in the model of seeing an individual with a low hormone, and restoring only that particular hormone. Human hormones are far more complex than this. Pushing too much of a single hormone without consideration to the effects on other hormones, is a recipe for disaster, with you the patient, being the one suffering.
Human Hormone Balance
Human hormones have very specific roles. These roles are defined not just by the action of an individual hormone, but also by the interplay that occurs between hormones. Human hormones are most often talked about by their larger categories. These include the stress hormones, progesterone, the androgens, and the estrogens. Each of these categories when taken alone has a unique role that makes them worthy of consideration.
Hormone Roles In The Body
When looked at in isolation, we can think of the broad actions of these categories. For example, the stress hormones, specifically cortisol, help us accommodate to stress by controlling glucose availability and managing the inflammatory response. The androgens are the building hormones of the body. When tissues need to be repaired or when there is the necessity for increased growth of a tissue, the androgens are the responsible human hormone category. Estrogens are our stimulators. They promote growth and activity, especially in the female body. In contrast, progesterone has a slight building response, but it also acts to counter act the actions of estrogen.
The isolated action of human hormones is to some degree an unrealistic way to think about hormones. It is a good way to begin to think about some of these hormones and learn the basics, but it is not the way that hormones function in the body. Human hormones are synergistic and antagonistic. It is these balances, or lack thereof, that are often the reason for the hormone symptoms we often think about.
Stress Hormones & Androgens
Let’s think about the relationship between the stress hormones and the androgens. With chronic stress, the stress hormones are consistently released to aid in accommodation. As this process is prolonged, cortisol begins to affect muscle and bone tissue. It breaks them down. It can even have effects on the brain and short term memory. To balance this breakdown activity, you need to be able to build the body back up. This is not going to happen without the stimulus from the androgens. Androgens are going to offset the negative effects of the stress hormones to the extent possible. We can extrapolate this to the aging process and the reason that many become interested in their hormones anyway. If you are breaking your body down faster than you are building it back up, you are accelerating the aging process.
Estrogen & Progesterone
What about estrogen and progesterone? These two categories are directly antagonistic. The estrogens stimulate and progesterone inhibits. Thus, if you are “hormonal” and suffering from symptoms such as breast tenderness and PMS, you have a hormone deficiency, likely progesterone. The ability of both of these hormones to balance each other is at the core of procreation and motherhood.
Clearly human hormones are important. They are the chemical messengers our body depends on. Yet, if you truly want to know what hormones are and how to deal with human hormone deficiencies, you have to consider the interplay they have between each other and not their isolated role. May be the question should not be what are human hormones, but rather what are human hormones as they relate to each other.
Contact Dr. Hill
Getting fully tested
I have spent a lot of time over the last few years listening to my patients talk about their hormones. A very common scenario that I see is that my patients have had only a few of their hormones checked. While this is valuable information about their state of health, it lacks completeness. Fully understanding the hormone cascade is vital to addressing hormone levels. The hormone cascade is highly dependent on all of the hormones. When men have their hormones checked, testosterone is the only hormone commonly checked. Women are not immune from this same narrow view of hormones. Many women that have their hormone levels assessed know their estrogen and progesterone levels, but they are not familiar with the hormones which more directly influence them.
One of the main categories of hormones that is rarely looked at is the stress hormones. The predominant stress hormone cortisol is responsible for a multitude of dysfunction that we typically blame on hormone levels not being balanced. The unfortunate aspect of this is that cortisol has an overwhelming impact on the other hormones. This predominant stress hormone will be produced at the expense of other hormones, thus denoting its importance. If the demand for cortisol is frequent enough, the ability to produce testosterone, estrogen and progesterone is greatly reduced. So for example when the level of testosterone or progesterone is low, the question should be asked if the need is related to lack of production of the hormone or if this is associated with increased need for the stress hormones. This emphasizes the point that when it comes to checking hormone levels, a full analysis must include cortisol.
However, cortisol cannot be assessed the same as any other hormone with a one-time blood draw. Cortisol fluctuates throughout the day. The levels of this hormone begin high in the morning and continue to taper off as the day progresses. This fluctuation provides insight into whether or not cortisol should be considered when it comes to restoring hormone levels. Elevated levels may indicate the shift of production away from vital hormones like estrogen, progesterone and testosterone over to cortisol. Additionally, if levels are low, a reduced state of total hormone production may have been reached, leaving the ability to make any hormone compromised.
Stress hormones are a key to checking hormone levels. Without the information they provide, adequate direction to guide hormone replacement therapy is lacking. I have seen many times in my patients that simply addressing stress hormones is enough to make significant changes in the hormones that are commonly checked. However, gaining control of your stress hormones means understanding those factors which most dramatically increase demand. A few of the more frequent ones are lack of sleep, a poor diet that includes the consumption of refined and pro-inflammatory foods, and lack of exercise.
Finding the correct approach to supporting your hormones is not difficult, it just means taking a complete approach. This is best done by not simply addressing the hormones that appear to be the cause of your hormone symptoms, but also looking at the hormones that may be most directly influencing them. This is most often the stress hormones. Upon adequately assessing the stress hormones as part of a complete hormone workup, a realistic plan can be put into action to help overcome hormonal deficiencies.
Stress has become such a routine part of our lives that we rarely give it the attention it deserves. In recently conversing with a patient, she told me that she only knew how to function in a stress state. Asking for clarification upon her comment, she went on to tell me that her life has become so inundated with stress and the seemingly perpetual growth of her “to do list”, that when she was not pushing to tackle the next line item that she was not being productive. On top of this she went on to tell me that she was suffering from unrelenting fatigue and that her menses had become increasing irregular.
The more I listened to my patient, it was clear that she was suffering from a hormone deficiency. Worse yet, it did not appear to be a single hormone, but multiple hormone deficiencies that were affecting her. The interesting part about this patient is that she is not alone. In fact, she is one of many that I see with similar presentations. Further emphasizing a broad scale problem is that hormone deficiencies secondary to chronic stress are. not gender specific; Males are equally as susceptible. The bigger picture is that we all live in a world that can trap us and make us victims if we allow it to. The secret is having the tools to help your body better deal with stress.
The onset of hormone deficiencies secondary to stress is not a mystery, but it is rarely talked about in the full context of its significance. I could walk into almost any clinic in Houston, or across the United States and find patients nearly identical to my patient that I initially described. Why? The answer goes back to the need for our bodies to handle stress. Stress is the priority for the body. It is the classic “fight or flight” response. Chronic stress requires consistent production of the hormone cortisol.
Many think about cortisol as being the hormone that promotes increased fat around the midsection. While this is a real consideration for cortisol, the main objective of cortisol is to increase the availability of glucose so that you can continue to accommodate to your stress. Cortisol has many affects in the body, but the primary action is glucose (blood sugar) regulation. Given that our body has a build in mechanism to handle stress, we are meant to endure it. The problem becomes when that stress is unrelenting. Our body can manage intermittent stress. In fact it actually does better when we are exposed to intermittent stressors. In contrast, relentless stress damages our body. This is where hormone deficiencies begin to present themselves.
Balancing Hormone Production
When you are dealing with stress and the demand for cortisol is high, the ability to produce other hormones is reduced. There is only a limited amount of total hormone that can be made each day. If the majority of that is going towards your stress hormones, then this leaves little to support the hormones such as progesterone, testosterone, DHEA, and the estrogens, just to name a few. As a result you end up with hormone deficiencies. Again, these are not just usually one hormone, but many, thus further explaining why symptoms can feel so relentless.
Overcoming a hormone deficiency means dealing with the cause. For most, that is going to be stress. According to research, we can actually use intermittent stress to help us better accommodate to chronic stress, whether physical or psychological. For example, routine exercise is a valuable part of the hormone restoration process when properly applied (). However, true restoration does not mean just using hormone replacement therapy. It means getting back to the core of the dysfunction, and in this case, that means aiding in your body’s ability to manage stress on a day to day basis while also offering the necessary precursors that would allow your body to inherently make its own hormone. You can beat hormone deficiencies, even those related to stress. It just takes a game plan that is specific to you and your needs.
The alarm clock buzzes and you wince as you roll over and hit snooze. All you want is just to sleep a little longer. If you only had another hour to sleep, it might make it better. You think to yourself it is only Tuesday. How am I going to pull myself through the rest of the week? Grudgingly, you finally pull yourself out of bed, your feet make their way to the floor and you begin dragging yourself through your day. Before the day even gets started, the thought of coming home at 5 o’clock already starts to sound good. But you know you must push yourself through the daily grind.
If this resembles you, you are not alone. The number of patients that I coming in with similar symptoms is countless. The day to day activities have become increasingly tiresome. It seems when I see patients suffering from similar presentations, the symptoms have been present for a while. There may have been efforts to try to alleviate the fatigue. The standard ones seem to present themselves repetitively. Maybe you have tried some B12, or energy drinks and supplements, coffee, or even going to the point of having your thyroid checked. If you are a man dealing with this in your middle ages, low testosterone was likely a consideration.
While not the only reason, a hormone deficiency is often the cause of fatigue, and many other symptoms. A hormone deficiency is often responsible for feeling unrefreshed when you wake in the morning, as well as becoming tired in the afternoon. If your levels are extremely low, you will feel tired at other times as well and maybe throughout the entire day. Living with a hormone deficiency is no way to live. You feel less than you know you should and it begins to ware on your after time. Lack of productivity makes you question your self-worth. Clearly, having a hormone deficiency is significant.
However, hormone deficiencies do not have to be a way of life. You do not have to live with the symptoms of a hormone deficiency such as fatigue, lack of motivation and low sex drive, just to name a few. Correcting a hormone deficiency can be a real life changer, literally! It is the difference between enjoying each day and continuing to feel like you are less than you know you truly are.If you are like many of my patients, you quickly realize after considering a few of these symptoms, that you indeed need to address your hormone deficiency. After all, no one wants to drag themselves through each day. Correcting your hormone deficiency means taking action. Hormone deficiencies don’t just go over time. In fact, they generally become worse. The first step is getting the right kind of testing. This means looking at the interplay between all of your hormones and not picking 1 or 2 to address. When you know the state of your hormone deficiency, only then can you set up a realistic plan to intervene.
I have seen the lowest of lows with my patients with they come in when it comes to fatigue and hormone deficiencies. I’m talking about levels low enough to make you question how someone ended up so deficient. Yet, nearly all of these patients turn a corner within a reasonable period of time. Their secret was nothing more than identifying their hormone deficiencies, and other possible sources of fatigue, and taking action.
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.