Understanding Hormones: The Great Communicators
Hormones are often called the "great communicators" of the body. They play a crucial role in almost every physiological process, from growth and development to metabolism and reproduction. In this blog post, we'll take a closer look at hormones and explore the difference between natural and synthetic hormones. We'll also discuss how hormones impact our health and well-being. If you're curious about hormones, read on!
Hormones are chemical messengers. They're secreted directly into the blood which carries them to other organs and tissues of the body where they exert their functions. There are many types of hormones and they act on all different aspects of bodily functions and processes.
Some of those processes include development and growth. We have the metabolism of food items, sexual function, reproductive growth, and health. We have cognitive function and mood, also the maintenance of body temperature and thirst. All of those come from hormones.
Interestingly, there are over 50 unique hormones and science knows a lot about how these hormones act on things. All the same, we're still very much discovering so many things related to hormones. For example, we’re still researching how the environment affects our hormones from substances in plastics like BPA to flame retardants that are everywhere in furniture, curtains, and carpets. We talked about this before in relation to detoxification. But now we're going to talk about how hormones can be a factor in this and make things a little harder.
The Endocrine System
Let's talk about hormones in the endocrine system. The endocrine system is composed of nine specialized glands: the pituitary gland, the thyroid gland, four parathyroid glands, two adrenal glands, and the thymus gland. We also have a number of organs that are capable of making hormones. That would include the pancreas, the heart, kidneys, ovaries, testicles, and even the intestines.
I think of the hypothalamus as being like the boss of our body factory. I think of the pituitary gland as being like the plant manager. The reason we talk about these as these two glands is because this is where most of our hormonal direction comes from.
The Hypothalamus
The hypothalamus is not a gland but a neurologic center. It plays a huge role in regulating the generation of hormonal signalers, which is a nerve bundle system. It's the boss and in charge of generating a lot of the signals. Closely related to the pituitary gland, the hypothalamus acts like a coordinator between the nervous system and our endocrine or hormone systems. We have been learning how the body works together. The epitome of that is seen with how the nervous system and hormones work together to make everything happen. The hypothalamus, the neurologic nerve center, reacts with the pituitary and other organs to directly re-regulate those processes. It regulates hunger, thirst, and body temperature, and even sleep.
The Pituitary Gland
The pituitary gland is generally considered the master endocrine organ with the size of a pea. It secretes ten different hormones. Those hormones are released directly into the space surrounding the pituitary gland. Because of the high density of the blood around these endocrine glands, those hormones spread throughout the body very quickly. Some of them circulate freely in the blood while others have to attach to carrier proteins, which get them to target cells.
There are ten hormones released from this small pituitary gland. We have the adrenocorticotropic hormone (ACTH), melanocyte-stimulating hormone, growth hormone, thyroid-stimulating hormone (TSH), gonadotropins such as follicle-stimulating hormone (FSH) and luteinising hormone (LH), which talked to our ovaries and testicles. Included as well are antidiuretic hormone (ADH), prolactin, and oxytocin. You can see this little tiny gland that's the size of a pea has a pretty significant job to accomplish.
Hormone Receptors
Hormones are highly selective. I like to imagine this as a lock and key mechanism. Each hormone is specific to a certain receptor and it's a perfect fit. This is for a really good reason. You don't want to be turning reactions on and off that are not intentional. An example is the case of Premarin. Premarin comes from the urine of pregnant mares (pre + mare + in = premarin). It has 10 types of estrogen components in it.
Humans have three estrogen components.That means there are seven extra estrogen similar components floating around that can sort of fit into some receptors, but not enough to turn reactions on and off that would otherwise not be affected. Clearly, we need to be using only the hormones that our body knows and intentionally works with.
The major hormones that we frequently will be referring to are testosterone, estrogens, progesterone, DHEA pregnenolone, cortisol, the thyroid hormones, free T3, T4, and reverse T3, vitamin D and growth hormones. Certainly, there's a lot of hormones in our system, but these are the common ones that we're going to be really digging in.
Hormones, their interactions with cells with each other, and the environment are very complex. Scientists work really hard to understand this complexity and also how that then affects our health. I like to compare hormones to instruments in an orchestra, playing different parts of a really complicated piece, ideally in sync to make the most beautiful production.
These hormones all play this beautiful interactive role in a coordinated fashion to make the most incredible symphony. Picture it that we have pathways of several different hormones. If you have an irregularity in one hormonal pathway, imagine what happens subsequent to that.
Bio-identical Versus Synthetic
Not all forms of hormones are the same. It's really important to make this distinction because much of the confusion and mistrust and fear that surrounds hormone therapy is due in large part to the lack of understanding between the differences of bio-identical and non bio-identical hormones
Bioidentical hormones are sometimes referred to as natural hormones and that's to distinguish them from synthetic non bio-identical hormones that are used in more traditional hormone replacement therapy. Bio-identical hormones can also be synthetic since they are made in a laboratory. The difference is in a bioidentical hormone, the formulas are structurally identical to hormones produced by the human ovary, the adrenal glands and testicular glands. Whereas non-bio-identical hormones are structurally different.
If we would take a molecule of someone's own estradiol and we would compare it to a molecule of bioidentical estradiol you would not be able to tell the difference. If we took a molecule of testosterone and we compared it to,for instance, an injectable form of synthetic testosterone, you would very clearly see the difference between those two molecules.
Just to be clear, bio-identical hormones are like the hormones your body already produces. They fit perfectly into the receptors. Non bio-identical hormones are not quite like the natural hormones, but they look close.
Think about a key that doesn't quite go into a lock. It was intended, but when you jam it in there tight enough and wiggle it around a lot, it can still open a door. That's how I think of the differences between a perfectly fitting key, which is bio-identical or an not quite right key, but you can make it work if you force it to, and you might've done a little damage in the process.
Progesterone versus Progestin
An example of a bio-identical versus non bio-identical hormone is progesterone versus progestin. Progestin is a synthetic form of the body's naturally occurring hormone, progesterone. Progestins were designed to interact with the progesterone receptors in order to cause those progesterone-like effects. This means that they do some functions of the body's natural progesterone. The synthetic progestins can mimic some of the natural progesterone effects. Progestins may also act differently with those receptors in the body.
A significant consequence of the side effects seen with the synthetic progestins as in birth control pills and some forms of hormone replacement we see is an increase in the risk of developing breast cancer. Clinical trials, such as one from The Women's Health Initiative, in which more breast cancer was seen in the group taking progestin, did not actually study: What if we used natural progesterone?
Progesterone is a natural hormone that helps increase fertility. Progestin is a synthetic version of this natural hormone. Provera is a common term for this hormone progestin, but it actually acts as a contraceptive.
Hormonal Cascade
The interactions and triggers and results in hormone production is incredible. Just keep in mind, every person's case is very individualized. That’s why we go into the depths. We dig into your history and do some very advanced testing. This way we know exactly what's happening in your body.
Premenopausal state
Let's talk about the pre-menopausal state or otherwise known as before menopause. Before menopause, it's everything that starts with your very first menstrual cycle. We have these beautiful fluctuations of luteinizing hormone, FSH, estrogens, and progesterone. This amazing cycle that happens every month is dependent on the hormonal release that triggers them to be up or down.
Unfortunately, when we run into issues with this pre-menopausal phase, some of the problems we see are premenstrual syndrome. This could include painful periods with irritability and mood swings, bloating, and headaches. We can also see abnormal periods which maybe are heavy, irregular or a combination of both. Cramps, fertility issues, mood fluctuations, and even anemia from excess bleeding may also occur.
Perimenopause
Next, we'll talk about that changing period called perimenopause, which is otherwise known as the time around menopause. This is considered a 15-year window around menopause. I like to think that pretty much every woman, age 40 and up, is starting to experience some of those peri-menopausal symptoms. It's a window of time when you have a dramatic change in your hormones. We know that these fluctuating levels cause a mixing of normal and abnormal cycles. You'll often hear women say; “I had two normal cycles and then I skipped three and then I had a horrible cycle after that.”
It's oftentimes an estrogen dominant period of time and that's related to a lot of the symptoms. This hormone release is not as regular so communication between those hormones is changing. That leads to irregular cycles and skip cycles and all other menopausal symptoms.
Menopausal State
The menopausal state happens once a woman has gone 12 consecutive months without a period. The hormone release has greatly slowed to the point where she makes very little if any type of steady state hormones.
Most typically the estrogen, progesterone, and the testosterone drop as well. She may still be symptomatic; meaning having hot flashes or mood swings or night sweats. Those menopausal symptoms are really what typically makes somebody dread this ‘ever feared change.’ The average age of menopause is 52.5 years old.
Post-menopause
Post-menopause is the point when all menopausal symptoms are totally gone. Typically this occurs in women older than age 55. However, about 30% of women will continue to experience those menopausal symptoms for quite some time.
Andropause
Now in men, there is a condition called andropause. A lot of times it's commonly referred to as the male menopause which is kind of an unhelpful term. The label is misleading because it suggests that men naturally have a drop in testosterone in middle age. The label suggests that they're going along just fine. However, all of a sudden they will have a sudden drop in testosterone, similar to what women have, but that's actually not true at all.
Although testosterone levels do fall as men age, the decline is really quite steady at about less than 2% a year from around age 30 to 40. This is unlikely to cause the problems really in itself. We know the andropause is more than just hormones. Men can develop a testosterone deficiency that develops later in life. This is what we commonly see. This is also referred to as late-onset hypogonadism, which certainly can have a major impact on symptoms.
The symptoms that we typically see can interfere with everyday life. There is certainly a loss of happiness and motivation. That is why it's really important to find the underlying cause and work out what can be done to resolve that. We certainly see many men. even in their twenties, who have testosterone levels in the three hundred. A normal ideal level for testosterone in men is between 900 ng/dL and 1100 ng/dL. You can certainly expect that a level of around 300 is very and not natural.
Testosterone and Disease Incidence
A study from the Journal of Clinical Endocrinology from an article in November 2006 shows us different relationships between testosterone levels that exist. For instance, erectile dysfunction typically happens at levels of 230 ng/dL or less. We have increased death rates and testosterone levels that are less than 600 ng/dL.
Osteoporosis and metabolic syndrome are more prevalent at testosterone levels less than 770 ng/dL. Sarcopenia, which is the loss of muscle mass happens with 700 ng/dL or less. Our ideal levels are between 900-1000 ng/dL. Those are kind of the sweet spots for making sure that we maintain all of the benefits of testosterone and what it naturally can do in men. Women also have a graph, but obviously, their levels are much different. We just want to make sure that we have a youthful level of testosterone when we're adjusting for them.
Symptoms of hormonal imbalance
We hear so many reports from brain fog, issues with mental clarity, horrible sleep issues and fatigue. All of these are different symptoms that we see patients present with when they have deficiencies in testosterone or their hormones are not in sync. Sometimes, there is weight gain that seems so impossible to resolve. Other times it's decreasing muscle mass or decreasing libido. Those are very common concerns.
Since hormones are your chemical messengers that turn reactions on and off, you can see why people experience so many different symptoms when their hormonal signals are being released in this kind of haphazard pattern.
When women go through menopause, our goal is always to normalize those hormones to a more youthful state and optimized values. What we're seeking to do is the optimal level of hormones to restore that youthful balance. In men, we see male factor infertility as the cause of 30% of infertility cases. Many factors contribute to a drop in testosterone and those include poor lifestyle habits, dietary choices, chemical exposures and lack of exercise. Certainly, increased stress is a big issue as well as taking antidepressants, blood pressure medications and birth control pills. These many things can be at the root of abnormal hormones or imbalances that we find in the body.
Hormonal Therapy
Benefits of Hormonal Therapy
A lot of people are interested in hormonal therapy and they really want to know what all is involved with that. There are lots of different things that we can improve on. Here is a list of those:
improved sleep,
mental clarity
focus on memory
improved word searching
stronger bones a
improved sense of wellbeing
improved energy
decreased risk of breast cancer
decreased risk of prostate cancer
There are a lot of different individual characteristics, but those are more case-based.
Caveats
We also have some added caveats of benefits as well. A lot of times people will say, “I started on my hormones three months ago and I haven't lost 20 pounds yet. I've been working out every day and I just don't notice a change in my muscles significantly.” That's because hormonal therapy is not this instant gratification type of process. Now in a woman, who's having uncontrollable hot flashes, we can say that she does have some quality of life change immediately, generally speaking. However, it takes time for that body to readjust to this change. An increase in muscle strength and mass has its maximum effect at 12 months of hormone use. Then you'll see increased bone mineral density maximum benefit at 36 months.
I love to reinforce to people that this is not instantaneous and that everything is perfect within three months, it does take time in a well adjusted system to see these maximum results.
Hormone Testing
It's really important to do testing at the right time. For instance, we need to consider if the person is still cycling regularly. If they are, we know we want to check days 19, 20, or 21 if they have a typical 20-day cycle. Are there cycles long or short, but regular and may be irregular. Maybe they don't ovulate at all. Or maybe they are on birth control pills.
It's very important to have the proper history before we choose which hormonal test is the most appropriate. In men, with luck, we can do testing pretty much any day. Mornings will show the highest level of testosterone so we need to keep that in mind. It doesn't mean we have to test in the morning. It just gives us an idea that if we check in the morning, we know that's going to be the highest level. If we check in the afternoon, we can assume that there was some variability as the mornings go a little bit higher.
If somebody is on birth control pills or patches, or injectables, we have to really pay attention to the mechanism of action of that specific contraceptive before we decide on testing. This is to figure out how they are metabolizing those hormones or how we can make the most benefit from what we are doing.
Hormone Therapy Safety
Twenty years have really passed since the large hormone therapy trials first happened. Since then there have been many more studies and we've realized a lot of things. Basically, I can sum it up with: hormone therapy is not the fountain of youth as it was thought to be in the 70s and 80s. it's also not the “Wolf in sheep's clothing”, as it was made out to be in the 90s. The pendulum of opinion because of scientific data is definitely swimming back towards a more favorable view with better knowledge to base our treatments on.
That being said, it's still a very divided medical world where people are either studying one aspect or the other. Rarely do people look into both forms of hormone therapy being more traditional versus bioidentical.
For instance, here's an issue that we have a lot of clarity on: hormone therapy is not indicated for primary or secondary prevention of heart disease. We don't just put somebody on hormones to try to prevent a heart problem. However, we do know that for instance, in women, if we start estrogen within three years of menopause, and treat for about an average of five years, those patients had the lowest progression of subclinical vascular disease.
There's no indication for using estradiol for preventing heart disease. But we do know that using a natural-based estrogen, shows that it certainly does not hurt the heart. We think there are advantages to using estrogen early in menopause.
About osteoporosis, we know that testosterone does an amazing job of building bone strength. A lot of people think: “I need to take estrogen for my bones.” A study in 1990 actually showed that with oral estrogen, there's actually a 1% - 2% increase in bone density per year.
Estrogen patches have a different absorption characteristics. There's actually a 3.5% increase per year for estrogen patches. With testosterone, bone density is amazing at an 8.3% increase per year. That maxes out at about an 18% increase in bone density, which is dramatically different from anything we can get with our prescription bone enhancers (i.e bisphosphonates).
You'll see that testosterone is actually a stronger improvement than even estrogen.
If hormone replacement therapy has started within five years of menopause in women, there's a 30% risk reduction in Alzheimer's disease, especially if it's used for more than 10 years. Protecting the brain is always of concern. In 2007, there was a study that had over 11,000 patients in it. It showed that low testosterone levels were related to a higher death rate. There was a 41% increase in the death rate of all-cause mortality and those with low testosterone. Every person is unique and each case must be looked at individually.
In terms of vitality, that's absolutely what we do. It's very important that that is always done with full history and evaluation in a very specific testing to know exactly what's happening with you. I tend to think of the risk levels, like a red light, yellow light, and green light. Here are those relative risk markers:
The red light
This is going to be your higher risk patient. Again, these are general categories. These are patients that hormone replacement therapy might be a bad idea because they have one of those classic contraindications. In women, it would be uncontrolled, vaginal bleeding or a history of breast cancer in the last five years. Having a history of estrogen-dependent endometrial cancer, or maybe they've had a blood clot or a pulmonary embolism are also among the risk factors. In men, this would be somebody with active prostate cancer, a blood disease called Polycythaemia or a man with breast cancer
The yellow light
These are the people with medium or variable risk. These patients might benefit from hormone replacement therapy and do not have any overt contraindications. Perhaps, they have indicators suggesting that hormone replacement could be an issue. These would be women who maybe have strong family histories of breast cancer or mammographically dense breasts that don't get evaluated, or they don't do breast exams to monitor. Women who have elevated baseline estrogen levels, maybe they have genetic abnormalities and estrogen metabolism, methylation, or detoxification, or maybe they have a lot of high-risk lifestyle factors.
The yellow light category will be for those who desire fertility. Testosterone therapy can oftentimes decrease sperm counts temporarily. A yellow light in a man might be severe urinary tract symptoms like hesitancy or urgency and uncontrolled sleep apnea.
The green light
Our green light is the minimal risk category. These women are typically younger and who recently started menopause. These could be men who have been healthy but are noticing signs and symptoms of low testosterone, such as more fatigue or lack of motivation. These patients tend to experience significant symptoms that affect their ability to move, but really don't have any contraindications. There's no significant risk factors and no real lifestyle variables that raise concern
For women in the yellow light category, breast cancer risk is at the top of the list of considerations. Interestingly, there are physicians who use testosterone in the treatment of breast cancer. So you'll realize these are all relative risks and contraindications. This is kind of a category to think of where you might be in that system.
Cookie Cutter Approach vs Personalized Therapy
We strongly promote a personalized approach. There are lots of benefits to personalized therapy over a cookie-cutter approach. Here are some them:
We tend to use plant-based hormones and while conventional hormone drugs that are derived from oftentimes animal sources like horse urine, custom hormone replacement therapy uses bioidentical hormones. Most of the time, those are derived from plant sources like soy and yams.
Personalized dosages are one of the greatest benefits of custom hormones for a lot of patients. Traditional prescriptions are standardized dosing that you may be forced to choose between a dose that is slightly too high and produces unwanted side effects. It could also be that you need to choose a dose that's too low and doesn't get enough symptom relief. Customization allows each patient to receive treatment according to their individual needs.
Exclusion of allergens is really important because so many people are developing sensitivities. The exclusion of allergens is very important. We do not like to have binders, oils and solvents used that are typically put in conventional hormone replacement therapy, Custom hormone medications are formulated according to the exact needs of a patient and without these fillers.
The other great thing is we have multiple preparations. The way the medication is administered can be a significant factor and how well it works for you, or even if you can take it at all. Custom hormone medications can be produced in a variety of formats. We have hormone pills, patches, creams, gels, injections and even pellets. You have the choice and appropriation that works for you for your preference and your lifestyle.
The benefits of hormone therapy not only make it the preferred treatment when we do custom therapy for many patients, but they may also allow even those who've not had success with conventional medicines in the past to find a durable and long-lasting symptom relief.
How to support hormone health
First of all, let's drink some water. This keeps everything smoothly flowing throughout your entire system. We can flush out some of those bad things and we can also deliver some of those nutrients.
The next thing we're going to talk about is breathing. Your cells love oxygen-breathing draws in the oxygen. It helps calm your nerves. Breathing and stimulating the parasympathetic nervous system really helps with stress reduction and allows our hormones to be released in a healing and repair mechanism and not through a fight or flight.
Next, we got some good quality sleep. There is absolutely no substitute for sleep in revitalizing all aspects of your mind and body, including your hormonal system. We know that sleep deprivation and sleep apnea have been shown to adversely affect hormones. In the beginning, we learned about the melanocyte stimulating hormone (MSH). We also learned about melatonin that comes from the hypothalamus. All of those things are crucial to the heal and repair mechanism of your body. It also interplays in that beautiful symphony of what's happening in your body.
All kinds of exercise, strength training, stretching and aerobic exercise help reduce stress, and hormone levels and provide some needed cardiovascular protection. Exercise has an amazing ability to stimulate chemicals that also act like hormones. We know that muscle is our metabolic currency. Make sure that exercising is a part of your daily routine. We know that men who exercise, on average, have a testosterone level of 200 points higher than those who don't.
Eat lean protein, healthy fats, fiber, and vegetables. That is really clean, healthy eating is going to fuel all the different pathways that actually fuel your body in the healthiest of ways. They'll also satisfy some of those cravings for nutrients that really fuel your system. We need to avoid sugary and processed foods. I think we all know that that's a really important thing for us to do. Food and drinks that are high in sugar aren't just empty calories. They're actually negative because they create spikes and crashes in your energy levels. This can leave your system constantly in that fighting period.
Portion control. Eat when you're hungry and try to avoid overeating. It releases a lot of hormones that are actually detrimental. They stimulate inflammatory pathways. So stay in tune with what your body is really asking for and give your system a break when it doesn't need food. Digestion related hormones can actually lose their effectiveness. Many people end up with a lot of significant craving issues and the body loses its sense of ability to tell when to burn fat calories and when to store them. It is vital to eat when you're hungry and try to avoid overeating.
Steps you can take
The last one I want us to really emphasize is to get a comprehensive, personalized evaluation. If you have issues with your hormones and you know that your hormones are out of whack, the best thing you can do is not try to spot treat yourself, but really go to somebody who knows exactly what they're doing.
We at Vitality Wellness pride ourselves on doing comprehensive, personalized evaluations and making sure we help your body perform in the most optimal condition. Healthy living is absolutely in your control. We know that people have the best outcomes when their systems are optimized. That includes your hormonal system and the incredible impact that has on your health.
Now, what have we learned? Hormones are important messengers in the body, and when they’re working well together, everything runs smoothly. However, when things go wrong and hormone communication is disrupted, it can lead to all sorts of problems. But don’t worry – there are ways to support healthy hormone communication! If you’d like to learn more about how our services can help you restore balance in your life, please schedule a free discovery call with us today. We would be happy to chat with you about how we could help get your hormones back on track. Thanks for reading!
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DISCLAIMER: The information in this email is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content is for general informational purposes only and does not replace a consultation with your own doctor/health professional