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 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.
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.
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.
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.
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.
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 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.
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.
Benefits of Hormonal Therapy