Endocrinology: Hormones, Can They Help Me?

Hello everyone Dr. Warren here and thank you for visiting my blog.  Today we are going to talk about endocrinology!  I am not going to zoom in specifically on one hormone, but we’ll talk about some of the pitfalls I encounter in my practice as well as symptoms, testing, and some solutions for hormone problems.

Let me start out by saying your hormones are a major player in your health.  You have hormone receptors all over your body!  This is why hormones affect our brains, bones, muscles, body fat, gut function, energy levels, and reproduction.  Hormones are a part of the super-triad of health(Neurology, Endocrinology, and Immunology) I and other like-minded doctors evaluate any patient that walks into our offices.

Hormones are really just a form of chemical messengers in your system.  The Neuro-Endo-Immune triad is actually a larger look at the communication system in our body and how they all fit together.  You can think of hormones like a guy on a loud speaker directing a crowd.  He just broadcasts the message to everyone who can hear.  Each hormone is a slightly different message so cortisol, estrogen, progesterone, testosterone, thyroxine, etc. all tell our body to do slightly different things.

Are you wondering if you have a hormone imbalance of some sort?  Here are some quick symptoms associated with various hormonal imbalances.  Glance through them and test yourself.

Alternating menstrual cycle Symptoms of sex hormone imbalance in a female (estrogen/progesterone)

  1. Abnormal menstrual cycle length
  2. Heavy or scanty blood flow during menses
  3. Breast pain and swelling during menses
  4. Irritable and depressed during menses
  5. AcnePortrait-of-young-pretty-woman
  6. Facial hair growth
  7. Hair loss/thinning

Symptoms of sex hormone imbalance in female (menopausal)

  1. Hot flashes
  2. Mental fogginess
  3. Mood swings
  4. Depression
  5. Painful intercourse
  6. Facial hair growth


Symptoms of sex hormone imbalance in a male (Testosterone)

  1. Decreased Libido
  2. Decreased spontaneous morning erections
  3. Mental fatigue
  4. Inability to concentrate
  5. Episodes of depression
  6. Decreased physical stamina
  7. Sweating attacks
  8. Unexplained weight gain

Symptoms of an adrenal hormone imbalance (Cortisol/Melatonin)

  1. Cannot stay asleep or fall asleep
  2. Craving salt
  3. Perspiring easily
  4. Waking up tired even after 6 or more hours of sleep
  5. Dizziness when standing up quickly
  6. Weak/brittle nails
  7. Slow starter in the morning
  8. Afternoon fatigue

How did you do on the testing?  Did any of the hormone categories correlate with some of your symptoms?  The next step in evaluating the health of your hormones is to test them.

watch-your-stepTesting Hormones – Common Pitfalls

  1. To accurately test hormones you need to know a few things about them.  For starters they come in two forms, bound and free.  About 99% of any given hormone is bound, and only a small percentage is free.  The free hormone is the “active component” while the bound hormone is in reserve, ready to be used but not active.  Think of the free hormone like product on the shelf of a store and the bound hormone like the huge stocks of inventory in a warehouse.  The stuff is in the warehouse, but it isn’t available for use in the store without a little work.  Many doctors and even endocrinologists will run the total or bound hormone without checking the free hormone!  This is wrong and can lead to gross mismanagement of hormone dosages.  The free hormone is the active hormone, and is the part most responsible for any hormone related symptoms you may be experiencing.
  2. Another key lesson to learn about hormones is many of them change rapidly.  For example estrogen and progesterone go up a down throughout a woman’s cycle each month.  Cortisol and melatonin go up and down each day to govern your sleeping and waking cycles.  Testosterone has a daily pattern also.  Taken together we find that in many cases it is appropriate to get more than one hormone test to get an accurate reflection of hormones and how they are moving.  I tell my patients that getting your blood drawn once to evaluate hormones is often like me taking a picture of one scene from a movie and then trying to figure out everything about the movie.  Do you see the problem?  How much can you tell about a movie you’ve never seen by a snapshot of 1 scene?

The Testing I Recommend

For the most part, the most clinically relevant hormone tests for you are free hormone tests, because they tell us about the active level of the hormone.  Furthermore, I recommend running these tests in the saliva rather than in the blood.  Studies have shown that testing hormones in the saliva correlate with free hormone levels as found in the blood[i],[ii].  This means we are testing the active form of the hormone.

The saliva testing has one major advantage over blood testing, which is the ability to collect multiple samples without having to go in for multiple different blood draws.  Because hormone levels move, most tests are better taken multiple times throughout the day.  Saliva samples can easily be taken without too much hassle at various times throughout the day, but most people do not want to go into the doctor 4 times throughout the day to get their blood drawn.  I cannot tell you how many women come in saying they’ve had their hormones tested and they have just had a 1 spot check of their estrogen and progesterone at a random time in their cycle.  This kind of testing simply doesn’t tell us if your hormones are acting correctly until the problem gets way, way out of hand.

looking-solutionHormone Solutions

In closing, I would like to talk about various solutions people offer to hormone related problems.  I get people in the office trying to solve their hormone problems in all kinds of ways.  Some endocrinologists put girls on the pill to “solve” any hormone problem.  Other endocrinologists use “bio-identical hormones” placing men and women on progesterone, DHEA, estrogen, testosterone, cortisol, and growth hormone.  Some women are using soy to balance their hormones, other women are avoiding soy to balance their hormones.  Other people are using vitamins or herbs restore their hormone balance.  With all this chaos, what is the right solution?

I believe the right approach to solving hormone problems is three fold.

  1. Restore foundational problems that can alter hormones.
  2. Provide vitamins and herbs that can help the body balance hormone production and clearance itself.
  3. When necessary, provide hormones (preferably bio-identical) to a person who is unable to make their own in healthy levels.

This is how I approach hormone problems in my office and to great success.  I believe one of the travesties of current endocrinology is that most people do one, and not all 3 of these things.  I also think it is absolutely ridiculous how quickly people jump to number 3 and provide people with exogenous hormones.  People ask me if I give hormones to my patients and the answer is yes, but most of the time I do not need to!  In fact, I find most people who are on bio-identical hormones are still very screwed up because the reason they were low in a hormone has never been addressed!  Let’s say you are low in progesterone, so a doctor gives you progesterone.  Did we ever stop to ask why you were low in progesterone?  In theory, a healthy person should never need exogenous hormones.  You always have the ability to make your own hormones, even after menopause, and even as a male gets older.

Your health will go better if I restore your body’s function.  Therefore, I would rather help your body make your own testosterone than to give it to you.  I would rather help your body make its own progesterone than to just give it to you.  I would rather help your body make its own *insert hormone here* than to just give it to you.

I will shortly summarize some common things I do in my practice for people with hormone problems, but please remember I decide which treatment is appropriate on a case by case basis, that is dependent upon specific test results.

  1. Restore foundational problems that can alter hormones.
    1. Things like anemia, leaky gut, poor blood sugar control, and poor detoxification can greatly alter hormone production, clearance and conversion. These things need to be considered if they are present in someone with a hormone problem.
    2. Provide vitamins and herbs that can help the body balance hormone production and clearance itself.  Some simple examples are:
      1. SERMs (selective estrogen receptor modulators) help for people with high or low estrogen.
      2. DIM or Indole 3 carbinole can aid in the clearance of excess estrogen.
      3. Adaptogenic herbs such as ashwaganda and ginseng can help people with adrenal and melatonin related problems.
      4. Phosphatidyl serine can also help people with adrenal and melatonin related problems.
      5. Chaste berry can help a woman make progesterone in healthy levels.
      6. Tribulus can help a male make testosterone in healthy levels.
      7. When necessary, provide hormones (preferably bio-identical) to a person who is unable to make their own in healthy levels.
        1. For those who are unable to make their own hormones (due to surgery or injury typically), bio-identical hormone replacement can make a world of difference.  Please ensure you are testing at least every 6 months with free hormone level testing!  We often find people not testing free hormone levels and they do not realize they are overdosing themselves.

Thank you all for reading.  I hope this has helped you in how you think about endocrinology and hormone health.  Have a great day!

Dr. Warren

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