Understanding Hormones Can Change Your Practice and a Patient's Life

Hormone levels affect us during our entire lifespan. When I first began studying hormones, I was stunned at the lack of information and understanding about this topic. I felt that if I had known as a 10year-old girl what I know now about hormones, my life as a teen, pregnant woman and mom would have been much different.

Hormone levels fluctuate with stress, menstrual cycles and aging. In women, a dramatic transformation occurs in later life, during a time called peri-menopause. Peri-menopausal symptoms often start between the ages of 35-55. Peri-menopause is a break in the menstrual cycle that eventually ends in menopause. Menopause itself decreases hormones such as estradiol, estriol, progesterone, testosterone, dehydroepiandrosterone (DHEA) and cortisol. Many women welcome the end of their monthly cycles until they become familiar with the cascade of symptoms it often brings, including hot flashes, itchy skin, sleep disturbances, depression, anxiety, weight gain around the waist, vaginal dryness, bladder changes, a decreased libido, irritability, a foggy thought process and fatigue.

In the past, most women took synthetic hormone replacement therapy (HRT) such as Premarin or PremPro. In 2002, the Women's Health Initiative terminated the HRT estrogen-progestin portion of its study, because many participants had shown an increased risk of breast cancer, heart attacks, strokes and blood clots. However, I believe the study results shouldn't be directly applied to women who have had hysterectomies or are taking birth control pills. I feel strongly that because individualized and follow-up hormone testing was rarely done, increased health risks occurred in this particular study. When thyroid dysfunction and hypothyroidism symptoms occur, a blood test is taken to evaluate thyroid levels and then medication is given and the blood is re-evaluated. A diabetic monitors his or her glucose levels regularly, but for some reason, synthetic hormones have been given for years after one blood test (if at all) and blood is rarely re-evaluated.

There are many options outside of traditional synthetic hormone therapy available to reduce hormonal symptoms and achieve an enhanced quality of life, including exercise, nutrition, dietary supplementation and bio-identical hormone replacement therapy (BHRT). BHRT uses hormones with the same structure as the hormones produced by the body, which can be individualized and dosed according to the patient's need and preferred application. BHRT is available through the following applications: oral, topical, sublingual, or vaginal/labial.

Interestingly, men can have a similar experience to the female menopause, called "andropause." Testosterone, DHEA and cortisol levels decline with age. Approximately 4-5 million men have hypogonadism1 - inadequate functioning of the testes as manifested by deficiencies in gametogenesis or the secretion of gonadal hormones.2 Approximately 5 percent to 10 percent of these men do not receive treatment due to embarrassment, lack of appropriate testing and clinical questioning about symptoms. Simultaneously, estradiol levels can go up while muscle mass, libido and energy levels plummet. Men also might experience an increase in cholesterol levels and abdominal fat. Remember cholesterol and the hormones listed above are all steroids! If you are measuring a man's testosterone by blood, please test the free testosterone levels, not the total testosterone. Free testosterone is the active form of testosterone and you also might need to measure albumin and sex hormone binding globulin (SHBG) to assess a deficiency correctly.

Often, both men and women will see a great improvement in all areas of life simply by holistically addressing these hormonal changes. However, this approach often can overlook the role the adrenal glands play in this process. The adrenal glands are located over the kidneys and help the body adapt to all kinds of stress. They secrete many hormones, including aldosterone, cortisol, DHEA-S, progesterone, estradiol, epinephrine, norepinephrine and dopamine. You can live without a thyroid, parathyroid, ovaries, uterus and many other glands and organs, but you will die quickly without your adrenal glands.

When a condition called "adrenal fatigue" is present, individuals might experience trouble waking up in the morning, depression, low libido, cognitive losses and a loss of lean muscle mass. If symptoms occur, such as anxiety and panic attacks, heart palpitations and weight gain around the waist, the adrenals usually are overworking. Stress and hormone disturbances usually trigger these symptoms.

The best way to determine if you or a patient has hormonal imbalances or adrenal issues is by way of subjective questions, as well as objective testing (a saliva test to measure DHEA and cortisol levels). For women experiencing menopause, estradiol, estriol, progesterone, and testosterone levels should be checked (at minimum). For men experiencing a decline in libido, testosterone and estradiol levels should be checked.

Most health care professionals are familiar with Addison's disease, which affects the adrenal glands, and they only will run tests if your symptoms are very severe. However, in most cases, these traditional blood tests will not help determine adrenal fatigue syndrome or excited adrenals. Saliva testing is the gold standard test for adrenal issues. At least four cortisol levels should be taken: the first sample upon waking, the second at noon, the third at 4 p.m. and the last at midnight. DHEA should be taken upon waking at midnight.

Learn all that you can about hormonal imbalances and adrenal fatigue through your peers, nutrition experts, books, integrative and functional medicine conferences, as well as agencies such as Professional Compounding Centers of America (www.pccarx.com). Book and seminar knowledge is great, but I can tell you that clinical experience with hormone testing and individualized BHRT, supplement and nutrition application, as well as listening closely to your male and female patients, is the key to clinical and professional success.

I am sure you have known a friend, mother, aunt, or your own husband or wife who has complained about these issues - or possibly you are in the midst of these symptoms. There is no reason to be miserable, ignorant or confused! The right assessment and therapy can change you or your patient's life.