Steroid Hormones Part 5: Hormonal Imbalances

Steroid Hormones Part 5: Hormonal Imbalances

At the core of many symptoms suffered by both men and women are hormonal imbalances.  Imbalances occur several ways.  There are deficiencies, there are excess, and there are relational imbalances.  We have previously mentioned “estrogen dominance” which is an example of a relational imbalance.  Relational imbalances are challenging as they can be a combination of deficiencies and excesses. 

To begin our understanding let’s start with some basic lists.  Estrogen imbalances include estrogen deficiency and estrogen excess.

Symptoms of Estrogen Deficiency

·         Hot flashes

·         Night sweats

·         Insomnia

·         Mood swings

·         Mental fogginess, poor memory

·         Dry eyes, nose, sinuses

·         Vaginal dryness, dry skin

·         Vaginal wall thinness, vaginal dysplasia

·         Vaginal and/or bladder infections

·         Incontinence, urethral irritations, urinary frequency

·         Headaches, migraines

·         Decreased sexual response

·         Loss of ambition or drive

·         Depression

·         Lack of stamina

·         Decreased breast size

·         Wrinkling of skin

·         Osteoporosis

·         Loss of subcutaneous fat

·         Increased risk of cardiovascular disease

Symptoms of Estrogen Excess

·         Heavy bleeding

·         Clotting, cramping

·         Water retention, bloating

·         Breast tenderness, lumpiness, cystic breasts, enlarged breasts, fibrocystic breasts

·         Weight gain

·         Headaches, migraines

·         Emotional hypersensitivity

·         Depression, irritability, anxiety, anger, agitation

·         Decreased sexual response

·         Thyroid dysfunction (resembling hypothyroidism)

·         Cold hands and feet

·         Blood sugar instability, sweet cravings

·         Insomnia

·         Gall bladder dysfunction (coagulated bile)

·         Acne

Progesterone imbalances include progesterone deficiency and progesterone excess.

Symptoms of Progesterone Deficiency

·         PMS

·         Heavy bleeding

·         Clotting, cramping

·         Inability to concentrate

·         Short term memory impairment

·         Muscle tension, spasm, Fibromyalgia

·         Water retention, bloating

·         Insomnia

·         Breast tenderness, lumpiness, cystic breasts

·         Weight gain

·         Thyroid dysfunction (resembling hypothyroidism)

·         Acne

·         Headaches, migraines

·         Anxiety, irritability, nervousness, moodiness

·         Hot flashes

·         Depression

·         Decreased sexual response

·         Osteoporosis

·         Amenorrhea (no periods at all)

·         Oligomenorrhea (infrequent periods)

·         Spotting

·         Endometriosis, adenomyosis (uterine endometriosis)

·         Fibroids

Symptoms of Progesterone Excess (usually from overdose resulting from progesterone replacement therapy)

·         Sleepiness

·         Bloating or constipation (excess progesterone slows the digestive tract)

·         Candida (excess progesterone can inhibit anti-candida immune system response)

·         Depression

·         Ligament laxity which can cause: persistent back pain; other joint pains and problems; incontinence; or mitral valve prolapse.

·         Progressive progesterone deficiency symptoms (Progesterone overdose, especially with creams and gels down-regulates and eventually shuts down progesterone receptors.)

·         High levels of free (unbound) cortisol which can lead to: high blood sugar; insulin resistance; weight gain; low thyroid function; sleep problems; osteoporosis; immune system dysfunction; and GI system problems. (Progesterone and cortisol compete for the same binding protein. When free progesterone floods the system long enough, it can compete with cortisol for the binding protein and release excessive amounts of cortisol into the system.)

·         Loss of hormonal feedback loop coordination which disrupts multiple other hormones balances.

Testosterone imbalances can occur in both men and women. 

Symptoms of Testosterone Deficiency

·         Decreased stamina and energy.

·         Low or absent libido.

·         Poor muscle tone.

·         Weakened, osteoporotic bones.

·         Trouble with balance and coordination.

·         Decreased sense of well-being.

·         Decreased armpit and body hair.

Symptoms of Testosterone Excess

·         Acne, oily skin.

·         Loss of head hair (male patterned baldness).

·         Excess facial hair, excess body hair.

·         Mood disturbance, excessive aggressiveness, irritability.

·         Deepened voice.

Estrogen Dominance

Estrogen dominance is a condition in which a woman or man can have deficient, normal, or excessive levels of estrogen, but has too little progesterone to balance the estrogen level. Estrogen Dominance has become common in both cycling and menopausal women, and men.  So, why is this?

Estrogen dominance has become so predominant due to many of our modern lifestyle choices.  One of the main causes is stress which sets off a whole range of hormonal chain reactions.  The increased need for cortisol to handle the stress response causes more progesterone to be converted to cortisol.  This may cause a shortage of progesterone to balance estrogen. 

As cortisol rises insulin rises increasing fat storage.  As cortisol rises thyroid hormones decrease, thus slowing metabolism and leading to fat storage.  Fat cells make estrogen, exacerbating the imbalance.

Weakened glands are another reason.  The adrenals may be fatigued from cortisol production and slow down progesterone production.  The ovaries may not produce sufficient progesterone during the luteal phase of the cycle.  Or there may be anovulatory cycles (cycles where menstruation occurs, but no ovulation) resulting in no ovarian progesterone being produced. Low thyroid function may slow down the adrenals and the ovaries as well.  All these activities can create a shortage of progesterone to balance estrogen.

The use of oral or injected contraceptives by its very nature is disruptive to the production of progesterone.  Remember contraceptives to not “regulate” the cycle, they “suppress” it.  Their usage can have both short term and longer term impacts on progesterone production. 

For menopausal women conventional hormone replacement therapy has been to provide estrogen.  As we have seen, progesterone is also needed in menopause.  Therefore an unbalanced replacement approach may lead to estrogen dominance.

There are also dietary and nutritional deficiency concerns.  The typical American diet: usually high in carbohydrates, low in good fats, high in trans-fats, and low in vegetables and healthy sources of protein leads to nutritional deficiencies and obesity.  Deficiencies in magnesium, zinc, copper, iodine, and B complex vitamins play a major role in the health of the endocrine glands and their production of hormones.  Obesity is a concern as estrogen is made in fat cells and excess fat cells make excess estrogen.

Last, but certainly not least is exposure to external hormones.  This includes xenohormone exposure and plant and animal hormones.  The animal hormones are found in our food supply while other hormones are typically found in health and beauty products (a small amount does not have to be labeled!).  Xenohormones are chemicals that disrupt our hormonal balance.  These are found in health and beauty products, cleaning products, plastics, and many other unsuspecting places as well as pesticides, fungicides, and medications. 

Symptoms of Estrogen Dominance

·         Anxiety, irritability, anger, agitation

·         Cramps, heavy or prolonged bleeding, clots

·         Water retention/weight gain, bloating

·         Breast tenderness, lumpiness, enlargement, fibrocystic breasts

·         Mood swings, depression

·         Headaches/migraines

·         Carbohydrate cravings, sweet cravings, chocolate cravings

·         Muscle pains, joint pains, back pain

·         Acne

·         Foggy thinking, memory difficulties

·         Fat gain, especially in abdomen, hips and thighs

·         Cold hands and feet (low thyroid function because estrogen blocks thyroid hormones)

·         Blood sugar instability, Insulin Resistance

·         Irregular periods

·         Decreased sex drive

·         Gall bladder problems (bile becomes thick and sluggish)

·         Infertility

·         Insomnia

·         Osteoporosis

·         Endometriosis, Adenomyosis

·         Functional ovarian cysts; Polycystic ovaries

·         Uterine fibroids

·         Cervical dysplasia

·         Allergic tendencies

·         Autoimmune disorder

·         Breast, uterine, cervical, or ovarian cancer

Natural solutions for estrogen dominance include dietary modifications, stress reduction techniques, animal glandular extracts without hormones, specific nutrients, and herbal remedies.  As you can see, estrogen dominance is even more complex than the previous hormonal imbalance issues we have discussed.  It is multi-faceted as it includes multiple organs and hormones.  We can use the symptom lists as guides to identify which hormones are in excess or deficient, yet for long term health and healing we want to support all the affected glands. 

There are times when a form of hormone replacement therapy is needed.  At those times the  more natural solution is “bioidentical” hormones.  Here too, just providing hormones does not address the underlying deficiencies and ultimately the health of the glands.  We are dealing with multiple glands and hormones so supplementing with specific hormones may throw the entire system even more out of balance, by creating additional communications challenges for the endocrine system.  Therefore, except for extreme cases, it may be best to start with glandular and nutrient support and allow the body to bring itself back into balance naturally.

Bernard Rosen, PhD is a Nutrition Consultant and Educator. He works with individuals, groups, and at corporations to create individualized nutrition and wellness programs. His office is in Mequon, WI. To learn more or to schedule an appointment, e-mail at bernie@brwellness.com, call (262) 389-9907 or go to www.brwellness.com.

Steroid Hormones Part 4: Female and Male Life Cycles

Steroid Hormones Part 4: Female and Male Life Cycles

Before we look at hormonal imbalances, let’s get a quick understanding of the hormonal stages of the typical female and male life cycles.

Female Life Cycle

Once the female reaches puberty she has entered her reproductive years.  To reach full reproductive maturity can take up to four years.  It is also common for the initial menstrual cycles to be irregular for several months or years.  The reproductive years last for approximately 30 plus years.

The next stage is called perimenopause.  It marks beginning of the transition to menopause. This can be one of the more difficult stages for the modern female as things begin to change.  Cycles and hormones now fluctuate creating more mood swings and fatigue.   In addition there are more cycles without ovulation.  Perimenopause officially ends with menopause which is considered to be 12 consecutive months with no cycle.

The biological wiring of the human female is for this process to take 2-3 years.  However, it has become common for this transition to take 8-12 years in the modern female.

Menopause is the permanent cessation of menstruation due to loss of most ovarian function.  There is another common misperception here.  While it is true that ovarian estrogen and progesterone production have stopped, there can still be testosterone production.  Therefore, the ovaries still do serve a purpose after menopause.  The average age for menopause is 51. Smoking has been shown to accelerate the process by two years.

Menopause is known for some unpleasant symptoms, some of which are also experienced during perimenopause.  Most of these originate with hormonal imbalances which we will discuss later.  Menopause symptoms affect both the physical, mental and emotional bodies. 

General physical symptoms include: hot flashes; night sweats; insomnia; dry skin, eyes, and sinuses; headaches; migraines; water retention and bloating; weight gain; liver and gall bladder congestion (leading to constipation); cold hands and feet; increased sugar cravings; muscle tension; increased risk of osteoporosis and cardiovascular disease; and loss of subcutaneous fat and increased wrinkling.

Symptoms affecting the reproductive system include: cystic or lumpy breasts; vaginal dryness, vaginal dysplasia and atrophy; more frequent urinary tract infections; and incontinence.  

General mental and emotional symptoms include: poor memory and foggy thinking; mood swings; depression; decreased ambition; irritability; anxiety; anger; and decreased libido.

A variety of factors have been identified that affect these symptoms.  Positive factors which reduce the symptoms include being in general good health and having a low stress lifestyle as the transition begins.  These women typically have strong adrenals, a healthy thyroid, have a good balance of minerals, and normal cholesterol levels (220-240).

Factors associated with a greater likelihood of experiencing these symptoms include: obesity; chronic stress; adrenal fatigue; estrogen dominance; liver congestion; thyroid imbalance; and insulin resistance.

Male Life Cycle

Yes, there is such a thing as the “grumpy old man.”  This is called andropause.  While it does not receive all the attention of its female counterpart menopause, it is just as real and disruptive to the person experiencing it.  The “official” definition of andropause is the loss of androgen dominance in men.

Andropause is different than menopause in that its onset is often gradual.  The symptoms are often missed or treated as separate issues without recognizing the underlying change in male hormone status.  The key hormone is testosterone.  Once men reach around 40 years old their free testosterone levels (the active form) begin to decline 1-2% each year.  You can see that it starts out slow, but 10-15 years or more down the road it is a significant drop from where the man was at age 20, 25, or 30!

Andropause impacts men on physical, mental, and emotional levels.  Typical physical signs and symptoms include: loss of energy, strength, and stamina; gradually increasing fatigue; loss of libido, fewer spontaneous morning erections, and erectile dysfunction (ED); muscle soreness, weakness, and decreased muscle mass; thinning and dry skin; sleep problems; blood sugar problems, insulin resistance, and increased risk for diabetes; weight gain; increased fat in hips and breasts; increased risk for cardiovascular disease (increased cholesterol, triglycerides, and blood pressure); increased risk for osteoporosis; and increased prostate and urinary tract problems.

Typical mental and emotional symptoms include: low mood; irritability; depression; discouragement; pessimism; withdrawal from activities and relationships; concentration and memory difficulties; less productive, decreased initiative, motivation, and drive; and loss of libido.

Positive and negative factors affecting a man’s experience during andropause are similar to those described above impacting menopause. 

It is important to note from our earlier discussion testosterone is made from cholesterol and plays an important role in maintaining healthy levels of cholesterol and triglycerides. Statin medications have been shown to lower testosterone levels.

Bernard Rosen, PhD is a Nutrition Consultant and Educator. He works with individuals, groups, and at corporations to create individualized nutrition and wellness programs. His office is in Mequon, WI. To learn more or to schedule an appointment, e-mail at bernie@brwellness.com, call (262) 389-9907 or go to www.brwellness.com.

Steroid Hormones Part 3: Introduction to Testosterone, Estrogen, and Progesterone

Steroid Hormones Part 3: Introduction to Testosterone, Estrogen, and Progesterone

Testosterone

Testosterone is the main male and androgen hormone.  It is produced in the testes (males) and in the ovaries and adrenal glands (females).  It is also produced by the conversion of androstenedione and at times DHEA. It is a steroid, anabolic, body building hormone.

In both sexes testosterone on a physical level is known to: enhance libido and improve sexual response; protect against heart disease and stroke; increase and enhance energy and stamina; build strong bones; build strong muscles and maintain muscle tone; assist in balance and coordination; normalize weight; improve insulin sensitivity; and help maintain a healthy cholesterol balance.  On a mental level it protects against depression, age-related mental decline, and helps to improve memory.

In men testosterone is also needed to achieve and sustain erections and may protect against prostate problems and cancer.

In women testosterone helps to reduce breast tenderness; reverses estrogen-induced breast proliferation; and decreases hot flashes and night sweats.

Estrogen

Did you know that there is more than one “estrogen?”  While we use the generic term “estrogen” in fact there are several types of estrogen.  It is made by the ovaries in women, and to a lesser degree, the testes in men. Estrogen is also made in fat cells (which is the primary site of production for both menopausal women and men.) Estrogens are steroids.

The three major estrogens are estrone (E1), estradiol (E2), and estriol (E3).  Estrone is typically 5-10% of total estrogen. It is considered a “strong” estrogen because of its ability to cause cell proliferation. Estradiol is also typically 5-10% of total estrogen. It is considered the “strongest” estrogen because of its ability to cause cell proliferation.

Estriol is typically 80-90% of total estrogen. It is considered the “weak” estrogen because it does not cause cell proliferation. It appears to balance the cell proliferating effects of estrone and estradiol, thus protecting against their cancer-causing ability.

Following are some of the main functions of estrogen.  This is by no means a complete list and there are many still unknown functions of estrogen as well.

Estrogen is known for promoting the female secondary sex characteristics. (Thus, you can now understand how overweight men will develop breasts.  Their fat cells are producing excess estrogen!)  Estrogen plays a key role in reproduction.  It promotes cell proliferation, especially of the uterine lining and breast tissue and is part of the hormone signaling sequence that induces ovulation.  It also maintains vaginal lubrication.

It also plays a key role in how we feel as it interacts with the nervous system.  It stimulates brain function thereby impacting cognition, memory, emotions, mood, stamina, ambition, pain perception, and sleep.

Estrogen’s emergence at puberty stops the growth of long bones in both females and males and slows bone loss. It can increase body fat, especially in the breasts, hips, abdomen and thighs.

Estrogen helps keep our skin healthy and smooth.  It increases production of type III collagen which helps skin heal faster and remain soft and pliable. It promotes the hydration of body tissues. 

From a heart health perspective estrogen increases HDLs, lowers LDLs and total cholesterol.  It also helps maintain the endothelial lining of the blood vessels.

Progesterone

Progesterone is a steroid hormone produced in the ovaries and adrenal glands during the follicular phase of the cycle and in the corpus luteum during the luteal phase of the cycle in women and in the adrenal glands in men. One of its primary roles is to work with and balance estrogen.  It is also produced by the brain and peripheral nerves, and possibly other locations.

Many of progesterone’s functions are highlighted below.  However, similar to estrogen, there are still many unknown functions.

Progesterone functions as a precursor for other steroid hormones, most importantly cortisol.  It is important to understand that stress and blood sugar handling take priority in the body.  Therefore, it is common to see progesterone deficiencies created as it is converted to cortisol to handle the stress response.

It is also critical to understand that progesterone is still needed in healthy amounts in menopausal women.  Although ovarian progesterone is no longer produced, the adrenals of menopausal women must continue to make sufficient progesterone to balance the effects of menopausal estrogen levels.  This is where the medical world got in trouble with estrogen only hormone replacement therapy by supplying unopposed estrogen and not its balancing partner progesterone.

Progesterone plays an important role in reproduction.  While estrogen causes cells in the endometrium to multiply, progesterone balances this effect by stopping cell division and signaling the process of cell maturation, differentiation, and apoptosis (cell death).  Thus, it prevents excessive production of the uterine lining. The production of progesterone in the second half of the cycle after ovulation helps signal other developing follicles to stop developing (and thus stop producing estrogen).  By maintaining the secretory endometrium it “ripens” the uterine lining for possible pregnancy.  If there is pregnancy progesterone maintains and protects the developing fetus; prepares the breasts; and promotes the development of the brain and nervous system.

Progesterone interacts with the nervous system and regulates how we feel.  It helps calm the mind, focus the brain, increases libido, and is a natural antidepressant (when in balance with estrogen).

It not only interacts with estrogen, but other hormones as well.  It facilitates thyroid hormone function and helps normalize androgen levels (keeps testosterone from getting too high).  It has been found to be preventative against breast, uterine, prostate, and other forms of estrogen related cancers.

Some of the other functions of progesterone include: stimulates new bone growth; helps burn fat for energy; a diuretic; and a muscle relaxant.

ONE FINAL IMPORTANT POINT: It is critical to understand that progesterone only functions correctly when it is in the right proportion with estrogen.  These two hormones are designed to work together.  In a cycling woman these proportions change throughout the cycle. In menopausal women the proportion of progesterone to estrogen will remain relatively constant.  When these are out of balance a condition known as “estrogen dominance” is present.  More on that later.

Bernard Rosen, PhD is a Nutrition Consultant and Educator. He works with individuals, groups, and at corporations to create individualized nutrition and wellness programs. His office is in Mequon, WI. To learn more or to schedule an appointment, e-mail at bernie@brwellness.com, call (262) 389-9907 or go to www.brwellness.com.

Steroid Hormones Part 2: Cortisol and Stress

Steroid Hormones Part 2: Cortisol and Stress

Cortisol

Cortisol is made in the adrenal cortex.  It is primarily known for its role in our stress response by engaging the sympathetic nervous system (better known as “fight or flight”).  Here’s the basic mechanism: We see a tiger.  We need to run.  In order to run we need energy.  To have energy we need blood sugar.  This is one of the functions of cortisol.  It gets sugar into the blood stream so we can run from the tiger.  The problem is when there really is not a tiger and no running is happening. 

If we are constantly under stress, we keep getting the “run signal.” This pumps sugar into the blood stream.  On the other side of the equation is insulin.  Insulin’s job is to move sugar out of the blood and into cells, primarily to be used to produce energy.  However, when there is not the need for energy the sugar needs to go into “storage.”  We know that as fat.  So, at the end of the day, and particularly when in excess both cortisol and insulin are fat storing hormones.  They follow a simple rule.  When cortisol goes up in your body, insulin will rise.  When insulin rises, cortisol will go up with it. The same concept works the other way. 

This is why stress management is so critical and why constant stress will lead to weight gain.  It is also important to know that constant increases in cortisol will also cause decreases in thyroid hormone production and increases in estrogen production (more on that later). 

To summarize the main activities of cortisol: 

For the nervous system it manages our sympathetic response and plays a role in healthy mood and emotions. 

For blood sugar management it recognizes when we need energy.  When blood sugar levels become low through our normal activities it is role of cortisol to take action.  It happens all day long.  The problem becomes when we remain in a stress response.  This ongoing excess can ultimately contribute to insulin resistance.

For the immune system in a normal mode it supports a healthy anti-inflammatory response.  However, at high levels it can be immunosuppressive while at low levels the immune system may be unable to engage effectively.

It is interesting that as a steroid hormone cortisol has catabolic (state of breakdown); anabolic (rebuilding); and anti-inflammatory functions.

It is clear from the above discussion there are many adverse effects of high and prolonged stress. We will discuss some of these later in more detail, but for a quick short list consider the following implications of increased cortisol:

•         Reduces fertility by lowering luteinizing hormone which impacts ovulation in females and testosterone production in males.

•         Reduces the active thyroid hormone T3 as increased cortisol increases rT3 which suppresses T3.

•         Creates estrogen dominance (to be discussed in more detail later in females and males.

•         Decreases DHEA.

•         Suppresses the immune system.

Bernard Rosen, PhD is a Nutrition Consultant and Educator. He works with individuals, groups, and at corporations to create individualized nutrition and wellness programs. His office is in Mequon, WI. To learn more or to schedule an appointment, e-mail at bernie@brwellness.com, call (262) 389-9907 or go to www.brwellness.com.