Your Female Hormones

As you understand more about the ageing process, particularly the role of depleting hormones, optimsing healthy younger adult level makes sense. Ageing is about many changes, some of which are: 

  • Genetic makeup
  • Hormone depletion
  • Nutrition
  • Toxic burden
  • Detoxification ability
  • Protection – anti-oxidant status
  • Inflammation control
  • Life stress 

Hormones – what are they

They are chemical substances secreted by endocrine glands to cause an effect on target cells by attaching to a specific receptor site. They pretty much ‘run the show’. In other words hormones are part of the body’s communications systems – other communications can be direct ‘hardwiring’ via nerve fibres, local chemical release such as prostaglandins, and cell-to-cell ‘talk’ via glycoproteins. Of course the brain is in overall control, we hope.
Certain hormones very well researched and well known for benefits by replacement. It is most important to understand that no hormones should be prescribed and taken in what is termed supra-physiological doses. Simply put, do not take excess amounts. Why not? Because the whole purpose is to restore levels to a healthy younger  adult range say 30-35. At this age hormones have ‘settled down’ to a healthy level. Children and especially adolescents can have very high hormones – don’t think we want that life stress again!

Did nature intend us to have low levels

Good question. Some have the opinion they would prefer to have deficient hormone levels because that’s natural, so accept the degenerative conditions that result as well as the not-so-subtle mind changes. Well, that’s ageing, but with this natural deficiency comes consequences. Many are now choosing to optimise ageing by retaining healthy hormone levels, so all cells can benefit. Same as with a diabetic who is insulin deficient; we don’t hesitate to give her insulin. Same as a thyroid depleted individual; we wouldn’t think twice about restoring thyroxine to healthy young adult levels. These examples are life threatening, these other hormones are threatening life quality. 

Its about ageing well!

And the key is : only replace with exactly the same biochemical molecules. In other words, we use Bio-identical hormone replacement therapy (BHRT) – not synthetic altered hormones which most pharmaceutical companies supply for commercial reasons. I have no problem with that freedom; I just do not want to have my patients use these while better options are available.. The human system is too delicate and side-effects commonly result – hence all the trouble with past HRT.

The Medical Politics of Natural Hormones

As with many non-mainstream health options, there are factions who remain highly sceptical and want to eliminate availability of molecular-identical, or BHRT hormones. Whether this is based on scientific fact, ideological opinion, personal views or whatever  – the result is the same; some want to remove personal choices. 

Which hormones are safely available naturally

  • Estrogens – Estradiol E2 | Estriol E3
  • Progesterone P4
  • Testosterone T
  • DHEA

Important Note

All natural hormones are extracted from plants such as the giant Mexican yam. They are then finally converted into complete bio-identical human hormone. Humans cannot convert yam cream into hormones in the body, contrary to what some natural cream manufacturers may imply. Pharmaceutical companies usually alter the chemistry of the natural steroid base of the hormone to enable patent rights. 

Estrogens and Progesterone

These are the classic female hormones. All mammalian species require these for feminisation and fertility. Across many species, there are shared similar, even some identical estrogens. Science or rather pharmaceutical industry has capitalised in this by producing prescription medicines by either using other species hormones or synthesizing hormones bearing a close similarity to human types. Both men and women share the same hormones but obviously in far different concentrations.

Estrogens and Progesterone have complimentary and opposite effects and are required together for this balancing of nature. When out of balance from disease, ageing causes or incorrect prescribing, then consequences may develop.

There are many estrogens but in particular three: 

  • Estradiol – E2 – is the most potent or active of the three. It can convert into Estrone then Estriol.
  • Estriol – E3 – is least potent yet the most abundant. It is extremely safe and has not been known to stimulate cancer cells for example. Temed the forgotten oestrogen being overlooked for the strong E2.
  • Estrone – E1 – 10 times less potent than Estradiol. It can more easily convert into less useful and potentially harmful metabolites. We prefer to avoid prescribing E1. Its also produced from fat cells – even in those big pot belly men. Thats a massive health risk in itself.

Estrogens are produced mainly in the ovaries but also in fat tissue as mentioned. Again, the brain controls production via pituitary hormones LH and FSH. (just like TSH is to the Thyroid and ACTH is to Adrenals)
By menopause, most of the original 2 million ovarian eggs are used up and since they and the ovaries are the principle estrogen producers, estrogen levels fall quickly resulting in problem symptoms for over 70% of women. Effects include complete change of character, moods, body shape, flushes, night sweats, weight gain, breast lumps or tenderness, loss of libido, poor concentration, muscle aches, joint aches, strange skin sensations and so on.
There are certain times when imbalances of estrogens and progesterone can result in mild to very severe problems for many young and older women. Vivid examples include PMT, Post Natal Depression, Endometriosis and mood changes.

These can be treated naturally, for example:

  • Teenage changes – moods, anger, poor coping, anxiety, acne, weight gain, menstrual problems
  • Premenstrual changes – PMT – irritability, depression, weight gain, cravings, breast pain and more
  • On the ‘pill’ – various side effects are common, some even dangerous. Most women have no problems at all.
  • Menopause, Endometriosis

Menopause – Symptoms can begin years before the actual periods cease. Progesterone production falls and finally ceases. Estrogens often fluctuate wildly before finally reducing to very low. During these swings many symptoms can develop, typical are flushing and night sweats. Many other complaints are suffered but often it is not realised that hormones are the cause. Whilst 30% of women sail though menopause with few symptoms most do not. It is not necessary to put up with these debilitating consequences as a variety of natural options is available from nutrients and herbs to safe bio-identical natural hormones.

Women who have early surgical menopause from ovary removal, will tend to have far worse hormone deprivation symptoms. The really need quick response with BHRT.
The burning question is: Are these normal or natural states or disorders? Well there are many view points depending on whether you have actually suffered these life-changing symptoms! Of course it is not normal. Normal is to go through life without adverse symptoms and a feeling of constant wellness!
Is menopause natural? Of course! But when hormones are deficient or out of balance with one another then the symptoms that result suggest a problem. We rush to supplement other hormones like insulin, thyroxin and cortisol – so it is commonsense to treat ovarian failure the same, as long as we use natural substances. Beneficial effects on quality of life can be enormous for the young or older woman.

Toxic Estrogen – whats this !

Environmental scientists find that there are many other sources of estrogens or oestrogen-like substances from the environment – some are very potent whilst others very mild like soy or clover. These non-human estrogen-like chemicals are termed xeno-estrogens. Sources are:

  • Industrial chemicals, agro-chemicals,  flowing through the food chain or by direct exposure
  • Naturally occurring plant derived such as red clover, soy, black cohish
  • Oral contraceptives, HRT in waterways

Some estrogen-mimicking chemicals can be thousands of times more potent than natural ones, and have been linked to many animal sexual aberrations as well as human sexual and reproductive disorders (read the contraversial “Silent Spring” or website www.ourstolenfuture.org).
In the body these go through detoxification via the liver – called Estrogen biotransformation. Breakdown products are formed, of which some are considered to increase risk of cancer and cardiovascular disease.
Examples are 2-hydroxy-estrones which are low or no risk but 4- and 16-hydroxy-estrones are high risk. These can be measured in the urine. Refer to lab tests available in the side-bar
Estrogen excess [estrogen dominance], imbalance or its metabolites and xeno-estrogens are said to be associated with multiple disorders:

  • Breast and prostate cancer
  • Endometriosis, fibrocystic breast disease, uterine fibroids
  • Depression, anxiety, PMT, obesity
  • Graves disease of thyroid, SLE

Testing you for imbalances

The most important step is taking the medical history and any relevant examination – your GP or gynaecologist will have done this probably. The symptoms ie history is more important than Lab tests – which are a guide only to ensure blood levels are kept in a physiological (normal healthy adult) range. Of course in certain situations hormone (eg diabetes) blood test levels are vital in monitoring a treatment. 

Laboratory blood testing indicate current levels of hormones. They can fluctuate during the day as well as day to day. Its important to know that labs give a result and compare yours with averages of persons your age. Sensible, but this strikes at the heart of wellness versus ageing ‘illness’. Do you want the hormone levels of an older person or a healthy young adult of say the 30’s? Most would say 30’s please. Critics say ‘its not natural’. It really depends on whether you want to retain health and vitality or get old with its infirmity. You choose.
One more thing – there is great discussion about whether saliva tests or blood testing is better. Blood tests, especially as we age and particularly post-menopause or andropause in males – is quite inaccurate for monitoring BHRT dosing. Saliva is possible better but more expensive. In both cases, too much emphasis is placed on a “result”. I stated, levels changed by the hour, the day. Ideally several tests should be taken over a day or days – even a month in tricky cases.
So please dont get hung up on blood testing. OK to do at the start and maybe 3-6 monthly – AS A GUIDE to see not too high or way low.
More extensive testing can be done to assess how you process your hormones through the liver. Is your metabolism healthy? We use the Precision Lab in the USA who offer the DUTCH test (Dried Urine Total Comprehensive Hormones. See www.dutchtest.com 

Treatment

Following assessment and laboratory evaluation, options are presented. At all times it is important to ensure good nutrition, specific nutritional supplementation and then the hormonal options. Balancing all hormones is preferable; it makes no sense to try to be smarter than nature; best just to do what nature has always done!

Progesterone

  • Micronised Oral Capsules – This is preferred when women are also supplementing with estrogens and still have their uterus (womb).
  • Transdermal creams – progesterone is dissolved in a safe cream base and applied to the skin daily. The hormone passes through the skin directly into the blood stream and on to the ‘target cells’ throughout the body. An extremely safe and efficient way of taking hormones.

Estrogen 

  • Transdermal creams – are the most preferred as estrogens taken by mouth all pass through the liver first. What  happens is very much an individual process for each woman. Some can produce a lot of estrogen breakdown products (metabolites)  called hydroxy-estrones. There are good ones (2-hydroxy estrones) and potentially bad ones (16-hydroxy estrones). These may be responsible in susceptible at risk women of triggering cancer cells, clotting or heart problems. In spite of this the risks of this still remain extremely low – after all, women have had these same estrogens and metabolites for hundreds of thousands of years. Transdermal creams with estrogens go directly into the bloodstream, just as if the ovary secreted estrogen into the blood stream. In nature, hormones are not swallowed. Progesterone taken orally however does not have his problem.
  • Patches – these are oestrogen and on prescription. Very cost effective and option instead of creams.
  • Troches – are effective and in some countries used often. I do not recommend these as the ‘swallowed amount’ is unpredictable.
  • Oral capsules – can be used sometimes when symptoms are very severe and transdermals not working. We prefer to use E3 or Estriol in this case. Then back to cream or patches  once everything settles. We should always add progesterone even if a woman has had her womb removed (hysterectomy)!

Side-effects – is it safe?

Usually no side-effects. Its putting back in what you had most of your life. Some women may experience changes when having hormones back after a long absence, or if still not balanced properly with other hormones. So its important to start with low doses especially if she has a known sensitivity to estrogens in particular.
Q. Are there risks of breast cancer or heart attacks because we have been told for so long that HRT is dangerous and many doctors wont prescribe it?
A. This is very interesting and a good question. The short answer is NO. See here for the full answer…
Hormonal supplementation should always be prescribed and monitored by a doctor properly trained in this field.

Testosterone for Women

Testosterone is just as important for women as for men. It has many roles, some are :

  • Improving mood, assertiveness; reduction of depression and anxiety.
  • Improving bone density and muscle size and strength. Affecting healthy skin oil secretion.
  • Enhances sex drive, sexual sensitivity including orgasm.
  • Maintains the female genital system; nipples, genitals especially clitoris and female body hair pattern.
  • May protect against arterial atheroma – new studies.

In the female, half of the T production is from a hormone called DHEA in the fat and other tissues, a quarter from the ovaries and a quarter from the adrenals. Women make 20 – 30 times less than men. Perhaps just as well.
The pituitary gland under the brain controls production in the ovaries by the hormones LH. T levels decrease with age so at 40 there is only half that of a 20 year old.
Factors reducing T production: 

  • Age
  • Intense emotional stress
  • Vigorous exercise like long distance running etc
  • Very high fibre diets (fibre soaks up T secreted in the bowel) 

Factors increasing T production: 

  • Higher fat and protein diets
  • PCOS – polycystic ovary syndrome 

What are the effects of T deficiency 

  • Losing muscle mass and strength
  • Reducing sex drive and sensitivity. Harder to orgasm (see O-Shot)
  • Losing interest in sports or activities
  • Depression a lot, excessive anxiety, fears
  • Low resistance to stress
  • Increasing cellulite, becoming more overweight

Testing for Testosterone 

  • Blood levels – the most commonly done and a reasonable guide only. Because female T levels are much lower than for men, blood tests are not very accurate.
  • Saliva testing – some believe this to be better
  • DUTCH Test

Treatment

  1. The traditional method was to insert long-acting testosterone pellets under the skin. Apart from the discomfort and cost, the daily release is not as natural and dosage not easy to adjust.
  2. Transdermal creams and gels – very effective, applied daily and far more physiological (natural). Of course only use bio-identical testosterone. Doses are easy to adjust. Dosage is based on blood test monitoring and response. 

Side-effects 

Q. Women may ask “will I grow a beard, or my voice deepen?”
A. Did you when you were younger and had much higher levels of testosterone? Of course not. As long as doses remain just as nature intended then you will not grow whiskers!
Rarely, a woman may intentionally overuse T gel just to get the ‘aggressiveness she thinks she needs at the workplace’. That may be asking for trouble, yet even if T levels get very high, it does take a long time to develop masculinising effects.
Women who need to be cautious are those who:

  • Tend to have bad acne, very greasy skin
  • Are prone to hairiness (hirsuitism)
  • Have male pattern hair loss
  • Breast cancer – no T should be used 

Testosterone is said to be ‘The Hormone of Desire’. 

DHEA 

An excellent hormone! DHEA (Dehydro-epiandrosterone) is the most abundant steroid hormone. The term steroid refers to the biochemical structure of a whole class of hormones, of which there are dozens. In fact most of the hormones from the ovaries, adrenals, testes are very similar biochemically. Its amazing how a tiny difference in the structure of each can make a world of difference to resulting affects.
By 1996, many workers including Stephen Cherniske MS, had published over 3000 research articles on DHEA. Ever since, the role of DHEA as one of the most potent ‘anti-ageing’ hormones has been hotly argued and debated. 

In summary, DHEA – the facts:

  1. Is the most abundant hormone, influencing over 150 known repair functions in the body and brain.
  2. It declines gradually with age – when degenerative processes also accelerate.
  3. Long living people on average have higher DHEA levels.
  4. If low DHEA, there is more depression, obesity, diabetes, autoimmune disease, osteoporosis, cancer and cardiovascular disease.
  5. Low DHEA is associated with increased death rate from all causes.
  6. DHEA and its metabolites can easily be measured to give a valid ‘Ageing Biomarker’.
  7. Mainstream leading endocrinologists approach is to regard the levels found in ageing populations to be ‘normal’ levels. The opposing view by ‘anti-ageing’ doctors is that these levels are NOT OPTIMAL but ‘disease levels’ from DHEA deficiency! Optimal levels are those of a healthy adult of around 30 years of age. OPTIMAL versus NORMAL AVERAGE concept.
  8. DHEA is absorbed well from oral dosing of 10-50mg daily.
  9. There is no evidence – clinical or experimental – of any adverse effects by supplementing physiological doses other than the production in a few susceptible women of oily skin and acne.
  10. It is speculation to claim, as some critics do, that it is necessary to have lower levels of DHEA as part of the natural and normal ageing process.
  11. DHEA has been used with patients on cortisone or prednisone to reduce side-effects and enhance the depressed immune state caused by these other steroids.
  12. DHEA is an ANABOLIC hormone (builds and promotes tissues) rather than a CATABOLIC one (breaks down tissues). For example people on long term cortisol-like steroids (catabolic) will develop osteoporosis, the destruction of bones, but DHEA will protect bones.

DHEA use 

In women, DHEA can convert easily into testosterone; it can be a good way of elevating low levels of T. Refer to the area on this page about Testosterone for Women.
Start with low doses and build up according to blood tests.
DHEA is like a ‘mother’ hormone.

Who may benefit

Anyone with sub-optimal DHEA levels and symptoms.

 

In brief – testosterone replacement is ideal for:  

  • Fatigue
  • Depression even just mild unhappiness, low moods, anxiety, low resistance to stress, noise
  • Low sex drive and satisfaction
  • Autoimmune diseases e.g. lupus, rheumatoid arthritis
  • On cortisol or prednisone therapy 

Optimising treatment – Mediterranean diet, low sugar and refines carbs.

Caution

As with most steroid hormones, it is prudent to NOT use in the presence of hormone sensitive cancer. Levels of other ‘conversion hormones’, like estradiol, must be monitored especially in males, and testosterone in females.
DHEA must be prescribed and monitored by doctors trained in Anti-ageing Medicine.