Whether the goal is to alleviate symptoms; help with fertility or libido; improve mood, energy, bone, cardiac and/or cognitive health; or to simply maximize health and slow aging, the evaluation, support, and correction of hormonal levels and imbalances with bioidentical hormone therapy are integral to achieving optimal health.

There are multiple factors that must be taken into consideration as we aim to achieve whole-body health, and one of the most important and often overlooked of these is hormones.

Hormones are responsible for the regulation of many processes, including digestion, metabolism, respiration, sensory perception, sleep, lactation, growth and development, movement, reproduction, and mood.

Specialized cells called endocrine glands produce chemical messengers that then travel to parts of the body where they regulate physiology and behavior; thus, they are important for optimal functioning and maintenance of the body.

The body produces and circulates approximately 50 hormones in the major endocrine glands, such as the pituitary, pineal, thymus, thyroid, adrenal glands, pancreas, testes in men, and ovaries in women. Many symptoms can result from a deficiency, excess, or imbalance of hormones, including weight gain or loss, infertility, decreased libido, osteoporosis, headaches, mood swings, fatigue, brain fog, erectile dysfunction, increased risk of cancer, dry skin, diarrhea, constipation, hair loss, cognitive difficulties, heart palpitations, blood sugar issues, night sweats, changes in menstruation, acne, and other problems. Hormones bind to receptor proteins on cells, causing a change in the cells’ functions. Factors that interfere with binding of the hormone can disrupt the function of that hormone. For example, xenoestrogens are chemicals in the environment that mimic estrogen, often at much stronger levels than natural estrogen. They can be found in water, pesticides, cleaning products, plastics, and canned foods, and, among other effects, they can cause feminizing effects in males and fertility issues in females. To minimize xenoestrogens it is important to drink filtered water, eat organic when possible, and use only non-toxic cleaning, personal hygiene, and chemical products.

Cortisol: The Stress Hormone

Hormones should be maintained at physiological levels and in proper balance. Fortunately, certain key hormones can be evaluated and treated to achieve proper levels, including cortisol—the stress hormone. Secreted by the adrenal glands, cortisol can help control mood, motivation, and fear. It is also involved in how the body manages carbohydrates, fats, and proteins and has effects on inflammation, blood pressure, the wake/sleep cycle, immunity, and energy needed to deal with stress.

Under stress, cortisol shuts down functions that are not high priority, such as digestion, immune function, growth, and reproduction. This may cause anxiety, depression, headaches, heart disease, memory and concentration problems, digestion problems, sleep issues, and weight gain. Too much cortisol production may not only lead to a catabolic state where everything is in “breakdown” mode, but cortisol production may wane over time. Furthermore, high cortisol interferes with other hormones, contributing to insulin resistance and blood sugar regulation that may progress to diabetes. Thyroid hormone production, conversion to its active form and its binding to cell receptors, is directly inhibited by elevated cortisol. Since the thyroid is important for metabolism, mood, bone health, and digestion, any interference in thyroid hormone can contribute to symptoms such as weight gain, brain fog, fatigue, and depression. Additionally, inflammation from stress, food, infections, mold, and environmental toxins can affect cortisol and insulin and decrease vitamin D, melatonin (affecting the sleep cycle), testosterone, DHEA, and other sex hormones.

Pregnenalone is the precursor, or building-block, for all other steroid hormones. It is converted directly into DHEA and/or progesterone. DHEA is an anabolic hormone that helps balance cortisol levels, is a precursor to other hormones such as testosterone and estrogen, and is important for energy, bone health, and immune function. As people age DHEA naturally decreases, leading to issues with fatigue, osteoporosis, mood issues, and vaginal atrophy.

Using bioidentical hormones to supplement DHEA can slow the aging process and improve well-being, cognitive function, energy, and body composition.

The Sex Hormones

The sex hormones—estrogen, testosterone, and progesterone—and their metabolites are responsible for sexual development, function, and desire. They also play a role in regulating bone and muscle growth, inflammatory responses, cholesterol levels, hair growth, body fat distribution, and sense of well-being. Sex hormone levels fluctuate throughout a person’s life and can be affected by stress, inflammation, medications, exercise, food, aging, and toxins, all of which can influence the hormones and contribute to menstrual and menopausal symptoms, sexual dysfunction, and fertility issues.

Imbalances or deficiencies of estrogen can cause changes in menstruation and premenstrual or menopausal symptoms, such as hot flashes, night sweats, lumps in the breasts and/or uterus, mood changes, sleeping problems, weight gain, low sex drive, vaginal dryness and atrophy, fatigue, depression, and anxiety. High levels of estrogen in males can lead to infertility, erectile dysfunction, and gynecomastia (breasts). Properly evaluating estrogen levels and supplementing with bioidentical hormones therapy can allow for management and potential alleviation of these symptoms. Furthermore, decreased estrogen levels during the first five years of menopause leads to increased bone loss. Supplementing estrogen during this time can help decrease bone loss, though not all women need estrogen replacement since estrogens are made by fat cells. Proper evaluation is necessary to determine an appropriate hormone replacement plan.

Progesterone is a hormone that is key to fertilization and pregnancy, helping the endometrium prepare for implantation of the fertilized egg. Low levels of progesterone can interfere with pregnancy and carrying pregnancies to term. Because progesterone is secreted by the egg sac following release of the egg at menstruation, it decreases with age, particularly during the perimenopausal years when eggs are not always released monthly. This may lead to too much unopposed estrogen and result in decreased sex drive, weight gain, gallbladder issues, and increased risk of breast and uterine cancer. Additionally, low progesterone contributes to osteoporosis, oftentimes occurring before menopause. Supplementing progesterone with bioidentical hormone therapy can help regulate blood pressure, improve mood and sleep, ease anxiety, help prevent overgrowth of certain cells that can lead to cancer, improve bone density, decrease migraines, aid fluid balance, improve libido and vaginal dryness, and decrease menopausal hot flashes and night sweats. Bioidentical progesterone supplementation will also increase the sensitivity of estrogen receptors, thus increasing the effects of estrogen.

Testosterone is the major male hormone important for sexual development and function. In puberty, testosterone is responsible for males developing deep voices and facial hair, increasing muscle mass, and developing sperm. As men age or with increased inflammation from a variety of causes, testosterone will decrease, causing symptoms such as low libido, fatigue, reduced lean muscle mass, irritability, erectile dysfunction, obesity, depression, loss of body hair, poor memory and focus, low energy, and poor endurance. Low testosterone has also been associated with metabolic syndrome (high blood pressure, high blood sugar, unhealthy cholesterol levels, and abdominal fat), cardiovascular disease, and obesity.

In women, high levels of testosterone can cause frontal balding, acne, an enlarged clitoris, increased muscle mass, and deepening of the voice. Polycystic ovary syndrome is a condition in which high testosterone can cause obesity, acne, thinning or excessive hair, menstrual irregularity, and difficulty becoming pregnant. It is also associated with insulin resistance, low levels of HDL cholesterol, elevated triglycerides, high blood pressure, increased risk for cardiovascular disease, and higher levels of circulating male hormones. A decrease in testosterone in women, which invariably occurs at menopause, can cause decreased libido, osteoporosis, and other symptoms. Bioidentical testosterone replacement may help alleviate these symptoms.

Hormone Treatment and Therapy

Fortunately, specialized tests can be used to measure key hormones and their metabolites and specific treatment protocols using bioidentical hormones can then be created and used to help correct imbalances.

Treatment may include nutritional supplements, herbs, and prescriptions. When using hormone replacement therapy, it is important to use bioidentical hormones that directly mimic hormones in the body, as synthetic hormones are often associated with many undesirable side effects, such as heart attacks, stroke, and cancer (e.g., uterine cancer from use of progestins).

Bioidentical hormone replacement therapy for estrogen, DHEA, progesterone, and testosterone can be administered in many forms, depending on the hormone and the wishes of the patient. Topical creams, sublingual drops, and implanted pellets are the most common. Hormone levels are then followed, along with improvement in symptoms, energy, mood, and libido, and adjusted as needed to achieve the best results. Pregnenolone, adaptogenic herbs, and vitamins are often used to support the adrenals and cortisol stress response. The thyroid can be treated with thyroid hormone and/or herbs that support thyroid hormone production. In addition, supplements to decrease inflammation are often an important component of the treatment plan.

When fertility is an issue, treating ongoing infections such as Lyme disease, eliminating heavy metals such as mercury and lead, and optimizing nutrition and mineral levels can be important adjunctive treatments. Estrogen and progesterone levels can be measured throughout the monthly cycle and if necessary can be adjusted to improve fertility and the ability to carry a pregnancy. Additionally, stress support efforts such as meditation, appropriate exercise, and a nutritionally dense diet free of toxins and additives provide the necessary nutrients for production and metabolism of hormones. Since inflammation directly affects hormone levels, addressing sources of inflammation such as infection, dietary stress, toxins, and injuries is also vital.

There are many natural, herbal supplements that can be used to help balance hormone levels. Here are just a few examples:

• Nigella seed (also known as fennel flower or black cumin seed):Nigella sativa can help regulate testosterone and thyroid hormone levels and behaves similarly to estrogen in the body.
• Black cohosh root:This supplement has been used, historically and today, to alleviate menstrual issues, PMS, and symptoms of menopause.
• Ashwaganda:When taken regularly, ashwaganda helps lower cortisol levels and may also help balance insulin levels and reproductive hormones.

Whether the goal is to alleviate symptoms; help with fertility or libido; improve mood, energy, bone, cardiac and/or cognitive health; or to simply maximize health and slow aging, the evaluation, support, and correction of hormonal levels and imbalances are integral to achieving optimal health.

Jennifer Letitia, MD, is a functional medicine physician at Whole Body Medicine (wholebodymed.com) in Fairfield.

Dr. Letitia treats a variety of chronic and environmental issues and uses bioidentical hormones to optimize health and wellness in her patients.

To schedule an appointment or a complimentary 15 minute telephone consultation with Dr. Letitia at Whole-Body Medicine in Fairfield, CT please call 203-371-8258 ext 2.