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Medicines & Miracles

Your Hormone Health

The naked truth behind hormone science and how to safely rejuvenate mind, body and spirit

BY GLORIA HAKKARAINEN MD, FACOG, FASBP, FABAAM

The newest data on hormone research shows that hormone replacement therapy (HRT) actually benefits patients when dosing route and medication are properly chosen, and when doctors monitor patients closely. The big scare which had women going off hormone therapy started in 2001, with the preliminary results of the Women’s Health Initiative (WHI). The WHI study looked into the use of Premarin and Prempro in women who on average were already 17 years into menopause. It showed that Prempro (a mixture of pregnant purified horse mare’s urine and synthetic progestin, medroxyprogesterone acetate) after approximately five years of use, led to an extra eight cases of breast cancer per 10,000 users. The news media rushed in early to bring it to headlines and soon medical societies were advising physicians to minimize or discontinue use altogether.

Another study which showed similar discouraging results was the HERS trial (the Heart and Estrogen Progestin Replacement Study), which evaluated 2,763 postmenopausal women with known cardiovascular disease. Prempro was used again and did not demonstrate any significant improvement in future heart disease protection for this group of women. Based on these two trials, many women stopped taking their hormones and have suffered from unrelenting symptoms of menopause. Of course, many forms of HRT exist and the risk analysis was blindly extrapolated to all forms of hormone use, both bio-identical and synthetic, to make everything more confusing than ever. As more rational and in-depth analyses came to light, however, we were able to see that by 2005 the hormone story was beginning to change.

When renowned hormone experts analyzed the data more carefully, it was shown that many of the women in the WHI study were already at high risk of developing cardiovascular disease. These women were largely overweight to obese, many already had been placed on cholesterol controlling drugs, were using aspirin, and quite a few had high blood pressure. They were essentially past the ability of hormone therapy to make much of a direct impact on improving their heart attack risk. The studies did show however that the synthetic progestin use (MPA) acts very differently compared with natural progesterone, and that not all progestins are alike.

More scientists have re-analyzed over 25 years worth of good HRT studies, now giving a more comprehensive understanding of what judicious hormone use can do for patients. Clearly HRT has many beneficial effects on the body, including improving skin quality and integrity, eliminating wrinkles, boosting immune system function, relieving symptoms of muscle aches, improving the elasticity and collagen content of the pelvic tissues, keeping the brain sharp, preventing osteoporosis, fighting depression and much more! Modern day hormone analysis provides not only a look at estrogen stores in the body, but also at a host of other hormones including testosterone, progesterone, DHEA (dehydroepiandersterone), melatonin, cortisol and thyroid— to name a few.

The latest data from the North American Menopause Society (NAMS) shows that when women start to replace declining hormones earlier than what was done in the WHI study (late 40s and 50s), the aging effect of hormone depletion can actually be forestayed or reversed. Also the route of administration: oral, sub-lingual, sub-buccal, transdermal, transvaginal, gel, patch, cream or injection can be customized for patient convenience and efficacy. One may, for example, attempt to avoid oral routes of estrogen if possible, as these can elevate triglycerides (the amount of fat in the blood) and lead to an increased risk for a blood clot, or affect the gallbladder.

Let’s take a closer look at these hormones and how they work together in a magnificent balance that makes up the human body. I will also mention a word about estrogen metabolism and breast cancer risk, and how specialized testing can be used to help a patient assess their overall risk of the development of breast disease.

Hormones are very special chemical molecules that direct many fundamental and critically important processes in the body. They can act both on tissues a long distance away from their secretion site (endocrine), on neighboring tissues (paracrine) and on the individual cell itself that released it (autocrine). Each endocrine organ system makes a distinct hormone whose release is controlled by two areas in the brain: the anterior pituitary gland and the hypothalamus. There is a complex interplay between various hormones as the brain receives and senses the needs of the body. There is also a negative feedback loop that works to ensure that just enough of each hormone is made. Replacing just one hormone doesn’t make sense as we see declining levels of many hormones during menopause. Evaluating and studying the hormone profile across systems ensures that all critical areas are treated.

There are ways for physicians to avoid the side effects of high level dosing of any one hormone. Just as a cook uses various key ingredients of a recipe, where all elements are needed are to make the dish come together, so too the body regulates each hormone and they all support one another’s function. For example, thyroid function helps estrogen maintenance and vice versa. Some hormones, like cortisol (the hormone that is released in response to stress), actually increase with age. Abnormally high levels of cortisol can accumulate leading to elevated blood sugar levels and metabolic syndrome (pre-diabetes). The following list touches on some of the more critical hormones that exist in the body:

THE THREE SISTERS OF ESTROGEN

(E1) Estrone: mainly made by the adrenal glands; also made in fat, muscle and skin and can be converted from estradiol; normally considered an estrogen reservoir; the primary estrogen seen in menopause, normally represents between 10 to 20 percent of circulating estrogens prior to menopause; after menopause the major source can be from fat cells so obese women can have an elevated estrone to estradiol ratio; high levels can increase risk of endometrial and breast cancers; clearance routes and metabolites can affect breast disease risk

(E2) Estradiol: made by the ovaries; primary estrogen seen in young women; the strongest acting of all the estrogens (12 times stronger than estrone and 80 times that of estriol); most active biologically and the one reproduced by “Big Pharma” in most Rx formulations

(E3) Estriol: made by the ovaries; the weakest estrogen strength of all three kinds (approximately 1/80 that of estradiol); rises with pregnancy; thought to be protective/neutral to the breast; the majority component of BHRT (Bio-identical) therapy

THE A-B-Cs OF HORMONES

Adiponectin: exciting newcomer to hormone research and therapy; made by fat stores and acts as a satiety signal to the brain; also vital to clearing local inflammation to coronary blood vessels to reduce plaque formation thereby reducing heart disease risk; huge future target for obesity and new cardio protective meds of the future; low levels indicate disease risk.

Cortisol: made by the adrenal glands; principal hormone produced in response to acute or chronic stress; induces sugar stores to be broken down and can lead to pre-diabetes; increases with age and can lead to unwanted abdominal/truncal fat; most patients respond well to behavior modification and supplements that help support the adrenal glands; over demand to the system can lead to adrenal fatigue and insufficiency and “burn out” states can lead to apathy, extreme depression and inability to fight disease

Insulin: very important in regulation of blood sugar in the body; increased resistance to insulin in the body with aging leads to diabetes and metabolic syndrome (elevated blood pressure, triglycerides or fat in the blood stream and noted borderline high levels of blood sugar); controlled by many body regulating signals that ultimately determine overall health; fasting levels can be used to detect early onset disease

(IGF-1) Insulin Growth Factor -1: hormone made by the brain at night that travels to the liver and is converted to growth hormone; essential in many processes in the body; used for retaining of lean body muscle to burn off unwanted excess fat; immune system enhancer; generates new growth of bone muscle and tissues used to maintain the body; levels start declining at around 30 years of age and viewed by many anti-aging experts as a vital part of a comprehensive hormone assessment

Melatonin: hormone made by the pineal glands (mostly at night with sleep in a darkened room); responsible for the sleep and wake cycle; newest data shows that proper melatonin levels can lead to improved antioxidant levels and ability to ward off cancer (especially breast)

Progesterone: made by the ovaries and adrenal glands; has mood enhancing and anti-depressant effects; protects the uterine lining from overgrowth and cancer; usually made mid-cycle and is the first hormone that starts to decline with aging; can be used to treat PMS (pre-menstrual syndrome) and endometriosis; helps to normalize irregular cycles; used in fertility treatments to support early pregnancy

Testosterone: important hormone for women that exists at lower levels than in men; called the “hormone of desire” because of a known powerful effect to enhance libido or sex drive; assists with self-confidence and is an anti-depressant; also needed to maintain lean body mass to burn off fat which helps women retain their youthful figure; important also for energy and motivation; builds bones, muscles and ligaments to ward off osteoporosis

(TSH) Thyroid Stimulating Hormone: hormone secreted from the anterior pituitary of the brain that signals the thyroid gland to release thyroid hormone from the colloid gland in the neck; the thyroid hormone that is put forth is usually not that active and then is converted to T3 (Tri-iodo thyronine); responsible for the rate of most metabolic reactions in the body; women are much more prone to thyroid disease than men and sluggish thyroid function can lead to weight gain, fatigue and dry, flaky skin and constipation problems, poor self esteem and depression; some patients can make antibodies attacking their own thyroid gland with age, thyroid function testing can determine a patient’s current status, thyroid supports natural estrogen maintenance in the body. These hormones can be measured reliably in many ways, including the use of blood serum, saliva, bloodspot and urine testing. Each test the use of blood serum, saliva, bloodspot and urine testing. Each test has been designed to check a particular hormone system and you should speak with your doctor to see if you need further testing. Some tests, like thyroid hormone are done as a routine screening check, while others can be done at a specialist’s office such as estradiol at an infertility clinic or with your gynecologist. Most patients will need follow up testing of their levels once they start replenishment to ensure that levels are still safely in normal ranges and to avoid unwanted side effects of high level dosing. For example, too much estrogen can lead to breast tenderness, too much progesterone to abdominal bloating, and too much testosterone can cause acne or hair growth.

Estrogen metabolites, such as the hydroxy estrones, can also be assessed if one is worried about breast cancer risk on hormone use. The 2-OH estrone is considered to be the main safe estrogen clearance route in the body while the 4-OH and 16 alpha OH estrones, if not cleared appropriately, can lead to inappropriate tumor promotion of certain lines of breast cancer seen in laboratory studies. The 2/16 ratio of hydroxy estrones has been a widely used method to assess how a person clears their estrogen naturally from the body. Patients who don’t clear their estrogen as optimally as others may benefit from an estrogen clearance promotion diet/eating plan that includes key supplements such as indolyl methanes, sulforaphanes and antioxidants to ensure a good 2/16 ratio. This can easily be rechecked on repeat testing of estrogen metabolites after patients start on an estrogen detoxification and estrogen dominance clearance plan after about six months of care.

So don’t let fear lead you to discount the importance of checking your hormones. When done safely with a hormone specialist, you can enjoy the well known benefits of hormone therapy to rejuvenate your total mind, body and spirit. Many physicians are now savvy to checking these levels for their patients. Ask to make sure that the physician you visit is boarded with a concentration towards hormone analysis and treatment. Certain physician societies exist such as the American College of Obstetrics and Gynecology, American Academy of Anti-Aging Medicine (A4M), the International Hormone Society, the World Society of Anti- Aging Medicine, the American Academy of Clinical Endocrinologists, the Institute of Functional Medicine and more, that have rigorous standards that physicians follow to help to ensure proper testing and treatment protocols are followed. Remember the human body is a marvelous creation indeed, listen to it and take care of it and you will have a “harmonious” future together. v

Dr. Gloria Hakkarainen MD, FACOG, FASBP, FABAAM is an OB/GYN and also board certified in multiple disciplines. She specializes in wellness, weight loss and anti-aging, all with a focus on prevention. She practices at Palm Beach Weight & Wellness in West Palm Beach.

Reading References for those interested in finding out more; Dr Pam Smith,MD HRT: The Answers; Dr Winnifred Cutler, PhD , Hormones and Your Health; Suzanne Somers, Breakthrough, Eight Steps to Wellness