Sex hormones

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(When supporting adrenals and optimizing thyroid is elusive, balancing
sex hormones is frequently the answer. The entire endocrine system
works together and all hormones interact to some degree. Sex
hormones can affect blood pressure. Low androgens cause poor
muscle tone which in turn causes poor functioning of all the body's vital
signs. Estrogen and insulin have a strong relationship and the levels of
one can affect the other.

• One hormone being too high or low often causes others to be
imbalanced. It is very important to test sex hormones and not assume
based on symptoms alone that one or the other is low or high. There
are too many confounding overlaps in symptoms

• Sex hormones imbalances can cause symptoms of their own, but also
affect how well thyroid works in the body.

• Estrogen increases found in pregnancy, replacement therapy and
birth control pills can increase thyroid binding globulin (TBG), while
androgens can decrease it
  
• In adrenal fatigue, the adrenals may sequester progesterone to help
make cortisol. The drop in progesterone creates a progesterone/
estrogen imbalance called estrogen dominance

• Low aldosterone indicators such as pupils fluttering or orthostatic
hypotension with perfect aldosterone levels can indicate resistance in
the cells caused by sex hormone imbalance, such as progesterone
being high in relation to estrogen

Androgens
Androgens are often thought of as male hormones, but they are just as
important, although at much lower levels, to women. The principal
androgen is testosterone. Other androgens include androstenedione,
dihydrotestosterone (DHT), dehydroepiandrosterone (DHEA) and
DHEA sulfate (DHEA-S).

Androgens are converted in pathways that begin with cholesterol. In
women, androgens -- produced in the ovaries, adrenal glands and fat
cells -- are converted to estrogen as well as having their own roles.

Androgens are believed to be involved in the function of many organs,
including the reproductive tract, bone, kidneys, liver and muscle. They
are involved in sexual desire and in the prevention of bone loss. As
with other sex hormones, androgens convert from one to another and
sometimes even in the reverse.

Sex hormone binding globulin
Sex hormone binding globulin is exactly what it sounds like. It is a
protein which binds the various sex hormones.

• High sex hormone binding globulin (SHBG) is most frequently caused
by low IGF-1. It also can be elevated by high levels of any of the
hormones it binds, including estrogen and testosterone, which can then
unbalance the other hormones it binds as well. It is also frequently
elevated by high doses of T3

• As cortisol falls estrogen may soar, causing high SHBG which may
also then lower the T3 available to the body. That is because the
proteins that are SHBG which bind sex hormones also bind T3

• Lowering sex hormones below healthy levels may lower SHBG but
will create other issues

• High SHBG should be addressed by balancing the hormones it binds
through supplementation

• Low testosterone in men and low estrogen in women, along with low
T3, can cause low SHBG. Low SHBG can cause insulin resistance

• If SHBG is high in someone on replacement hydrocortisone,
increasing the hydrocortisone may help correct it


Testosterone
An adequate level of testosterone helps T3 work better. Total
testosterone may appear to be in good range, however it is the free
testosterone and bioavailable testosterone which are active in the
body. Most circulating testosterone is bound to sex hormone-binding
globulin (SHBG). A lesser fraction is bound to albumin and a small
amount is unbound or free.

At one time only free testosterone was thought to be biologically active.
It is now understood that testosterone that is weakly bound to albumin
can readily become available for tissue uptake and so is considered
bioavailable.

• Free testosterone is calculated from total testosterone and SHBG
(which in men is called testosterone-binding globulin)

• Bioavailable testosterone is calculated from total testosterone and
albumin to which is is only loosely bound

A free testosterone/biovailable testosterone
calculator is available here

• In men, diabetes and insulin resistance can suppress testosterone
levels

• In women, it may be hard to raise testosterone until estrogens are at
good levels, as in the normal hormone pathways testosterone converts
to estrogens

• Supplementing with testosterone will not reduce cortisol. However,
with insufficient cortisol, testosterone supplementation may cause
fatigue


Estrogen
Estrogen is tested as Total Estrogens and also as Estrogen Fractions,
which are E1-Estrone, E2-Estradiol, and E3-Estriol. Most of the
estrogen in a woman’s body and the one most frequently tested is
estradiol. It is the estrogen that provides the most symptom relief when
supplemented. Estriol is the good estrogen that protects and
counteracts the negative effects of estradiol and estrone. Estrone is the
most cancer-promoting estrogen and the estrogen most often elevated
post menopause.

• Bioidentical hormone replacement therapy often uses a combination
of 80 percent Estriol to 20 percent Estradiol (80/20). Estriol by itself
may be safer and also be effective, although it requires larger dosages

• High, over-range estrogens virtually always reflect low cortisol. In
men, any elevation of estrogen indicates low cortisol

• High levels of estrogen cause an increase in levels of corticosteroid
binding globulin (CBG)

• Low estrogen causes palpitations which may be mild until thyroid
medication triggers a worsening of them

• Unbalanced estrogen can also make it difficult to stabilize
temperatures when addressing adrenal fatigue

• The best thing for estrogen dominance is to treat the cause. If
progesterone is low then progesterone may help; If progesterone is not
low, then cortisol is the natural way to lower estrogen

Progesterone
Progesterone is the hormone of reproduction. From the day of
ovulation until menstruation begins, progesterone builds to its highest
level. When no egg is fertilized, progesterone plummets to its monthly
low triggering menstruation.

• Among the symptoms of high progesterone are:
• bloating
• sore breasts
• high blood pressure
• fluid retention
• carb cravings
• Low estrogen can also cause these same symptoms by allowing
progesterone to become dominant. Progesterone dominance does not
always mean high progesterone. There can simply be too much of it in
relation to estrogen

• High progesterone can also cause low potassium

• Progesterone dominance symptoms may be helped by raising
estrogen, if estrogen is low, and by raising potassium, if it is low

• Progesterone is a precursor to aldosterone. High progesterone can
actually cause progesterone to mimic aldosterone and cause
aldosterone resistance by binding to aldosterone receptors; however,
progesterone is not aldosterone and does not fully turn on the
aldosterone receptors; it is possible for high progesterone to cause
cortisol resistance by the same process

• When progesterone levels are high, it may take up to six months to
clear excess progesterone; until progesterone normalizes, low cortisol
symptoms can be treated with more HC to overcome the resistance

• Low progesterone can be the cause of low cortisol or low aldosterone.
Sometimes progesterone can go too low because the body is utilizing it
better.

Luteinizing Hormone and Follicle Stimulating Hormone
In both men and women luteinizing hormone and follicle stimulating
hormone may be tested to
  
• Determine the cause of infertility
• Diagnose conditions associated with dysfunction of the ovaries or
testicles
• Aid in the diagnosis of pituitary or hypothalamus disorders, which can
affect their production
  
In women, levels are also useful in:
• Investigating menstrual irregularities
• Predicting onset or confirmation of menopause
• LH spot tests done at home can help determine when ovulation will
occur

Controversy regarding supplementing
In researching this article, what stood out the most is that there is
absolutely no consensus when it comes to hormone replacement
therapy (HRT) for women. Unlike other areas where the distinction is
between traditional and alternative medicine, opinions on HRT come in
all shapes and sizes. Much of the discussion about risks and rewards
does not distinguish between bioidentical and conjugated equine
estrogens or between natural progesterone and progestins. There is
almost never a distinction made in discussions among the types of
bioidentical estrogen, E1, E2 and E3.

There are those who promote progesterone as the one and only
answer, those who insist estrogen alone is all that is needed, and those
who promote a balance of the two.

While some women are satisfied with traditional hormone replacement
therapy with conjugated estrogen (Premarin®), the variety of studies
showing increased risk of cancer has deterred many women.
Bioidentical hormone replacement therapy using E2 and E3, and more
recently E3 alone, has been shown in more recent studies to reduce
the risk of estrogen-associated cancers in addition to relieving most
symptoms and reducing the risk of both heart disease and
osteoporosis.

Supplementing sex hormones
Particularly with adrenal fatigue and thyroid issues, supplementing sex
hormones may not be straightforward. Different individuals will find they
do better with one or another of the methods of supplementation.
• In addition to topical preparations, estrogen is available in
transdermal patches, troches and intravaginal administration

• Progesterone is supplemented in troches or topicals

• Testosterone and other androgenic hormones can supplemented with
topical preparations, sublingual lozenges and for men also
intra-muscular shots and subcutaneously implanted pellets

• Bioidentical USP (United States Pharmaceutical) progesterone
creams are readily available over the counter in healthfood stores and
online. It also may be prescribed; only about 20% of oral products is
absorbed

• Some estrogen products are available online

• Testosterone must be prescribed by a physician

• Applying topical preparations to the genitals may provide the best
absorption for topical preparations

• Oral estrogens are not recommended. They raise serum levels of sex
hormone binding globulin (SHBG). Elevated SHBG levels alter the
levels of androgenic hormones (such as testosterone) and the doses
needed to achieve functional levels

• Low cortisol can cause intolerance to some forms of estrogen
supplementation. It may be necessary to try more than one form to find
what is best tolerated

• Supplementing too much estrogen too fast may crash weak adrenals

Testing sex hormones
Sex hormones should be tested to determine current levels before
supplementing. Testing should be repeated at six week intervals to
evaluate how well dosages are working until the desired levels are
achieved. Thereafter, testing at four to six month intervals can be done.