Why do I need hormone testing?
One size does not fit all when it comes to hormones! For decades, western medicine has prescribed HRT as if everyone needed the same thing and the same amount. Nothing could be further from the truth. Your hormones are like your fingerprints and, in order to achieve optimal health, you need to know your specific imbalances. To find out about your hormonal status, you'll need to have lab tests performed. But what kind? There are several ways to test (saliva, serum and urine), but the state-of-the-art testing is through saliva. This is because it measures only the active portions of your hormones and it is these portions that determine how you feel. So if you're seeking bio-identical hormone replacement (BHRT), you'll need to know active hormone levels. In addition, if using a topical (transdermal) hormone preparation for therapy, saliva testing is the most accurate tool to measure and monitor your hormone status.
Which Hormones Need Testing?
The major players in the sex hormone arena are estradiol, progesterone and testosterone. The main adrenal hormones are DHEA and cortisol. These five hormones will provide crucial information about your deficiencies, excesses and daily patterns. A therapy approach can then be specifically tailored for you, one far more beneficial than the old "shotgun" method. Below is a brief description of each of these five hormones, their purpose and how they interact with one other.
Estrogen: There are three forms made by the body: estrone, estradiol and estriol. Estradiol is the form used in past hormone replacement therapies, often in the form of concentrated pregnant mare's urine (Premarin). It is a proliferative (causes growth) hormone that promotes growth of tissue lining the uterus. It is also known to cause breast and endometrial (uterine) cancer in women and prostate cancer in men. It will moderate menopausal symptoms like hot flashes, insomnia and memory-loss. With the bio-identical formulas, estriol is matched with estradiol (biest) to provide protective effects and additional estrogenic benefits. Progesterone is the other major protective hormone keeping estradiol from running amok.
Progesterone is called the "anti-estrogen" because it balances estradiol's proliferative effects. It is considered a preventive for breast and prostate cancers, as well as osteoporosis. In addition, too little progesterone promotes depression, irritability, increased inflammation, irregular menses, breast tenderness, urinary frequency and prostate gland enlargement (BPH).
Testosterone is an anabolic hormone (tissue building) hormone essential for men and women. The proper level of testosterone is necessary for bone health, muscle strength, stamina, sex drive and performance, heart function and mental focus.
DHEA is an important adrenal gland hormone essential for energy production and blood sugar balance. DHEA is a precursor to other hormones, mainly testosterone.
Cortisol is your waking day hormone (highest in the morning and lowest at night). It is necessary for energy production, blood sugar metabolism, anti-inflammatory effects and stress response.
Some of the common imbalances identified through testing include estrogen dominance, estrogen deficiency, progesterone deficiency, androgen (testosterone and DHEA) excess or deficiencies, adrenal dysfunction and adrenal fatigue.
State-of-the-Art Saliva Testing
This testing is accurate, easy to collect, FDA approved and has rapid turn-around-time. Healthwalk is proud to now offer this clinical service, overseen by Ross Nicely, R.N. Our tests are unique because they deliver accurate results requiring a much smaller sample size (one fifth the volume previously required). Sample collection only takes 2-3 minutes. Four samples are collected and pooled to give a truer reflection of hormone levels (hormones fluctuate dramatically throughout the day, thus one sample does not reflect your average levels). The exception is cortisol, which has its own daily rhythm, and is measured before the samples are pooled. With this state-of-the-art saliva testing you will find solutions to your health problems which, until now, have been unexplained.
Hormone Testing Resources
To set up an appointment in our facility or in the privacy of your own home, and to see which hormone test is right for you, please call us at 760.929.1520 to set up a consult time.
Why Test For Hormones?
Now that you know how testing works, you might want to know the most common and uncommon reasons for testing, and symptoms to look for... HealthWalk tests six different hormones: estradiol, progesterone, testosterone, DHEA, cortisol, and most recently Estriol. You can test levels for any of these hormones in any combination.
ESTROGEN AND PROGESTERONE:
Estradiol and progesterone are two hormones often tested together. When you test these two hormones together, Labrix also provides you with a Pg/E2 ratio. This ratio allows you to determine if the patient (male or female) has "estrogen dominance". Estrogen dominance is a risk factor for breast cancer and osteoporosis risks in females and prostate gland enlargement and cancer in males. The term "estrogen dominance" is less related to the amount of circulating estrogen and more related to the ratio of estrogen to progesterone in the body. Menopause and PMS are not the result of estrogen deficiency; although, estrogen levels do decline during the latter phases of a woman's reproductive cycle. More relevant is that the estrogen levels drop by approximately 40 percent at menopause or during periods of stress while progesterone levels plummet by approximately 90 percent from premenopausal levels. It is the relative loss of progesterone that causes the majority of estrogen dominance symptoms. The disproportionate loss of progesterone begins in the latter stages of a woman's reproductive cycle, when the luteal phase of the menstrual cycle begins to malfunction. The malfunction is initiated when the corpus luteum, the primary source of progesterone, begins to lose its functional capacity. By about age 35, many of these follicles fail to develop, creating a relative progesterone deficiency. As a result, ovulation does not always occur and progesterone levels steadily decline. It is during this period that a relative progesterone deficiency (estrogen dominance) develops.
Typical Symptoms of Estrogen Dominance Include:
- Irritability/Mood Swings
- Depression
- Irregular Periods
- Heavy Menstrual Bleeding
- Vaginal Dryness
- Water Retention
- Sleep Disturbance
- Hot Flashes
- Headaches
- Fatigue
- Short-term Memory Loss
- Weight Gain
The Progesterone/Estradiol (Pg/E2) reference ranges are optimal ranges determined by Dr. John R. Lee MD. While they are not physiological ranges, they are optimal values for protection of the breasts, heart and bones in women, and the prostate in men. Salivary values within these ranges have been shown by Dr. Lee to decrease both breast and prostate cellular proliferation, thereby providing protection to these vital tissues.
TESTOSTERONE
Testosterone is often tested when the patient talks of low libido. Declining testosterone levels are the number one cause of low libido in males, and plays a contributing factor in females. Declining testosterone levels are commonly seen in men beginning in the fourth decade of life. Suboptimal or low testosterone levels in males are often associated with symptoms of aging and are referred to as "andropause" or male menopause.
Testosterone is an important anabolic hormone in men. It increases energy, prevents fatigue, helps maintain normal sex drive, increases strength of all structural tissues such as skin/bone/muscles (including the heart), and prevents depression and mental fatigue. Testosterone deficiency is often associated with symptoms such as night sweats, insulin resistance, erectile dysfunction, low sex drive, decreased mental and physical ability, lower ambition, loss of muscle mass and weight gain in the waist. The primary cause of this increase in girth is visceral fat, not excessive subcutaneous (under the skin) fat.
The visceral fat cells are the most insulin resistant cells in the human body. As a person ages hormone levels change in favor of insulin resistance. The insulin levels rise while progesterone, growth hormone and testosterone decline. The visceral fat cell begins to collect more fat in the form of triglycerides. A vicious cycle is initiated, which if not interrupted with natural hormone balancing will lead to abdominal obesity, diabetes and high cholesterol levels. This phenomenon is known as "Metabolic Syndrome." In males, Metabolic Syndrome results in lower testosterone levels; however, in females Metabolic Syndrome results in high testosterone levels and a phenomenon known as "Polycystic Ovarian Syndrome" (see below).
Stress management, exercise, proper nutrition, dietary supplements, and androgen replacement therapy have all been shown to raise androgen levels in men and help counter male Metabolic Syndrome symptoms. The "trick" is to know how much testosterone is required for each individual male. This is where knowing the salivary testosterone levels come into play. Initial salivary testing and following salivary monitoring are crucial for determining the most optimal prescription.
Metabolic Syndrome and Polycystic Ovarian Syndrome (PCOS) in females exhibit the same visceral fat pattern, insulin resistance and triglyceride formation as in males: however, the female patients with PCOS and Metabolic Syndrome had high levels of testosterone and often DHEA. This results in a typical symptom pattern seen in women with Metabolic Syndrome - acne, increased facial and body hair, hair loss on the head, trunk obesity and infertility. Salivary testosterone and DHEA levels can diagnose this syndrome and follow up testing is key for monitoring therapy. It is important to note that women do not need to have their ovaries to have Metabolic Syndrome. The adrenal glands in women who have a predisposition to Metabolic Syndrome can produce above normal levels of testosterone and DHEA.
DHEA AND CORTISOL
While DHEA is an adrenal hormone, it is also made in the ovaries. When we measure DHEA, we are eliciting information about both the adrenal glands and the ovaries. This is particularly important when DHEA levels are high. High levels of DHEA can mean that the adrenal glands are increasing DHEA production on response to stress or high glucose levels, or that the ovaries are increasing the production of DHEA as part of the PCOS cascade. High levels of DHEA are often seen years before a female develops Metabolic Syndrome and should be used as a risk factor marker for insulin resistance.
Low levels of DHEA are seen in evolving "adrenal gland fatigue" (hypoadrenia). As acute stress becomes more chronic, the constant demand by the body for adrenal gland hormones begins to wear out the adrenal glands, and DHEA and cortisol levels fall. It is for this reason that DHEA is often measured in combination with cortisol levels. Cortisol is a hormone produced by the adrenal glands in response to stress and blood sugar levels. Cortisol secretion has a diurnal rhythm. Normal cortisol levels should be highest one hour after waking in the morning and drop gradually throughout the day. Measuring the diurnal rhythm with four cortisol levels throughout the day gives a very accurate measure of adrenal gland function and their ability to cope with stress. Adrenal fatigue occurs in stages. The stage at which a patient is at can be determined by looking at the diurnal cortisol graph and DHEA levels. Symptoms of evolving adrenal gland fatigue include fatigue, sleep issues, inability to cope with stress, anxiety, nervousness, irritability and allergies.
Hypothalamic Pituitary Axis (HPA) Dysregulation is due to chronic stress with the resultant excess cortisol production and down regulation of cortisol receptors in the hypothalamus. In other words the negative feedback loop that normally shuts down the production of ACTH release is blunted and cortisol production by the adrenal glands is uncontrolled. If this continues, hypoadrenia always evolves. The symptoms of HPA and hypoadrenia are essentially identical but salivary testing easily distinguishes the two. This is crucially important as therapy of each can be very different.
Measuring cortisol and DHEA levels will also diagnose complex diseases such as Addison's Disease and Cushing's Syndrome. Addison's disease occurs when the adrenal glands do not produce enough of the hormones cortisol and DHEA. The disease is also called adrenal insufficiency, or hypocortisolism. However, it has no relationship to end stages of "adrenal gland fatigue" described above. The two illnesses have very different mechanisms of action. Most cases of Addison's disease are caused by autoimmune destruction of the adrenal cortex. Symptoms include chronic fatigue, weight loss, loss of appetite, muscle weakness, and hyperpigmentation of the skin. Cushing's Syndrome results in excessive production of cortisol by the adrenal glands. Symptoms include rapid weight gain of face, trunk and back of neck, hirsutism, depression, anxiety and panic attacks.
The Skinny on Belly Fat
Q: I have been noticing more belly fat despite changing my dietary habits and feeling low energy. What can I do to lose the belly fat and gain back my energy levels?
A: We are often asked this question this time of year. A better question would be how do I lose fat? This is an important and timely question because obesity is on the rise in the U.S. to the point of epidemic proportions.
There is a phenomenon that can develop in the body called insulin resistance (also referred to as Metabolic Syndrome and Syndrome X). Insulin resistance refers to a state whereby the cellular insulin receptor sites become unresponsive to the binding of insulin. Several mechanisms can contribute to insulin resistance, but for the purposes of this article we are going to focus on one main factor: elevated cortisol. Stress causes the hypothalamus to release corticotrophin-releasing factor (CRF), which signals the pituitary gland to release adrenocorticotropic hormone (ACTH). This then stimulates the adrenal glands to secrete cortisol. Elevated cortisol causes insulin resistance, but insulin resistance can, in turn, cause elevated cortisol. It's a vicious feed-forward cycle.
Signs and Symptoms of Insulin Resistance
Conservative estimates suggest that 25-35 percent of Westernized countries suffer from some degree of insulin resistance. That can pencil out to be at least 60 million U.S. adults meeting the following criteria:
- Central adipose tissue (A.K.A. belly fat)
- Fatigue
- Craving for sweets and caffeine
- Constant hunger
- Migrating aches and pains
- Elevated triglycerides and/or low HDL cholesterol
- Elevated blood pressure
- Elevated cortisol
This ominous list of signs and symptoms become risk factors for very common and severe health problems, including type 2 diabetes mellitus, polycystic ovary syndrome, dyslipidemia, hypertension, cardiovascular disease, sleep apnea, certain hormone-sensitive cancers, and obesity.
You Can Monitor your Cortisol Levels
Fortunately, with the advances in functional diagnostic lab testing you can easily and non-invasively monitor your cortisol levels. A salivary sample is the most accurate way of evaluating the cortisol. The two main adrenal hormones that are assessed are cortisol and dehydroepiandrosterone (DHEA). In general, cortisol tells us how much stress the body has experienced and DHEA tells us how the body is adapting to that stress. Four salivary samples are collected at specific times on a single day and the hormones are analyzed by the lab. More often than not, the rest of the hormone panel is tested along with cortisol and DHEA. Other main hormones involved with metabolism are estrogen, progesterone, and testosterone. Testing all of these hormones together is important because the ratios are just as imperative, if not more imperative, than the individual hormones.
- Estrogen
- Progesterone
- Testosterone
- DHEA
- Cortisol (4 samples of cortisol are collected)
- Cortisol:DHEA Ratio
- Progesterone:Estradiol Ratio
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