Hormones interact with each other. Changes in one hormone invariably affect the activity of other hormones. For instance, testosterone is converted in fatty tissue to estrogen, and the administration of testosterone increases estrogen levels as well. In addition, the symptoms of different hormone deficiencies overlap. Fatigue, for instance, may be a manifestation of deficiency of estrogen, testosterone, thyroid hormone, or cortisol, or of several of them at the same time.
Thyroid hormone status should be assessed in all patients undergoing sex hormone evaluation. Thyroid hormone activity impacts both the production and the activity of sex hormones. Hypothyroidism may suppress menstruation, and cause many of the symptoms of menopause: fatigue, weight gain, depression, memory loss, hair loss, dry skin. A woman may appear to be entering menopause when in fact she has a thyroid disorder, and correction would restore her menses and eliminate the other symptoms.
Hypothyroidism is very common in women, affecting over 10%. It is generally an autoimmune disorder, meaning an attack by the body’s immune system against itself, and anti-thyroid antibodies can be measured. It occurs less frequently in men. Thyroid insufficiency raises blood pressure and cholesterol, increasing the risk of cardiac disease.
Treatment generally involves administration of thyroid hormone in doses to normalize the TSH (thyroid stimulating hormone) level. Symptoms start to improve in less than a week. We prefer to use an animal-derived formulation containing both T3 and T4, called Armour thyroid or Naturthroid (available in our office). Most commercial preparations contain only T4, which some individuals do not easily convert to T3, which is the more active form in the brain. Thyroid-related depression should be addressed with T3 augmentation.
Some authorities assert that hypothyroidism results from allergy to gluten, a grain-based protein found in wheat, rye and barley. Elimination of these foods may improve a thyroid condition.
DHEA is an adrenal hormone with activity similar to testosterone, the level of which falls progressively with age. It is considered an antiaging hormone, with beneficial effects on bone density, immune function, sense of well-being, and libido. People in the poorest health will have the lowest levels. Adrenal gland suppression, which occurs with administration of steroids for asthma and autoimmune disorders, will reduce DHEA to near zero.
We measure DHEA in all older patients and those with immune disorders. DHEA is provided in a dose to increase the blood level to that of a young adult. Although DHEA is a hormone, access is not regulated, and it can be purchased without prescription. It should not be taken, however, without first measuring the blood level. Subsequent DHEA determinations will inform the need for dose adjustment. Excessive doses may cause acne or hair loss.
Cortisol is produced by the adrenal glands. It is considered a stress hormone, in that levels rise with physical or emotional stress. Running a marathon, encountering a tidal wave, or getting a threatening letter from the IRS will all raise cortisol levels. Prolonged stress, which is common in our current overburdened lives, is thought to cause adrenal compromise. The adrenals are no longer able to properly release cortisol, and the normal day to night variation, where cortisol is high in the morning and declines throughout the day, no longer holds.
Salivary cortisol measurements, taken four times during the day, reveal aberrations in production, with low levels in the morning, high levels at night, or elevated or depressed levels throughout the day. This can be corrected by reducing stress, addressing other hormone imbalances, and providing nutrients to re-establish normal adrenal activity. Nutrients to support cortisol production include pantothenic acid, pyridoxine, vitamin A, vitamin C, and niacin. Supplements to suppress overactive adrenals include phosphatidylserine, ashwagandha, L-theanine, rhodiola and Siberian ginseng.
Growth hormone levels decline with age, and depletion contributes to fatigue, depression, reduced physical performance, osteoporosis, heart failure, muscle wasting and deposits of abdominal fat. Since growth hormone blood levels are normally very low, adequacy is assessed by measuring IgF1, a hormone produced in the liver under the influence of growth hormone. Low levels of IgF1 correlate with increasing incidence of congestive heart failure, the major cause of hospitalization in older adults.
Growth hormone supplementation increases muscle mass, reduces abdominal fat, improves the sense of well-being, helps to heal muscle and tendon injuries, and improves survival in congestive heart failure.
Apparently because of abuse by professional athletes, the FDA limits growth hormone prescription to short children, and patients with inflammatory bowel disease, AIDS, pituitary insufficiency, and proven adult growth hormone deficiency.
Human growth hormone levels can be measured at thirty minute intervals after giving an oral dose of L-dopa and carbidopa, which stimulate growth hormone release by the pituitary. Failure of blood levels to rise indicates growth hormone deficiency. Human growth hormone (hGH) can then be administered by injection into abdominal tissues, usually in a dose of one unit daily.
Human growth hormone releasing hormone (GHRH) is related to growth hormone. It is given by injection, and raises growth hormone levels by stimulating the pituitary gland to release growth hormone. Its use is not restricted by the FDA. IgF1 levels should be measured before and three months after growth hormone therapy, to assess response.
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