hormone seminar

“The compounding specialists”

Welcome

Hormones

• Powerful chemical messengers• Derived from cholesterol• Made in the brain, ovaries, testicles, adrenal

glands and body fat• Affect every tissue in the body• Overall effect depends on the balance between

various hormones• Duration of exposure is as important as dose

Bio-Identical Hormones

• Bio-Identical Hormones are chemically identical to those in the human bodyo Derived from cholesterol-like molecules called

saponins (extracted from soybeans and yams) Plants do not make hormones (only precursors)

o Some available without prescription (ProGest)o Others require prescription

a few manufactured products (eg: Vivelle, Estrace, Prometrium)

custom compounded medications

Estrogens Estriol, Estradiol, Estrone

• Exert a stimulating effect on breast, uterus and brain

• Prevent bone loss by osteoclasts• Involved in vasodilation and improved

blood flow• Promote fat storage at hips • Maintain integrity of urogenital tract

Progesterone

• There is only ONE progesterone • Works synergistically with estrogens

o Balances effect of estrogens in many cases slows cell growth normalizes blood clotting enhances estrogen’s cardiovascular benefits decreases fluid retention (bloating) improved fat metabolism

• Progesterone levels drop at peri-menopause

Testosterone

• Anabolic hormone o builds and strengthens tissue, bone, urogenital

tract, muscle• Declines with age• Vasodilator• Balances effects of estrogen and cortisol• Important for sex drive/sexual response

Dehydroepiandrosterone (DHEA)

• Made in the adrenal glands• Declines steadily with age• Has important roles in immune function,

ability to handle stress, and glucose disposal

• Balances cortisol• Can convert into testosterone and

estradiol

Cortisol

• Made in the adrenal glands• Catabolic hormone: breaks down tissue

(part of the normal cycle of remodeling)• Balances testosterone• Stress hormone: modulates immune

function, raises blood glucose, stores fat for energy

• In excess: osteoporosis, muscle wasting, obesity, brain neuron atrophy

Thyroid Hormone

• Determines metabolic rateo Nutrient utilization by tissue

(fats, carbs, and protein)o Effect protein synthesiso Regulate bone growtho Heat generation

• Interacts with cortisol, progesterone, testosterone and estradiol

Female Hormone PatternsMenarche to Menopause

• Teenso Anovulatory cycles are common o Low Progesterone o Estrogen Dominance


• 20 to 30 years oldo May have regular monthly bleeding but may

not be ovulatingo If stressed: PMSo Unbalanced hormone levels affect fertility and

pregnancy


• 40 to 50 years oldo Peak progesterone level declineso Total progesterone output throughout the luteal

phase declines o Average estradiol level increases

May lead to estrogen dominanceo Ovaries may secrete more testosterone

instead of progesteroneo Anovulatory cycles with irregular bleeding


• 40 to 50 years oldo Estrogen dominance o Functional hypothyroidism o Normal TSH, but classic symptoms of under-active

thyroid o Weight gaino Feeling coldo Dry skin, thinning scalp hairo Aching muscleso Fatigueo Low sex drive


• 50+ & Menopauseo Estradiol level drops o Estrone level stays the same or rises o Ovary stops making progesterone and

testosterone

Symptoms of Hormone Imbalance

• Estrogen Excess o Tender, swelling, and/or fibrocystic breastso Water retentiono Irritabilityo Weight gain at hipso Sometimes increased headaches or migraineso Hypothyroid symptoms


• Estrogen Deficiency o Hot flashes & night sweatso Vaginal dryness (also lips, skin, eyes...)o “Brain fog” & memory problemso Urinary incontinence (stress incontinence)o Depressiono Bone loss


• Estrogen Deficiency o Low percent of body fat = at risk for low

estrogen Estrogen CAN be made in body fat...if you have

enough! Women with enough body fat may not need

estrogen supplementation for menopause Women with low body fat may need extra estrogen


• Progesterone Deficiency o Irregular periods (teens and pre-menopause) o Tender and/or fibrocystic breastso Water retentiono Irritabilityo Anxiety/depressiono Weight gain at hipso Migraineso Hypothyroid symptoms


• Androgen (Testosterone) Excess o Acne, oily skino Facial hair growtho Weight gain at waisto High triglycerides o Seen in insulin resistance, polycystic ovary

syndrome, obesity


• Androgen (testosterone) Deficiency o Depressiono Fatigueo Vaginal drynesso Low sex driveo Bone losso Decreased sense of well being


• Cortisol (Stress Hormone) Excess o Irritability, anxiety, feel “burned out”o “Brain fog” & memory problemso Bone losso Insomnia & fatigueo Low sex driveo Weight gain at waist (“apple” profile)


• Cortisol Deficiency “Adrenal Fatigue”o Usually preceded by prolonged stress/chronic

illness o Fatigue, feel “flat” or “burned out” o Allergies; immune function lowo Feel cold all the timeo Can’t get started in the morningo Low sex driveo Depressiono Unstable blood sugar

Approach to Female Hormone Imbalances

• The solution isn’t always HRTo Stress reduction (good diet, sleep, exercise,

relaxation training) o Weight loss o Address insulin resistance o Nutrients o Herbs

Male Hormone Patterns

• Young Males o High testosterone o Low estradiol o Low progesterone

Male Hormone Patterns• 35 + years old • Testosterone drops about 1% per year • Estradiol and estrone may rise; Prog stays low• Gain weight around middle • Sleep problems associated with excess weight

may lead to increased cortisol• Abdominal fat converts testosterone to estradiol

under the influence of cortisol• Cortisol and estradiol directly oppose the action

of testosterone • High estradiol is sensed by the brain and may

shut down testosterone production

Approach to Male Hormone Imbalances

• Weight loss • Weight training • Reduce dietary estrogen burden • Testosterone supplementation• Aromatase inhibitors

Solving Hormone Problems

• History 85%• Physical examination 10%• Lab tests 5%• Respect individual differences • Endocrinology will always be somewhat of

an art, not an exact science

Role of Testing

• Symptoms help us reach a tentative diagnosis

• Lab testing confirms or refutes the diagnosis

• Need to do comprehensive testing

Thank You

John C. Richards Pharm.D.Barbara Dace Pharm.D.

Professional Village Pharmacy

916-483-3455www.ProfessionalVillageRx.com

hormone seminar

Health & Medicine