In the practice of functional medicine hormonal balancing winds up being a foundational piece along with diet and lifestyle modifications. There are some classic presentations of patients that suggest imbalanced hormones are at the core of the problem. Women may experience weight gain in the truncal region, muscle loss, fatigue, insomnia, hot flashes, night sweats, mood swings, depression or anxiety, irritability, trouble concentrating, bloating, dry hair and skin, decreased libido. Men present similarly and will contact me when they have diminished stamina, low energy, mood instability, weight gain or increased breast tissue, low sex drive or erectile dysfunction. Do any of these symptoms resonate with you?
What hormones are we talking about? Most of us pay close attention to the sex hormones since they seem easier to track and find subtle differences. The sex hormones for women are the estrogens (estrone, estradiol, estriol) and progesterone with a small amount of testosterone. They are secreted from the ovaries with some mild contribution from the adrenal glands. Estrogen is essential in the development of the female body during various phases of change, such as puberty, pregnancy, and menopause. The men secrete testosterone from the testicles and some from the adrenal gland. Under certain conditions, there is some conversion of that testosterone into estrogen at the tissue level. Both reproductive glands receive their signals from the pituitary (luteinizing or follicle stimulating hormones), and that pituitary receives its order from the hypothalamus (gonadotropin releasing hormone). There is also prolactin produced from the pituitary that stimulates breast milk production. All these chemical messengers “talk” to each other and form a whole network of hormones needed to regulate our base functioning, and that is just the reproductive hormones!
Another branch of the hormonal network is contained in the adrenal glands. Cortisol is our main stress hormone that should be neither too high nor too low. This get up or downregulated depending upon the amounts of physical or mental stress we impose upon ourselves. It receives its orders from the pituitary from ACTH (adrenocorticotropin). There are some salt saving and glucocorticoid hormones in the adrenal gland as well which can get high tech and specified in the treatment. DHEA at the adrenal level is a precursor hormone that can convert into the sex hormones, estrogen or testosterone depending on the patient’s conditions or needs. The adrenal gland may also need to be balanced to help with our sex or other hormones.
Do not forget our thyroid gland as another epicenter for the hormonal signaling going on throughout the body every minute of the day. Our thyroid gland secretes thyroxine (T4) and triiodothyronine (T3). It receives its signals of TSH (thyroid stimulating hormone) from the pituitary. The pituitary receives its signal from the hypothalamus in the form of thyroid releasing hormone (TRH). Our thyroid gland is one of the master traffic cops and sometimes referred to as the “mother gland” responsible for all other communications in the body. We need a full network of hormones to optimize our health and no one hormone is more important than the other.
There are some other noteworthy characters in our cast worth mentioning that include our parathyroid glands and their secretion of calcitonin and parathyroid hormone (PTH). These glands get into the regulation of vitamin D and calcium regulation. Another actor is human growth hormone, commonly known as HGH, secreted by the pituitary gland. This hormone strengthens bone density, enhances tissue growth, and increases muscle mass throughout the life cycle. HGH is imperative for growth in children then cellular repair in adulthood. There are other hormones that circulate throughout the bloodstream to help organs receive input from remote locations. We need these messengers, along with a good energetic flow of information, to bounce to their “cell towers” in the body to keep harmonious balance. So how does functional medicine work through these hormonal imbalances and dysfunctions to create harmony and symphonic resonance to optimize health? What are those factors that cause decline in these hormones?
Chronic stress, exposure to toxins, poor diet leading to nutrient deficiencies, poor sleep, and advanced aging directly impact these fragile biochemicals. Sedentary and high-tech living styles are big contributors to the low hormonal states that some of us live in. This also suggests that electrosmog with stray and chaotic electromagnetic frequencies count as toxins in our environment. Levels can be measured for nearly all these hormones, but some of the hormones’ biggest impact is within a targeted cell. These levels cannot be measured to date, so the blood, urine, or saliva testing will help infer what the hormones are doing at the cellular level. Once measured an initial approach will include many techniques that are within your power to manage.
Diet is foundational. This is a mandatory first step or all other techniques will be inadequate. Clean up all intake to avoid sugary, processed, deep-fried, synthetic, preserved, gluten-laden, and inflammatory food and drink. Alcohol must be limited. Steer clear from oils high in omega-6 fats (sunflower, corn, cottonseed, canola, peanut, and safflower oil). Eat a variety of foods high in short, medium and long-chain fatty acids because our body needs various types of fats to create hormones, including saturated fat and cholesterol. Eggs are good for us, and 95% of our sex hormones are made up of cholesterol! Great examples of good fats include coconut oil, avocados, grass-fed butter, and wild-caught salmon. These fats can replace refined carbs and leave you more satisfied. Cook with herbs and consider high mineral content such as those found in Himalayan salt. For instance, thyme and sage help to balance female hormones. Thyme balances and promotes progesterone secretion. Hemp seeds contain GLA (gamma-linoleic acid) which also aids in progesterone balancing. We also have a whole network of hunger hormones that are peptide based which requires protein for their synthesis and regulation. High quality proteins at each meal can ensure that those hunger hormones will help keep the network synchronized.
Work on your stress reduction. This may come in energetic forms such as reiki, breathing techniques, meditation, yoga, therapy, grounding, acupuncture, exercise, light therapy, sound, and music therapy. The improved diet will also quiet the excessive insulin levels that rise and stimulate cortisol in response that sugary food. Poor sleep is not only impacted by stress but is also causative of stress. Any non-medicated approach to assist in sleep should be employed using the techniques already mentioned. Waking with the sun and turning in with the nightfall will allow the much-needed sleep and repair processes that only happen at nighttime. As one example, growth hormone is secreted at night when we sleep. Without it we have no mechanism for cellular repair. Poor sleepers have poor health.
Exercise is one foundational piece that is mandatory for body and hormone health. Daily movement can reduce insulin consistently. This lowers inflammation and helps keep cortisol low. Exercise can also optimize the dopamine and serotonin neurotransmitters to create coherent brain function, but did you know that exercise helps boost levels of testosterone, estrogen, IGF-1 (a measurement to indicate HGH), and DHEA? Incorporate daily movement into your day and watch the shifting of your body as it returns to its balanced state.
Supplements may be needed to round out your management. I describe some of these as “food” required for functioning. Our environment is no longer rich in minerals and nutrients. This is where some high-quality supplementation may be needed. Considering the thyroid, I usually recommend a high dose b-complex vitamin, selenium, and iodine. I do not recommend thyroid extracts unless under supervision of a physician. The adrenal gland (and to a degree the thyroid), when under chronic stress, does well with adaptogenic herbs. Some of these herbs may be alone or in a blend to include: ashwagandha, medicinal mushrooms, rhodiola and holy basil. Traditional Chinese Medicine also has an array of herbal concoctions that provide homeostasis for the hormonal pathways. Vitamin D almost acts like a hormone inside the body and has important implications for keeping inflammation levels low and regulating the thyroid gland. Probiotics are healthy bacteria that can improve your production and regulation of key hunger and satiety hormones like insulin, ghrelin, and leptin. There are some supplemental programs that exist to add all the essential minerals and nutrients with the premise that many of our imbalances are directly attributable to elemental and mineral deficiencies. I believe this to be true.
When your personal attempts at harmonizing your hormones is not enough the trained physician is needed. There are natural products as well as pharmaceutical products and each has its merit under certain circumstances. The thyroid balancing may be the most well-known. There are porcine glandular extracts that keep the same ratio of T4/T3 since it is rendered thyroid glands from a mammal. I will not use those in the autoimmune patient since the animal proteins may cause a cross-reactivity in the autoimmune phenomenon. There are synthetic versions of T4 and T3 separately. There are gluten-free medications also in synthetic compounds. I find great value in the products through a compounding pharmacist that are very “clean” and can have the T4/T3 combined and in many titrations or variations that will “dial in” to the patient’s specific levels needed.
Adrenal support may also come in the form of medication if the patient’s compensatory strategies cannot work. Glandular extracts do not come from the pharmaceutical world, but reputable nutraceutical companies carry some great products. Glandular extracts have to managed with physician input as well. Those same extracts also need to be used cautiously in the autoimmune patient for the same reasons elucidated above. Cortef, in the pharmaceutical world may be needed to regulate the amount of corticosteroid needed to help the patient maintain function and blood pressure control. A burned out adrenal gland will not support blood pressure and these patients can have profound hypotension and recurrent syncope (passing out).
Sex-hormone management outside of the supplemental approach is optimal in the bio-identical arena. The compounding pharmacists do a tremendous job at titrating and finding absorbing creams, troches, liquid drops or capsules to allow very fine tuning of the hormones that are not only hand made specifically to the patient, but also contain plant extract powders that are chemically identical to what our bodies naturally produce. A natural, bio-identical product is easily recognized and easily broken down by the body with little side effects to deal with. In these compounds we can also put a few into one cream for ease of administration. We can allow adjustments to be made based upon the patient’s testing and symptoms in need of improving. Some of the compounds can also allow for other pituitary or adrenal hormones to add into the compound. This allows for DHEA to be added into the compound if needed. Of course, there are pharmaceutical medication on the market for nearly all the sex hormones, and some great strides have been made in the infertility world because of it. Many of those cases are specialized and in need of a reproductive endocrinologist who is trained in this level of prescribing. As with anything else you can get too much of a good thing!!
If you think your hormones are imbalanced and you do not know which ones are, find yourself a trained functional physician adept in this field and take the guess work out of it. There is no harm is starting the foundational pieces of diet and exercise without the knowledge of your hormone levels. Once that is not enough, I am ready for our visit!