Hormone Help Part 3: Progesterone, Testosterone, DHEA and Cortisol

Progesterone

While estrogen is the most well known female hormone, Progesterone should be considered “a girl’s best friend.” This hormone is responsible for helping us feel the way we prefer to feel. It supports a good mood, good sleep, weight maintenance and much more such as:

• reduce cholesterol levels

• improve insulin resistance.

• enhance thyroid hormone activity

• improves estrogen receptor sensitivity

• helps decrease estrogen dominance  

• helps to burn fat for energy.

• can be a potent antidepressant

• helps retain bone density

• supports cancer prevention

The balance of progesterone and estrogen is the key in estrogen dominance, so having optimal progesterone levels are a major factor in good hormone health. Most women struggle to produce enough progesterone after about age 30 which is in part, the start of the road to menopause, but more often a function of high stress. Women in their 30’s are generally raising young children, not sleeping well enough, going back to work soon after childbirth and not providing their bodies with enough time and support to reestablish good hormone balance after birth. Many more women require progesterone supplementation to even maintain pregnancy indicating their hormone balance was struggling before they even got pregnant. Then add on the massive toll pregnancy takes on the body, and the lack of recovery most women can afford, it is easy to see how women can struggle with hormone issues for many many years.

The “mother” of all hormone production is actually cholesterol which produces pregnenolone which then produces estrogen, testosterone and progesterone. In situations of high stress, progesterone can become cortisol- the stress hormone. This takes resources from the body’s normal mechanisms of making estrogen and testosterone and depletes stores of progesterone. Knowing your progesterone level and working with a practitioner who can safely improve the levels if needed, can be one of the simplest ways to feel significantly better in a short amount of time. This is also a great example of why all 5 of the “hormone heavy hitters” are important in your overall hormone health. They are constantly all work together to keep you well.

Testosterone

Testosterone is the hormone most dominant in men, but it is an extremely vital part of the female hormone system as well. The role of testosterone in men is further discussed in our male hormone series. Testosterone is secreted by the adrenal glands and ovaries. It decreases with age and when taking oral estrogen. Testosterone can become elevated in women with insulin resistance and in Polycystic Ovarian Syndrome (PCOS).  An important factor with testosterone that is often overlooked is the potential for testosterone to convert to estrogen. This happens in both men and women through increased aromatase enzyme activity. When this enzyme is overactive, this conversion of testosterone to estrogen can be a significant cause of estrogen dominance in both men and women.

More functions of testosterone:

• Supports making neurotransmitters for improved brain function

• Improves sleep

• Helps sense of well being, energy, and vitality

• Required for libido, arousal and orgasm

• Improves bone density

• Can inhibit fat accumulation

Low testosterone for men and high testosterone for women is an increasingly common issue that is showing to worsen year by year. It is estimated that testosterone levels have declined about 1% each year for the past 30 years in American men. While declining testosterone levels have primarily been studied in men, the lifestyle and environmental reasons for which testosterone declines in men also contribute to the increase in testosterone in some women causing hormone imbalances.

Environmental and lifestyle factors contributing to testosterone imbalances include:

• Endocrine disrupting chemicals in body care products and plastics with phthalates, parabens and more

• Chronic high stress

• Decreased quality of food

• Decreased soil quality

• Increase use of pesticides, herbicides, and chemicals

• Low fat diets

For women, one of the most significant way to help decrease high testosterone levels is to manage blood sugars to improve or prevent insulin resistance. Men should not try to increase testosterone themselves with testosterone creams or gels. Low testosterone is a symptom of other underlying health issues that need to be addressed. Simply adding in testosterone can actually complicate things further.

DHEA

For women, there are two hormones that are considered androgens. These are testosterone and DHEA which are considered male hormones. These hormones decrease with age and in women, are increased with insulin resistance. DHEA is converted to both testosterone and estrogen. It is an important hormone for immune function. After menopause, almost all estrogen is converted from DHEA through the aromatase enzyme. Depending on your genetics and how sensitive your body may be to DHEA, it is possible for the body to convert DHEA into testosterone instead of estrogen. This is why working with a functional medicine practitioner who understands which labs are needed and how to interpret them for optimal hormone balance is imperative. It is not uncommon for our office to see hormone imbalances become significantly worse after inadequate treatment from practitioners who are well intentioned, but simply do not understand the complexity of how hormones impact each other.

DHEA is imperative for mood management and the decline of DHEA with aging is a contributing factor in mood changes leading up to and during menopause. DHEA helps the mind cope with stress and improves memory.

Other roles of DHEA include:

• Elevate mood, calm emotions, increase alertness

• Improve memory

• Improves immune function

• Supports motivation and sense of wellbeing

Androgens are the combined term for testosterone and DHEA. They share some of the same characteristics when they are elevated in women. This is another reason why lab testing and interpretation by a skilled functional medicine practitioner is necessary for the right treatment.

Symptoms of Elevated Androgens

If you suffer from any of these symptoms, consider the possibility of high testosterone and/or DHEA:

• Acne

• Hair loss (primarily on top on the head)

• Increase in face and body hair.

• Increase levels of triglycerides.

• Polycystic ovarian syndrome (PCOS)

High androgen levels for too long will also increase the risk of breast cancer, heart disease, and metabolic syndrome.

High androgen levels can happen at any age, while androgen deficiency is more common as women age since both testosterone and DHEA decrease with age. Many of the common menopause symptoms come from the changing levels of DHEA and testosterone. Far too many women suffer from uncomfortable symptoms as they age, but this does not have to be the case. If you suffer from any of these symptoms, consider working with a practitioner to determine if androgen deficiency may be contributing.

Symptoms of Androgen Deficiency

• lack of motivation

• decreased libido, sexual receptivity

• osteoporosis and osteopenia

• Decreased mood and decreased mental clarity

• Incontinence

• body aches

• fatigue

• insomnia

• fibromyalgia

• hot flashes

• vaginal dryness

Cortisol

This hormone is most well known as the stress hormone for which it sometimes gets a bad wrap. However, it is important to understand how cortisol has two modes.

Proactive mode:

• Coordinates sleep/wake cycle

• Regulates food intake

• Supports attention and integration of sensory information

Reactive mode:

• Increases in stress to provide the “fight or flight” response

• Promotes learning and memory processes

Due to the chronic nature of stress that most people experience, the body can be in the reactive mode all the time. This is called stress adaptation. This can occur when cortisol levels are chronically high or chronically low. When the body adapts to stress so often for so long the body becomes vulnerable to damage which is how stress can actually make you sick. The adrenal and hormone system is combined with neurotransmitters and the immune system. When these systems are constantly on high alert they adapt by becoming either less responsive or hyper-responsive. This leaves these systems either unable to read their normal signals or so fatigued it can do nothing about it.  

The reactive mode of the cortisol response is what becomes adrenal fatigue. Even though there are many different patterns of cortisol dysregulation many of the symptoms remain the same.

Symptoms of cortisol dysregulation:

• Unexplained weight loss or gain

• Body aches

• Fatigue

• Blood pressure issues (high or low)

• Salt and sugar cravings

• Blood sugar imbalances- shakiness or lightheadedness between meals

• Dizziness

• Feeling tired, but unable to calm the brain (tired and wired)

• Sleep difficulty

• Low libido

• Severe allergies

We need cortisol to be able to support us in the proactive mode as it is designed to do. Cortisol’s reactive mode is only designed for short intermittent need such as an emergency response. When the bod is in chronic high stress, it is forced to be in the reactive mode almost all the time. This prevents the body from being able to get back to the proactive mode. Lifestyle factors supporting the body resting and relaxing is the best way to get out of the reactive mode. However, when cortisol patterns are out of balance for a long time, they sometimes need support to relearn the proactive mode. A skilled functional medicine practitioner can help calm down stuck high cortisol responses and reboot stalled or low cortisol responses.