Sex hormones are that are involved in the regulation of sexual development and reproduction. The primary sex hormones are estrogen, progesterone, and testosterone. Men and women have all of these, just in different amounts and ratios...
When men and women have low energy caused by an imbalance in their sex hormones, it is usually from different hormones. For men, it is usually due to a testosterone deficiency. For women, it is usually due to estrogen and/or progesterone imbalances.
The symptoms of menopause are no joke. They are incredibly uncomfortable and can change the quality of your life significantly. When a woman comes to me with menopausal symptoms, she is usually pretty desperate for relief. I use both natural and pharmaceutical therapies to get her that relief.
I am a big believer in natural medicine. It can be very powerful and work very well. I prefer to use it as long as the natural treatment is safe and strong. Unfortunately, when treating low thyroid, we usually need both the natural and the prescription treatments. In college, I learned from playing the card game euchre not to “send a boy to do a man’s job.” In medicine, this means using the treatment that you know will work. If I think a natural treatment will work, but I know that a medication will work, I should use the medication as long as there are no significant side effects. This is because I want to make sure you get results right away so that you can get your life back
Thyroid disease is one of the most common health problems we face today. The majority of people with thyroid dysfunction have hypothyroidism. Hypothyroidism (“hypo” means low) is a condition where the amount of thyroid hormone in your body is less than what is needed for optimal function. According to the American Thyroid Association, more than 12 percent of the US population will develop a thyroid condition during their lifetimes, and more than half will be unaware that they have a problem. Women are five to eight times as likely as men to develop thyroid problems.
Last week, I went over the recommended supplements to treat Adrenal Fatigue. This week I’ll go over adrenal recommendations as well as a plan to reduce stressors.
Treating the physical symptoms is only the first step. Once you start to feel better, it’s important to begin addressing the causes of the problem: the sources of stress that compromised your adrenals in the first place.
Last week we discussed the main symptoms as well as the causes of adrenal fatigue. This week, I will focus on testing and supplement options for treatment.
If you have most of the symptoms listed last week, you probably have adrenal fatigue. However, how do we test for adrenal dysfunction?
This week I will discuss how adrenal fatigue is a primary cause of chronic fatigue.
It's estimated that up to 80% of adults experience adrenal fatigue during their lifetimes, yet it remains one of the most under-diagnosed illnesses in the United States. Conventional medicine does not yet recognize adrenal fatigue as a distinct syndrome
Food allergies can cause almost any symptom the body can manifest, including low energy. The gastrointestinal tract maintains a delicate balance of good bacteria, specialized immune cells, and various neurological and hormonal activities. In fact, 80% of your immune system resides in your gut, so anything you put in your mouth can trigger a reaction. Once your digestive system detects what it considers a “foreign particle,” your immune system reacts, and the inflammation that follows creates pain and dysfunction.
Food is a touchy subject, especially if you’re not feeling well. We have a lot of emotional attachments to it, and it can give us joy at times when nothing else can. However, food allergies play a significant role as a cause and contributor to fatigue and, as a doctor, I have seen amazing improvements in the health of my patients when they change their food choices.
The symptoms of menopause are no joke. They are incredibly uncomfortable and can change the quality of your life significantly. When a woman comes to me with menopausal symptoms, she usually is pretty desperate for relief. I use both natural and pharmaceutical therapies to get her that relief.
Maca is an adaptogenic herb that can boost sex hormone function by stimulating endocrine glands. Sometimes called “Peruvian Ginseng,” maca is a South American adaptogenic root tuber that, when grown under certain conditions, can nourish the hypothalamus-pituitary-adrenal axis (HPA axis). In doing so, it supports the body’s production of estrogen, progesterone, and testosterone.
I have had success with the product FemmenessencePro by Natural Health International for this purpose. It has its own ramp-up that I will discuss at the end of the post. In clinical trials, 84% of post-menopausal women using FemmenessencePRO experienced a highly statistically significant reduction in menopausal symptoms within two days to eight weeks – the average was three weeks.
Another herb that can be helpful is black cohosh. Black cohosh can boost estrogen levels and reduce hot flashes. Other therapies that can be helpful include exercising, soy, optimizing adrenal and thyroid hormone function, and consuming an anti-inflammatory Paleo diet of vegetables, lean meat, and no grains.
These herbal and lifestyle remedies can be very helpful. Do you remember reading my approach to natural remedies that I shared in the Thyroid posts? Let me remind you: I am a big believer in natural medicine. It can be very powerful and work very well. I prefer to use it as long as the natural treatment is safe and strong.
If these natural options do not resolve your symptoms though, I recommend moving on to bio-identical hormone replacement therapy.
Bio-Identical Hormone Replacement Therapy
Bio-identical hormone replacement therapy (BHRT) refers to the use of hormones that are identical on a molecular level to those hormones that we naturally produce in our bodies. BHRT is usually referring to sex hormones, but desiccated thyroid is a perfect example of bio-identical hormones as well.
My mantra in hormone replacement therapy is “start low, go slow, mimic nature, and measure, measure, measure.” I learned this from Jonathan V. Wright, MD, who wrote the first BHRT prescription in the United States in the 1980s.
Besides resolving annoying symptoms, optimizing sex hormones has other health benefits, such as reducing your risk of cardiovascular disease, heart attack, stroke, and Alzheimer’s disease.
There are three naturally occurring estrogens in the body: estrone, estradiol, and estriol. For bio-identical estrogen therapy, I recommend a combination of estradiol and estriol (called Biest) compounded into a cream and applied to the vulva (outside the vagina) at bedtime. We chose this location because we want to mimic nature by releasing the hormones near the gonads and because the blood vessels and mucus membranes quickly absorb it. In men, this is going to be the anus, because it is the closest mucous membrane to the testes.
The combination of estradiol and estriol supports the benefits of the treatment while decreasing the risks associated with it. Estradiol is great at reducing estrogen deficiency symptoms, but it may promote the risk of heart disease and cancer. To balance this, estriol protects the heart and prevents cancer, but is weakly estrogenic and not great for treating low estrogen symptoms on its own. Consequently, they make a great team. I use more estriol than estradiol in the Biest cream to decrease the risks of therapy. I typically use a ratio of 80 percent estriol to 20 percent estradiol. I recommend starting with 0.25 to 0.5 mg of cream, applying 0.2 ml to the vulva each night. If your symptoms of estrogen deficiency are not relieved, increase the dose by 0.1 ml per week until you experience breast tenderness (a sign of too much estrogen), then back down to your previous dose. I call this the Estrogen Ramp-Up protocol. Once you have figured out the right dose for you, check your levels in urine.
I also recommend using progesterone with the Biest to provide additional anti-cancer and heart-protective effects. You can add progesterone even without symptoms of low progesterone. I recommend 20 mg added to the cream after you have completed the Estrogen Ramp-Up and you’ve figured out the right dose of Biest for you.
If you don’t have access to a medical provider, consider the supplement Ostaderm-V, a fermented plant derived estriol cream derived from wild yam. You ramp-up by 1/8 tsp every week.
Progesterone can be applied topically as a cream or swallowed as a pill. What?! But what about the risks, Dr. Evan? Didn’t you just say that when hormones are consumed orally that they are changed by the liver and can cause cancer? Yes, I did. However, progesterone is fat soluble, not water soluble, so it does not get processed by the liver and does not have any of the associated risks. With progesterone, I prefer the oral form because it is more effective in treating insomnia and anxiety symptoms, the two most common progesterone-related complaints that I hear.
To find out the right dose of progesterone for you, use my Progesterone Ramp-Up protocol. Start with one 25 mg capsule of compounded progesterone at night. Increase it by one capsule every three or four days until your symptoms have resolved or until you feel groggy in the morning (that means you’ve taken too much). Then back down a capsule or two. The maximum dose of progesterone is about 200 mg or eight capsules per night. There is a non-compounded bio-identical form of progesterone called Prometrium, but it only comes in 100 mg or 200 mg capsules. Some of my patients also react to the fillers in there, but it is an option for those who don’t have access to a provider who will write a prescription for compounded hormones.
If you don’t have access to a medical provider, consider the supplement Progonol, a fermented plant derived progesterone cream derived from wild yam. You ramp-up by 1/8 tsp every three or four days.
Once you have found the right dose for you, check your levels in urine.
For testosterone treatment in women, I recommend 1 mg in 0.1 ml of cream. If that doesn’t resolve your testosterone deficiency symptoms, then use the Testosterone Ramp-Up. This entails increasing by 0.1 ml every week up to a maximum of about 0.5 ml (5 mg). In women, signs of testosterone excess include excessive hair growth and aggression.
In men, I recommend starting with 50 mg per day in 0.1 ml of cream applied to the anus. If that doesn’t resolve your symptoms, then increase weekly by 50 mg until your symptoms resolve, you get symptoms of testosterone excess, or you achieve the maximum of 300 mg. Testosterone can convert to other hormones that you don’t want, so you’ll need to check these regularly. They are dihydrotestosterone (DHT) and estrogen. You can check these in blood. If these levels are increasing, then discontinue or decrease the testosterone, or use supplements and medications to inhibit the conversion.
If you are not responding to testosterone therapy, you may need to remedy the usual suspects first.
If you are experiencing the symptoms listed above, schedule a time to chat so we can discuss a plan to get your hormones balanced and get you back on the road to higher levels of energy.
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Evan H. Hirsch, MD
Evan H. Hirsch, MD, (also known as the EnergyMD) is a world-renowned Energy expert, best-selling author and professional speaker. He is the creator of the EnergyMD Method, the science-backed and clinically proven 4 step process to increase energy naturally. Through his best-selling book, podcast, and international online telehealth programs that can be accessed from everywhere, he has helped thousands of people around the world increase their energy and happiness. He has been featured on TV, podcasts, and summits, and when he’s not at the office, you can find him singing musicals, dancing hip-hop, and playing basketball with his family.