Hi, this is Dr. Susan Riegg, from www.susanrieggmd.com, and in this short video I'd like to give just a brief overview of bioidentical hormones, what they are, how we test for them, and how we treat imbalances that occur.
Hormones should really exist in harmony with each other. There is no hormone that acts by itself, and every single hormone in the body interacts with other hormones. So we really are looking at the entire endocrine system, because hormone imbalances can affect any of these organs. So, we're talking about the hypothalamus, the pituitary gland, thyroid gland, adrenals, ovaries, testes, and of course the pancreas producing insulin. We are going to have a particular focus on thyroid, adrenal, and sex hormones from gonads.
It turns out that all of these are controlled by the pituitary gland, which secretes prohormones that circulate in the body, and then arrive at the end organ and stimulate it to produce its final hormonal effect.
There is one form of bio-identical hormone balancing that everyone is familiar with, and that is replacing deficient insulin in patients who are insulin-dependent diabetics. The principles of this are very, very similar to testing and restoring estrogen, progesterone, testosterone, and thyroid hormones.
There are a whole host of symptoms involved with hormonal imbalances, some are very similar between men and women, but there are some unique symptoms that are specific to each gender. For women, the primary symptoms include weight gain, mood swings, hot flashes and night sweats, tender breasts, loss of sex drive (libido), and then interestingly, many women have extreme fatigue during the day and then insomnia and problems sleeping at night. Men can have similar symptoms, but they are more commonly describing things like a burned-out feeling, decreased mental clarity and memory, decrease in sex drive, irritability, depression, erectile dysfunction, and other symptoms.
It turns out that the root cause of many hormone imbalances is the effect of chronic stress, and it's really difficult to describe why this is without showing you just a little bit a biochemistry. I won't go too deep but I just want to demonstrate the effect of chronic stress on sex hormones and on thyroid hormones. You can see in this diagram, we're seeing all of the steroid hormones, which are being produced in a cascade. The beginning of this pathway starts with cholesterol, and then the pathway can go in two different directions. We can go in this direction to make sex hormones, which is primarily estrogen and testosterone, or the second pathway which takes us to cortisol, which is stress hormone. Now I'm sure you can appreciate that if there is a great deal a chronic stress, whether be psychological stress or physiologic stressors, the pathway going to produce cortisol is going to be dominant, and it's going to pull away the precursors; take them away from production of sex hormones. So this illustrates how elevated chronic stress actually decreases your production of sex hormones.
In a different mechanism, elevated stress takes away from thyroid function, and specifically, it affects thyroid in a way that does NOT show up on the TSH test. So, when stress is greatly elevated, the
hypothalamus is communicating with the pituitary, and the pituitary communicating with the adrenal to produce cortisol.
Now, there are a number of instances here where the stress response is dominant over the thyroid, and it crosses over and can inhibit production of different thyroid hormones. So, for example, corticotropin-releasing hormone can inhibit production of TSH. Also, when cortisol is being produced abnormally, as in chronic stress, it will also inhibit production of TSH, and it will inhibit conversion of T4 hormone to T3 hormone. T3 is really the hormone that we need for metabolic processes. That's the active thyroid hormone. In addition, what's not shown here is that if cortisol is too low, it will inhibit proper interaction of T and the T receptor on the cell.
So, the main point being, a couple points actually. First of all, elevated stress causes significant disruption of thyroid hormones, and secondly, we will talk more about this in a future video, but TSH test as a screening test (TSH stands for Thyroid Stimulating
Hormone) is specific but not sensitive. All that means is that if TSH is normal or even low, that does NOT necessarily mean that you have normal thyroid function, because it can be suppressed by all of these other problems. So TSH test is not a reliable test, and if you have all the symptoms of hypothyroidism, you should really consider checking much more than a TSH test. You should be checking your free T4 level, free T3 level, and also thyroid peroxidase autoantibody (TPO).
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