Hormone Cookbook

Joanna Wilson, D.O., NACPBoard-certified Internal Medicine

My first hormone memory…

Familiar Uses of Hormone Therapies

• Freedom from menstrual symptoms• Control of when and how many children we

have• Reversal of infertility• Relief of menopausal symptoms

Sex Hormones Affect These Issues, Too!• Infection susceptibility• Asthma• Oral health• Autoimmune disease• Vascular disease• High blood pressure• Dementia• Bone strength• Muscle strength• Mental health • Breast, lung, prostate, colon, kidney cancer• And just about every other disease

How Hormones Work

• Cofactors which modify the cell’s response• Timing of hormone production (pulsatile or

continuous)• Dose response• Central control (positive and negative pituitary

feedback)• Interaction with other hormones• Cell surface receptor

Main Ingredients For Today’s Recipes

• Estrogen• Progesterone• Testosterone

Progesterone Effects• Protects the uterus from overgrowth due to estrogen

stimulation• Helps nerve cells repair• Prevents bloating from estrogen• Inhibits the breakdown of serotonin• Helps stabilize mood• Increases body temperature during ovulation• Antiinflammatory• Increases appetite• Improves sleep• Chemotherapy for breast, prostate, and renal cell cancers

Testosterone Effects

• Muscle mass and strength• Bone mass• Sex drive

Estrogen Effects

• Improved cognition and memory• Improved neuronal healing• Improved glucose tolerance• Maintenance of fat distribution in periphery• Improved bone mass and strength• Raises HDL, lowers LDL cholesterol• Improved blood vessel healing

Estrogen Receptor Locations

CONTRACEPTIONRecipe #1

Ovarian Hormones in 28 Day Cycle

Brain- Ovary Conversation-Positive Feedback

Brain

Ovary

How Do We Convince The Brain To Ignore The Ovary?

Negative FeedbackNo surge = No ovulation

• All (combination) birth control pill options have stable daily estrogen dose

• Low, consistent hormone dose prevents pituitary surge to prevent ovulation

X

Progestogen Receptor Activations

Progestogen Characteristics and Side Effects

Can We Prevent Ovulation Only When We Need To?

Emergency Contraception

175 pounds

MENSTRUAL RELIEFRecipe #2

Contraceptive Pill Options

• Cyclic- 7 days of no progestin (“withdrawal”)– Monophasic– Triphasic

• Continuous- no withdrawal week– Monophasic only

Estrogen and Progestin Levels on Continuous vs Cyclic Birth Control

Vein Clot Risks(per 10,000

women/year)

4

6 9 10 to5

20

MENOPAUSERecipe #3

Endothelial Cell Layers in Healthy Postmenopausal and Premenopausal Women

• Postmenopausal cells show evidence of endothelial cell death, denudation, and RBC, platelet, and protein attachment, as well as fractured basal membranes, and loss of intercellular junctions

• Premenopausal cells show tight connections, a continuous layer of endothelial cells, and thick plasma membranes

Estrogen Sources

Before Menopause• Ovaries

After Menopause• Adrenal glands• Fat• Tissues

Labrie F (2007) Drug Insight: breast cancer prevention and tissue-targeted hormone replacement therapyNat Clin Pract Endocrinol Metab 3: 584–593 doi:10.1038/ncpendmet0559

Figure 4 Effect of age on DHEA and DHEA-S levels in women

Why Not Just Start Everyone On Hormones?

Timing Hypothesis of Menopausal Hormone Therapy

Safest Therapy Choices

• FDA Approved:– Transdermal Estradiol– Vaginal Progesterone (cyclic)

• Not FDA Approved:– Bioidentical therapy

Compounded “Bioidentical” Hormones

• Dosing schedule mimics premenopausal state in postmenopausal women

• Plant derived hormones modified to be identical to human molecules

• Not regulated for purity of modification process• Saliva levels do not accurately measure tissue

levels• Progestogen skin cream has not been proven

effective to prevent endometrial cancer

Testosterone SupplementationRisks

• Possible increased risk of breast cancer• Acne• Hair loss

Manipulation of Testosterone Supplementation

• Aromatase blocker to reduce conversion to estrodiol (Femara, Arimidex)

• 5α-reductase blocker to reduce conversion to dihydrotestosterone (Propecia)

Estrogen Therapy Challenges

• Estrogen receptors in tissues cycle, but independently of ovarian function

• Serum or saliva tests do not show what is needed in the cells– Optimal levels for dosing are not known

• Receptor stimulation or blockade is required to prevent cancer and blood clots– We don’t know how to do this, yet!

Creating the Perfect Estrogen Replacement

ENDOCRINE DISRUPTING CHEMICALS

Ingredient Substitutions and Flavor Enhancers

Yummy Endocrine Disruptors (Phytoestrogens)

Endocrine Disruptors = Hormone Receptor Imposters

www.dnr.metrokc.gov/WTD/community/edc

• ‘EDCs are commonly found in food and food containers, plastic products, furniture, toys, carpeting, building materials, and cosmetics. They are often released from the products that contain them and enter the bodies of humans and wildlife through dust or through the food chain’.

Endocrine Society Scientific Statement

Newest EDC: Triclosan

Developmental Stage at Exposure to EDC Changes Impact

Hormone Cookbook: Summary

• Estrogen, Progesterone, and Testosterone contribute to the health of every cell and organ

• Using hormones in various ways helps us maintain reproductive control and prolong health

• Exposure to chemicals which stimulate hormone changes may have long-term effects

THANK YOU FOR BEING HERE!

Questions?