Hormone replacement. Testosterone replacement. Bioidentical hormones. Hormone therapy. T therapy. Sex hormones. Hormone pellets.
Do any of these words sound familiar to you? Perhaps you are using a hormone that has been prescribed by your doctor. It may be that you are using an over-the-counter supplement to feel better, build muscle, or charge your sex life. Clearly individuals who choose to utilize hormonal therapies often do so in their quest to feel better.
Your decision to use hormones may be more practical, like maintaining bone health, or decreasing your risk for heart disease. Directed therapies may help to sharpen thinking, language and memory. Appropriate hormone use may help us to achieve these goals.
Hormone balance is essential for health and longevity
So exactly what is a hormone? Why are hormones so important, and how are they related to a sense of fatigue? This blog will address these questions, and help you to understand your biology, and optimize your hormone therapies.
Lasting health results when a series of biological systems have been addressed. When systems are balanced, and working synchronously, we see an improvement in health. Hormone therapy is one of these systems.
The hormonal system is a dependant one. Its ability to work well, to function in all of the ways that we would hope, relies on a strong foundation of the other systems. Hormone therapy can never stand alone.
When it comes to whole-body health, hormonal therapy is like the icing on the cake. The cherry on the sundae. The cat’s meow.
Let’s get things straight. We are talking about sex hormones here.
Readers of my blogs understand that there are numerous hormones in the body. We have covered several of them in other blogs on this site.
- Insulin is a hormone released by the pancreas that lowers the blood sugar.
- Cortisol and adrenaline are hormones released by the adrenal glands in times of stress. They help us to get away from a tiger, or to survive a period of starvation.
- Thyroid hormone is our body’s thermostat. When stress is low, and food is plentiful, we burn hot (and have lots of energy). In times of stress, or when our food supplies are low, we conserve. Often our body’s normal adaptation to our environment is perceived as fatigue.
These are some of the more well-known hormones. They are called hormones because they are made in a gland (above, pancreas, adrenal, and thyroid respectively) and exert their effects remotely from where they were made.
That’s right. A hormone is defined by the fact that it is made in a gland, and delivered elsewhere by the blood stream to carry out its message at a different gland or tissue. (Technically a gland can signal to itself, too.)
Thyroid hormone is made in the thyroid gland, but every cell in the body has a dedicated receptor to this hormone. Every cell is waiting to hear its communications, its message.
We are thought to have ten trillion cells. Imagine having a Twitter account with ten trillion followers.
OK, doc. What makes a sex hormone different from these other hormones?
Excellent question. By definition, a sex hormone is like any other hormone. It is made in a gland (adrenal, testis, ovaries) and instructs a cell’s DNA somewhere else in the body. Several characteristics of the sex hormones make them unique, and an avenue for addressing aging and fatigue.
The most obvious job for our sex hormones is the act of reproduction.
Our thoughts, emotions, and interpersonal interactions collectively hinge on hormonal activity. From a simple smile on the subway to a roll in the hay, we are dependant on hormonal function and balance, to keep us human. Hormones influence how our bodies and our minds work.
The point here is that we are sexual animals, and sexuality has deep roots in biochemistry, biology and society. Balanced hormones allow us to satisfy all three of these factors. Let’s look at each of these individually.
- Get your biochemistry grooving. Hormones drive biochemical processes. They do this by working within the nucleus of the target cells. Steroid hormones bind to the DNA of cells, and instruct the cells what proteins they need to make. The protein made may be structural, modifying the size and strength of a muscle, a ligament, organ or bone. A protein might be functional, like an enzyme that drives metabolic transformations. The protein could even be another hormone, like the molecule insulin. It all depends on the cell type receiving the message, and the instructions delivered by the hormonal messenger.
- Get your biology grooving. Hormones, in particular the sex hormones which we are discussing today, set us up to reproduce. We know that reproduction is crucial for a species’ survival, whether a you are a bacterium, plant or a human. The sex hormones influence our mindset, our receptivity, and the function of our reproductive tissues. If you are fatigued, and tired all the time, it may be nature’s way of saying this is not the right time to use the energy required to pass on your genes to the next generation. Stress and fatigue are directly related to libido and sexuality.
- Get your relationships grooving. As humans, we are social animals. For the most part we rely on social relationships to keep us safe and fed. The sex hormones feed into this relationship. When our hormones are balanced, we feel good, and look good. We search out interpersonal relationships. We engage with one another, and sometimes we flirt. A glance, a blush, a fantasy, and a smile all reside in sex hormone balance. Sex hormones are the societal “glue” that hold us together emotionally.
Our primary sex hormones are estrogen, progesterone and testosterone. They must be evaluated within the context of the adrenal hormones DHEA and cortisol.
Take a look at the following block diagram below. This is a simple representation of the “steroid cascade.” This simplified diagram depicts the broad categories our body can choose when making a steroid hormone from the molecule cholesterol.
As a nation we have been on such a (misguided) rant against cholesterol over the past few decades, we have collectively forgotten what cholesterol does in our body. The sole job of cholesterol is not just to cause heart disease. (Which it doesn’t really directly do. Stay tuned for a much more involved discussion on that one. I’ll stay off of my soapbox for now.)
Cholesterol is good for us.
- It is the foundation of our sex hormones
- Our brain is 60% fat, a quarter of which is cholesterol
- Cholesterol makes up about half of the molecules in each cell wall
The cholesterol molecule is pretty important, to say the least.
Cholesterol, stress and sex hormones: A balancing act
This simple block diagram outlines the essential basics of steroid hormone production. In this diagram, arrows represent enzymes that drive chemical reactions. Depending on our environment (stress, toxins, food/starvation) our body chooses to send cholesterol down one of two pathways.
- Cortisol is catabolic. Catabolism breaks down tissues. It raises blood pressure, blood glucose, and heart rate to keep us alive. Cortisol sets survival as a priority. “Let’s stay alive, and survive the tiger attack. We can lick our wounds later.” It is OK to be transiently diabetic (high blood sugar), tachycardic (high pulse), and hypertensive (high blood pressure). If you are being attacked by a tiger, this kind of a response is extremely beneficial.
The cortisol side of the balance dominates in times of stress. The stressor might be an infection, a period of starvation, or bodily harm. These are significant stressors in life, and they deserve a strong adrenal stress response.
However the stressor could also be entirely in our minds. Our minds are powerful, and stress-based physiology can dominate regardless of the presence of an actual stressor. We can drive our biology with only our minds.
Through the power of our brains, we can manifest the same physiological changes that would occur with a genuine stressor. The cortisol goes up, and it cracks the whip for all of the downstream tissues, regardless of an actual threat or not.
- DHEA is anabolic. Anabolic processes build up tissues, and make us stronger. It makes sense that a stronger, fitter, and nutritionally sound animal would want to make strong, fit baby animals. Are you continually running from a tiger, depleted, and weak? This may not be the best time to make babies. Our bodies understand this. Pregnancy, a direct extension of our sexuality, takes a lot of cellular and metabolic energy.
Another way to look at this association is with an even simpler diagram, shown below.
Generally, these two hormones are thought to move inversely relative to one another. Our body pulls its resources towards a more catabolic state (cortisol), or anabolic (DHEA.)
Ideally DHEA and cortisol are in balance. We remain fit, well energized and trim, yet we spark when we need to rise to the unexpected challenge or stressor.
When survival is at question, the body asks one simple question:
Do I fight to stay alive, or do I reproduce?
Do I make the sex hormones, testosterone and estrogen, or do I make cortisol?
Over time, the constant drive to make cortisol at the expense of our sex hormones wears us down. We get tired, grumpy, and our thinking starts to falter. Our metabolism paradoxically slows, and we gain weight.
As a doctor I see a triad of imbalance in the sex hormones, low thyroid, and poor insulin function. All of these hormones, sex and otherwise, are directly related.
In health, this relationship is dynamic. We are balancing transient stressors with the opportunity to grow and heal. Depending on the environmental pressures, we should ideally favor anabolism, which is the building of tissues.
Catabolism, on the other hand, breaks tissues down. In this state we “harvest” our own tissues to recruit the energy to stay alive.
When times are good, we favor the anabolic pathway, with plenty of reserves for the real stressors. A real stressor is a predatory feline: an infectious microbe, a drawn-out tribal war, a slim harvest. Your next stressor could be none of these, just a surprise meeting with the company head. You will want to tap into this stress response, and respond with power and focus.
When we spend too much time driving cortisol and catabolism, we get weary. We lose muscle mass, brain power and libido. We become fatigued.
It is essential to consider sex hormones within the context of our stressors, and the balance of the steroid cascade. Simply replacing sex hormones without addressing cortisol and DHEA will invariably leave you chasing your hormonal tail!
Sadly the use of sex hormones in our society has become greatly commercialized, with information from all sides promoting the newest cream, injection of gel. As with so many things associated with human physiology, it is never as simple as just fixing a single component.
The secret to wellness is the ability to look at the human body within a spectrum of systems. In this post I have introduced the concept of maintaining a balance within our catabolism/anabolism as an initial step towards really fixing our fatigue, improving our health and aging.
Here we are balancing two systems.
The first system, sexuality and reproduction, depends on the requests that we are making of our body as we dip into our energy reserves. Dip too often, and the tank gets low. We de-emphasize this system when we are under stress. As an adaptive mechanism, this just makes sense.
The second system is that of energetics. It is here that our body makes an assessment of our nutritional and energetic stores. It prioritizes either storing or utilizing energy, depending on the environmental pressures.
How does this look clinically?
I frequently see sex hormone imbalances reflected in low energy, fatigue, poor focus and diminished libido. Metabolic changes follow, with a redistribution of fat and muscle, and diagnoses based in abnormal insulin, blood pressure and blood sugar.
Hormone imbalances look different in men and women. Do you experience some of the symptoms listed below?
- Loss of drive. (Not just sex drive!) Low motivation and focus
- Poor sleeping
- Increased blood pressure, blood glucose and body fat
- Decreasing libido
Women (pre- and perimenopausal)
- Mood and memory changes
- Menstrual changes. Can be more or less frequent, heavier or lighter
- Weight gain, particularly around the midsection and hips
- Decreasing libido
In later posts, we will dive deeply into hormone specifics: the tissues they primarily affect, the messages they send to those tissues, and their relationship to one another. As we develop our knowledge further, we can then address the ways to measure, and modify these hormonal messages.
In many people, hormone management to treat fatigue and aging is an appropriate step. But it is done most safely and successfully when we have established some foundations.
Build a foundation of health to support your hormones
We need to first consider a patient’s nutritional state. Sound nutrition guides our ability to metabolize the sex hormones that are made in, or added to our body. Nutrients allow us to make the neurotransmitters that keep our brains and nervous system in check. Our nutritional state allows us to keep the fires burning, and burning well.
We need to be thinking about how our sex hormones relate to how we are energized. Sex hormone function and balance is necessarily associated with our adrenal glands, and our perception of stress.
Hold on to the image of the cortisol—–DHEA teeter-totter. To really understand fatigue, we need to know where we are in the catabolism—–anabolism balance.
Our ability to digest, to detoxify, and degree of inflammation all contribute to hormonal function.
As we work within these systems, we begin to heal. We beat fatigue, reverse disease, and slow the aging process.
Learn to dance to your hormonal symphony
Balanced hormone levels and function are essential to health. Don’t be fooled by the hawkers, clinics and products that claim that a simple cream, tablet or food will solve all of your woes.
Hormones are part of a choreographed “dance.” I will frequently use the term “symphony” to describe how all of the hormones, sex and otherwise, need to play well together for optimal health.
Our sex hormones function in concert with the other aspects of our physiology outlined in bold in the paragraphs above. You can learn more via the navigation tabs at the top of this page. By addressing all of these systems, we can experience durable, lasting health.
Hormone therapy can help your fatigue, sharpen your mind, and straighten out your health. But be sure to consider all of the players in your body’s hormonal symphony.
You don’t want to be dancing to just a single drum.
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