Hormone Cookbook - Amarillo Diagnostic Clinic, PA

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Hormone Cookbook
Joanna Wilson, D.O., NACP
Board-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!
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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
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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
Recipe #1
CONTRACEPTION
Ovarian Hormones in 28 Day Cycle
Brain- Ovary ConversationPositive Feedback
Brain
Ovary
How Do We Convince The Brain
To Ignore The Ovary?
Negative Feedback
No 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
Recipe #2
MENSTRUAL RELIEF
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
4
6
Vein Clot Risks
(per 10,000
women/year)
9
20
10 to5
Recipe #3
MENOPAUSE
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
Figure 4 Effect of age on DHEA and DHEA-S levels in women
Labrie F (2007) Drug Insight: breast cancer prevention and tissue-targeted hormone replacement therapy
Nat Clin Pract Endocrinol Metab 3: 584–593 doi:10.1038/ncpendmet0559
Why Not Just Start Everyone On
Hormones?
Timing Hypothesis of Menopausal
Hormone Therapy
High Blood
Pressure
Diabetes
Smoking
Time Since
Menopause
Heart Attack
Stroke
Breast Cancer
Blood Clot
Safety of
Hormone
Treatment
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 Supplementation
Risks
• 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
Ingredient Substitutions and Flavor Enhancers
ENDOCRINE DISRUPTING
CHEMICALS
Yummy Endocrine Disruptors
(Phytoestrogens)
Endocrine Disruptors = Hormone
Receptor Imposters
www.dnr.metrokc.gov/WTD/community/ed
c
• ‘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?

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