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! • • • • • • • • • • • • 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 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?