Hormone Replacement Therapy and Hormonal Imbalances

I get a phone call or two every week asking if I offer hormone replacement therapy. I don’t offer that or recommend it for 99% of the population even if they are “bio-identical” or “natural”. Now stay with me, as this may get controversial because even many holistic practitioners advocate HRT.

You can be prescribed hormones generally for two reasons, the first is because you had lab work and the lab shows a low value and two it can be due to symptoms like abnormal menstrual cycles, hot flashes, night sweats or vaginal dryness.

It is important to know that in most cases, even if lab values are low, this is only just a symptom and treating symptoms only leads to TEMPORARY relief or even worse, aggravation of symptoms.

Why Adding Hormones Isn’t A Real Solution

1.  It doesn’t really fix the problem. As I stated above, hormonal imbalances are almost always a symptom of another process not working correctly. By fixing the underlying systems (aka root causes) then the hormones balance themselves out.

2.  It can make the problem worse. Hormones are all about balance not always quantity. Every bit of hormone in the body uses body processes to function, the more there is, the more there is to balance. I like to think of a ballerina trying to balance on one toe vs. a sumo wrestler trying to balance on one toe. While both are possible you can imagine how much easier it is for the petite ballerina to deal with her lighter load.

3.  It alters your natural hormone production. As soon as you start taking a natural or synthetic hormone, the body’s natural processes shut down because it no longer needs to do the work. You see this commonly with the thyroid, but it also happens with the steroid hormones like estrogen, progesterone and testosterone. For decades men have known that taking testosterone (aka steroids) causes a decrease in “size”.

4.  More, more, more. Every person I have ever met that has taken a prescription hormone ends up with a future hormonal imbalance. It may take 6 months, a year or even two, but it is definitely going to happen. Almost always hormone dosages are increased or a different hormone like testosterone is added for many women. The cycle is endless until the patient usually gives up and then looks for answers elsewhere.

How To Naturally Fix Hormonal Imbalances

The natural route to hormone balancing is not only healthier but it is longer lasting. The reason why is because if we can discover the true source of the problem then the problem is less likely to return versus just treating symptoms. In addition each underlying source controls multiple processes allowing us to fix many things at once.

Root Sources of Hormonal Imbalances

Digestion & Dysbiosis

Almost every article I write will list digestive problems as a contributor to imbalances. From the day you are born when you inherit your mother’s gut flora, the little bacteria inside of your digestive tract can predispose you to high levels or low levels of estrogen.

Dysbiosis. The main problem with dysbiosis with regards to hormonal balancing is that it can undo the work that your liver has done. In order to dispose of excess hormones the liver binds them and prepares them for excretion. After leaving the liver, the bacteria in your gut can actually unbind the hormones and release them back into circulation. This can lead to a perpetual cycle of excess hormones in your blood stream.

In addition, this dysbiosis can lead to “leaky gut” which promotes inflammation. Inflammation in the body is viewed as a stressor.

Stress, Cortisol, Adrenals

There is something we refer to in functional medicine as the HPA axis. (Hypothalamus-Pituitary-Adrenal axis) The hypothalamus and pituitary are the major regulators of thyroid hormones, sex hormones and adrenal hormones. When you are under constant stress or high levels of stress the HPA axis creates more cortisol. Chronically high levels of cortisol lead to obesity, depression and overall lack of motivation. With a chronic need for cortisol, we are unable to produce adequate amounts of other hormones such as estrogen and progesterone.

Last, but not least, excess cortisol can lead to leaky gut which we mentioned above.

Insulin Resistance

Poor diet, the wrong kind of exercise and inadequate sleep can all lead to insulin resistance and sugar handling problems. High levels of insulin promote inflammatory chemicals called prostaglandins that can lead to chronic pain. Inflammatory chemicals (prostaglandins) lead to more cortisol production.

Insulin also promotes an enzyme called 17,20-lyase. This enzyme promotes the conversion of estrogen into testosterone in females, which can lead to PCOS and infertility.

Liver Detoxification

Poor liver detoxification can occur due to excess exposure to hormones, chemicals, heavy metals, mold, pesticides, and plastics and frequently due to nutrient depletion.

When the liver isn’t optimally functioning, hormones are either partially broken down or not broken down at all. The obvious one is when hormones aren’t broken down, they just keep circulating in the system and building up.

The less obvious situation is when partially detoxified hormones (partially conjugated) can re-enter the circulation and bind just like a normal hormone, but their effects are not the same. They take the spot of normal hormones and thus your lab values look normal, but you have hormonal imbalance symptoms.

High nutrient intake is important for getting the most from your liver. The standard American diet of white bread and processed sugar is very low in nutrients. Many people view the Paleo diet as only being a high protein, low-carb and gluten-free diet. While those may be true, I think the major benefit of a Paleo or Primal diet is that it is the most nutrient dense way to eat.

Healthy Fats

Getting as many healthy fats as possible while avoiding bad fats is the key. Healthy fats include organic butter, coconut oil, olive oil, heavy cream, egg yolks, bacon, grass-fed beef, avocados, etc. Unhealthy fats are things like vegetable oil, corn oil, safflower oil, etc. which are all found in processed foods, restaurants and almost anything that you buy in a bag or a box.

Putting it all Together

The best way to describe hormonal imbalance and its root causes is as a vicious cycle where each problem leads you to the next. You can start anywhere in the circle, but depending on how long you have had a hormonal imbalance, you will likely end up with all of them if you don’t find where it all began.

hormone imbalance cycle

Conclusion and Recommendations

 If you look closely at some of the real causes of hormonal imbalances you can clearly see that adding more hormones to an imbalanced system will not address root level issues and even more important it can make it worse by overloading the liver and other detoxification organs which will lead to the “vicious cycle”.

Treating hormonal imbalance can be started at home by:

1.  Eating a nutrient dense anti-inflammatory diet. This means avoiding refined sugars and grains. Healthy fats are critical, but if you are consuming a high amount of sugars and grains then it may even make things worse.

2.  Decrease your stress! Stress creates cortisol and leads to the mess we mentioned above. In addition it prevents the adrenals from doing its job of helping to balance the nuances of hormones, mood and brain cognition.  Remember that stress can be chemical, mental or physical so diet, relationships and pain all play a role in total stress load.

3.  Sleep, eat and exercise right to avoid extra adrenal stress. If you already have sleeping problems you might have a cortisol problem. If that is the case you need to focus on diet first. If you are sleeping well and eating poorly, start with eating. Exercising is a complex topic, but the focus should be on staying within your limits for exercise. If you haven’t exercised in 5 years, joining CrossFit may not be for you. Long evening walks can act as both exercise and relaxation.

After you have locked in your diet, sleep, exercise and stress levels, if you still suffer from any symptoms you probably need to find a professional to help you out with the specifics.

I offer free consultations in both Mesa and Scottsdale for female and male hormone problems like PCOS, infertility and other hormonal imbalances.