Which Hormones Need Testing? 

The major sex hormones to assess are estradiol, progesterone and testosterone. The main adrenal hormones are DHEA and cortisol. These five hormones will provide crucial information about deficiencies, excesses and daily patterns, which then result in a specifically tailored treatment approach and one far more beneficial than the old “shotgun" approach.

Below is a brief description of each of these five hormones: 

Estrogen:  there are three forms made by the body: estrone, estradiol and estriol. The form used in past hormone replacement therapies is estradiol, often in the form of concentrated pregnant mare’s urine (premarin).

It is a proliferative (causes growth) hormone that grows the lining of the uterus.

It is also a known cancer-causing hormone: breast and endometrial (uterine) in women and prostate gland in men. It will treat menopausal symptoms like hot flashes, insomnia and memory-loss. With the bio-identical formulas estriol is matched with estradiol (biest) to provide protective effects and additional estrogenic benefits. The other major protector in keeping estradiol from running amok is progesterone. 

Progesterone  is called the anti-estrogen because it balances estradiol’s proliferative effects. It is considered preventive for breast and prostate cancers as well as osteoporosis. In addition too little progesterone promotes depression, irritability, increased inflammation, irregular menses, breast tenderness, urinary frequency and prostate gland enlargement (BPH). 

Testosterone  is an anabolic hormone (builds tissue) that is essential for men and women. The proper level of testosterone is necessary for bone health, muscle strength, stamina, sex drive and performance, heart function and mental focus. 

DHEA  is an important adrenal gland hormone, which is essential for energy production and blood sugar balance. DHEA is a precursor to other hormones, mainly testosterone. 

Cortisol  is your waking day hormone (highest in the morning and lowest at night). It is necessary for energy production, blood sugar metabolism, anti-inflammatory effects and stress response. 

Some of the common imbalances identified through testing include estrogen dominance, estrogen deficiency, progesterone deficiency, androgen (testosterone and DHEA) excess or deficiencies, adrenal dysfunction and adrenal fatigue. 

ESTROGEN AND PROGESTERONE: 

Estradiol and progesterone are 2 hormones that are often tested together. 
When you test these 2 hormones together we also provide you with a Pg/E2 ratio. This ratio allows you to determine if the patient (male or female) has “Estrogen Dominance". Estrogen dominance is a risk factor for breast cancer and osteoporosis in females and prostate gland enlargement and cancer in males.  

The term “Estrogen Dominance" is less related to the amount of circulating estrogen and more related to the ratio of estrogen to progesterone in the body. Menopause and PMS are not the result of estrogen deficiency; although, estrogen levels do decline during the latter phases of a woman’s reproductive cycle.

More relevant is that the estrogen levels drop by approximately 40% at menopause or during periods of stress while progesterone levels plummet by approximately 90% from premenopausal levels.

It is the relative loss of progesterone that causes the majority of symptoms termed estrogen dominance. The disproportionate loss of progesterone begins in the latter stages of a woman's reproductive cycle, when the luteal phase of the menstrual cycle begins to malfunction.

The malfunction is initiated when the corpus luteum, the primary source of progesterone, begins to lose its functional capacity. By about age 35, many of these follicles fail to develop creating a relative progesterone deficiency. As a result, ovulation does not always occur and progesterone levels steadily decline.

It is during this period that a relative progesterone deficiency, or what has become known as Estrogen Dominance, develops.  

Typical Symptoms of Estrogen Dominance Include: 

Irritability/Mood Swings  

Depression  

Irregular Periods  

Heavy Menstrual Bleeding  

Vaginal Dryness  

Water Retention  

Sleep Disturbance  

Hot Flashes  

Headaches  

Fatigue  

Short-term Memory Loss  

Weight Gain  

The Progesterone/Estradiol (Pg/E2) reference ranges are optimal ranges determined by Dr. John R. Lee MD. While they are not physiological ranges, they are optimal values for the protection of the breasts, heart and bones in women, and the prostate in men.

Salivary values within these ranges have been shown by Dr. Lee to decrease both breast and prostate cellular proliferation, thereby providing protection to these vital tissues.  

TESTOSTERONE: 

Testosterone is often tested because the patient talks of low libido. Declining testosterone levels are the number one cause of low libido in males, and plays a contributing factor in females.  

Declining testosterone levels are commonly seen in men beginning in the fourth decade of life. Suboptimal or low testosterone levels in males are often associated with symptoms of aging and are referred to as “Andropause" or male menopause.  

Testosterone is an important anabolic hormone in men. It increases energy, prevents fatigue, helps maintain normal sex drive, increases strength of all structural tissues such as skin/bone/muscles; including the heart and prevents depression and mental fatigue.

Testosterone deficiency is often associated with symptoms such as night sweats, insulin resistance, erectile dysfunction, low sex drive, decreased mental and physical ability, lower ambition, loss of muscle mass and weight gain in the waist. The primary cause of this increase in girth is visceral fat, not excessive subcutaneous fat (fat under the skin).  

The visceral fat cells are the most insulin resistant cells in the human body. As a person ages hormone levels change in favor of insulin resistance. The insulin levels rise while progesterone, growth hormone and testosterone decline.

The visceral fat cell begins to collect more fat in the form of triglycerides. A vicious cycle is initiated, which if not interrupted with natural hormone balancing will lead to abdominal obesity, diabetes and high cholesterol levels.

This phenomenon is known as “Metabolic Syndrome". In males, metabolic syndrome results in lower testosterone levels, however, in females metabolic syndrome results in high testosterone levels and a phenomenon known as Polycystic Ovarian Syndrome (see below). 

Stress management, exercise, proper nutrition, dietary supplements, and androgen replacement therapy have all been shown to raise androgen levels in men and help counter male metabolic syndrome symptoms.

The “trick" is to know how much testosterone is required for each individual male. This is where knowing the salivary testosterone levels come into play. Initial salivary testing and following salivary monitoring are crucial for determining the most optimal prescription.  

Metabolic Syndrome and Polycystic Ovarian Syndrome (PCOS) in females results in the same visceral fat pattern, insulin resistance and triglyceride formation as in males, however, the female patients with PCOS and metabolic syndrome had high levels of testosterone and often DHEA.

This results in a typical symptom pattern seen in women with metabolic syndrome – acne, increased facial and body hair, hair loss on the head, trunkle obesity and infertility. Salivary testosterone and DHEA levels are diagnostic for this syndrome and follow up testing is key for monitoring treatment.

It is important to note that women do not need to have their ovaries to have metabolic syndrome. The adrenal glands in women who have a predisposition to metabolic syndrome can produce above normal levels of testosterone and DHEA. 
 

DHEA AND CORTISOL: 

DHEA is often thought of as an adrenal hormone and in fact it is, however, DHEA is also made in the ovaries. When we measure DHEA we are eliciting information about both the adrenal glands and the ovaries.

This is particularly important when DHEA levels are high. High levels of DHEA can mean that the adrenal glands are increasing DHEA production on response to stress or high glucose levels, or that the ovaries are increasing the production of DHEA as part of the PCOS cascade.

High levels of DHEA are often seen years before a female develops metabolic syndrome and should be used as a risk factor marker for insulin resistance. 

Low levels of DHEA are seen in evolving “Adrenal Gland Fatigue" (hypoadrenia). As acute stress becomes more chronic, the constant demand by the body for adrenal gland hormones begins to wear out the adrenal glands and DHEA and cortisol levels fall.

It is for this reason that DHEA is often measured in combination with cortisol levels. Cortisol is a hormone produced by the adrenal glands in response to stress and blood sugar levels. Cortisol secretion has a diurnal rhythm.

Normal cortisol levels should be highest one hour after waking in the morning and drop gradually throughout the day. Measuring the diurnal rhythm with 4 cortisol levels throughout the day gives a very accurate measure of adrenal gland function and their ability to cope with stress.

Adrenal fatigue occurs in stages. The stage at which a patient is at can be determined by looking at the diurnal cortisol graph and DHEA levels. Symptoms of evolving adrenal gland fatigue include fatigue, sleep issues, inability to cope with stress, anxiety, nervousness, irritability and allergies.  

Hypothalamic Pituitary Axis (HPA) Dysregulation is due to chronic stress with the resultant excess cortisol production and down regulation of cortisol receptors in the hypothalamus. In other words the negative feedback loop that normally shuts down the production of ACTH release is blunted and cortisol production by the adrenal glands is uncontrolled. If this continues, hypoadrenia always evolves. The symptoms of HPA and hypoadrenia are essentially identical but salivary testing easily distinguishes the two. This is crucially important as treatment of each can be very different.  

Measuring cortisol and DHEA levels will also diagnose complex diseases such as Addison’s Disease and Cushing’s Syndrome. Addison's disease occurs when the adrenal glands do not produce enough of the hormones cortisol and DHEA.

The disease is also called adrenal insufficiency, or hypocortisolism. It has however, no relationship to end stages of “adrenal gland fatigue" described above. The two illnesses have very different mechanisms of action.

Most cases of Addison’s disease are caused by autoimmune destruction of the adrenal cortex. Symptoms include chronic fatigue, weight loss, loss of appetite, muscle weakness, and hyperpigmentation of the skin.  

Cushing’s Syndrome results in excessive production of cortisol by the adrenal glands. Symptoms include rapid weight gain of face, trunk and back of neck, hirsutism, depression, anxiety and panic attacks.