From the Doctor’s Desk: Salivary Hormone Testing Backed by Science
Saliva testing for hormones first appeared in the medical research literature in the early 1980′s. Salivary testing is becoming the testing method of choice for many reasons including: 
- Saliva testing evaluates the “free” (active) hormone levels. A hormone has to be unbound to elicit a physiologic action. Saliva testing looks at the active hormone inside the cell, at the site of action. Saliva testing has been validated as a testing method for measuring the hormones cortisol, estradiol, progesterone, DHEA, and testosterone to name a few.
- Saliva testing requires no needles.
- Saliva testing has been shown to be well validated and superior than blood, with sensitivities and specificities exceeding 100% and 97.4% respectively. Other than perfection, you can’t get much better than that.
- According to the National Institute for Health, saliva testing is useful in “detecting various cancers, heart disease, diabetes, periodontal disease…”
- Saliva testing is also useful in disease evaluation. Saliva testing of cortisol has been recommended as the first-line test for Cushing’s syndrome due to “high diagnostic accuracy.”
Testing hormones through saliva is backed by science. But don’t take my word for it. In fact, it’s well supported in medical literature and is the right thing to do. Below are links to several abstracts regarding salivary hormone testing. Read them for yourself and learn about the science behind this form of hormone testing.
- Belkien LD, Bordt J, Moller P, Hano R, Nieschlag E. Estradiol in saliva for monitoring follicular stimulation in an in vitro fertilization program. Fertil Steril 1985;44:322.
- Bolaji II, Tallon DF, O’Dwyer E, Fottrell PF. Assessment of bioavailability of oral micronized progesterone using a salivary progesterone enzymeimmunoassay. Gynecol Endocrinol 1993;7:101-110.
- Campbell BC, Ellison PT. Menstrual variation in salivary testosterone among regularly cycling women. Horm Res 1992;37:132-136.
- Aardal-Eriksson E, Karlberg BE, Holm AC. Salivary cortisol- and alternative to serum cortisol determinations in dynamic function tests. Clin Chem Lab Med 1998;36:215-222.
These articles are published in well-respected journals; and if you notice, they are not recent. Salivary testing of hormones has been well published in the medical literature for some time now.
Here are a few quotes from these studies:
- “…salivary cortisol may be used as an alternative parameter in dynamic endocrine tests.”
- “…assessment of ovarian function…can be performed precisely with the saliva estradiol assay.”
- “…saliva collection has provided the medical and research community with an excellent medium for the monitoring of plasma steroid levels.”
Nowhere else in medicine do we blindly treat people without assessing a baseline and post treatment level(s). Balance is the key; not one individual hormone. Unfortunately, the medical field is very slow to learn and change.
For more information about salivary testing, read Evaluating Hormones Requires More Than Just a Blood Test.
The Low-T Epidemic: Hormone Receptors Revealed
Male infertility. Decreased sperm count. Did I grab your attention? These are just two of the symptoms of Testosterone Deficiency (TD), more commonly referred to as Low-T.
TD has become such a widespread problem that one study (The 20-Year Public Health Impact and Direct Cost of Testosterone Deficiency in U.S. Men) projects over the next 20 years TD will:
- Be involved in the development of approximately 1.3 million new cases of cardiovascular disease;
- Be involved in the development of 1.1 million new cases of diabetes mellitus;
- Be involved in the development of over 600,000 osteoporosis-related fractures; *create medical-related costs, in the first year, of approximately $8.4 billion;
- And be directly responsible for approximately $190–$525 billion in inflation-adjusted U.S. health care expenditures over the 20-year period.
So if TD is causing such widespread health issues, how will we solve the Low-T problem? As I mentioned in my last post, there are four components necessary for wellness, good physiologic function, and symptom-free living. Let’s take a look at the fourth on the list.
Hormone receptors must appropriately respond to the signal sent by the hormone to your body. To take a closer look at the Low-T problem, let’s look at androgen receptors.
What is a hormone receptor? Hormone receptors are the landing place for hormones inside your cells. Once a receptor receives the hormone and its message, the receptor undergoes a change sending a signal to the cell nucleus and DNA. [Side note: This is one reason that hormone testing via saliva (not just blood) is such an effective way to evaluate hormones in the body. Saliva testing allows a look at hormones at the sight of action, revealing the free, bioactive hormone inside the cell.]
What is an androgen receptor? Androgen receptors play catch to the two most potent androgens, Testosterone and dihydrotestosterone (DHT) which actually compete for the same receptor. These two hormones are present in both males and females but are typically known as male hormones. Both Testosterone and DHT are very important in development, but here’s an unexpected fact – the androgen receptor actually likes DHT better than Testosterone. What?
You heard me correctly. The androgen receptor has an affinity for DHT over Testosterone. So why in the world are we prescribing so much Testosterone to cure the Low-T problem if it’s not the best solution? Here are some DHT facts.
- DHT inhibits estrogen production. Remember estrogen is a major culprit in inflammation, obesity, weight gain, and hormone imbalance.
- DHT is a more potent androgen than Testosterone. DHT is the most potent androgen exceeding that of Testosterone by a ratio of 3:1. Its increased potency is through its greater affinity for the androgen receptor. And that greater affinity is by a ratio of 3:1.
- DHT does not get converted to estrogens. This is a major problem with simply prescribing Testosterone to men…the body is converting much of it to estrogen.
- DHT binds with a higher affinity and longer duration (5 x longer) to the androgen receptor. Testosterone compensates for this by increasing it’s concentration relative to DHT. Only about 5% of testosterone is converted to DHT. So, a smaller amount of androgen (DHT) has a larger signaling effect due to it’s higher affinity and binding time with the receptor.
New Perspectives On Hormone Balance Ahead
Perspective. It affects everything. Take, for example, the beauty of the earth. Some might look at the magnificence of the earth and think of Darwinian theory. But as I stand in my back yard, I am amazed by God’s creation. When I look out of the window on my many plane flights, I am amazed by God’s creation. And when I see the perspective from space as seen by astronauts, I am still amazed at God’s creation.
Perspective colors the way we see everything around us. For those, like myself, who believe in the God of creation, I view the world a certain way. And for those who choose to believe otherwise, they view the world a certain way.
Perspective is an important part of the medical world as well. As technology improves, the amount of information available to me as a physician changes the way I treat my patients because I now have more data than I’ve had in the past helping me make a better decision.
So, let’s talk about how perspective is an important part of evaluating hormones! (And you thought the only important perspective about hot flashes was “where’s the air conditioner”!)
If men were only about testosterone and women were only about estrogen, life would be easy and all would be symptom free. Unfortunately, that is, in a nutshell, the current perspective on treatment of hormone imbalance issues. It is not, however, an accurate perspective based on physiology. Just watch an hour of TV in the evening. The pharmaceutical companies are inundating us with ads about testosterone creams and the like. Regardless of clever marketing, looking at the reality of physiology based on the latest testing methods reveals that hormones are a lot more complicated than treating the level of just one hormone.
When it comes to hormones, there are four important components necessary for physiologic function and symptom-free living.
- Hormone levels need to be in the “normal” range. We don’t need the respective hormone levels too high or too low.
- Hormones need to be balanced. This is where many in the medical field get it wrong since all hormones work together to communicate to the body.
- Your body needs to effectively use the hormones present. Hormone metabolism is a key element in evaluating hormones in the body.
- Hormone receptors must appropriately respond to the signal sent by the hormone to your body.
The past (and current) perspective of the medical community is that the absolute levels of individual hormones are what is important and little attention is given to balance between hormones. Very little attention is given to the balance between hormones. For example, women, post-hysterectomy, are prescribed estrogen only. But we know that prior to the hysterectomy, all hormones are needed for a normal, functioning cycle, not just estrogen alone.
Some of the risks associated with estrogen therapy pertains to how the individual metabolizes or detoxifies the estrogen. Hormone metabolism can be affected by internal factors like genetic variations, or SNPs (single nucleotide polymorphisms), located in the detoxification pathways. These are small genetic coding errors. Hormone metabolism can also be affected by external factors such as magnesium and zinc, co-factors in those same internal detoxification pathways of hormone production and metabolism. Just the presence of the detoxification pathways does not a functional detoxification pathway make.
Finally, and the purpose of this post, are the receptors. Hormone receptors determine how the hormone’s signal to the body is then interpreted. Here’s an analogy to help you understand hormone receptors. I have four beautiful children. As with any parent, getting them to clean their room is an ongoing battle. The signal I give them is a verbal instruction such as “Kids, it’s time to get your rooms cleaned.” How that signal is interpreted is quite different. That signal may be interpreted differently based on the environment or pre-existing conditions. If my children are in one of their “moods” (side note: all four of my kids are redheads), then they may just not clean their rooms out of defiance. There is a reason we call the youngest one “the spicy tomato.”
All this to illustrate one important fact — how the signal is interpreted is just as important as the signal that is to be interpreted.
Scientifically speaking, hormone receptors are defined as “a large family of ligand-activated nuclear transcription regulators, which are characterized by organization into different functional domains and are conserved, to differing degrees, between species and family members.”
Was that as clear as mud? In plain English, hormone receptors are how the external signal, hormones, provide to the internal genome a message to turn genes on or off. There is also non-genomic signaling, but a large portion of signaling is actually done with your DNA. This is what hormones do — interact and turn on and off the expression of your DNA. Pretty amazing, huh? And you just thought hormones floated through your blood causing hot flashes in women or ED in men. That is the way most, including physicians, see hormones. However, that just couldn’t be more further from the truth. There’s so much more to it than that.
Hormone receptors are being used in the medical vocabulary today. If you know someone with breast cancer, you might be familiar with the term ER/PR positive or negative. This is in reference to estrogen receptors and progesterone receptors. This evaluation occurs from an actual tissue sample from the tumor itself and allows the medical team to determine the best course of action for that particular individual. In ER/ PR positive tumors, hormone therapy is used in contrast with ER/PR negative tumors where no hormone therapy is used.
The medical community is addressing the realities of hormone receptors and the role they play in disease. But what about those individuals with hormone imbalance symptoms like hot flashes or erectile dysfunction? Stay tuned. This testing hasn’t made it to the clinical setting yet, but animal testing holds great promise in helping to complete the full picture and improve the perspective that we have on hormones and all their related issues and factors.
Hormone receptors are my current area of research, and I’m writing articles on estrogen, progesterone, and androgen (male hormones) receptors as part of that research. Visit the Seasons Wellness Clinic blog often in the upcoming months so that YOU can become more educated on the body’s communication system — hormone and their receptors.
Navigate Your Health Journey With Good Reading
Because Tennessee ranks 39th in overall health of its citizens [according to America’s Health Rankings], we are passionate about educating the community on how to improve their health. I spend time daily reviewing the latest findings from scientific studies related to health and wellness topics to insure that Seasons is always offering the latest and best solutions for pursuing wellness.
Contrary to the belief of many, good health is not something that can be mandated from government or given to you by a physician. Health is a personal journey acheived only through education and self-awareness. At Seasons, our goal is to provide you with the resources you need to improve the health of you and your family.
Here are five books that are easy reads and are rich in good information for your health journey.
Inflammation Nation by Floyd H. Chilton, PhD
Inflammation Nation was written by Dr. Floyd H. Chilton in 2005. While the book goes back a few years, it is still incredibly relevant. Inflammation is one of the primary problems/obstacles to health today. Inflammation, in the short term, is a necessary part of the healing process. When you are cut, the “inflammation” present through redness, pain, and swelling works to protect the body from invasion and to start the process of healing. But the inflammation subsides quickly. However, in some, inflammation rages on and promotes disease.
It would make sense that if something, certain types of food for example, were causing inflammation in our body and ultimately leading to disease, we would want to eliminate the problem, reduce the inflammation and prevent disease, right? Dr. Chilton discusses the immune system and how our diet affects it. The old adage “you are what you eat” definitely applies here.
Inflammation Nation is an easy read and provides many easy recommendations to incorporate into your daily life.
The Wheat Belly by William Davis
The Wheat Belly is written by William Davis. Very rarely do I encounter clients that have not read or heard of this book. This book touches on a growing problem in America and the world today – an adulterated food supply. Not food supply that is adulterated with parasites or bacteria, but that is adulterated from within. What does that mean? In The Wheat Belly, Dr. Davis touches on the fact that the wheat of today is not the wheat our parents ate. Not only is the nutritional value present in wheat lost, but the genetic modification is likely contributing to inflammatory problems.
The problem with genetically modified foods (GMO) is we have limited knowledge of their impact on the body. And the federal government and its agencies have never done a good job of investigating these items before rushing them to market. Just look at the history of environmental toxins such as phthalates, parabenes, and other volatile solvents, all brought to market labeled as safe only to be removed from the market when revealed as seriously dangerous toxins.
This book is also a very easy read and provides easy dietary recommendations to immediately bring positive changes to your health.
What Your Doctor May Not Tell You About Breast Cancer by John R. Lee, M.D., David Zava, Ph.D., and Virginia Hopkins
This was the very first integrative medicine book I read in 2006. This book goes back to several founding people in the integrative medicine movement like Dr. John Lee, an oncologist who led the movement in bioidentical hormones and saliva testing. Dr. Lee was ostracized by the medical community, but his commitment to his patients and to true scientific evidence is an example for all to follow. In fact, Dr. Zava believed in this movement so much that he started a saliva-testing company.
As it relates to breast cancer, there are few more published than Dr. Lee and Dr. Zava. I have met Dr. Zava personally on several occasions, and there are few that I would put above his in both scientific integrity and commitment to true science.
This book lays out a different approach to breast cancer, one focusing on prevention instead of early detection. Traditional medicine focuses instead on early detection and cancer treatment. Don’t get me wrong. We need that, but true prevention is where we should first focus.
The book is deep at points, but is a good discussion of biochemistry and physiology as it relates to breast cancer. Its focus on more natural ways to prevent breast cancer is based on the scientific research. The book clears up much of the misinformation about hormones and breast cancer and equips the reader to be advocate in the prevention of breast cancer.
The book’s authors were unafraid to take on traditional medicine, but do so with a good foundation of science.
The Blood Sugar Solution by Dr. Mark Hyman
Dr. Hyman is a great proponent of wellness and a pillar in the integrative medicine community. This book, published earlier this year, is an easy weekend read with numerous tools to incorporate into everyday life. The focus of this book is nutrition, sugar, in particular.
Obesity is at epidemic levels in the United States. According to CDC data, 13 states now have an obesity rate greater than 30 percent, while in the year 2000, NO states reported obesity rates greater than 30 percent. This book takes the major culprit head-on: diet.
The Blood Sugar Solution delves into diet, insulin, insulin resistance, and a host of other factors contribute to poor health. The book provides many tools to succeed in the “battle of the bulge,” and even includes recipes to help you succeed in your personal health journey.
What Your Doctor May NOT Tell You About Hypertension by Dr. Mark Houston
If you ever have the chance to meet Dr. Mark Houston, you will surely be impressed. Mark Houston, M.D., is Associate Clinical Professor of Medicine at Vanderbilt University School of Medicine, Director of the Hypertension Institute and Vascular Biology, and Medical Director of the Division of Human Nutrition at Saint Thomas Medical Group, Saint Thomas Hospital in Nashville, Tennessee.
While his list of credentials are a mouth full, to hear him speak will fill your ear! As a cardiologist focused on an integrative approach, there are few that speak so eloquently on the deep biochemical disease found in cardiovascular disease.
While the subject matter might sound intimidating, this book, is a very easy read and focuses on the underlying dynamics of hypertension and associated complications. Dr. Houston defines the problem and lays out solutions with his wildly successful program for treatment of hypertension using an integrative medicine approach.
Dr. Houston also provides a health discussion of hypertension medications, when needed, and the mode of action and side effects of each. This a definite must-read for anyone on hypertension medications. You might just become more informed than your own physician!
While this book is a self-help guide to natural treatments of hypertension, it is based on sound science and the approach has been extremely successful. This book is also heavily referenced, allowing you the option of pursuing deeper learning if desired. This book removes every obstacle to reducing hypertension except you. It’s your job to act on what you read.
The Naturally Healthy Woman: Whole Health for the Whole Woman by Shonda Parker
Yes, I know I said five and this is number six! But this is a very good manual for women and their health. As an OB/Gyn, my first passion was women’s health. The author, Shonda Parker, whom I have met, is a true blessing to know. There are few who have a passion for health that exceeds hers, and she has an ever better spirit. Shonda is a nurse midwife, has authored many books, and speaks nationally on health and other related topics. This book highlights many of the health issues facing women today, and I predict that the edges of this book will become tethered due to your repetitive use after reading it.
As a nurse midwife, the author’s first passion is pregnancy. This book begins by touching and then builds into many other health issues affecting women. The author provides many natural remedies at the end of each section for the different health issues discussed. The book not only provides natural therapies for the mother/wife, but also for the rest of the household.
Every pathway to health is different. Every journey to wellness is unique. At Seasons, our desire for wellness for all begins with education and knowledge for you. I hope that these books will become additions to your library and provide you with the knowledge you need in your personal journey toward wellness.
Evaluating Hormones Requires More Than Just a Blood Test
Dr. Nathan Goodyear
“I just don’t feel right.” These are frequently the first words I hear a patient say. “I’m so hormonal…I know I’m not balanced. I’m tired, cranky….” and so goes the list of symptoms, all of which indicate hormone imbalance.
It’s amazing to me that most patients know intuitively that they don’t feel good and it has something to do with hormones, but they’ve had a blood test by their physician and everything checked out “okay.” That blood test, however, didn’t change the fact that they still feel terrible.
There is a lot of debate these days regarding the different methods of evaluating hormones: blood, saliva, and urine (oh my). In a few short weeks, school will start. So to get back in the swing of things, today school is “in session” and a science lesson is the order of the day. The topic? How are hormones evaluated and which is the best test for you?
Hormone Delivery and FedEx?
Understanding complicated topics is often made simple with a great analogy. My good friend, Dr. Eldred Taylor, uses the analogy of FedEx trucks to explain hormones and their delivery to the cells of the body. And I especially like this analogy because my dad has been a pilot for FedEx for many years!
FedEx trucks are everywhere during the month of December. It wouldn’t be unusual for a lot of trucks to pass your house during that month. But, if the FedEx trucks don’t stop at your house, it doesn’t really matter how many trucks have driven by your house or how many packages each truck contained. The fact remains that none stopped for delivery. It only takes one FedEx truck to stop at your house and the Christmas tree is full.
I’ll take it one step further. The day after Christmas, the boxes and wrapping paper are piled up at the road-side for pickup. You might comment as you drive by your neighbor’s house “It looks like the Jones’ had a good Christmas” based on the curbside aftermath. You can even make out what the gifts were based on the leftover boxes and debris on the curb.
What does it all mean? The FedEx trucks symbolize hormones in transport in the blood. It doesn’t matter how many hormones are transported through the blood (FedEx trucks), they are inactive (the truck didn’t stop at your house). When the FedEx truck stops at your house, it symbolizes when hormones are dropped off for action inside the cell. One truck can drop off 100 packages or 100 trucks can drive by, dropping off no packages. Finally, the post-Christmas driveway debris represents the hormones after the body has broken them down into metabolites.
Hormones can be evaluated through three different testing methods: blood, saliva and urine. Blood testing evaluates the number of FedEx trucks in your neighborhood. Saliva testing evaluates the number of packages delivered at your house. And urine testing evaluates the post-Christmas driveway debris to identify what packages were delivered and opened.
So what does the science say about the hormone testing methods of blood, saliva, and urine?
Blood Testing
Testing hormones present in the blood has been used to develop the current reference norms that we use in the diagnosis and management of many diseases. It has been around a long time. This kind of testing is effective in the disease model of medicine. However, in the wellness model of medicine, we are looking for dysfunction, not just disease. And this is where the effectiveness of blood testing breaks down. By identifying physiologic dysfunction, we hope to prevent disease. It is the move into true preventative medicine, not just early detection, the wellness model of medicine has found the blood testing of hormones to be lacking.
There are three main problems with blood hormone testing.
- First, is the whole idea of a needle. If we can evaluate hormone levels without puncturing the skin, then we should.
- Blood testing evaluates hormones in transport. This is typically reported as “total” hormone levels and the “free” active levels are calculated. Transported hormones are inactive. Hormones in the blood are bound to proteins (estimated at 95-99%) and inactive. Going back to the FedEx truck analogy, blood testing tells me how many FedEx trucks there are and how many packages they have to deliver. But it doesn’t tell me how many packages were delivered at your house. And that’s a very important piece of information. Are your hormones coming or going? And is your body utilizing the hormones you have?
- It is not the most accurate form of testing. Saliva testing is proving to be superior to blood testing for measuring hormones (see Saliva below).
Urine Testing
The use of urine to evaluate cortisol has been present for awhile. And this is a valid method to test cortisol, one of your body’s hormones. The problem with this form of testing is that most people don’t want to carry a jug around collecting urine for 24 hours.
Currently, the interesting research on urinary testing of hormones is in the measurement of metabolites. Think back to our analogy. Urinary testing is best used for looking at the curbside debris to see what presents were opened at Christmas. By measuring metabolites, we can see how effectively your body is metabolizing hormones. If your body is ineffectively metabolizing hormones, the resulting symptoms and conditions can include Chronic Fatigue Syndrome, obesity, fatigue, and increased breast cancer and prostate cancer risk to name a few. These issues are all treatable at Seasons Wellness Clinic with a customized wellness plan based on your test results.
Saliva Testing
Saliva testing for hormones first appeared in the medical research literature in the early 1980′s. Saliva is becoming the testing method of choice for many different reasons. Going back to our analogy, saliva testing measures the number of packages that are delivered by the FedEx truck at your house.
- Saliva testing evaluates the “free” (active) hormone levels. A hormone has to be unbound to elicit a physiologic action. Saliva testing looks at the active hormone inside the cell, at the site of action. Saliva testing has been validated as a testing method for measuring the hormones cortisol, estradiol, progesterone, DHEA, and testosterone to name a few.
- Second, saliva testing requires no needles.
- Saliva testing has been shown to be well validated and superior than blood, with sensitivities and specificities exceeding 100% and 97.4% respectively. Other than perfection, you can’t get much better than that.
- According to the National Institute for Health, saliva testing is useful in “detecting various cancers, heart disease, diabetes, periodontal disease…”
- Saliva testing is also useful in disease evaluation. Saliva testing of cortisol has been recommended as the first-line test for Cushing’s syndrome due to “high diagnostic accuracy.”
Saliva testing gives me the information I need to diagnose what’s going in your body. And while that is my opinion based on my training, it’s also opinion based on scientific fact according to hundreds of research articles (see links to additional articles below). Saliva testing is now considered the “gold standard” for hormone evaluation.
Today you have learned about the three methods physicians use for evaluating hormones: blood, saliva and urine. You’ve also learned that each test is useful for measuring different things. We can evaluate hormones many different ways at Seasons and determine not only the amounts of a specific hormone in your body, but also how effectively your body is actually using (or not using) those hormones with saliva and urinary testing.
Most important is the clinical relevance of each test. Testing the hormones at the site of action provides the best physiologic approach (saliva testing). Testing the hormone metabolites provides the next best approach (urine testing). Through the evaluation of the body’s metabolism of hormones, the physiologic mechanisms of how the body removes hormones can be evaluated. The evaluation of hormones in transit (blood testing) provides the least physiologic assessment.
While each test provides an appropriate measure, the question is, does that measure provide insight into physiologic dysfunction? And, can an appropriate therapeutic intervention be undertaken to effect a change? At Seasons, we provide answers using those test results, creating a customized wellness plan that will put you on the road to a life with more energy, balance, and, ultimately, happiness.
Cheers to the pursuit of wellness.
Man vs. Estrogen: It’s Not Just A Woman Thing!
Nathan Goodyear, M.D.
Testosterone is the defining hormone of a man. Estrogen is the defining hormone of a woman.
So when we talk about estrogen, it’s that word men whisper in secret when the women in their lives seem a little hormonal, right? When people find out that my wife and I have 3 daughters, the resulting comment is usually, “Wow, that’s a lot of estrogen in your household!” (Thankfully, I have a son, too, who helps balance the estrogen to testosterone ratio at our house!)
I’m sorry to burst your bubble, guys, but estrogen is not exclusive to women. We make estrogen, too. In fact, some of us make a LOT of estrogen. Too much, in fact. And it creates some serious problems.
But before we talk about estrogen, we need to talk about testosterone. Testosterone levels in American men are at an all-time low! There are four major reasons for that: stress, weight, endogenous estrogens, and xenoestrogens. In this post, I’ll address three of those – stress, weight, and endogenous estrogen.
So let’s get started learning four important facts about testosterone, estrogen, and men!
What problems do high estrogen levels create in men?
1. High estrogen = low testosterone. One of the primary causes of low testosterone is a high estrogen level. Estrogens can be endogenous (produced by your body) or exogenous (from the environment, also known as xenoestrogens). Estradiol and Estrone (two of the three kinds of estrogen produced by your body) feed back to the hypothalamus and pituitary and shut off testosterone production.
2. High estrogen = inflammation. Not only do high estrogen levels decrease testosterone in men, they also increase inflammation. And this is VERY significant. Inflammation, just like stress, is a biochemical process.
Inflammation is the natural result of the immune system. Remember the last time you got a paper cut? It was incredibly painful, probably red, warm and swollen, all cardinal symptoms of inflammation. Inflammation, in the right setting, is actually the body protecting itself. However, when the immune system becomes imbalanced or chronically activated, the immune system causes damage through inflammation. For example, chronically activated immune cells in the brain (glial cells) play a pivotal role in the development of Alzheimer’s, Parkinson’s, and Multiple Sclerosis.
Inflammation is a SERIOUS issue. Chronic inflammation has been linked to many of the chronic diseases of aging: Type II Diabetes, obesity, hypertension, and cancer. In fact, a new term has been coined to describe inflammation arising from the gut which results in many of the above listed disease states - metabolic endotoxemia.
We’ve established that high estrogen levels are bad for men, shutting down testosterone production and causing chronic inflammation leading to disease.
What causes high estrogen levels in men?
1. High aromatase activity = high estrogen. First, high endogenous estrogen levels in men come from high aromatase activity. Aromatase is the enzyme that converts androstenedione and testosterone into estrone and estradiol respectively. Aromatase is present in many different tissues. But in men aromatase is highly concentrated in that mid-life bulge.
Unfortunately, aromatase activity in men increases as we age due to stress, weight gain, and inflammation. None of us are going to get away from aging (it’s right there with death and taxes). And who do you know that has NO stress? (Remember, it is estimated that 90% of doctor visits are stress-related.) Typically, as we age we gain weight and have more inflammation.
That “age-related” tire around the mid-section is more than just unsightly. It is a hormone and inflammation-producing organ. Remember metabolic endotoxemia, the disease-producing state I mentioned earlier? Metabolic endotoxemia is inflammation arising from the GI system which causes obesity and then turns right around and produces inflammation. It’s a vicious cycle! And guess what is concentrated in fat? If you guessed aromatase activity, then you are absolutely correct. Aromatase activity in men accounts for 80% of estrogen production.
Hormones are not just about numbers, but balance and metabolism as well (read my recent post on the topic).
2. Overdosage of testosterone = high estrogen. As mentioned earlier, testosterone levels in men are at an all-time low. And the mass solution for this problem with most physicians is to increase testosterone without evaluating or treating the underlying causes for low testosterone. Unfortunately, this complicates the entire low testosterone problem. Overdosage of testosterone increases estrogen production.
What? You mean you can dose too high on testosterone? Yes, and most of the patients I see who are being treated with testosterone have been, in fact, overdosed.
In fact, at Seasons Wellness Clinic and Seasons of Farragut, we have seen many men must donate blood due to excess production of hemoglobin and hematocrit, a by-product of testosterone overdosage. A 20-22 year old male normally produces 5-10 mg daily of testosterone. It is during this age range that men are at their physical peak of testosterone production. For me, this was during my college football years.
Does it make sense for 40-and-up men currently taking testosterone, that they did not need to donate blood monthly during their peak years of natural testosterone production, but are currently required to donate blood regularly with their current regimen of testosterone? Of course not. So, if you didn’t have to donate blood with your peak testosterone production in your 20′s, you shouldn’t have to donate with testosterone therapy in your 40′s and beyond either. Something is wrong here, right?
The starting dosage for one of the most highly-prescribed androgen gels is 1 gram daily. Men, we didn’t need 1 gram of testosterone in our early 20′s, and we don’t need it in our 30′s and beyond.
80% of a man’s testosterone occurs from aromatase activity, and aromatase activity increases as we age. So high doses of testosterone don’t make sense. Doctors are just throwing fuel on the fire with these massive doses. More is not better if it’s too much, even when it is something your body needs.
Then, there is the delivery of testosterone therapy. The body’s natural testosterone secretion follows a normal diurnal rhythm. Testosterone is known to be greatest in early morning and lowest in the evening. But with many prescribing testosterone therapy today, it is very common to get weekly testosterone shots or testosterone pellets. This method of delivery does NOT follow the body’s natural rhythm. The shots and pellets delivery method of testosterone produce supra physiologic (abnormal) peaks. If the purpose of hormone therapy is to return the body to normal levels, then that objective can never be reached with this type of testosterone therapy.
The effects of Testosterone to estrogen conversion in men and women are different. That’s certainly no surprise. In men, high aromatase activity and conversion of testosterone to estrogen has been linked to elevated CRP, fibrinogen, and IL-6.
Are these important? CRP is one of the best indicators of future cardiovascular disease/events (heart attacks and strokes), and is associated with metabolic syndrome. And yes, it is more predictive than even a high cholesterol level. Fibrinogen is another marker of inflammation that has been associated with cardiovascular disease and systemic inflammation. IL-6 is an inflammatory cytokine (immune signal) that has been implicated in increased aromatase activity (conversion of testosterone to estrogen) and at the same time is the result of increased testosterone to estrogen activity.
So, what’s the big deal? The studies are not 100% conclusive, but it is clear that inflammation increases the testosterone to estrogen conversion through increased aromatase activity. And the increased estrogen conversion is associated with increased inflammation in men. It’s a vicious cycle that will lead to disease states such as insulin resistance, hypertension, prostatitis, cardiovascular disease, autoimmune disease, and cancer, to name a few.
You may be thinking, “Is the testosterone I need leading me to disease?”
The answer is, “Yes, it sure can.” If your testosterone therapy includes prescription of supra physiologic levels of testosterone, lack of follow-up on hormone levels, and no effort to balance hormones and metabolism, then yes, it sure can.
Is there a safe and effective way to balance hormones, lower estrogen and increase testosterone for men?
Effectively administering hormone therapy requires the following:
- A physician with extensive training in hormones and body biochemistry.
- The best and most accurate testing possible to determine current hormone levels and to track hormone levels after therapy is administered.
- Hormones that most closely replicate the natural ones produced in your body — bioidentical hormones.
- A therapy plan with the objective of returning your body to normal, not super-charging the body with unnatural levels of testosterone or any other hormone.
At Seasons of Farragut, Nan Sprouse and I are fellowship-trained (or completing fellowship training) specifically in the areas of hormone therapy and wellness-based medicine.
Our patient experience begins with an initial consultation to evaluate symptoms and develop an evaluation plan.
The next step is testing. In the case of hormone imbalance, we evaluate hormones with state-of-the-art hormone testing via saliva, not just blood. As stated in a 2006 article, “plasma levels of estradiol do not necessarily reflect tissue-level activity.” Saliva has been shown to reveal the active hormone inside the cell at the site of action.
After initial testing and a therapy program, hormone levels are re-evaluated to ensure the progression of treatment and necessary changes are made to the treatment program. Testing and follow-up are key to proper balance of hormones (read my recent post). At Seasons of Farragut, our approach to treatment and therapy is fully supported in the scientific research literature, and we’re happy to share that research with you if you’d like to educate yourself.
The way estrogens are metabolized plays an equally pivotol role in hormone risk and effect. At Seasons of Farragut, our system of testing, evaluating, and monitoring is the only way to ensure that testosterone therapy for men is raising the testosterone and DHT levels instead of all being converted to estrogen. Hormone therapy is safe, but for it to work effectively, it must be properly evaluated, dosed, followed, and re-evaluated.
If you have questions or comments, please post them below and I’ll respond as soon as possible. What is your experience with testosterone therapy? How has your physician tested and re-evaluated your therapy program?
For more information about the Seasons approach to wellness or to schedule an appointment, please contact our office at (865) 675-WELL (9355).
The Top 3 Answers to the Question “Why Should I Take Hormones?”
Dr. Nathan Goodyear
Recently during a patient’s visit, we were reviewing her most recent OB/GYN appointment. Her physician asked why she was taking hormones. Unable to offer a technical explanation, she simply stated that she felt much better than she did before she began her treatment program.
While the basic question of WHY is a good question by her physician, we actually need to answer three questions.
- What are my individual hormone levels?
- Are my hormones in appropriate balance?
- Is my body metabolizing those hormones in the right way?
The answers to these three questions will answer the one question: “Why should a patient take hormones?”
What are my individual hormone levels?
Contrary to what most think, hormones are not just about individual numbers. Instead, hormones work collectively as a means of communication within the body. I am amazed at the answers I get when I ask postmenopausal women, “Does your body still have or need hormones?”
The answer is a resounding YES, but most people seem to think otherwise. The body must have hormones to survive. For example, those who suffer from Addison’s Disease have a life-threatening deficiency of cortisol (one of the body’s many hormones).
Far too often I hear the comment, “I’ve had a hysterectomy, so I don’t need progesterone.” The truth is having a hysterectomy does not eliminate your body’s use or need for hormones. It just means you are missing your uterus. Hysterectomy or not, millions of cells throughout the body have progesterone receptors and those cells could care less if you’ve had a hysterectomy or what your OB/GYN thinks about progesterone. [Insert laugh here!] These organ systems throughout the body have receptors for progesterone because they need progesterone.
The aforementioned patient’s hormone therapy included progesterone cream and DHEA capsules. Testing results showed her to be deficient in both progesterone and DHEA (read about how we test hormones at Seasons), and thus replacement was needed. In addition to test results, the patient’s clinical symptom history warranted the replacement of these hormones.
So why was DHEA included in her treatment program? Two reasons. The first is that her DHEA levels were low in her testing results. The second reason? This patient had Type II Diabetes and, after some additional testing, was found to have chronic inflammation throughout her body. DHEA has been shown to reduce inflammation, improve insulin function, and reduce obesity, all of which are associated with diabetes. DHEA does this through a complex interaction with the hormones adiponectin and insulin. As insulin levels rise with insulin resistance, adiponectin falls. This hormone imbalance will result in Diabetes for many people.
Additionally, Type II Diabetes has been shown to be the result of chronic inflammation. What does that mean, you ask? Chronic, dysregulated inflammation causes insulin resistance. What is the source of this inflammation, you ask? Fat cells! The obesity epidemic is the root cause of our current healthcare crisis.
Let’s go back to the patient’s hormone therapy. Her test results showed her deficient in progesterone. Becauseprogesterone is a natural anti-inflammatory, it is currently being used in traumatic brain injuries (TBI) to reduce inflammation and improve outcomes. In addition, women with low progesterone tend to have significantly more menstrual cramps, the result of inflammatory signals called prostaglandins. Progesterone therapy has been shown to reduce those prostaglandins and thus reduce menstrual cramps.
Are my hormones in appropriate balance?
Hormones don’t exist in a vacuum, as many seem to think. Hormones exist in a delicate balance. The most well publicized imbalance is that of the estrogens and progesterone. Imbalance of estrogen and progesterone have been linked to many health problems: fatigue, weight gain, headaches, and increased risk of breast cancer to name a few.
I often tell patients that with every cause there is an effect. You can’t give one hormone without affecting many others. The addition of progesterone to the body when it has been chronically low will not only restore progesterone to an appropriate physiologic level, but will also allow estrogen signals to work better. The balance of hormones allows each hormone to work as it was intended. Mind you, we are NOT talking about using synthetic hormones which are simply not what the body is looking for and contain harmful additives. We only treat with bioidentical hormones (bioidentical hormone replacement therapy, also known as BHRT).
Is my body metabolizing my hormones in the right way?
The final key point is looking at how the body processes hormones (metabolism). Hormone metabolism is just as important as the individual hormone levels and the hormone balance.
Let’s use estrogen metabolism, for example. Estrogens (there are actually three different types of estrogen) can be metabolized three ways: 2-hydroxy estrone, 4-hyroxy estrone, and 16-alpha-hydroxy estrone. Some of the risks associated with estrogen come from the body metabolizing estrogen utilizing the 4-hydoxy estrone pathway. This pathway results in many dangerous metabolites (break down products). Think of it as turning down the wrong road as you’re driving somewhere, and you end up in a briar patch!
Think about it. Many women with breast cancer and men with prostate cancer don’t take bioidentical estrogen nor do they take synthetic estrogen. Their problem, as it relates to hormones, comes from endogenous hormone production (the body’s own hormone overproduction or underproduction), hormone metabolization, and the often undiscussed environmental xenoestrogens (from environmental toxin exposure). In lay terms, the body is metabolizing estrogen using the 4-hydoxy estrone pathway resulting in higher risk of cancer.
It has only been in the last 50 to 60 years that major hormonal imbalances in industrialized countries seem to have come to our attention. Before that, people and their hormones seemed to do just fine for thousands of years. We can attribute much of that to diminishing nutritional value in our foods and continually increasing exposure to toxins. Nutrition and toxins both have profound effects on the body, hormones included.
In conclusion, why should a patient take hormones (BHRT)?
The answer is a summary of the three points we’ve looked at here. By determining current hormone levels, restoring balance, and evaluating the body’s metabolic processes, the body can once again function as God intended it. Should a patient be on hormones? Well, only if you need them. But the truth is few of us have perfectly balanced hormones due to nutrition, toxin exposure, and prescription medication side effects.
At Seasons Wellness Clinic, we use state-of-the-art testing that reveals your body’s biochemistry. With our years of advanced training, we can carefully customize a treatment plan to restore your body, offsetting the damage of poor nutrition, toxins, and prescription drugs. Our goal is to eliminate any need for prescription medication! We want you to be HEALTHY!
WELLNESS IS POSSIBLE! You don’t have to settle for a body that is not working as it should. You can make a conscientious choice towards good health and a longer, happier life.
Get Your Body Back On Track With These 5 Points of Wellness
“What is Seasons? And what do you do?”
These are questions I am often asked. In short, Seasons breaks free from the disease model of medicine. Our focus is wellness by optimizing your health. What does this mean? Just because you are free of disease does not mean you have great health. A wellness model of medicine is the only way to prevent disease and promote healthy living.
At Seasons, we work to achieve health and wellness with balance using our 5 Points of Wellness: Nutrition, Exercise, Hormones, Inflammation, and Detoxification.
NUTRITION
Are nutrition and health related? Absolutely. We are what we eat. Hippocrates said it best, “Let food be your medicine and medicine be your food.” Your diet must be individualized to meet your metabolic needs, limit inflammatory responses, and meet your lifestyle demands.
We offer personalized nutritional counseling to develop a plan for disease management, disease prevention, and overall good health. At Seasons, your nutritional plan is individualized to meet your needs in a way that fits your lifestyle.
EXERCISE
Exercise is an important part of any weight-loss or weight-maintenance program. Maintaining healthy weight is an excellent benefit of exercise, but it does so much more for your body. Exercise builds muscle, relieves stress, and helps to detoxify, just to name a few. However, too much exercise can severely harm the body.
At Seasons, we work to maximize your calorie expenditure, while reducing the damage to your body from excessive exercise. We do this in a way to match your lifestyle and your physical abilities.
HORMONES
Regardless of your age, your body needs hormones to function. Hormones are a means of communication with your body. And balance of those hormones is the key. Sure, it would be great if men were just a Testosterone sponge; or women just an Estrogen factory. But, that is not the case and the key is to create a balance. When your hormones are balanced, so are you. When your hormones are not balanced, your body will let you know.
Your hormone balance is unique and will change based on factors such as weight loss, weight gain, stress, and even nutrition. The only way to determine your imbalance is to share any symptoms you may be having with your healthcare team at Seasons. This gives us information on where to look for hormone imbalance issues. Only then can we identify your particular imbalance and formulate a plan to balance your hormones. Balanced hormones = better health.
INFLAMMATION
Inflammation is the greatest obstacle to good health and is a part of the body’s immune system signaling department. Pain, redness, swelling, heat, and loss of function are common manifestations of inflammation. Inflammation is not new. The first four classical signs were described by Celsus (30 BC – 38 AD).
The source of inflammation is unique to each person. It may be due to deficiencies, such as vitamin D, poor dietary intake of antioxidants, such as resveratrol and curcumin, or even a deficiency of fish (low Omega-3 intake leads to inflammation). Your gut could also be the source of inflammation! Did you know that up to 75% of your immune system lines your gut? In many ways, your health starts with your gut.
The source of inflammation is as different as the individual. The only way to identify your unique source of inflammation is through symptom evaluation and state-of-the-art testing. At Seasons we can identify the causes of inflammation and implement specific therapy to eliminate inflammation, which can be as diverse as parasite treatment to dietary changes.
DETOXIFICATION
We live in a toxic world today. There is no way around that! According to a recent study, detectable levels of toxins were found in up to 99% of pregnant women even though many of these chemicals have been banned since the early 1970’s. This number will only rise with the approximately 1,800 new chemicals approved annually. This tidal wave of toxins are overwhelming our detoxifications systems proven by the exponential rise in rates of autism spectrum disorder and neurodegenerative diseases such as Alzheimer’s, Parkinson’s and Multiple Sclerosis.
The ability to detoxify is critical to health. Every cell must detoxify. At Seasons, we evaluate your individual ability to detoxify with state-of-the-art testing and treat those areas that are dysfunctional. We focus on your major detox organs — liver, skin, kidneys, lymphatics, and GI tract — through which every cell in the body must detoxify. We provide a detoxification plan to meet your specific toxic load and to support your identified needs.
Nathan Goodyear, M.D.
WHAT NEXT?
At Seasons, we offer individualized therapy to aggressively eliminate the obstacles to good health and maximize your body’s performance. We are not your disease doctor, we are your partners in health. We work to restore your health and then maintain that good health.
As Aristotle said, “The whole is more than the sum of its parts.” And at Seasons, our holistic approach encompasses all the body’s functions creating one plan giving you the tools you need to pursue wellness.
Questions? Spend some time on our website getting to know us and what we do. Then call 865.675.9355 and speak with one of our Patient Relations Specialists. Remember, good health is a choice. And at Seasons, we offer you that opportunity. Don’t miss your opportunity to choose a health and wellness lifestyle.
The Truth About Low T: Men, Middle-Age and More
Dr. Nathan Goodyear
I admit it. Those low T commercials are great marketing. The middle-aged man dancing with his testosterone shadow, all his strength, energy and vigor restored. His simple solution? Testosterone supplementation. It paints an oversimplified picture of men, as if we are nothing but testosterone sponges. When we get low, we just stop off at the local testosterone dispenser and we are good to go. However, the truth is not that simple about low T.
Low testosterone is a very common problem in men today. But it is much more complex than just adding testosterone to solve the problem. Men are complex. (And you thought only women were complex!) Looking at the specific causes of low T in an individual is a critical part of creating a plan to solve the low T problem.
What is testosterone? Testosterone is the predominate hormone in men. From the moment of conception, it is the key to male development. It is what makes a man a man. It is what gave us Tim “the tool man” Taylor.
What is low T? Quite simply, it is low testosterone. Symptoms include fatigue, reduced libido, estrogen dominance, weight gain, and loss of confidence and motivation. Low T is, in many ways, the middle-aged man suffering the dreaded “mid-life crisis.” Think about it. At the same time that women experience menopause, men are experiencing their own life change. Men are just as hormonal as women; however, the symptoms of change are different.
Low testosterone is a lot more common than you think. Approximately 40 million US men suffer from low testosterone. Only a fraction of these men are symptomatic, which means most men with low T don’t even know it.
Not only is low T a silent problem, it is a growing problem. Men are discovering low T at younger ages, too. I’ve seen men as young as their mid-20’s with low testosterone. Typically, however, most men living with low T are in their 40’s and beyond.
What is the cause of low T? It would be convenient if the answer was simply low testosterone production. But look at our bodies. We are complex creations. In most cases, low T results from a combination of issues.
Cause #1: Excess weight. Today, we eat so many items that suppress the body’s natural testosterone production. Just look at the American diet. Americans eat up to 200 pounds of refined sugar, 90 pounds of fats, 63 dozen donuts, 60 pounds of cakes and cookies, 23 gallons of ice cream, 22 pounds of candy, and 15 pounds of chips, popcorn, and pretzels annually. Obviously, this leads to excess weight.
Excess weight, especially around the mid-section, becomes a major estrogen-producing factory. Not only does the associated weight gain help produce more estrogen, but the enzyme that converts testosterone to estrogen increases as we age as well. We become estrogen dominant. Increased weight = increased estrogen and decreased testosterone.
Cause #2: The environment. The environment is full of hormone-like chemicals. Xenoestrogens are environmental estrogens. They range from pesticides and insecticides to plastics to hormone-laden meat and dairy products. Although not native to the body, the body views them as estrogens nonetheless. Xenoestrogens = increased estrogen and decreased testosterone.
Cause #3: Hormones. That’s right. Even giving testosterone to some men can be a problem. A 27-year male patient came to me after he was given testosterone for a suspected low T problem by another physician. The testosterone replacement made him feel worse. Why? He was already estrogen dominant, and the additional testosterone was like throwing gasoline on the fire. His proposed cure, testosterone supplementation, turned out to be the source of his problem: excess estrogen. Too much testosterone = increased estrogen.
What is the answer to low testosterone? There is no single answer. Answers are found through customized testing which determines exact hormone levels. From these results, we can create an individualized therapy plan. Because we are all created uniquely, causes can vary. Likewise, your therapy plan should be unique. Your symptoms are clues to the underlying problem. By uncovering the problem’s root cause, an effective treatment plan can be developed which will solve those health issues and eliminate your symptoms.
The truth about low T? Only a few men really need testosterone. The majority of men need weight loss, reduction of estrogen, and the elimination of environmental xenoestrogens. It is easier to simply supplement testosterone. But that will NOT treat the problem at the source and achieve true healing.
Now that you know the truth about low T, what will you do about it? If you have symptoms and need answers or more information, call our office at 318-255-3223.
It’s Not Depression…It’s Stress!
Dr. Nathan Goodyear
I am amazed at the number of clients that I see who are prescribed anti-depressants these days. I have only been in practice for 6 years, but I have seen these drugs used excessively to treat everything from PMS to stress.
The major problem with these medications is there are no long-term studies on the impact these drugs have on the body. Don’t forget that these medications have side effect profiles that rival the novel “War and Peace.
Aside from the litany of side effects, anti-depressants typically don’t treat the actual problem. And what I’m finding is that it’s not depression…it’s stress.
Sure, there are people out there that undeniably suffer from depression. But most are struggling with overwhelming stress. It is well accepted that 90% of doctor visits today are due to stress or some stress-related condition.
Let’s look at physiology to see how stress affects the body.
Our stress response is a protective mechanism. It is our body’s way to help us run from that tiger or turn and fight that tiger. It is our fight or flight response. Therein lies part of the problem.
We aren’t running from any tigers, at least not on this continent. But our stress level is constant and higher than ever…bills, economy, family. From the time we wake up to the time we go to sleep, we are under stress. The body doesn’t know the differences between types of stress — whether tiger chase or financial pressure — it just responds to the stress.
We cannot discount the impact of stress on the body. The stress response comes from our adrenal glands. Epinephrine, norepinephrine, cortisol, and DHEA are the main components of the stress response. Under intense stress, our body releases norepinephrine and epinephrine. These neurotransmitters stimulate cortisol and DHEA release from the adrenal glands. This results in dilated pupils, fast heart rate, edginess…all physical manifestations of the fight or flight response.
It doesn’t stop there. That same long-term elevated cortisol will cause a depletion of the stimulators norepinephrine and an inverse drop in the serotonin levels. And THAT is the cause of depression.
The extended exposure to stress is the problem. And the band-aid solution of treating with anti-depressants is not a good solution.
The alternative? As a metabolic specialist, my approach is to support the the body’s stress response with a customized prescription of vitamins, minerals, bioidentical hormones, amino acids first. Then, we develop a healthy living plan that will help reduce stress and restore the body to normal function so that it is no longer non-functional from extended periods of stress overload.
While exercise and proper nutrition go a long way, the long-term affects of a stress-filled life require customized medical care to reverse their effects. And that’s what we do here at Seasons Wellness Clinic – customized wellness.
Cheers to the pursuit of wellness!
Related articles
- Cortisol and Stress: How Cortisol Affects Your Body, and How To Stay Healthy in the Face of Stress(stress.about.com)
- Stress (room4truth.com)
- Describing the Function of Adrenal Glands: A Study Guide (brighthub.com)
