Hormone CookbookJoanna Wilson, D.O., NACPBoard-certified Internal Medicine

My first hormone memory

Familiar Uses of Hormone TherapiesFreedom from menstrual symptomsControl of when and how many children we haveReversal of infertilityRelief of menopausal symptoms

Sex Hormones Affect These Issues, Too!Infection susceptibilityAsthmaOral healthAutoimmune diseaseVascular diseaseHigh blood pressureDementiaBone strengthMuscle strengthMental health Breast, lung, prostate, colon, kidney cancerAnd just about every other disease

How Hormones WorkCofactors which modify the cells responseTiming of hormone production (pulsatile or continuous)Dose responseCentral control (positive and negative pituitary feedback)Interaction with other hormonesCell surface receptor

Main Ingredients For Todays RecipesEstrogenProgesteroneTestosterone

Progesterone EffectsProtects the uterus from overgrowth due to estrogen stimulationHelps nerve cells repairPrevents bloating from estrogenInhibits the breakdown of serotoninHelps stabilize moodIncreases body temperature during ovulationAntiinflammatoryIncreases appetiteImproves sleepChemotherapy for breast, prostate, and renal cell cancers

Testosterone EffectsMuscle mass and strengthBone massSex drive

Estrogen EffectsImproved cognition and memoryImproved neuronal healingImproved glucose toleranceMaintenance of fat distribution in peripheryImproved bone mass and strengthRaises HDL, lowers LDL cholesterolImproved blood vessel healing

Estrogen Receptor Locations

CONTRACEPTIONRecipe #1

Ovarian Hormones in 28 Day Cycle

Brain- Ovary Conversation-Positive FeedbackBrainOvary

How Do We Convince The Brain To Ignore The Ovary?

Negative FeedbackNo surge = No ovulation

All (combination) birth control pill options have stable daily estrogen doseLow, consistent hormone dose prevents pituitary surge to prevent ovulation

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Progestogen Receptor Activations

Progestogen Characteristics and Side Effects

Can We Prevent Ovulation Only When We Need To?

Emergency Contraception175 pounds

MENSTRUAL RELIEFRecipe #2

Contraceptive Pill OptionsCyclic- 7 days of no progestin (withdrawal)MonophasicTriphasic Continuous- no withdrawal weekMonophasic only

Estrogen and Progestin Levels on Continuous vs Cyclic Birth Control

Vein Clot Risks(per 10,000women/year)46910 to520

MENOPAUSERecipe #3

Endothelial Cell Layers in Healthy Postmenopausal and Premenopausal WomenPostmenopausal 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 SourcesBefore MenopauseOvariesAfter MenopauseAdrenal glandsFatTissues

Labrie F (2007) Drug Insight: breast cancer prevention and tissue-targeted hormone replacement therapyNat Clin Pract Endocrinol Metab 3: 584593 doi:10.1038/ncpendmet0559Figure 4Effect of age on DHEA and DHEA-S levels in women

Why Not Just Start Everyone On Hormones?

Timing Hypothesis of Menopausal Hormone Therapy

Safest Therapy ChoicesFDA Approved:Transdermal EstradiolVaginal Progesterone (cyclic)

Not FDA Approved:Bioidentical therapy

Compounded Bioidentical HormonesDosing schedule mimics premenopausal state in postmenopausal womenPlant derived hormones modified to be identical to human moleculesNot regulated for purity of modification processSaliva levels do not accurately measure tissue levelsProgestogen skin cream has not been proven effective to prevent endometrial cancer

Testosterone SupplementationRisksPossible increased risk of breast cancerAcneHair loss

Manipulation of Testosterone SupplementationAromatase blocker to reduce conversion to estrodiol (Femara, Arimidex)5-reductase blocker to reduce conversion to dihydrotestosterone (Propecia)

Estrogen Therapy ChallengesEstrogen receptors in tissues cycle, but independently of ovarian functionSerum or saliva tests do not show what is needed in the cellsOptimal levels for dosing are not knownReceptor stimulation or blockade is required to prevent cancer and blood clotsWe dont know how to do this, yet!

Creating the Perfect Estrogen Replacement

ENDOCRINE DISRUPTING CHEMICALSIngredient Substitutions and Flavor Enhancers

Yummy Endocrine Disruptors (Phytoestrogens)

Endocrine Disruptors = Hormone Receptor Imposters

www.dnr.metrokc.gov/WTD/community/edc

www.dnr.metrokc.gov/WTD/community/edc

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

Endocrine Society Scientific Statement

Newest EDC: Triclosan

Developmental Stage at Exposure to EDC Changes Impact

Hormone Cookbook: SummaryEstrogen, Progesterone, and Testosterone contribute to the health of every cell and organUsing hormones in various ways helps us maintain reproductive control and prolong healthExposure to chemicals which stimulate hormone changes may have long-term effects

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Questions?

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