Basic Hormone Physiology
A Holistic Approach
It would be nice if life were simple. It would be great if the best pathway in hormone management were well worked out; everyone responded the same and the best treatments were clear. The American College of Obstetrics and Gynecology and the North American Menopause Society rate the quality of published research. The studies they like best are double blind, placebo controlled studies of large groups of women. Unfortunately, these studies lump together many women with very different problems, different physiology, different needs and very different reactions to whatever medication regimen was chosen. Small but statistically significant differences may only be confined to certain segments of the whole population studied. The WHI is a good example of the problem. We need to look more closely at individuals.
The human body is complex. There is vertical integration. The upper brain, hypothalamus, pituitary and ovary are integrated together. With the ovary, there is interplay of theca, granulosa and germ cells. There is also horizontal integration. Thought patterns, nutrition, physical and emotional stress acting directly on the brain and through the adrenal gland affect hypothalamic and pituitary control of ovarian output. Estrogen, progesterone and testosterone levels affect carbohydrate craving, eating patterns, fat distribution and metabolism and conversion of the thyroid hormone T4 into the more active T3. Cortisol output affects thyroid output and effectiveness. Insulin levels stimulate IGF-I receptors all over the body, stimulating estrogen effects and creating estrogen effects of its own. There are multiple activins, inhibins, growth factors, stimulating factors, necrosis factors that run around the body. Diet and exercise patterns are all involved in hormone production and metabolism.
Learning the major interactions of the various hormones and how they affect our patients takes a little time but common problems tend to be most common. Once the patterns are learned, patients tend to fall into various groups and types. Sorting out individual issues become easier. For the health and happiness of the patient, it is well worth the study. Physicians have to look at the whole patient — listen to their story— they will tell you what needs to be done.
What Your Doctor May Not Tell You About Menopause (read full review) and What Your Doctor May Not Tell You About Premenopause (read full review) , both written by John R. Lee, MD.
These are the original bioidentical hormone texts. The physiology is sound, the writing is clear and there is a vast amount of good information. I disagree with Dr. Lee about two points: Progesterone does not have to be given as a topical cream, as other routes work just fine. Also, I find that there are certain weaknesses to salivary hormone levels. These books are a good place to start. I have tried many of the therapies described by Dr. Lee, following patient reactions and lab work. The results have been most gratifying with many of my patients telling their friends.
Clinical Gynecologic Endocrinology and Infertility, Seventh Edition by Leon Speroff and Marc A Fritz (read full review)
This is an incredible book — it is important to read the 7th edition. The sixth edition was printed in 1996 and new research had not yet been done, but I wanted to understand the relationship between Metformin use and PCOS. When I received my copy of the 7th edition (copyright 2005), I turned directly to the chapter about PCOS. Topics included Inhibin B, Inhibin A, IGF-1 and IGF-2 receptors, binding hormones and much more. I was not aware of this subject matter. I flipped back and forth from the index to the early, basic physiology chapters. It became clear that I was going to have to start with page one — it is very dense material. It took nearly four months before I arrived back at the PCOS chapter for a second time — by then, I was a changed man. Virtually all of the things Dr. John Lee had said about progesterone and hormone balance were confirmed by Speroff and Fritz. Unfortunately, Spiroff and Fritz still use mostly synthetic hormones in their recommended patient therapies.
I have great respect for Leon Spiroff. When everyone else was losing their heads after the WHI findings were released, Dr. Spiroff quietly proceeded with deliberate and reasoned analysis of the data. He is the calm at the center of the current menopause storm. His knowledge is vast and deep. I just wish I could get him on the bioidentical hormone bandwagon. His text is a guidebook to the physiologic use of real hormones.