The pituitary gland, which sits deeply centered within the brain, communicates with three vital glands located in the periphery. These glands include the thyroid, adrenals, and the sex glands. The absence or low production of any one of these powerful hormones in circulation can lead to extreme fatigue, weight gain, brain fog, joint pain, and 50+ other symptoms or diseases. Individual labs should be evaluated in the presence of symptoms that align with deficiencies of any of these hormones. Because it is difficult to always clearly observe the symptoms in each patient accurately, and because even the patient may find it difficult to correctly observe and accurately describe the subtleties of hormone deficiencies, there is great value in running a complete profile on all hormones secreted from peripheral organs and a few from the pituitary gland. Comprehensive lab testing such as this is often recommended with all new patients and when appropriate once yearly for accurate tracking of trends over time. Read below to discover what labs we run and their potential impact on the human body.
Baseline labs we run on new patients and as part of an annual review may include TSH, Free T4, Free T3, Antithyroglobulin Antibody, and Thyroid Peroxidase Antibody.
The thyroid gland is one of the most important glands in the body. If the thyroid gland is under-functioning it is known as hypothyroidism. The most common symptoms that accompany the diagnosis are fatigue, hair loss, constipation, weight gain, dry skin, absent or delayed menstrual cycle, cold intolerance, low libido, and depression. Hashimoto’s thyroiditis is one of the more common ways in which the thyroid hypo-functions. Hashimoto’s thyroiditis is an autoimmune condition where the individual’s immune system turns on itself and begins to attack the body’s tissues, and in this case, the thyroid. The attack on the thyroid can initially cause an increase in the release of the thyroid hormones but eventually, the hormones will dwindle as the gland is destroyed causing the thyroid gland to fail. Once this occurs thyroid replacement is inevitable.
At East Valley Naturopathic Doctors we thoroughly diagnose and monitor our hypothyroid patients by testing TSH, Free T4, Free T3, Anti-Thyroid Peroxidase Antibodies, and Antithyroglobulin Antibodies. There are other tests that we commonly utilize to determine what caused the hypothyroidism initially. The issue remains that what initially contributed to the thyroid disruption may still be negatively impacting the body in other ways, which is why it is extremely important to investigate further. Consider the root causes of Hashimoto’s thyroiditis as an example:
- Wheat gluten and other food sensitivities
- Chemical and metal exposures: Mercury
- Viral illness
Other contributing factors to cause Hypothyroidism
- Mineral deficiencies particularly selenium, vitamin E, zinc and B vitamins are needed to convert T4 to T3 the more active of the thyroid hormones.
- Adrenal function
- Lifestyle: Stress, poor diet, and smoking are all factors that cause stress to the body which affects thyroid function.
- Thyroid medications
There are many different options to replace or assist the thyroid. The first option is a natural preparation derived from porcine thyroid glands containing both active forms of T4(Levothyroxine) and T3(Liothyronine). NP Thyroid and Armour thyroid are examples of this type of formulation. The second option is synthetic T4, which is mostly commonly known as Synthroid, levothyroxine, and levoxyl. Newer versions of T4 such as Tirosint are much better absorbed, with patients finding frequently feeling better on changing to this form from natural preparations or the older versions of levothyroxine. Sometimes another option can include dosing of synthetic T3(Liothyronine) with symptoms of low thyroid and if blood levels of Free T3 are low. It may be utilized solely or in combination with a T4 medication.
Baseline labs we run on new patients and as part of an annual review may include: Cortisol AM, DHEA-S, Pregnenolone, Catecholamines(Epinephrine, Norepinephrine, Dopamine)
The adrenal glands produce two major stress hormones, adrenaline, and cortisol, that help us respond to daily challenges of life without becoming overwhelmed. They also help us to engage in the protective flight, flight, or freeze mechanisms when danger presents. Adrenal fatigue syndrome has been proposed for a number of years as part of the cause of chronic fatigue disorder and even Fibromyalgia. Many of the underlying causes for chronic fatigue are the same for Fibromyalgia. Adrenal fatigue syndrome is often the result of poor recovery from everyday normal stress or chronic stress, such as found in chronic infections or chronic illness as found with toxic exposures or autoimmune disorders. Under normal conditions or demands, the body increases the excretion of norepinephrine and epinephrine (same as adrenaline), and cortisol when we are under stress. Normal circulating levels of these neurotransmitters and hormones help us feel like we are able to handle the stress. We have both the physical and mental coping ability to deal with and recover from stress whether small or large and unexpected.
Chronic or lingering stress strains the adrenal gland and central nervous system(CNS) leading to a slow depletion of cortisol, and the stress catecholamines, epinephrine(adrenaline), and norepinephrine(nor-adrenaline). Low levels result in fatigue and a feeling of being too easily overwhelmed by what used to be normal or average stressors. Other symptoms that may coexist with poor stress response are poor sleep quality or regular restorative sleep.
Lab testing is required here to determine the presence and extent of the adrenal fatigue. Many types of testing exist from straight measurement of morning cortisol, DHEA, and adrenaline in varying sources including urine, saliva, blood, or serum. Cortisol can frequently be measured in saliva throughout the day in order to assess the baseline and circadian rhythm. Cortisol should be highest in the morning at rising and in the first few hours of the day. It follows a bell-shaped curve and reduces toward a steady baseline in the late afternoon and through the night. A flat or low bell curve toward the morning indicates adrenal fatigue syndrome. Typically 4 saliva samples at varying times of the day allow us to extrapolate an individual’s curve. Samples are taken at 8 am, 12 noon, 4 pm, and 10 pm for example.
This same curve or rhythm can be assessed using blood or serum samples throughout the day or simply as a single sample in the morning. If the curve or single sample of cortisol is low, adrenal fatigue syndrome may be present. If any tested labs appear to be suspicious additional lab testing will be recommended to discover the adrenal gland’s overall impact on the presenting symptoms.
Low DHEA-sulfate in saliva, urine, and blood tests will also indicate possible adrenal fatigue. Low DHEA-s can also be an indicator of general sex hormone imbalance or deficiency. The other extremely valuable test is a serum catecholamine test measuring norepinephrine, epinephrine(adrenaline), and dopamine. Low norepinephrine and epinephrine are indicators of adrenal fatigue syndrome. These central and peripheral neurotransmitters are also found present in many other health concerns such as sleep disorders, depression, dysthymia, and inability to manage stress. When treated correctly, adrenal function can return to normal very quickly. Best outcomes occur when both the catecholamines and cortisol are assessed. Treatment to restore adrenals includes targeted amino acid therapy and herbs with specific actions which increase the output of norepinephrine, epinephrine, and cortisol.
Adrenal Fatigue Staging
In chronic stress response, all body functions have become compromised due to prolonged hormone, immune, and metabolic depletion. This can lead to a cascade of chronic degenerative diseases from which the weakened body has a reduced chance to recover. Adrenal exhaustion progresses in three stages.
Stage I is distinguished by an increase in the output of ACTH by the anterior pituitary gland, increased adrenocortical stimulation, increased cortisol output an increased probability of pregnenolone steal, and decreased DHEA. When in a chronic stress response, pregnenolone, the common precursor to cortisol, DHEA, and other hormones is preferentially diverted to cortisol production at the expense of the rest of the steroidal hormones. Generally in Stage I cortisol increases and DHEA and its metabolites decrease or an imbalance occurs especially between testosterone and estrogen.
Stage II adrenal exhaustion is marked by the transition from increased to decreased cortisol output. This stage is characterized by continuing high levels of ACTH and thus: adrenocortical stimulation, normal total cortisol output, low or borderline low morning, noon, or afternoon cortisol levels, normal nighttime cortisol level, and an increased probability of pregnenolone steal and a further decrease in DHEA. This is a transitional phase in which although ACTH stimulation remains high or even increases, the adrenal output of cortisol declines due to the adrenal fatigue associated with continued hyperstimulation.
Stage III adrenal exhaustion is an advanced stage of adrenal exhaustion characterized by decreased total cortisol output. This stage is characterized by continuing high levels of ACTH and thus adrenocortical stimulation, low total cortisol output, and increased probability of a low nighttime cortisol level and pregnenolone steal and even further decrease in DHEA. The adrenal glands are now exhausted to the point that even though there is ongoing hyperstimulation (high ACTH); they continue to lose their capacity and reserve to produce enough cortisol. The eventual result is a crash of the hypothalamic-pituitary-adrenal axis (HPAA) in which essential neuroendocrine feedback loops are unable to return the system to homeostasis.
Assessment of adrenal output and function involves evaluating levels of cortisol(morning only unless expanded testing is recommended), DHEA-S, epinephrine(adrenaline), and other supporting hormones such as norepinephrine, and pregnenolone. Evaluation can be accomplished through serum, urine, and salivary testing, although serum testing is most likely to be covered by insurance.
Though accurate evaluation of the adrenal gland can be challenging, many natural herbs, amino acids, and a few bio-identical prescriptions can provide safe support and help restore the adrenal gland to its proper function.
Baseline labs we run on new patients and as part of an annual review may include: Estrogens, Progesterone, Testosterone Total and Free, FSH, LH, SHBG, PSA(for men only)
In recent years, our hormone replacement therapy in Mesa AZ has gained in popularity amongst andropausal men and menopausal women to improve their hot flashes, sexual function, mood, sense of well being, muscle density, bone mass and strength. In addition, some hormone therapy has been found to be beneficial in preventing heart disease, diabetes, and even Alzheimers Disease. There is a growing trend over the last decade for both men and women opting for the use of bioidentical, compounded natural hormones for the treatment of andropause and menopause, respectively.
The testosterone, estrogen, and progesterone used in the bio-identical hormone replacement therapy (BHRT) is identical to that produced in the human body. Although BHRT has long been utilized in other countries, the United States has predominantly used synthetic hormones for the past 40-50 years beginning with the introduction of oral contraceptives in the early 1960s. The uniqueness of the compounded bio-identical formulations are what makes it so attractive to prescribers and users alike. The ability to alter the dose specific to each individual does not compare to the two to three options that pharmacies currently offer to relieve the same symptoms for everyone. Each formulation prescribed by your physician is easily altered to increase the dose when needed to help ease symptoms or reduce levels easily if someone is looking to go off of the hormones.
What is also the most unique to these formulations in women, is the utilization of both estradiol with estriol. Estriol is well known for its weak estrogenic activity compared to the more potent estrogens the body produces, estradiol and estrone. The advantage of including estriol in your hormonal formulation is that it has the ability to bind with the estrogen receptors on the breast cells more weakly than estradiol. Therefore, it can actually block the stronger estrogens from binding to the breast cells and subjecting them to the higher estrogenic activity which can put some women at risk for cancer.
Before men or women start with hormone replacement therapy, laboratory tests are necessary to determine if there is a physiological need for hormone replacement. For men both free and total testosterone are measured, along with dihydrotestosterone(DHT) and sex hormone binding globulin (SHBG), Prostate Specific Antigen(PSA), DHEA-S, and Cortisol.
For women, we like to check a hormonal baseline before administering hormones. We often test for estradiol, estrone, progesterone, total testosterone, free testosterone, cortisol AM and DHEA-S amongst other general labs if they haven’t been completed. For women, a risk assessment for estrogen and progesterone sensitive cancers must be considered and an exam performed, if not up-to-date before beginning hormone replacement therapy.
If hormone levels come back within normal limits, hormone replacement therapy is not likely necessary nor beneficial. However, if a man or woman is experiencing symptoms of andropause or menopause and they have low levels of hormones, hormone replacement therapy may be initiated with significant potential for benefit.
Routes of Administration
The methods of administration of hormone replacement therapy include oral administration, application of topical creams, intramuscular injections, and the implantation of pellets under the skin. The route of administration determined is based on the individual’s personal history and symptoms, blood work and personal preferences. Below is a brief description of the options available.
Capsules– The most common hormone prescribed orally is progesterone, although estrogen can also be prescribed this way. The least favorable route to receive estrogen replacement therapy is oral as it has been associated with increasing risks for clotting disorders, like deep vein thrombosis, where the topical options are not.
Lozenge/Troches– Lozenges are a combination of oral and sublingual absorption which allows hormones to release in small doses into the bloodstream. Common hormonal combinations include estradiol, estriol, testosterone and/or progesterone.
Creams and gels- Creams and gels are the most favorable route of administration of BHRT, due to lack of discomfort of an injection, and ease of application. They work best if applied daily on a particular schedule and are applied to the thin skin of certain areas of the body such as inner wrists, behind the knees, or the top of the feet. These are the most effective as they avoid the first pass through the liver and are absorbed directly into the bloodstream. In addition, they seem to mimic the natural rhythm of sex hormone secretion that occurs in the human body throughout the day. Common hormonal combinations include estradiol, estriol, testosterone and/or progesterone.
Intramuscular Injections- Testosterone is the only hormone that is injected and it is a great option for those who have low testosterone on their blood work and symptoms of low libido. This combination of blood work and symptoms can warrant testosterone replacement which can be made easy with weekly injections.
Pellets- Pellets are a great option for both men and women. Hormone pellet therapy is customized to the needs and labs of each patient. Patients have the pellets placed every 3-4 months and do not have to think about a daily application. The theory behind this method is that the body will draw from the pellets what it needs creating a stable balance of delivery. The pellets are about the size of a piece of long grain rice and are placed just under the skin in the gluteal region. Estradiol and testosterone are the two hormones that come in pellet form.