Estrogen Dominance is Really Progesterone Deficiency

The term "Estrogen Dominance" can be confusing at times because it is less related to the amount of circulating estrogen and more related to the ratio of estrogen to progesterone in the body. Contrary to popular belief, Menopause and PMS are not the result of estrogen deficiency although estrogen levels do decline during the latter phases of a woman reproductive cycle.

More relevant is that the estrogen levels drop by approximately 40% at menopause 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 remnant tissue of the follicle (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 are:

• Mood Swings
• Irritability
• Depression
• Irregular Periods
• Heavy Menstrual Bleeding
• Hot Flashes
• Vaginal Dryness
• Water Retention
• Weight Gain: Hips, Thighs and Abdomen
• Sleep Disturbance (Insomnia, less REM sleep)
• Decreased Libido
• Headaches
• Fatigue
• Short-term Memory Loss
• Lack of Concentration
• Dry, Thin, Wrinkly Skin
• Thinning of Scalp Hair
• Increased Facial Hair
• Bone Mineral Loss (Osteoporosis)
• Diffuse Aches and Pain

Patients experiencing a majority of these symptoms most likely will benefit from natural hormone replacement. The most effective way to assess hormone status is to test saliva for the appropriate hormone levels. Saliva is the best method for testing "functional" tissue levels of hormones.

The Progesterone/Estradiol (Pg/E2) reference ranges are optimal ranges determined by Dr. John Lee. 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.

Progesterone & Traumatic Brain Injury

As hormone replacement practitioners, we know the many benefits of progesterone therapy: mood and memory improvement, decrease in fibrocystic breast conditions, fewer hot flashes, less water retention…the list goes on. A preliminary study published in the Annals of Emergency Medicine shows promise for using the hormone progesterone in a new way: to treat traumatic brain injury (TBI). In the three year study, conducted at the department of emergency medicine at Emory University, 77 TBI patients received intravenous progesterone, while 23 received a placebo. A 50 percent reduction in the rate of death was found in the group treated with progesterone.

Progesterone is traditionally thought of as a pregnancy and/or female sex hormone, but it is also vital for brain cell health. It is a neurosteroid naturally present in small amounts in the brains of both females and males. During pregnancy, progesterone levels soar, leading researchers to hypothesize a relationship with brain development and maturation. With that in mind, study data suggests that the hormone has the ability to prevent neuronal loss, reduce brain swelling, and improve brain function in those with traumatic injuries.

Interestingly, the majority of damage (approximately 75%) suffered in TBI occurs hours and even days after the initial injury. Inflammatory and cytotoxic processes cause edema in the parenchyma and brain cells, causing further destruction. Modern medicine has yet to discover a treatment effective enough to reduce or even halt the cascade of events within the brain after injury, which is why the progesterone study is so meaningful. Extensive animal research has shown that progesterone significantly reduces cerebral edema, which in turn reduces further tissue and cell injury. The application potential for humans is obvious, which is what led Emory researchers to their study.

The study was designed to assess the safety of using progesterone for the treatment of TBI and became so promising that further clinical studies are planned. The study subjects that were given the hormone received amounts approximately three times higher than those seen during pregnancy within 11 hours of initial injury for three consecutive days. Significant improvement of functional outcome, level of disability and death rate was seen at a 30 day follow up. Another important element of the study results was the lack of adverse effects from the hormone administration: none were reported.

According to the study’s lead author, progesterone has potential in numerous situations, such as the one out of every three soldiers seen at Walter Reed Medical Center who suffered TBI, usually from improvised explosive devices. Eventually the hormone may be administered by paramedics at accident scenes, and there is promise for stroke victims and newborns affected by a traumatic birth. It is also suggested that premature senility and Alzheimer’s disease patients may benefit from progesterone as well.

While further clinical studies are pending, this research helps confirm what many of us already know: progesterone is a safe, effective, and beneficial hormone.

DHEA: A Commonly Overlooked Hormone

A commonly overlooked hormone in our testing menu is DHEA. It is an often misunderstood, yet very important part of the whole hormonal picture and is a key player in achieving hormone balance.

So what exactly is DHEA and why is it important to test?

DHEA (Dehydroepiandrosterone) is the most common steroid hormone in the body and is mainly produced by the adrenal glands, but smaller amounts are made elsewhere in the body. It is metabolized from pregnenolone and is a precursor to the sex hormones: namely testosterone, but also the estrogens. These features are why testing DHEA is a valuable part of dealing with hormone imbalance: the result will reflect how the adrenal glands are functioning, and a baseline DHEA level is important for dosing supplementation, as DHEA can raise testosterone and estrogen levels due to its precursor status. Female patients with low levels of DHEA and sex hormones having complaints of symptoms like low libido will be well served on DHEA, as they convert DHEA to testosterone more readily than men.

While DHEA is often seen in applications and discussions of anti-aging and adrenal function issues, it has also been found to be involved in many other processes in the body. Studies have shown that DHEA displays significant positive results in areas such as the regulation of insulin, cortisol and immune activities, cardiovascular protection, anti-dementia, bone stimulation, antibacterial activities, energy, and well being.

The potential promise of future applications of this hormone is leaking into the mainstream and increasing awareness, although not always with the best outcome. A simple internet search yields hundreds of sites touting the “magical" properties of DHEA, especially the feature of improving one’s feeling of well being. What they don’t say, of course, is how unwise the unmonitored use of this hormone is. As mentioned above, it can raise estrogen levels. This is not something a patient should do on their own. Someone who is feeling “blue" and has perfectly normal levels of DHEA and testosterone may start supplementing with over the counter DHEA and create a whole new set of problems by throwing their hormones out of balance. It is important to look at the whole picture when treating hormone imbalances, and DHEA is a critical part of that process.

Bioidentical Hormones: One Size Does Not Fit All!

The severity of problems caused by the use of synthetic hormones led to a landmark decision in 2002 by the Women’s Health Initiative (WHI), a long term health study of postmenopaual women. After discovering that instances of breast cancer, heart disease and osteoporosis increased with the use of medroxy progesterone and pregnant mare’s urine conjugated estrogens, research was halted. Bioidentical hormones were brought into the spotlight after women sought a safe alternative for synthetic hormone replacement therapy.

The difference between bioidentical and synthetic hormones starts at the molecular level. Bioidentical hormones have the same chemical structure as hormones made by the human body, and can replicate the actions of those made naturally. Side effects and risk factors are minimized when your body recognizes its own molecular structure, fills its receptor cites efficiently, and can utilize, break down, and detoxify hormones effectively. Bioidentical hormones can be tailored to match each individual’s needs by a compounding pharmacist. Synthetic hormones, on the other hand, have an altered molecular structure that the body does not recognize completely, thus their actions are not straightforward and they are not detoxified from the body as easily. Side effects are common with these types of hormones because they are foreign to the body. Synthetic hormones are prescribed as a “one size fits all", and cannot be specifically made for an individual.

The individualized approach of bioidentical hormone treatment requires a saliva hormone test. This will measure only active (free/unbound) hormone levels unlike serum tests, which reflect inactive (total/bound) levels. Measuring inactive hormone levels is not useful in assessing function or balance. When testing the sex hormones through saliva, it is also important to assess adrenal status (DHEA and diurnal cortisols). Even if the chief complaints seem to be an imbalance of the sex hormones, the adrenal and sex hormone pathways are so closely linked that an imbalance in one area will affect the function and efficiency of the other.

The state of the art delivery system for bioidentical hormones is transdermal. By applying hormone to the skin rather than ingesting it, the liver first-pass is averted, thus therapeutic levels can be reached with far less hormone. Studies have shown that measurement of transdermal hormones is best done through saliva rather than serum. Overdosing of hormone supplementation is often seen when using serum to monitor topical hormones (often 4-5 times higher than is needed).

A good starting place for assessing hormonal status is to measure estradiol, progesterone, testosterone, DHEA, and morning cortisol. Remember: cortisol has a well established 24-hour diurnal rhythm, and the time of day when this is measured will reveal unique aspects of one’s health. If there are complaints of sleep disruptions, a night cortisol should also be performed, and if there are suspected metabolic and blood sugar dysregulations, all cortisols should be tested (morning, noon, evening and night).

Bibliography 1. Peter O'leary, Peter Feddema, Katherine Chan, Mario Taranto, Margaret Smith, Sharon Evans (2000) Salivary, but not serum or urinary levels of progesterone are elevated after topical application of progesterone cream to pre-and postmenopausal women . Clinical Endocrinology 53 (5), 615–620.
2. Lee, John R. MD. Letters to the Editor Menopause. 10(4):374-377, July 2003
3. Mead, Jay H. MD. Saliva versus Serum Bibliography, Labrix Clinical Services, Inc. (2004)
4. FDA Statement on the Results of the Women's Health Initiative (8/13/2002) Women’s Health Initiative (WHI) Results Signal Need for Reassessment of Risks and Benefits of Conjugated Equine Estrogens/medroxyprogesterone Acetate (Prempro) in Postmenopausal Women.
5. Risks and benefits of estrogen plus progestin in healthy postmenopausal women. JAMA 17 July 2002; 288:321-333
6. Diurnal changes of salivary estradiol in a female during luteal phase., IBL Hamburg Germany (2004)

Male Menopause

Male menopause, also known as andropause, somatopause and men’pause, is most often ignored by conventional medicine yet it affects the majority of men. Declining testosterone levels are commonly seen in men beginning in the fourth decade of life. This is analogous to menopause in women when ovarian production of estrogens and progesterone begins to decline. Undetected yet equally as powerful, a male’s hormonal status changes dramatically during this time. The production of testosterone by testicles declines at exactly the same time as the amount of protein that binds testosterone (sex hormone binding globulin) increases. This may seriously lower the amount of free testosterone available to the target organs. Unless the level of free testosterone is sought and assessed, a man’s symptoms are often ignored and he is blown off as having a "mid-life crisis", or his physician diagnoses depression and an antidepressant is prescribed.

Testosterone is an important anabolic hormone in men. It plays many roles in maintaining both physical and mental health by increasing energy, preventing fatigue, maintaining normal sex drive, and increasing strength of structural tissues.

Testosterone deficiency is often associated with symptoms such as:

• Night Sweats
• Hot Flashes
• Erectile Dysfunction
• Loss of Energy
• Aches and Pains
• Reduced Flexibility
• Low Sex Drive (libido)
• Decreased Mental Acuity
• Loss of Muscle Mass

Furthermore, insulin resistance and diabetes are quite often additional serious consequences associated with testosterone deficiency. Stress management, exercise, proper nutrition, dietary supplements (particularly adequate zinc and selenium), and androgen replacement therapy have all been shown to raise androgen levels in men and help counter andropause symptoms. Androgen replacement therapy should be discussed with a qualified health care provider.

Insufficient testosterone is not the only hormone imbalance that a man experiences. An excess amount of estradiol relative to progesterone is routinely discovered in the saliva during andropause, which is known to be associated with prostate gland diseases such as benign prostatic hypertrophy (BPH) and prostate gland cancer.

Menopause

Contrary to popular belief, Menopause is not simply the result of estrogen deficiency; although, estrogen levels do decline during the latter phases of a woman's reproductive cycle. Estrogen levels drop by approximately 40% at menopause while progesterone levels plummet to approximately 90% of the pre-menopausal levels. It is the relative loss of progesterone that causes the majority of symptoms. The disproportionate loss of progesterone begins in the latter stages of a woman’s reproductive cycle, while unbeknownst to her, the luteal phase of the menstrual cycle begins to malfunction. The malfunction is initiated when the remnant tissue of the follicle (corpus luteum), the primary source of progesterone, begins to lose its functional capacity. By approximately 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 are:

• Mood Swings: Irritability, Depression
• Irregular Periods
• Heavy Menstrual Bleeding
• Hot Flashes
• Vaginal Dryness
• Water Retention
• Weight Gain: Hips, Thighs and Abdomen
• Sleep Disturbance (Insomnia, less REM sleep)
• Decreased Libido
• Headaches
• Fatigue
• Short-term Memory Loss
• Lack of Concentration
• Dry, Thin, Wrinkly Skin
• Thinning of Scalp Hair
• Increased Facial Hair
• Bone Mineral Loss (Osteoporosis)
• Diffuse Aches and Pain

The most effective way to assess hormone status is to test saliva for the appropriate hormone levels. The reason that saliva is the best method of testing is that "active" tissue levels are measured, opposed to serum testing in which essentially measures the "inactive" levels.

Menopause

Contrary to popular belief, Menopause is not simply the result of estrogen deficiency; although, estrogen levels do decline during the latter phases of a woman's reproductive cycle. Estrogen levels drop by approximately 40% at menopause while progesterone levels plummet to approximately 90% of the pre-menopausal levels. It is the relative loss of progesterone that causes the majority of symptoms. The disproportionate loss of progesterone begins in the latter stages of a woman’s reproductive cycle, while unbeknownst to her, the luteal phase of the menstrual cycle begins to malfunction. The malfunction is initiated when the remnant tissue of the follicle (corpus luteum), the primary source of progesterone, begins to lose its functional capacity. By approximately 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 are:

• Mood Swings: Irritability, Depression
• Irregular Periods
• Heavy Menstrual Bleeding
• Hot Flashes
• Vaginal Dryness
• Water Retention
• Weight Gain: Hips, Thighs and Abdomen
• Sleep Disturbance (Insomnia, less REM sleep)
• Decreased Libido
• Headaches
• Fatigue
• Short-term Memory Loss
• Lack of Concentration
• Dry, Thin, Wrinkly Skin
• Thinning of Scalp Hair
• Increased Facial Hair
• Bone Mineral Loss (Osteoporosis)
• Diffuse Aches and Pain

The most effective way to assess hormone status is to test saliva for the appropriate hormone levels. The reason that saliva is the best method of testing is that "active" tissue levels are measured, opposed to serum testing in which essentially measures the "inactive" levels.

Andropause and Metabolic Syndrome

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. This is the equivalent of menopause in women when ovarian production of estrogens and progesterone begins to decline.

Testosterone is an important anabolic hormone in men, meaning it plays important roles in maintaining both physical and mental health. It increases energy, prevents fatigue, helps maintain normal sex drive, increases strength of all structural tissues such as skin/bone/muscle; 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. They have excess hormone binding receptors for cortisol and androgens and decreased receptors for insulin (resistance to insulin). As a person ages hormone levels change in favor of insulin resistance. The cortisol and insulin levels rise while progesterone, growth hormone and testosterone decline. The visceral fat cell with its increased receptors, blood supply and innervation 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. Stress management, exercise, proper nutrition, dietary supplements (particularly adequate zinc and selenium), and androgen replacement therapy (controversial in prostate cancer) have all been shown to raise androgen levels in men and help counter andropause symptoms. The “trick" is to know how much testosterone is required for each individual male. This is where knowing the salivary testosterone levels comes into play. Initial salivary testing and following salivary monitoring are crucial for determining the most optimal prescription.

Prior to initiation of testosterone therapy the PSA level needs to be within the expected range. There is no evidence that testosterone increases the risk of prostate gland cancer; however, if cancer has already developed testosterone may accelerate its growth. The PSA test is a good guide as to presence or absence of cancer and is a good indicator of inflammation within the prostate gland.

Hormone Case Presentations

Progesterone Deficiency/Estrogen Dominance: Mrs. J.T., a 45 year old woman with regular menstrual cycles complained of tender breasts, headaches and bloating (fluid retention) for two years just before her menses. Her fibrocystic uterine fibroids and fibrocytic breasts have also worsened. Her saliva tests showed a low progesterone level in the second half of her cycle (luteal phase) relative to estrogen, which was high-normal. Supplementation with topical progesterone cream during the luteal phase of her cycle resulted in major improvement in her symptoms.

Testosterone Deficiency: Mr. M. C., a 62-year-old man complained of progressive fatigue, loss of interest in sex, and dulling of cognition. His saliva testosterone level was found to be low, and use of testosterone resulted in a marked improvement.

Inappropriate Hormone Replacement: Mrs. D. L., a 55-year-old woman stopped menstruating at age 49, and was prescribed oral estrogen and medroxyprogesterone acetate (a synthetic form of progesterone, called a "progestin") for relief of hot flashes. She developed weight gain, bloating (fluid retention), migraine headaches, and worsening of hot flashes. Her salivary progesterone to estrogen ratio was very low, indicating a relative lack of progesterone compared to estrogen. Use of topically applied progesterone cream in place of the "progestin" allowed her to reduce her estrogen dosage. All of her symptoms stopped and she reported that she felt normal again.

Cortisol/DHEA Imbalance: A 48 year old vegetarian woman complained of fatigue. Her naturopathic physician diagnosed hypoglycemia. Salivary testing showed that her AM Cortisol was low and her DHEA was high. This is a good example of potentially using inappropriate supplementation with DHEA. Supplementation with DHEA would have caused harm to this patient. DHEA supplementation would worsen her adrenal gland function by lowering her cortisol level further. She needed physician guided adrenal gland support.

Progesterone/Estrogen Insufficiency: This 67 year old woman complained of vaginal dryness with painful intercourse, burning on urination and extreme mood swings. She went into menopause at age 51 and was never directed to take any sex hormone supplemenation. Her salivary estrogen and progesterone levels were low. She was directed to supplement with natural progesterone skin cream, which improved the majority of her symptoms. However, complete resolution of her complaints was obtained only after the addition of biestrogen (estradiol + estriol) to her skin cream.

DHEA Deficiency: A highly stressed, 55-year-old businesswoman complained of poor recovery from workouts, low libido, vaginal dryness, loss of muscle tone, and lethargy. Additionally, her bone scan showed osteoporosis. Saliva levels of DHEA and testosterone were extremely low. Oral DHEA supplementation resulted in weight loss in the waist, increased libido and energy, more muscle tone, and an overall improved sense of wellbeing. Her osteoporosis completely resolved after 12 months of replacement therapy. Note: In women, DHEA is readily converted to testosterone; therefore, supplementation with DHEA will raise the testosterone level.

Adrenal Insufficiency: A 41-year-old woman complained of excessive AM fatigue, sugar cravings, sleep disturbance, depression, anxiety, allergies and multiple chemical sensitivities. Saliva testing revealed low levels of DHEA and cortisol (throughout the day) indicating adrenal gland fatigue (hypoadrenia). After 9 months of following rigorous physician directed adrenal gland support, her cortisol levels returned to normal and all of her symptoms resolved.

Testosterone Deficiency: A 44-year-old had her uterus and both ovaries removed two years ago because of fibroids and endometriosis. She now complains of low sex drive, osteoporosis, vaginal dryness, memory lapses and weight gain, despite supplementation with oral triple estrogen and progesterone skin cream. Her saliva DHEA and testosterone levels were below normal. Her physician directed supplementation program with DHEA and testosterone resulted in an improved sex drive and a modest weight loss.

Infertility: A 32 year old had tried to conceive unsuccessfully for over 10 years. Saliva estrogen and progesterone levels on day 21 of her menstrual showed normal estradiol but subnormal progesterone output. Sufficient progesterone is required for successful conception and gestation. Her physician supplemented her with a progesterone cream during the latter phase of her menstrual cycle and she is now a proud mother.

Polycystic Ovaries: Since puberty, a 27 year old woman experienced irregular periods, facial/body hair growth, acne, and weight gain about the waist. Several attempts on several of the popular low fat/high carbohydrate diets were unsuccessful, though they helped temporarily. Following each attempt at dieting, there was a rebound with even more weight gain. Saliva testing during the second half of the menstrual cycle (luteal phase) indicated high-normal estradiol, low progesterone, and high DHEA and testosterone (androgens). Examination by her doctor revealed cystic ovaries. Extensive dietary modifications, regular exercise and use of natural progesterone helped restore normal menstrual cycles and resolve the majority of symptoms.

Saliva vs. Serum

Saliva vs. Serum: Why saliva testing is truly superior to serum for accurately monitoring transdermal (topically applied) hormones.

Saliva testing is proving to be the most reliable medium for measuring hormone levels. Hormone levels in saliva accurately represent the amount of hormone delivered to receptors in the body, unlike serum which represents hormone levels that may or may not be delivered to receptors of the body. Clinically, it is far more relevant to test the amount of hormones delivered to the tissue receptors as this is a reflection of the active hormone levels of the body.

The majority of hormones in the blood exist in one of two forms: free (5%) or protein bound (95%). While 95% of the hormones in the body are protein bound, it is only the 5% free hormones that are biologically active. Saliva measures the free bioavailable hormone levels in the body, while serum measures only the protein bound non-bioavailable hormone levels. Therefore, serum is a much less accurate measurement than that of saliva when assessing functional hormone levels.

Saliva Measures the "Unbound" Biologically Active or Free Hormone Levels in the Body:
When blood is filtered through the salivary glands, the bound hormone components are too large to pass through the cell membranes of the salivary glands. Only the unbound hormones pass through and into the saliva. What is measured in the saliva is considered the "free", or bioavailable hormone, that which will be delivered to the receptors in the tissues of the body.

Serum Measures the "Protein Bound" Biologically Inactive Hormone Levels in the Body:
In order for steroid hormones to be detected in serum, they must be bound to circulating proteins. In this bound state, they are unable to fit into receptors in the body, and therefore will not be delivered to tissues. They are considered inactive, or non-bioavailable.

Only Saliva Testing Measures Topically Dosed Hormones:
The discrepancy between free and protein bound hormones becomes especially important when monitoring topical, or transdermal, hormone therapy. Studies show that this method of delivery results in increased tissue hormone levels (thus measurable in saliva), but no parallel increase in serum levels. Therefore, serum testing cannot be used to monitor topical hormone therapy.

To view the Saliva vs. Serum Bibliography please visit www.labrix.com resource center.

Hormone Guide Introduction

Labrix Clinical Services, Inc. tests six different hormones - Estradiol, Progesterone, Testosterone, DHEA, Cortisol, and most recently Estriol. As clinicians you have a choice of testing any of these hormones in any combination.

Below you will find a quick reference to each of the hormones we test, as well as others.

Estrogens:

The body produces three types:

Estrone (E1):
E1 is in equilibrium with E2 and therefore can be approximated by knowing the E2 level. There is no need to supplement with E1. In fact, metabolites of E1 are thought to be carcinogenic.

Estradiol (E2):
The strongest form of estrogen and when deficiency exists it causes: hot flashes, night sweats, insomnia, memory loss and emotional lability. It is best supplemented topically because PO supplementation is known to reduce Growth Hormone levels.

Estriol (E3):
Considered the weakest estrogen, but also the protective estrogen. Is used widely to treat vaginal dryness/atrophy and as a safe estrogen replacement for breast cancer survivors. It is generally added whenever E2 is supplemented in the form of "Biest" (most often in a 1:4 ratio of E2 to E3). The recent medical literature strongly suggests that estriol is most helpful for autoimmune conditions, e.g., multiple sclerosis.

Progesterone:
The bio-identical hormone known to block or protect against the proliferative effects of Estrogen (E2). It is protective of breast and endometrial tissue. When replaced in physiologic doses, it stabilizes mood, increases bone mineralization, reduces PMS and post-menopausal symptoms, and decreases cancer risk. It is best supplemented topically or sublingually.

Progestin:
Is used to refer to a group of synthetic progesterones that have high risk effects (increased breast and endometrial cancer risk, heart disease, stroke and pulmonary embolism) since it is more than a single molecule. These are dangerous compounds and should be avoided.

DHEA:
An adrenal hormone which may also be converted to testosterone, cortisol, and estrogen. DHEA supplementation in addition to supporting adrenal health/energy metabolism (when low) will readily optimize testosterone levels in women.

DHEA-S:
The sulfate form of DHEA which cannot be accurately assessed through saliva.

Testosterone:
The major sex hormone in males produced in the testes, and in women in the adrenal glands and ovaries. It is essential for sexual function, cardio-protection, stamina, muscle strength, bone density and stable sugar metabolism. In males, it is prostate gland-protective.

Cortisol:
The adrenal’s primary glucocorticoid, secreted in a known 24-hr pattern (diurnal rhythm) essential for sugar metabolism and immune modulation. It is foundational for energy production and optimal thyroid function.