Sex Hormones Flashcards
Testosterone def diagnosis
Serum < 300 on 2 samples
Subtypes of low T
Central (brain): low FSH/LH
Primary (gonadal): low T (FSH, LH normal)
Elevated prolactin
Role of aging in testosterone
declines starting in 20s-30s, associated with inflammation and chronic disease
70% of adult-onset hypogonadism have this chronic condition
metabolic disease
Common conditions assoc with low T
chronic opioids, obesity, metabolic syndrome, diabetes, AIDS, HTN, dyslipidemia, ED
Which heavy metal is assoc with low T?
Cadmium
Side effects of T replacement
acne, apnea, edema, baldness, elevated cholesterol, gynecomastia, infertility, testicular atrophy
Lifestyle to support endogenous T
“Production”
exercise, weight loss
nutrients - A, D, zinc
sleep and stress
test for and tx cadmium
Transport protein for T
“Transport”
SHBG
decrease SHBG to liberate testosterone: exercise, nettle root, EPA/DHA, whey protein
Modulating androgen receptors
“Sensitivity”
exercise: increases androgen receptor density in skeletal muscle
nutrient to increase sensitivity - vit A
manage estradiol (via aromatase and 5 alpha reductase) as it increases DHT and androgen receptors in the prostate
“Detoxification” to support T
inhibit aromatase and 5-alpha reductase (address body fat, insulin, leptin, inflammation)
tx cadmium if present
5 alpha reductase inhibitors
saw palmetto, nettle, quercetin, green tea, soy isoflavones, chrysin, lysine
aromatase inhibitors
lignins from flaxseed, green tea, soy, resveratrol
which vitamin can increase total T?
vitamin D
which two factors can increase aromatase?
insulin, alcohol
Nutrients and botanicals for BPH
B-sitosterol, Pygeum africanum, rye grass pollen extract
Which vitamin can prevent prostate hyperplasia?
vitamin C
nutrient that acts as weak inhibitor of 5-alpha reductase
zinc
nutrient that can decrease PSA
Selenium
anti-inflammatories for prostate health
quercetin, cranberry
Where is estrogen primarily produced?
“Production”
ovaries and adipose (via aromatization)
Which hormone stimulates aromatase?
insulin
Aromatase is elevated in which conditions?
fibroids, endometriosis, breast CA
Does the endometrium have aromatase?
No
SHBG is increased in these conditions
pregnancy, hyperthyroid, aging, cirrhosis/hepatitis, HIV
SHBG is increased by these meds/supplements
exogenous estrogens, anticonvulsants, vit D
SHBG is increased by these diets
low fat
low protein/vegetarian
SHBG is decreased in these conditions
DM2, obesity, metabolic syndrome, hypothyroid, nephrotic syndrome
SHBG is decreased by these hormones
insulin, IGF-1, GH, androgens, progesterone, prolactin
SHBG is decreased by this lifestyle thing
exercise
to decrease estrogenic effect, what should you try to do to SHBG?
increase it
Ways to modulate estrogen receptors
“Sensitivity”
supplement with weaker phytoestrogens
soy isoflavones, kudzu, cohosh
Estrogen “Detox”
Nutrients to support phase I
DIM, I3C, cruciferous veggies, lifestyle
phase I adds a OH group
3 Phase I estrogen metabolites
2-OH: “good”, very weak estrogenic effect, protective against breast CA
4OH: “very bad”, carcinogenic via quinones
16OH: “bad”, full estrogenic effect, carcinogenic
Causes of low 2OH:16OH ratio
obesity, alcohol, RA, SLE, hypothyroid, low fiber, OCPs
Phase II estrogen detox (3)
Sulfation
Methylation
Glucoronidation
Ways to support Phase II estrogen detox: sulfation
sulfur donors
glucosamine sulfate, MSM, NaSO4
Ways to support Phase II estrogen detox: methylation
folate, B6, B12, methionine, TMG, SAMs, MSM
Ways to support Phase II estrogen detox: glucoronidation
calcium-d-glucarate, fiber, probiotics
Estrogen dominant conditions
headaches, PMS/PMDD, mastalgia, fibrocystic breasts, fibroids, endometriosis,
Estrogen dominance causes
obesity, inflammation, alterations in estrogen metabolism, alcohol, dysbiosis, endocrine disruptors
Luteal phase dysfunction s/sxs
luteal phase <11 days or low serum P
may have low FSH, E, LH
frequent menses, spotting pre and post
Luteal phase dysfunction conditions
anorexia, obesity, infertility, early miscarriage, HMB, stress, thyroid dz, hyperprolactinemia
Luteal phase dysfunction causes
SAD, low fat/low cal, excess exercise, stress, hypothyroid, PCOS
LPD supportive nutrients
vitamin C black cohosh vitex vit E B6 avoid meats with hormones
Fluctuations in hormone levels conditions
perimenopause, major stress, illness, abnormal response to normal fluctuations (e.g. PMS/PMDD)
Hormonal insufficiency conditions
aging, menopause, POI, HA
Suboptimal hormone metabolism examples
SNPs, alcohol, endocrine disruptors
Using serum testing in women
post-menopausal, bound and unbound
Using salivary testing in women
measures free hormones only
Using urine testing in women
metabolites
This condition is characterized by estrogen dominance + progesterone def + stress
PMS
This condition has estrogen dominance with LPD
PCOS
Nutrients to support PMS
B6
Vitex
Nutrients to support PCOS
inositol
Functional med approach to treating fibroids and endo
Aromatase inhibitors: fiber, lignin from flax seed, soy, resveratrol plant-based diet normalize insulin GI/5R Support detox Reduce estrogen levels Topical or oral P
