Sex Hormones

Question 1

Testosterone def diagnosis

Answer 1

Serum < 300 on 2 samples

Question 2

Subtypes of low T

Answer 2

Central (brain): low FSH/LH
Primary (gonadal): low T (FSH, LH normal)
Elevated prolactin

Question 3

Role of aging in testosterone

Answer 3

declines starting in 20s-30s, associated with inflammation and chronic disease

Question 4

70% of adult-onset hypogonadism have this chronic condition

Answer 4

metabolic disease

Question 5

Common conditions assoc with low T

Answer 5

chronic opioids, obesity, metabolic syndrome, diabetes, AIDS, HTN, dyslipidemia, ED

Question 6

Which heavy metal is assoc with low T?

Answer 6

Cadmium

Question 7

Side effects of T replacement

Answer 7

acne, apnea, edema, baldness, elevated cholesterol, gynecomastia, infertility, testicular atrophy

Question 8

Lifestyle to support endogenous T

“Production”

Answer 8

exercise, weight loss
nutrients - A, D, zinc
sleep and stress
test for and tx cadmium

Question 9

Transport protein for T

“Transport”

Answer 9

SHBG

decrease SHBG to liberate testosterone: exercise, nettle root, EPA/DHA, whey protein

Question 10

Modulating androgen receptors

“Sensitivity”

Answer 10

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

Question 11

“Detoxification” to support T

Answer 11

inhibit aromatase and 5-alpha reductase (address body fat, insulin, leptin, inflammation)
tx cadmium if present

Question 12

5 alpha reductase inhibitors

Answer 12

saw palmetto, nettle, quercetin, green tea, soy isoflavones, chrysin, lysine

Question 13

aromatase inhibitors

Answer 13

lignins from flaxseed, green tea, soy, resveratrol

Question 14

which vitamin can increase total T?

Answer 14

vitamin D

Question 15

which two factors can increase aromatase?

Answer 15

insulin, alcohol

Question 16

Nutrients and botanicals for BPH

Answer 16

B-sitosterol, Pygeum africanum, rye grass pollen extract

Question 17

Which vitamin can prevent prostate hyperplasia?

Answer 17

vitamin C

Question 18

nutrient that acts as weak inhibitor of 5-alpha reductase

Answer 18

zinc

Question 19

nutrient that can decrease PSA

Answer 19

Selenium

Question 20

anti-inflammatories for prostate health

Answer 20

quercetin, cranberry

Question 21

Where is estrogen primarily produced?

“Production”

Answer 21

ovaries and adipose (via aromatization)

Question 22

Which hormone stimulates aromatase?

Answer 22

insulin

Question 23

Aromatase is elevated in which conditions?

Answer 23

fibroids, endometriosis, breast CA

Question 24

Does the endometrium have aromatase?

Answer 24

No

Question 25

SHBG is increased in these conditions

Answer 25

pregnancy, hyperthyroid, aging, cirrhosis/hepatitis, HIV

Question 26

SHBG is increased by these meds/supplements

Answer 26

exogenous estrogens, anticonvulsants, vit D

Question 27

SHBG is increased by these diets

Answer 27

low fat | low protein/vegetarian

Question 28

SHBG is decreased in these conditions

Answer 28

DM2, obesity, metabolic syndrome, hypothyroid, nephrotic syndrome

Question 29

SHBG is decreased by these hormones

Answer 29

insulin, IGF-1, GH, androgens, progesterone, prolactin

Question 30

SHBG is decreased by this lifestyle thing

Answer 30

exercise

Question 31

to decrease estrogenic effect, what should you try to do to SHBG?

Answer 31

increase it

Question 32

Ways to modulate estrogen receptors | "Sensitivity"

Answer 32

supplement with weaker phytoestrogens | soy isoflavones, kudzu, cohosh

Question 33

Estrogen "Detox" | Nutrients to support phase I

Answer 33

DIM, I3C, cruciferous veggies, lifestyle phase I adds a OH group

Question 34

3 Phase I estrogen metabolites

Answer 34

2-OH: "good", very weak estrogenic effect, protective against breast CA 4OH: "very bad", carcinogenic via quinones 16OH: "bad", full estrogenic effect, carcinogenic

Question 35

Causes of low 2OH:16OH ratio

Answer 35

obesity, alcohol, RA, SLE, hypothyroid, low fiber, OCPs

Question 36

Phase II estrogen detox (3)

Answer 36

Sulfation Methylation Glucoronidation

Question 37

Ways to support Phase II estrogen detox: sulfation

Answer 37

sulfur donors | glucosamine sulfate, MSM, NaSO4

Question 38

Ways to support Phase II estrogen detox: methylation

Answer 38

folate, B6, B12, methionine, TMG, SAMs, MSM

Question 39

Ways to support Phase II estrogen detox: glucoronidation

Answer 39

calcium-d-glucarate, fiber, probiotics

Question 40

Estrogen dominant conditions

Answer 40

headaches, PMS/PMDD, mastalgia, fibrocystic breasts, fibroids, endometriosis,

Question 41

Estrogen dominance causes

Answer 41

obesity, inflammation, alterations in estrogen metabolism, alcohol, dysbiosis, endocrine disruptors

Question 42

Luteal phase dysfunction s/sxs

Answer 42

luteal phase <11 days or low serum P may have low FSH, E, LH frequent menses, spotting pre and post

Question 43

Luteal phase dysfunction conditions

Answer 43

anorexia, obesity, infertility, early miscarriage, HMB, stress, thyroid dz, hyperprolactinemia

Question 44

Luteal phase dysfunction causes

Answer 44

SAD, low fat/low cal, excess exercise, stress, hypothyroid, PCOS

Question 45

LPD supportive nutrients

Answer 45

``` vitamin C black cohosh vitex vit E B6 avoid meats with hormones ```

Question 46

Fluctuations in hormone levels conditions

Answer 46

perimenopause, major stress, illness, abnormal response to normal fluctuations (e.g. PMS/PMDD)

Question 47

Hormonal insufficiency conditions

Answer 47

aging, menopause, POI, HA

Question 48

Suboptimal hormone metabolism examples

Answer 48

SNPs, alcohol, endocrine disruptors

Question 49

Using serum testing in women

Answer 49

post-menopausal, bound and unbound

Question 50

Using salivary testing in women

Answer 50

measures free hormones only

Question 51

Using urine testing in women

Answer 51

metabolites

Question 52

This condition is characterized by estrogen dominance + progesterone def + stress

Answer 52

PMS

Question 53

This condition has estrogen dominance with LPD

Answer 53

PCOS

Question 54

Nutrients to support PMS

Answer 54

B6 | Vitex

Question 55

Nutrients to support PCOS

Answer 55

inositol

Question 56

Functional med approach to treating fibroids and endo

Answer 56

``` 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 ```