The Functional Approach to Hormonal Imbalance
Dicken Weatherby, ND
It is the way of modern medicine and of some “alternative” practitioners to simply address the symptoms of hormonal imbalance, say by prescribing hormones or herbs rather than looking at the case from a functional perspective. Between 15% and 20% of post-menopausal women are on hormone-replacement therapy (HRT; online posting, n.d.). The goal of HRT is to relieve the symptoms associated with hormonal changes due to menopause; symptoms such as hot flashes, vaginal dryness and weight gain. Doctors also prescribe hormone replacement to pre- and peri-menopausal women for symptoms such as bloating before periods, migraine headaches and mood changes. Rarely is the goal of HRT to address the underlying causes of the symptoms. It is a one-size-fits-all approach, a way to throw a pharmaceutical answer at a very complex issue that differs by patient. Functionally oriented practitioners must not take this superficial route, one that might alleviate symptoms for a time but also may end up missing something more important. The point is not to treat the symptoms alone, but to look beyond the presentation and find out what the underlying causes of dysfunction might be.
Functional Diagnosis of Hormone Issues
In diagnosing a hormonal imbalance, we want to look broadly (i.e., at as many of the body systems as possible) and as far back as we can (with a detailed history) to be as comprehensive as possible in our perspective of what is happening now. Having a patient fill out a signs-and-symptoms questionnaire is a great way to learn whether the hormonal system is a primary issue, and to begin to discern which hormones need attention. The following presenting signs and symptoms are suggestive of a hormonal imbalance:
- Sleep irregularities
- Mood swings
- Heavy or irregular periods
- Hot flashes
- Breast tenderness
- Low libido
- Adult acne
- Lack of concentration.
The more information we can get and the more specific it is, the easier it will be to get an idea of what is actually happening and how to treat the most basic causes.
Predisposing Factors That can Underlie Hormonal Imbalances
With hormonal disturbances, look for pre-disposing factors and possible triggers that affect optimal hormonal function. These may not be the presenting signs and symptoms, but elements in the medical history that have led the patient to the situation they present with. Some common examples include:
- Chronic stress Chronic stress can lead to “Pregnenolone Steal” or “Cortisol Escape.” When the body is in a “chronic stress response,” pregnenolone, the precursor to the rest of the steroidal hormones, is diverted to cortisol. This is at the detriment of all the other steroidal hormones; i.e. progesterone, aldosterone, DHEA and its metabolites: the sex hormones, estrogens and testosterone. As pregnenolone is diverted to cortisol-cortisone, DHEA depletion begins. The result is a depressed cortisol-to-DHEA ratio and an imbalanced hormonal system. This is measurable with a Functional Adrenal Stress Profile.
- Toxicity/xenoestrogens Many of the toxins we are exposed to on a daily basis have hormone-like activity and are known as xenoestrogens. They have the ability to either mimic estrogen or act as endocrine disruptors sitting on estrogen receptors, kicking off the real hormone and creating a myriad of problems in the body.
- Nutritional deficiencies Certain nutrients act to detoxify hormones and act as essential cofactors in not only the synthesis of hormones but the biotransformation of hormones in peripheral tissues.
- History of synthetic hormone use This would include oral contraceptives and infertility treatment.
Some questions to ask yourself when looking at hormone systems concern the function of the hormones. A practitioner would want to look at how the process of hormone synthesis is working, as well as how the hormone is getting distributed. Other factors include the hormone’s interaction with other hormones, the function of the hormone receptors (i.e., if they are too sensitive or not sensitive enough), how the cells are functioning, and how the hormones are being broken down and excreted. These factors open up the hormone issue to look at the whole cycle of creation of the hormone, how it works and interacts with other hormones and cells, and how it gets broken down and excreted. It is a much more comprehensive and therefore effective way of addressing a case with these issues.
In other words, once we have a sense of the possible triggers and predisposing factors, we need to look at their impact on hormonal function and ask these questions:
- Is there a problem in the synthesis and production of a particular hormone?
- Is there disruption at the cellular receptor level that would have an impact on how the hormonal message is received by the target tissue?
- Is there a problem with the detoxification of hormones?
- Is there a problem with the excretion of hormones?
- Is there a problem with a downstream metabolite of a hormone?
The next step is to order lab tests to help evaluate the hormonal balance. Consider running saliva and/or blood tests to check hormone levels, looking at estrone, estradiol, estriol, progesterone and testosterone. I would also check for adrenal function with in-office techniques, such as the paradoxical papillary response test and Ragland’s test (orthostatic hypotension) as well as the salivary adrenal stress index. If you suspect thyroid involvement, you might want to order a comprehensive thyroid panel, which would include TSH, free T4, free T3, reverse T3 and thyroid auto-antibodies. I always recommend a comprehensive chemistry screen and CBC because elements such as glucose, triglycerides, fasting insulin and cholesterol are greatly impacted by hormonal dysregulation.
Once the underlying causes have been confidently identified and looked at from this broad perspective, treatment can be advised with greater confidence. Protocols might include stress reduction, botanical/herbal medicine, HRT, nutritional supplements, diet and lifestyle changes, acupuncture, and naturopathic treatments such as castor-oil packs and hydrotherapy.
Dicken Weatherby, ND is based in southern Oregon. A graduate of NCNM, Dicken is co-author of the bestselling book Blood Chemistry and CBC Analysis-Clinical Laboratory Testing from a Functional Perspective. He has self-published seven other books in the field of alternative medical diagnosis, has created numerous information products, and runs a number of successful Web sites (www.BloodChemistryAnalysis.com, www.Health-E-Marketing.com and www.StrawBale.com). He is involved in research, writing and consulting, and teaches functional diagnosis seminars in both the U.S. and his native country, the U.K.
New York Times: www.nytimes.com/specials/women/whome/hrt.html