by Dr. Glenn Wilcox, D.O.M.
Part 1 of this article was in the January/February 2019 issue of Truly Alive and can be found at TrulyAlive.net.
Your hormones are essential to your health and vitality. They must be sufficient and in balanced harmony. But how to know? (Mostly in conventional medicine), blood tests are used to determine hormone levels. Blood tests are good, but there is a better way!
Here are the primary hormones to evaluate:
Estrogens: Estrone (E1), Estradiol (E2), and Estriol (E3)
Thyroid Stimulating Hormone (TSH)
Other Important Hormones
Blood Hormone Tests: If your doctor is using blood tests to evaluate the levels of the above hormones, you are fortunate. Many conventional docs don’t even test for them. Blood tests for these hormones are useful and important. However, they do not provide a complete picture. A blood test is similar to a snap shot of your hormones at one moment during the many moments of your day. But hormone levels fluctuate throughout the day; some more than others.
Hormone Levels Fluctuate: For example, cortisol is produced by your adrenal glands and is considered a stress hormone that increases when you’re experiencing a stressful situation (fight or flight). It gives you energy and helps you use blood sugar more efficiently, so you can run from the bear or get that urgent task completed at work. However, cortisol is being produced all day, even if you’re not stressed. Normally, lots of it is produced in the morning to get you up and going and as the day progresses, production declines and off to sleep you go. It helps provide you with normal good energy. But some folks have overtaxed their adrenals with too much stress, or a prolonged illness, or whatever, and don’t produce enough cortisol in the morning. They just don’t have the energy to get up and going. They’re “slow starters” and some just never get going at all during the day and experience chronic fatigue. Even worse, some of those folks with low cortisol during the day get an excessive increase of cortisol in the evening and then can’t get to sleep. They are “tired and wired.”
Urine Hormone Tests: Since hormones fluctuate during the day, and a blood test provides only a one-point snapshot, what to do? The most advanced doctors doing bioidentical hormone therapy in the nation use urine testing. Urine contains an accurate reflection of all the hormones your body is making and eliminating. There are two options for testing hormones using urine. The first is to collect all your urine for 24 hours and send a representative sample of that to the lab for analysis. The second is to catch your urine four times during the day – on waking, before lunch, before dinner, and at bedtime. For each catch, you dip a test strip in the urine, allow it to dry and send the four strips to the lab for analysis. This is called a 4 Point Dried Urine Hormone Test. It is relatively new and provides almost the same accuracy as the 24-hour urine test, but at less than half the cost. I use both in my practice, along with blood tests.
Safety: Safety is another reason why urine testing is essential. Hormones, after they have done their job, are broken down into metabolites that can be reused or eliminated in the urine. Urine tests can reveal these metabolites. Blood tests don’t. But why are they important? Studies show that some metabolites are good and even help prevent cancer, while other metabolites are problematic and even contribute to the development of cancer. Therefore, if you are not metabolizing your hormones well, this is important to know, whether you are using supplemental hormones or not. If you doctor is not evaluating this, you are at risk. If you have issues with your hormone metabolism pathways, those can usually be corrected with natural supplements. Doing so is an essential aspect of good hormone therapy. Unfortunately, it is rarely given the attention it should receive. Make certain you doctor is managing your metabolites and not just your hormones.
Free and Bound Hormones: Finally, hormones exist in your body as free and bound hormones. The free hormones are available to do their job. The bound hormones are not active. Therefore, knowing your free hormone levels is essential. Unfortunately, blood tests do not evaluate some of your free hormones. The three estrogens are a good example. However, urine testing will reveal your free estrogens. Again, blood hormone tests are good and necessary. And, urine hormone tests are superior and provide essential information so your hormones can be evaluated and properly managed by your doctor.
The Hormone Symphony: I frequently refer to The Hormone Symphony and with good reason. Many doctors pay attention to one part of this Symphony, but good hormone therapy demands an awareness and conducting of the full orchestra. Please refer to the flowchart in this article. It shows how many of these hormones are intimately connected. Don’t allow its complexity to confuse you or make you apprehensive. The yellow highlighted hormones are the main players. Focus on those. The others are metabolites in the process, some helpful, some harmful, some both. Yes; it’s a bit complex. But it’s also essential to understand in order to manage your hormone health. This flowchart was created by Meridian Valley Lab. That’s the lab I use. Their medical director is Jonathon Wright, M.D. Dr. Wright pioneered the use of bioidentical estrogens and DHEA in the 1980s, and he has more clinical experience in hormone replacement therapy than any other practitioner. He’s one of my mentors.
As you can see from the flowchart below, Pregnenolone (the mother hormone) is created from Cholesterol. On one side of the flow, Pregnenolone converts to Progesterone, then Cortisol (that we discussed above for energy), and then Cortisone. On the other side DHEA, that is also produced by your adrenal glands, is converted into Testosterone or Estrone and then on to the other Estrogens. Simple!
My History: In 1997, I led my profession in New Mexico to include the prescription of bioidentical hormones in the laws of our licensing Practice Act. We were the first medical profession in New Mexico to do so, maybe in the nation. As a result, Doctors of Oriental Medicine with advanced training and Board Certification have been at the forefront of bioidentical hormone therapy in our state and across the country. I have over two decades of experience helping my patients learn to successfully conduct their hormone symphony. Let’s tune up your orchestra!