Hormone Cookbook

1. Hormone Cookbook Joanna Wilson, D.O., NACP Board-certified Internal Medicine

2. My first hormone memory…

3. Familiar Uses of Hormone Therapies • Freedom from menstrual symptoms • Control of when and how many children we have • Reversal of infertility • Relief of menopausal symptoms

4. Sex Hormones Affect These Issues, Too! • Infection susceptibility • Asthma • Oral health • Autoimmune disease • Vascular disease • High blood pressure • Dementia • Bone strength • Muscle strength • Mental health • Breast, lung, prostate, colon, kidney cancer • And just about every other disease

5. How Hormones Work • Cofactors which modify the cell’s response • Timing of hormone production (pulsatile or continuous) • Dose response • Central control (positive and negative pituitary feedback) • Interaction with other hormones • Cell surface receptor

7. Main Ingredients For Today’s Recipes • Estrogen • Progesterone • Testosterone

8. Progesterone Effects • Protects the uterus from overgrowth due to estrogen stimulation • Helps nerve cells repair • Prevents bloating from estrogen • Inhibits the breakdown of serotonin • Helps stabilize mood • Increases body temperature during ovulation • Antiinflammatory • Increases appetite • Improves sleep • Chemotherapy for breast, prostate, and renal cell cancers

9. Testosterone Effects • Muscle mass and strength • Bone mass • Sex drive

10. Estrogen Effects • Improved cognition and memory • Improved neuronal healing • Improved glucose tolerance • Maintenance of fat distribution in periphery • Improved bone mass and strength • Raises HDL, lowers LDL cholesterol • Improved blood vessel healing

11. Estrogen Receptor Locations

12. Recipe #1 Contraception

13. Ovarian Hormones in 28 Day Cycle

14. Brain- Ovary Conversation-Positive Feedback Brain Ovary

15. How Do We Convince The Brain To Ignore The Ovary?

16. Negative FeedbackNo surge = No ovulation • All (combination) birth control pill options have stable daily estrogen dose • Low, consistent hormone dose prevents pituitary surge to prevent ovulation X

18. Progestogen Receptor Activations

19. Progestogen Characteristics and Side Effects

20. Can We Prevent Ovulation Only When We Need To?

21. Emergency Contraception 175 pounds

22. Recipe #2 Menstrual relief

23. Contraceptive Pill Options • Cyclic- 7 days of no progestin (“withdrawal”) • Monophasic • Triphasic • Continuous- no withdrawal week • Monophasic only

24. Estrogen and Progestin Levels on ContinuousvsCyclic Birth Control

26. Vein Clot Risks(per 10,000women/year) 4 20 6 10 to5 9

27. Recipe #3 Menopause

29. Endothelial Cell Layers in Healthy Postmenopausal and Premenopausal Women • Postmenopausal cells show evidence of endothelial cell death, denudation, and RBC, platelet, and protein attachment, as well as fractured basal membranes, and loss of intercellular junctions • Premenopausal cells show tight connections, a continuous layer of endothelial cells, and thick plasma membranes

31. Estrogen Sources Before Menopause After Menopause Adrenal glands Fat Tissues • Ovaries

33. Figure 4 Effect of age on DHEA and DHEA-S levels in women Labrie F (2007) Drug Insight: breast cancer prevention and tissue-targeted hormone replacement therapy Nat Clin Pract Endocrinol Metab3: 584–593 doi:10.1038/ncpendmet0559

34. Why Not Just Start Everyone On Hormones?

35. Timing Hypothesis of Menopausal Hormone Therapy

36. Safest Therapy Choices • FDA Approved: • Transdermal Estradiol • Vaginal Progesterone (cyclic) • Not FDA Approved: • Bioidentical therapy

37. Compounded “Bioidentical” Hormones • Dosing schedule mimics premenopausal state in postmenopausal women • Plant derived hormones modified to be identical to human molecules • Not regulated for purity of modification process • Saliva levels do not accurately measure tissue levels • Progestogen skin cream has not been proven effective to prevent endometrial cancer

38. Testosterone SupplementationRisks • Possible increased risk of breast cancer • Acne • Hair loss

39. Manipulation of Testosterone Supplementation • Aromatase blocker to reduce conversion to estrodiol (Femara, Arimidex) • 5α-reductase blocker to reduce conversion to dihydrotestosterone (Propecia)

40. Estrogen Therapy Challenges • Estrogen receptors in tissues cycle, but independently of ovarian function • Serum or saliva tests do not show what is needed in the cells • Optimal levels for dosing are not known • Receptor stimulation or blockade is required to prevent cancer and blood clots • We don’t know how to do this, yet!

41. Creating the Perfect Estrogen Replacement

42. Ingredient Substitutions and Flavor Enhancers Endocrine Disrupting chemicals

43. Yummy Endocrine Disruptors (Phytoestrogens)

46. Endocrine Disruptors = Hormone Receptor Imposters

47. www.dnr.metrokc.gov/WTD/community/edc

48. ‘EDCs are commonly found in food and food containers, plastic products, furniture, toys, carpeting, building materials, and cosmetics. They are often released from the products that contain them and enter the bodies of humans and wildlife through dust or through the food chain’.

49. Endocrine Society Scientific Statement

50. Newest EDC: Triclosan