A Pandemic Wasn’t The Plan Part 3: Hormones

Well, I bled for 16/30 days in April plus 5 in May. This is not my normal. This is pandemic menses. I don’t remember the relationships between cortisol, ovarian function and the reproductive cycle and frankly I haven’t had the energy to look it up again. I am also 46, so my ovarian reserves are low and having anovulatory/ short cycles could be the new normal until I get fully into bioidentical hormone replacement land. Still: Why such extended Abnormal Uterine Bleeding (AUB) ? And why this extended pain, expense and moodiness when I am already working long hours, alternating day and night shifts, and having to accept the global panic of COVID?

I have not changed much of my regular hormone regime. I have been taking bioidentical progesterone the second half of my cycle for the past 10ish years. Ovaries start decreasing progesterone production around 35yo often causing worsening PMS, cramps, and shorter lighter cycles. Taking progesterone lengthens my cycle from 21 to 26ish days and really helps with cyclic breast pain, bloating, cravings, PMDD and cramps. I had been on vacation when all this started and had not been taking it consistently 🙁

I also take testosterone as a subQ injection intermittently. It is prescribed as a weekly shot, but I tend to take it only every 2-3 weeks, mostly because I forget. Sometimes I forget to take it for months at a time. Cis female ovaries and adrenals produce small amounts of testosterone throughout the lifetime, and testosterone is the dominant cisfemale hormone of menopause! Endogenous production tends to decrease around age 40 as an average.

When I was working at Age Management Center, I tested dozens of women’s testosterone levels between ages 25-75 and it was extremely common to have very low levels: more common than normal levels! Optimization of this all-gender hormone brings a sense of vitality, physical and mental strength, increased muscle mass, heightened endurance, and improved orgasm strength (or orgasms, maybe for the first time!) It helps me have the energy to get to the gym and enjoy workouts. I also had an improvement in libido and sexual satisfaction. I have been taking this rx more frequently these days as internal medicine is *exhausting* so low T is not at the root of my hormonal shifts.

That leaves estrogen as the possible culprit, and this could certainly be the case.There are 3 different estrogens in the body that can be measured. Estradiol is the major circulating hormone that has all the beneficial effects – elasticizing bone, brain, blood vessels, and skin. Estrone is a metabolite of both testosterone and estradiol through aromatization and is theorized to have more inflammatory and proliferative effects. The ideal Estradiol: Estrone ratio is 2:1in the body. Estriol is the weakest estrogen and is localized to the uterus and vagina. This enhances vaginal lubrication and tissue health. It is also what is typically used for vaginal replacement in menopause or transmasculine health because it has less systemic effects. I am due to go get my hormone levels tested to see of I have had a big shift in estrogen levels. Lab work is ideal when done between days 19-21 of a cycle to catch all 3 hormone levels. I have not had any side effects of low estrogen yet, but as a 46yo, the decrease is coming.

I will likely transition to bioidentical hormone replacement when my ovaries retire fully. Humans used to go into menopause around 50-55 then die around 65. I do not think we were made to live an extra 40-50 years (90 yo) without any gonadal hormones. And as someone who will be in high productivity for many years head working in medicine, I will need these juicy, foundational, resilient, life giving hormones! Plus, I love the feeling of being strong physically, mentally, sexually and emotionally!

What about Breast Cancer you ask? Well, fortunately I do not have the gene that puts me at higher risk. I also eat lots of foods full of plant nutrients, antioxidants, fibers, and phytochemicals and good quality meats and fats. I exercise occasionally, especially out in nature where I can fill my lungs with fresh oxygen. I have a lot of stress in my life, but I do my best to counteract that with affection, loving kindness towards myself, sleep, mindfullness meditation, therapy, strong friendships and sunshine/water/flowers. Estradiol does increase proliferation of breast tissue; bioidentical progesterone counteracts that maintaining a balance of growth and suppression. Testosterone itself is also apoptotic meaning it is anti-cancer/ pro cellular health in nature. For me, in this body, having a well of hormones to draw from as I continue to function in the world is a source of inner vitality that I can give myself, even when my ovaries stop being able to produce it themselves. And, I will probably stop full bHRT after around 15 years, which is what evidence has shown is the time when long term hormone replacement therapy in ciswomen stops being as effective and starts to drift towards harmful. I may even just continue testosterone in those years which has less negative evidence as well as less links to breast pathology.

I have effectively convinced myself this was probably an estradiol dip in ovarian production resulting in a very short cycle partially due to low progesterone followed by an ovulatory but still low estrogen short cycle. Fingers crossed that this is not my new normal. I have also re-upped my commitment to taking my daily thyroid medication as well as adrenal herb supports, because the hormone systems all work in tandem and when one part is dysfunctional, others need to work extra hard. But the adrenal and thyroid systems are a whole other conversation for another day. And maybe I will read up more on the links between stress and hormones between now and then.

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Meanwhile, This Gal needs to get ready for her night shift in the COVID ICU. Stress. Yup. Exhausting emotionally and physically. Yup. My ovaries can probably read the cortisol and adrenaline levels in my blood and there may be another month of AUB ahead as my body instinctively tries to preserve its resources for essential functioning only in these pandemic times. At least I know what to do for it! I also did book an appointment with a new gynecologist to have an expert on board in case I need something like imaging or a more extensive workup. A Doctor cant always heal herself!


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Ideal Weight Program

photo 3Welcome to a new way of working with body image, metabolism, eating patterns and ultimately, weight management. This is not a diet. Let me repeat. This is not a diet.

Study after study have shown that only 2% of people who lose weight by dieting are able to keep it off for life; 98%  of dieters gain back the weight they have lost plus more. This endless cycle slowly but surely adds pounds while eroding your sense of self worth. It also creates chaos within the blood sugar, hormone and neurotransmitter system that leads to further metabolic disruption.

Now is the time to change the old patterns. With awareness and a commitment to change, you can rewrite the story of your body. Your cells are constantly regenerating themselves; with direction from your mind and an individualized, functional medicine approach to improving structure and function you can reach your ideal metabolism, energy, and physique.

This program is divided into four phases. Each phase is at least 90 days long. Some people will need more time in an individual section, and can stay in each section as long as needed. The four sections are like a wheel, and where you start depends on your health, area of interest, and life circumstances. Some people will move in a linear direction through each step, and others will hopscotch from one area to the other. The secret to success is that we follow your body, your life, and your needs to unlock your ideal.

The four treatment sections are: FOOD, DIGESTION, STRESS, HORMONES

FOOD:  It only makes sense to work with food when addressing weight. Food is actually a very complicated topic, and one that most people have layers and layers of  complex conditioning around. We will start with a comprehensive 200 food ALCAT sensitivity test that will empower and educate you to make food choices based on YOUR immune system reactions to food (food sensitivities.) There are so many diets, so much information, so many food gurus and opinions out there! This test allows you to claim your own power around food choices based on your body’s unique message. In this section we will also teach you how to identify when you are hungry, and when you are full. These simple intuitive eating approaches build awareness and compassion, connecting you to your own primitive need for food as fuel.

DIGESTION: Effective food breakdown and waste elimination is crucial to a healthy body. Nausea, bad breath, appetite fluctuations, heartburn, indigestion, gas, cramping, bloating, constipation, hard stools, soft stools and diarrhea are all signs that your body is not digesting effectively. We will use a CDSA (Comprehensive Digestive Stool Analysis) to investigate all parameters of digestion including beneficial and pathogenic flora levels to truly repair and restore your digestive tract. This will have multiple health benefits including a more balanced immune response, increased energy,  regular bowel movements, potential pain relief and much more. As your digestive system is renewed you will be able to maintain your ideal weight more effectively as the body processes the food you eat with ease.

STRESS: Our brain decides when we are hungry, and when we are full. It also decides when we will eat. These two actions are not neccessarily in harmony. By looking at neurotransmitter levels that are intricately linked to food and well-being, we can understand some of the complexity of the mind-body-food relationship. During this time we will assess the stress in your life, and build stress management skills. Using botanical medicine we will tonify your endocrine system, enhancing your capacity to experience stress with ease and resiliency. At the same time, awareness exercises continue the weight-related exploration of finding and maintaining your ideal physical body with a healthy, relaxed mind.

HORMONES: Most people gain weight when their hormones begin to decline. This usually refers to reproductive hormones like estrogen, progesterone and testosterone, but  thyroid and adrenal hormones are also crucial to a vibrant and efficient metabolism. Finally, Human Growth Hormone levels dictate the speed at which we age.  This section utilizes the Age Management comprehensive hormone blood work panel to thoroughly investigate the state of your hormones. Using cutting edge anti-aging therapies and Bioidentical hormone treatments we will optimize your hormones, rejeuvenating your sex life, cognitive function, energy levels and more.  Some participants may also choose to do a 26 day HCG diet as part of this personally tailored hormonal wellness program for more radical weight loss.

Each of these components make up the whole that is your living body and each have a profound effect on weight. Whether you want to lose 10 lbs or 100lbs, or even want to learn how to maintain your current weight in a more relaxed fashion, our Ideal Weight Management program will bring you closer to that which we all seek – your ideal Self. As your awareness of the triggers behind your disordered eating patterns come clear, your need to medicate with food will shift. Functional issues like constipation, heartburn, and nausea will transform into easy, successful elimination of your body’s waste, allowing a more effective fuel-burning metabolism to emerge. And, you will feel more energized and better able to handle the stresses of everyday living without food as a crutch.

This program is not for the faint of heart. It is for people who have dieted all their life. It is for all genders and all ages. There is no standardized program that you must sacrifice and change to be accepted into – this is a truly individualized series of sessions that unearths the inner you …that you will adore.

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Naturopathic Trans Health 101

** This is a handout from PTHC June 2013 – Please email me at thewrightnd@gmail.com with your experiences using natural medicines in transition! **

Naturopathic Medicine is: licensed in the state of Maine and many other states and Canadian provinces. We provide primary care using medical and alternative medicine. Naturopathic philosophy is based on the premise your body knows how to heal itself, and medicines from nature can help you overcome obstacles to health.

Naturopathic Doctors tools are: Botanical Medicine, Homeopathy, Nutrition, Lifestyle Counseling, Stress Management. Some ND’s also provide hands-on treatments (Chiropractic, Massage, CranioSacral Therapy,) Prescription medication (thyroid and female hormones, antibiotics, some Lyme medications, topical products),  Acupuncture, Traditional Chinese Medicine and IV Therapies.

FOUNDATIONAL NATUROPATHIC SUPPORT – FOR ALL GENDERS

  • Green tea 1-2 cups daily– anti-cancer, antioxidant, immune system support
  • Adrenal support – adrenals are a major source of hormone production when the gonads are taken out of the picture as is evidenced in menopause and andropause. B5, vit C, Siberian ginseng, Ashwaganda, Rhodiola, Licorice.
  • Probiotics – the digestive tract is the seat of our vitality and overall health.
  • Cruciferous vegetables, fresh ground flax seeds, green tea, sprouts all enhance excess (endogenous and environmental) estrogen elimination – important for every body!

GENERAL TRANSMALE SUPPORT

–       Support adrenals with herbs known to increase testosterone production.

–       Testosterone metabolizes into Dihydrotestosterone (DHT) – a biologically active metabolite of testosterone 30x more potent because of its increased affinity for T receptors. DHT is known to promote hair loss. This conversion can be modulated with SAW PALMETTO – stops the conversion of T –> DHT. PLus ZINC 10-30mg daily.

–       Nettle Tea – decreases bound T/ increases free (active) T, lymphatic support.

–       Reservage Keratin Booster  – prevention of baldness.

GENERAL TRANSWOMAN SUPPORT

–       Breast health! Reduce methylxanthine chemicals found in coffee, black tea, caffeine, and chocolate. At least monthly breast massage for lymphatic health using herbal oils.

–       Aerobic exercise.

–       Freshly ground flax seeds help the body eliminate excess estrogen – add to smoothies or yogurt with fresh fruit and maple syrup. Cancer prevention.

–       What is a phytoestrogen? Plant compounds that bind to estrogen receptors throughout the body.  Soy Isoflavones, Alfalfa (Medicago Sativa), Burdock (Arctium Lappa), Dong Quai (Angelica Sinensis), Evening Primrose, Pau D’arco (Tabebuia Avellanedae), Red Clover (Trifolium Pretense), Saw Palmetto (Serenoa Repens.)

–       Organic non-GMO soy 1-3 times week if tolerated.

–       HRT Companion by Vitanica** Great prevention product for long term use.

–       Reduce systemic inflammation for optimal long-term health – estrogen is protective for heart and bone health, but it can also be inflammatory. How to reduce inflammation? (CRP, homocysteine measures on bloodwork.)

SEXUAL TONIC HERB REVIEW– from The Male Herbal by James Green

Ashwaganda – WITHANIA SOMNIFERA Withanaloid chemicals resemble steroids biochemically. They are classified as an adaptogens to enhance libido and restore fertility and sexual potency.

PANAX QUINQUEFOLIUM – American ginseng.  PANAX GINSENG – Asian Ginseng. All ginsengs provide ginsenoside compounds that effect hormonal balance. Their overall chemistry supports strong sexual function through tonifying activity. They can also increase nitrous oxide levels, improving blood flow where needed. Panax ginseng is classically only used for men as it is too Yang for women’s health unless specifically prescribed.

Horny Goat Weed – EPIDEMIUM SAGITTATUM, EPIDEMIUM GRANDIFLORUM Exhibits moderate androgen-like effect.  Contains flavonoid ICARIIN which is a cGMP-specific PDE-5 inhibitor (like Cialis, Viagra and Levitra)

Muira Puama  – PTCHOPETALUM OLACOIDES Increases circulation, nervous system tonic, improves sexual weakness and diminished sexual desire in all genders.

Maca – LEPIDIUM MEYENII, L. PERUVIANUM ** Nutritive tonic for all genders. Simulates ovarian and erectile functions. **  – Could restore fertility for FTM’s who decide to want to conceive after testosterone use.

Gokshura  – TRIBULUS TERRESTRIS ** Prostate and urinary system tonic. Contains saponin, a steroidal plant chemical to improve libido with impotence. Improves sexual desire, fantasy life and sexual self-confidence. May prolong duration of intercourse before ejaculation. Increases endogenous LH levels. May stimulate endogenous testosterone production in men and women.  ** May also stimulate ovarian or testicular action in ways that are not desired. Use with caution.

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