MNT sex hormones

Question 1

Progesterone

Answer 1

-cholesterol->pregnenolone>progesterone or HDHEA and HDEA> Estrogen and Testosterone
-progesterone help an embryo implant in the uterus
-Progesterone levels can be low, amidst normal estrogen levels, giving symptoms of estrogen dominance: Breast tenderness before periods, swelling, water retention, weight gain, sweet cravings.

Question 2

Estrogen

Answer 2

Cholesterol -> Pregnenolone -> Progesterone or DHEA and DHEA -> Estrogens and Testosterone
● Estrogens
○ Three kinds: estrone (E1), estradiol (E2), estriol (E3)
○ In women, estrogen produced mostly in ovaries until menopause; then shifts more production
to in adrenal cortex; when pregnant, placenta also produces estrogen
○ Until menopause, estradiol is primary estrogen hormone; after menopause, estrone is primary
○ Fat cells can also produce estrogen
● Estrogen physiologically involved in
○ Ovulation; breast development; bone mineral density; elasticity of skin
● Excess estrogen can result in ovarian or breast cancer
● Falling estrogen levels most commonly cause vasomotor symptoms (e.g., hot flashes/night sweats)
and mood changes

Question 3

Testosterone

Answer 3

Cholesterol -> Pregnenolone -> Progesterone or DHEA and DHEA -> Estrogens and Testosterone
● Produced in the testes and decreases with age (after hitting peak in early 20s)
● Builds muscle, grows hair, drives libido
● Testosterone is believed to decrease with age and estrogen increases, greater likelihood to develop
prostate problems, trouble urinating
● Decrease in testosterone can impact sex drive, weight gain, less mental focus, night sweats

Question 4

Imbalance of sex hormones

Answer 4

● Menopause or perimenopause: vaginal dryness, night sweats, hot flashes, thinning hair, dry skin, weight gain in belly, sleep disturbances
● Estrogen dominance (in women): irregular menstrual cycle; fibrocystic breasts; weight gain (particularly in belly); fatigue; foggy thinking; PMS
● Androgen excess (in women): acne; hirsutism; receding hairline
● Low progesterone (in women): miscarriage; spotting before period, breast tenderness
● Low androgens (in women): decreased libido; muscle weakness (among athletic women); possibly linked to lower
orgasims and dryer vagina
● Low testosterone in men: erectile dysfunction; low sex drive; reduced lean muscle mass; depression; loss of body hair; less beard growth; obesity; fatigue

Question 5

Androgens

Answer 5

Pregnenolone&raquo_space;>DHEA> DHEAs
or&raquo_space;>DHEA> Androstenedione> Testosterone

Question 6

Excess estrogen hormones,
overall (E2)

Answer 6

Suspect gut dysbiosis (“The gut microbiota regulates estrogens through secretion of β-glucuronidase, an enzyme that deconjugates estrogens into
their active forms.”)
● Reduce alcohol intake (competition for excreting estrogen and
alcohol is same) 2
● Quercetin, curcumin, milk thistle to activate Nrf2 (3) (which
combats oxidative stress) as does Schisandra chinensis (4)
● Reduce hormone-laden foods (e.g., conventional dairy)
● The role of fiber 5

Question 7

When testosterone converts to
estrogen (resulting in low
testosterone and high E2)

Answer 7

Reduce belly fat, inflammation, and trigcylerides
● Reduce stress and improve sleep
● Reduce fasting leptin levels to <15 (optimal <10)
● Acupuncture may help

Question 8

Testosterone preference for 5-
alpha (androgenic pathway, facial hair growth, thinning head hair) PCOS?

Answer 8

● Red reishi, also called LingZhi (Ganoderma lucidum)
● Green tea (Camellia sinensis)
● Spearmint (Mentha spicata [Labiatae])
● Saw Palmetto (Serenoa repens) (men’s health)

Question 9

If testosterone is already low,
be weary of (can wipe out testosterone)

Answer 9

Licorice
● White Peony

Question 10

2-OH-E1 LEss than ideal (protective
pathway) (green)

Answer 10

Check Iron status
● Reduce environmental toxins, including smoking

Question 11

Excess 4-OH-E1(red)
(not protective)

Answer 11

DIM (200mg daily) or I-3-C (need sufficient stomach acid)
● Glutathione (or NAC, Mg) and cofactors (C, E, CoQ10, ALA, Mg,
Zn, B6, B9, B12)
● Caraway, anise, celery

Question 12

High levels 16-OH-E1
(associated with proliferation)

Answer 12

Upregulated by all non-coffee caffeine (e.g., energy drinks)

Question 13

Poor methylation in Phase 2
estrogen metabolism

COMT genetic mutation

Answer 13

SAMe and Mg (if COMT genetic mutation)
● Triymethyl Glycine, choline, or methionine
● Methylated B vitamins (beware MAO-A genetic mutation)
● Zn, Alpha-Lipoic Acid 3

Question 14

Low progesterone (PMS)

Answer 14

Reduce stress
● Vitex 11 (AEs), Melissa officinalis, wheat germ, saffron
(AEs), fennel, orange peel essence ( Citrus sinensis ), Hypericum perforatum, ginger
● Balance EFAs

Question 15

Estrogen/Progesterone imbalance
across cycle

Answer 15

Seed cycling: Follicular phase (1T flax, 1T pumpkin) to
boost estrogen; Luteal phase (1T sesame, 1T sunflower) to
boost progesterone,

Question 16

Vasomotor Symptoms (hot
flashes, night sweats)

Answer 16

Valerian 530mg b.i.d. for two months 15
● Red Clover (OTC Promensil(R)) 80mg for 12 weeks 16
● Black cohosh: meta analysis lacks safety and efficacy data 17
● Reviews of acupuncture, Chinese Herbal Medicine, movement
(including yoga), and other relaxation techniques lacked efficacy
data 18, 19, 20
● Evening primrose oil 500mg for 6 weeks 21
● Ginseng - indeterminant 22
● Flax seed - no improvement in symptoms 23
● Sage herb/Saliva Officinalis, Lemon balm/Melissa Officinalis,
Fenugreek/Trigonella Foenum, The Black Seeds/Nigella sativa,
Hayfork/Vitex Agnuscastus, Fennel/FoeniculumVulgare, Ginkgo/
Ginkgo Biloba, Alfalfa/Medicago Sativa, Ginseng/Panax Ginseng,
Anise/Pinpinella Aanisune, Glycyrrhiza Glabra/Licorice, Passion Fruit, Passiflora Incarnata

Question 17

Decreasing sexual function

Answer 17

DHEA

Question 18

Testosterone decreasing

Answer 18

Support glucose management, especially insulin processes 27
● Ashwaganda root extract 300mg b.i.d 28 with resistance training
(study is for young, athletic men)
● Shweta Musali (Chlorophytum borivilianum L.) 500mg b.i.d. 2

Question 19

Erectile Dysfunction

Answer 19

DHEA
● TCM and Acupuncture

Question 20

Estrogen levels are high in postmenopausal women

Answer 20

Can often be linked with excess uterine lining, etc, and need
to be evaluated by an MD

Question 21

DHEA is high

Answer 21

-confirm no exogenous sources
-Send to PCP for serum lab tests.

Question 22

PCOS

Answer 22

What? Hyperandrogenism; Ovulatory dysfunction; Polycystic ovaries
● Symptoms? Oligo-ovulation; Infertility; Acne; Hirsutism
● No unified diagnostic criteria yet (e.g., “insulin resistance…is not included in any of the
diagnostic criteria”); PCOS remains a Dx by exclusion; assessments may include:
○ Androgen secreting tumor; Exogenous androgens; Cushing syndrome; Nonclassical congenital adrenal
hyperplasia; Acromegaly; Genetic defects in insulin action (Leprechaunism, Rabson Mendenhall syndrome,
Lipodystrophy); HAIR-AN syndrome; Primary hypothalamic amenorrhea; Primary ovarian failure; Thyroid
disease; Prolactin disorders
● Unclear if Autoimmune condition:

Question 23

Risk factors

Answer 23

Non- Modifiable

-Maternal PCOS
● Elevated Serum Testosterone
● Parental factors of MetSx (obesity and/or insulin resistance)
● Unclear if ethnicity is a factor
● Maternal Rx while in utero

Question 24

comorbities and/or sequalae (PCOS)

Answer 24

• Insulin Resistance
  ● Metabolic Syndrome
  ● Mood disorders (anxiety and depression most notably)
  ● T2DM
  ● T1DM
  ● Sleep Apnea
  ● NAFLD
  ● Dx Obesity
  ● Infertility
  ● Skin Disorders
  ● Gynecological Cancers
  ● CVD

Question 25

Treatment for PCOS

Answer 25

“Therapy revolves around suppression of symptoms” ● PCOS Seeking Pregnancy ○ Obese: lifestyle Modifications, Letrozole (aromatase inhibitor) Rx ○ Non-obese: Letrozole Rx ● PCOS Not Seeking Pregnancy ○ Glucose Tolerant: Oral Contraceptives and Lifestyle if obese ○ Glucose Intolerant: Metformin Rx and Lifestyle ● Anovulatory: first line therapy Clomiphene citrate; second line therapy Gonadotropins ● Infertility: first line therapy IVF; second line therapy Ovarian Surgery ● Metformin Rx is contraindicated for women wanting to get pregnant; however, it is suggested to be the most useful long-term maintenance Rx for PCOS ● Research is controversial with some finding “little evidence to support the effectiveness of hypocaloric dietary intervention to restore normal ovulatory function in PCOS.”

Question 26

Dietary Impact of PCOS

Answer 26

*Findings suggest that women diagnosed with PCOS under-report simple sugar intake 7 Lots of data pointing toward reduction in symptoms and levels, but the data is short-term and problematic. ● 8 week study only assessing low dairy, low starch ● 800 kcal/day diets improved pregnancy outcomes

Question 27

Lifestyle PCOS

Answer 27

*2017 meta-analysis on acupuncture: “We found a low level of evidence that acupuncture is more likely to improve ovulation rate and menstruation rate compared with no acupuncture.” (10) ● “Stress is believed to be an important component of PCOS. It encompasses different definitions that are all equivalent, like metabolic, inflammatory, oxidative and emotional stress. “ 11 ● Minimize exposure to BPA (animal trials) 12 ● Exercise produces anti-inflammatory effect 13 ● Smoking (retrospective study): “Smokers group has significantly higher free testosterone, 17-hydroxyprogesterone, delta 4 androstenedione, T4, low-density lipoprotein, and white blood cells.”

Question 28

Supplement PCOS

Answer 28

Quercetin 1 gram daily for 12 weeks; "Quercetin supplementation decreased resistin plasma levels and gene expression, and testosterone and LH concentration in overweight or obese women with PCOS." ● Ensure appropriate Vitamin D levels ● 400mg daily Vitamin E and 200mg CoQ10 daily for 8 weeks (and these patients on metformin 1500mg Rx) (beneficial effects on … insulin levels, as well as ... total testosterone levels). However, only co-supplementation affected SHBG concentrations.” ● For 6 months combined administration of 2 grams myoinositol + 75mg gymnemic acid + 400mcg l-methyl-folate, especially for overweight/obese patients” led to “reduced LH, testosterone levels, restore menstrual cycles, etc... ● 1g B.I.D. “omega-3 fatty acid supplementation for 12 weeks to patients with PCOS had beneficial effects on mental health parameters, insulin metabolism, total testosterone, hirsutism and few inflammatory markers and oxidative stress” ● Chromium (not enough information) Limited effects on weight control, glucose control... ● probiotic supplementation of Lactobacillus acidophilus, Lactobacillus casei and Bifidobacterium bifidum (2 × 109 CFU/g each) of PCOS women for 12 weeks had beneficial effects on total testosterone, SHBG, mFG scores, hsCRP, TAC and MDA levels but did not affect other metabolic profiles.

Question 29

PCOS interventions

Answer 29

*Nutrients important to assess: Ca, Mn, Mg, Cr, Zn, Cu 23 ● Vitex agnus-castus and Cimicifuga racemosa in the management of oligo/amenorrhea and infertility associated with PCOS and Cinnamomum cassia for improving metabolic hormones in PCOS ● 370mg chamomile capsules T.I.D. for 12 weeks resulted in decreased testosterone levels ● Trigonella foenum-graecum seed extract (fenugreek seed extract, Furocyst, 2 capsules of 500 mg each/day) over a period of 90 consecutive days showed a reduction in cyst size or resolution,return to regular menstrual cycle, and some became pregnant. ● Resveratrol decreased testosterone and fasting insulin (thereby having a positive effect on androgens) ● Soy isoflavones 50mg/day for 12 weeks “improved markers of insulin resistance, hormonal status, triglycerides, and biomarkers of oxidative stress” ● Mentha spicata (spearmint tea) two times daily for 30 days to improve hirutiusm.30 And animal study with peppermint oil calling for more research ● Plant-derived anti-androgens: Reishi (Ganoderma lucidum) or LingZi: reduce levels of 5-alpha reductase; Licorice (Glycyrrhiza glabra): decreases testosterone in healthy volunteers; White Peony (Paeonia lactiflora): inhibits production of testosterone; Green Tea (Camellia sinensis): inhibit 5-alpha reductase conversion; Chaste Tree (Vitex agnus-castus): Reduction in prolactin levels affects FSH and estrogen levels in females; Saw Palmetto (Serenoa repens)