A Primer on Hormone Balancing

Author: Dr. Victoria J. Mondloch, MD, S.C., Preventive Health and Wellness, Family Medicine and Women’s Health

The foundation of everyone’s health is something most healthcare providers have never been taught; it’s actually as simple as knowing that there are four basic hormone groups. Realizing that there are ‘four legs of a hormone chair’ means that each of these four basic hormone groups is as important as the other three—and that they are all equally important when it comes to balancing the foundation of your health.

The four hormone groups and their importance

It’s really important to realize that your body is not a group of individual systems that work independently of each other. That’s what Western medicine wants you to think because that’s how it approaches healthcare: “You have a problem, I have a pill for that.” 

This type of mentality fragments our body into ‘silos’ that work independently of other parts of the body. Nothing could be further from the truth. Instead, realize that your body is a complex machine that counts on and relies on the other systems in your body. Your body does not rely on single body systems alone—it is a finely tuned and integrated body that works like a well-tuned orchestra. If one instrument of that orchestra is out of tune, the sound coming from that orchestra makes the audience uncomfortable. They can usually hear it immediately and they know something is wrong. It’s the same concept with your body—when one hormone system is off, it impacts the other hormone groups in your body, and it forces the others to try to ‘rebalance,’ even though it cannot.

Why is this conversation so important?

Because it’s very difficult to sit on a chair with a broken leg. You need to sit very gingerly, or you will find yourself sitting on the floor with no idea how you got there. So, you dutifully re-right that hormone chair and sit back down on it. But if you haven’t rebalanced your hormone groups, you are still sitting on a chair with a broken leg. Then you find yourself doing the same thing over and over again—the very definition of insanity, which is doing the same action but expecting a different result. It won’t happen. Instead, you will put additional stress on the other three legs of the chair, and they will become more and more stressed until they are also pulled out of balance. Before long, you may have two legs broken, then three legs broken, and sometimes all four legs of that chair are broken and you’re sitting on the floor with no idea how you got there and no idea of how to fix the situation. Unfortunately, this is happening to more and more people because doctors and healthcare providers are not taught the importance of hormone balancing these four hormone groups.

What are these four hormone groups?

1. Sex Hormones
   • For Women: Estradiol, Progesterone
   • For Men: Total Testosterone, Free Testosterone, DHEA-S
2. Thyroid panel: TSH, Free T3, Free T4, Thyroglobulin AB, and Thyroperoxidase AB
3. AM Cortisol: also Vitamin B12
4. Insulin: plus fasting glucose and HgBA1C

First leg of that hormone chair: The sex hormones

It’s not just important to know that these hormones are ‘in normal range.’ What’s really important is to know if these levels are ‘age-appropriate.’ In the bigger picture, realize that ‘in normal range’ may be a woman who is twenty-five years old having levels that are more appropriate for a forty-year-old woman. That may be ‘normal’ but certainly not ‘age- appropriate.’

The same goes for men. There is an actual formula that determines where the ‘age-appropriate’ level for a male’s Testosterone level should be. However, too often, males are told that their Testosterone levels are ‘within normal limits.’ However, if a thirty-five-year-old man has the level of an eighty-year-old man, is that what he will best thrive at? Are there health consequences for age-inappropriate T levels, despite having T levels ‘in normal range?’

YES! Too many times I saw a male presenting with significant symptoms of Deep Fatigue, Insomnia, Short-Term Memory Loss, Infertility, and Migraines, along with many other symptoms. Their Free Testosterone levels would show ‘in normal range’ but were much lower than their ‘age-appropriate range.’ They would be told that there was nothing to be done for them, that there must be another explanation by their primary care MD. Yet replacing their T levels back to ‘age-appropriate’ levels would handle all of their symptoms and they could feel like their old selves again.

My question is, why is this concept so difficult to understand? Why can’t western medicine remember that there is an established formula and that being ‘age-appropriate’ and ‘optimal’ is what everyone wants, not just to be ‘in normal range?’

The same is true for females—except that there are four hormones to balance, not just two hormones. And women should actually be more female than male. This may sound obvious but there are healthcare providers who actually prescribe male hormone for symptoms that are actually under the jurisdiction of female hormone, ie. libido.

One of the most basic medical approaches that healthcare providers can have with women is to not only understand where age-appropriate female hormones should be, but also where in their cycle they are, which also helps dictate where their hormone levels should be. Then, just to complicate things a little more, it is important to know that female hormone levels should be a higher percentile than male levels. But 15-20% of women actually have a genetic condition called PCOS or Polycystic Ovarian Syndrome, which is a more male vs female hormone imbalance. Yet too often, hormone levels are not assessed, even with people presenting with multiple symptoms that go along with PCOS, so women are never made aware. The importance of ‘age-appropriate’ hormone levels is equally important as being female vs male.

Then there is the question of where female/male hormone levels should be with menopausal women. This is important as appropriate levels of female hormone are essential to prevent breast cancer, heart attack, stroke, osteoporosis, and tooth decay (that may mean a huge dental bill for implants and bridges.) Knowing that an Estradiol level of thirty is essential for the absorption of calcium from the GI tract, that without a blood level of thirty the body cannot absorb calcium from your diet or supplements so it will steal calcium from another source—your bones and your teeth! 

The other pearl to take away—giving a menopausal woman Estradiol alone will create Estrogen dominance. The problem with Estrogen dominance in menopause is that this puts every woman at risk for breast cancer. Why? Because there is not a balance between Estradiol and Progesterone, and this has implications in higher incidences of breast cancer. And it doesn’t help that a woman’s additional belly fat has a type of estrogen in the body fat called Estrone—a portion of this Estrone gets converted to Estradiol so, again, balancing with Progesterone is essential.

The values for menopausal Estradiol and Progesterone:

• Estradiol: 30-50; if less than 30, you cannot absorb calcium from GI tract
• Progesterone: 1-4; this value needs to be a minimum of 2:1 ratio with Estradiol to keep a woman’s female organs safe from hyperstimulation.

Example: 
A sixty-year-old female with
E-35 or 25^th%
P4-2 or 33^rd%

Technically this is more P4 than E (33^rd vs 25^th) but this is not a 2:1 ratio which would be a higher P4 of 50^th% or 2.5. Then you need to know the Free Testosterone levels and how that translates to a % that needs to be lower than the female balance of hormone.

Remember, this is only the first leg of that hormone chair. If these values are off, then the other three hormone legs are going to be ‘stressed’ out of their normal ranges, which may throw your hormone equilibrium out of balance.
For men, realize that the ‘age-appropriate’ hormone levels mean that low T levels can also throw off your other three hormone groups. If a fifty-year-old man has a T level of an eighty-year-old man, that’s a problem that needs fixing. So, replacing Testosterone to age fifty years old is the right thing to do…period.

Second leg of that hormone chair: Thyroid

Thyroid is the hormone that controls your metabolism. This hormone is absolutely essential to the speed at which your body functions. It’s going to be one of the essential hormone groups that is the foundation for how your whole body works. This is one of the most common abnormalities that both men and women can undergo—and it is especially common in the US Midwest where there is no natural source of iodine in the groundwater. This is less common on the coasts due to iodine being in the salt water, the salt air, and in the more commonly available seafood that coastal people have the opportunity to include in their diet.

What are the thyroid tests that need to be drawn?

• TSH or Thyroid Stimulating Hormone: this is made in the pituitary and signals the thyroid gland to do its job.
• Free T4: this is the protein that is made in the thyroid gland and supports the gland.
• Free T3: this is the protein that is converted from Free T4 that the thyroid gland sends out to the rest of the body for energy. Know that there is the ‘normal reference range’ and there is the ‘optimal range’ for where these thyroid values should be.
• Thyroglobulin AB: this will be elevated when your immune system attacks your Free T4 or your thyroid gland. This can result in an enlarged thyroid gland with nodules, a way that the thyroid gland tries to protect itself from the immune system attack.
• Thyroperoxidase AB: this will be elevated when your immune system attacks your Free T3 which goes out to your muscles and your joints.

One of the fallacies of autoimmune thyroid disease is that ‘once your AB’s are elevated, they will always be elevated and that there is no further need to follow these levels.’ Nothing could be further from the truth!  Know that antibody levels are elevated in the face of inflammation. Once this inflammation is addressed and reduced, the immune system’s response will also be reduced and antibody levels will fall, many times to normal levels or showing remission!  Yet, re-exposure to American gluten can elevate these antibody levels again, so you need to be aware and vigilant.

Of course, reducing inflammation for thyroid isn’t just about the thyroid—it’s also about reducing gluten exposure in the GI tract which triggers the inflammation in the thyroid. Gluten sensitivity or gluten-caused inflammation is many times triggered by the contamination of the American wheat seed by the overuse of the pesticide, DEET. Unfortunately, DEET has become irreversibly incorporated into the wheat seeds’ DNA and people are usually responding to the DEET contamination vs the actual wheat—but it’s too difficult to separate out. However, know that people who are sensitive to American wheat are usually less sensitive to European wheat, as DEET was banned earlier in Europe than it was in the US. So, when travelling to Europe, you may be able to handle wheat products there. There are also a few longer-term US organic wheat farms whose products people have fewer reactions to—but this can be ‘hit and miss’ and also depends on the purity of those farms’ neighbors’ fertilizer habits in the past twenty years, as much as their own habits.

Third leg of that hormone chair: Adrenal and AM Cortisol

This is the body’s stress hormone. And who doesn’t have stress!!! 

The power of AM Cortisol being at optimal levels cannot be emphasized enough. In other words, a level that is at the upper limits of normal is called ‘stress.’ When the level is at the lower limits of normal, it is called ‘distress.’ Higher levels of elevated Cortisol can be tolerated for longer periods of time, but they can cause havoc by forcing the other hormone groups to compensate and ‘help out.’ If Cortisol remains elevated for too long a period of time, the biggest threat is that Cortisol levels can plummet down through the normal range to the level of distress. Once in distress, many people are unable to function. They may even be at a very high risk of psychiatric intervention or inpatient admission for psych evaluation and a total ‘reset’ of their emotional health—often ending up on medication. This can be quite serious and disruptive. There is little wiggle room here.

Support for an elevated or low AM Cortisol is best done with methylated Vitamin B Complex with methyl Vitamin B12 and methyl Folate. However, you also need to know if there is a confounding factor of a genetic deficiency of MTHFR. When a person is heterozygous or homozygous in missing one gene of C677T, one gene of A1298T, one gene of each, two genes of either C677T, or two genes of A1298T, it means that person may need as much as three or four times the usual replacement dose of methyl Vitamin B Complex than a person who is not missing any of these genes. Therefore, knowing this information is critical to how someone responds to their abnormal Cortisol treatment protocol. It is important to discuss this with your healthcare Practitioner to seek guidance.

Fourth leg of that hormone chair: Insulin
(not FBS and not HgBA1C, but INSULIN)

It doesn’t mean that all three of these are not important, but Insulin is the hormone, and it is highly important that insulin levels are not only normal but optimal. Know that labs will typically only report the male reference range for insulin and not the female range. I also want to tell you that an optimal insulin range is how you can help a person prevent Alzheimer’s! In other words, this is one of the most misunderstood hormones in the body and one that is least often checked.

Part of this discussion includes talking about glucose. The body needs glucose to function. If the body fasts greater than twelve hours, the body will break down its glycogen stores and will artificially dump high levels of sugar into the bloodstream which the pancreas will respond to by putting insulin into the bloodstream. So, fasting for more than twelve hours will put excess stress on the pancreas and actually trains the body to become diabetic! The problem with the American diet is usually not about timing—it’s usually more about portion size.

The other issue that is rarely addressed is knowing your metabolic body type. In other words, not everyone responds to a high protein diet or to a high ketone diet. Everybody has a genetic predisposition to how their body wants them to eat for both weight loss and for weight maintenance. You may WISH your body to respond to a high protein diet, but you may actually gain weight vs releasing weight on a high protein diet. I believe it’s critical for you to know your own metabolic body type definitively vs wishing or guessing what your body needs. Trying to get your weight under control can be quite frustrating, but this is the correct information that you need to know to best support your own health. Reach out to a healthcare provider who offers a ‘Decision Genetics’ cheek swab to learn your metabolic body type. It only needs to be done once as this is genetic information.

In Summary

Putting all of this information together, the best foundation for your health is balancing all four hormone groups and working to achieve optimal hormone levels in all areas. Remember that if one hormone group is out of balance, it will pull the other three out of balance.

Frequency of checking?

How often do you need to check all four hormone groups? In my practice, I routinely checked them every three months because, living in the upper Midwest, the change of seasons caused subtle changes in bloodwork that would knock people out of hormone balance and would require tweaks in their supplements or medication dosing to accommodate. Levels of physical activity may also change with the seasons so be aware that checking every three months is a starting point from which you can adjust. Testing every six months, in my experience, was usually too long of a gap, as more significant tweaks needed to be made vs the shifts that occurred every three months.

Working to keep all four hormone groups in balance is the goal. It is not always the easiest thing to do, as tweaking one can knock others out of balance. But NOT working to keep all four hormone groups balanced can result in catastrophe.

Be involved in the decision-making with your healthcare provider. Work with a healthcare provider who is a partner with you in your own healthcare. This will empower you to make better health decisions about your own health on an ongoing basis. After all, it is about YOU!