Sunday, July 27, 2014

The Hormone Trilogy

by Glen Depke, Traditional Naturopath
The Adrenal Summit

You've heard me discuss estrogen dominance in the past but today we need to dive deep into this health issue for both men and women. Yes, I did say men and women.

Most often it is thought that estrogen dominance is a female issue. While it is true that many women in my practice are challenged with estrogen dominance for a variety of reasons, it is equally as challenging for men in my practice.

First off let's look at the primary causes for estrogen dominance. For both men and women I feel that the main issue is an overproduction of an enzyme aromatase. Too much aromatase in the body will convert testosterone into estrogen type hormones and leave both men and women with low testosterone and high estrogen hormones. High estrogen is a risk factor for breast cancer in women and prostate cancer in men, both of which are a significant concern for each gender. The other issue is tied into the health challenges due to low testosterone. Testosterone influences mood, memory, metabolism, bone density, energy, and ability to burn fat and build muscle. In women, a small amount of testosterone is produced in the ovaries while most is produced in the adrenal glands. Testosterone binds to receptors inside the body’s cells where it exerts its effects.

As an example, I had a male client that came to see me due to symptoms of hormone imbalance. He had seen another practitioner in the past that tested his testosterone due to symptoms shared. Low energy, lack of motivation, lack of sex drive and weight gain. When his testosterone testing came back, this did show low testosterone. At this time, this practitioner suggested the implants of "rods" under the skin that would slowly release testosterone over the next year to help this person achieve optimal testosterone levels. By the time this client came to Depke Wellness and we reviewed a comprehensive adrenal panel, he not only showed very little improvement but this estradiol specifically was at 16. This was for a man that should have an estradiol level of 1-3. Yikes! I knew this gentleman personally and I joked that he was becoming a woman, except it really was not a joke. When I shared this he mentioned that his breast tissue was increasing and his moods were changing dramatically. Basically what was happening is that the increased testosterone due to supplementation was being converted into estrogen hormones. That is not what we're looking for.

Obviously with this example, the low testosterone was not the issue but rather the conversion of testosterone into estrogen hormones. This is not just a male issue though, I see this in women with regularity also.

From here there are two different focal points. Number one, if you do have elevated estrogen hormones, this should be addressed ASAP because as mentioned above, this is a risk factor for breast cancer in women and prostate cancer in men. When I do find this estrogen dominance, I recommend Myomin, which is a collection of Chinese herbs that assist the body in lowering the aromatase. Remember, this is the enzyme that converts the testosterone into estrogen hormones.

But let's not stop there. I feel that it is important to get to the bottom of why the aromatase is high in the first place. This is where the insulin comes in. When we are consuming foods that are high glycemic foods or if we are chronically stressed, this will leave us with high blood sugar levels. This high blood sugar will require an increase in insulin to assist in removing the sugar from the blood. In the end, the high insulin will lead to an increase in aromatase, thus the conversion of testosterone into estrogen hormones.

Hopefully you can see the necessary steps already. First, when you are looking at hormones, look at all of them and not single hormones. At Depke Wellness, we do this with a comprehensive adrenal test kit. You really want the full picture of what is going on in your adrenal glands as well as ovaries and testicles. Once you recognize estrogen dominance, address this ASAP with Myomin and also be sure to focus on your nutrition and stress to get to the core of your challenge.

There is one more disturbing challenge for estrogen dominance that I have to share. I often see women estrogen dominant due to the use of estrogen creams. I do not want to say that other practitioners do it wrong and Depke Wellness does it right, I am just going to say that we do it different. At Depke Wellness, we never recommend estrogen creams because these vascular creams tend to build up in the fat tissue with very little making it into the blood, which is where it needs to be actually. This build up in the fat tissue will often leave women estrogen dominant, and we see this so often in our clinic.

The other challenge with using estrogen creams is that this is simply a symptom care because you are working with a "end result" hormone. If you are tested with low estrogen hormones, we recommend that you focus on balancing your adrenal gland function and get to the bottom of what is triggering this. That's dealing with your estrogen issues where it's really off.

So in the end, be sure to understand that your potential low testosterone, estrogen dominance and insulin are creating a trilogy that is less than enjoyable for you.

Thankfully, this can all be balanced when tested and addressed properly.

Please leave a post below if you have a comment or question about this article or visit us at The Adrenal Summit Facebook page for ongoing discussions on similar topics.


  1. Thank you for this excellent post. There has always been a mystery for me when it comes to hormones. Could someone still be estrogen dominant even if the blood test reveals low estrogen? If it's stored in the fat, I assume this is not showing up in the blood and so I assume that estrogen dominance is still possible. Is that correct? If correct, what test would reveal estrogen dominance for this? Thanks so much!

    1. My pleasure Debbie and yes, your blood can show normal or even low estrogen and still be estrogen dominant based on saliva test results.

  2. Glen - this post was a serious light-bulb moment for me as I wasn't aware of the effects of insulin on Aromatase. I think I finally have all of the pieces put together. Can you review this and let me know if I've figured out the puzzle?

    This is in the context of a woman who has both PCOS and Endometriosis:

    1. You experience ongoing mental and physical stress.
    2. Your body produces cortisol and adrenaline in response to that stress.
    3. The more cortisol you need, the more cholesterol you need to produce it (Cholesterol -> 17OH Pregnenonlone - > 17a OH – Progesterone.
    4. Your cholesterol increases, especially and unfortunately, your LDL cholesterol.
    5. This same pathway also depletes your progesterone. Progesterone also drops in perimenopausal and menopausal women when ovarian function diminishes.
    6. The cortisol released from the adrenal glands raises glucose levels, which crash and peak, crash and peak, creating inflammation and cravings.
    7. You eat sugary and carbohydrate loaded foods to trigger a release of serotonin, a feel-good chemical, in the brain and to raise blood sugars again in response to the cortisol.
    8. Your body is in an elevated state of insulin from both a) elevated cortisol and b) the carbohydrates you ingest.
    9. Your body becomes “insulin resistant” over time because of this constant peak/crash, driving blood sugars higher and higher.
    10. Your blood sugar and insulin levels rise to pre-diabetic or diabetic levels.
    11. Aromatase is stimulated by elevated insulin; the more resistant you are, the more insulin your body releases into your system, leading to more Aromatase activity in your body, especially the sensitive cells of the endometrium.
    12. Patients with Endometriosis are known to have aberrant Aromatase in their endometrium (normal controls do not).
    13. Aromatase in the endometrium converts testosterone to Estradiol (bad) and prevents the conversion of Estradiol (bad) to Estrone (good).
    14. Localized estrogen dominance occurs, even in the absence of high circulating estrogens in serum, urine or saliva.
    15. The endometrium thickens wherever the localized aromatization occurs. This becomes hyperplasia without atypia (initially).
    16. Adding Progesterone helps in the beginning of treatment, but this effect does not last as levels can go too high if left unmonitored at high doses.
    17. High levels of Progesterone activate hunger and sugar cravings and raise levels of cortisol.
    18. Rinse and repeat.

    1. Very good! Could not have said it better myself. I would only add that other triggers for adrenal insufficiency are food sensitivities, inflammation and infection.

  3. Thank you Glen! So I assume in this scenario the endometriosis (however it got started) would continue this feedback loop as well. Guess the next question is - how to fix this! Better give you guys a call! Thanks again.

  4. You are correct with your assumption.

    Call the office at (949)954-6226 and set up a complimentary 20 minute new client phone consult.

    You're welcome!