Good basic assessment of sex steroid and adrenal hormones collected in the morning when levels should be at their peak with an additional test in the evening. Six (6) Tests: Estradiol (E2), Progesterone (Pg), Testosterone (T), DHEA-S, morning and evening Cortisol (C1).
Estradiol and progesterone levels and their ratio are an index of estrogen/progesterone balance. An excess of estradiol, relative to progesterone, can explain many symptoms in reproductive age women including endometrial hyperplasia, pre-menstrual syndrome, brocystic breasts, and uterine fibroids. In older women using estrogen supplements alone, a defciency in progesterone can also result in symptoms of estrogen dominance, which include weight gain in the hips and thighs, brocystic and tender breasts, uterine broids, irritability, water retention, and thyroid problems. These symptoms are also seen in some women approaching menopause, whose estrogen levels swing wildly from high to low without the balancing effects of progesterone. If estrogen dominance is not corrected, it can lead to cancers of the uterus and breasts, and insulin resistance. With the onset of menopause, when ovarian estrogen and progesterone production declines, a new subset of symptoms can result from
low estradiol levels, including hot flashes, night sweats, vaginal dryness, sleep disturbances, foggy thinking, more rapid skin aging, and bone loss. Maintaining appropriate levels of estradiol, adequately balanced with progesterone, at any age is essential for optimal health.
Testosterone levels can also be either too high or too low. Testosterone in excess, often caused by ovarian cysts, leads to conditions such as excessive facial and body hair, acne, and oily skin and hair. Polycystic ovarian syndrome (PCOS) is thought to be caused, in part, by insulin resistance. On the other hand, too little testosterone is often caused by excessive stress, medications, contraceptives, and surgical removal of the ovaries. This leads to symptoms of androgen deficiency including loss of libido, thinning skin, vaginal dryness, loss of bone and muscle mass, depression, and memory lapses.
Estradiol is tested because too much of it, relative to testosterone levels, suppresses testosterone receptors in target tissues and eventually leads to feminizing effects in men, such as breast enlargement. In healthy young men, testosterone is at its highest level and estradiol is very low. However, as men age, this shifts to a higher estradiol/testosterone ratio. Even if testosterone levels are normal, symptoms can indicate a functional testosterone de ciency because of the effects of higher than normal estradiol levels.
There are several mechanisms by which relative levels of estradiol and testosterone can change. Weight gain, whether or not this results from low testosterone, results in increased production of aromatase in fat cells, which converts testosterone to estradiol. Rising estradiol levels also cause the liver to produce more SHBG, which has a greater affinity for testosterone than estradiol. This acts to suppress further the amount of circulating free testosterone. Estradiol also decreases luteinizing hormone (LH) production by negative feedback on the pituitary gland, which in turn acts to decrease testicular testosterone production. High estradiol levels can be controlled by weight reduction to decrease the amount of aromatase-producing adipose tissue. There are nutritional and pharmaceutical approaches to aromatase inhibition.
Progesterone is present in men but at a much lower level than found in premenopausal women. Some men supplement with topical progesterone to help with sleep, to support adrenal cortisol production (progesterone is a cortisol precursor), and to counterbalance the effects of estrogens on the prostate. It has also been used as a mild antiandrogen in patients with BPH and to reduce male pattern baldness, because of its competition with testosterone and DHT for androgen receptors. Salivary progesterone levels can, therefore, be useful to monitor supplementation.
Testosterone is the primary indicator of male hypogonadism and andropause. Many things can contribute to low testosterone levels, including high cortisol levels and high estrogen levels, as described above. Testosterone production in the testes is controlled by the hypothalamic-pituitary-testicular axis, and so dysfunctions of the hypothalamus or pituitary can affect levels, as well as the negative feedback effect of estradiol on LH levels to suppress testosterone production.
Both Women and Men:
DHEA is a precursor for the production of estrogens and testosterone, and is therefore normally present in greater quantities than all the other steroid hormones. It is mostly found in the circulation in its conjugated form, DHEA sulfate (DHEA-S). Its production, which occurs in the adrenal glands, declines gradually with age.
Like cortisol, it is involved with immune function and a balance between the two is essential. Low DHEA can result in reduced libido and general malaise.
Cortisol is an indicator of adrenal function and exposure to stressors. Under normal circumstances, adrenal cortisol production shows a diurnal variation and is highest early in the morning, soon after waking, falling to lower levels in the evening. Normal cortisol production shows a healthy ability to respond to stress. Low cortisol levels can indicate adrenal fatigue (a reduced ability to respond to stressors), and can leave the body more vulnerable to poor blood sugar regulation and immune system dysfunction. Chronically high cortisol is a consequence of high, constant exposure to stressors, and this has serious implications for long-term health, including an increased risk of cancer, osteoporosis, and possibly Alzheimer’s disease.