Which Hormones Need
The major sex hormones to assess are
estradiol, progesterone and testosterone. The main adrenal hormones are DHEA and cortisol.
These five hormones will provide crucial information about deficiencies, excesses and daily patterns, which then
result in a specifically tailored treatment approach and one far more beneficial than the old “shotgun"
Below is a brief description of each of these five
There are three forms made by the body: estrone, estradiol and
The form used in past hormone replacement therapies is estradiol, often in the
form of concentrated pregnant mare’s urine (premarin).
It is a proliferative (causes growth) hormone that grows the lining of the uterus.
It is also a known cancer-causing hormone: breast and endometrial (uterine) in women and prostate gland in men. It
will treat menopausal symptoms like hot flashes, insomnia and memory-loss.
With the bio-identical formulas estriol is matched with estradiol (biest) to provide protective effects and
additional estrogenic benefits. The other major protector in keeping estradiol from running amok is
Is called the anti-estrogen because it balances estradiol’s
It is considered preventive for breast and prostate cancers as well as osteoporosis.
In addition too little progesterone promotes depression, irritability, increased inflammation, irregular menses,
breast tenderness, urinary frequency and prostate gland enlargement (BPH).
Is an anabolic hormone (builds tissue) that is essential for
men and women.
The proper level of testosterone is necessary for bone health, muscle strength, stamina, sex drive and
performance, heart function and mental focus.
Is an important adrenal gland hormone, which is essential for
energy production and blood sugar balance. DHEA is a precursor to other hormones, mainly
Cortisol: is your waking day
hormone (highest in the morning and lowest at night). It is necessary for energy production, blood sugar
metabolism, anti-inflammatory effects and stress response.
Some of the common imbalances identified through testing include estrogen dominance, estrogen deficiency,
progesterone deficiency, androgen (testosterone and DHEA) excess or deficiencies, adrenal dysfunction and adrenal
Estradiol and progesterone are 2 hormones
that are often tested together.
When you test these 2 hormones together we also provide you with a Pg/E2 ratio.
This ratio allows you to determine if the patient (male or female) has “Estrogen Dominance". Estrogen dominance is
a risk factor for breast cancer and osteoporosis in females and prostate gland enlargement and cancer in males.
The term “Estrogen Dominance" is less
related to the amount of circulating estrogen and more related to the ratio of estrogen to progesterone in the
Menopause and PMS are not the result of estrogen deficiency; although, estrogen levels do decline during the
latter phases of a woman’s reproductive cycle.
More relevant is that the estrogen levels drop by approximately 40% at menopause or during periods of stress while
progesterone levels plummet by approximately 90% from premenopausal levels.
It is the relative loss of progesterone that causes the majority of symptoms termed estrogen dominance. The
disproportionate loss of progesterone begins in the latter stages of a woman's reproductive cycle, when the luteal
phase of the menstrual cycle begins to malfunction.
The malfunction is initiated when the corpus luteum, the primary source of progesterone, begins to lose its
functional capacity. By about age 35, many of these follicles fail to develop creating a relative progesterone
As a result, ovulation does not always occur and progesterone levels steadily decline.
It is during this period that a relative progesterone deficiency, or what has become known as Estrogen Dominance,
Typical Symptoms of Estrogen
Heavy Menstrual Bleeding
Short-term Memory Loss
The Progesterone/Estradiol (Pg/E2)
reference ranges are optimal ranges determined by Dr. John R. Lee MD. While they are not physiological ranges,
they are optimal values for the protection of the breasts, heart and bones in women, and the prostate in
Salivary values within these ranges have been shown by Dr. Lee to decrease both breast and prostate cellular
proliferation, thereby providing protection to these vital tissues.
Testosterone is often tested because the
patient talks of low libido.
Declining testosterone levels are the number one cause of low libido in males, and plays a contributing factor in
Declining testosterone levels are commonly
seen in men beginning in the fourth decade of life.
Suboptimal or low testosterone levels in males are often associated with symptoms of aging and are referred to as
“Andropause" or male menopause.
Testosterone is an important anabolic
hormone in men. It increases energy, prevents fatigue, helps maintain normal sex drive, increases strength of
all structural tissues such as skin/bone/muscles; including the heart and prevents depression and mental
Testosterone deficiency is often associated with symptoms such as night sweats, insulin resistance, erectile
dysfunction, low sex drive, decreased mental and physical ability, lower ambition, loss of muscle mass and weight
gain in the waist.
The primary cause of this increase in girth is visceral fat, not excessive subcutaneous fat (fat under the skin).
The visceral fat cells are the most
insulin resistant cells in the human body.
As a person ages hormone levels change in favor of insulin resistance.
The insulin levels rise while progesterone, growth hormone and testosterone decline.
The visceral fat cell begins to collect more fat in the form of triglycerides.
A vicious cycle is initiated, which if not interrupted with natural hormone balancing will lead to abdominal
obesity, diabetes and high cholesterol levels.
This phenomenon is known as “Metabolic Syndrome".
In males, metabolic syndrome results in lower testosterone levels, however, in females metabolic syndrome results
in high testosterone levels and a phenomenon known as Polycystic Ovarian Syndrome (see below).
Stress management, exercise, proper
nutrition, dietary supplements, and androgen replacement therapy have all been shown to raise androgen levels in
men and help counter male metabolic syndrome symptoms.
The “trick" is to know how much testosterone is required for each individual male. This is where knowing the
salivary testosterone levels come into play.
Initial salivary testing and following salivary monitoring are crucial for determining the most optimal
Metabolic Syndrome and Polycystic Ovarian
Syndrome (PCOS) in females results in the same visceral fat pattern, insulin resistance and triglyceride
formation as in males, however, the female patients with PCOS and metabolic syndrome had high levels of
testosterone and often DHEA.
This results in a typical symptom pattern seen in women with metabolic syndrome – acne, increased facial and body
hair, hair loss on the head, trunkle obesity and infertility.
Salivary testosterone and DHEA levels are diagnostic for this syndrome and follow up testing is key for monitoring
It is important to note that women do not need to have their ovaries to have metabolic syndrome. The adrenal glands
in women who have a predisposition to metabolic syndrome can produce above normal levels of testosterone and
DHEA is often thought of as an adrenal
hormone and in fact it is, however, DHEA is also made in the ovaries. When we measure DHEA we are eliciting
information about both the adrenal glands and the ovaries.
This is particularly important when DHEA levels are high. High levels of DHEA can mean that the adrenal glands are
increasing DHEA production on response to stress or high glucose levels, or that the ovaries are increasing the
production of DHEA as part of the PCOS cascade.
High levels of DHEA are often seen years before a female develops metabolic syndrome and should be used as a risk
factor marker for insulin resistance.
Low levels of DHEA are seen in evolving
“Adrenal Gland Fatigue" (hypoadrenia).
As acute stress becomes more chronic, the constant demand by the body for adrenal gland hormones begins to wear out
the adrenal glands and DHEA and cortisol levels fall.
It is for this reason that DHEA is often measured in combination with cortisol levels. Cortisol is a hormone
produced by the adrenal glands in response to stress and blood sugar levels. Cortisol secretion has a diurnal
Normal cortisol levels should be highest one hour after waking in the morning and drop gradually throughout the
Measuring the diurnal rhythm with 4 cortisol levels throughout the day gives a very accurate measure of adrenal
gland function and their ability to cope with stress.
Adrenal fatigue occurs in stages. The stage at which a patient is at can be determined by looking at the diurnal
cortisol graph and DHEA levels.
Symptoms of evolving adrenal gland fatigue include fatigue, sleep issues, inability to cope with stress, anxiety,
nervousness, irritability and allergies.
Hypothalamic Pituitary Axis (HPA)
Dysregulation is due to chronic stress with the resultant excess cortisol production and down regulation of
cortisol receptors in the hypothalamus.
In other words the negative feedback loop that normally shuts down the production of ACTH release is blunted and
cortisol production by the adrenal glands is uncontrolled. If this continues, hypoadrenia always evolves.
The symptoms of HPA and hypoadrenia are essentially identical but salivary testing easily distinguishes the two.
This is crucially important as treatment of each can be very different.
Measuring cortisol and DHEA levels will
also diagnose complex diseases such as Addison’s Disease and Cushing’s Syndrome. Addison's disease occurs when
the adrenal glands do not produce enough of the hormones cortisol and DHEA.
The disease is also called adrenal insufficiency, or hypocortisolism.
It has however, no relationship to end stages of “adrenal gland fatigue" described above. The two illnesses have
very different mechanisms of action.
Most cases of Addison’s disease are caused by autoimmune destruction of the adrenal cortex. Symptoms include
chronic fatigue, weight loss, loss of appetite, muscle weakness, and hyperpigmentation of the skin.
Cushing’s Syndrome results in excessive
production of cortisol by the adrenal glands. Symptoms include rapid weight gain of face, trunk and back of
neck, hirsutism, depression, anxiety and panic attacks.