Menopause Hormones – Testosterone

Interviewer: Gail Edgell

Gail Edgell: What exactly is testosterone and how does it function in women?

Dr. Cabeca: Testosterone is a hormone, like other sex hormones — estrogen, progesterone, cortisol, adrenalin. Typically, when we are talking about sex hormones, we are talking about estrogen, progesterone, testosterone and DHEA. Testosterone is a female hormone. In women, it is produced by the adrenal glands and in small amounts by the ovaries. Testosterone is in balance with our other hormones but starts to decline, along with our other hormones, in our 30s and 40s. Testosterone typically is responsible for our libido and sense of receptivity. For a woman to want to have sex or to be receptive to sex, she has to have some testosterone on board.
When I first started practicing medicine, I would check testosterone in patients. The normal range for women, according to the lab, was 0 to 6. To me, 0 would never be normal. Thankfully, there has been more research over the past decade to look at and evaluate normal testosterone ranges for women. It’s still a controversial topic in the area of hormone replacement for women — researchers are reluctant to study women because of the potential risks and side effects of it. But when used in low therapeutic doses, patients respond very, very well to testosterone therapy. There are many studies to confirm that.

Gail Edgell: The first step for a woman in her 30s and going into her 40s is to get all of her hormone levels tested — especially testosterone — just to see where those beginning levels are, correct?

Dr. Cabeca: It’s nice to find out what a woman’s “normal” is. If she has problems as she ages, she can look back and say, “This is the level I was used to having. Now my level is only one-third of that, and I can feel it.”

With low testosterone, you may have decreased libido, decreased ability to have an orgasm, and a decreased interest in having sex. You may have early memory loss, a reduced intellectual agility. I had a woman who was the CEO of a large firm come to me. She was in her early 50s. She said, “I just feel like I’ve lost my edge. I just can’t do the pace I was used to doing. I can’t react as quickly as I used to react. I get fatigued more easily.” When we looked at her hormones, her estrogen was fine, and her progesterone needed to be increased. But her testosterone was almost nonexistent. By replacing the testosterone in a small physiologic dose via a bioidentical compounded cream, she was, as she put it, “back on her game” within six weeks. We monitored her levels to keep them in a safe, normal range. That was very important.

Other signs of low testosterone are mood swings, depression, reduced activity, passivity, general fatigue or tiredness, nervousness, anxiety, irritability, feeling weak, a reduced interest in the usual activities that you like to do, and a general unrest or unsettled feeling. All can all be associated with low testosterone.

Early in my practice, over 10 years ago, an executive at a biotech firm who had a diagnosis of an advanced stage of cancer came to me. She was reluctant to do any hormone replacement therapy. But she said, “Without my sex drive…” She felt like she would be better off dead. She had no interest in living, no interest in doing her usual activities, and no sex drive whatsoever.

I researched the literature to find out what hormones I could prescribe safely — that lead me into this field. I put her on a small amount of vaginal estrogen, which is safe in low doses even for breast-cancer survivors. I also used a sublingual testosterone on her. That made a tremendous difference in her life. In fact, I just saw her last week. She is 73 years old now, still an executive of this biotech firm, lobbying in Washington, D.C. and happy with her life. She doesn’t have the vaginal atrophy. She doesn’t have many of the other side effects that go with hormone depletion such as osteoporosis. Her bones are like those of a 30-year-old. She has had no cancer. I was able to safely treat her therapeutically and also give her life back to her. We gave her her libido back, which was very important. But that is only one of the health benefits she has gotten through bioidentical hormone replacement.

Gail Edgell: Do you recommend saliva-testing, blood-testing, what kind of testing for all of these hormones?

Dr. Cabeca: Typically, baseline. If a woman is menstruating, I like to get peak hormones levels. That will be on Day 19 to 21 of her cycle. We can do testing via saliva or blood. The main thing is that she is not on birth-control pills. If she is on birth-control pills, that completely skews the results.

I will typically follow up with either blood- or saliva-testing, depending on what I am doing for treatment. If a person comes to my office complaining of decreased libido, reduced muscle strength, general fatigue, hot flashes, perimenopausal symptoms — and if she is in Day 19 to 21 of her cycle — I’ll do an initial blood test and look at those hormone levels. It’s quick. I can get the answers back in a few days. Saliva-testing takes a little bit longer. I will base my treatment recommendation on those results, her symptoms and her physical examination. I do not just treat the labs.

The treatment plan typically begins with one of my 21-day detoxification programs, which I make patients do to clean up their diets. It includes my purity cleanse shake to help their bodies support liver detoxification and colon-cleansing. It gets them off to a good start, so that their digestive systems are cleared up. They are then better able to absorb the hormones that I recommend. Often, in those 21 days, patients tell me they feel better than they have in years, just by cleaning up their diets and doing balanced amino-acid shakes.

Gail Edgell: Can you get any testosterone from food?

Dr. Cabeca: That is one of the hormones injected into meats. The cattle industry is loaded with testosterone. We are going to get it from other animals. I will give you an example. It’s interesting, what is in our farming industry.

I have a friend who is allergic to penicillin. He was eating farm trout and had a complete anaphylactic reaction to eating this trout. Well, the farm trout was dosed with penicillin, so that they wouldn’t get sick. He absorbed it through them. Therefore, yes, we are exposed to so many chemicals and hormones from the farming industry. You have to be very, very careful what you eat.

Gail Edgell: Does that mean the woman you spoke of earlier probably did not eat those kinds of things? Or if we are getting testosterone in meat, we cannot utilize it in our own bodies? Does eating a lot of meat increase our testosterone levels, or does it affect it at all?

Dr. Cabeca: There is no research on whether that affects it or not. I know that hormone disruptors can affect our receptor sites — they can bond to our receptor sites but do not act like our natural hormones. Foreign animal testosterone may fall into that category. I am not sure whether or not it’s a significant enough amount to make a big difference in our bodies. Our bodies are intelligent enough to know what we are producing naturally, and that is what we want to eat.

Gail Edgell: Can you summarize what we’ve discussed about testosterone for our audience?

Dr. Cabeca: Testosterone is a female hormone, and there are several ways that we can replace it. We can use creams — sublinguals that can be made up by a compounding pharmacy — gels and injections, which I typically do not like because they build you up really fast and take you down really fast. I am fond of testosterone pellets, which are the size of a grain of rice. We insert them through a small incision in the backside, in the fatty area. Typically, a testosterone pellet will last four to six months. There is good research on that. In fact, Dr. Rebecca Glaser just published a poster presentation showing that testosterone pellets actually decreased the risk of breast cancer and increased bone mass in her studies. It’s a very excellent study to support some testosterone replacement in women.

We want to use testosterone in low doses. Typically, when I am using a cream, I use a milligram per day. Again, we want to monitor and evaluate those results in the patient.

I do want to mention that I see younger women who complain of decreased libido after having their second child. Decreased libido involves many factors, of course: stress, busy home life, extra responsibilities, etc. The adrenal glands are producing the majority of the testosterone in women. The adrenal glands can fatigue — I also see that in these younger women with one or two children with low testosterone levels. Sometimes we need to help those patients by building up those levels as we resuscitate those glands, ovarian function, etc.

It is very important to get your body to produce the hormones you need in as balanced a way as possible and only supplement when necessary. Exercise, sleep, appropriate diet and good nutrients are all building blocks for your hormones.

Note: This article is an edited transcript of an audio interview. Changes have been made.

Adrenal Failure – It Could Be You

Interviewer: Gail Edgell

Gail Edgell: What exactly is cortisol?

Dr. Painovich: Cortisol is actually called the stress hormone because it is a hormone that is released when the body is under stress. The reason why it’s such a hot topic today is that elevated cortisol levels can mimic the same symptoms associated with menopause and menopausal symptoms.

Gail Edgell: What else does it affect? Does it affect hormone levels or other glands? Will it affect your immune system?

Dr. Painovich: It definitely can. I think the bigger issue, when you start to look a little deeper into these symptoms, is that of the adrenal glands. The adrenal glands can mimic the same symptoms associated with menopause. The adrenal glands not only produce cortisol but also other hormones in the body such as DHEA, estrogen, progesterone and testosterone. These are obviously big players in menopausal symptoms.

Gail Edgell: What are some things that really affect cortisol levels, as far as our everyday lives go? I think about that fight-or-flight syndrome, when you’re out in the wilderness and you see a tiger. You want to either fight it or run the other way. How does it affect us in our everyday lives?

Dr. Painovich: There are so many stressors in today’s world that people aren’t even aware can affect the adrenal glands. This in turn directly correlates to the levels of cortisol in our systems.

A lot of things are challenges today — our demanding jobs, the fact that we are always under financial stress. If you have a job where the boss is hard to work with, or you have coworkers who are hard to work with, these are chronic stressors that you become used to and think are no big deal. But in actuality, to the adrenal glands and cortisol levels, they’re a very big deal.

Other things that can affect cortisol levels are lack of sleep and even job stability, especially with the current economy and people wondering if they are going to have their jobs taken away. Raising children is a big one. In today’s world, women who are both holding down a job and running a household get used to that. They think it’s not that big of a stressor, but it is. The other thing that most women really are not aware of is that being in an unhealthy or unhappy marriage can directly affect cortisol levels and adrenal fatigue. Unhealthy dieting is a big factor. Even exercising too much can actually reduce adrenal-gland function. Exercising in moderation is good, but there is a fine line between what is good and what is too much.

The other thing that I think is really missed is when women happen to have some unresolved emotional stressors from childhood, whether it’s being an adult who was the child of an alcoholic or some kind of abuse issues that come into play. Believe it or not, the things that happened to us early in life can affect the menopause transition, your cortisol levels and adrenal fatigue. There are so many things that can play a part in that.

Gail Edgell: Like you said, there are so many things that play a role in having elevated cortisol levels. What are some simple things that listeners can do at home to get their cortisol levels back into normal range? Also, what are some more drastic approaches they can take if they cannot control cortisol levels on their own?

Dr. Painovich: Like you said, cortisol was originally meant to be released in something like a man-versus-nature situation — if we were running for safety from an animal or whatever, we would get that flight response to go fast and get away from danger. We would relax after that, when we were safe. That no longer happens — we are under constant stressors. We’re finding that people who have these elevated cortisol levels have symptoms such as fatigue, foggy thinking, memory loss, increased abdominal fat and weight gain. They have decreased immune systems. They can also be more at risk for diabetes. They can also have insomnia and increased inflammation and body aches. When you look at that, like I said, it very much mimics the symptoms that many menopausal women complain of. When you go to a little deeper level and look at adrenal fatigue, it’s all those things that we talked about as well.

The other thing that can happen with adrenal fatigue is decreased sex drive or decreased interest in sex in general, depression and vaginal dryness. It goes deeper and deeper. Those symptoms become greater and begin to mirror those symptoms associated with menopause.

A little bit more about the adrenal gland — not only does it produce cortisol, but it also produces our backup hormone system. I don’t think it’s so much that the ovaries normally reduce our estrogen and progesterone levels. I don’t think that is the problem. I think the problem is the backup system that comes from the adrenal glands, this DHEA, which is a precursor to testosterone, estrogen and progesterone. If the adrenal glands are tired, then they’re not able to produce the backup systems that should make the transition through menopause easier.

The good thing — and there is a good thing — is that there are so many other things that can help women transition through menopause. The easiest thing is good exercise and good diet. I often say to a lot of my patients that if they just exercise and eat well, 90 percent of all their health issues will go away. I think that is true for high levels of cortisol and adrenal fatigue.

Other things that women can do are meditation, yoga and, of course, all the things that you have on your Web site, Gail — other supplements that are offered through naturopathic physicians and other experts. Then again, if single herbs and supplements are not enough, you can go to things like acupuncture and Chinese herbs. Herbs can be a multitude of herbs that are combined together. Often times, we can directly combine them so that the result affects all of your systems.

There are many things that women can do that work very, very well. Usually, if they do these things, a lot of their symptoms can completely disappear or certainly become manageable, so that they do not have to go to that next level of hormone replacement therapy if they do not want to do so.

Gail Edgell: How is cortisol measured?

Dr. Painovich: That is a good question. That is actually a controversial topic. In the study we are doing right now, that I am overseeing, the way that we look at cortisol is through a 24-hour urine analysis. The reason why we need to do at least 24 hours of analysis is because cortisol works from a diurnal pattern, meaning that it is higher in the mornings and then should start to lower as the day goes on. It should be lowest as we go to sleep. If we take a cortisol level from saliva at noon, it’s going to be different from one taken at 5 p.m. Unless we collect it over a 24-hour period, oftentimes, it’s not going to be accurate.

The other thing that we are doing in our study is an adrenal stress test. We do a blood analysis of cortisol levels. We then stimulate the adrenal gland to see how the body responds and how it reproduces cortisol, along with other hormones. There are a couple different ways that we can look at it, but again, that is still controversial. That is probably the best way to do it, but time will tell.

Gail Edgell: You’re saying that from your research so far, you feel as if urine might be the better option, but that you can also measure cortisol via blood and urine as well.

Dr. Painovich: You can. But again, we know that even with blood, if we run our tests first thing in the morning — when our cortisol levels should be the highest — that may not be the best time to take it, but it’s usually the highest. I have heard that saliva is very inconsistent and inaccurate. Like I said, there is a lot of controversy around all of these tests.

Gail Edgell: It sounds like cortisol really is the basis for a lot of issues that may be occurring in menopausal women.

Dr. Painovich: Absolutely. Any time a woman comes into my practice for the control of menopause systems, 90 percent of my focus is on the adrenal glands and cortisol levels.

Gail Edgell: To sum it up, some things that our audience can do are start an exercise program, eat a diet with lots of fruits and vegetables, meditate and do yoga to decrease their stress levels, and get into acupuncture and even herbs. They can move into these areas if they happen to need additional support.

Dr. Painovich: Yes, either additional support or at the same time. The good thing about acupuncture and herbs are that they really work to get the body into a calm, balanced state throughout the day and for a lifetime. That induces all types of good health.

Gail Edgell: Do you have anything else that you would like to add regarding cortisol?

Dr. Painovich: Women need to be proactive in their care of this menopause transition. It should be a transition, and it should be something that they can ease through. If they are proactive with the right, good lifestyle, then the transition should be easy, the cortisol levels should be balanced, and life should be good.

Note: This article is an edited transcript of an audio interview. Changes have been made.

Adrenal Fatigue Symptoms

Interviewer: Gail Edgell

Gail Edgell: I think you probably have dealt with women who are going into menopause and suffering from burnout, fatigue and adrenal stress. Can you tell us a little bit about that?

Dr. Chilkov: I think that in modern life, most of us are spread quite thin. We use up our energy every day and do not get enough rest. This is particularly true of women in midlife who may be trying to take care of many generations of family members or juggling careers and family. They may experience chronic fatigue, even though they may sleep enough at night. This can become an ongoing cycle for women.

Gail Edgell: If that is the case, what are some things they can do?

Dr. Chilkov: I want to address a few things. I want to talk about adaptogenic herbs. These are herbs that are used to counteract the adverse effects of stress. I will talk a little bit about lifestyle and things to avoid as well.

The real beauty of Chinese herbs is in their ability to nourish and support us, particularly when we are burned out and deeply stressed. I want to give you a sense of what adaptogens are because there are quite a lot of them — the most famous is Ginseng. These are herbs that help us deal with stressful and environmental challenges. They reduce some of the negative effects of stress, enhance physical and mental performance, and help us recover from prolonged exhaustion or prolonged illness. They promote vitality and longevity and really boost the immune system and overall well-being. Traditionally, this is how they have been used to increase energy.

Gail Edgell: There are three of them that you want to talk about?

Dr. Chilkov: I am going to talk about three herbs that anyone can use quite safely. I want to emphasize that these are not stimulants. They are not like using caffeine. These feed your energy at the base. It’s really important to understand that these tonic herbs are really like concentrated foods or super vitamins.

The first herb is called Rhodiola; it’s common name is “arctic rose.” This herb actually is native to Siberia and Russia. Many of these herbs live in harsh environments. The plant makes defenses against said environment and concentrates certain constituents. These are the things that end up making that plant medicine for us.

Rhodiola is one of my favorite herbs. It has a wide range of actions, as most adaptogens do. It’s really one of the great anti-fatigue herbs. It’s used by Olympic athletes, for example — it really increases physical endurance and allows you to work much more productively. It’s one of the greatest longevity herbs. It really shortens recovery time if you are dealing with an illness. It also has a really big impact on the brain, which is one of the reasons that I like it so much. It increases memory and learning capacity.

Some people have insomnia because stress hormones are spiking at night and waking them up. Rhodiola is one of the herbs that will lower cortisol, the stress hormone, in your brain. Having elevated cortisol in your brain will also lead to depression. So Rhodiola is used both to help people sleep and to deal with depression and extreme stress. Of course, depression and insomnia can be symptoms of stress. This is an herb that balances the nervous system and the endocrine or hormonal system. It’s a much more balanced herb than Ginseng, and it can be taken by a wide range of people.

Rhodiola has also been used for sexual enhancement. It’s used by bodybuilders and in weight reduction. But mostly, I think of it as an herb for stress and for the immune system.

Gail Edgell: Did you say that you have two others?

Dr. Chilkov: Yes. American Ginseng is a very unique Ginseng. It’s an herb that I like much better for women than Korean Ginseng and Chinese Ginseng, although those are quite safe for women. American Ginseng is much more balanced. It not only will boost your energy, but it will help you relax and calm down as well. This is what the Chinese call the balance between “yin” and “yang.” American Ginseng is very good at this in the same way that Rhodiola is.

Ginsengs have been used in Asia for over 5,000 years. They are among the most widely used and valued herbs in all herbal traditions. Actually, “Ginseng” translates into “promoting essence.” This is a way to think about adaptogens and Ginseng in particular. We are lucky to have a very potent Ginseng that comes from right here in America. You will see American Ginseng labeled as Panax quinquefolium rather than Panax ginseng. It is not as warming as Chinese Ginseng and Korean Ginseng — because women have hot flashes as a part of menopause, they don’t want to take heating herbs. It is a very good choice for that reason. It is a soothing, relaxing energy tonic. It also happens to be very good for digestion.

Ginseng also helps balance our blood-sugar levels. When our blood-sugar levels are going up and down, we can be very moody. And that can be very stressful.

The last herb I want to discuss is an herb from India. It is called Ashwaganda. This is sort of like the Ginseng of India. It is one of the most widely used herbs. Again, I am choosing this herb out of all the adaptogens to include in this group because it not only boosts your energy but calms you down and relaxes you. Sometimes, when we are stressed, we are so tired that we cannot relax. We want to look for herbs that not only will give us more stamina, endurance and solid energy but that will also help us unwind and get through the day without being tight, constricted and strained. I like this very much for that reason.

Ashwaganda has had a lot of studies done on it. It seems to prevent the depletion of Vitamin C and cortisol, the stress hormone that is produced by the adrenal gland — the gland that helps us deal with stress. Vitamin C is stored in the adrenal gland. When you are under a lot of stress, your need for Vitamin C goes up.

Ashwaganda is effective in preventing stress-related ulcers — that is one of its unique benefits. It also has this wonderful effect on the brain, providing clarity of mind. It has some anti-inflammatory properties; therefore, it has some anti-aging benefits as well.

Gail Edgell: Do people get these herbs from a natural food store? Are they all in one tablet or combination, or do people buy them separately?

Dr. Chilkov: You will see these herbs in separate capsules or separate extracts. You will also see stress formulas that combine these herbs. Putting them all together really gives complete support. You always want to buy high-quality herbs. I always suggest that you go to a natural food store or a natural pharmacy where there are knowledgeable people. Do not buy cheap herbs and vitamins. You won’t get the full effect.

I just want to say that you can’t ignore lifestyle choices when you are trying to manage stress. You just can’t take herbs and expect to feel dramatically better if you’re not getting enough sleep and exercise, if you’re not eating a diet that is high in protein and low in refined sugars. You also need to be getting good, healthy fats in your diet, particularly the omega-3 fats from fish oils or flax oil. And, of course, you want to avoid things like caffeine, stimulants and excess alcohol intake. If you really want to have a holistic plan for addressing burnout, you have to take a look at your lifestyle choices.

Gail Edgell: It sounds like there are a number of things that individuals can do for burnout, fatigue and adrenal stress.

Dr. Chilkov: To review, you can use adaptogenic, tonic herbs such as Rhodiola, American Ginseng and Ashwaganda. You also want to address your lifestyle factors. You want to be eating a good diet that is high in protein and high in healthy fats. You want to drink plenty of water. Practice good sleep habits, and avoid caffeine, stimulants and excessive alcohol intake.

Note: This article is an edited transcript of an audio interview. Changes have been made.