Hormone Imbalance

Our steroid hormones govern a broad number of processes impacting energy, repair, blood sugar regulation, mood and several other functions. The majority of steroid hormones are made in two locations; ovaries/testicles and the adrenal glands. Almost the identical pattern of steroid hormones are made in each type of gland. The one exception however, is the hormone cortisol which is uniquely made in the adrenal glands.

The figure below shows the adrenal steroid production pathways. Notice that the adrenal glands contribute to progesterone, testosterone and estrogen production.

The “priority” in adrenal hormone production is cortisol as it plays crucial roles in blood sugar regulation, brain alertness during stress/danger and in controlling inflammation. Excessive demands on adrenal cortisol by any of the above factors will eventually begin to impair the adrenal gland contribution of the other steroid hormones to the total body circulating pool. This becomes particularly true in midlife and later as the ovaries/testicles produce less, and adequate circulating hormone levels depend on healthy adrenal glands.

The graphic below demonstrates the progressive responsibility the adrenal glands have in maintaining circulating hormone pools. A good indicator of adrenal function is the ease or difficulty experienced during the peri-menopause/menopause transition. As the ovarian hormone production sharply declines, adequate adrenal production of progesterone, estrogens and testosterones will minimize symptoms.

The same hormone time line occurs in men with the role of the ovary being done rather by the testicles. The mid-life hormone decline tends not to be quite as abrupt but it occurs in a similar fashion and causes similar problems when imbalanced adrenals exist.

It is often assumed that the levels of steroid hormones such as estrogen, progesterone and testosterone should be negligible at 50-60 years of age. There is an emerging body of research to suggest that that is not true and in fact several of the diseases of aging may relate to excessive hormone decline.

One of the areas of research that has examined hormone levels during aging and disease risk is the study of Alzheimer’s disease (AD). Hormone intervention during menopause has been found to lessen the risk of this neurodegenerative disease. Estrogen stimulates the production of acetylcholine, the neurotransmitter that has been shown to decline in brain areas affected by AD. Estrogen levels have also been associated with larger numbers of synapses or connections in the hippocampus, a key brain area involved in memory formation.

Progesterone has been shown to be needed to control inflammation in the brain, a key factor in all degenerative brain diseases. It also stimulates the production of BDNF which is a key chemical in the brain that helps support both neuron survival and growth in memory areas of the brain.

Considerable research has been done regarding hormone replacement during mid-life to prevent chronic disease. Unfortunately, far less has been done concerning insuring healthy adrenal gland function with age to let the process balance naturally.

Adrenal imbalance

Many men and women transition into mid and later life with little difficulty symptomatically that would suggest the natural hormonal “decline”. This is because they experience a hormonal shift rather than a drastic hormonal decline. Healthy adrenal activity in this phase of life creates a shift to somewhat lower but steady levels of all of the steroid hormones as the ovaries/testicles begin to accelerate the decline in production.

Weak or imbalanced adrenal glands typically relate to one or more of three stressors; glycemic dysregulation, mental stress and inflammation. Glycemic dysregulation is the need to produce cortisol to frequently control blood sugar. The body maintains blood glucose levels in a fairly tight range. If glucose gets too high, the pancreas produces insulin to lower it. However, when it gets too low, the adrenal glands release cortisol to raise blood glucose levels.

The graphic below shows 2 blood glucose curves in the 4-5 hour interval after eating either a high or low glycemic load meal. Glycemic load is the amount and rate at which sugars are absorbed from the digestive tract. A meal high in refined carbohydrate/sugar content causes very rapid absorption of dietary sugars and a very high and rapid rise in blood glucose. This is shown in the green curve which will cause a very high level of insulin response. High insulin causes a rapid disposal of glucose mostly by conversion to a fat called triglyceride in the liver. This also causes an excessively quick drop in blood glucose with “over shooting” where it will fall far triggering hypoglycemia.

Hypoglycemia triggers cortisol release which causes the body to break down protein in bone and muscle to allow the liver to turn them into sugar. The catch is that because low blood sugar can damage the brain and other tissues, cortisol will remain elevated for 6-8 hours as extra protection. Repeated daily cycles of this dynamic in response to diet eventually causes adrenal fatigue where not only cortisol becomes low but all other adrenal steroids as well.

Chronic mental stress is much more straightforward to understand. It causes cortisol release to activate the brain to deal with the “danger”. Too much stress over time fatigues the adrenal glands. There are a wide variety of non-drug methods such as neurofeedback which are effective in correcting the imbalances induced by chronic stress.

Cortisol is our primary anti-inflammatory hormone. Chronic causes of low grade inflammation such as from a food sensitivity eventually fatigue the adrenal glands. While any one factor can cause adrenal hormone imbalance with time many people have two or even three combined triggering factors. They will often experience problems much earlier in life such as menstrual irregularity or impaired fertility.

Healthy steroid hormone levels are needed throughout life. At all phases, but particularly at midlife and after, the adrenal glands play a progressive role in hormonal health.

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