1. Joanna Wilson, D.O., NACP Board-certified Internal Medicine
Hormone Cookbook
Joanna Wilson, D.O., NACP
Board-certified Internal Medicine

2. My first hormone memory…

3. Familiar Uses of Hormone Therapies
Freedom from menstrual symptoms
Control of when and how many children we have
Reversal of infertility
Relief of menopausal symptoms

4. Sex Hormones Affect These Issues, Too!
Infection susceptibility
Asthma
Oral health
Autoimmune disease
Vascular disease
High blood pressure
Dementia
Bone strength
Muscle strength
Mental health
Breast, lung, prostate, colon, kidney cancer
And just about every other disease

5. How Hormones Work Cofactors which modify the cell’s response
Timing of hormone production (pulsatile or continuous)
Dose response
Central control (positive and negative pituitary feedback)
Interaction with other hormones
Cell surface receptor

7. Main Ingredients For Today’s Recipes
Estrogen
Progesterone
Testosterone

8. Progesterone Effects
Protects the uterus from overgrowth due to estrogen stimulation
Helps nerve cells repair
Prevents bloating from estrogen
Inhibits the breakdown of serotonin
Helps stabilize mood
Increases body temperature during ovulation
Antiinflammatory
Increases appetite
Improves sleep
Chemotherapy for breast, prostate, and renal cell cancers

9. Testosterone Effects
Muscle mass and strength
Bone mass
Sex drive

10. Estrogen Effects Improved cognition and memory
Improved neuronal healing
Improved glucose tolerance
Maintenance of fat distribution in periphery
Improved bone mass and strength
Raises HDL, lowers LDL cholesterol
Improved blood vessel healing

11. Estrogen Receptor Locations

12. Recipe #1
Contraception

13. Ovarian Hormones in 28 Day Cycle

14. Brain- Ovary Conversation- Positive Feedback

15. How Do We Convince The Brain To Ignore The Ovary?

16. Negative Feedback No surge = No ovulation
All (combination) birth control pill options have stable daily estrogen dose
Low, consistent hormone dose prevents pituitary surge to prevent ovulation X

18. Progestogen Receptor Activations

19. Progestogen Characteristics and Side Effects

20. Can We Prevent Ovulation Only When We Need To?

21. Emergency Contraception
175 pounds

22. Recipe #2
Menstrual relief

23. Contraceptive Pill Options
Cyclic- 7 days of no progestin (“withdrawal”)
Monophasic
Triphasic
Continuous- no withdrawal week
Monophasic only

24. Estrogen and Progestin Levels on Continuous vs Cyclic Birth Control

26. Vein Clot Risks (per 10,000 women/year)4 20 6
10 to5 9

27. Recipe #3
Menopause

29. Endothelial Cell Layers in Healthy Postmenopausal and Premenopausal Women
Postmenopausal cells show evidence of endothelial cell death, denudation, and RBC, platelet, and protein attachment, as well as fractured basal membranes, and loss of intercellular junctions
Premenopausal cells show tight connections, a continuous layer of endothelial cells, and thick plasma membranes

31. Estrogen Sources Before Menopause After Menopause Ovaries
Adrenal glands
Fat
Tissues

33. Figure 4 Effect of age on DHEA and DHEA-S levels in women
Labrie F (2007) Drug Insight: breast cancer prevention and tissue-targeted hormone replacement therapy
Nat Clin Pract Endocrinol Metab 3: 584–593 doi: /ncpendmet0559

34. Why Not Just Start Everyone On Hormones?

35. Timing Hypothesis of Menopausal Hormone Therapy
Safety of Hormone Treatment
Time Since Menopause
High Blood Pressure
Diabetes
Smoking
Heart Attack Stroke
Breast Cancer
Blood Clot

36. Safest Therapy Choices
FDA Approved:
Transdermal Estradiol
Vaginal Progesterone (cyclic)
Not FDA Approved:
Bioidentical therapy

37. Compounded “Bioidentical” Hormones
Dosing schedule mimics premenopausal state in postmenopausal women
Plant derived hormones modified to be identical to human molecules
Not regulated for purity of modification process
Saliva levels do not accurately measure tissue levels
Progestogen skin cream has not been proven effective to prevent endometrial cancer

38. Testosterone Supplementation Risks
Possible increased risk of breast cancer
Acne
Hair loss

39. Manipulation of Testosterone Supplementation
Aromatase blocker to reduce conversion to estrodiol (Femara, Arimidex)
5α-reductase blocker to reduce conversion to dihydrotestosterone (Propecia)

40. Estrogen Therapy Challenges
Estrogen receptors in tissues cycle, but independently of ovarian function
Serum or saliva tests do not show what is needed in the cells
Optimal levels for dosing are not known
Receptor stimulation or blockade is required to prevent cancer and blood clots
We don’t know how to do this, yet!

41. Creating the Perfect Estrogen Replacement

42. Endocrine Disrupting chemicals
Ingredient Substitutions and Flavor Enhancers
Endocrine Disrupting chemicals

43. Yummy Endocrine Disruptors (Phytoestrogens)

46. Endocrine Disruptors = Hormone Receptor Imposters

48. ‘EDCs are commonly found in food and food containers, plastic products, furniture, toys, carpeting, building materials, and cosmetics. They are often released from the products that contain them and enter the bodies of humans and wildlife through dust or through the food chain’.

49. Endocrine Society Scientific Statement

50. Newest EDC: Triclosan

51. Developmental Stage at Exposure to EDC Changes Impact

52. Hormone Cookbook: Summary
Estrogen, Progesterone, and Testosterone contribute to the health of every cell and organ
Using hormones in various ways helps us maintain reproductive control and prolong health
Exposure to chemicals which stimulate hormone changes may have long-term effects

53. THANK YOU FOR BEING HERE!
Questions?