Podcast Summary
Understanding the role of diodinases in thyroid function.: The conversion of T4 to the active hormone T3 is crucial for thyroid function, and deficiencies or imbalances in diodinase enzymes can lead to health effects. Understanding endocrine systems and hormone regulation is key for treatment.
The thyroid gland produces T4 and T3 hormones, where T4 is mostly inactive, and T3 is active hormone responsible for promoting thyroid functions. Diodinases enzymes are responsible for converting T4 into T3. D1 and D2 enzymes convert T4 into active hormone T3 and D3 enzyme makes reverse T3 which is inactive. Thus, deficiencies or imbalances in these enzymes can lead to a variety of health effects. Overall, understanding the basics of endocrine systems, their feedback cycles, and the regulation of hormones is essential for treating hormonal deficiencies and imbalances, and can be gained by watching the videos accompanying this special episode of The Drive.
Understanding the Role of Reverse T3 in Hypothyroidism and Treatment Options: Reverse T3 can inhibit the effects of T3 and lead to symptoms of hypothyroidism. Treating hypothyroidism with T3 may be more effective in certain cases, but may also be difficult for some patients to tolerate.
Reverse T3 is produced in response to nutrient shortage and slows down metabolism by blocking the effects of T3. High amounts of reverse T3 and low amounts of T3 can result in the symptoms of hypothyroidism, making it difficult to diagnose. Standard treatment for hypothyroidism is giving synthetic T4, which is converted into T3, but in cases where D1 and D2 are down-regulated and D3 is up-regulated, giving T3 may be a better option. Giving T3 bypasses the step where the body may produce more reverse T3 and can effectively treat the condition. However, patients may find regular T3 difficult to tolerate.
Understanding the complexities of hypothyroidism treatment: Treatment for hypothyroidism requires a careful consideration of each patient's symptoms and lab results. It may involve a combination of T4 and T3 medications, with a focus on monitoring and adjusting T3 due to its shorter half-life. Doctors should also order comprehensive lab tests beyond TSH to determine the most effective treatment plan.
The treatment of hypothyroidism is complex and requires an understanding of the different formulations of T4 and T3. While desiccated thyroid may work for some patients, others may need a combination of T4 and control release T3 or an immediate release T3, depending on their unique needs. It's important to take into account each patient's symptoms and lab results when deciding on a treatment plan. While T4 has a longer half-life and missing a dose is usually not a concern, staying on top of T3 is crucial due to its shorter half-life. Doctors should consider ordering more than just TSH lab tests and may need to investigate free T4, free T3, and reverse T3 as well.
The Importance of Measuring Free Cortisol in Understanding Adrenal Health: Analyzing adrenal health cannot be done through a simple blood test. Measuring free cortisol through a saliva or urine test, such as the Dutch test, is crucial in determining biologic activity. Adrenal fatigue is not always accurate, and understanding cortisol metabolites, inflammation, and obesity is key to interpreting adrenal health.
Understanding the adrenal system is complex and cannot be analyzed by just one blood test, which only measures total cortisol. Free cortisol is the important type that exerts biologic activity. This can be measured through a saliva or urine test, with the recommended urine test being the Dutch test. The test measures the amount of free cortisol, free cortisone, and their metabolites over a period of 24 hours. The adrenal fatigue term is not always accurate as it suggests a lack of cortisol production which is not true in most cases. Cortisol metabolites are helpful in understanding what cortisol production looks like, but inflammation and obesity can also accelerate the conversion of cortisol into cortisone, thereby decreasing free cortisol levels.
Adrenal Health Assessment: A Holistic Approach: A comprehensive analysis of cortisol and its converter enzyme, in conjunction with other factors like obesity, insulin resistance, and inflammation, is required for efficient management of adrenal health issues. Supplements like adrenal support and phosphatidylserine can balance cortisol levels, and licorice root can elevate cortisol production.
Adrenal health is a complex issue and cannot be assessed by a simple blood test as it provides only a snapshot in time. It is essential to examine the normal rhythm of cortisol and its converter enzyme, 11-beta-HSD in conjunction with obesity, insulin resistance, leptin resistance, inflammation, and thyroid function. Supplements like adrenal support and phosphatidylserine can balance cortisol levels efficiently, and licorice root can elevate cortisol production. In addition to addressing the cortisol and cortisone levels, understanding their metabolites help provide an overall assessment of adrenal output. Therefore, a holistic approach is necessary in identifying and addressing adrenal health issues.
Importance of Understanding Cortisol and the Menstrual Cycle: Prioritize lifestyle management and supplements to reduce cortisol levels instead of relying on glucocorticoids. Monitor FSH levels during day three to five to detect approaching menopause.
Understanding the balance of cortisol and cortisone is important as excess cortisol can be stored and drawn as needed. Using glucocorticoids should be reserved for individuals truly in distress, while addressing underlying issues that reduce cortisol levels is the priority through lifestyle management and supplements like licorice root. The female reproductive system's menstrual cycle is divided into two phases, the follicular phase driven by follicle stimulating hormone and estrogen to ripen the follicle for ovulation, and the luteal phase dominated by luteinizing hormone and progesterone to prepare the endometrial lining for implantation. As women approach menopause, monitoring FSH levels during day three, four, or five can indicate when menopause is approaching.
Understanding a Woman's Hormonal Changes and Menstrual Cycle: Changes in FSH, LH, estradiol, and progesterone levels can help determine menstrual cycle stage, perimenopause risk, and PMS symptoms. Administering low doses of progesterone can ameliorate PMS symptoms. Understanding women's hormonal system is crucial for accurate health assessment.
Changes in FSH, LH, estradiol, and progesterone levels in a woman's body can help determine where she is in her menstrual cycle. High FSH levels, typically north of 25, 35, 40, and low estradiol levels indicate menopause. Day 21 to 28 of a woman's cycle, marked by a drop in progesterone levels, can cause PMS in susceptible women. Administering low doses of progesterone from day 21 to 28 can help ameliorate symptoms. It is important to understand a woman's hormone system and menstrual cycle to determine her health status accurately. This can be particularly important when cycles are irregular or perimenopause is approaching.
Hormonal Solutions for Women's Health.: Proactive measures, such as hormone replacement therapy, should be considered to manage menopause risk factors. Regular FSH level screenings can indicate proximity to menopause and be used for early intervention. Understanding the female endocrine system is crucial.
Women can experience a profound level of hormonal withdrawal during the end of their luteal phase. There are several hormonal ways to address this, including progesterone, oral contraceptives, and testosterone. As women enter menopause, their body becomes less able to produce estradiol and progesterone, resulting in high levels of FSH and LH. Hormone replacement therapy should be initiated before a woman reaches this state to control vasomotor symptoms, cardiovascular and bone risk factors. Understanding how the female endocrine system works is essential for women and those who care about them. And, FSH level at day three, four, and five becomes crucial blood draw as a woman becomes perimenopausal, as it indicates her proximity to menopause.
Hormone Replacement Therapy And The Male Sex Hormone System: Hormone replacement therapy is crucial for women experiencing menopause, but testosterone, DHT, and estrogen play important roles in the male hormone system as well. Feedback inhibits the hypothalamus and pituitary gland as testosterone levels increase.
Hormone replacement therapy is recommended for women with elevated levels of hormones indicating onset of menopause. The male sex hormone system is less complex than the female system, but still has nuances. Testosterone produced by the testes is mostly bound to hormones and a small percentage of it is free. Free testosterone is what exerts its biologic effect on the androgen receptor. Dihydrotestosterone (DHT) has a higher binding affinity for the androgen receptor than testosterone, making it a very important sex hormone. Estrogen, which is produced by converting testosterone into estradiol, is also important for men. Feedback loop inhibits both the hypothalamus and pituitary gland as testosterone levels rise.
Understanding the Complexities of Testosterone Replacement Therapy.: Low testosterone levels can present with a range of symptoms, but treatment options should only be considered after evaluating free T levels and other factors like the number of androgen receptors. Testosterone replacement therapy should be approached with caution to avoid any harmful effects.
Testosterone replacement therapy is a complex issue and can't be determined solely by measuring total testosterone or free T levels. Symptoms such as low libido, erectile dysfunction, low mood, difficulty putting on muscle mass, and insulin resistance may indicate low testosterone levels, but there are other factors to consider, such as the number of androgen receptors a person has. Treatment options include direct methods like giving testosterone in various formats, including topical, injectable, and intranasal formulations, and indirect methods like using HCG or Clomid. However, caution should be exercised as testosterone is an overused hormone, and giving it without considering free T levels and other factors could be harmful. Feedback from estrogen in the brain is crucial for mood, so using Clomid may not be ideal for all men.
Considerations for Testosterone Replacement Therapy: TRT should only be considered for individuals with low free testosterone levels and symptoms, and should be monitored closely for potential side effects. Symptom improvement is more important than fixing biochemical issues or numbers.
Testosterone replacement therapy should only be considered if the patient has low free testosterone levels and exhibits symptoms that can be attributed to low testosterone. Side effects can occur depending on genetic and lifestyle factors, such as hair loss and increased estradiol production in overweight individuals. Anastrozole is a drug that can block excessive estradiol conversion, but it is typically not needed unless levels exceed 50-60. TRT should only be given for a period of 8-12 weeks to fix the biochemical issue, and then symptoms should be assessed. If symptoms do not improve, it does not make sense to continue TRT, except in cases where the patient has osteopenia and low estradiol. Symptom improvement is more important than numbers or fixing biochemical issues, and symptoms should be monitored even after stopping TRT.
