This episode of the BioBalance health cast talks about the importance in planning for the end of ones life. This includes creating a will, a power of attorney, and discussing with your family and loved ones the specifics of your desires for your funeral. Planning for the future can save your family from a lot of stress.
There are ways to avoid the unfortunate circumstance of being a burden on your family in your old age due to your declining health. Find out more about how to prevent such a drastic need for dependency on others.
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As women age, hormone levels—including progesterone—begins to decrease. In this episode of the BioBalance Healthcast we talk about this decrease which causes an imbalance in the estrogen levels. Without progesterone, estrogen increases and leads to fibroid tumors. These tumors lead to heavy bleeding and often, hysterectomies in peri-menopausal women. Progesterone is not needed by our bodies post-menopause with the drop of estrogen levels. We cover the role progesterone plays in our body and how it effects us when it begins to decrease.
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In episode 57 of the BioBalance Healthcast we talk about some of the medical and emotional causes of depression. Last week we talked generally about Depression and Anxiety. This episode focuses more specifically on the role hormone imbalance can play in causing anxiety and how it can often be treated with bioidentical hormone pellet therapy. The discussion is in part based on a chapter of my book, Testosterone, The Secret Female Hormone. Following is an excerpt of the draft manuscript.
Anxiety and Hormones
Anxiety. Worry. Fear. Anxiety is a term most people use loosely to describe “over worry,” but when intermittent worry, turns into constant fear or recurrent episodes of fast heart rate, sweating and/or the feeling of impending doom, that won’t go away with deep breathing or the many anti-anxiety drugs on the market, a true medical condition called Anxiety is the best label. The many and varied symptoms of anxiety are listed below. A patient with anxiety can have one or the majority of these symptoms.
Here are some of the symptoms of Anxiety:
There are many causes of the disease known as anxiety. The one cause responsible for anxiety in women over 40, is testosterone loss and after 50 estradiol deprivation. Before using bioidentical hormones to treat the other symptoms of hormone loss, I treated anxiety like any other doctor; with medications like Xanax, or Ativan, to treat the symptom, but never really looking at the cause that began the process. This is the one symptom that I never in my wildest dreams considered to be related to the loss of testosterone or estradiol!
I was trained to replace these hormones in the most natural way, to alleviate many other symptoms, but anxiety was not one of them. Soon after I began to use Bio-identical testosterone pellets, my patients came to report on their success. At the end of the conversation, they would usually add a statement like this, “I thought that the many symptoms of menopause and peri-menopaus would be gone, but it was so weird…I don’t have anxiety attacks, or I don’t have anxious worry anymore! Why do you think that is?”
After going through the research I found papers on the fact that elevated FSH and LH prior to menopause can cause atypical “hot flashes”. They were described in many ways, one of which was an anxiety attack or overwhelming anxiety, and worry all the time. The anxiety attacks were related to brief elevations of FSH and LH from the pituitary that did not feel hot or generally sweaty (although sweating could accompany the anxiety), like a hot flash, but was perceived as an anxiety attach with fast heart rate, fear and jitteriness. The surge of FSH/LH destabilized the neurotransmitters of the brain and instead of stimulating the temperature center, it stimulated the area of the temporal lobe that controls mood, causing a brief but potent anxiety attack. By replacing testosterone and estradiol (after menopause), the surges subsided and so did the anxiety attacks. Even now, some of my patients can tell their testosterone pellets are wearing off because their anxiety attacks start up again!
Just to be complete, other psychiatric and medical illnesses can masquerade as anxiety, and are not responsive to replacement with hormones. The most likely illnesses that appear like anxiety can be, Bipolar disorder, Attention Deficit Disorder, and personality disorders, to mention a few. It takes a physician, lab work and a few sessions in the office to decide which disease is the primary issue.
In the case of long standing anxiety,(appearing earlier than age 40) a genetic component can be integral to the appearance of anxiety in a particular patient. In some cases the cause is a gene that translates into low serotonin and norepinephrine levels. It can also be from genetically low testosterone levels, and in that case the history of a low sex drive is typical as well.
Lastly, a few other hormones can be guilty of hyper-secretion, causing anxiety. Cortisol and Thyroid are the two most likely suspects. Longstanding high cortisol is called Cushings, and increases anxiety, energy, decreases immunity, and allergies, but can exhibit the anxiety with anger and irritability, as well as sleep.essness. If hyperthyroidism is the cause, an auto immune thyroid condition stimulates the thyroid so temperature, pulse, rate of breathing increase as well as anxiety. Most often weight drops rapidly and sleep is not necessary to function.
Now for the women who are dealing with this symptom and have no idea that it could be related to hormones,the characteristics of anxiety caused by testosterone deprivation have some telltale signs that are characteristic to loss of testosterone as the primary cause.
Helen Hormonal is a 43 year old working mother of three who sits down quickly in her doctors office, drums her fingers on the desk and sighs over and over again before she starts to discuss her problem. Helen feels very different than she did a few years ago and her biggest worry is that she feels anxious all the time, punctuated with severe anxiety attacks, especially at night that feel like she is having a heart attack. Helen tells her doctor, “I worry more than ever before, in fact, all the time, but when I try to sleep, or relax in the evenings I get surges of anxiety that come and go, lasting a few minutes at a time. I feel my heart beat quickly, I sweat and get chest pressure and feel like I’m going to die, right there!” Helen is clearly afraid she has heart disease, but she has already had a cardiac work up and it is negative. She is asked about other symptoms that are new; Helen remembers that she wake up at 2 am and can’t go back to sleep, and she is not interested in sex any more. Helen thinks awhile and tells her hormone doctor that she has noticed that the more severe episodes of anxiety occur when she is having her period. She remembers that her mom had the same thing when she was in her 40s, and was given valium. She finally asks her doctor,” None of the anti-depressants or antianxiety pills that my primary care doctor gave me help, and some even made me worse. I don’t get it, my life is great, I have had nothing to be anxious about. What is wrong with me?”
Helen is the typical patient who needs testosterone replacement. She knows there is something physical wrong with her, but the traditional treatments for the symptoms she is having don’t work. Her anxiety is new since she turned 40, and she wants an answer and a treatment for the cause of her symptoms.
Specifically following is the diagnosis of Helen’s symptom list: The hormonal reason behind her symptoms of anxiety are complex, but include surges of FSH and LH stimulated by low testosterone levels causing an increase of these hormones that cause an atypical hotflash. The anxiety attack is cause by the surge of FSH and LH that cause tachycardia, sweating and shortness of breath. The low testosterone decreases the amount of seratoinin and Norepinephrine that is produced in the brain, and in return makes the woman feel depressed and anxious from lack of neurotransmitters. Many women treat their anxiety by having regular sex to improve endorphins, but as libido disappears their unconscious self-treatment goes with it.
Body Composition
Oh, forgive me but I forgot the most common source of depression in ,my previous chapters…weight gain! The change in our bodies after we turn 40 is the most external sign that we are aging, and if you are a doctor the most obvious symptoms that testosterone has decreased! There are very few women in America who can avoid this physical change without replacing the lost hormones or exercising to excess or both.
Helen Hormonal came to her hormone doctor for her second visit before she had started her hormonal replacement.
“I am so freaked out! I looked in the mirror and my mother looked back at me! I have her sagging double chin, and none of my clothes fit…I have tried every diet and my belly keeps getting bigger! I am so depressed and it is so unfair! If I had a sex drive I would still be too embarrassed to have sex because of my body! I got married at 120 lbs and now I’m 165! Aaagghhh!”
Helen has a lot of company! Her doctor consoles her and tells her that she will give her the missing hormones back and write a script to replace her flagging thyroid, but she has to do her part as well. “Helen, you are going to have to stop eating 6,000 calories of fast food, and carbohydrates a day. You won’t need it to medicate your miseryanytmore.” Helen looks like she lost her best friend…her Cherry Coke! “ Helen, you will feel better in a month or so and then I want you to exercise 3 times a week, no excuses. Exercise means sweating too! I also want you to begin a low carb,6 feedings a day, diet. It took a long time to get here and it will take a while to work your way back to health!” Helen nods and considers her dilemma. Dr. Hormone reassures her that with her replaced hormones she has a chance to regain her health, and her body, and she will soon feel more like exercising when she is not so tired.
Here’s some of what you might be seeing in the mirror:
When we are young we take our beauty, youth and our hormones for granted. Some of us did destructive things to ourselves, like smoke, drink, and eat too much of the wrong things, but youth protected us. Now everything fails all at once and aging plus our bad habits show up all over our body. What happened and what can we do?
Much of what has happened is the result of declining levels of free testosterone, estradiol, progesterone, and growth hormone, and possibly thyroid, combined with increased levels of estrone and androstenedione from the adrenal gland.
Helen hormonal wants a reason for all of this. She asks her hormone doc why this happens in the middle of our lives?
“ We were built to live about 40 years. Now our intelligent medical minds have given us a longer life, but we were built to last 40 years. When our ability to reproduce decreases after 40 the outward appearance was a sign that we were no longer fertile. Both pregnant and older women lose their waistlines….that is why having a small waist is so important to men and women. It is a sign of youth and fertility. Some things don’t change, but we can outsmart an outmoded system. We can restore our minds and bodies with replacement hormones and give us back a quality life instead of a sick, but long life!”
Helen was so excited to understand the cause of this seemingly senseless mess!
Take a look at the list of functions of estradiol and testosterone do for our tissues:
The addition of all three of your missing hormones into your health regimen increases the collagen and the supportive tissues for your skin. This improves your body composition to a more youthful figure over about 12 months. Of course, damage from sun and smoking is not reversible in this manner and must be dealt with in other ways.
Cellulite is a function of a low-oxygen-environment surrounding superficial fat. The largest areas of cellulite on women are the fatty areas covering the large muscles of the thigh, hip and gluteus (buttocks). When testosterone decreases, muscles shrink, and do not demand as much oxygen. The fat lying on top of those muscles are “starved” for oxygen, and they succumb to scarring areas of muscle in response to a low oxygen environment. These scars pull the skin down and “dimple” the skin overlying the hypoxic fat. This is where cellulite comes from. All treatments for treatment of cellulite are aimed at oxygenating the fat. The best oxygenator is replacing the testosterone so blood and oxygen is drawn to the working and growing muscles. This heals the cellulite from the inside out. For severe cases or faster repair, I-Lipo laser or radiowave cellulite treatments help stimulate the bloodflow quickly and helps dissolve the fat as well.
Restoration of our previous youthful body requires patience, time, work, a Mediterranean low carb diet and exercise. First, hormonal replacement restores tissue integrity. Weight remains stable, rather than inching upward, as muscle builds and fat decreases for one year. Clothing size, and waist measurement decreases as muscle builds. Finally, weight begins to decrease after one year of therapy, and continues until you reach ideal weight.
Remember, it took years of hormone insufficiency to get here, it will take at least a year to get back. It will be easier than you think once you get your energy back. It is truly amazing to watch the reformation of your figure after you follow this treatment plan.
Dry Eyes and Testosterone
Dry eye syndrome is defined as a decrease in the production of tears or poor quality of the tears, e.g., tears that break down too quickly to be of benefit. It can also be excessive tear evaporation. When tears are lacking or of poor quality, the cornea becomes dry and vision is distorted. This condition can prevent you from wearing contacts and cause you to have difficulty preventing corneal abrasions. This is not a minor symptom of testosterone deficiency.
There are other causes for dry eyes, but the one cause that is most prevalent is the loss of testosterone that occurs after 45 y.o in women. Every gland that produces “wetness”, like lacrimal ducts (tears), salivary glands (saliva), sweat glands (sweat), among others dry up when the level of testosterone becomes critical. This is a recent finding in the literature and has been discussed and evaluated mostly by opthamologists. Because they don’t replace hormones, and it is kind of tricky, they have used topical drops with testosterone, but they were only mildly successful.
The real treatment for this condition, when secondary to low testosterone levels is systemic testosterone, that is replaced 24/7. Many of my patients have been happily surprised when they could throw away their “cheaters”, and put their contacts back in, after being treated with testosterone pellets for other reasons. Some opthamologists send me their most difficult patients to treat for dry eyes, with testosterone pellets, however there are generally multiple causes in the worst cases, and it has not been as successful as in the patient who presents for some other testosterone deprivation syndrome.
If you think this is a minor problem compared to lost libido and memory loss, then think again. The statistics about dry eyes might surprise you. Did you know that 3.2 million American women over 50 suffer from dry eyes? One point six million American men over 50 do, as well. Hispanic and Asian women are at higher risk than other ethnic groups.
Symptoms of dry eye syndrome:
Testosterone is essential to the health of the lachrymal duct and is crucial to the production of tears. Decreased testosterone causes increase in “cytokines” which are an inflammatory chemical in the blood and tears. Once the lachrymal duct is inflamed it stops producing tears.
There are conditions other than testosterone deprivation that can cause dry eye syndrome, as well:
Pregnancy is a notable cause of dry eyes. “A significant proportion of women report dry-eye syndrome during pregnancy, especially when they have had at least one prior birth.” Joel Schechter, Ph. D., reported, “…In Dr. Evans’ study, symptoms were four times more likely to be worse during pregnancy than before it.” “During pregnancy, androgens are deficient, causing insufficient lachrymal gland function.”
But pregnancy isn’t the only hormonal culprit – there’s also menopause. “Dry eyes occur most frequently in older persons and more often in women than men. The androgens that are released normally by the lachrymal gland help maintain the gland’s structural integrity.”1 This substantiates the connection between dry eyes and the endocrine system.
Women are forced to stop wearing contact lenses just when bifocals are needed! We have noticed for years that patients taking testosterone pellets resolved or improved their dry eyes. Now research has proven that parenteral (IV or IM or pellets) replacement can relieve dry eye symptoms. 2 Testosterone eye drops are also being compounded for patients who cannot take testosterone pellets, but are found to be less effective than pellet therapy.”
1 All from Evans, Jeff, “Study shows dry eyes a problem in pregnancy,” AMA News,
2 0062 Schaumberg DA, et al, “Prevalence of dry dye syndrome among US women,” Am Journal of Ophthalmol, 2003 Aug;136 (2):318-26; Schaumberg DA, et al, “Hormone replacement therapy and dry eye syndrome.” JAMA 2001 Nov 7; 286(17): 2114-9.
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In episode 56 of the BioBalance Healthcast we talk about some of the medical and emotional causes of depression. The discussion is in part based on a chapter of my book, Testosterone, The Secret Female Hormone. Following is an excerpt of the draft manuscript.
Most women know what the terms Anxiety and Depression mean. These terms are used commonly in casual conversation, and are two of the most common complaints in doctors offices all over America. We all know that these two symptoms are much more common in women than in men. We also may be aware that the onset of anxiety and depression is most common after 40 years of age. It may enter our emotional state for no definable reason, or it may be related to a life event that stressed us, followed by a chemical imbalance that continues long after the situation resolves. Why do life events impact us more severely after we turn 40, and why can’t we bounce back? Why do these symptoms occur when our lives are going well, and there is no identifiable reason for these feelings to overwhelm us? The reason is simply that we are losing our hormones with every birthday after 40, and with them go our neurotransmitters that supplied the energy, and emotional stamina that allowed us to withstand the stresses of life.
Here are the common symptoms of depression:
Everyone thinks of the neuro-transmitter serotonin when they hear depression because that is the chemical that is needed in the brain for us to maintain our cheery mood. The end of the process is serotonin, but what begins the process that leaves us depressed? That is what we should be looking to, for a preventive treatment. Testosterone is one of the hormones that drop after 40, and the free form of the hormone that crosses to the brain is less available to stimulate the production of serotonin. Testosterone also stimulates the secretion of norepinephrine in the brain that gives us energy, and improves mood as well. When we add the stress of modern life to the mix, testosterone drops faster and to a lower level because of elevated adrenal hormone, cortisol. The modulating hormone testosterone works wonders when plentiful, but leaves us more vulnerable to stress and over-work when we are over 40.
Depression may be augmented or caused by deficient levels of other hormones such as progesterone, thyroid and melatonin. If you ask most PMS patients, they say that they are depressed two out of every four weeks a month. This type of depression is generally from low testosterone, and lower than normal progesterone. Both these hormones stablilize the brain and improve serotonin levels. The second half of the cycle is dependent on progesterone, so when the ovary makes a lower than necessary amount of progesterone, estradiol increases and depression is the outcome. Thyroid is another hormone responsible for mood, and when deficient thyroid hormones are secreted, for any reason, patients feel depressed. This type of depression is generally described as a type of slow motion or fatigue and depression combined that feels like walking through a bowl full of jello. Lastly hormone dependent depression secondary to decreased light, as in winter when there are fewer than 10 hours of light per day, is a shortage of melatonin that suppressed the secretion of serotonin. This cyclis depression is called seasonal affective disorder (SAD), and it becomes more severe as we age from a lack of testosterone leading to lower neurotransmitters.
Your impression of what depression actually is may not be accurate because the word has been used in many ways that dilute the meaning of true depression. When someone is medically depressed, they are not sad today, and ok tomorrow. Depression is not considered mourning for a loved one lost, as everyone who misses someone they love is sad and emotionally in shock, but not necessarily, depressed. The symptom of depression includes daily low mood for more than three months, that in most cases is unrelated to an identifiable cause. It can occur long after an event that normally causes sadness but the depression lasts longer than a year after the loss of a loved one, or a major life event like divorce. Other common symptoms included in the overall label depression includes interrupted sleep, around 2 am, irritability, and poor concentration. Most women who suffer from depression ask, “Is this all there is?”. People who are depressed believe that their happiest experiences are not fulfilling, or enjoyable. They believe that life is dull and humorless. True depression is evident in the eyes of the depressed patient; dull and emotionless. Depression is a chemical imbalance, with the final physiologic effect resulting in lack of serotonin. The initial trigger in women over 40 is the loss of testosterone and thyroid, which makes them much more susceptible to chemical depression.
visit BBH.com for more info about bioidentical hormones/anti-aging/skin care.
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