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Tag: HPA axis

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Bioidentical Hormones Benefits Overview for Patient Wellness


Transform your health with bioidentical hormones and elevate patient wellness through natural hormonal balance.

Navigating Hormonal Health: An Integrative Approach to Wellness

In this educational post, I will explore the complex and fascinating world of hormone optimization from an integrative perspective. Drawing upon the latest evidence-based research and my clinical experience, we will delve into the nuances of hormone replacement therapy (HRT), including the transition from traditional birth control to bioidentical hormones. We will discuss the physiological basis for common symptoms like menstrual migraines and perimenopausal anxiety, and I’ll share specific protocols for managing these conditions effectively. Furthermore, we will examine the crucial role of nutrition, sleep, and targeted supplementation in supporting hormonal balance. This discussion will also cover advanced testing methodologies and address common concerns, such as the use of topical estrogens and the safety of HRT in various patient populations. Finally, I will explain how integrative chiropractic care is an essential component of this holistic treatment model, helping to restore overall physiological function and enhance the body’s innate healing capabilities.

Foundations of Bioidentical Hormone Replacement: Source and Application

As a practitioner dedicated to functional and integrative medicine, I frequently encounter a question from both patients and fellow clinicians about the origins of the hormones we use. Specifically, “What is the source of the bioidentical hormones, like estrogen, used in therapy?”
This is a fantastic and crucial question. The bioidentical estradiol and progesterone we use in compounded therapies are derived from plant sources. The starting molecule, diosgenin, is extracted from wild yams. It is important to note that this is not the sweet potato but the true yam plant. Diosgenin is a phytosteroid, a plant-based steroid, with a molecular structure that makes it an ideal precursor. In a compounding pharmacy, skilled chemists modify this diosgenin molecule, altering its chemical structure to create 17-beta estradiol and progesterone. These resulting hormones are termed “bioidentical” because they are molecularly identical to the hormones our bodies produce naturally. This molecular mimicry is key to their efficacy and safety profile, as the body’s cellular receptors recognize and utilize them just as they would endogenous hormones.
Historically, some hormone precursors were derived from soy, but the industry has largely shifted to yam-based sources to avoid potential issues related to soy sensitivities and phytoestrogenic effects.
Another common clinical question is about layering different types of therapies. For instance, can a topical cream for enhancing libido be used in conjunction with hormone pellets?

  • Yes, absolutely. You can layer these therapies. A topical cream, which might contain a blend of ingredients such as testosterone, oxytocin, or other compounds designed to increase local blood flow and nerve sensitivity, works through a different mechanism and pathway than systemic hormone pellets do.
  • The pellets provide a steady, baseline level of hormones (like testosterone and estradiol) systemically, which addresses the root cause of low libido from a physiological standpoint.
  • The topical cream provides targeted, localized support. Because it’s utilized differently, there’s no contraindication; in fact, this multimodal approach can be highly effective for patients with refractory libido issues.


Navigating the Transition from Birth Control to BHRT

A significant part of my practice involves helping women transition from synthetic hormonal birth control to bioidentical hormone replacement therapy (BHRT). The conventional practice of keeping women on birth control pills until age 51 and then abruptly stopping is outdated and, frankly, unsafe.

The Risks of Prolonged Oral Contraceptive Use

Birth control pills are designed for one primary purpose: contraception. Once a woman no longer requires them for preventing pregnancy—perhaps due to a tubal ligation, having an IUD, or a vasectomized partner—she should not remain on them for other reasons like managing menstrual migraines or endometriosis. Synthetic hormones in oral contraceptives carry significant risks, including:

  • Deep Vein Thrombosis (DVT)
  • Pulmonary Embolism (PE)
  • Stroke

In my clinical practice and from collaborating with my colleagues, I have seen devastating cases of women in their 40s with no other underlying health issues suffering major strokes directly linked to their oral contraceptive use. While the risk-benefit ratio may be acceptable for a 20-year-old (where the risk of a DVT from pregnancy is comparable to the risk from the pill), this ratio shifts dramatically as a woman ages and no longer faces the risk of pregnancy.

The Transition Protocol

So, how do we safely transition a patient? The key is to determine her true menopausal status, which is masked by the synthetic hormones in birth control pills.

  1. Initial Bloodwork: I start by testing the Follicle-Stimulating Hormone (FSH) level while the patient is still on the pill.
    • An FSH of 10 mIU/mL or greater strongly suggests she is in the menopausal transition.
    • An FSH of 5 mIU/mL or less indicates she is likely still premenopausal.
  2. The “Gray Zone”: If the FSH falls into the intermediate range (e.g., 6-9 mIU/mL), clarity is needed. I will have the patient stop the birth control pill for approximately three weeks. During this washout period, it’s crucial to use a reliable barrier method of contraception, like condoms.
  3. Confirmatory Testing: After the three-week washout, I retest the FSH. A level of 23 mIU/mL or higher is a definitive indicator of menopause.
  4. Seamless Transition: Once menopause is confirmed, the transition can happen literally overnight. She stops the pill and begins her personalized BHRT protocol, which typically includes bioidentical estrogen and testosterone (often via pellets) and oral micronized progesterone at bedtime.

For a perimenopausal patient, meaning she hasn’t been without a cycle for a full 12 months, a more cautious approach is warranted. I would start with a lower dose of estrogen, such as 6 mg, to avoid inducing bleeding. We can always titrate the dose upwards based on her symptoms and follow-up lab work in six weeks. It’s always easier to add more hormone than to deal with the consequences of overdosing.

The Critical Role of Integrative Chiropractic Care

In my practice, where I hold credentials as both a chiropractic physician and an advanced practice nurse, I have observed the profound impact of combining hormonal and metabolic treatments with physical medicine. Integrative chiropractic care is not just about addressing back pain; it is a foundational element of restoring systemic health.
The nervous system is the master controller of the body, directly influencing the endocrine system via the hypothalamic-pituitary-adrenal (HPA) axis. Structural misalignments in the spine, known as vertebral subluxations, can create nerve interference, disrupting the delicate communication between the brain and the body’s glands, including the ovaries, adrenals, and thyroid.

  • Restoring Neurological Function: Chiropractic adjustments correct these subluxations, reducing nerve interference and optimizing HPA axis function. This can help normalize cortisol production, which in turn reduces the “theft” of pregnenolone (the mother hormone) for cortisol synthesis, leaving more available to produce progesterone and other vital sex hormones.
  • Improving Blood Flow: Adjustments improve circulation to the pelvic organs and endocrine glands, ensuring they receive the oxygen and nutrients needed for optimal function.
  • Reducing Systemic Stress: The physical act of a chiropractic adjustment has been shown to decrease sympathetic (fight-or-flight) tone and increase parasympathetic (rest-and-digest) activity. This physiological shift is crucial for hormonal balance, as chronic stress is a major disruptor of the endocrine system.

By integrating chiropractic care, we are not just treating symptoms; we are addressing the underlying structural and neurological dysfunctions that contribute to hormonal imbalance, thereby creating a more robust and lasting foundation for wellness.


Addressing Specific Conditions: Anxiety, Migraines, and Sleep

Perimenopausal Anxiety and PMS

Severe anxiety and mood swings, particularly those linked to the menstrual cycle (PMS/PMDD), are often rooted in hormone fluctuations. While testosterone replacement is a cornerstone for mood stabilization, oral micronized progesterone is a powerful tool, especially for anxiety.
Progesterone’s calming effect comes from its metabolite, allopregnanolone, which acts as a positive allosteric modulator of the GABA-A receptor in the brain. GABA is the primary inhibitory neurotransmitter, and enhancing its function promotes relaxation and reduces anxiety.

  • Nighttime Dosing: For sleep disturbances and generalized anxiety, I typically prescribe oral progesterone at bedtime.
  • Daytime Anxiety: For patients with severe daytime anxiety, a small dose of 25 mg of oral progesterone can be remarkably effective. I have seen this strategy transform the lives of patients, including young women in their teens with debilitating hormonal fluctuations, allowing them to avoid psychiatric medications.


Menstrual Migraines

Menstrual migraines are triggered by the sharp drop in estrogen that occurs right before the onset of menses. The treatment is elegantly simple and highly effective.

  • The Protocol: I prescribe a very low dose of topical estrogen (e.g., a small dab of estradiol cream) to be applied daily for the seven days leading up to the expected start of the period.
  • The Mechanism: This small amount of estrogen is just enough to create a “trough” level, preventing the precipitous drop that triggers the migraine cascade. It’s a drop in the bucket in terms of total monthly estrogen exposure and is not enough to disrupt the natural cycle or require opposing progesterone. This simple intervention has a success rate of over 95% in my clinical experience.

Sleep, Growth Hormone, and the Modern Epidemic

Sleep is non-negotiable for hormonal health. The most critical period for hormone production is between 11:00 PM and 2:00 AM. During this deep sleep window, the body produces growth hormone (GH), which in turn stimulates the liver to produce Insulin-like Growth Factor 1 (IGF-1).
I see a concerning trend in younger patients. They are staying up until 2:00 AM on their phones, bathed in blue light that suppresses melatonin production. This lifestyle completely obliterates their deep sleep cycle. Consequently, they are not producing adequate growth hormone, their IGF-1 levels are collapsing, and their entire hormonal cascade suffers. This is often compounded by a diet high in sugar and processed foods. The result is a generation of young people with the hormonal profiles of much older individuals.
My approach involves a comprehensive lifestyle overhaul:

  • Dietary Intervention: An organic, whole-foods diet, eliminating sugar and processed foods.
  • Supplementation: A targeted regimen including a high-quality B-complex, Vitamin D, iodine, and probiotics.
  • Sleep Hygiene: Strict sleep schedules and eliminating screen time before bed.
  • Chiropractic Care: To reduce systemic stress and improve neurological function.


Advanced Topics and Clinical Pearls

Topical Estrogen on the Face

Some patients ask about using topical estrogen on their faces for cosmetic benefits. While estrogen does improve skin elasticity and collagen production, applying a standard BHRT estrogen cream directly to the face is problematic. The facial skin is highly vascular, and this application would lead to significant systemic absorption, driving serum estrogen levels dangerously high. A much safer alternative is to use a compounded cream containing estriol (E3), the weakest of the three main estrogens, which provides local benefits with minimal systemic absorption.

Testing and Monitoring

Accurate testing is paramount. For thyroid hormones, I prefer using Liquid Chromatography-Mass Spectrometry (LC-MS). It is more precise than radioimmunoassay (RIA), which can be subject to cross-reactivity with substances like biotin, leading to falsely elevated estradiol results. When testing T3, it’s essential to know when the patient took their last dose of thyroid medication, as a recent dose can cause a transient spike in levels.

Interacting with Other Medical Professionals

Unfortunately, there can be resistance from practitioners in other specialties, such as oncology or cardiology, who may not be up to date with the literature on BHRT. The best approach is education and providing data. Dr. Rebecca Glaser, a leading researcher, has an excellent open-access website that collates studies on the safety of testosterone therapy, even in breast cancer survivors. Providing this evidence-based literature to concerned colleagues can help bridge the knowledge gap and ensure continuity of care for our patients.
Hormone optimization is a journey that requires a personalized, evidence-based, and integrative approach. By addressing the biochemical, structural, and lifestyle factors that influence hormonal health and by using tools like BHRT and integrative chiropractic care, we can empower our patients not just to manage symptoms but to achieve true vitality and wellness.

References


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Hormone Optimization Techniques For Thyriod Health

Achieve optimal thyroid health through hormone optimization and support your body’s natural balance and energy.

Abstract

In this educational post, I will explore the nuanced and highly individualized world of hormone optimization, moving beyond rigid, population-based “normal” ranges to focus on patient-centered, evidence-based outcomes. We will delve into the physiological importance of key hormones like testosterone, thyroid hormones (T4 and T3), and progesterone, and discuss the complex considerations surrounding estrogen therapy, particularly for patients with a history of cancer. My goal is to illuminate the rationale behind a functional and integrative approach, emphasizing that true health is about how a patient feels and functions, supported by data, not just about achieving a specific number on a lab report. We will discuss why a low testosterone level, even if the patient feels “normal,” poses significant long-term health risks, including increased all-cause mortality, type 2 diabetes, and Alzheimer’s disease. Furthermore, I’ll explain how integrative chiropractic care, by addressing the body’s structural and neurological integrity, provides a foundational pillar of support for these hormonal therapies, enhancing overall physiological function and patient well-being. This journey is about empowering patients with information, fostering a collaborative provider-patient relationship, and using a comprehensive, multi-system approach to unlock true, lasting health.

The Fallacy of “Normal”: Redefining Hormone Lab Ranges

As a practitioner in functional and integrative medicine for many years, I have found that one of the most common hurdles I encounter is the conventional reliance on standardized lab ranges. When we receive a lab report with a “goal range,” it’s crucial to understand that this is merely a starting point—an initial target. It is not a one-size-fits-all destination for every individual. My clinical philosophy, which aligns with the leading minds in this field, is to use that initial goal as a starting point for a journey. From there, the true art and science of medicine begin as we work to find the specific, optimal range in which that unique patient thrives.
I’ve had countless conversations about this. For example, a man might have a total testosterone level of 300 ng/dL. The lab report may not flag this as critically low, and he might even report feeling “asymptomatic” or “normal.” This is where a deeper, evidence-based understanding is vital.

  • The Problem with a “Normal” Low: A testosterone level of 300 ng/dL is not sufficient for optimal physiological function. At this level, the androgen receptors throughout the body—in the brain, muscles, bones, and cardiovascular system—are not adequately saturated. This undersaturation is a major risk factor.
  • Long-Term Health Risks: Leading researchers like Dr. Abraham Morgentaler from Harvard have published extensive work linking low testosterone to severe health consequences. Evidence clearly shows that men with levels in this lower range have a significantly higher risk of:
    • All-cause mortality (risk of dying from any cause)
    • Type 2 Diabetes
    • Alzheimer’s Disease
    • Cardiovascular events

So, when I have a patient in this situation, my conversation shifts from “how do you feel?” to a more comprehensive discussion about future-proofing their health. I explain that while I am glad they feel well now, my primary responsibility is to mitigate their future risk of chronic disease. We aren’t just treating a number; we are treating the person attached to that number, with a clear eye on their long-term vitality. The feeling of “normal” is often just a baseline that a person has become accustomed to; it is not synonymous with optimal health.

The Interplay of Hormones: A Symphony of Systems

It’s a fundamental principle of endocrinology that hormones do not work in isolation. They function as a complex, interconnected orchestra. If one instrument is out of tune, the entire symphony is affected. This is why we cannot look at testosterone without also considering other key players, such as cortisol and thyroid hormones.
Someone with a sub-optimal testosterone level will inevitably have imbalances elsewhere. Perhaps their sense of “normal” is their body’s maladaptive state. The fatigue they attribute to a poor night’s sleep might actually be a symptom of an underactive thyroid, which is itself affected by low testosterone. This is where a thorough, functional workup becomes indispensable. We must assess the entire hormonal cascade to understand the root cause of a patient’s condition.

Cracking The Low Thyroid Code- Video

The Role of Integrative Chiropractic Care

This is where my perspective as a Doctor of Chiropractic (DC) synergizes with my training as a Family Nurse Practitioner (FNP-BC) and Functional Medicine Practitioner (IFMCP). The nervous system is the master conductor of the endocrine orchestra. The hypothalamus and pituitary gland, located in the brain, are the command center for hormone production.

  • Structural Integrity and Neurological Function: Spinal misalignments, or subluxations, can create nerve interference that disrupts the signaling between the brain and the rest of the body, including the endocrine glands.
  • Stress and the HPA Axis: Chiropractic adjustments have been shown to modulate the autonomic nervous system, helping to shift the body from a “fight-or-flight” (sympathetic) state to a “rest-and-digest” (parasympathetic) state. This directly impacts the Hypothalamic-Pituitary-Adrenal (HPA) axis, helping to regulate cortisol production. Chronically elevated cortisol can suppress testosterone and disrupt thyroid function.

By ensuring the spine is properly aligned and the nervous system is functioning without interference, integrative chiropractic care helps create a stable physiological foundation. This allows hormonal therapies to be more effective, as we address both the biochemical and bio-structural aspects of health simultaneously.

Navigating Complex Cases: Hormone Therapy After Diagnosis

One of the most sensitive and important areas of my practice involves guiding patients experiencing significant hormonal decline and imbalance. There is a great deal of fear and misinformation surrounding hormone therapy, particularly regarding estrogen. It is my duty to provide these patients with the most current, evidence-based information so they can make empowered decisions about their health.

Here are the key principles I follow, based on the latest research and clinical consensus among functional medicine experts:

  • Progesterone is Generally Safe: For nearly all patients, bioidentical progesterone is considered safe and beneficial. It is a calming, protective hormone that supports mood, sleep, and overall hormonal balance.
  • Thyroid Optimization is Crucial: Essential for energy, metabolism, recovery, and overall well-being. There are generally no contraindications to providing appropriate thyroid hormone support.

Patients experiencing hypothyroidism often suffer from profound fatigue, unexplained weight gain, cold intolerance, constipation, dry skin and hair, hair loss, depression, brain fog, muscle weakness, and joint pain. If left unmanaged, it can contribute to elevated cholesterol, slowed metabolism, cardiovascular strain, and long-term impacts on heart and brain health. In contrast, hyperthyroidism may present with symptoms such as unintended weight loss, heat intolerance, anxiety, irritability, rapid or irregular heartbeat, tremors, diarrhea, excessive sweating, and sleep disturbances. Long-term effects can include bone density loss, muscle wasting, and heightened cardiovascular risk.

  • Testosterone for Men and Women: Testosterone is a critical hormone for both men and women, supporting muscle mass, bone density, cognitive function, and mood. It can be safely administered with proper monitoring.
  • Estrogen is a Case-by-Case Decision: The question of estrogen therapy is the most nuanced. The decision depends heavily on the patient’s symptom severity, overall health profile, duration of hormonal decline, and quality of life.

Integrative Chiropractic Perspective
Patients with these complex hormonal and thyroid imbalances frequently experience increased muscle tension, restricted cervical and thoracic mobility, and elevated sympathetic nervous system activity. Gentle chiropractic care—including targeted spinal adjustments, soft tissue techniques, diaphragmatic breathing instruction, and postural optimization—helps regulate nervous system function, reduce physical stress, improve sleep, and support healthier endocrine balance. This integrative approach enhances the benefits of hormone therapy and addresses the full spectrum of symptoms more comprehensively.

An Individualized Approach to Estrogen

When a patient with a history of breast cancer comes to me suffering from severe symptoms of estrogen deficiency—debilitating hot flashes, recurrent urinary tract infections (UTIs), vaginal atrophy, bone density loss, and cognitive decline—we have a very serious conversation. We have to weigh the theoretical risks against the very real, quality-of-life-destroying, and health-endangering consequences of estrogen deprivation.
Consider this clinical scenario: A woman, ten years post-diagnosis for a Stage 1 breast tumor, who underwent a double mastectomy, is now miserable. Tamoxifen, a drug designed to block estrogen, has left her with a host of debilitating side effects. Her oncologist offers no alternatives. In this case, she came to me seeking to reclaim her life. After a thorough discussion of the risks and benefits, and confirming her ER-negative status and the complete surgical removal of breast tissue, we can carefully initiate bioidentical estrogen therapy. We use the right formulation (often Bi-Est, which favors the weaker, more protective estriol), monitor her levels closely, and support her detoxification pathways.
What is the alternative? A life plagued by chronic infections, a high risk of osteoporosis-related fractures, an increased risk of cardiovascular disease, and a descent into cognitive decline and Alzheimer’s. The very conditions that will likely shorten her life and destroy its quality are directly linked to the absence of estrogen. Leading research, such as the comprehensive review by Sarrel et al. (2020), highlights the profound negative impact of estrogen deprivation on urogenital, cardiovascular, and bone health. My job is to present the full picture, allowing the patient to participate in their own decision-making process. This right is too often taken away in conventional oncology settings.

The Importance of Thyroid Hormone T3, Especially During Pregnancy

Another area where conventional practice often falls short is in managing thyroid health, particularly in distinguishing between T4 (thyroxine) and T3 (triiodothyronine). T4 is the inactive, storage form of thyroid hormone, while T3 is the active, powerhouse hormone that drives metabolism in every cell of the body. While many patients do well on T4-only medication (like Synthroid or levothyroxine), a significant portion—perhaps up to 20%—are poor converters. Their bodies cannot efficiently turn T4 into the usable T3. For these individuals, continuing on a T4-only protocol leaves them symptomatic and unwell.
This becomes critically important during pregnancy.

  • Fetal Brain Development: During the first 18-20 weeks of gestation, the fetus is entirely dependent on the mother’s thyroid hormone supply for neurological development. Specifically, it is the mother’s active T3 that crosses the placenta and is essential for brain development in the baby.
  • Clinical Protocol: To ensure the health of both mother and baby, my protocol is to keep a pregnant woman’s TSH (Thyroid Stimulating Hormone) below 2.5, and often closer to 1.5, during the first trimester. I ensure she has adequate T3 available. After 18-20 weeks, the baby’s own thyroid gland becomes functional, and while we continue to monitor the mother closely, the most critical window for fetal dependence has passed.

Denying a woman the necessary thyroid support during this period is a profound disservice to the neurodevelopment of her child. The research is unequivocal on this point, as detailed in the American Thyroid Association guidelines (Alexander et al., 2017).

The Power of Patient Empowerment and Building Trust

Ultimately, my role is to serve as an educator and a partner. I present the data, I share the clinical evidence, and I explain the physiological “why” behind every recommendation. Whether we are discussing testosterone, thyroid, or post-cancer hormone therapy, the patient must be at the center of the decision.
I often see patients who have been dismissed or even fear-mongered by other practitioners. They come to me frustrated and hopeless. My approach is to build a relationship based on trust and shared knowledge. I might say, “What you have been doing for the last five years hasn’t worked. Let’s try something different for 12 weeks. We will monitor you closely. If you don’t feel significantly better, you can walk away, and we will try something else. But let’s give your body the tools it needs to heal.”
This collaborative approach is transformative. When patients feel heard, respected, and empowered with knowledge, they become active participants in their healing journey. Over the 16 years I have been in this field, I have seen countless lives changed. The “crazy endocrinologist,” as some of my former colleagues jokingly called me, is now the one they send their most complex patients to, because they see the results. They see patients not just surviving, but truly thriving. And that is the ultimate goal of everything we do.


References

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