The document discusses various hormones including estrogens, progesterone, testosterone, DHEA, cortisol, and thyroid hormone. It describes where each hormone is produced in the body, its functions, and how levels change with age for both males and females. Symptoms of hormone imbalances are provided for each hormone. The approach to treating female hormone imbalances is said to not always require hormone replacement therapy but can involve lifestyle changes and other natural remedies.

1. “The compounding specialists”
W elc o me

2. Hormones

3. Hormones
 Powerful chemical messengers

4. Hormones
 Powerful chemical messengers
 Derived from cholesterol

5. Hormones
 Powerful chemical messengers
 Derived from cholesterol
 Made in the brain, ovaries, testicles, adrenal
glands and body fat

6. Hormones
 Powerful chemical messengers
 Derived from cholesterol
 Made in the brain, ovaries, testicles, adrenal
glands and body fat
 Affect every tissue in the body

7. Hormones
 Powerful chemical messengers
 Derived from cholesterol
 Made in the brain, ovaries, testicles, adrenal
glands and body fat
 Affect every tissue in the body
 Overall effect depends on the balance between
various hormones

8. Hormones
 Powerful chemical messengers
 Derived from cholesterol
 Made in the brain, ovaries, testicles, adrenal
glands and body fat
 Affect every tissue in the body
 Overall effect depends on the balance between
various hormones
 Duration of exposure is as important as dose

9. Bio-Identical Hormones

10. Bio-Identical Hormones
 Bio-Identical Hormones are chemically identical
to those in the human body
 Derived from cholesterol-like molecules called
saponins (extracted from soybeans and yams)
 Plants do not make hormones (only precursors)
 Some available without prescription (ProGest)
 Others require prescription
 a few manufactured products (eg: Vivelle, Estrace,
Prometrium)
 custom compounded medications

11. Estrogens
Estriol, Estradiol, Estrone

12. Estrogens
Estriol, Estradiol, Estrone
 Exert a stimulating effect on breast, uterus
and brain

13. Estrogens
Estriol, Estradiol, Estrone
 Exert a stimulating effect on breast, uterus
and brain
 Prevent bone loss by osteoclasts

14. Estrogens
Estriol, Estradiol, Estrone
 Exert a stimulating effect on breast, uterus
and brain
 Prevent bone loss by osteoclasts
 Involved in vasodilation and improved
blood flow

15. Estrogens
Estriol, Estradiol, Estrone
 Exert a stimulating effect on breast, uterus
and brain
 Prevent bone loss by osteoclasts
 Involved in vasodilation and improved
blood flow
 Promote fat storage at hips

16. Estrogens
Estriol, Estradiol, Estrone
 Exert a stimulating effect on breast, uterus
and brain
 Prevent bone loss by osteoclasts
 Involved in vasodilation and improved
blood flow
 Promote fat storage at hips
 Maintain integrity of urogenital tract

17. Progesterone

18. Progesterone
 There is only ONE progesterone

19. Progesterone
 There is only ONE progesterone
 Works synergistically with estrogens
 Balances effect of estrogens in many cases
 slows cell growth
 normalizes blood clotting
 enhances estrogen’s cardiovascular benefits
 decreases fluid retention (bloating)
 improved fat metabolism

20. Progesterone
 There is only ONE progesterone
 Works synergistically with estrogens
 Balances effect of estrogens in many cases
 slows cell growth
 normalizes blood clotting
 enhances estrogen’s cardiovascular benefits
 decreases fluid retention (bloating)
 improved fat metabolism
 Progesterone levels drop at peri-menopause

21. Testosterone

22. Testosterone
 Anabolic hormone
 builds and strengthens tissue, bone,
urogenital tract, muscle

23. Testosterone
 Anabolic hormone
 builds and strengthens tissue, bone,
urogenital tract, muscle
 Declines with age

24. Testosterone
 Anabolic hormone
 builds and strengthens tissue, bone,
urogenital tract, muscle
 Declines with age
 Vasodilator

25. Testosterone
 Anabolic hormone
 builds and strengthens tissue, bone,
urogenital tract, muscle
 Declines with age
 Vasodilator
 Balances effects of estrogen and cortisol

26. Testosterone
 Anabolic hormone
 builds and strengthens tissue, bone,
urogenital tract, muscle
 Declines with age
 Vasodilator
 Balances effects of estrogen and cortisol
 Important for sex drive/sexual response

27. Dehydroepiandrosterone
(DHEA)

28. Dehydroepiandrosterone
(DHEA)
 Made in the adrenal glands

29. Dehydroepiandrosterone
(DHEA)
 Made in the adrenal glands
 Declines steadily with age

30. Dehydroepiandrosterone
(DHEA)
 Made in the adrenal glands
 Declines steadily with age
 Has important roles in immune function,
ability to handle stress, and glucose
disposal

31. Dehydroepiandrosterone
(DHEA)
 Made in the adrenal glands
 Declines steadily with age
 Has important roles in immune function,
ability to handle stress, and glucose
disposal
 Balances cortisol

32. Dehydroepiandrosterone
(DHEA)
 Made in the adrenal glands
 Declines steadily with age
 Has important roles in immune function,
ability to handle stress, and glucose
disposal
 Balances cortisol
 Can convert into testosterone and
estradiol

33. Cortisol

34. Cortisol
 Made in the adrenal glands

35. Cortisol
 Made in the adrenal glands
 Catabolic hormone: breaks down tissue
(part of the normal cycle of remodeling)

36. Cortisol
 Made in the adrenal glands
 Catabolic hormone: breaks down tissue
(part of the normal cycle of remodeling)
 Balances testosterone

37. Cortisol
 Made in the adrenal glands
 Catabolic hormone: breaks down tissue
(part of the normal cycle of remodeling)
 Balances testosterone
 Stress hormone: modulates immune
function, raises blood glucose, stores fat
for energy

38. Cortisol
 Made in the adrenal glands
 Catabolic hormone: breaks down tissue
(part of the normal cycle of remodeling)
 Balances testosterone
 Stress hormone: modulates immune
function, raises blood glucose, stores fat
for energy
 In excess: osteoporosis, muscle wasting,
obesity, brain neuron atrophy

39. Thyroid Hormone

40. Thyroid Hormone
 Determines metabolic rate
 nutrient utilization by tissue
 fats, carbs, and protein)
 affect protein synthesis
 regulate bone growth
 heat generation

41. Thyroid Hormone
 Determines metabolic rate
 nutrient utilization by tissue
 fats, carbs, and protein)
 affect protein synthesis
 regulate bone growth
 heat generation
 Interacts with cortisol, progesterone,
testosterone and estradiol

42. Female Hormone Patterns
Menarche to Menopause

43. Female Hormone Patterns
Menarche to Menopause
 Teens
 Anovulatory cycles are common
 Low Progesterone
 Estrogen Dominance

44. Female Hormone Patterns
Menarche to Menopause

45. Female Hormone Patterns
Menarche to Menopause
 20 to 30 years old
 May have regular monthly bleeding but may
not be ovulating
 if stressed: PMS
 unbalanced hormone levels affect fertility and
pregnancy

46. Female Hormone Patterns
Menarche to Menopause

47. Female Hormone Patterns
Menarche to Menopause
 40 to 50 years old
 Peak progesterone level declines
 Total progesterone output throughout the
luteal phase declines
 Average estradiol level increases
 may lead to estrogen dominance
 Ovaries may secrete more testosterone instead
of progesterone
 Anovulatory cycles with irregular bleeding

48. Female Hormone Patterns
Menarche to Menopause

49. Female Hormone Patterns
Menarche to Menopause
 40 to 50 years old
 Estrogen dominance
 Functional hypothyroidism
 Normal TSH, but classic symptoms of under-active
thyroid
 Weight gain
 Feeling cold
 Dry skin, thinning scalp hair
 Aching muscles
 Fatigue
 Low sex drive

50. Female Hormone Patterns
Menarche to Menopause

51. Female Hormone Patterns
Menarche to Menopause
 50+ & Menopause
 Estradiol level drops
 Estrone level stays the same or rises
 Ovary stops making progesterone and
testosterone

52. Symptoms of Hormone
Imbalance

53. Symptoms of Hormone
Imbalance
 Estrogen Excess
 Tender, swelling, and/or fibrocystic breasts
 water retention
 irritability
 weight gain at hips
 sometimes increased headaches or migraines
 hypothyroid symptoms

54. Symptoms of Hormone
Imbalance

55. Symptoms of Hormone
Imbalance
 Estrogen Deficiency
 Hot flashes & night sweats
 vaginal dryness (also lips, skin, eyes...)
 “brain fog” & memory problems
 urinary incontinence (stress incontinence)
 depression
 bone loss

56. Symptoms of Hormone
Imbalance

57. Symptoms of Hormone
Imbalance
 Estrogen Deficiency
 Low percent of body fat = at risk for low
estrogen
 estrogen CAN be made in body fat...if you have
enough!
 women with enough body fat may not need
estrogen supplementation for menopause
 women with low body fat may need extra estrogen

58. Symptoms of Hormone
Imbalance

59. Symptoms of Hormone
Imbalance
 Progesterone Deficiency
 Irregular periods (teens and pre-menopause)
 Tender and/or fibrocystic breasts
 water retention
 irritability
 anxiety/depression
 weight gain at hips
 migraines
 hypothyroid symptoms

60. Symptoms of Hormone
Imbalance

61. Symptoms of Hormone
Imbalance
 Androgen (Testosterone) Excess
 Acne, oily skin
 Facial hair growth
 Weight gain at waist
 High triglycerides
 Seen in insulin resistance, polycystic ovary
syndrome, obesity

62. Symptoms of Hormone
Imbalance

63. Symptoms of Hormone
Imbalance
 Androgen (testosterone)
Deficiency
 Depression
 fatigue
 vaginal dryness
 low sex drive
 bone loss
 decreased sense of well being

64. Symptoms of Hormone
Imbalance

65. Symptoms of Hormone
Imbalance
 Cortisol (Stress Hormone) Excess
 Irritability, anxiety, feel “burned out”
 “brain fog” & memory problems
 bone loss
 insomnia & fatigue
 low sex drive
 weight gain at waist (“apple” profile)

66. Symptoms of Hormone
Imbalance

67. Symptoms of Hormone
Imbalance
 Cortisol Deficiency “Adrenal Fatigue”
 Usually preceded by prolonged stress/
chronic illness
 Fatigue, feel “flat” or “burned out”
 Allergies; immune function low
 Feel cold all the time
 Can’t get started in the morning
 Low sex drive
 Depression
 Unstable blood sugar

68. Approach to Female Hormone
Imbalances

69. Approach to Female Hormone
Imbalances
 The solution isn’t always HRT
 Stress reduction (good diet, sleep, exercise,
relaxation training)
 Weight loss
 Address insulin resistance
 Nutrients
 Herbs

70. Male Hormone Patterns

71. Male Hormone Patterns
 Young Males
 High testosterone
 Low estradiol
 Low progesterone

72. Male Hormone Patterns

73. Male Hormone Patterns
 35 + years old

74. Male Hormone Patterns
 35 + years old
 Testosterone drops about 1% per year

75. Male Hormone Patterns
 35 + years old
 Testosterone drops about 1% per year
 Estradiol and estrone may rise; Prog stays low

76. Male Hormone Patterns
 35 + years old
 Testosterone drops about 1% per year
 Estradiol and estrone may rise; Prog stays low
 Gain weight around middle

77. Male Hormone Patterns
 35 + years old
 Testosterone drops about 1% per year
 Estradiol and estrone may rise; Prog stays low
 Gain weight around middle
 Sleep problems associated with excess weight
may lead to increased cortisol

78. Male Hormone Patterns
 35 + years old
 Testosterone drops about 1% per year
 Estradiol and estrone may rise; Prog stays low
 Gain weight around middle
 Sleep problems associated with excess weight
may lead to increased cortisol
 Abdominal fat converts testosterone to estradiol
under the influence of cortisol

79. Male Hormone Patterns
 35 + years old
 Testosterone drops about 1% per year
 Estradiol and estrone may rise; Prog stays low
 Gain weight around middle
 Sleep problems associated with excess weight
may lead to increased cortisol
 Abdominal fat converts testosterone to estradiol
under the influence of cortisol
 Cortisol and estradiol directly oppose the action
of testosterone

80. Approach to Male Hormone
Imbalances

81. Approach to Male Hormone
Imbalances
 Weight loss

82. Approach to Male Hormone
Imbalances
 Weight loss
 Weight training

83. Approach to Male Hormone
Imbalances
 Weight loss
 Weight training
 Reduce dietary estrogen burden

84. Approach to Male Hormone
Imbalances
 Weight loss
 Weight training
 Reduce dietary estrogen burden
 Testosterone supplementation

85. Approach to Male Hormone
Imbalances
 Weight loss
 Weight training
 Reduce dietary estrogen burden
 Testosterone supplementation
 Aromatase inhibitors

86. Solving Hormone Problems

87. Solving Hormone Problems
 History 85%

88. Solving Hormone Problems
 History 85%
 Physical examination 10%

89. Solving Hormone Problems
 History 85%
 Physical examination 10%
 Lab tests 5%

90. Solving Hormone Problems
 History 85%
 Physical examination 10%
 Lab tests 5%
 Respect individual differences

91. Solving Hormone Problems
 History 85%
 Physical examination 10%
 Lab tests 5%
 Respect individual differences
 Endocrinology will always be somewhat
of an art, not an exact science

92. Role of Testing

93. Role of Testing
 Symptoms help us reach a tentative
diagnosis

94. Role of Testing
 Symptoms help us reach a tentative
diagnosis
 Lab testing confirms or refutes the
diagnosis

95. Role of Testing
 Symptoms help us reach a tentative
diagnosis
 Lab testing confirms or refutes the
diagnosis
 Need to do comprehensive testing

96. Thank You
John C. Richards Pharm.D.
Barbara Dace Pharm.D.
Debby DeJager Pharm.D.
P ro f es s i o n al Village Pharmacy
91 6 - 4 8 3 - 3 4 5 5
www.professionalvillagerx.com