Imbalanced—Can hormones be balanced? PART 1
Can you fix my hormone imbalance?
It is quite popular today to advertise the goal of balancing hormones to improve generalized fatigue and weight gain experienced in our fast-paced lives today. To start this post, I will first honestly share that I do not believe one can ‘balance’ their hormones, of which there are well over 50 hormones and steroids described in the human body. I believe that many selling expensive supplements, extensive hormone panels, and high-cost, quick fix programs are profiting off this notion that hormones are the root of our problems and can be ‘balanced’ leading to whole health. I do believe there are many patients with true hormone deficiencies, excess, or dysfunction who need appropriate evaluation and treatment by an expert endocrinologist to improve their overall health and quality of life. I will share my thoughts on hormone testing and treatment below.
I am writing this blog post to help educate potential endocrine patients as well as set expectations for patients who chose to see me. I will summarize at the end what I do and do not order and treat. If you are hoping for a ‘hormone doctor,’ please read this post before scheduling a visit with me to ensure my approach aligns with what you are looking for.
Measuring Hormones
First, a hormone is a chemical secreted into the bloodstream to act on target tissue, generally to regulate its function. Some hormones circulate regularly in the blood at high levels, some circulate at low levels as their primary action is local (called paracrine signaling), and some hormones are secreted in a regulated or pulsatile fashion. Some hormones travel in blood easily while others must be carried on other proteins (such as albumin or a hormone binding globulin), whose levels can vary from person to person. When evaluating the function of an endocrine pathway, one must choose whether to measure the basal hormone level, a stimulated or suppressed hormone response, or the result of the hormone’s function.
For example, when considering growth hormone function, the measurement of a random growth hormone is not helpful as this is secreted in a pulsatile fashion from the pituitary. One must either measure a more stable downstream product, Insulin-like growth factor-1 (IGF-1), stimulate growth hormone production with hypoglycemia, OR suppress growth hormone production with hyperglycemia. The selection of the correct test to establish a diagnosis for an appropriate patient takes mastery of endocrinology.
When looking for endocrine pathology, one must know whether we are looking for hormone deficiency, hormone excess, abnormal response to the hormone, or an endocrine gland tumor. Selection of appropriate testing depends on clinical presentation by history and exam, and one should not be measuring random levels to see if ‘high’ or ‘low’ to then investigate for pathology. The appropriate timing of day, time in the menstrual cycle, and response to other therapies are all crucial to appropriate diagnosis.
Finally, which lab assay is ordered impacts accuracy of the measurement. Hormones can be measured by immunoassay, immunometric assays, liquid chromatography-mass-spectrometry (LC/MS), and enzyme-linked immunosorbent assay (ELISA) methods. Some methods have higher risk of cross-reactivity, meaning inappropriately measuring other substances in the blood as the hormone in question, or are more accurate at very low levels. Therefore, in addition to correct patient, correct timing, correct stimulation/suppression, one must also select the correct test to make the diagnosis in question.
When all of these essential factors are considered, it becomes clear that it is neither possible nor appropriate to order a ‘comprehensive hormone panel.’ This is why seeing a trained endocrinologist can guide appropriate testing for each patient.
Please continue reading on Part 2, which you can find here.
