The Hemp Connection:
testosterone

Not long ago I created a webinar about bioidentical hormone replacement therapy. I found a great graphic that explains something most people have not considered when it comes to reproductive hormone health. Many of the hormones that we need for proper function of our reproductive systems (whether we're trying to conceive or slow down aging), are made out of cholesterol. Just look at this picture below!

As you can see, we need a decent supply of cholesterol in the body in order to even make progesterone and estrogen! However, we've become very obsessed with the idea that cholesterol is a"bad" thing. So much so that in 2001 the National Cholesterol Education Program lowered the level of ideal cholesterol so much that the number of people who ideally should be on cholesterol-lowering medications…tripled.
This may be more pertinent to women with PCOS, approaching menopause, who are more likely to be placed on statin medications than younger women who are trying to conceive.
However, I just wonder, a lot, if it's not really a coincidence that as we focus on cholesterol and getting it out of our bodies, we also seem to be developing more problems related to hormone imbalances…infertility, early menopause, even Alzheimer's, which is starting to be recognized as a consequence of insulin resistance, which is associated with PCOS.
Bottom line: Eat well, and be careful of obnoxiously high cholesterol levels, but try to avoid an obsession with a"lower is better" mentality. Cholesterol is an essential compound, and not to be feared.

Practically every time I hear a health professional explain, on the Internet or in person, why a woman with PCOS has carbohydrate cravings, they blame it on insulin resistance. The rationale is, that because glucose is not getting into cells, the cells are hungry and asking for sugar.

Did you know, as rational as this explanation sounds, research does not support it?

A study published in 2004 (and one of the few I've ever even seen that acknowledged that women with PCOS crave sugar) compared several appetite hormones to appetite measures in 16 pairs of women with PCOS matched with controls. They could find no statistically significant correlation between reported appetite and insulin levels. Rather, it was testosterone levels that seemed to be the problem.

Because insulin resistance has some effect on how much free testosterone is available to affect appetite, it could be argued that the effect is still there, but more indirect. However, another study reported that it is the eating of too much sugar and the resulting change in liver function that ultimately determines free testosterone levels, not insulin. (In this particular study the diet was up to 70% sugar, to be sure the desired metabolic effect was achieved and could be studied.) The resulting fat production by the liver was correlated with reduced levels of sex hormone binding globulin, the blood protein that binds to testosterone and inactivates it.

So while the cravings are there, be sure not to blame their cause on a solution that may not help. Our philosophy at inCYST is that balancing fatty acids helps calm down the nervous system and reduce its need for sugar. It also helps the liver better process fats, thus preventing the testosterone issue described above.

I know, I know, you're getting tired of hearing about fish oil.

I won't belabor the point, today I'll just challenge you to think outside the same old test tube.: )

Hirschberg AL, Naessén S, Stridsberg M, Byström B, Holtet J. Impaired cholecystokinin secretion and disturbed appetite regulation in women with polycystic ovary syndrome. Gynecol Endocrinol. 2004 Aug;19(2):79-87.

Selva DM, Hogeveen KN, Innis SM, and Hammond GL. Monosaccharide-induced lipogenesis regulates the human hepatic sex hormone–binding globulin gene. J Clin Invest. 2007 December 3; 117(12): 3979–3987.

Here's a study about lean women with PCOS--the women who I like to call"the forgotten cysters". I have lost track over the years of the number of women who have written me to share that they went to their physician asking for help with a list of PCOS symptoms they had…only to be told they couldn't possibly have PCOS because they were not overweight. Up to 70% of women who have this disorder are not overweight!!!

My belief is that many women who have adopted extreme eating and exercise behaviors to manage their weight, quite possibly many women who have been diagnosed with and who are being treated for eating disorders, actually have undiagnosed PCOS.

We need to get over this belief that thin equals healthy, and that a person cannot have PCOS if her BMI and weight are within normal limits. If you have to adopt extreme measures to stay within your recommended weight range, that is a serious problem and your physician needs to listen to you.

Now for this study to illustrate. Eight lean women who actually had been diagnosed with PCOS ("cysters") were compared to 7 lean women without PCOS. The cysters had higher testosterone, and prolactin levels. They also had lower sex hormone binding globulin levels (this protein binds and inactivates testosterone).

There you have it. You can be thin AND out of balance. Sisters…and cysters…it is your right to be heard and to not be told that nothing is wrong with you when you know there is. That is where my program name, inCYST, came from. You have the right to inCYST on the appropriate treatment for the appropriate problem and not to be told you do not need treatment just because you may not fit the common profile for PCOS, or for any disorder.

Grimmichová T, Vrbíková J, Matucha P, Vondra K, Veldhuis PP, Johnson ML. Fasting insulin pulsatile secretion in lean women with polycystic ovary syndrome. Physiol Res. 2008 Feb 13 [Epub ahead of print]

For anyone who is interested in the topic of bioidentical hormone replacement therapy, I will be presenting a webinar comparing this treatment to nutritional options.

This webinar will be held on February 23, at 6 PM Eastern time. The cost is $35.

Information can be found at our Facebook page.

You can register at this link.

There is an option to purchase the recorded version of this webinar if you are interested in the information but cannot attend the live presentation.

As a skin care therapist I would often be the first one to recognize a serious hormonal imbalance based on the acne that a client might be struggling with. As nutritionist it’s clear that it’s an “inside-out” problem.

Women with PCOS often have elevated levels of free-testosterone, which is one of the markers of PCOS. When the body breaks down the testosterone, one of the by-products that can occur is DHT (Dihydrotestosterone). There are areas on our bodies that are particularly sensitive to the signals from DHT which are the face, neck, chest and back. The message is “make more oil!”.

We do need some oil on the skin in order to keep it protected and supple, but when it goes on overdrive, it literally backs up in the pore. The oil (sebum) we produce is very sticky so it doesn’t allow the dead skin cells to exfoliate easily so it becomes like have a tight lid on a pressure cooker.

The naturally occurring bacteria on the skin, along with dead skin cells and the oil end up creating a pretty nasty “stew” resulting in reddened, painful and pustular acne. If this material cannot get out of the skin, it can break the pore wall underneath the skin causing more acne (you might notice a little “family” of breakouts that always groups together). Most people, (men get it too for the same reason), focus only on trying to treat the skin externally — but the goal is to get the body back in balance.

Some basic strategies are as follows:

1. Try to eat organic and hormone free as much as possible, especially when it comes to dairy products. The hormones that the cows receive to keep them lactating as long as possible go right into the milk and it’s by-products (cheese, ice-cream etc.) which go right into you — creating a further hormonal imbalance.

2. Stress is a huge trigger for increasing DHT — it is critical to create your own menu of"stress-busters" that can be used throughout the day and work for you! A simple one is to just stop for one to two minutes and do deep breathing. This short-circuits the stress hormone release response.

3. Acne in all forms is primarily an inflammatory disease. Fish oils, which are also beneficial for neurotransmitter balance, do double duty since they help tremendously with inflammation.

4. Eat inflammation quenching foods, rich in antioxidants — fruits and vegetables. Remember when fried foods were believed to cause acne? They may not do it directly, but indirectly they are highly inflammatory.

5. Getting hormones especially your estrogen to testosterone ratio back in balance is the key to getting to the source of the problem. Work closely with your In-Cyst trained expert toward this goal.

Next blog I’ll share information on strategies for dealing with the skin from the outside in.

Carmina McGee, MS, RD, LE
Registered Dietitian/ Licensed Esthetician
805.816-1629 / Ventura, California
www.CarminaMcGee.com
Carmina@CarminaMcGee.com

Hello UK friends!

Thanks to Twitter, I learned that your PCOS management is being directly affected by the medication shortage being experienced by the UK.

It must be stressful to feel like something you feel is essential is just beyond the grasp of your fingers. I'm very sorry to hear about this and I hope the situation resolves quickly.

My first thought on hearing about this dilemma was wondering what this kind of situation does to a woman's psyche--being told she has a certain diagnosis, that she needs to take medications for that diagnosis, and then being told she cannot get those medications. Likely dredges up the same kind of feelings you had if you've ever, on your PCOS journey, been told you're infertile. And…if you're not careful, some self-destructive ways to deal with the anxiety and frustration these kinds of situations have the potential to generate.

I hope, in those of you affected who are reading this, that you don't allow this situation to control you. In times like this, there can be a temptation to engage in behaviors (such as binge eating), to manage the stress. To feel like there is nothing you can do, so why bother? And those are exactly the times when you cannot let those feelings get the best of you.

This may actually be a time of opportunity for you, if you choose to frame the situation in that way! It can be your chance to revisit lifestyle changes and try some new things. Maybe tighten up the eating a bit, become more committed to regular activity. Focus on as many good things as you can do for yourself as possible. The name inCYST is a very intentional choice, as it encourages a more active involvement in your own well being. There is much more you can control than you can sometimes be told!

Of course, this blog is one resource. I also recommend www.pcoschallenge.com for emotional support and accountability.

Flutamide is not approved in the US because of toxicity concerns(for those of you unfamiliar with it, it is an androgen binder), so natural options for balancing androgens is something we're always looking to write about. Because it's never been a treatment option here, everything we write about on this blog is from the perspective of helping the woman who doesn't have access to that medication. So take some time and browse.

Lifestyle change is not the be-all-end-all solution. But it is an essential foundation. Take a few minutes and browse our archives. Find a new food to try. A reason to put the running shoes on. A coping technique that averts stress eating (if you haven't read Dr. HOUSE's post on how to avoid binge eating, now's the time!).

Even though this blog is primarily devoted to the kind of infertility found in women, it's important to not forget the men. And…to remember that even if you are a male and aren't interested in having children, the same factors that can cause infertility in men who want to have children can be attributed to low testosterone and its associated symptoms: less strength and endurance when working out, fatigue, low sex drive, feeling sad or grumpy, memory issues, trouble concentrating, and trouble enjoying activities you used to find pleasurable. Reversing andropause is, essentially, restoring your fertility.

And, not surprisingly, all of the factors that exacerbate PCOS, are the same ones that exacerbate male infertility and low testosterone. Everything you read in this blog has pertinence to men as well as women.

The top issues I have seen affect testosterone include:

1. Being a night owl. Not sleeping well interferes with insulin function and can cause weight gain.
2. Not enough exercise.
3. Not managing stress. By this I mean ignoring it or leaning too heavily on things like exercise to manage it. With regards to exercise, it's important to find that place of balance, rather than swing between extremes of too much and too little.
4. Eating too much of the pro-inflammatory fats: safflower, sunflower, soybean, corn, cottonseed
5. Drinking too much alcohol, which interferes with sleep patterns.

Because obesity, overexercising and focus on being"buff", stress, and poor sleep habits are common issues in our culture, men are rendered susceptible to more problems with testosterone levels. And to service this population, clinics offering testosterone replacement are becoming more common. While this is certainly an option, I am struck when reading many of the advertisements for these clinics how they tend to play on mens' insecurities in order to motivate them to come in for treatment. This type of treatment is commonly not reimbursed by insurance. You can see where I'm going here.

"Natural" or bioidentical hormone replacement is truly a buyer beware choice. These therapies are not currently FDA approved, which means adverse effects are not even being reported. That means, no one really knows what the long term consequences of such treatments are. Clinics making money off of this issue certainly aren't going to report problems with their product if they're not required to!

It is worth your time to work with a skilled inCYST practitioner to evaluate your diet, sleep, and stress patterns to see if a few tweaks can pull you back into balance, before taking the next, bigger step.

I'm pasting a link to a nice story done by the Today Show yesterday about male menopause to provide some more information.

Important Lab Tests for PCOS
Many women who have PCOS have not had the correct blood work done or don't know what blood tests to ask to have done.I would like to post some important labs used to diagnose and monitor PCOS
1. Total testosterone (elevated levels are > 50ng/dl
2. Free testosterone
3. Luteinizing Hormone (LH) (plays a role in ovulation and egg development)
4. Follicle Stimulating Hormone (FSH) (responsible for egg release from the ovaries)
5. LH/FSH ratio (results should be under 2)
6. DHEA-sulfate (this test tells how much androgens or"male hormones" your body is producing) DHEA sulfate converts into testosterone.
7. Prolactin
8. Thyroid Stimulating Hormone (TSH) this test will help to rule out hypo or hyperthyroidism (slow vs fast metabolism issues)
9. Liver Function tests (LFT's). Important since medications pass through the liver, to check for possible damages. Checking every 3-6 months is recommended.
10. Fasting Lipid Profile: Total Cholesterol (<>45 mg/dl is ideal)Low Density Lipoproteins (LDL) (<130 mg/dl is ideal)Triglycerides (fat in blood) (<150 mg/dl is ideal)
11. Fasting Insulin (results should be <10) difficult to do, it needs to be frozen when brought to the lab and tested before it reaches a certain temperature, expensive but would be very beneficial in determining and monitoring insulin resistance.
12. Fasting blood chemistry panel (includes glucose, electolytes and sometimes renal labs)
13. Fasting glucose to insulin ratio (used to diagnose and monitor insulin resistance, ratio under 4.5 usually indicated insulin resistance)

Ellen Reiss Goldfarb, RD
11500 W. Olympic Blvd, Suite 400
Los Angeles, CA
310-408-1770
info@ellenreissgoldfarb.com