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Sex Hormones and Thyroid Health: An Interview with Dr. Deb Matthew

On Friday July 2nd I interviewed Dr. Deb Matthew, as we chatted about sex hormones, and below is the written transcript. If you would prefer to watch the interview you can access it by clicking here [1]:

Here is the transcript:

Dr. Eric:

Well, hello everyone. Happy Friday!  I hope everyone is doing great today. With me, I have Dr. Deb Matthew. She just practices right down the road from me, so a lot of times we have practitioners from all over the world, all over the United States, so it’s nice every now and then to speak with someone who’s not too far away. Dr. Deb is known as the happy hormones doctor, and she’s a bestselling author, international speaker, educator, wife, and mom of four boys. After suffering for years with fatigue and irritability, her quest to resolve her personal health led her to change everything about her practice of medicine. And that’s the case with a lot of medical doctors, right?

Dr. Deb:

Yeah, of course.

Dr. Eric:

Yeah, practicing conventional and then something happens and then they open up to functional medicine. And so you’ve been featured on national podcasts, radio broadcast shows including NBC, ABC, CBS, and Fox, and thank you so much for joining us, Dr. Deb.

Dr. Deb:

Well, it’s great to be here.

Dr. Eric:

So we’re going to talk about sex hormones and thyroid health, talk also a little bit about adrenals … or maybe a lot about adrenals. It depends on you, how much you want to talk about adrenals. So the main sex hormones, testosterone, estrogen, progesterone … of course, there are different types of estrogens. Why don’t we start with testosterone, because first of all, I read your recent book, which focused on testosterone. But testosterone, just like all the sex hormones … When we think of testosterone, a lot of people just think men, but, of course, testosterone plays a big role in both men and women. And the same thing with progesterone and estrogen. Bpth men and women have all these hormones. But again, we’ll start with testosterone. As far as testosterone deficiency, what are some of the common symptoms of a testosterone deficiency?

Dr. Deb:

Well, testosterone is really important for muscles. It’s important for strength, stamina, and endurance. It’s important for muscle tone. It’s also really important to keep our bones strong, but you wouldn’t feel it if your bones are not strong. Testosterone is also really, really important for sexual health, so interest, caring about sex. It’s important for erectile function. For women, it’s important for vaginal lubrication. But what a lot of people don’t realize is testosterone is really important for how we feel on the inside. It’s important for how we relate to the world around us, how we react to other people. It’s kind of like our emotional shield or our inner strength, so it gives us competitive drive, motivation, confidence, assertiveness, self esteem, decisiveness.

When testosterone levels go down … and they can go down for men and for women … we just kind of tend to feel a little flat, kind of blah. For the most part, we put one foot in front of the other, we make our way through the day, if something has to happen today, we’ll make it happen. But if it doesn’t have to happen, a lot of times we kind of leave it by the wayside because we’re just not really feeling it, so we’re more prone to kind of procrastinating or having to kind of force things because we don’t feel like it, and it’s just not normal to feel that way. And because this is not something where people are thinking, “Gee, maybe it’s my testosterone,” usually what happens is if it gets bad enough, people will go to their doctor and they’ll say, “I have no motivation. I don’t feel like myself. I don’t really feel like doing the things I used to enjoy doing.”

What ends up happening is, the doctor whips out their prescription pad and the next thing you know, you got some kind of an antidepressant. The problem is, if the real underlying cause of why you’re not feeling great is low testosterone, then an antidepressant is really not going to do the trick. So it’s important that people know so that they can get the right diagnosis and then get the right treatment.

Dr. Eric:

All right. Thank you for mentioning that. So when it comes to diagnosing, what do you look at? I assume total testosterone, free testosterone, maybe sex hormone binding globulin?

Dr. Deb:

Yeah, exactly. We look at free and total testosterone. The total testosterone is obviously the total amount you’re making. The free testosterone is the tiny little fraction that is available to your cells to actually do the job. And there’s a whole bunch of things that can make it so that even if you were able to make enough testosterone, there’s not enough of that free fraction to feel. And one really important thing to mention for women is the use of birth control pills. Because when women are on birth control pills or on synthetic hormone replacement pills or really any kind of estrogen replacement pills, the body makes more of what’s called SHBG, sex hormone binding globulin, and this is a protein in our bloodstream that can grab hold of testosterone and inactivate it. So there’s less of that active free testosterone, and then you feel all those symptoms of low testosterone. And while we’re talking to people who may have hyperthyroidism, one of the things that can happen in hyperthyroidism is your body can make too much of the sex hormone binding globulin too, and so that can kind of make your testosterone levels or the free testosterone level go down so that you feel a little bit like you’re low testosterone, even if your body happens to be making enough testosterone.

Dr. Eric:

All right. That is very interesting. So they kind of go hand in hand where you see the high sex hormone binding globulin, SHBG, and then also the free testosterone. Are there times when you don’t see that pattern?

Dr. Deb:

Yeah. So very commonly, total testosterone, all the testosterone, kind of of goes down, and there’s a few scenarios for that. So for men, testosterone levels naturally decline with age, and it’s very gradual. So when women have hormone changes, it’s usually all up in our face. We get menstrual changes and we get hot flashes. Whereas for men, it’s very gradual. But it’s very common for men over the age of 40 for their testosterone levels to decline, and then they just don’t feel like they should. They lose that drive and energy. For women, testosterone levels commonly decline when we’re in the decade of our 40s, and then by the time we go through menopause, it’s very typical for testosterone levels to be low.

Another reason besides just age for testosterone levels to become low is adrenal stress. We talked a little bit about maybe mentioning adrenals, but when we are under a lot of stress, that affects cortisol, which is our main stress hormone that’s, of course, made in our adrenal glands. And cortisol and testosterone are kind of like opposites. When our body is under a lot of stress, it tries to put all the resources into making enough cortisol to help you cope with that stress. But another hormone that your adrenal glands are supposed to make is called DHEA, and when you’re under a lot of stress, often what happens is all the resources go to cortisol and then you don’t make as much DHEA anymore. The problem is, DHEA is the ingredient that our body can use to make more testosterone, and so that’s why stress can make testosterone levels lower.

So if you’re a man over 40 or a woman over 40, then your testosterone levels may be lower naturally. And maybe if you’re a younger woman on birth control pills, that’s interfering with testosterone. And then if we add the stress of top of all of that, that’s just enough to kind of push you over the edge, so you just really don’t feel good.

Dr. Eric:

So with men, the older you get, the lower the sex hormones get, but it could also be stress. But if it’s, let’s say, a 20-year-old male or a male in their 20s or 30s with a lower libido, if they have low testosterone, it’s probably not due to age.

Dr. Deb:

Exactly.

Dr. Eric:

You’re saying it’s a good chance it’s stress related, because obviously, they’re not going to be on birth control if it’s a male, so probably stress is the factor?

Dr. Deb:

Yeah. I think that’s a really, really important point, is it’s actually not as unusual as you might think for us to find young men with low testosterone these days. But it’s really important, in my opinion … we want to be asking why. So if some guy who’s 25 or 35 doesn’t feel good, lost libido, et cetera, they get their testosterone level tested and it’s kind of low, instead of just knee-jerk writing a prescription for testosterone replacement, we should be asking the question, “What is going on here?”

So maybe it’s stress, and there’s a way that we can sort of tell, because cortisol impacts our pituitary gland in the brain, and the pituitary gland makes a hormone called luteinizing hormone, or LH, which is something we can measure on a blood test. So when you’re under a lot of stress, that pituitary gland sometimes gets shut down a bit so that you don’t make enough LH, and so your body is just not getting the message to make testosterone. It’s not that it can’t, just the stress is turning the message off. And so in that case, if we deal with the stress, we can make things better.

On the other hand, if that LH, that hormone is high, that means your brain is already yelling, trying to get more testosterone made, which implies that the problem is in the testes, which is where testosterone is made for men, which means it’s a different kind of a medical problem that needs to be sorted out. So especially for young men, it’s really important to have that LH test done so that we can figure out, is it a brain problem or a testicular problem?

But one of the most common reasons that we see is the impact of environmental toxins. Because we live in this crazy world. We are all exposed to so many chemicals every day. They’re in pesticides in our food, they’re in plastics, they’re in our personal care products, the air we breathe. It’s just everywhere. And a lot of these chemicals are hormone disruptors. They mess up how our hormones work. And for men, they can suppress testosterone, they can make men create too much estrogen. It impairs fertility for men. It causes all kinds of problems that makes men not feel good. And so sometimes, looking at toxins in the environment, cleaning up your environment, doing things to help flush these toxins out of your system can actually go a long way towards restoring testosterone.

I think it’s important to note that a lot of times, men have all these things going on at the same time. So we might have a guy who’s 50 years old and he’s under a lot of stress and he’s had a lifetime exposure to all these toxins, maybe drinking too much alcohol, because alcohol is just toxic to the testes and not good for testosterone production. So it’s sort of the culmination of all of these things, and so we always want to be looking at somebody in a holistic way. So what I see happen in modern medicine … which I think is actually a good thing … is more and more doctors are aware of the importance of testosterone in men. They’re not doing such a good job for testosterone in women, unfortunately. But they’re more and more aware of how important testosterone is in men and they’re much more likely now than ever before to actually be willing to measure a testosterone level.

So it’s not that hard to get your doctor to measure a testosterone level. The problem is, they’ve only got one tool in their toolbox, which is testosterone replacement. And listen, sometimes that really helps and that’s really important. But if we’re not at least trying to understand why the testosterone is low, we don’t really get the best results. And if anybody is going to be on any kind of hormone replacement therapy, we want to be putting the hormone in a healthy body, so we want the healthiest version of you, whether you’re going to be on the testosterone replacement or not.

Dr. Eric:

Yeah. I’m glad you said that, because you are a medical doctor who does recommend at times bioidentical hormones, but what you’re saying here is that you want to address the cause of the problem even if someone does need to take testosterone replacement. That’s something I also tell patients as well, is that you want to improve adrenal health and correct other imbalances, and if someone still needs to be on testosterone or if a woman needs to be on estrogen, progesterone, then I completely understand. But you’re right, a lot of practitioners will just put people on the hormones without addressing the underlying imbalances.

Dr. Deb:

I learned this the hard way, because … I was a regular doctor and I didn’t know about any of this stuff. But I went through my own challenge. My personal story has to do with thyroid and adrenal problems, and my quest to figure out how to help myself is what had me change. Because there was nothing in my medical training to help me understand why I was so irritable and tired all the time and why my thyroid replacement medicine wasn’t making me feel better. And once I discovered there’s all these other things going on that affect our hormones and how we feel, I learned about hormone replacement therapy, about bioidentical hormone replacement.

But when I first started in my practice, that’s kind of all that I was doing, was I would measure hormones and then I would prescribe bioidentical hormones. And in the first few months of my practice, I recognized right away that some people felt a lot better right away, but there were some people that we just weren’t fixing the problem. We would try to adjust their dose, but we never could really get it right. That’s when I really realized we got to address adrenals and toxins and gut health and stress and lifestyle habits and nutrition. All of these things are so, so important in how our hormones work, and a prescription, even if it’s a more natural prescription, can never really be the whole solution all the time.

Dr. Eric:

Yeah. I of course agree with everything you said. Also, you mentioned endocrine disruptors. Of course, it’s not just with men, it’s with both men and women. Some examples like bisphenol A and phthalates, I mean, they’re widespread. And then, of course, people will say, “Well, I drink out of BPA-free bottles,” but then there are other chemicals in the BPA-free bottles.

Dr. Deb:

It can feel kind of overwhelming. How I talk to people about it … Because we could talk about all the chemicals. There’s even tests where we can measure different chemicals in people’s bodies. But the problem is, we’ve all got all kinds of chemicals in our body. Those test results are just really kind of depressing, and then it’s really hard to know, well, which of these chemicals is causing the problems? And it’s very hard to pinpoint all of that. But there are some really simple things that we can do in order to try to minimize exposure to toxins, and so I really try to help people focus on the simple things that we can be doing, like don’t microwave in plastic and buy skincare products that specifically say paraben free. Like you said, try not to use the plastic, because even if it’s BPA free, we don’t really know what’s in it.

So there are some fairly simple things that we can all do that are not really more expensive that really could go a long way. And focusing on the simple things, I think, is really important, instead of feeling overwhelmed and hopeless at escaping all of the toxins, because they really are pretty much everywhere these days, unfortunately.

Dr. Eric:

Yeah, exactly. Whatever you do, you’re not going to completely avoid them, but try to minimize your exposure and then maybe do things to improve detoxification. I mean, we’re always detoxifying, but just eating plenty of vegetables and sauna, things like sweating will help with the elimination of toxins. All right, well, so besides testosterone, there’s also, of course, estrogen and progesterone. And again, they do play a role in both men and women, but when we think about estrogen and progesterone, we do tend to think more about women. But I guess if you could talk more about that, and even maybe a little bit about estrogen dominance. I did have someone else a few months ago speak about that, but maybe talk a little bit about that.

Dr. Deb:

Yeah. Estrogen and progesterone are really important hormones for women. And if I could just say for two seconds about men and testosterone … Men can sometimes end up with too much testosterone because of inflammation, because of being overweight, because of toxins in the environment, and that doesn’t feel good for men. So we don’t want too much estrogen and we don’t want not enough testosterone. For women, when women are premenopausal, but especially in the perimenopausal time of our life which is sort of roughly age 35 until about 50, sometimes estrogen levels can really fluctuate a lot up and down. But progesterone levels tend to go downhill over this time, so what often happens is estrogen is still okay, but progesterone is too low.

So that’s what we call estrogen dominance, like you mentioned. And when women are estrogen dominant, we tend to start to have problems with menstrual cycles, so heavier periods, periods coming more often, lots of PMS symptoms, things like fibroids growing. And so a lot of women end up with a hysterectomy because that’s what their doctors have to offer, is birth control pills to make their periods better or a hysterectomy. But if we can replace natural progesterone in order to bring back balance, we can make periods lighter and more regular and minimize the growth of fibroids. But in addition to menstrual kind of things, progesterone is very calming. So it helps us to be relaxed and chilled out. It helps us to sleep soundly. So when our progesterone levels tend to drop, a lot of women notice anxiety, panic attacks, irritability. We sometimes feel just negative, impatient, critical, easily annoyed, not the best version of ourselves.

I lived this, and I can speak to this, but I hear it from my patients all the time. We’re shrieking at our kids and the poor kids didn’t really hardly do anything at all, but we can’t help it. Or one minute, we’re looking at our husband thinking, “What a great guy,” and then the next minute, we just want to stab him in the back because he’s so darn aggravating. We can’t help these crazy moods that we’re feeling and we don’t understand what the heck is going on with us, or the men in our lives don’t know what the heck to do with us. And once again, if you go to your doctor to complain, anxiety pills, sleeping pill. Progesterone helps us sleep soundly through the night so we wake up feeling refreshed in the morning, so we tend to wake up and have night sweats and things like that when progesterone goes down.

So after we go through all of that hot mess, then eventually we hit menopause. That’s when estrogen drops too, and estrogen is energizing, it’s a natural antidepressant, it’s good for our brain and our memory. And so when estrogen drops, sleep can get worse, we can feel just more tired and worn out, we can feel more moody, depressed, flat, irritable, and one of the most common things I hear women complain about is just our brain doesn’t work. There are just not enough sticky notes to keep track of everything because we keep forgetting stuff. We can’t get that word out that we want to say. We can’t remember why we walked in the room, where we left the car keys. Our brain is just not doing what it needs to do, and it’s scary. If you’re 16 and you forget something, you just laugh about it. But when you’re in your 50s or your 60s or your 70s, if your brain isn’t remembering things as well as it used to, you can’t help but worry that it’s the early signs of Alzheimer’s. That’s just where we all go. That’s what we think.

And most of the time it’s really not. It’s just that estrogen is what’s keeping those rich connections between your brain cells so that your brain can do its job and women can really notice a difference when that goes down. Another thing that often happens when estrogen goes down is vaginal dryness. Things can get dry and painful, and often, testosterone is going down at the same time so first we lose interest in sex, but then it hurts, so then who’s going to want to participate if it’s just uncomfortable? And when women are having a negative experience with sex, that impacts relationships, it impacts intimacy, it causes marital problems. So it really is kind of a big deal beyond just pleasure, and it’s something that is really very fixable. So it’s really just a shame for women to have to go through those kinds of experiences when there’s things that we can do to make it better.

Dr. Eric:

Yeah. Thank you for that. As you mentioned, when women hit menopause, the estrogen levels drop and all hormones as we age get lower. But again, in a scenario with a younger woman … again, in their 20s or 30s … when they have lower progesterone, is that once again more usually of an adrenal problem?

Dr. Deb:

You’re right. So when women are over 35 and especially getting into their 40s, so their ovaries are not working as well anymore, so progesterone can go down, and that’s mostly age. But on top of that, like you said, toxins and adrenals and all the rest just make it worse. But for younger women, they can also have estrogen dominance. They can have a lack of progesterone, but it’s not age, so that means we need to figure out what is the root cause. Sometimes it can be from too much stress in their lives. Sometimes it’s from something called PCOS, polycystic ovarian syndrome. And in this particular condition, there’s too much testosterone and problems with blood sugar metabolism, and so women aren’t ovulating regularly, and if you don’t ovulate, then you don’t make progesterone and you end up with this estrogen dominance and you gain weight and you struggle with things like acne and hair growth. It is super common. 1 in 10 women has PCOS. The vast majority are never diagnosed, and it’s an important thing for women to know about themselves so that they can get the proper help.

But there are other things as well that can interfere with ovulation and with progesterone. Another really common one that I see is a gluten sensitivity. So sometimes it’s super common for women who have hormone issues to also have digestive issues. They have IBS or just chronic digestive symptoms, and very commonly we find hidden food sensitivities, especially gluten, which is the protein in wheat. That’s the most common one. But there’s lots of other ones, and if we can get them to really clean up their diet, remove the foods that they’re sensitive to, often menstrual cycles get better, they ovulate again, the progesterone levels just are restored naturally, and that’s all that it took was just some lifestyle changes and eliminating a couple of foods that were causing big problems.

Dr. Eric:

So is it fair to say it’s not maybe just the gluten, but just anything that might cause gut inflammation in general?

Dr. Deb:

Anything that causes gut inflammation in general, and gluten just happens to be a really common cause of it.

Dr. Eric:

All right. And you mentioned PCOS. So PCOS is more of a blood sugar problem, more like an insulin-resistant problem than a hormone problem? Is that correct?

Dr. Deb:

Well, it’s two things. It’s the blood sugar problem and it’s a testosterone problem. When women have insulin resistance, one of the things that happens is the ovaries get triggered to make more testosterone and the extra testosterone causes the body to make more insulin, and so you get this kind of feed-forward cycle. Then the testosterone and the insulin interfere with ovulation, so it causes low progesterone, because if you don’t ovulate, you don’t make progesterone. So what may have started as a blood sugar issue ends up causing the hormone issues. And unfortunately, it’s how it’s generally treated … because a lot of times, women won’t have regular periods. They either have bleeding, long heavy periods that go on and on, or they don’t have any periods at all, or they get something in between.

So usually, how it’s treated is just by giving women birth control pills in order to try to regulate their period. And while often birth control pills can regulate the period, it’s kind of just artificially doing it. It’s not really fixing the underlying problem, it’s not addressing the blood sugar problem, and so then sadly, eventually women come off the birth control pills wanting to start a family, only to find out that they have fertility problems because that’s another part of PCOS. So we’re going off on a whole different ballpark here, but PCOS is a really common problem and most women who have it don’t even know that they do.

Dr. Eric:

Okay, yeah. We are straying a little bit, but covering a wide variety of different topics here. So let’s go back to testing. With testosterone, you mentioned free testosterone, total testosterone, sex hormone binding globulin, FSH, LH. So how about when it comes to estrogen and progesterone?

Dr. Deb:

Yeah. For estrogen and progesterone … and for the testosterone too … there’s different ways we can measure. We can do a regular blood test. For testosterone, I actually am perfectly fine with doing a regular blood test. For estrogen and progesterone, we have other ways besides that, in addition. So we have saliva testing, we also have urine testing, and we can get more information from these other tests than we can with just a blood test. The one that’s kind of becoming one of the most popular ones is called a DUTCH test, which stands for Dried Urine Test of Comprehensive Hormones. A DUTCH test can tell us how much estrogen you’re making. It tells us three different kinds of estrogen, and it tells us how you are metabolizing the estrogen. So you have to flush the estrogen out of your system in order to make way for tomorrow’s estrogen, and those estrogen byproducts are important, because some of them are breast protective and some of them could contribute to breast cancer. So we’ll know how your body is processing your estrogen, and if it’s the good way or the bad way.

For testosterone, we can also get how your body is metabolizing the testosterone, we can get more information. So a DUTCH test is something that’s really popular. It’s really important, no matter whether it’s going to be blood, saliva, or urine … it’s really important for premenopausal women, when they have their hormone testing done. So if you go into your gynecologist’s office to ask for your hormone levels to be done, usually you get one of three responses. One is just, “No, we don’t do that.” Another one is sometimes, “You’re too young to have hormone problems.” Or the third thing is, they’ll sometimes do an FSH, which kind of tells us if your ovaries are getting close to menopause or not, but oftentimes they don’t actually measure your estrogen, progesterone, and testosterone levels. They are certainly not going to offer you a DUTCH test. It is not covered by health insurance, but it’s just not something that the regular mainstream doctors even know about yet, and they don’t also typically do saliva testing.

But it’s really important when you get your tests done. So if you happen to have your gynecology appointment at 3:00 on some random Thursday, then part of why they don’t really want to measure your hormones is because it depends if you’re on your period, all those hormones are going to be low. If you ovulate, your estrogen’s going to be really high. The week before your period, estrogen and progesterone are going to be higher than the other times of the cycle, so it changes depending on where you are in your cycle. The best time for us to do the test is about a week before your next period is due, so about day 19, 20, or 21 of a 28-day menstrual cycle is the best time to have these tests done. And if you’re menopausal and you’re past menopause and not having any more periods, well, then it doesn’t matter. You can do it anytime.

Dr. Eric:

And it’s also important to mention that with the DUTCH test, for those who are cycling, they do have a cycle mapping test you could do … They have the DUTCH complete, but then the cycle mapping test, you’re collecting samples … I think it’s every few days of your cycle. I don’t think it’s every single day, right?

Dr. Deb:

Correct. And that’s great because then we can see when you ovulate and we can watch this whole dance that the hormones do, because through the cycle, our hormones are going up and down and that natural rhythm is really, really important.

Dr. Eric:

Yep. And some companies that do saliva testing also offer a cycling hormone panel as well.

Dr. Deb:

Yeah. They’ll also do that

Dr. Eric:

But thank you for that advice for those who are doing blood testing, because that’s the norm. Most people still will test the sex hormones in the blood and, as you said, timing is important. All right, so again, we covered testing, did we cover symptoms of … I guess some of the symptoms of testosterone. So estrogen, when someone’s low in estrogen, I think you mentioned the hot flashes, the night sweats.

Dr. Deb:

Yeah, vaginal dryness, dry skin, memory problems. Yep.

Dr. Eric:

Yep. And then progesterone, you mentioned sometimes they’ll be more anxious.

Dr. Deb:

Yeah, anxiety.

Dr. Eric:

Which is not … well, I was going to say it’s funny. It’s definitely not funny, but it’s coincidental with hyperthyroidism, Graves’ Disease, we see a lot of people with anxiety and problems with sleep. And the elevated thyroid hormone level definitely could be a factor with that, but also there could be other variables, such as low progesterone, so that’s also something to keep in mind. You were talking earlier about, essentially, the cortisol steal or pregnenolone steal where the body prioritizes cortisol at the expense of DHEA. But really, it’s sacrificing all the sex hormones, because DHEA is a precursor to testosterone, which is a precursor to estrogen, and progesterone is in the same pathway as cortisol. But essentially, it’s all about cortisol when you’re stressed out, so that in your practice, I imagine focusing on improving adrenal health is very important. So what are some of the things, whether it’s diet or stress management or supplements, that you do to help people with their adrenals?

Dr. Deb:

Yeah. The first thing is trying to find healthy balance. So if we can reduce stress, of course, that’s great, simplifying. Sometimes we do it to ourselves, like we were talking earlier. My superpower is over-scheduling myself, so I create my own stress. So if we have ways to reduce the stress in our lives, that’s always a wise idea. Sometimes there are stresses that we can’t get away from though, and so if we have ways of bringing balance, that’s really important. So things like breathing exercises, meditation, yoga, being outside in nature, prayer, laughter. All of these things elicit the relaxation response, which is kind of the opposite of our fight or flight response, and that can be really helpful for calming down adrenal function. So healthy ways of coping with stress can help to protect us from the harmful impacts of that excess cortisol can help right things.

Eating is also really important, so we want all the healthy nutrients that our body needs. And sugar is a toxin, first of all, but it stresses your cortisol. Because one of cortisol’s jobs is to help prevent your blood sugar from crashing too low, and so if you’re eating a lot of sugar, your blood sugar will spike up and then it crashes, and so that’s hard on your adrenals. Alcohol is hard on your adrenals too. Caffeine is hard on your adrenals, it kind of kicks them when they’re down. So in the moment, it makes you feel a little better, but in the long run, it’s not really helping. So cleaning up nutrition and having healthy lifestyle habits, whole foods, lots of fruits and vegetables, all the things that we know to do for a healthy diet, those things are really important.

And getting enough sleep is important too. Sleep is so restorative. For people who have adrenal problems, sometimes sleeping in just a little bit longer can be really kind of magical for making them feel better if that’s possible. But then there are some nutritional supplements that can be helpful too. And we can’t really make personal recommendations on a venue like this, but some of the herbs that can be really helpful are things like ashwagandha, which is something that’s been used for thousands of years all over the world to help people cope with stress. And of course, thousands of years ago, they may have not known all the chemistry inside our cells for how it works, but science has figured it out now and so there’s ashwagandha.

Holy basil is another herb that can be really helpful for people who have high cortisol at night, which is common … Cortisol is supposed to be higher in the morning so you have energy in the day. It’s supposed to be lower at night so that you can sleep. But a lot of people get flipped around backwards, so it’s too low in the morning and it’s too high at night. So phosphatidylserine is a nutrient that can actually help calm cortisol levels at night when it’s too high, and that can help you to go to sleep, fall asleep, stay asleep better so that maybe you wouldn’t need your Ambien or Lunesta or whatever kind of sleeping pill you’ve turned to in order to try to help you cope with sleep.

So there definitely are nutritional supplements that we can do, and if we can measure your cortisol to know what your personal pattern is, then we can kind of know, is it high? Is it low? Is it high one time of the day, low the other time of the day? That way we can target the right kind of treatment.

Dr. Eric:

So for high cortisol, the phosphatidylserine, ashwagandha … which is adaptogenic, and so really can be used even for low cortisol, but commonly also for high cortisol. So for lower cortisol, do you ever recommend things such as licorice root … which you do need to be cautious about because it could also affect blood pressure, so I just want to mention that before either one of us forgets to say that … but do you recommend licorice root or adrenal glandulars or anything else for lower cortisol?

Dr. Deb:

Yeah, I actually use a lot of adrenal glandulars, and that was one of the things that when I was first starting out as … I’d come from being a regular doctor and now I’m trying to do this functional medicine … I was really resistant about using adrenal glandulars because it just … I don’t know, it doesn’t sound very medicine-y, right? It doesn’t sound very science-y. But they work so well for so many people, and so it is one of the things that when I get people started on these, they sometimes feel so much better. And let’s say six months down the line, they’re doing better and I suggest, “Listen, maybe you don’t need these anymore. Why don’t we try to stop them?” A lot of people will tell me, “Oh no, please don’t take those away from me. I can really tell the difference. I really like those.” So this is one of the things that people keep coming back for more because they can really tell the difference. It’s really kind of helping give your adrenal glands what they need in order to do a good job, so I do use a lot of adrenal glandulars.

Dr. Eric:

All right. And then moving on to supplements for the sex hormones. So maca … which also could affect the HPA axis too … but Maca root, and there’s chaste tree, vitex … both are the same… to help with progesterone production, black cohosh. So  do you recommend any of these or other types of herbs?

Dr. Deb:

Yeah. So especially for younger women who aren’t making enough progesterone and they’re having a lot of PMS and menstrual problems, we really like the chaste tree because that can help you to make more progesterone, better progesterone production. Another supplement that we sometimes use to help women boost their testosterone, especially if they’ve got adrenal problems, is DHEA because that’s the other hormone from your adrenal gland that you can use to make testosterone. So typically, we would want to measure your DHEA level first, because if it’s already normal or high, then adding more can just cause side effects. But it can actually help to boost testosterone levels for women. Tribulus is an herb that we can use to help boost testosterone in men and in women. And then, as you mentioned, things like black cohosh can help kind of just calm down hot flashes and things like that.

So there are some women who … and I see lots of these women in my practice … they are eating a clean diet, they’ve minimize sugar, they’re eating their vegetables, they exercise regularly and do yoga and they’re taking their vitamins. They’re doing all the things. And nobody’s perfect, but they’re doing a pretty decent job and yet they still are exhausted, or sex is painful, or the night sweats are just preventing them from sleeping. They just have done all that they can, and those are the women where adding a little bit of bioidentical hormone replacement therapy can really make all the difference. There’s no herb that can really do the same thing as hormones for keeping your bones strong and keeping your brain healthy and your skin looking young. So it’s not that everybody needs bioidentical hormone replacement therapy, but for the women who do, it really, really can make a big difference.

Dr. Eric:

Well, a good comparison is thyroid hormone because I get patients asking me, “Is there an herb that I can take instead of thyroid hormone replacement?” But if you’re truly deficient in thyroid hormone, I mean, herbs such as ashwagandha, yes, it can in some cases stimulate, effect the HPT axis, the hypothalamic pituitary thyroid access, as well as adrenals, but in this case, maybe help with thyroid hormone production. But if someone has an autoimmune condition such as Hashimoto’s which is damaging the thyroid gland and just over time their levels are really deficient, taking ashwagandha probably is not really going to help, unfortunately. In this case, they may need to take thyroid hormone replacement… whether it’s Levothyroxine or desiccated thyroid.

But I agree. There is a time and place. And when it comes to hormones, if you’re truly deficient, of course you want to try to address the cause of the problem, as you said, so you always want to address the cause. But in some cases, hormone replacement is necessary. So of course, thyroid is what a lot of my patients deal with … either hyperthyroidism/Graves’, hypothyroidism/Hashimoto’s, and I know you work with thyroid patients as well. So you briefly mentioned that you had a thyroid problem and that’s kind of how you got into the functional medicine aspect with the thyroid?

Dr. Deb:

Yeah. When I was in medical school … Well, I used to be tired all the time. Napping was my favorite hobby. I needed more sleep than anybody else. I was always cold. I had dry hair. But those symptoms had been going on for so long, I just thought it was me. And when I was in medical school, on two different occasions, doctors would look at my neck and say, “Your thyroid is enlarged. You should go get it checked.” So I went and got it checked. I was told my labs were normal, and so I just accepted that and kept on being tired. I’d been on birth control pills all these years because I never had regular periods, so then I came off birth control pills in order to become pregnant and shockingly enough still didn’t have regular periods. I’m not sure why I would have thought it would be different. And in my infertility workup, I was diagnosed with Hashimoto’s.

I was given Synthroid and it worked. I’ve got four babies, so it worked for the fertility problem, but I didn’t feel any different. I still struggled with my weight, I was constipated, I had no libido, I was tired all the time, but my labs looked normal. And for 10 years, I was on that Synthroid, and it wasn’t until I read a book, actually, by Suzanne Somers, about natural hormones and this whole bioidentical thing and that there were natural ways of treating things. Totally blew my mind. I had no idea. They didn’t teach me any of that stuff in medical school. All I knew was if your TSH is not normal, we can give you a pill if it’s too high, we can give you a pill if it’s too low, but once your TSH is normal, then you’re normal and there’s so much more to the story than that.

So that’s when I got myself in better health. I addressed my adrenals, I addressed my low progesterone. I’d been having panic attacks in the middle of the night for no reason. And it just completely transformed my life. I got myself on desiccated thyroid. They will have to pry that out of my cold, dead hands because I will never go back to Synthroid again. It just does not work for me. But I couldn’t go back to just what I was doing before, which was just writing prescriptions for everybody all day long because that just didn’t make any sense to me anymore. And so I completely retired from my old job and I retrained in functional medicine. And so now for the last almost 15 years, I’ve been treating men and women to help them get their hormones back in balance so that they can actually get well, often get off a lot of their prescription medicines, and love the way they feel.

Dr. Eric:

All right. Have you had any issues with the recalls and everything going on? It seems like every year there’s something going on, whether it’s Nature-Throid or WP Thyroid, which have the same manufacturers, and then a number of years ago, Armour. I don’t know if there’s been anything recent with Armour, but I think even with NP Thyroid there’s been some issues.

Dr. Deb:

Yeah. It’s hard because thyroid hormone is in microgram doses. So most things are … like acetaminophen or Tylenol is like 500 milligrams, but when we’re talking about thyroid, we’re talking in micrograms. They’re tiny, tiny, little amounts and so it’s very difficult to be super perfect when we’re talking about such tiny little amounts. And the way the FDA works is you’re allowed to have 10% more … like if it’s supposed to be whatever the dose is, you’re allowed to be 10% above or 10% below, but you have to be that close. And so if it’s 12% below, then it gets recalled. And so even the regular Levothyroxine and things can have recalls sometimes, but it’s really sort of disheartening.

And one of the things that’s most disheartening about it is a lot of regular doctors don’t believe in desiccated thyroid. The only thing that they’re willing to talk about is Levothyroxine, which is fine for lots of people, but for some people like me, it just doesn’t really do it completely. And they’re so against the desiccated thyroid because they felt like it wasn’t properly regulated, and so when we have these recalls, it just reinforces that belief and so it makes it harder and harder for women to get the kind of medication that would actually really help them.

Dr. Eric:

Yeah. It is unfortunate that more don’t open their mind to desiccated thyroid, even though things are changing, I think. There are more doctors who are getting into functional medicine, so who knows. Hopefully in the upcoming years and decades ahead, more and more practitioners will recommend it.

Dr. Deb:

Hopefully.

Dr. Eric:

Yeah. So adrenal health, obviously, very important for optimal sex hormone health. And would you say then the same with thyroid? You need to have optimal thyroid health in order to have optimal sex hormone health?

Dr. Deb:

Yeah. Thyroid is so critical for so many parts of you, and in order for us to ovulate, we need enough thyroid. So in my case, the reason that I wasn’t having regular periods, the reason that I had fertility problems is because my thyroid was off. So I didn’t need birth control pills to regulate my periods. I needed thyroid to regulate my periods, but nobody was looking in the right place. So all of these different hormones that we’re talking about today, they all interact with each other, they all work together. And so if we’re really going to be looking at somebody hormonally, we need to look at the big picture. We need to look at all these different hormones together so that we can take into account how they all interplay, because what we’re really looking for is balance. Sometimes one hormone can be normal, but kind of high normal, and another hormone could be normal, but it’s kind of low normal, and so we’ve got this imbalance. So even though technically they’re both normal, you won’t feel your best. And so if we can bring it back into balance, symptoms melt away and you just feel so much better.

Dr. Eric:

Yeah. I’ve covered this with some other guests on this platform, but optimal ranges versus lab ranges … So that’s another thing. I mean, we won’t get into too much detail here, but you can’t just rely on the lab reference range.  So if someone has a TSH of, let’s say, 3.5, most labs will say that is fine and most doctors will go by those reference ranges, but unfortunately, that’s not optimal.

Dr. Deb:

That’s not optimal.

Dr. Eric:

Yeah, exactly. All right, well, thank you so much for sharing everything about sex hormones, Dr. Matthew. Where can people find out more about you?

Dr. Deb:

Yeah, well…

Dr. Eric:

And your books as well. I’ve seen your books on Amazon, but …

Dr. Deb:

Yeah. I wrote a book for women. It’s called This Is Not Normal: A Busy Woman’s Guide to Symptoms of Hormone Imbalance, and you can actually get a free copy at isityourhormones.com. So isityourhormones.com, you can download a free copy of the book for women. It’s got lots of quizzes about symptoms of low testosterone or symptoms of adrenal problems so that you can kind of figure out for yourself what sort of things are going on. I have a book for men. It’s called Why Can’t I Keep Up Anymore? A Guide to Regaining Energy Focus and Physical and Sexual Performance for Men Over 40. Both of those books are available on Amazon. There’s more information at my website, which is signaturewellness.org.

Dr. Eric:

All right. Wonderful. Well, thanks again for taking the time, and I’m sure everyone found this to be valuable. Let’s see if there are any questions. I think there are some questions. All right, so let’s see here. Okay. Just a thank you. You are very welcome. All right, then another thank you here. So again, if there are any questions about sex hormones, let us know. I think Victoria asked this. I think I saw this pop up with the adrenal desiccated. There’s a lot of different … well, I won’t say a lot, but there’s different companies that have adrenal desiccated. I know Standard Process has desiccated adrenal, and I think Seeking Health, there’s a few different companies. I don’t know if Dr. Deb has a favorite that she-

Dr. Deb:

Yeah. My favorite, actually, is Dr. Wilson’s. It’s called Adrenal Rebuilder. I use a lot of that.

Dr. Eric:

Okay. All right. Yeah, which is a awesome book as well, the Adrenal Fatigue book. All right, if there are any other questions, let us know. If not … Oh, here we go. All right, so, “My daughter is newly diagnosed with hyperthyroidism and is showing really high cortisol as well as high testosterone. Is that common with hyperthyroidism or is that a different issue maybe?”

Dr. Deb:

Hyperthyroidism doesn’t directly increase testosterone levels. But if she has high cortisol and if her adrenals are overacting, they also may be making a lot of DHEA, which is the one that can be made into testosterone. So the link that we would need to know is what is her DHEA level, and that might help explain why the testosterone level is high.

Dr. Eric:

All right. And I guess it could be something else as well, maybe a different issue. So yeah, as Dr. Deb said, it could be adrenals and looking at DHEA.

Dr. Deb:

Yeah. It could even be PCOS. That’s a common one.

Dr. Eric:

Yeah, that’s what I was thinking with the testosterone, even though that won’t necessarily cause high cortisol, but it can. People can present with PCOS, high cortisol, high testosterone.

Dr. Deb:

And that’s actually really, really common, is to have multiple things going on at the same time, because it’s almost like there’s … You know how you line up all those dominoes in a row and then you tip the first one and it tips the next one and it tips the next one? So once you have, let’s say, hyperthyroidism and you get all this inflammation going on in your system and your whole sympathetic nervous system gets revved up because of all that extra thyroid, that can rev up your adrenal glands, so now they can pump out more adrenal hormones and then the DHEA gets converted into testosterone. So then you may present to the doctor for a symptom over here, but if we really look at the big picture, we realize, “Okay, well, it really started from that one over there. That’s the root cause of the problem and we need to start over there.” So that’s why looking at all these different hormones actually really can help us, instead of if they just only looked at the thyroid, for example, without also looking at cortisol and testosterone, some of the other ones.

Dr. Eric:

Now, when you look at DHEA in the blood, do you look at both total DHEA and the sulfated version? Because on the DUTCH test, they look at both, but I know some practitioners will just test regular DHEA or sometimes it’ll just be DHEAS.

Dr. Deb:

Usually I just do DHEAS because that’s kind of the form that it circulates in the bloodstream. If we just look at DHEA, just kind of plain, that sort of comes and goes and so it’s not as stable in the bloodstream. So that’s why the DHEAS is kind of the standard one that we look at.

Dr. Eric:

Okay. All right. And this is just someone else here saying thank you. Then a followup here. “Pretty sure the DHEA was normal”. Okay, so the total testosterone that was high along with the cortisol with DHEA being normal.

Dr. Deb:

Okay. So probably something a little bit different. I mean, probably not the hyperthyroidism that caused the testosterone to be high. But it still could be something like PCOS, and some people just naturally have higher levels of testosterone. There are other precursor hormones besides just the DHEA, and in a DUTCH test, it looks at some of those other androgen hormones as well. But so we sort of need to know the whole rest of the history and the whole rest of the story to really be able to properly give input here.

Dr. Eric:

Yeah. And that’s an advantage of the DUTCH test, is that it does look at all the hormones and then it also looks at the hormone metabolites as well. But again, you could do…not the hormone metabolites in the blood, but you can get a good picture in the blood. One thing I wanted to ask you is … with PCOS… I know that typically will increase free testosterone. Will you also see the total testosterone and the free testosterone elevated?

Dr. Deb:

Usually. Usually we do. And sometimes the testosterone is normal, but the DHEA is high. So if we don’t measure both of them, then one might look okay. So in this case, the testosterone’s high, the DHEA is normal. Sometimes we see the other way around. But it’s not always both, so that’s why more information, more labs, the more that we can figure things out.

Dr. Eric:

Yep. All right. Makes sense. Are there any other questions? We’ll do last call for questions here. I think everybody’s ready for their July 4th barbecues, especially after last year, with all the craziness last year. There are a lot more people traveling. Let’s see, we did have this pop up… Okay, “See DHEA is on the …” Okay, so I think this is the same person. So DHEA is on the higher end of normal. All right. Well, if we’re done with questions, we’ll go ahead and call it a day and let Dr. Deb get back to whatever you need to do, whether it’s your practice or family, either way. But thank you again for joining us. Yeah, it was a pleasure talking about sex hormones and just again, testosterone, progesterone, and estrogen. We didn’t speak, of course … there’s estrone and estriol. Maybe we’ll do a followup in the future.

Dr. Deb:

That’s right. There’s so much to talk about, right?

Dr. Eric:

Yeah. Do a part two. And definitely check out her books. I did read the one on testosterone, which like she said, you can get both on Amazon. But then what was the website for the other one? You said the other one they could get for free? They can get it on Amazon, but also they could get a free version?

Dr. Deb:

Mm-hmm (affirmative). Yeah, it’s called isityourhormones.com.

Dr. Eric:

All right. That’s a good website. Isityourhormones.com. Okay. That’s the one for women, correct?

Dr. Deb:

That’s the women’s book, yeah.

Dr. Eric:

All right. Well, thank you. Thank you so much for talking about sex hormones and adrenals and, of course, thyroid health. Appreciate you taking the time, and yeah, maybe we’ll do a part two in the future.

Dr. Deb:

That sounds great.

Dr. Eric:

Yeah. And everyone, thanks for tuning in on this holiday… well, getting ready for the holiday weekend, and I hope I catch you next week. I’ll be on next Friday and yeah, everyone again have a wonderful day, a wonderful July 4th, and a wonderful week ahead. And you as well, Dr. Deb.

Dr. Deb:

Thank you so much. You too. Take care.

Dr. Eric:

All right, thanks. Take care, everyone.