What causes estrogen dominance, infertility and andropause or male menopause?

Our endocrine system has several glands, enzymes, hormones that work together in a complex system of negative feedback loops. Pregnenolone is the precursor to many of our hormone pathways.  It requires cholesterol and an enormous amount of cellular energy (ATP) to form. There is a limited amount of pregnenolone in the body and that’s if we ensure adequate intake of healthy fats and cholesterol.

Why is it important to know about pregnenlone?  Chronic stress high jacks all of our other hormones by stealing from this precious and limited resource in order to feed the cortisol pathway.  High cortisol can lead to and vice versa creating a vicious cycle which is why maintaining blood sugar levels is so crucial for stress management.

How does it work in men?

When insulin levels rise an enzyme called aromatase up regulates.  This enzyme is converts testoterone (T) to estrogen (E) so in excess can lead to estrogen dominance.  In a case like this where T is low and hormone replacement is used then the problem will be exacerbated. Simply replacing low hormone levels with pharmaceuticals also disrupts the feedback system and receptor sensitivity.  This leads to a higher need over time and the body will produce less and less.

More on Blood Sugar
In andropause (or ‘manopause’) T can be normal and its the E’s that our out of range again throwing off the equilibrium and creating estrogen dominance..  Clinically I’ve seen patients stabilize blood sugar, change their diet and use acupuncture to effectively bring levels into a normal range within a few months.  For women high insulin up regulates an enzyme called 17, 20 lyase increasing T and leading to polycystic ovarian syndrome which is the number one cause of infertility.  As E rises it suppresses the follicle stimulating hormone (FSH) from the pituitary gland.

More on Stress
The pituitary gland is the control tower of the HPA axis which stands for hypothalumus, pituitary, adrenal axis.  The term adrenal fatigue is more accurately called a dysregulation in the HPA axis. Adrenal symptoms are not always related cortisol levels or rhythms.  It can be resistance at the cellular level or dysfunction anywhere along the axis.   This is why we do comprehensive lab work and look at the detox pathways of each individual.

I won’t go into the physiology much more because I want to offer solutions and steps you can take on your own.  Just before I do this let me highlight that inflammation from any chronic condition, allergy or stress can suppress the hypothalamus and pituitary function.  Inflammatory cytokines cause hormone resistance.  For example gut dysbiosis increases beta glucosidase causing hormones to re-circulate in the liver. This inhibits proper functioning of the active hormones.

Diet, Exercise and Sleep
A growing number of people are becoming highly sensitive to foods and supplements which indicates a number of things one of which is impaired ability for the liver to detoxify.  Reducing inflammation helps to open these detox pathways. Ensuring you have enough omega 3’s in the diet also is effective and also helps with blood sugar stability.  Removing foods that are common allergens can help you regain a new level of health.  These include gluten, dairy and soy.

Eat real food and limit flour and sugar. High-quality protein can be eaten in small amounts at every meal and plant foods like vegetables and fruit ought to make up the bulk of your diet. Healthy fats need to be eaten at each meal as well.  Fats are an excellent source of energy and give you a slower burn than carbohydrates. People aren’t reactive to fats and they help with nutrient absorption.  If you are removing grains be careful as a very low carb diet is not recommended for hormone health especially where adrenal or thyroid function is impacted.  As far as detoxification we excrete excess hormones through bowels so taking steps to optimize gut flora and motility is important.  Resistant starch from twice cooked potatoes or plantain for example are incredible for the large intestine.

Nutrient-dense foods like liver, eggs, fatty fish, leafy greens, and full-fat dairy products provide vitamins and minerals that support metabolic function, detoxification and ovarian health.

A woman with PCOS symptoms could have normally functioning ovaries with no cysts and no insulin resistance, yet still fit the symptomatic profile of the syndrome simply due to gut dybiosis (2) or excess androgens from the adrenals (1). I’m using PCOS to illustrate how hormone imbalance can erupt from all angles.

Balancing the right amount of activity and exercise is key.  There are a rising number of active women who are eating low-fat and low carb or vegetarian diets with PCOS. (3,4,5).  Maintaining a health weight means a body fat index between 16 and 30%.  Not enough food during the day can trigger the stress response.  If you have trouble sleeping at night or are losing your menstrual cycle this could be what’s happening (6, 7).  Increasing the amount of darkness in your life can boost your mood and your hormones (8).

There are numerous studies on PMS and stress affecting young people and leading to infertility (9,10)  This is an area where acupuncture shines and the research agrees (11,12). I often will see a patient once a week for one full cycle and see remarkable changes that are lasting.

1. http://emedicine.medscape.com/article/273153-overview
2. http://www.ncbi.nlm.nih.gov/pubmed/22543078
3. http://www.ncbi.nlm.nih.gov/pubmed/23954993
4. http://www.ncbi.nlm.nih.gov/pubmed/22741211
5. http://www.ncbi.nlm.nih.gov/pubmed/12882481
6. http://www.ncbi.nlm.nih.gov/pubmed/23954993
7. http://www.ncbi.nlm.nih.gov/pubmed/25458772
8. http://www.ncbi.nlm.nih.gov/pubmed/17601857
9. http://emedicine.medscape.com/article/273153-overview HPA axis
10. http://www.ncbi.nlm.nih.gov/pubmed/18488870
11. http://www.ncbi.nlm.nih.gov/pubmed/23522721
12. http://www.ncbi.nlm.nih.gov/pubmed/21833961