Estrogen, Progesterone, Testosterone and Mood

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I'd like to welcome everybody today's presentation on sex hormones and your mood. Last week we talked a lot about the different neurotransmitters, Serotonin, gaba, dopamine, yada, yada. But there are a lot of other things that contribute to the availability of serotonin. Gaba, dopamine, norepinephrine, and those all influence one another. So we're going to talk about that today because again, like I've mentioned, right, repeatedly just throwing an SSRI at depression or throwing a benzodiazepine at anxiety, it may mask the symptoms for a while, but it's not addressing the underlying cause. So we want to figure out, is this person's serotonin system really not working? Or maybe is it their sex hormones, their estrogen, their testosterone, their progesterone? Are those not working really well, or do they have cortisol that's too high, Their HPA axis is, is kind of off the charts and that's suppressing everything else and throwing it out of whack. So it's not necessarily that the serotonin system isn't working. It could be things working against it. Think about it like when you have, you know, 100 pounds of dog food in your car and you get really crappy gas mileage. Well, that's not a problem with the car. The problem is you got 100 pounds of dog food back there. And as soon as you take the dog food out, the car gets better gas mileage. So same sort of thing with neurotransmitters. We don't necessarily know that the dysfunction is in the neurotransmitters in the person's body. It could be something else that is suppressing or enhancing the availability of the neurotransmitters. And once that underlying cause is addressed, then the neurotransmitters will stabilize on their own. We're going to identify the effects of estrogen, progesterone and testosterone levels on mood. We'll explore the effects of cortisol on sex hormones and mood and identify the cause of sex hormone imbalances and some possible interventions. And you'll find that a lot of the things that cause the sex hormones to be out of balance are very similar to things that cause leaky gut and a variety of other issues. So it's not anything that is super. What's the word I'm looking for? Clinical, if you want to use that word to address. Estrogen is linked to mood disruptions that occur only in women. Now, this statement is a little bit misleading because estrogen is linked to mood disorders in men, and we'll get there. However, there are certain disorders that only women have that. That are linked to estrogen. So there's probably a misplaced modifier in there somewhere. Anyway, pms, premenstrual dysphoric disorder, and postpartum depression are linked to mood disruptions, and. Well, we will go with that for right now. The PMS and PMDD for certain are only things that women get. And there is some argument that men do experience postpartum depression. So I don't wanna neg, but estrogen is linked to mood issues, and they find that right during when a woman gets pregnant, when a woman has a baby, and when a woman stops breastfeeding, and when we go into perimenopause and menopause and post menopause, all six of those times, there are huge hormone changes. And those are the times that women are more likely to. To develop mood symptoms. Oh, and adolescence, when people have their first menses. So there is a link somewhere. And they're not 100% sure what that link is, but they know that varying estrogen levels affect the individual. Interestingly, estrogen levels in women with PMS or PMDD are almost always normal. So if you're saying, okay, well, Sally, you're depressed, the SSRIs aren't seeming to work, or before we throw, you know, psychotropics at you, go get a blood test and see if your sex hormone levels are normal or see if it's a hormonal thing. Well, Sally's gonna go and get this blood test done, and it very well may come back that her estrogen levels and her progesterone levels are normal. And so she may feel very frustrated because, you know, the SSRIs might not be working, but there's no other cause that she's seeing immediately. The problem may lie in the way that estrogen talks to the parts of the brain involved in mood. So there could be a disruption in the estrogen system, if you will, or in the serotonin system. But the levels, when you just measure how much is there, might be very adequate. During perimenopause, up to 10% of women experience depression that may be caused by unstable estrogen levels. This is an interesting little thing. Some studies suggest that using a transdermal estrogen patch by itself can improve depression during perimenopause. We're going to get into some of the ups and downs of that in just a second. So possibly using a transdermal estrogen patch could work. But too much estrogen is bad and too little estrogen is bad for mood. Mood related functions of estrogen. It increases serotonin and the number of serotonin receptors in the brain. Estrogen makes serotonin more bioavailable to the body. So that's a good thing to a certain extent. But remember, too much serotonin can lead to anxiety and potentially depression. Too little serotonin may lead to depression as well or anxiety. Modifying the production and effects of endorphins is another function of estrogen. Now, endorphins, those are some of our feel good chemicals aside from dopamine. So having estrogen in your body helps you feel good. When your estrogen levels are low, you may feel flatter if you will. Serotonin neurons in the brain have been found to contain estrogen inducible progestin receptors. What the heck does that mean? These serotonin neurons in the brain interact with estrogen in order to make sure that estrogen and progestin stay in balance. So serotonin can say, oh, we need to ramp up one or we need to suppress another. But serotonin, estrogen and progestin all seem to interact because these serotonin neurons have estrogen receptors on them. So we know that serotonin and estrogen have have a link with them. Ovarian hormones have also been found to affect numerous factors regulating serotonin synthesis and serotonin levels in the central nervous system. The enzyme. Monoaming off my. The m are the old. Sam. Chronically elevated levels of estrogen can actually induce depression by causing functional hypothyroidism. So that's an important point that when our estrogen's high, it may not even necessarily affect serotonin, but it may be affecting the thyroid hormones. And we know when people are hypothyroid, they have symptoms of depression. Chronically elevated levels of estrogen can contribute to anxiety by also contributing to excess serotonin, another issue that we're looking at. So elevated levels of estrogen can contribute to depression by affecting the thyroid or anxiety because it increases levels of serotonin. Estrogen also interferes with the release of cortisol. And estrogen deficiency that occurs with menopause can cause anxiety. So when you have too little estrogen, you may have anxiety. When you have too much estrogen, you may have anxiety, it's just finding that happy medium and part of that happy medium is a happy medium where estrogen and progesterone are imbalanced. Estrogen enhances the excitatory neurotransmitters dopamine and your excitatory neurotransmitters like glutamate and norepinephrine, as well as dopamine and your histamines. Dopamine is your feel good chemical. So if you don't have enough estrogen, you may not have enough dopamine, which is your feel good, your motivation, your focus chemical. You may not have as much norepinephrine, which is another motivation chemical, or glutamate, which is your get up and go neurochemist. All of those things are really important. So if you have too much estrogen, you're going to have too much of those things. If you have not enough estrogen, you're not going to have enough of those things. However, again, it may not be the estrogen levels themselves, but somewhere in the estrogen system that there's a breakdown in estrogen's availability to the body. Estrogen can be tested through a simple blood test, so that is something that they can do at a doctor's office. Causes of low estrogen Age we naturally, and the same thing is said for testosterone. We naturally start losing or decreasing our levels of estrogen and testosterone from about age 40 on. For women, premature ovarian failure or hysterectomy, anything that makes the ovaries go bye bye will cause an abrupt decline in estrogen. Congenital conditions such as Turner syndrome, thyroid disorders, excessive exercise. When people exercise a lot, actually it puts their body under stress and it will contribute to low estrogen, being severely underweight, chemotherapy and a low functioning pituitary gland. So any of these things can cause low estrogen, which we know will reduce the amount of excitatory neurotransmitters and dopamine and that's going to affect mood. Leaky gut also can affect estrogen. So we talked about leaky gut in other presentations. The fact that when our gut is exposed to cortisol, when it's exposed to stress, when serotonin levels are low, then inflammatory molecules can actually leak out through the gut and cause low grade inflammation throughout the body. This leaky gut can also contribute to high estrogen because it's a condition in which the gut microbiome is just all out of whack and a lot of our hormones are actually produced in in our gut. So we need a healthy gut thyroid dysfunction. Processed food intake can also contribute to high estrogen because of the high amount of sugar, especially stress, because stress causes cortisol secretions and a variety of other things and pharmaceutical or drug use, all of which can change gut flora and digestive function. Most of us can look at the slide on slow, on low estrogen or high estrogen and say, yeah, you know, some of those things apply to me. So we probably don't have optimal estrogen levels. And this is true even if you're a dude, because men do make estrogen. Progesterone affects GABA receptors in the brain. When you go on birth control, for example, some people go on estrogen only. Some people go on estrogen and progesterone. Estrogen and progesterone do this happy little dance where they need to balance each other out. It's kind of like when you bake. One of the things my grandmother taught me was, when you bake, if you use vanilla, then you want to use half as much lemon and it brings out the flavor of the vanilla. Likewise, when you use sugar, you need to use a little bit of salt and somehow it enhances the flavor. They work together synergistically and kind of balance each other out. But progesterone affects the GABA receptors. Increases in progesterone cause dose dependent improvements in premenstrual anxiety, irritability, and nervous tension. There are some natural progesterone supplements that women's doctors can put them onto, creams and things that they can get. And it might be something for some clients to take a look at. But again, it's not a panacea. If we increase the progesterone, we have to ask, why is the progesterone low? Cortisol and progesterone are both made from pregnelone. When we're chronically stressed and make more cortisol, cortisol production steals from progesterone levels. All right, so there we go. Why is progesterone low? Well, it may be because stress is high. If stress is high and the body is using way more pregneolone to make cortisol, there's not enough to make progesterone, which will contribute to low progesterone levels. So one intervention may be helping people reduce their stress or their cortisol levels. Way easier said than done, I realize. However, I want people to see how thoughts and environments and things can also affect their sex hormones and their mood and everything, the whole system. High estrogen and low progesterone progesterone. Think of it as your anti anxiety. It's your gaba. Estrogen is your antidepressant. It's more involved with serotonin. But the two of them balance each other out. Too much of either can produce an edgy feeling and the higher estrogen levels go, the more cortisol is released, making us less able to adapt to stress. High estrogen levels can contribute to subclinical hypothyroidism, which also decreases GABA release. So high estrogen levels can contribute to hypothyroidism, can affect the thyroid levels, which also impacts the availability of gaba. So not only are you feeling flat and exhausted and fatigued, you may also feel more anxious. Well that really sucks to have all those things all at once. High estrogen also affects people's levels of dopamine. So you can see how these sex hormones, which we don't really talk about hardly at all, if at all in graduate school, really do have a significant effect on the neurochemicals in the brain and the neurochemicals of mood. Serotonin can increase estrogen and estrogen is excitatory. Too much serotonin is associated with anxiety. Too little serotonin is associated with depression in some, but not all. Remember, sometimes when people are anxious for too long, they go into that conservation stage. So they may have too much serotonin causing them high levels of anxiety for too, too long. And then they go into this hypocortisol state where their body is in conservation mode and, and they're going to feel depressed. We can't say just based on whether somebody's anxious or depressed whether their estrogen or their serotonin is too high or too low. We don't know which one of these chemicals might be affecting it. Testosterone can have a significant impact on mood as well. It helps with people's sense of well being and self confidence. And remember, men and women have testosterone. We just don't have as much as the guys do. And men don't have as much estrogen as we do, but we all have a little bit. Depression and anxiety are well known symptoms of low testosterone. Depression and anxiety are also symptoms of low testosterone in women. Oh, okay. So it's not just the estrogen, it's not just the progesterone, it could be the testosterone. When people present with a symptom, we need to try to figure out what's causing it because there are so many things that can cause depressive symptoms. Evidence supports anxiolytic and antidepressant roles for testosterone and surgical removal of the ovaries increased mood disturbances and depression in some women, which was actually reversed by testosterone. So for some women, an estrogen patch helped. For some women, testosterone helped. That was an interesting finding. One of the questions comes in, could a person taking birth control cause them to have problems with these hormones and thus their mood? Yes. There are a lot of women who start taking birth control pills, and maybe they're taking the combo, maybe they're taking one, whatever, and it throws their estrogen, progesterone balance out of whack, and they will have mood symptoms and they will have potentially worsening PMS or PMDD symptoms. Numerous clinical studies in postmenopausal women and men in the andropause showed improvements of learning and memory after testosterone supplementation. Testosterone also impacts GABA bimodally. What does that mean? It means that when there's too little gaba, it has an effect. And when there's too much GABA, or when there's too little testosterone, it impacts gaba. And when there's too much GABA, can't do this testosterone, it impacts gaba. So there's a sweet spot in there where testosterone is giving you just the right amount of gaba. Not too much, not too little. Testosterone correlated negatively with Global 5 HT4R, which is a serotonin receptor, suggesting that men with high levels of testosterone have higher levels of serotonin. So when we think about this, higher levels of serotonin often are attributed to anxiety. When people take steroids, it increases their testosterone levels. And often you see a lot of aggression and anxiety in people who are taking high levels of steroids. So that's kind of an interesting combination to see that when testosterone is up, then these men often have higher serotonin levels. Low serotonin and high testosterone in the central nervous system has a significant effect on the neural mechanisms involved in the expression of aggressive behavior. So if somebody has high testosterone but their serotonin is still really low for some reason, it can cause a lot of aggression. So we do see roid rage, as they call it. Another thing to be aware of, not saying that that means somebody can take steroids and then just supplement with serotonin. That's not what I'm saying. But what I'm saying is different levels and different combinations of these hormones can produce differing effects. Testosterone modulates serotonin receptor activity in a way that affects aggression, fear, and anxiety. So when there's high levels of testosterone and think about serotonin as being Sort of a calming chemical or something that takes the edge off, gives you a little bit more of a wise mind. When serotonin is low and testosterone's high, people are going to be going gangbusters and they tend to be more aggressive, more fearless or fearful and out there. So those are things that we want to take into consideration when we're making our preliminary assessment of what might be some causative factors for people's mood disorders. And I know I'm going a lot faster on this today because I want to try to do it before we cut out again, but I will rerecord this and give it a little bit more time if you want to come back and watch it. Anyhow, Testosterone suppresses dopamine. Well, that stinks. Again, a certain amount of testosterone is going to help keep dopamine levels, okay. But adolescent males have an increased risk for developing schizophrenia, implicating testosterone in the precipitation of dopamine related psychopathology. So if there's not enough testosterone to suppress the dopamine, then dopamine levels may get too high, which can trigger a psychotic episode of some sort. That was just one of those interesting findings. Now, that doesn't mean that testosterone is the be all end all. Obviously women have some testosterone, but probably not enough where the levels of testosterone cause schizophrenia in them. However, we do know that high levels of dopamine too high levels of dopamine can be associated with psychotic features. So especially in men, this is something to take a look at. Low testosterone levels trigger symptoms such as anorexia, fatigue, decreased libido, which all may impact mood. And when we think about it, lack of appetite, fatigue, and lack of sex drive are all pretty much symptoms of depression. So yeah, you know, when you're feeling that way, you're already feeling kind of sluggish and slow and blah. And that can make you feel even worse because you can feel hopeless and helpless not knowing what's causing it or how to make it go better. When testosterone is lowered, cortisol is more likely to increase because they kind of control each other. So when testosterone is low, stress goes high and testosterone is not keeping it in control. Testosterone has antidepressant effects, interestingly, in women with anorexia, women with dysfunctional pituitary glands and low testosterone, and men with SSRI resistant depression. So again with the serotonin in men who have taken antidepressants and it hasn't been effective, the research indicates that, hey, it may not be serotonin after all, maybe it's testosterone and they Found in a significant portion of these men that it is their testosterone, not their serotonin. They already had plenty of serotonin. Causes of low testosterone obesity. Fat cells manufacture estrogen. The more estrogen in ratio to testosterone that young men have, the less healthy their testosterone signals are. When we have older men who have obesity, they're still manufacturing the fat. Cells are still manufacturing estrogen. When we have women who are obese, guess what? They're making estrogen. So they may have estrogen dominance because they have an excess of fat, which is manufacturing an excess of estrogen. And there's not enough progesterone to balance it out because fat doesn't manufact progesterone. So obesity is a big cause of low t, low testosterone and high estrogen. When testosterone levels decline in men, so does estrogen. Since your body converts some free testosterone to estrogen. That was an interesting little, interesting little find there. So just like serotonin is converted to melatonin, testosterone, some of it is converted to estrogen, especially in a male's body. Insulin resistance and diabetes can also cause low testosterone. Elevated insulin and blood sugar create issues with testosterone signaling. Pornography can disrupt testosterone levels because the increases in testosterone that men normally get, that rush that men normally get when they see female to whom they're attracted or a male to whom they're attracted, it doesn't signal the same way when they watch too much porn, because real people don't end up doing it for them anymore. They tend to focus more on what's online. And watching porn tends to lead to a lot of masturbation. And masturbation also messes up the dopamine and testosterone signals. Excessive masturbation. Sick guts. I know we talked about leaky gut earlier. Bacteria impact the levels of testosterone. Testosterone levels are intimately related to the health of your microbiome. Just like the microbiome in the gut, estrogen is produced, testosterone is produced, serotonin is produced. All this stuff is produced in the gut as well as other places. So if the gut bacteria is not healthy, if your little workers that are down there to make these hormones are not healthy, then the right levels of these hormones are not going to get made. So we need to keep our guts healthy. Endocrine disruptors, which are chemicals in our air, food and water that act as anti androgenic compounds, can damage testosterone receptors. Endocrine disruptors can also lead to estrogen dominance. So again, we want to look at what are we eating and drinking and are we taking in too many BPAs? What types of Things are we ingesting now that might be affecting our sex hormones for some people. And the research is really split, for example, on whether it's okay to, to eat foods that are high in phytoestrogens, like soy foods and edamame. If you have a history of breast cancer in your family or have a personal history of breast cancer, some studies say that it's actually more healthy to do that. Other studies say that it's not. But phytoestrogens are basically weak estrogens. So they go in and take up part of the receptor so that the bodily estrogens, if you will, can't get as much through, through the gate, through the receptor gates. Any of these things can be considered endocrine disruptors. And hypertension can also cause low testosterone. Think about how many clients we see who have hypertension, obesity, and a sick gut, not to mention, you know, the endocrine disruptors like the nitrates and the nitrites and the PofAs and BPAs and, you know, I can just continue, but I won't. We have a lot of lifestyle factors that clients can actually change that can significantly help their mood and well being. Cortisol and sex hormones. Cortisol and progesterone are made from pregneolone. We already talked about this a little bit. When the body needs cortisol, when the body's under stress, when that HPA axis goes off, the production of progesterone gets sacrificed, leaving higher levels of estrogen in your system. So that can lead to estrogen dominance, which can lead to anxiety. It can lead to a whole lot of other things. Progesterone balances out the effects of estrogen, and there's a negative relationship between cortisol and testosterone. So as cortisol goes up, testosterone goes down. As cortisol goes down, testosterone goes up. Which means if you just think about cortisol as our stress hormone, if somebody's testosterone is low, well, in order to get it up, we probably need to help them lower their stress levels and turn down that HPA axis. Now, people who have PTSD have a chronically high level of cortisol in their systems a lot of times, and that's that hypervigilance that we see. Like I said earlier, it's easier said than done to lower cortisol levels. But if people are aware of the impact of cortisol in their body, then they can do things to affect it. Now we need a little bit of cortisol. Like every other hormone in our body, we need the Right amount, not too little, not too much. Cortisol naturally wakes us up in the morning. It peaks mid morning and declines throughout the afternoon. That's our normal circadian rhythm secretions of cortisol that we want. What we don't want is those cortisol spikes, or we don't want it to go too high or we don't want it to stay elevated. So somebody's cortisol levels are still way high at 6 in the evening. Any sort of stimulants will increase cortisol levels, pain will increase cortisol levels. Remember that nicotine stays in your system for two hours and caffeine stays in your system for about 12 hours after you consume it. Both of those things will keep cortisol levels higher, which can suppress testosterone. Let's think about some of our clients who may be heavy into working out. A lot of your pre workout supplements contain high, high, high levels of caffeine as well as other hormone disruptors, if you will, like Yombi. So it's important to encourage clients if they are taking these pre workout supplements to get that rush, get that edge before they go to the gym. Encourage them to be aware of how long it stays in their system after they work out. Because if they're working out in the evening, then that caffeine is probably not getting out of their system until 4 or 5 in the morning and encouraging them to be aware of the impact of the stimulants on their cortisol levels and their overall health. And finally, leaky gut. The estrobolome is the collection of microbes capable of metabolizing estrogens. So you have these estrogen created in your gut and estrogen in your gut and estrogen receptors in your gut. And the estrobolome metabolizes these estrogens, it breaks them down and impacting if your gut is leaky, then it may not effectively get rid of the effective aggressive estrogen metabolites. So it breaks them down. You've got all this estrogen waste sitting in your gut and if your gut is leaky, it may not be escorting all the waste out. And you know, if you've ever, you know, made the mistake and you did your dishes and you forgot to run the disposal and you know, for two or three days and two or three days later you start to do your dishes again and you're like, oh, there is something rank in this kitchen. Well, the same sort of thing for your gut. If you're not getting all those toxic byproducts out, then they're just sitting in there. And if your gut is leaky, those toxic byproducts may be pouring out, if you will. That's not the word I'm looking for, but maybe seeping out into your bloodstream and causing higher levels of estrogen as well as inflammation. A leaky gut also increases cortisol because of the inflammatory response. And we already talked about how cortisol affects everything else, so. So if people are under stress, then they're going to probably have some GI problems. Those GI problems can cause the gut to become leaky, which is going to further increase inflammation and cortisol levels. So both men and women have testosterone and estrogen. We don't want to forget that we all have both of these hormones. Estrogen, testosterone and progesterone impact serotonin and GABA levels. Gaba, remember, is mainly your natural volume, if you will, but serotonin, they're still trying to figure out exactly how it works with depression and anxiety. They know low and high levels of serotonin can contribute to mood disorders. Cortisol, your stress hormone, reduces the amount of your sex hormones. Generally, when cortisol gets high, testosterone gets low, yada yada. Well, that makes sense. When you're under stress, when you are fleeing from the tiger, it is not the time to reproduce. So your body says, okay, we're gonna shut that down for right now because we're focused on survival. Too much estrogen or testosterone can contribute to anxiety and too little may contribute to depression. Progesterone balances estrogen. That's a big take home. And remember that blood levels on a lot of people who have estrogen related issues may be very normal. Their blood plasma levels of estrogen may be very normal. There may be a dysfunction in their estrogen signaling system. Cortisol is made from pregnolone, which is the same hormone that progesterone is made from. So if people are under stress, they're not going to make as much progesterone. So the body can't balance out. And they will become estrogen, can become estrogen dominant. Too much cortisol means too little progesterone and estrogen dominance. Leaky gut also contributes to estrogen dominance and excessive cortisol. Finally, hypertension, obesity, diabetes and stress all impact testosterone levels. And as well as leaky gut, these are all factors, lifestyle factors that we can address. Now, if somebody's diagnosed with diabetes, obviously that's a lifelong thing that they're dealing with. However, they can pay attention to their blood sugar and their insulin levels. And not be like my grandfather in law and be like, well, I'm going to have a big old piece of chocolate cake, so I guess I better take an extra shot of insulin. Yeah, that's not the way to go. But these are things that can be somewhat controlled. And as clinicians, it's important for us to educate clients that there's only so much that we can do in our counseling session. There are certain lifestyle factors that are going to mediate or moderate the progress they make. So unless they start getting their body machine healthier, then all those chemicals and neurotransmitters are going to have a harder time working. So it's good to have a multidisciplinary team. A question comes in. If you have a client who's clinically depressed, would you refer them to be tested for leaky gut, hormone levels and thyroid in order to rule out? Well, if you can find a physician who will actually test for leaky gut, that would be awesome. Most western medicine physicians have still not embraced the concept of leaky gut, just like it took them over a decade to embrace the concept of fibromyalgia. So, that being said, yes, I definitely refer for an assessment of hormone levels and thyroid levels in order to rule out anything that can be tested. And I also encourage clients to keep a daily journal of how they're feeling and female clients a daily journal of how they're feeling and when their monthly cycle is in order to identify any trends. So even if their estrogen levels come back normal and their progesterone levels come back normal, we might still see a fluctuation in mood as their hormone levels fluctuate, which could indicate a dysfunction in the system somewhere. I also encourage them to keep down, write down any supplements that they're taking, etc. So we can rule those things out. With all of my clients, whether they have generalized anxiety or depression, I strongly, I can't mandate it, but I strongly encourage them to get a full physical with a full blood panel to get things, get any physical causes ruled out. Generally, in a annual physical, especially for people who are, you know, older, 35 and above, we can get the hormone levels and thyroid checked with no problem as part of an annual physical. The leaky gut or adrenal fatigue or anything like that, that's not commonplace. They may have to pay for out of pocket. And Amanda points out that a lot of times people with autism can identify struggles with a leaky gut. So can this be hormone related? They have found yes, yes, they have found a connection between Leaky gut and symptoms of autism. So that's that's the short version. And if you go to the video that I did on Gut Health, I guess it was about three weeks ago. Now, I do talk about that a little bit in that video on our YouTube channel. Leaky Gut Testing is from a holistic doc. Some of your naturopathic physicians and some of your internists may be willing to consider it. But yes, it generally is something that the client has to pay for out of pocket. If this podcast helps you help your.

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