Today I speak with Dr. Lo about female hormone health. We detail what causes female hormone imbalances, testing to quantify imbalances, and what the available treatment options are.
Dr. R’s Fast Facts
Some of the most common symptoms of female hormone imbalance are
- Cycle abnormalities
- PMS: irritability/mood swings, bloating, fatigue
- Depression, anxiety
- Weight gain
- Low libido, vaginal dryness
- Hot flashes, night sweats
- Accelerated aging; dry/thin hair, skin, nails
The most common hormone imbalance seen by Dr. Lo is polycystic ovarian syndrome (PCOS)
- PCOS involves cysts on ovaries, signs of androgen excess (male hormones), loss or irregularity of cycling
- Often caused by blood sugar imbalances or inflammation
- Finding the source of inflammation can be very important; diet, gut health, infections
- Spearmint tea can also lower the androgens associated with PCOS
Testing options for female hormones
- Urine testing to test hormone breakdown and detox
- Serum testing; all 3 forms of estrogen, progesterone, total and free testosterone and SHBG
Dietary/lifestyle female hormone treatments
- Reducing inflammatory foods
- Reducing stress and optimizing sleep
- Iron, selenium, B vitamins, vitamin D, Zinc
- Iodine can be helpful for fibrocystic breast
- Healthy fat and cholesterol
Other female hormone treatments
- Gut health
- Herbal medicines
- Estrogen: black cohosh, dong qui
- Progesterone: chaste tree
- Bio-identical HRT
- Get help with female hormone health.
- Get a free gut health eBook and be notified when my print book becomes available.
- Healthcare providers looking to sharpen their clinical skills, check out the Future of Functional Medicine Review Clinical Newsletter.
Typical Symptoms … 00:03:29
Stress, Progesterone, & Dopamine … 00:07:09
Chemicals & Estrogen … 00:09:32
Significance of Weight … 00:15:08
Common Imbalances … 00:17:16
PCOS & Alleviations … 00:19:41
Hormone Testing … 00:25:41
Detox Testing … 00:28:45
Bio-Identical HRT … 00:31:26
(click gray Topics bar above to expand and see full outline/time stamp)
Dr. Ruscio Resources … 00:33:05
SHBG … 00:34:03
Diet & Lifestyle … 00:36:14
Iodine … 00:40:52
Herbals or Bio-Identicals … 00:42:22
Episode Wrap-up … 00:46:38
Download Episode (Right click on link and ‘Save As’)
Female Hormone Health with Dr. Lo
Dr. Michael Ruscio: Hey, everyone. Welcome to Dr. Ruscio Radio. Today, we are talking with Dr. Lo about female hormones, which is a topic that we haven’t spoken a lot about, but I think is actually a very important topic, one that can garner a lot of improvements without a lot of fuss.
And so I am super excited to have this conversation. Dr. Lo, welcome to the show.
Dr. Lauren Noel: Hey! Good to be on the air, this time talking about something maybe not as graphic as the last time we spoke.
DrMR: Yeah, the last time we spoke, I was on her show, and we talked about diarrhea, which is always a fun party conversation.
DrLN: For almost an hour. We were pretty lucky to talk about that for almost an hour. It was a good day.
DrMR: Yeah. So a little less of a socially taboo topic today—female hormones. But before we jump into that, I guess, in case anyone hasn’t come across your name yet, let people know a little bit about your background and what you’re doing relevant to female hormones now in practice.
DrLN: Yeah, for sure. Well, I’m a naturopathic doctor by training. So what that is—I’m trained in conventional medicine, also natural medicine.
And we typically look at things pretty differently than most doctors. We’re really looking for the root of the issue. We do lots of testing to get to the underlying reasons why people have certain symptoms.
So my visits are at least half hour, usually an hour with my patients. We really ask a lot of questions. I try to be the kind of doctor I wish I had because—rewind back to when I was in high school. I was going through the whole medical system, in and out of doctors’ offices not having any answers for why I was several pounds overweight. I wasn’t able to lose weight. And I was a teenager. There was no reason for it, although I was eating pretty crappy back then, because they wouldn’t talk about diet at all.
And face was covered in acne. I developed a thyroid issue and never really got any answers. So I just felt so—I don’t know. I just felt like a victim to medicine. And I never really understood how my body worked until I ended up seeing a naturopathic doctor.
And she reversed things that I didn’t even know I had. I had a leaky gut. I didn’t know what that was the first time she ever even—the first time I ever heard that term, she was explaining what this was and how my issues, even though they were on the outside, they were starting from what was happening inside.
DrLN: And so I got so much of an amazing lesson in how my body works. And I just felt like, “I’ve got to learn this thing for myself.” So I ended going to medical school, really with just the intention of learning.
And now I have this amazing job of helping people. I have a clinic here in San Diego, Shine Natural Medicine. We’ve been open for about three and a half years now. And it’s been amazing, just the growth and how many patients we’ve been able to help.
And then about six years ago, I started my podcast, Dr. Lo Radio. And we’ve had over 2 million listens now. And it’s crazy that we’re reaching this many people all over the world. And so yeah, it’s just wild.
DrMR: Cool. So being a female, I’m sure you’ve probably experienced the female hormone imbalance issue on both sides, both the clinical and the personal end.
DrMR: So I’m definitely curious to get your perspective as we dig deeper into this topic. Let’s start off with just helping orient people to what some of the typical symptoms are. I’m sure people probably have heard of things like PMS or hot flashes. But let’s go through some of the typical symptoms that you see that, when you see these, flag that there may be a female hormone imbalance present.
DrLN: There are a few different patterns that I see with women. It depends on which stage in their life that they’re in. So if it’s a girl that’s maybe in high school or in her early 20s and she’s just having really difficult periods or maybe she’s having acne, that’s going to be a different hormone imbalance than maybe a woman who is having some hot flashes and night sweats in her 50s or late 40s.
So it just depends on what phase she’s in with her life. And I actually feel kind of lucky, because I’ve experienced a lot of these different symptoms in different phases of my life.
So I’ll just start with thyroid. 27% of women have Hashimoto’s and don’t even know it, which is crazy. It’s an epidemic. And the symptoms could be just fatigue, difficulty losing weight, dry skin, can’t poop. These are so common. And they’re misdiagnosed so many times. So it could be a thyroid issue.
It could be sex hormones that are in the tank. Maybe a woman is feeling like she can’t lose any weight even though she is eating a lot less and working out more. She’s having hot flashes, night sweats. And depending on what stage of her life it is, it could be a hormonal change is happening in her 40s or 50s. And that’s going to be different than thyroid issues.
But really at the root of it, so much of it is rooted in adrenal deficiencies, adrenal imbalance. And that’s coming down to stress. Pretty much, the common theme that strikes a chord with all the different imbalances comes down to stress.
So no matter what a patient is dealing with, whatever phase of her life, that’s usually the first place we’ll start. Let’s get your stress dialed in. Let’s focus on your sleep. We’ll start with the basics, no matter where you’re at.
But if you’re having symptoms like fatigue—it’s hard to get up in the morning. You’re getting a crash in the afternoon. If you’re feeling like a completely different human being when you have your period, let’s say at maybe day 21, day 22 rolls around and you just start to be very different mood-wise, there’s probably a good chance it’s related to your hormones.
I hear this all the time with my lady patients. “God bless my husband. He’s so wonderful. But I’m not attracted to him anymore. I’d rather take a nap. I do not want to have sex. Bless his heart.” How many times have you heard that? So these are all clues that there’s something going on a little deeper that we get to look at.
DrMR: Absolutely. And I’m in complete agreement with you that getting rid of stress or getting to the bottom of stress is only going to help hormone imbalances, both adrenal, female, male, thyroid. It’s only going to tax your system globally—stress that is.
DrMR: So certainly, I’m in total agreement with you that that’s the foundation. A few other things just to throw in, in terms of symptoms. And there are a lot of them. And some of them are so basic that we, I think, sometimes even forget about them. But just to maybe help orient the audience. Also, remember if you are cycling, having cycle abnormalities, meaning a cycle that’s very short in terms of your time in between menstruation is significantly more or less than about 28 days or that your menstrual period is very long or very heavy. Also, of course, mood, like you mentioned, and libido. And then as you get older, of course, some of the keynote symptoms can be things like hot flashes and night sweats or also signs of accelerated aging. So there’s definitely a lot here in terms of symptoms.
Stress, Progesterone, & Dopamine
And we’ve touched on one of the common reasons that the female hormones get out of balance, which is stress. And one of the things that I think is interesting about stress—this actually ties into something we’ll talk about later, which is some of the herbal medicines.
But stress can affect some of the hormones in your brain. And that can actually have a negative impact on how the brain signals to the ovaries. And this is the stress-prolactin connection.
And just as a review, stress can eventually stimulate and then eventually deplete dopamine. And in the brain, dopamine is supposed to tonically inhibit prolactin. So they have this built in inverse relationship.
And if you overdo it, you overstress yourself, you burn yourself out, you can deplete your dopamine. And then as dopamine goes low, it allows prolactin to go up. And when prolactin goes up, it can interfere with luteinizing hormone, which is then needed to signal progesterone release.
And this may be part of the reason why so many, I think, especially younger women and especially if they’re overstressed, overworked, underslept, type As, they’ll tend to exhibit signs of progesterone deficiency.
And I’m sure you see a lot of this. Would you agree that you see a lot of, at least symptoms—
DrMR: Okay. So what are your thoughts about that whole piece before, I guess, I go any further on my diatribe.
DrLN: Yeah, no. I think that whole mechanism is really helpful to understand, because you don’t want to just jump to, “Oh, you have low progesterone. Let me give you progesterone.” That doesn’t fix the problem at all. It’s just putting a band-aid on it. So you have to back track and go, “Okay, what’s happening at the root of this upstream?” rather than focusing just on the downstream.
And the other part of that too is the higher prolactin, the more you’re going to be, like you said, suppressing progesterone. And that tends to also suppress the thyroid too. There’s the whole thyroid connection there.
DrMR: I would think that sometimes listeners or readers might roll their eyes when they hear the whole stress piece. “Oh, stress again. Stress, stress, stress. Everyone mentions stress.” But I think we clearly just mapped out a mechanism or a few mechanisms through which stress is going to have a negative impact on both your female hormones and on your thyroid hormones.
So it’s not trying to beat a dead horse, so to speak. But it’s just making sure that before you go to testing and treatments that are going to require time and money and effort and energy, you want to make sure you have the foundation underneath you first.
Chemicals & Estrogen
DrMR: So we talked about one of the reasons for female hormone imbalances, which is stress. Now, another one that I’m sure people have heard about is these environmental toxins that can function as pseudo-estrogens in the body. What are your thoughts on that, Doc?
DrLN: Oh, yeah. Well, I’m sure one of the common patterns you see is an estrogen-dominant situation. We already talked about how progesterone can be suppressed due to the whole HPA connection, dopamine being depleted, also spiking prolactin.
But the other flip side of that is things that are increasing estrogen. And that also imbalances the estrogen-progesterone balance. So it’s kind of like a teeter-totter. We want them to be in balance with each other.
And it’s very common, especially in women who have different periods or mood changes with their cycles, or they feel like their breasts are getting way bigger, they can’t fit in their clothes before their period, water retention, all that stuff.
It’s very common to see an estrogen dominant situation in that case, so there’s too much estrogen compared to progesterone.
And it could basically be one of two situations or both. It could be that the progesterone is suppressed because of what we just talked about. Or it could be that and too much estrogen because of some of these environmental toxins that you’re talking about.
So pesticides, herbicides, chemicals in our cosmetics, in our lotions, in our perfumes. Women are slathering on so many of these chemicals before ever even leaving the house. And so they’re leaving with a disadvantage already that they’re throwing off their own hormones. So that’s big.
And then there are other foods that can increase too. If a woman going to Starbucks every day and getting her latte and getting soy milk every day, that right there is going to throw things off and start to suppress the thyroid from that perspective, too. So it’s multi-factorial.
But definitely, the environmental exposure piece is real. And it’s getting worse. So you have to be really kind of like your own personal bodyguard sometimes with the things that we’re exposed to out there.
DrMR: Totally agreed. And maybe just to back up for a second—in case anyone doesn’t understand what estrogen and progesterone are—and if you have another way you’d like to define these, please, please chime in.
The way I like to define these is these are your two essentially chief female hormones, estrogen and progesterone. They have to be in balance. It’s not about having absolutely more or less of one or the other. If you hear progesterone is good, it’s not about just having more and more and more progesterone, but rather having a balance in between these two.
And part of this has to do with the function that they have. Estrogen tends to cause cellular growth. And progesterone tends to cause cellular differentiation or specialization.
So if you have enough estrogen simulation, which causes growth of cells, but you don’t have enough differentiation into those cells, this may underlie part of the reason why there are certain estrogen-mediated cancers and why a high level of estrogen stimulus with a low level of progesterone stimulus, in some cases, may underlie some cancers, because you have this cell stimulating effect without this cell differentiating effect.
So it’s important to have both estrogen and progesterone together to have healthy cellular function.
So I know that’s maybe a bit vague. But would you add anything to how we define hormones for people who are maybe scratching their heads in terms of what they actually are?
DrLN: Yeah, I also think of estrogen as the builder and progesterone as breaking down. So you want to have both, especially for bone health. It’s an important piece for that. That’s why it’s so common for women as they go through menopause to get osteoporosis.
And then also, how it relates to females’ menstrual cycles is if—let’s say one of you ladies listening, you’re having spotting between your periods or you’re having heavy periods, how that oftentimes is related to this estrogen dominant situation is I think of estrogen as helping to thicken the lining of the uterus. And so it does that throughout your cycle.
Obviously, that’s what builds up to where you can actually have a period ultimately, because that’s the blood that you lose with a period. So estrogen helps to build up the lining. Progesterone helps to pat it down and keep it in place.
So if you’re not going to have enough of that, then obviously, you can get some spotting throughout the month and, like you said, you get too much of this growth of tissues that can increase certain cancers like endometrial cancer and all that. So it’s just about having that healthy balance between the two hormones.
Hey, guys. I’d like to tell you about 2 companies I use and trust and who have also helped make this podcast possible. Aerodiagnostics™, my go-to SIBO lab – impeccable organization, customer service, test quality, and support.
Regarding support, if you’re not highly proficient with SIBO labs, Gary offers some of the best clinical support I’ve ever come across. He will go over labs with you in detail and offer insight and analysis.
Aerodiagnostics™ offers cash pay and insurance billing options. And they do a terrific job at keeping costs low and billing easy. They offer accounts for clinicians and direct-to-consumer testing also. Aerodiagnostics™, I highly recommend them.
Also, Designs for Health. Designs for Health is one of my favorite and most used supplement companies. Their science-first philosophy is, of course, in alignment with my approach. And you see this reflected in their evidence-based formulas.
Some things I like in particular, they offer a line of paleo-compliant products. Also, their product line is hypoallergenic, meaning it’s devoid of irritants, allergens, and fillers, so they work well for sensitive patients. In fact, we used a number of their products in the SIBO biofilm study we performed at my office. I highly recommend Designs for Health.
Okay, back to the show.
Significance of Weight
DrMR: Now, there are two other thoughts I wanted to offer. And one of those is another cause for female hormone imbalances, which is actually your body composition, because fat is a tissue that can actually produce estrogen. And so being excessively overweight or underweight can actually impact your levels of estrogen.
And this is one of the things I do in the clinic where you can kind of read the person. And some of this is pretty well documented where very thin and small females have a higher tendency to be estrogen deficient, whereas a female who has some extra body fat is less at risk for being estrogen deficient and more at risk for being estrogen dominant.
So it’s just one thing, I think, that’s important to keep in mind, which is looking at the person, because if someone comes in who is very, very thin, they may need some estrogen support.
And sometimes what I’ve seen happen is someone has gone on the internet. They’ve read about how bad estrogen is, how there are so many forms of plastics that are similar to estrogen or can stimulate the estrogen receptor, and how people who are overworked and stressed and burnt out have low progesterone. And they’ve formed, through their internet research, this progesterone-centric viewpoint of female hormone imbalances.
DrMR: Yet they come in with glaring signs of estrogen deficiency, like really bad hot flashes and vaginal dryness. So I just offer that so as not to forget to look at yourself relative to the conversation, because I think the conversation on the internet is a bit more progesterone-centric. But it’s important to just keep in mind that you, as an individual, may also need some estrogen support.
DrMR: Have you seen that same pattern?
DrLN: Yeah, it’s interesting because it’s never something you expect. But I definitely have seen women, even in their early 20s, with super low estrogen. And a lot of times, I’ll see it with especially athletes if they’ve been really, really athletic or maybe marathon runners, triathletes, stuff like that. I’ll see that commonly. Just a lot of chronic stress.
But yeah, it’s something that you don’t want to just assume just because a woman is in her 20s or maybe 30s, that if she has a hormone imbalance that it’s a progesterone deficiency. It’s not always the case.
DrMR: So what are some of the most common imbalances that you see?
DrLN: Well, a really common one is PCOS, so polycystic ovary syndrome. Have you guys talked about that much on the show?
DrMR: No, we haven’t.
DrLN: Or should I go into it?
DrMR: Yeah, give people the basic definition, and then please go from there.
DrLN: So basically, to be diagnosed with PCOS, you need to have two of the three following. So one is a cyst on the ovaries. So what’s interesting about that is you can actually have PCOS without actually having cysts on your ovaries technically. So if you have the second and third criteria, then it would be considered a causative even if you don’t have the cyst.
So the first one is the cyst. The second one would be signs of androgen excess. So that would be maybe hair growth on the chin, male pattern baldness. Maybe you have hair growth maybe on the nipples. So it’s just clues of high androgen. And androgens are male-dominant hormones. That would be testosterone or also DHEA.
And then the third would be anovulation, meaning you don’t ovulate, or if you don’t have regular cycles. And it’s a spectrum. It’s not like you have it or you don’t. You can have varying levels of PCOS.
And it’s actually the most common cause of infertility in the United States. So it really affects your ability to have healthy eggs. And at the root of it is typically a blood sugar imbalance problem, because for a woman when she’s having spikes of insulin, which is that blood sugar storage hormone—when you have spikes of insulin—and oftentimes chronic stress can do that as well for a woman.
What’ll happen is she can turn her estrogen into testosterone. And so that can disrupt the health of the fertility in the eggs. And so that can really affect the ability to ovulate.
For men, it can do the opposite actually. So when men have a similar mechanism happen, they turn their testosterone into estrogen. That’s a whole different topic if we did a man show.
And we tend to see PCOS more commonly in women who are overweight, especially if there is low thyroid. There could be a connection with PCOS and low thyroid as well. It’s a lot more common than ladies think.
And I love treating PCOS, because I actually was diagnosed with PCOS myself. And at 36, I have healthier fertility than I did in my 20s because I’ve been doing the naturopathic protocols, how to address it, really getting to the root of the issue. And it’s amazing what the body can do to heal it up.
So it’s not like you have it, and you’re screwed, and you’ll never have a baby. That’s not the case. It can be healed. So that’s a really common one that I see.
PCOS & Alleviations
DrMR: So I’m really glad you actually mentioned that one because, to be honest, I totally overlooked that. I was so preoccupied with estrogen-progesterone balance, how that pertains to symptoms, helping to get a woman asymptomatic with all these symptoms that I totally overlooked what is very important—and I absolutely agree with you—is PCOS.
Now, we talked about blood sugar which, of course, is a huge fundamental and probably why metformin is so commonly prescribed for women with PCOS (metformin just being a blood sugar lowering agent).
DrMR: Inflammation you also mentioned. Totally agree. And this is why some cases of PCOS that may not be driven by blood sugar will respond very well to improving their diet, getting out inflammation foods, perhaps some vitamin D. We’ve discussed some of the clinical trials showing potential benefit in PCOS with vitamin D. Also improving someone’s gut health. All these anti-inflammatory, foundational pieces.
But let’s say someone has done those things. And they still haven’t responded. What are some of the other deeper therapies that you’ve found to be really helpful for PCOS?
DrLN: Well, you mentioned the sugar, dropping the sugar out of the diet?
DrLN: Yeah, so what’s cool, though, is it’s quick though. For a woman who hasn’t dropped off sugar, if she were to cut it out just for a week, it drops testosterone by 20%. So I like to really stress that because it could be as simple as that.
DrLN: So let’s say a woman has taken care of that. We’ve got to think, “What else affects blood sugar?” A woman can be a diabetic even with having a great diet. So we’ve got to see what disrupts blood sugar beyond just sugar.
Okay, well, cortisol really disrupts blood sugar. We know that. So what’s at the root of that? Maybe there are underlying infections potentially. So that’s one of the things I love doing with my practice. Let’s dig and see if there are other reasons that your blood sugar is being affected.
So I’ll see infections like parasites, viruses, fungal infections, bacteria. And what happens is when the body is exposed to these different pathogens, it can create a stress response, that then you’re having these surges of cortisol. That right there can disrupt your blood sugar and make you more prone for something that’s going to affect your hormones, maybe potentially PCOS.
So it seems like, “How can an infection be related to that?” But if you really look at all the mechanisms, it’s possible. So I always like to look for infections, because they’re not typically looked at.
And also food sensitivities too—that can be another thing that’s continually spiking cortisol, being exposed to foods that your body just doesn’t respond to. Maybe it isn’t eating sugar, per se. But it could be a gluten allergy or a dairy allergy or something else you’re eating that is continually causing this inflammation that’s disrupting your blood sugar.
So those are two things that usually aren’t really talked about much with PCOS. What else? What else can you think of?
DrMR: Well, I’m wondering if you’ve ever used spearmint tea. There have been a few clinical trials that have shown a significant reduction in androgens by using just simple, store-bought spearmint tea. Have you ever experimented with that?
DrLN: No, I haven’t. That’s pretty cool.
DrMR: Yeah, it is pretty cool because some of the research is pretty compelling. And tea may seem like something that couldn’t have such a powerful effect. But the studies fairly clearly show that. But some people don’t tolerate spearmint tea. Sometimes, people will have reflux or reflux-like symptoms from the spearmint because it’s very cooling.
DrMR: And so if they have sensitive esophageal or stomach tissue, then that can sometimes cause that side effect there. And then the other—not that I think this is a great option—but there have been some patients where we’ve done everything else. And nothing has really gotten the skin under control, the acne under control. And this is a small percentage of people, but there has definitely been a handful. And they’ve gone on hormonal birth control. And they’ve seen terrific response.
DrMR: And while there are certainly things to criticize about hormonal birth control, every once in a while, you see a young adolescent girl where the skin health has such strong social implications.
DrMR: And you’ve done everything else. And we just had them go on a short course, maybe six months, of birth control. And in some cases, that’s been enough to reset things. And so it’s made me a little bit more open-minded to birth control, even though, yes, there are definitely some things that you can criticize. Sometimes, I like to be open-minded to a short term therapy that may not be “the best” if it can help us with a longer term objective.
DrLN: Totally. I just think, use what works.
DrMR: Right. Exactly.
DrLN: You can’t be attached to, “Oh, it’s a pharmaceutical. So we can’t ever do that.” It’s like, no, use what works. I’m sure you and I both, we don’t use medication too often. But if the situation warrants it, then you do what you’ve got to do.
DrMR: Absolutely. And in my mind, it’s also a pro-con where, yes, there are definitely criticisms of birth control, especially some of the hormonal birth controls. But what is the impact of the psychosocial stress on a 17-year-old teenage female who is getting tired of being made fun of at school and unable to have a date?
DrMR: So I try to factor in things outside of just the ideology of natural medicine and think about the person globally.
DrLN: For sure, yeah.
DrMR: So any other things that you’ve found helpful for non-responders? This is my own selfish inquisition.
DrLN: Well, the few things off the top of my head that we use—chromium, we use that at pretty high doses. Inositol. D-pinitol we’ve had good results with that. It’s kind of a natural metformin. Also, saw palmetto, cinnamon. Sometimes, we’ll use metformin if we need to.
And fiber. Fiber is a big one. Just getting more fiber in the diet makes a big difference on delaying that blood sugar spike. Zinc is an obvious. So 30 to 50 mg of zinc. Omega-3s. And then I’m trying to think if there’s anything else.
Changing diet—so switching to a paleo tends to work great for a lot of ladies with PCOS. Not everybody, but I’d say the majority do better on that. And also addressing their thyroid, too. Those would all be things, I think, that can make a big difference.
DrLN: But yeah, I don’t know if those were any new ideas from what you do. But those are some common ones we do.
DrMR: Yeah, I think that hits the main tenets. So yeah, that definitely is pretty much in alignment with what I’ve been doing.
DrMR: So one of the things I know that you also wanted to talk about was testing. And we’ll get to some more treatment stuff here in a minute just for the audience, because we’re not going to leave treatment fully. But I wanted to make sure to touch in on testing.
And the audience, I’m sure, at this point has come to expect from me a fairly critical analysis on testing. Or maybe critical is not the best term. But a fairly conservative viewpoint on testing, because I do think we sometimes over-test in functional and natural medicine. So I try to always be bringing things back to the most practical.
And as an example for that, I’ve done a lot less with female hormone testing the more I’ve come to use some of the herbal adaptogens. And so some of the herbals are going to modulate you in the appropriate direction irrespective if you’re a little bit high or low, let’s say for example, in estrogen.
So for some women, saving a few hundred dollars on the testing, knowing that we’re going to use an agent that is corrective. And we’re also going to be working to address, hopefully, the underlying cause of those problems, whether it be diet or lifestyle or gut infections or whatever. So it’s made me a little bit more tempered in some of the testing.
But that’s just my viewpoint on that. There may be some certain things that you find incredibly valuable. There may be some things that you find to be less valuable. And I’d be really curious to hear what those are. But yeah, what’s your take on testing?
DrLN: I’m a tester. I test probably more than maybe the average doc. But I don’t know. I just stay on my patients a lot. I like to test usually every three months until we get to a good place. And then we’ll let them go off for a while for six months or a year and then retest. So I do a lot of testing.
But I always keep in mind that the test only says one thing. If a patient’s symptoms and how they’re feeling is completely different than what the test shows, I’m going to listen to their symptoms. I’m never going to say, “Oh, your tests are normal. You’re fine.”
DrLN: But I also know that certain tests have flaws to them. Food sensitivity testing is known for not being the most accurate. And even checking hormones, progesterone is really hard to get an accurate reading in the blood. So I try to keep that in mind.
But a lot of my patients are doing bioidentical hormones, so I like to monitor and make sure that they’re in really safe ranges.
DrMR: Yeah, I think that’s probably the most important aspect to test for, is preventing overdose on bioidenticals.
DrMR: Totally. Yep.
DrLN: Right. And then I also like to see how they’re breaking down their hormones, too. So when I first started practicing, I was mainly checking hormones in their blood and the saliva. And in the last year, I’ve been doing a lot more testing in the urine, because I like to see how they’re breaking it all down. I want to see which pathways are more active than others.
And I know that it’s not 100% accurate. But it gives some really good, helpful information. I can check 5-alpha-reductase activity. That’s helpful, especially if a woman has PCOS. For people who are like, “What the heck is that?” That’s an enzyme that basically converts testosterone into something called DHT.
And for a woman—actually for a woman and a man—when that’s happening too much, that’s not a good thing. And for a woman, that’s when she can get a lot of those symptoms like the acne, the hair loss on the head, symptoms in line with PCOS.
So I think it’s helpful to get that information. But I do agree that I think a lot of doctors will rely on tests rather than their own clinical information. And that’s not a good thing.
DrMR: Yeah, no. Completely agree with you. And in terms of the detox or the breakdown testing, tell us a little more about those, because I know there are a couple different ones. But as someone who is using these things day in, day out, I’m curious what you’ve found to be your go-to for metabolite tracking.
DrLN: Yeah, so there are a couple of different companies. I’ve been using Dutch lately. So from Precision Labs, it’s the Dutch test. And it’s really easy, because you basically just pee on this piece of cardboard. And you do it around dinnertime, you do it at bedtime, and then when you wake up in the morning, and again a couple hours after you wake up.
And what it’s testing is it’s checking your cortisol and cortisone. So you get to see the pattern that your adrenals are doing. You also get to see your progesterone, your estrogen, testosterone, DHEA, and your melatonin.
And for the estrogens, it gives you the breakdown of the 2 and the 16 ratio. So you can see if you’re breaking things down safely with the liver. Especially if there’s been a family history of breast cancer, other endocrine cancers, it’s helpful to see if maybe there’s some dominant pathways for a woman. And then it also checks methylation, too, so showing phase 1 and phase 2 activity. So I think that’s super valuable.
You can’t really do it if you’re on birth control because it’s going to throw off the levels. And if you are taking hormones, it’s just important to know that to see how the hormones are being broken down.
And yeah, that’s what I’ve been using. I’ve been really happy with it.
DrMR: Now, if a cycling woman comes in, are you using the month-long cycling female hormone panel?
DrLN: I just feel like most women aren’t going to do that, just to keep it realistic.
DrMR: Thank you.
DrLN: I’ve done the cycling one probably five times. So it’s mostly for women who have irregular cycles, and we can’t seem to figure out when she’s ovulating. So we’ll just have her basically pee on a little cardboard strip. I think it’s every two or three days for the whole cycle.
DrMR: Right, yeah.
DrLN: So that’s really helpful. I actually was able to see some really interesting patterns with a few patients that I didn’t really suspect until we got their results. So it was very helpful.
But usually I’ll have them do it around day 21 of their cycle. But if a woman is having, like you said, shorter cycles or longer ones, it could be confusing to know when her actual day 21 is. So sometimes, we’ll use ovulation strips. She’ll do them at home maybe starting day 10 or 11, start to pee on the strips.
And then once she gets a positive, then we know she’s probably going to have that spike of progesterone about five to seven days later. So we’ll do it like that to capture their own day 21. But usually, if it’s a 28-day cycle, she’ll do the test on day 21.
DrLN: We’re complicated creatures as women.
DrLN: So we need little special things.
DrMR: So now with that maybe as a transition into some of the treatment options, are you using lab testing for—let’s say a woman is not cycling anymore and you’re considering using bioidentical HRT, are you testing before you treat?
Or do you use some treatments and use their response to find the dose that best alleviates their symptoms and then test to make sure you’re not overdosing or test to reaffirm that the levels are in an appropriate range?
DrLN: Yeah, I would say at least 90% of the time, I’m testing before I start.
DrLN: Yeah, I like to see where it’s at first, because sometimes I get surprised. But then I’ll put them on hormones. And we always test three months later. I never let them go longer than three months to see where things are at.
DrMR: Gotcha. And are you using LabCorp and Quest? Are you using specialty testing for this?
DrLN: Yeah, we use LabCorp, Quest. We’ll run through SpectraCell or other specialty ones. But it’s all probably through the same lab. But I like to see their serum levels, because that’s the best way to monitor bioidentical hormones, because let’s say they’re on hormones. You can’t really do saliva at that point, if they’re doing creams. The levels are just going to be way too high. So yeah, I’ll do the serum testing, usually LabCorp or something.
DrMR: And you’re looking at all three fractions of estrogen and progesterone?
DrLN: In the blood work, I’ll do estrogen. So it’ll do estrone, estriol, estradiol. And then we’ll check progesterone, DHEA, testosterone total, and free testosterone. We’ll also always check SHBG [sex hormone binding globulin], which is so commonly out of balance. So we’ll check that. And then we’ll usually check cortisol, too, even though it’s not the most accurate in the blood.
Dr. Ruscio Resources
Hey, everyone, in case you’re someone who is in need of help or would like to learn more, I just wanted to take a moment to let you know what resources are available. For those who would like to become a patient, you can find all the information at DrRuscio.com/GetHelp.
For those who are looking for more of a self-help approach and/or to learn more about the gut and the microbiota, you can request to be notified when my print book becomes available at DrRuscio.com/GutBook. You can also get a copy of my free 25-page gut health e-book there.
And finally, if you’re a healthcare practitioner looking to learn more about my functional medicine approach, you can visit DrRuscio.com/Review. All of these pages are at the DrRuscio.com URL, which is D-R-R-U-S-C-I-O.com, then slash either “Get help,” “Gut book,” or “Review.” Okay. Back to the show.
DrMR: For imbalances that you find with sex hormone binding globulin, are there any—I know, of course, blood sugar and insulin have a big impact on that.
DrMR: Are there any other key things that you look at for that?
DrLN: Well, for sure checking out liver. If the liver is congested, it’s more common that that will be the case. I actually have a little cheat sheet here, because I was seeing this so often, I was just like, “I have to figure out why this is happening so much.”
It’s really common to have imbalances with that if there are certain deficiencies. And just so people know what SHBG is, it’s basically like a little taxicab that you’re hormones ride around on. And if you have too much of this, it binds to your hormones so you don’t have enough free hormones to be usable. So hormones are only active if they’re free, if they’re not bound to a protein.
And sometimes, if there’s too much of a hormone—your body is really smart, so it makes more just protein to bind to all of them so your levels are more in a safe range. We’ll see this a lot with birth control pills. We’ll see high SHBG oftentimes on oral contraceptives. Or if a woman is—let’s say she’s not on the pill, but she just has high estrogen. A lot of times, the SHBG will go up to protect her. So our bodies are really cool like that. There’s always this compensation that can happen.
But unfortunately, when you have too much of this protein, it binds to your hormones so you don’t have enough to use. And that’s where we’ll see the classic maybe high testosterone or normal testosterone, but the actual free testosterone is really low. And that can come along with low libido, low energy, stuff like that.
So yeah, if I see a high SHBG, the first few things I’ll look at are: how is their magnesium? How is their zinc? How is their vitamin D? Those are probably the three most common ones, and then also fish oil. So those have some legit research supporting their ability to lower SHBG.
And then also, too, sometimes what can drive up SHBG is soy. So taking soy out of the diet, I think is important for that. And then also oftentimes, it’s a stress response. If cortisol is high, that can throw that off.
So that’s probably one of the biggest reasons why high stress causes low sex drive, because high stress is increasing that SHBG, which binds to your testosterone. Hence, low libido.
DrMR: Gotcha. That makes sense.
Diet & Lifestyle
DrMR: Okay. So as we go a little more into treatment now, I want to work our way around to what I would consider the end-phase treatments, which would be the herbal medicines and some of the bioidenticals. But before we get there, are there any other things in diet and lifestyle that you think are important to mention? I know we’ve covered diet and lifestyle already and emphasized the importance of those. But anything else that we haven’t hit on yet that you want to mention?
DrLN: Probably the most important of this entire show is sleep, because no matter all the different hormone imbalances we’re talking about, if you guys just focus on the first thing, just focusing on your sleep, that’s going to help no matter what imbalance you have.
So we only heal when we’re sleeping pretty much. That’s when you get that spike of growth hormone. Our melatonin is incredibly for the body. It’s very anti-cancer. That’s when we’re detoxing the body. That’s when we’re consolidating memories.
So I would say—it may not be the sexiest answer—but sleep is the biggest to focus on. Yeah, and if there’s anything else about sleep you can think of, but it’s a game changer for any hormone imbalance.
DrMR: Yeah, sleep is just massive. There is almost nothing that a sleep deficiency is going to help.
DrMR: And probably almost nothing that it could help. So yeah, completely agree with you.
DrLN: Yeah, you might get a little more done. But the next day, you feel like a train wreck. So it’s maybe not worth it. Yeah.
Yeah, that would be one I would think of. And I think cutting off the sugar. Take the processed stuff out. Eat real food. We can all agree on that. Eat more vegetables. I don’t care if your macrobiotic, paleo, vegan. We can all agree that more vegetables are going to do the body good. So lots more veggies. More water.
And just having a regular stress reduction practice. For me, it’s walking. And it’s not the sexiest thing. But I walk daily. I have to get out. Middle of my day. If I’m seeing patients, I have to go walk at my lunch. And that just gives me that reset. It reminds me that there’s a world out there beyond being at the office. There’s sunshine. There’s fresh air. Getting that rest is important.
And so that could be meditation. We know meditation has so many medicinal benefits. You don’t need to do a whole lot, just having it be a regular practice.
I think that’s the key. No matter what hormone imbalance you have, it comes down to adrenal balance. Adrenals love consistency and love routine. So pick whatever it is that works for you and just do it consistently. It doesn’t matter what it is. Just have it be consistent, whether that’s walking or meditating or yoga.
Let it be this sacred practice that you really embrace that nothing comes in the way of, because it’s going to be that needle mover that affects everything else in your life.
DrMR: Yep, I completely agree. And that’s why we always mention stress, because if you don’t have that in order, it’s really hard for these other interventions to be effective. And it’s not to say that, okay, if you have some stress in your life that you can’t control, it doesn’t mean you’re doomed and that can’t move on to some of these other interventions. But it’s just meant to illustrate that you want to try to do the best to address the fundamentals, which are your stress and your diet and your lifestyle, before moving on.
DrMR: And yes, it’s not that you have to be perfect with those. You may have a really bad job. And you can’t get out of that job. But let’s make sure that you’re also having some time in nature, some time with friends. And you’re trying to get at least a reasonable amount of sleep, at least 7 hours a night, I’d say.
DrMR: So yeah, I think it’s important to maybe to mention the other side of that too, so people don’t feel like they’re pigeon holed if they have stress that they can’t get—
DrLN: What do you do for stress for yourself personally? Because being a doctor and seeing patients, we have to take care of ourselves. I’m just curious.
DrMR: I love walking in nature or just walking in general. For me, walking, especially in a pair of minimal-soled shoes, is super, super—it just feels great. I don’t know exactly what the term is I want to use. But I guess it’s very stress-relieving. It feels good to me.
DrMR: Exercise at the gym. I also play soccer a few nights a week. I also play music.
DrLN: Nice! Cool!
DrMR: And then I also enjoy having a few glasses of wine and getting silly and being a goofball on occasion.
DrLN: Yeah, it’s the time for play, too. What instrument do you play?
DrMR: I play guitar. And I’m just dabbling in piano now also.
DrLN: That’s cool. Do you sing?
DrMR: Yeah, I do okay.
DrLN: We’ll have to jam out sometime.
DrMR: After three drinks I’ll sing.
DrLN: Well, I sing. You could play the guitar. And we’ll jam out sometime.
DrMR: Yeah, I’m surprised we haven’t crossed paths at a conference yet and made that happen.
DrLN: I know! I feel like I’ve seen you but didn’t put the face to name. And so I’m sure it’ll happen soon.
DrMR: That’s what’s great about podcasting is you get to get a deeper connection with people that you’ve maybe heard their name, but you don’t really know them.
DrMR: And after we talked about diarrhea for an hour, you don’t get much closer than that.
DrLN: I know. We’re like soulmates now. It’s a bonding experience.
DrMR: Something else that just shot into my head—and before it shoots out—is iodine.
DrMR: Iodine, there have been a few trials. And I’ve been very critical of iodine in regard to thyroid. And I do think that some of the proposed utility of iodine for thyroid conditions has been way overstated. But there are some impressive clinical trials with fibrocystic breast disease using iodine.
DrMR: So that’s another important one maybe to mention for people.
DrLN: Totally. I know—who is it? Dr. Jonathan Wright. I remember going to some of his trainings back in the day. I loved going to his trainings. And he was talking about using an iodine solution that you put on the bottom of the woman’s feet before going to sleep. And over time, he was saying, that that really helps to decrease the fibrocystic breast. But I thought that was kind of interesting.
DrMR: Yes, and I think it’s because it helps to shift from estrone to either estradiol or estriol in the breast tissue.
DrMR: So it shifts the form of estrogen from a more pathogenic or proliferogenic to a lesser so form.
DrLN: Interesting. I never knew the mechanism. Cool.
DrMR: I think that’s the mechanism. I could be wrong.
DrLN: Yeah, and also taking them off coffee for fibrocystic breast. That’s a big one.
DrMR: Now, is that because that uses the COMT enzyme, which is the same one that helps to detoxify some of these estrogens?
DrLN: Yeah, because that coffee can be estrogenic. So yeah, that would make sense.
DrMR: We’re geeking out now. We’ve got to get back to the show here.
DrLN: I know. Nerd alert!
Herbals or Bio-Identicals
DrMR: So I think we went through some of the more salient dietary pieces. And we’ve also talked about other treatments like gut health. But let’s get more into the female-hormone-specific treatments.
And in my mind, there are really two big ones. And maybe you have a couple others. But the two big ones that I use that are direct female hormone treatments are either the herbals, things like black cohosh, dong quai, chaste tree, or bioidenticals.
DrLN: Yep, I’d agree with that. Also certain nutraceuticals. There are certain vitamins or minerals that have specific effects on these pathways. So I’d say maybe those three. I’d say vitamins/minerals, and then botanicals, and then the hormones.
DrMR: Now, are you using—I guess, let me give the way I do this as an example. I typically will almost always start someone off with herbals and see if we can get enough effect with those. And I have to say, for most women, in conjunction with using the herbals and treating whatever else we find—diet, gut health, lifestyle—we have pretty good results. And we don’t oftentimes need to use the bioidenticals.
DrMR: That’s the way that I approach this. But do you have a certain pattern that you see and you jump right to bioidentical?
DrLN: No, I rarely jump to bioidenticals. In fact, I never do unless their liver is looking okay, because that’s the filter. I don’t want to just have them slather on hormones if they’re not going to filter them okay.
So usually, I’ll start with testing everything. I’ll check their thyroid, their blood sugar, their deficiencies, check their hormones. Just kind of get an idea where things are at.
And then I’ll usually start with nutrient deficiencies first. But most of the time when adding in nutrients that are deficient, I’ll usually do some herbs, too. I’ll usually do some adaptogens most of the time, I would say.
So I start with step one which is deficiencies. And then a lot of times, I’ll jump to step two, which is the botanicals. I’ll do both.
And then yeah, once I see that their liver is looking okay—because some people come to me specifically for bioidentical hormones. Sometimes they’re like, “Oh, just start right away.” It’s like, “No, we have to make sure that you can break them down properly.” So the next step will be doing the hormones at that point.
But rarely, actually never, do I put someone only on hormones. I’m always doing the other stuff—the liver support, the deficiencies, treating things even with botanicals. It just works better that way.
DrMR: Yeah, I completely agree. I tell my patients that if we put hormones into an inflamed body, they’re not going to do what we want them to do.
DrLN: Right. And they can be dangerous, too.
DrMR: Yeah, yeah. Absolutely. Absolutely.
DrMR: Alright, so I think we’ve picked through the topic pretty well. Was there something else you wanted to go over?
DrLN: I was just going to say, specific deficiencies that I’ve seen most common for female imbalance—definitely iron. We hadn’t talked about that. It’s so common to see iron deficiency. Actually, right before our call, I had a patient with a ferritin of 5.
DrMR: Oooh, boy.
DrLN: The lowest ferritin ever. And just for reference, 70 is about optimal. So 5? And she’s like, “Oh, that’s why I’m yawning all the time, and I can’t catch my breath. I’m just winded walking up the stairs.” It’s like, “Yeah, because iron and oxygen are attached to each other.” So iron is a big one.
Selenium, so going back to the whole thyroid health thing. Selenium is really important for the thyroid. Zinc, super common deficiency. And especially with PCOS. And then B vitamins, just the whole B1 through 12, but especially B12 and folate. It’s super common to see those low. And I actually see B5 probably even more deficient than the other B vitamins, which is the main adrenal B vitamin, which would make sense.
DrLN: And then vitamin C is a big one, too. So vitamin C deficiency can also be associated with low progesterone. So if I see low progesterone, I’m always seeing, “How’s your vitamin C?” A lot of times, I’ll focus on that first, because vitamin C also supports the adrenals. And that can be why progesterone is depleted if the adrenal system is depleted. So we’ll focus on that. And then that helps everything else. So I felt like those were important to mention.
DrMR: Gotcha. No, totally. I’m glad you brought those up.
DrMR: So iron, selenium, vitamin C, B vitamins—
DrLN: And zinc.
DrLN: Oh, and vitamin D. Duh!
DrMR: Right. Right. Yeah.
DrLN: Vitamin D should stand for vitamin duh.
DrMR: If you forget it, yeah.
Episode Wrap Up
DrMR: All right. So yeah, I think we went through a pretty good run down on the topic. Anything else before we come to a close that you want to mention?
DrLN: Eat more broccoli. I’d say the broccoli family is a great food. I love talking about food as medicine. So love your liver. Eat foods that the liver loves. Broccoli, artichoke, Brussels sprouts, cauliflower. These are wonderful things for the liver.
And get more sleep. Hug people more. Get more sunshine.
DrMR: Yeah. All those things.
DrLN: Well, there you go, right there. That increases oxytocin. That’s another sexy hormone. So oxytocin helps all of these to get better. So my challenge for you guys listening is the next time you hug someone, hold for at least 20 seconds. You’ll get a spike of oxytocin. And that’ll lower your stress.
DrMR: And I hear from some of my anti-aging cohorts that oxytocin hormone supplementation has been used to help increase libido, but more so orgasm.
DrMR: So for any of the guys out there that are not wanting to do a good job with foreplay, maybe there’s a hidden incentive to foreplay and cuddling that will benefit both parties.
DrLN: Oh, yeah!
DrMR: So something to think about.
DrLN: Totally agree.
DrMR: And where can people track you down if they wanted to check out your podcast or read some of your blogs or what have you?
DrLN: Yeah, so the practice is Shine Natural Medicine. So if you’re interested in looking into things health-wise, that’s the website to learn more about the practice. My podcast is Dr. Lo Radio. So that’s on iTunes and Stitcher and all those places.
And then I’m also pretty active on Instagram. I’m @HealthyLo on Instagram. I was big into Snapchat, but I know there’s this whole take over and Instagram is taking over. It’s like all these social media wars. So HealthyLo at Instagram. And yeah, you guys will find me pretty easily.
DrMR: Awesome. Well, thank you so much for taking the time. And hopefully, we’ll connect at a conference soon and get a chance to have a jam session.
DrLN: For sure. I’m into it. Thanks for having me. I appreciate it.
DrMR: Absolutely. Thank you again.
- Get help with female hormone health.
- Get a free gut health eBook and be notified when my print book becomes available.
- Healthcare providers looking to sharpen their clinical skills, check out the Future of Functional Medicine Review Clinical Newsletter.
What do you think? I would like to hear your thoughts or experience with this.
Dr. Ruscio is your leading functional and integrative doctor specializing in gut related disorders such as SIBO, leaky gut, Celiac, IBS and in thyroid disorders such as hypothyroid and hyperthyroid. For more information on how to become a patient, please contact our office. Serving the San Francisco bay area and distance patients via phone and Skype.