Episode 56: A Guide to Your Hormone Health with Dr. Holthouse Part 2

Dr. Robert Rountree:

This is the Thorne Podcast, the show that navigates the complex world of wellness and explores the latest science behind diet, supplements and lifestyle approaches to good health. I'm Dr. Robert Roundtree, Chief Medical Advisor at Thorne and functional medicine doctor. As a reminder, the recommendations made in this podcast are the recommendations of the individuals who express them and not the recommendations of Thorne. Statements in this podcast have not been evaluated by the Food and Drug Administration. Any products mentioned are not intended to diagnose, treat, cure, or prevent any disease.

Dr. Robert Rountree:

Hi everybody, welcome to the Thorne Podcast. Today, I'll be continuing my conversation with Dr. Mark Holthouse on hormone health. If you miss that first episode, be sure to go back in your feed to learn more about Mark and his practice as we lay the groundwork surrounding hormone health. So let's pick up the conversation as we dive into some questions from our listeners. The first question this week comes from a listener who asked besides estrogen and testosterone are there hormones that males should worry about more than females and vice versa? Is estrogen and testosterone the whole story, Mark or are there other hormones?

Dr. Mark Holthouse:

Yes, there are. And estrogen is important in men just like it is obviously in women. Estrogen has some unique things that it really does better than other hormones in men. In particular, it's important for maintaining bone density. A lot of the guys that I see that have a lot of aromatase enzyme activity that's trying to convert or steal their testosterone to make extra estrogen and this is happening naturally, sometimes when they have a little more girth around the midsection, because that enzyme is up regulated or in just people that are inflamed. We know inflammation up regulates that, extra insulin up regulates that enzyme. So many of these gentlemen come to me with a prescription that actually inhibits that enzyme and that's great.

Dr. Robert Rountree:

It inhibits aromatase.

Dr. Mark Holthouse:

It inhibits aromatase and-

Dr. Robert Rountree:

So Arimidex or something like that.

Dr. Mark Holthouse:

Exactly. Yeah. The Anastrozole generic and what their practitioners that they're seeing are trying to do is just prevent that conversion from testosterone to excessive estrogen. And sometimes they get a little overzealous with the dosing of that prescription or they don't follow the estrogen and they can actually suppress the estrogen so low they become osteoporotic and we'll check bone densities on these guys. And even though they're on really healthy levels of testosterone, depending on what their DHEA hormone is doing, which we'll talk about here in a minute and their estrogen, you can cause harm. And so we find that it's like everything in medicine, there's this dance. And you know, if a little's good, a lot might not be better always.

Dr. Mark Holthouse:

Yeah, so estrogen in men that's a common one. We deal with something called DHEA is something made by the cortex of the adrenal gland in men and women. And we know that it's got specific and independent receptors all over the body, just like we have for estrogen and testosterone and progesterone. It has its own independent risk factors like extra heart disease problems when it's low. Independently of testosterone and estrogen levels very important. We used to call it the fountain of youth hormone. I kind of look at it as the yin and the yang relationship between cortisol, cortisol, being the yang, the thing that really is meant to be used short term, it can in a long term situation like with long term unrelenting stress become quite destructive and tears us down. We lose muscle, we gain body fat and things like this.

Dr. Mark Holthouse:

Whereas DHEA also coming from the adrenal cortex as does cortisol does kind of all the opposite. It's kind of this zen building, what we call anabolic hormone. And it acts very similar to testosterone and things like growth hormone. Growth hormone is almost a topic in and of itself, especially in the context of a lot of guys coming in and asking about human growth hormone supplementation. There's some really good data that says, unless you've got a documented deficiency, you're low in growth hormone, there's not data that I have seen that shows you're going to get benefit on body composition or function dosing growth hormone if you don't have a documented deficiency. And this has been a real big area of controversy for some of the guys that will come in and I just show them the data. I also show them the data on the side effects of growth hormone, which can be daunting cancer being one of them.

Dr. Robert Rountree:

Cancer growth. Yep.

Dr. Mark Holthouse:

Exactly.

Dr. Robert Rountree:

Would you say that the anti-aging clinics that all used to promote growth hormone really heavily that many of them have backed off on that?

Dr. Mark Holthouse:

Absolutely. And where I saw a lot of it too was with the dietary weight loss clinics with not just the HGH and caloric restriction, but they were kind of touting these anabolic protocols along with, especially in men falling out of favor. And the same thing is really true with women in testosterone replacement. I think it's great if you're assessing someone and finding that they're low and they've got symptoms that match the lab to get them into the normal range. But now we've got all this really great data that is showing my, goodness there's a huge uptick in the incidence of onset Type II diabetes in women supplementing with testosterone. There's also problems with more breast cancer in women substituting or replacing with. So I'm always getting is-

Dr. Robert Rountree:

Is that in higher doses? I'm really curious about that is that, you know, we typically use like one to three milligrams of testosterone. So is that happening at those dose levels?

Dr. Mark Holthouse:

Not so much. It's usually the folks that are coming in on something 4, 5, 6 milligrams per day in the female side.

Dr. Robert Rountree:

Super physiologic level.

Dr. Mark Holthouse:

They're super physiologic, or they've had some pellets placed which you know, once they're in, they're in, and until things kind of calm down they can have this super physiologic levels that they'll see, and it could be sustained for a few months. And these are the ones that not only do they have bleeding and vaginal bleeding problems that we have to kind of work with that mess that can be created. But then we see their fasting sugar's climbing. We see their insulin resistance become more of an issue in addition to their breast cancer risk going up. So I don't get nervous when I've got documentation that they were low below reference ranges in this case with symptoms. And we've got them on reasonable doses and we're monitoring what we're doing either in the serum or with the dried urine testing.

Dr. Robert Rountree:

So be careful with replacement is what you're saying. You know do it in a thoughtful, meticulous kind of way.

Dr. Mark Holthouse:

Absolutely. Yeah. Knowing that there are these side effects with other diseases that you can inadvertently trigger if you push too hard.

Dr. Robert Rountree:

Okay. And in a minute, I see we have some questions about what to do to make sure that if you're taking hormones you're doing it safely. So we'll circle back around on that. Meanwhile, we have a listener that wants to know, how can I tell if my hormones are imbalanced? You mentioned estrogen dominant. What is that? What's the estrogen dominating over?

Dr. Mark Holthouse:

Yeah. Yes. That's a great question and we're taught in this type of medicine to recognize patterns and it turns out that it works. And the more experience you get with it, the more folks that you see with these recurring groups of patterns you start to get more confident about treatment ideas. So you'll often see this pattern, we talked about the pre-menopausal 30 year old, who has ever since they started having periods, had very heavy, painful periods, passing large clots sometimes they've got associated endometriosis and really bad pelvic pain just up to the period. They have problems sometimes with night pain, which excruciating ovarian cyst pain and they'll know this because they've gone in the ER at 2:00 AM, which is when these things usually occur. And they've got an ultrasound and some astute ER doc behind the ultrasound report has said, "Oh, by the way, you've got a cyst there."

Dr. Mark Holthouse:

So you hear these diagnoses, these histories from these women. And oh, by the way, I've got PMS that's really bad and for the week before my period, my husband and I just have this kind of understanding. And it's amazing when you see this pattern, you can come in and you can start talking about how progesterone and estrogen have this dance that they play. And they'll say, well, estrogen dominance does that say something about me as an alpha female? What are you trying to say? And I say, no, it has nothing to do with your personality and in fact, it really doesn't have much to do with your absolute estrogen levels. It has to do with the dance-

Dr. Robert Rountree:

The balance.

Dr. Mark Holthouse:

And whatever it is that's causing you to retain excess estrogen or make more relative to progesterone that's what we've got to get at. And it's often these microbiome problems, it's often an issue with the detoxification of estrogen in the gut, but it can also be problems with a bunch of Motrin you're taking for your painful periods, causing you to leak things across your bowel wall that are now directly raising inflammation markers in your bloodstream that go to the ovary and to the testicle and shut off the production of progesterone and testosterone specifically.

Dr. Mark Holthouse:

So we talk about excess estrogen, we talk about trouble getting rid of it in the level of the gut, especially with folks that are constipated. Some of these really easy things to kind of go after, but we also talk about how the alternative dance partner, the progesterone and testosterone can get shut down by anything that's causing... We have a fancy term for it called metabolic endotoxemia, which just means your blood is seeing an influx of inflammatory mediators or messengers, if you will, that are being dumped into the blood for a number of reasons. So when you come in with these symptoms, using these premenopausal girls, as an example, recognize a pattern and you can kind of reverse engineer what might have gotten them into that situation.

Dr. Robert Rountree:

An interesting thing to me about metabolic endotoxemia is that we're basically talking about the same physiology that's involved in toxic shock syndrome.

Dr. Mark Holthouse:

Exactly.

Dr. Robert Rountree:

Right. It's the same thing, it's just much, much less severe. So it's very low level toxic shock syndrome.

Dr. Mark Holthouse:

Exactly.

Dr. Robert Rountree:

[inaudible 00:12:35] that was caused by tampons which would cause certain bacteria to accumulate and causes severe life threatening inflammatory reaction, but on the lower end of the spectrum, you have this condition that also causes inflammation and obesity and predisposes to metabolic syndrome, diabetes, et cetera. But I would say not many of our mainstream colleagues even know about it.

Dr. Mark Holthouse:

No, it's always a surprise when I talk about this to my urology guys here locally that do a lot of hormone work. They're completely caught off by that. It's interesting I think how a lot of these start at mucosal surfaces, right? You bring up toxic shock syndrome, which is a vaginal mucosal interface. We've been talking about the gut mucosal surface, and then you've got the whole oral systemic problem with periodontal disease in the mouth and that mucosal surface. It's almost like wherever there's a membrane or an interface between the environment, whether it's the gut getting across into the lymphatics and the portal circulation or the blood brain barriers, separating the blood from the brain, kind of these sacred spaces where if there's derailment these inflammatory consequences follow.

Dr. Robert Rountree:

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Dr. Robert Rountree:

We have several questions that I think I can roll into one because all the questions have to do with, "Well, what do I do if I have a hormonal imbalance, right? How do I bring it back into balance again?" One question was, well, does omega three fatty acids that Marine lipids, long chain polyunsaturated Marine lipids, do they help or are there herbs that help? So really that's what everybody wants to know. Okay, I've got this problem, I have estrogen dominance what do I do? Or I have what appears to be testosterone deficiency other than taking hormones what do you do? What approaches do you take?

Dr. Mark Holthouse:

So since we've been really on this estrogen dominance discussion what we'll often do is we'll work on making sure they're having regular bowel movements so that they're getting rid of the estrogen that the liver so diligently metabolizes, if it just sits there it gets resorbed, it's kind of a dirty trick nature plays. And the liver has to re-detoxify this stuff over and over again. So there's bacteria that make enzymes, that make this possible. And so we have to balance the critters who's there and so the constipation being dealt with that. So that's why we talk so much about fiber. Now fiber can have multiple mechanisms in this discussion being regular is just one elementary part of it. We talk also about specific plants and botanicals. Things that act like progesterone, progesterone agonists that can reestablish the dance, the balance between estrogen and progesterone things like chaste tree berry, vitex agnus-castus, which is a beautiful way to, without using a hormone, help reestablish this balance. We also use black cohosh for the same reason.

Dr. Mark Holthouse:

Both of these are very safe from most people. And we'll combine that with managing stress. Hey, let's make sure that your mother hormone, if you will, the upstream hormone that makes all this stuff is really set up for success to go down the sex steroid production pathway instead of cortisol and stress. So we do things like telling people to do gratitude journaling and mindfulness meditation, and laughing, and singing and humming and all kinds of things that we know elevate what's called the vagus nerve. That's kind of that opposite effect of cortisol and stress and living in that fight or flight world. That ends up having a huge part to play with hormone balance. So we use botanicals, we use we what we know about gut health, and we use mind, body medicine as a whole quiver, if you will, of things to try against these imbalances.

Dr. Mark Holthouse:

And we do the same thing for men. You know, if they come in with testosterone symptoms, we check their lab and indeed, hey, you're low. We'll both these symptoms and signs corroborating the lab, because there's a lot of guys with really funky labs that have no symptoms. And that's a topic for another day, but we don't necessarily just jump on to treating all of them. With the guys will address the sleep, we know that people that get less than five hours of sleep for a week or more have as much as a 15% drop in their T levels. Who knew? I'm glad I didn't know that Bob in residency, we slept very little. And you know, getting rid of the insulin resistance so we'll focus on the pre-diabetes, we'll get them on intermittent fasting doing some of these kinds of things, lowering insulin, lowering aromatase, lowering inflammation has the effect of raising natural testosterone.

Dr. Mark Holthouse:

And with the guys, we know that if we don't shore up the leaky gut, as we call it, they will have these inflammatory mediators that directly tell the gonad, the testes, hey, shut down the process, don't make any more T. And so it becomes such a broad discussion beyond just here's the needle and here's the vial twice a week, stick yourself and sometimes we do that when we need to as well.

Dr. Robert Rountree:

I'm thrilled that you talk about starting with the gut and I'm sure a lot of men and women that come in with a hormonal problem are going to be a little taken aback. When you say, yeah, it's not your testes I'm concerned about, it's not your ovaries I'm concerned about it's your intestines. To that end, I'm wondering do you ever use calcium D-glucarate as part of your intervention? And maybe if you do explain to our listeners what that is and why you do that?

Dr. Mark Holthouse:

Yeah, we use it all the time. We had a little study time with the providers here. In fact, at noon yesterday on calcium D-glucarate. Calcium D-glucarate is a great little product that you take kind of spread out throughout the day that you know people mistakenly think it's a calcium supplement and I'm like, "Well, it's got calcium in it, but that's not why I'm giving it to you." The way that we get rid of these sex steroid hormones from the liver, we've got a couple of phases of detoxification. The second of which uses a very fancy handle called conjugation.

Dr. Mark Holthouse:

And part of conjugation has to do with escorting these chemicals, steroids in this discussion, out from the bile, the liver into the small intestine where we literally poop the stuff out, if we're doing it correctly. Now, if we've got an imbalance of certain gram-negative bacteria that like to make an excessive amount of an enzyme that messes with this conjugation, we tend to reabsorb estrogen and things like that back into the liver from the gut. And so what calcium D-glucarate does is it tends to hijack that system from occurring so we can actually get rid of the estrogen instead of holding onto it and reprocessing it through the liver.

Dr. Robert Rountree:

So one thing I might point out is that we're not just talking about estrogens made in the body, we're talking about all these xenoestrogens, which means foreign. The xeno is foreign, the xenoestrogens that we're all swimming in from pesticides and phthalates leaching from personal care products and plastics. And so we're living in an estrogen-dominant environment and we're exposed to this stuff all the time. So we're almost all kind of stuck with that scenario unless we do something about it.

Dr. Mark Holthouse:

Yeah, yeah. These pesticides, it's a dirty trick chemically and that they mimic estrogen and that can reek all kinds of havoc with men and women. You know men can have an estrogen dominance as well, manifest a little differently.

Dr. Robert Rountree:

So that kind of brings me to a last question is what's the role of broccoli and brassica vegetables and that whole group, the brussel sprouts and cabbage, and what's in those vegetables that might help with estrogen metabolism. And do you use only foods or do you use supplements to accomplish that?

Dr. Mark Holthouse:

Yeah. Great question. We've talked a lot about how to eliminate and detoxify. There are ways to kind of stack the deck botanically with extracts in therapeutic doses that can actually help the enzymes that determine which way estrogen goes to go down more favorable pathways versus things that can lead to things like breast cancer. And so glucoraphanin and sulforaphane. We have all these fancy names that we give to these things that are derived from broccoli seed. Come to find out you'd have to eat a whole lot of broccoli in and of itself when you've got a real challenge in some of these enzymatic imbalances. So I do-

Dr. Robert Rountree:

A pound or two a day, I think.

Dr. Mark Holthouse:

Exactly. Yeah. I talk on the scale of wheelbarrow loads with some of these whole foods, because people will ask me why can't I just eat fish to get my fish oil? Why can't I just eat broccoli? And a lot of times it comes down to therapeutic dosage. And we know that if you're getting an extract that's pure just derived from these plants we can actually see changes in the downstream metabolites and which ones are formed to bring about better health. And yes, we want people doing rosemary and hops. And it's about that time that the guys say does that mean I get to drink more beer?

Dr. Robert Rountree:

It had to be a lot of beer.

Dr. Mark Holthouse:

There's all of these botanicals that have been isolated and found to have key enzymatic roles either making an enzyme run faster or slowing it down that can help with the basic life stuff that we've been chatting about this morning.

Dr. Robert Rountree:

So sulforaphane is a win in your perspective that sometimes called SGS Sulforaphane Glucosinolate, SGS. And do you use that with diiodomethane or DIM as well? Like you combine the two.

Dr. Mark Holthouse:

Yes, we will combine the two often and whether it's this diiodomethane or other chemicals that have similar effects, the idea is to promote and try to influence the way that they're metabolizing these things. Absolutely. You know, on that same topic, Bob with botanicals and testosterone my favorites to augment lifestyle change have been ashwagandha we like to call that Ayurvedic ginseng. It's an adaptogenic herb that is used for so many things, but there's pretty good science on it, not only improving semen parameters, but also testosterone levels. Along with a couple of other of my favorites, one being mucuna, which is a root and another one is called black seed, nigella-

Dr. Robert Rountree:

Including black cumin?

Dr. Mark Holthouse:

Black cumin seed we use that a lot for folks that have autoimmune Hashimoto's thyroiditis along with ashwagandha, there's some pretty at data on antibodies against the thyroid with both of those. And it just so happens that those are helpful at raising testosterone, along with the mucuna. And you know there's various platforms where you can get these, but some of the things that we initially thought with terrestris tribulus and things like this maca haven't been as robust at helping with testosterone production, although some swear it works. They're a little bit better probably for sperm parameters and quality of semen.

Dr. Mark Holthouse:

Maca has been shown there's many different colors of that, there's red, yellow, black. The yellow and black are great for improved fertility and sub-fertility sperm with guys haven't been shown to do a whole lot though for testosterone levels. A lot of people tout maca as helpful for enlarged prostates and really the only data on that is in rats. We don't have any human data. Where maca is really also helpful though, is just general vigor and moods and all of those things it's been known for.

Dr. Robert Rountree:

Well, I have a feeling that you and I could talk for a couple more hours.

Dr. Mark Holthouse:

I would love to.

Dr. Robert Rountree:

But so maybe we should do the... I think we're going to have to have you come back and continue this conversation. But what you've told us today is that there are a lot more possibilities for dealing with potential hormone problems than most people would think, right? Most people would think, yeah, it's a basic thing, simple thing, our hormone level's low, you check the level and you replace it. So you're saying, well, you may do that, but there's a lot more to it than that. So you've opened a lot of doors and windows for us and I greatly appreciate your time.

Dr. Mark Holthouse:

My pleasure, Bob. Yeah. You know everyone always says, well, do you write prescriptions for hormones? Absolutely. It just takes me a little longer to get there because I'm trying to avoid once we start that often it's a long term deal.

Dr. Robert Rountree:

So people want to follow your work, your research, get into your practice. What's the best way for them to check in with you?

Dr. Mark Holthouse:

Yeah. Probably the best way would just be to search the Functional Medicine of Idaho. And that's it's a www I think it's actually funmedidaho, which is really the reason I took the job I just liked their email. And yeah, you'll see our website if you Google Search Functional Medicine of Idaho and you'll see all of us there and all of our bios and all of that stuff.

Dr. Robert Rountree:

Wonderful. Well, I don't think this will be the last time our listeners hear from you.

Dr. Mark Holthouse:

I would enjoy talking more. I have really enjoyed my time, thank you.

Dr. Robert Rountree:

Terrific. Well, thank you all for listening and until next time. Thanks for listening to the Thorne Podcast. Make sure to never miss an episode by subscribing to the show on your podcast app of choice. If you've got a health or wellness question you'd like answered, simply follow our Instagram and shoot a message to @thorneresearch. You can also learn more about the topics we discussed by visiting thorne.com and checking out the latest news videos and stories on Thorne's Take 5 Daily blog. Once again, thanks for tuning in and don't forget to join us next time for another episode of the Thorne Podcast.