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Hormones and Chronic Lyme Disease

Hormones and Chronic Lyme Disease

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy


As of 2013, the Centers for Disease Control and Prevention estimate that there are approximately 300,000 new cases of Lyme disease per year in the US, which is 10 times more than the number of cases officially reported. And there are potentially many more “victims” who have yet to discover that they have the disease because the symptoms can mimic other disorders, such as arthritis, chronic fatigue syndrome, fibromyalgia, multiple sclerosis, Parkinson’s, and Alzheimer’s disease.

An article entitled “Lyme, Neurotoxins and Hormonal Factors, an interview with Nancy Faass, MSW, MPH,” which appeared in the July 2014 edition of the Townsend Letter, offers further insight into the complexity of diagnosis and treatment. Wayne Anderson, ND, and Robert Gitlin, DO, were the experts interviewed for the article.

Chronic Lyme disease patients experience a myriad of complications that make it difficult to diagnose, much less treat and restore the patient to wellness. Lyme disease patients are likely to be struggling with a whole host of problems beyond the infection from the Borrelia bacteria from the tick bite, including but not limited to co-infections such as Babesia, Bartonella, Ehrlichia, and Mycoplasma, along with assaults from mold toxins, petrochemicals, and heavy metals.

Adding to the complexity, some of the symptoms associated with the Borrelia infection are the same as symptoms caused by hormone imbalance. Dr. Gitlin finds that the vast majority of his Lyme disease patients are in a state of adrenal depletion, which needs to be addressed before addressing other hormone depletions.

In patients with Lyme disease, the hypothalamus is affected by the neurotoxins produced by the infectious agents. The hypothalamus is the master gland that ultimately affects the production of thyroid hormones, as well as the sex and adrenal hormones, so supplementing hormones can help offset the deficiencies.

To make matters worse, when Lyme disease symptoms are present, hormone transitions may be more difficult. Dr. Anderson suggests that, if you are directing your patients with bioidentical hormone therapies and they are not responding, chances are good that this patient also has Lyme disease and should be evaluated further.

Low testosterone levels provide an opportunity for infections to take hold. Starting during perimenopause and continuing after menopause, women get about half of their testosterone from the conversion of adrenal DHEA, as opposed to only about 10% in men. Consequently, menopausal women with Lyme disease will suffer even more than men with this disease.

The sex and adrenal hormones tend to have anti-inflammatory actions, so the decline of these hormones in all Lyme disease patients is even more critical, and some patients will present with chronic pain. Dr. Anderson will treat more aggressively with hormone therapies, in order to take advantage of the anti-inflammatory effects the hormones provide in these situations.

Progesterone and pregnenolone are both adrenal hormones, and are precursors to creating more cortisol and DHEA. Because the chronic stress of Lyme-related infections deplete these hormones, supplementing progesterone, pregnenolone, and DHEA can help.

Some patients with Lyme disease present with liver and/or gall bladder tenderness. Dr. Gitlin observes that, because most hormones are metabolized in the liver, using hormones at this point is likely to fail, and patients will not tolerate the hormones. It would be more prudent to address the infection and other toxicities first.

Low levels of DHEA impair liver detoxification and the flow of bile from the gall bladder. (Bile is needed absorb fats from the diet, and structurally it is related to the sex and adrenal hormones.) As a result, the liver becomes even more congested with toxins. As evidence of this, low DHEA levels and subsequent poor detoxification are also associated with an increased risk of breast cancer.

In addition, magnesium, which is an essential element and necessary for hormone balance, becomes critically depleted in patients with Lyme disease. The presence of mercury, a toxic heavy metal, may also be found with Borrelia infections.

Thyroid optimization is another key in helping Lyme disease patients, but only after adrenal support has been added. Hashimoto’s disease tends to be the result of an inflamed gastrointestinal tract, but a Lyme disease infection may also be part of the problem. In fact, Dr. Gitlin has observed the presentation of Hashimoto’s disease, a low white blood cell count, and an increased bilirubin levels (Gilbert’s disease) pattern, which he thinks may be a hallmark of Lyme disease.

Understanding the impact of Lyme disease on hormones (and vice versa) can help create the perspective needed for successful treatment. Why do hormones not work as effectively in some patients? Why do some women suffer much more at menopause transitions? And why do women tend to be more symptomatic with hormone imbalances than men? Considering the possibility that Lyme disease may be present and addressing the dimensions noted may increase the chance of success.

Hormones and Chronic Lyme Disease2018-04-04T14:58:50-05:00

Reading Your Face: What Can It Tell You About Hormone Balance?

Reading Your Face: What Can It Tell You About Hormone Balance?

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

If you know what to look for, the reflection of your face in a mirror can reveal signs of a hormone imbalance. Let’s start at the top to see what you might find.

If you are losing hair at the crown of your head, you might have a thyroid deficiency. Thyroid hormone affects the thickness of the hair shaft and the abundance of hair. Adequate amounts of the sex hormones, such as the estrogens and testosterone, also contribute to hair luster. Another factor to consider is your diet — your hair might need more minerals and proteins. Insufficient intake of these nutrients in your diet, or the inability to assimilate those nutrients, can also contribute to hair problems. Low stomach acid makes it difficult to absorb minerals and protein. Because digestive enzymes are needed to break down protein so it can be absorbed, supplements may be needed.

If you have thinning eyebrows, or you have lost the outer third of your eyebrows, this is called the “Sign of Hertoghe,” named after the endocrinologist who first made this observation. This is also typically a sign of low thyroid function.

If your eyelids are drooping over your eyes, many people resort to plastic surgery to snip away at the extra tissue. Growth hormone deficiencies contribute to the loss of elasticity of this tissue. Dark circles under the eyes may be related to cortisol deficiency.

If your eyes are constantly dry or watering unexpectedly, it may be due to an inability to build the fatty layer of your tears. Proper production of tears has been shown to be influenced by testosterone, DHEA, progesterone, and the estrogen hormones. See the article “Dry Eyes” in our e-newsletter archives for a more extensive discussion.

Eyelashes are considered a point of beauty in our society. Both hypo- and hyperthyroid states can lead to loss of eyelashes. Sex hormone deficits associated with aging can also contribute to losing eyelashes, and is second only to allergies as a cause of eyelash loss. Having allergies is also an indicator of low adrenal hormones, such has hydrocortisone.

Although you may not readily see it in your face, nasal stuffiness is associated with the ebb and flow of hormones. When estrogens peak mid-cycle, you might find that nasal stuffiness also peaks. If you are also plagued with an itching nose and develop a habit of rubbing your nose in an upward fashion, you may develop a horizontal crease across your nose.

Moving down to the upper lip, let’s look for signs of a problem called melasma. Melasma is hyperpigmentation of the skin associated with hormone disturbances, especially with pregnancy and birth control pill use. Sun exposure may trigger melasma, or make it worse. However, the underlying hormone responsible is melanocyte stimulating hormone (MSH). This hormone increases the production of melanin, which is responsible for darkening the skin.

The upper lip is a frequent location, but you may find dark spots in other areas as well. These are sometimes called liver spots, age spots, or sun spots. An increase in areas of darkened skin can actually be related to adrenal fatigue. As you become stressed, your body produces more and more cortisol to help cope with the stress. As more cortisol is produced, the precursor hormones like progesterone and pregnenolone are depleted, which leaves the estrogens in an unbalanced situation. This extra estrogen stimulation actually increases MSH, which in turn increases the amount of melanin deposited. Re-establishing hormone balance and relieving stress can help prevent this, and may even help reverse it. See the article “The Hormones of Relationship” in our e-newsletter archives for a discussion of how the hormone oxytocin can also help tone down high levels of cortisol.

While you are looking at the lips, do you notice wrinkles vertical to the lips? These wrinkles may indicate an estrogen deficiency, as well as a testosterone deficiency, both of which accompany menopause. Dry or cracked lips are also frequently associated with menopause. It is certainly true that older women do not have the full luscious lips of their youth, and applying lipstick may just emphasize the cracks in the lip tissue. Some advocate treating menopausal lips with a progesterone cream applied directly to the lips. Just as a side note, vitamin D may enhance the effectiveness of progesterone, and vitamin D deficiency is rampant in North America (See our newsletter on Vitamin D for more information.)

And what about one of the most annoying features of menopause, which is the proliferation of chin hairs? You can tweeze, you can shave, you can wax or use a string, you can use lasers and electrolysis, but what is really going on? In general, as women age, the androgen hormones start to predominate, including testosterone, dihydrotestosterone, and androstenedione. These hormones are believed to become more active as other hormones, such as the estrogens, progesterone, and cortisol are depleted.

Chin hair growth is especially egregious if polycystic ovary syndrome (PCOS) has developed. These chin hairs resemble the hairs on our head rather than the soft downy hairs we associate with femininity. The solution should include a careful evaluation of hormone balance. Progesterone deficit likely plays a role. As estrogen levels decline, less of the carrier protein sex hormone binding globulin (SHBG) is produced, which means that more of the testosterone-like hormones are unbound and therefore more active. Restoring estrogen may help as well. Some synthetic drug options include blocking receptor sites for the testosterone-like hormones, or blocking conversion of testosterone to its more active form, dihydrotestosterone.

Another factor potentially contributing to the problem of unwanted facial hair in women is the dysregulation of insulin and glucose, which also occurs with PCOS. Some women have reported diminished facial hair growth with a gluten free diet.

Moving on to the neck area, do you notice any skin tags? These little growths of excess skin are commonly found in the neck area and on the eyelids. Skin tags are also considered to be related to glucose and insulin hormone imbalances. Skin tags are prevalent with metabolic syndrome, pre-diabetes, diabetes, and PCOS. (See our newsletters on Diabetes and PCOS for more information about these conditions.) Although skin tags are painless, and can be easily removed surgically or at home using kits from the pharmacy, skin tags are an indicator of hormone imbalances that can be addressed.

There might also be deposits of fat around the neck, resulting in a double chin or moon face appearance. This appearance has been linked to glucose and cortisol imbalances, and diminished thyroid function. The neck can also be flabby, like waddles on a turkey neck, or have lines of extra skin. Solutions may include neck exercises, yoga, and surgery. However this neck tissue is thin and changes quickly become apparent with losses in hormones, such as progesterone, pregnenolone, and DHEA.

Now let’s look at your face overall. Is your skin pale? Thyroid hormone ensures blood circulation to the skin and, when it is compromised, pallor is evident, rather than a healthy rosiness. Are your cheeks sagging? The androgenic hormones such as DHEA, testosterone, dihydrotestosterone, and growth hormone may be deficient.

Is your skin dehydrated, as in shriveled and shrunken, or plump? If it is dry, an obvious cause may be that you are not drinking enough water. Additionally, according to Dr. David Brownstein, you may not be using enough natural whole salt. The many minerals available in whole salt allow the body to hold on to the water in the cells. And there’s a hormone connection: if you are not getting enough salt and water, the adrenal glands suffer and eventually become exhausted. The hormones affected include DHEA, progesterone, cortisol, aldosterone, the estrogens, pregnenolone, and testosterone. Furthermore, adequate thyroid function is dependent upon the adrenals.

Looking at your face in the mirror can provide clues about your hormone health, especially as you age. Your face is a reflection of potential hormone issues that affect your entire body. (See more about age-related health issues in our Successful Aging newsletter on our website.) Take notice of the changes you might first see in your face, then work with your healthcare practitioner to restore your hormone balance. Your face, as well as the rest of your body, will reflect the results.

Reading Your Face: What Can It Tell You About Hormone Balance?2018-04-09T14:31:59-05:00

Low-Dose Naltrexone: Treating Pain and More

Low-Dose Naltrexone: Treating Pain, Autoimmune Disorders, Cancer, and More

By Kathy Lynch, PharmD – Women’s International Pharmacy

low-dose naltrexone image of spoonful of pillsThe late Dr. Bernard Bihari discovered and developed the therapeutic use of low-dose naltrexone (LDN) in the mid-1980s while practicing internal medicine in New York City. He was treating drug addicts with a new drug, Naltrexone, which blocked the heroin “high.” Unfortunately, 50 milligrams daily had unpleasant side effects. When his addicts started dying from AIDS, he began to search for a drug that would help them.

Dr. Bihari knew that endorphins, small neurochemicals produced by the body, had pain-relieving, anti-inflammatory properties. Dr. Bihari and his colleagues hired a lab scientist to measure patient endorphin levels. He discovered that his HIV patients had sub-normal endorphin levels. His team determined that LDN doses ranging from 1.75 to 4.5 milligrams increased endorphin levels by two to three hundred percent. By blocking the body’s endorphin receptors, LDN caused an overproduction of endorphins.

Dr. Bihari then started a small foundation to study the use of LDN in HIV patients. After one year, he discovered that the patients who took LDN had an eight percent death rate while patients taking placebo had a thirty-three percent death rate. He and his colleagues went on to treat hundreds of patients with LDN.

Endorphins have a positive effect on the immune system by increasing T-helper and natural killer cells. Not only does LDN help people with autoimmune diseases like multiple sclerosis (MS), it also seems to be beneficial as an adjunct treatment for certain types of cancer. Cancer cell surfaces have receptors for endorphins. When Dr. Bihari gave a few cancer patients LDN, their tumors shrank and they remained in remission. Dr. Bihari attributed this success to LDN’s ability to increase natural endorphin levels which in turn attach to cancer cells, causing them to die.

Today LDN is used around the world to treat pain, fibromyalgia, MS, autoimmune diseases, cancer, Crohn’s disease, autism, AIDS, and other disorders. It is particularly popular in Europe. To learn more about current LDN research go to https://www.lowdosenaltrexone.org. LDN is available only from compounding pharmacies. Call and speak to a pharmacist for more information.

Low-Dose Naltrexone: Treating Pain and More2017-11-07T14:39:28-05:00

Hormones and Traumatic Brain Injury

Hormones and Traumatic Brain Injury

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy


Traumatic brain injury (TBI) is an area that has received little clinical attention—until now.

Medical researchers are now studying the impact of acute injury on the pituitary and the hypothalamus, two important hormone-producing glands in the middle of our brains.

The staggering number of soldiers returning from the wars in Afghanistan and Iraq with head injuries caused by improvised explosive devices prompted medical researchers and practitioners to review the literature for anything that would help these veterans recover. A 2010 update to a literature review in Future Neurology notes that there are literally hundreds of studies regarding the “neuroprotective” effects of progesterone and its metabolites, with most of these studies being published in the last few years. In particular, two clinical trials demonstrated the effectiveness of using progesterone to successfully treat patients with moderate-to-severe head injury, resulting in sparing the lives of about 50% of those treated. This revelation provided a ray of hope for both practitioners and veterans.

The picture gets much bigger when you factor in the many others suffering from lingering brain injuries. Each year, approximately two million Americans suffer from some sort of brain injury, ranging from mild (such as concussions) to severe, due to childhood head injuries, car accidents, sports, and even childbirth. A sudden impact to the head from external forces, or even sudden acceleration or forceful rotation, can cause an acute TBI with effects lasting anywhere from a few hours to becoming a life-long condition.

Medical researchers are now studying the impact of acute injury on the pituitary and the hypothalamus, two important hormone-producing glands in the middle of our brains. What they are finding is that long after a brain injury, and even when brain scans show no physical distortions after healing has occurred, the hypothalamus and pituitary may never fully recover. The consequences of this can be far-reaching because the hypothalamus and pituitary glands are master glands that signal the proper production of thyroid, adrenal, and sex hormones.

The resulting hormone imbalances cause a number of psychological, physiological, and physical symptoms. Some of these are depression, angry outbursts, anxiety, mood swings, memory loss, inability to concentrate, learning difficulties, insomnia, increased risk for heart attack and stroke, high blood pressure, diabetes, loss of libido, menstrual irregularities, premature menopause, obesity, loss of lean body mass, muscular weakness, and more. Practitioners working with an aging population will easily recognize these symptoms as those that mirror declining levels of TSH and thyroid hormones, DHEA and corticosteroids from the adrenal glands, and estrogens and testosterone from the ovaries and testes. These symptoms are also beginning to be recognized as associated with TBI, as well.

Dr. Mark Gordon of the Millennium Health Center in Los Angeles was among the first to make a connection between the symptoms of TBI and pituitary dysfunction, and to incorporate that discovery into his clinical practice. According to an article in the January 2012 Life Extension magazine, Dr. Gordon employs a comprehensive laboratory test panel that covers all pituitary-related hormones when treating patients with brain injury. For direct testing of pituitary hormones, he looks at growth hormone (HGH), luteinizing hormone (LH), thyroid stimulating hormone (TSH), adrenocorticotropic hormone (ACTH), follicle stimulating hormone (FSH), and insulin-like growth factor (IGF-1) levels. He also orders tests for the secondary hormones (i.e., those produced from the thyroid, adrenal, ovary, and testes glands) including T3 and T4, cortisol, testosterone, and estrogens.

Dr. Gordon and others believe that growth hormone is particularly important because it is also neuroprotective, meaning that it enhances the survival of damaged nerve cells and even promotes the creation of new nerve tissue. Declining growth hormone has been associated with cognitive decline and memory loss, symptoms which may persist after a brain trauma.

An interesting study published in the Journal of Neurotrauma tracked cortisol, progesterone, testosterone, estradiol, and pituitary FSH and LH in men and women who had suffered traumatic injuries in car accidents, taking measurements each day after the accident. The authors noted that FSH and LH declined steadily, as did progesterone, and that these results indicated damage to the pituitary gland, which could continue chronically. They suggested that progesterone treatment might be appropriate in both men and women, but cautioned that such treatment would also affect other hormones. They also noticed that a rise in estradiol in men and a rise in testosterone in women after the trauma seemed to predict a poor outcome. In another study mentioned in the literature review update in Future Neurology, the authors reported finding that combining progesterone and vitamin D provided better outcomes, because progesterone was not as neuroprotective when a vitamin D deficiency existed.

We are fortunate to have access to hormones that can fill in these deficits and perhaps significantly improve the quality of life for the millions of people suffering from traumatic brain injuries. Unfortunately, we are sometimes hindered by the gap in time before the information gathered by research is put into practice for patients. If you have had a past head injury, it is very important to make your practitioner aware of it, especially if you suffer from any of the symptoms mentioned. In addition, requesting broader hormone lab tests may provide some answers.

Hormones and Traumatic Brain Injury2017-12-14T14:48:42-05:00

Book Review – Venus on Fire, Mars on Ice

Book Review – Venus on Fire, Mars on Ice: Hormonal Balance – The Key to Life, Love and Energy by John Gray, PhD

Written by Carol Peterson, RPh, CNP – Women’s International Pharmacy

In his book Men are From Mars, Women are From Venus, Dr. John Gray focused on the differences between men and women; in Venus on Fire, Mars on Ice he delves into why those differences occur. Dr. Gray explains that, not only do we need a balance of hormones for managing PMS, post-partum depression, menopause, and andropause, but hormone balance also has a great impact on our relationships. Specifically, coping mechanisms for stress affect our relationships, and hormones play a vital role in the different ways men and women use to deal with stress.


Due to unrelenting demands of life in the modern world, many men and women are constantly stressed. As a result, cortisol production–which is designed to reach peak levels when challenged with an emergency and then quickly drop down–stays at a high level. A chronic high level of cortisol may contribute to emotional instability (among other things), which can affect relationships.

When trying to reduce or deal with stress, men release testosterone and women release the pituitary hormone oxytocin. High cortisol levels may interfere with normal production of both testosterone and oxytocin, hampering both men and women from their attempts at stress reduction.

Testosterone and Oxytocin

When a man’s testosterone level is adequate, it allows him to react in urgent situations where he needs to focus keenly, step up, and solve a problem. In fact, solving problems may cause some men’s testosterone levels to actually rise, while simultaneously lowering stress hormones like cortisol.

While small amounts of testosterone will also help women feel good, too much will actually increase their stress levels. Higher testosterone levels in women might be useful for competition, such as in the workplace, but sustained high levels of testosterone take a toll. When women get home from work, their stress levels may rise as they face the pressures of all the things that need to be done.

In contrast with the use of procrastination to increase testosterone in men, planning ahead stimulates oxytocin release in women. For women, a release of oxytocin makes them feel safe and nurturing, feelings that in turn encourage oxytocin levels to rise further. On the other hand, oxytocin doesn’t help men deal with stress and can even bring their testosterone levels down.

Insulin and Serotonin

Other fundamental substances that play an important role in relationships include the hormones insulin and serotonin and their interaction with glucose (blood sugar). Every cell in the body needs a consistent supply of glucose to function, and insulin controls how it is utilized. The brain is particularly sensitive to fluctuations in blood sugar, altering our moods, decision-making abilities, and other aspects of behavior that can affect interpersonal relationships.

When blood sugar drops, the production of serotonin (which has a calming effect) also drops. To make matters worse, the body responds to the low serotonin levels by producing more cortisol, which increases anxiety.


Dr. Gray believes that understanding these basic hormonal differences in each other is the key to maintaining loving relationships. Aging leads to lower levels of testosterone and oxytocin, as well as increased insulin resistance and low serotonin levels. This creates even more difficulty in dealing with stress, and makes hormonal balance even more critical. Dr. Gray suggests that diet and lifestyle are important building blocks to producing and maintaining these hormones in proper balance.

Book Review – Venus on Fire, Mars on Ice2018-07-10T17:41:01-05:00

Can Testosterone Protect Against Breast Cancer?

Can Testosterone Protect Against Breast Cancer?

Written by Kathy Lynch, PharmD – Women’s International Pharmacy


Compounded testosterone therapy for women has been prescribed for years in this country. Since testosterone can convert to estrogen in the body, practitioners are sometimes hesitant to prescribe it, thinking that testosterone might increase a woman’s chance of getting breast cancer.

Dr. Rebecca Glaser and her colleague Constantine Dimitrakakis set out to examine this assumption. They designed the Testosterone Implant Breast Cancer Prevention Study to explore the relationship between testosterone subcutaneous implants and breast cancer. This study looked at 1,268 pre- and postmenopausal women who received either testosterone or testosterone-anastrozole (an estrogen blocker) implants. These same women were not using systemic estrogen therapy.

While the time period for this study is ten years, an analysis conducted at the five-year mark reported a breast cancer rate that was less than 50% of the rate reported in previous menopausal hormone replacement therapy studies. Study participants who most closely adhered to the testosterone regimen experienced an even lower rate of breast cancer. According to the National Cancer Institute’s surveillance program, more than twice as many cases of breast cancer would be expected in this particular study population if no specific interventions were made.

Dr. Glaser believes that these interim study results support her theory that testosterone use does not increase the occurrence of breast cancer. Further studies are warranted. Different dosage forms, as well as the possibility that testosterone therapy might protect against breast cancer, should be studied.

Can Testosterone Protect Against Breast Cancer?2018-04-03T17:20:42-05:00

Why Do We Get Hemorrhoids?

Why Do We Get Hemorrhoids?

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy


Hemorrhoids are very common. At least we think so. It is difficult to get a handle on the prevalence of hemorrhoids since they can come and go. Many Hemorrhoids bathroomhemorrhoid sufferers will find relief from over the counter and home remedies, but some will be so miserable they will seek help from a health care practitioner. Hemorrhoids tend to be a sensitive subject. People just don’t like to talk about them.

Hemorrhoids Defined

Hemorrhoids can form above and below the rectal sphincter. If you can imagine, hemorrhoids are like varicose veins in the rectum. The veins weaken and swell. If the swollen veins are located above the rectal sphincter, they may cause few problems, but you might see bright red blood in the stools if they happen to bleed. Hemorrhoids above the rectal sphincter may begin to cause pain if the tissue prolapses which means the hemorrhoid falls below the rectal sphincter.

Hemorrhoids can also form outside of the anus below the rectal sphincter. These hemorrhoids tend to cause the most problems with pain and itching. They can also bleed. It is possible the pooling of the blood in the swollen veins may cause a blood clot or thrombus to form. The common name for hemorrhoids, “piles” (from Latin pillae meaning balls), comes from the observation of the small balls these clots form in the swollen veins.

Theories Abound

Why hemorrhoids form is still a mystery. Hemorrhoid formation may be associated with standing or sitting for long periods of time, obesity, and straining while defecating with constipation or diarrhea. Hemorrhoids also often occur during pregnancy. The exact genesis is not clear whether it is the added pressure to the pelvic region by the baby, the changes in hormones which occur during pregnancy, the straining which occurs at delivery, or perhaps a combination of all of these.

Some say that being human and walking on two feet is a risk factor for hemorrhoids; however, this is not a health issue that only occurs in humans. Dogs, cats, horses, cattle, and sheep have all been identified to suffer from hemorrhoids on occasion. Moreover, a rat model for hemorrhoids was easily created by exposing the rat’s anal tissues to an irritating oil.

Along with the cause of hemorrhoids, a number of trends have yet to be explained:

  • There may be a hereditary component in some families
  • Women with hemorrhoids during their first pregnancy often have them again in subsequent pregnancies, but the hemorrhoids then disappear once the baby arrives
  • Hemorrhoids don’t seem to occur in the young or in the elderly

Hemorrhoids and Hormones

How hormones play a role in the formation of hemorrhoids is complicated. For example, constipation is a hallmark symptom of low thyroid function. Connective tissue weakness is also a sign of low thyroid. Is the constipation the direct cause of hemorrhoid formation or is there some innate laxity in the tissue associated with hypothyroidism that causes hemorrhoids to form? Or perhaps a combination of both?

As early as 1942, a theory existed that proposed the high levels of progesterone and estrogens that occur during pregnancy may contribute to the formation of varicosities in the legs and also to hemorrhoids:

  • Increased progesterone was thought to be responsible for decreased tonicity in the vascular walls of the veins
  • Increased estrogens were thought to increase blood volume putting greater stress on venous blood circulation and leading to increased stagnation and pooling of the blood

However, as Dr. de Barros and his colleagues point out in their paper, “Pregnancy and lower limb varicose veins: prevalence and risk factors,” this does not account for the fact that varicosities can occur in one leg and not the other under the same hormonal control.

Confounding Observations

Interestingly, not all studies show the same results with regard to hemorrhoid risk factors. A September 2015 study published in PLOS ONE revealed a lower risk of hemorrhoids with a high fiber diet as have other studies. However, the reduced risk of hemorrhoids was not associated with less constipation, and the number of pregnancies a woman experienced did not affect the risk of hemorrhoids one way or the other. Surprisingly, being sedentary even correlated with a decreased risk of hemorrhoids.

Treatment of Hemorrhoids

Hemorrhoids may come and go without a clearly identified cause or remedy. However, when hemorrhoids and the associated pain become serious, most seek help from a professional. Surgical procedures such as cauterization (burning the hemorrhoids) and ligation (banding or clipping the hemorrhoids) are part of the practitioner’s medical bag to bring relief. As welcome as the relief may be, these procedures do not prevent hemorrhoids from returning and do not address the underlying cause.

Numerous home remedies may also bring some relief:

  • Apple cider vinegar and witch hazel are astringent and may help relieve the swelling
  • Hydrocortisone and even progesterone creams applied to the area may relieve inflammation
  • Whether or not constipation is a cause of hemorrhoid formation, more fiber, more hydration, and any techniques to create softer stools are likely to reduce irritation to the tender tissues
  • Soaking in warm bath water or a sitz bath may ease the pain, and Epsom salts can be added for additional magnesium
  • Cold packs may be used to help reduce inflammation and shrink the hemorrhoids

Joanne May, Doctor of Oriental Medicine, says, “It’s simple.” She feels hemorrhoids are caused by a spleen qi deficiency. In Traditional Chinese Medicine, it is the spleen which governs the muscles and organs, and a deficiency of qi may cause an overall muscle weakness including the muscles lining the veins. Hemorrhoids are thought to be a sagging or prolapse of these muscles. Dr. May recommends using herbs to strengthen or tonify the muscles.

In conclusion

It’s astonishing something as common as hemorrhoids still poses such a mystery to our medical community. Researchers are working diligently to find the answers to our questions about hemorrhoids. Hopefully, these answers will come soon. Hemorrhoid prevention will bring great relief to many.

  • Azeemuddin M, et al. An Improved Experimental Model of Hemorrhoids in Rats: Evaluation of Antihemorrhoidal Activity of an Herbal Formulation. ISRN Pharmacol. Volume 2014 Mar 11;2014:530931. doi: 10.1155/2014/530931. eCollection 2014.
  • De Barros N, et al. Pregnancy and lower limb varicose veins: prevalence and risk factors. J. vasc. bras. [online]. 2010;9(2): 29-35.
  • Peery AF, et al. Risk Factors for Hemorrhoids on Screening Colonoscopy. PLoS One. 2015 Sep 25;10(9):e0139100. doi: 10.1371/journal.pone.0139100. eCollection 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4583402/pdf/pone.0139100.pdf.
  • May, J. Personal conversation: December 23, 2015.\
  • Petersen C. Hypothyroidism: Is 98.6° Really Normal? Women’s International Pharmacy. https://www.womensinternational.com/connections/thyroid-hypothyroidism/.
Why Do We Get Hemorrhoids?2018-04-05T11:28:03-05:00

Testosterone in Women

Testosterone in Women – A Commentary

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy


Professor Susan Davis is a women’s health researcher. In 2005 she became the inaugural Chair of Women’s Health in the Monash University Department of Medicine at the Alfred Hospital in Melbourne, Australia. In addition, she is a consultant endocrinologist at Alfred Health and Cabrini Medical Centre, also in Melbourne.

Professor Davis has been involved in the study of the role of estrogens and androgens (e.g., testosterone and DHEA) in women. She has been investigating the effects of hormones throughout the body, rather than just how they affect reproductive functions. She has published over 300 peer-reviewed articles. She is indeed a giant in the world of research involving the use of testosterone in women.

In December of 1999, Dr. Davis published a commentary on the nature of testosterone replenishment in women. Almost 20 years has passed since this commentary was published, yet not much seems to have changed. Scientists and physicians are still unclear on what actually constitutes a deficiency of testosterone in women. The clinical picture of a woman with adequate testosterone has not been established or agreed upon. There is no agreement on how low testosterone levels must be before action is taken.

The following is a brief synopsis of a number of subjects taken from Dr. Davis’s commentary.

Declining Testosterone

It is well established that testosterone and DHEA production steadily declines with aging. There are also a number other reasons testosterone levels may be low:

  • 50% of testosterone production is lost when the ovaries are removed (oophorectomy) as part of a “complete hysterectomy.”
  • Chemical damage to the ovaries produced by chemotherapy in cancer treatments.
  • The use of estrogen only hormone therapies and oral contraceptives. Both increase sex hormone binding globulin (SHBG), which binds testosterone and prevents the body from using it.
  • Treatment with corticosteroid drugs like prednisone turns off the production of adrenal testosterone. This may be the cause of osteoporosis when using these drugs. It has been established that the best bone mineral density levels are associated with strong levels of testosterone and DHEA.
  • Premature ovarian failure.
  • Loss of cycling due to lost signaling from the hypothalamus.


It has been established that adequate testosterone levels are associated with sexual interest in a way that estrogen levels are not. However, because sexuality is complicated and multi-faceted, using libido and sexual activity as distinct markers for adequate testosterone levels is not reliable. One should also consider vaginal atrophy, pain during intercourse (dyspareunia), loss of interest in a partner, or other psychological factors as contributors to sexual dysfunction.

Bone Loss

Bone loss may continue to occur even with estrogen and progesterone supplementation. When testosterone supplementation is added, bone growth may be restored. Some suggest that testosterone acts as a prohormone for estrogens and that this interplay must be in effect for good bone health.

Body composition

In general, muscle mass declines in the elderly and fat mass increases. Testosterone has been demonstrated to improve muscle mass in postmenopausal women. Additionally, testosterone has been effective in restoring muscle mass in both immune compromised men and women.

Autoimmune disease

Women are more prone to autoimmune diseases. It has been theorized that the higher testosterone levels enjoyed by men contribute to this gender difference. Testosterone replacement has been used successfully in diseases such as autoimmune rheumatoid arthritis.

Premenstrual Syndrome (PMS)

Below average levels of circulating testosterone have been identified throughout the entire menstrual cycle in some women who have PMS symptoms. In Australia and the UK, testosterone has been used for treatment of PMS.

Forward to 2015

In 2015, Dr. Davis published another review article. She added cognition, cardiovascular health, and vaginal integrity, including pain relief to her documentation. She cites numerous studies about the anti-proliferative effect of testosterone in breast and ovarian cancer, but points out it is difficult to draw conclusions without considering the effects of multiple other hormones, including estrogens. In spite of testosterone being a much more prevalent hormone than even estrogen in women, we still don’t know much about its effects. Dr. Davis says that research in women lags about ten years behind where it should be. Too many studies are small and limited in their scope, making solid conclusions impossible.

In Closing

In spite of several attempts to obtain FDA approval for gels and patches delivering testosterone replenishment for women, nothing has been approved. This appears to be due to a lack of consensus on the function of testosterone in women. However, testosterone has been available to women for decades with the assistance of compounding pharmacists. Testosterone can be prescribed in oral capsules, creams, gels, suppositories, drops, troches, pellet implants, and injectables. Thanks to compounding pharmacies, practitioners may choose to treat each of their patients’ testosterone deficiencies and monitor the effects — one patient at a time.

  • Davis SR. Androgen Replacement in Women: A Commentary. J Clin Endocrinol Metab. 1999; 84(6): 1886-91.
  • Davis SR. Testosterone in Women: the Clinical Significance. Lancet Diabetes Endocrinol. 2015 Dec;3(12):980-92. doi: 10.1016/S2213-8587(15)00284-3. Epub 2015 Sep 7.
Testosterone in Women2017-12-14T15:41:59-05:00

Chronic Fatigue Syndrome Gets a Name Makeover

Chronic Fatigue Syndrome Gets a Name Makeover

Written by Kathy Lynch, PharmD – Women’s International Pharmacy

In February of 2015, the Institute of Medicine (IOM) put forth a proposal to change the name and the diagnostic criteria for chronic fatigue syndrome (CFS). People who suffer from this condition are often made to feel that their symptoms are psychological or a figment of their imagination. Patients may see multiple practitioners in an attempt to find symptom relief for their CFS.

The name “chronic fatigue syndrome” was coined by the Centers for Disease Control in 1988. The Europeans prefer to call this condition myalgic encephalomyelitis (ME) which focuses on central nervous system (CNS) inflammation with muscle pain. Many experts now call this condition ME/CFS.

Since CNS inflammation and muscle pain are not universal components of ME/CFS, an IOM panel undertook the task of defining the major symptoms suffered by people with CFS. They concluded that the most prominent and universal symptom of CFS is a lingering depletion of energy after minimal physical and/or cognitive exertion. The panel recommended that CFS be renamed systemic exertion intolerance disease (SEID) or post-exertional malaise (PEM) for short.

The panel proposed the following diagnostic criteria:

  • Extreme fatigue lasting more than six months
  • Post-exertional malaise
  • Unrefreshing sleep
  • Either cognitive impairment or orthostatic intolerance (symptoms made worse by standing and relieved when reclining)

Wisconsin researchers recently published an interesting study in this area. Thirteen CFS patients and 11 healthy controls exercised to their maximal capacity. Researchers obtained blood samples and administered symptom questionnaires before and up to 72 hours after exercise. They measured gene expression for metabolite, cortisol, adrenaline and immune system receptors. Individuals with CFS had a significant increase in the number of cortisol and adrenaline receptors up to 72 hours after exercising compared to control subjects.

Could low cortisol levels be a factor in CFS? A review of multiple scientific studies found significantly low cortisol levels in people with CFS. Hydrocortisone supplementation may be an important piece of the recovery puzzle for people with chronic fatigue.

  • Tuller D. Chronic Fatigue Syndrome Gets a New Name. The New York Times. https://well.blogs.nytimes.com/2015/02/10/chronic-fatigue-syndrome-gets-a-new-name: February 10, 2015.
  • “Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Key Facts” by Institute of Medicine of the National Academies.
  • Meyer JD, et al. Post-exertion malaise in chronic fatigue syndrome: symptoms and gene expression. Fatigue: Biomedicine, Health & Behavior. 2013; 1(4): 190-209.
  • Lineke M, et al. Meta-analysis and meta-regression of hypothalamic-pituitary-adrenal axis activity in functional somatic disorders. Biol Psychol. 2011; 87: 183-194.
Chronic Fatigue Syndrome Gets a Name Makeover2018-04-02T16:18:01-05:00

Book Review – The Upside of Stress by Kelly McGonigal

Book Review – The Upside of Stress: Why Stress is Good for You and How to Get Good at It by Kelly McGonigal, PhD

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

Stress is bad, right? It damages our body, causes depression, shortens our lives…the list goes on and on. We say things like, “All this stress is giving me an ulcer!” or, “This stress is killing me!” Your practitioner, if unable to pinpoint the source of your malady, may advise that you reduce your stress level. We have whole industries designed to decrease stress in our lives: yoga classes, meditation courses, massage therapy, breathing exercises, exercise, and life style coaching.

Dr. Kelly McGonigal urges us to rethink the idea that “stress is bad” in her book, The Upside of Stress: Why Stress is Good for You and How to Get Good at It. Dr. McGonigal is a health psychologist who teaches at Stanford’s School of Medicine Health Improvement Center and the Stanford Center for Compassion and Altruism.

A Little History
Dr. Hans Selye, an endocrinologist, found that introducing any sort of unpleasant experience produced a loss of muscle tone, ulcers, immune breakdown, and ultimately death in his lab rats. Having already seen human patients who experienced similar breakdowns in their health, he drew from his observations and his rat experiments to define stress as any demand made on the body. Further, he felt that just about anything that happened to someone in life (good or bad) was toxic.

Dr. McGonigal argues that Dr. Selye’s definition is much too broad. She believes there is a huge difference between the body’s response to near death experiences and electric shocks as the lab rats endured (she calls it The Hunger Games for rats!), and the everyday stresses of living life in the modern world that humans commonly experience.

Fight or Flight
The classic description of the body’s response to stress is “fight or flight.” The body reacts to a stressor by stopping all non-essential processes, like digestion and fertility, and releases a flood of energy and oxygen needed to flee a dangerous situation or to fight for survival. Although this process has served human beings and other animals well throughout millennia in their survival efforts, “fight or flight” may not be always appropriate in modern life. It isn’t very effective to run away from a disagreement with your boss or an argument with your spouse, and it isn’t possible to fight for survival against past due bills or an IRS audit. Dr. McGonigal points out our stress responses have adapted over time and aren’t limited to this one “fight or flight” response. We have developed many more coping strategies.

A More Finely Tuned Stress Response
Dr. McGonigal describes three types of stress responses in addition to “fight or flight,” which all serve to handle stress in such a way that may have a positive effect on the body:

  • Rise to the Challenge: This stress response allows us to focus our attention, heightens our senses, increases motivation and mobilizes our energy. This stress response is of benefit, for example, to an athlete who is about to compete.
  • Connect with Others: This stress response activates the need to protect our tribe and dampens fear and increases courage.
  • Learn and Grow: This stress response helps us integrate experiences and helps the brain learn.

The Main Stress Hormones
The hormones cortisol (also called hydrocortisone) and DHEA produced by the adrenal glands are considered the primary responders to stress. The outpouring of these hormones can affect the body positively rather than negatively. For example:

  • Research has shown that supplementing these stress hormones to enhance the stress response has been beneficial to those with post-traumatic stress disorder (PTSD) and panic attacks.
  • Psychiatrists have begun using these stress hormones before a therapy session and surgeons before surgery to improve outcomes.
  • Experiments designed to measure stress hormone responses find that those with the largest increase in DHEA are the most resilient under stress. DHEA can act as a neuro-steroid and actually help your brain grow stronger after stressful events.

Many More Hormones
While cortisol and DHEA are the main stress hormones, there are a number of other hormones involved in the body’s stress response.

  • Adrenaline (also called epinephrine) pours out of the adrenal glands with cortisol and DHEA, and serves to activate and focus our senses. The pupils of the eyes dilate to let in more light and hearing sharpens. The liver starts to dump fats and sugars into the blood stream to provide more energy for the brain and the muscles.
  • The release of endorphins, testosterone, and dopamine, along with adrenaline, actually provides a feeling of exhilaration that many find enjoyable. This “adrenaline rush” is the feeling thrill seekers are after when they skydive or ride roller-coasters.
  • Oxytocin is produced by the pituitary gland. Oxytocin increases our ability to bond with others and during times of stress, it allows our courage to dampen our fear. Interestingly, heart tissue contains many receptors for oxytocin which allow for regeneration and repair. Many believe that stress will give you a heart attack; however, the outpouring of oxytocin may actually strengthen your heart.

The Mindset
Early in her career, Dr. McGonigal , like many, believed that stress produces negative effects in the body. Then she came across a study that she just couldn’t reconcile with her belief system. This study documented that people who were exposed to stressors had different outcomes dependent upon their mindset about stress. If people believed stress was bad and produced unhealthy effects, it was so. If people believed stress was a part of life and a challenge to meet, they were healthier and even had enhanced life spans when compared to those with low levels of stress.

After this, Dr. McGonigal turned her career around. She no longer teaches fear of stress and stress management. She sums up her change in mindset in the introduction of her book: “The latest science shows that stress can make you smarter, stronger and more successful. It helps you learn and grow. It can even inspire courage and compassion.” She shares the tools to change one’s mindset in her book. Better yet, science shows that mindset is malleable for all of us.

Book Review – The Upside of Stress by Kelly McGonigal2018-05-02T11:18:19-05:00