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Hormones, Probiotics, and the Human Microbiome

Hormones, Probiotics, and the Human Microbiome

Adapted from the Connections eBook Probiotic Potential

Written by Carol Petersen RPh, CNP 
Reviewed and Updated by Michelle Violi PharmD 
Published by Women’s International Pharmacy

The microbiome organ is a collection of microbes or single-celled microorganisms—called microflora—that live on and in the body. The human body contains 100 trillion cells, and 90% of them are not even our own—nearly all of these are bacteria; the rest are yeasts and parasites. These microbes are incredibly diverse in size, shape, col­or and growth rates, and may include as many as 1,000 different species.

Among our body’s microbes you will find:

  • The “good” – Probiotics like Lactobacillus, a strain of bacteria commonly found in yogurts with active cultures.
  • The “bad” – Bacteria that usually result in serious illness, such as Salmonella.
  • The “risky” – Several bacterial species that are beneficial when they are in the right place and quantity, but may lead to health issues if their numbers are unbalanced or if they are located in the wrong part of the body. For example, species of Klebsiella make vitamins B12 and K when they’re in the small intestine, but may cause pneumonia when they’re inside the lungs.

The microbiome begins developing at birth and changes throughout our lifetime. Environment plays a larger role in determining microbiome makeup and health than genetics, which explains why members of the same household may have similar conditions even without being genetically related.

Microbial imbalance in our gut can affect other systems in our body, including our hormonal system. The digestive system plays an important role in the proper disposal of es­trogens from the body. When the flora in the intestines is disturbed, estrogen that should be excreted may instead be recycled into the bloodstream, creating hormone imbalance.

The development and changing of the microbiome over time may coincide with other physical changes. Many major life changes such as puberty, pregnancy, and menopause that affect the microbiome also affect hormone balance: University of Utah’s webpage Your Changing Microbiome provides just a few examples, saying: “puberty affects skin microbes by causing changes in skin oils. And pregnancy brings on changes in the vaginal microbiome: species start to grow that will colonize and benefit the baby as it’s born.”

Optimizing Microbiome Health to Maintain Hormone Balance

A probiotic—literally, “for life” in Greek—is defined as “a preparation or a product containing a sufficient number of live microorganisms to alter the flora of the host and bring about beneficial health effects.” In short, probiotics are “friendly” bacteria (and sometimes fungi) that we import into our system to hold more dangerous mi­crobes in check. A growing number of scientific studies have found that probiotics may aid both digestive and immune system health.

Yogurt, aged cheese, and many other cultured and fermented foods make up this category of “superfoods.” Probiotic foods or supplements are generally safe and widely available. Most people find them both tasty and easy to digest.

In general, probiotics promote healthy diges­tion. Microbes in the intestines make short-chain fatty acids (needed for GI tract health), antioxi­dants, amino acids, and vitamin K. Nutrients in fermented foods absorb more readily than nutrients in unfermented foods. Fer­mented foods use agents such as yeast, bacterium, molds, or enzymes to break down a substance into simpler substances; examples include converting milk to yogurt or cheese, fermenting soy to make miso, and fer­menting cabbage to make kimchi or sauerkraut.

Getting a beneficial effect for individ­ual health need depends on various factors, including:

  • The strain of probiotics selected and how the body can use it
  • The numbers of live probiotics in the pur­chased product, and whether they are stored and taken properly

Safety, Storage, and Use of Probiotics

Probiotics are safe for the majority of people, except for those at high risk for infections of all types (such as those with HIV/AIDS or cancer), or those taking immune-suppressive steroids. It is always advisable to check with your prac­titioner before taking any new supplements, as probiotics do have the potential to interact with some medications. Moreover, your practitioner can help you select the probiotic that is best suited to treating your particular condition, notes Dr. Kelly Dowhower Karpa in the book Bacteria for Breakfast: “You may have to search for the right probiotic, the appropriate number of microorganisms, or the necessary combination of probiotics until you find the right mix to successfully fill the bacterial niche missing in your gastrointestinal tract.”

Whether taken by pill (as a supplement) or by plate (in food), either form of probiotics can be effective as long as proper procedures of storage and ingestion are followed. Although it might seem that pill supplements would be required for the lactose-intolerant, that is not neces­sarily the case. Probiotics have been shown to help break down lactose, reducing symptoms of the illness and allowing sufferers to reintroduce dairy into their diet—at least in the form of yogurt and other fermented products.

Any form of probiotic should be purchased with care to ensure you are receiving the promised strain and quantity of live bacteria (or, in some cases, fungi), and that it has been properly stored. Foods containing live cultures must be kept refrigerated, and storage dates must be strictly followed. In Acidophilus and Your Health, author Frank Murray includes this advice when purchasing yogurts:

  • Always purchase yogurt with “live, active cultures,” including Lactobacillus acidophilus
  • Avoid frozen yogurt or pudding-style yogurts, which have stabilizing chemicals and artificial sweeteners added


Probiotics play an integral part in many of the body’s functions, including:

  • Microbiome health
  • Proper digestion
  • Hormone balance
  • Strengthening the immune system
  • Prevention of allergy development

When trying to incorporate dietary or supplemental probiotics into your lifestyle, recommendations from your healthcare practi­tioner may help guide you to reliable products from proven manufacturers. Finding the right probiotic for your individual needs may help optimize microbiome health—and, by extension, hormone balance and overall wellness.

Read the complete Connections e-Book:

Probiotic Potential

Using “Friendly” Bacteria to Promote Healthy Digestion, Strengthen Immunity, and More

  • Karpa KD. Bacteria For Breakfast: Probiotics for Good Health. Trafford Publishing; Victoria, BC, Cana­da; 2003.
  • Murray F. Acidophilus and Your Health. Keats Publishing Inc.; New Canaan, CT; 1998.
  • Petersen C, Violi M. Probiotic Potential. Women’s International Pharmacy. https://www.womensinternational.com/portfolio-items/probiotics/. Reviewed and updated August 2019.
Hormones, Probiotics, and the Human Microbiome2019-08-23T12:19:11-05:00

Is DHEA Beneficial to Aging Skin?

Is DHEA Beneficial to Aging Skin?

Written by Michelle Violi, PharmD – Women’s International Pharmacy

Dehydroepiandrosterone (DHEA) is one of the most abundant circulating steroid hormones in humans, with concentrations typically peaking between the ages of 25 and 35 and then gradually declining with age. It is released mostly from the adrenal glands as a precursor to androgens and estrogens, but it may have its own effects on the body as well. A plethora of benefits has been associated with DHEA, from immune system support to improved sexual satisfaction. Some have called DHEA a “super hormone” and an “anti-aging panacea;” this article examines whether this bold reputation extends to the skin.

Skin Treatments with DHEA

The positive effects of DHEA on the skin have been supported by a number of studies, including both systemic (total body) and localized treatment methods. In 2000, Dr. Étienne-Émile Baulieu et al. conducted a study where 280 women and men, ages 60-79 years old, were given 50mg of DHEA by mouth daily for one year. A number of different outcomes were evaluated. With regard to skin, the results showed improvements in:

  • Sebum production
  • Skin surface hydration
  • Skin pigmentation
  • Epidermal thickness

The researchers concluded “a lack of harmful consequences” for the 50mg per day dose. However, like any other sex hormone, DHEA can have symptoms of excess if the dose is too high, such as:

  • Excessively oily skin
  • Acne
  • Increased facial or body hair
  • Breast tenderness

It is important to watch for these symptoms in order to adjust dosing levels.

Another study, conducted by Dr. Stephanie Nouveau et al., went the topical route, which allowed for a more directed approach and a lower dose of DHEA. Over the course of four months, 20 postmenopausal women applied a DHEA 1% (10mg/gm) cream to the skin on their face and hands. When compared to a group of 20 postmenopausal women who applied a cream with no active ingredient, Dr. Nouveau et al. found the topical DHEA tended to improve skin brightness and to counteract epidermal atrophy (a characteristic feature of hormone-related skin aging) as well as the papery appearance of aging skin.

DHEA and Vaginal Tissues

Vaginal atrophy is a common condition in postmenopausal women that often occurs with urinary symptoms and causes considerable discomfort. Typically, women with vaginal atrophy experience:

  • Dryness
  • Itching
  • Irritation
  • Burning of the vaginal and/or vulvar tissues
  • Painful sexual intercourse

Traditional treatments for these symptoms have included vaginal lubricants/moisturizers and vaginal estrogens. More recently, however, DHEA has also been shown to improve symptoms of atrophy. In a 12-week study by Dr. Fernand Labrie et al., involving almost 500 menopausal women, 6.5mg of DHEA was administered vaginally on a daily basis. The results of this study showed the following benefits:

  • Improvements in vaginal pH (which is important in preventing infections)
  • Improved skin thickness and color
  • Increased vaginal secretions
  • Reduced pain during sexual activity
  • Reduced vaginal dryness

DHEA blood levels remained well within the normal postmenopausal values. 


As with all hormones, the key to optimizing DHEA is balance. While supplementing DHEA deficiency can have manifold benefits, it’s equally important to watch for symptoms of excess and to adjust dosage levels to fit individual needs. The studies discussed in this article—along with many others—indicate that, with the guidance of a healthcare practitioner, DHEA may be used to optimize skin health, particularly in inhibiting or even reversing the effects of aging.

© 2019 Women’s International Pharmacy

Edited by Carol Petersen, RPh, CNP; Women’s International Pharmacy

Is DHEA Beneficial to Aging Skin?2019-07-19T09:31:15-05:00

Book Review – Hair Like a Fox by Danny Roddy

Book Review – Hair like a Fox by Danny Roddy

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

Men and women alike have issues with hair loss. Is this natural? Is this normal? For Danny Roddy, author of Hair like a Fox: A Bioenergetic View of Pattern Hair Loss, fear of hair loss was imprinted in his childhood. At the age of 19, he made it a personal challenge to learn about hair loss and do all that he could to keep his hair. As he had feared, Roddy did begin losing hair despite his efforts. It was only by discovering the work of Dr. Ray Peat that Roddy finally found a new perspective on the underlying cause of hair loss and how it may be prevented.

Conventional Theories of Hair Loss Causes

The Androgen Hypothesis

Let’s examine the history first. In the 1940s, Dr. James B. Hamilton published his observations of 104 men without functioning testicles. He found these men did not mature sexually and had altered hormone levels. They also retained their scalp hair, had reduced oiliness of the scalp, and little to no dandruff.

Seeing this connection, Dr. Hamilton administered testosterone to men without functioning testicles who were not bald but who had a family history of baldness. Soon they experienced hair loss, which abated when the treatment stopped. When the testosterone was later resumed, balding proceeded again. Dr. Hamilton concluded that baldness was caused by androgens, specifically testosterone.

In the 1970s Dr. Julianne Imperato-McGinley studied a population in a remote area of the Dominican Republic who were born with ambiguous sexual features. From birth and throughout their childhood, these individuals appeared to be girls. At puberty, however, they developed male sex organs.

These men had no signs of baldness, had small prostate size, and normal testosterone levels. However, they lacked the enzyme needed to convert testosterone to its stronger metabolite, dihydrotestosterone (DHT). Dr. Imperator-McGinley became convinced that DHT—not testosterone— was responsible for male pattern baldness.

Merck and Finasteride

Merck scientists became aware of Dr. Imperato-McGinley’s research and developed a drug which would block the production of DHT. The result was finasteride. Finasteride not only reduced symptoms and helped shrink the prostate in men with enlarged prostate glands, but incidentally contributed to regrowth of hair as well.

According to Roddy, finasteride may have enough progesterone activity to help with hair loss–at least part of the time. This new treatment was not without drawbacks, however: Large numbers of men suffered side effects such as erectile dysfunction, lack of libido, depression, and suicide. In addition, finasteride was not the total answer for the hair problem, either, as it was only effective for about 40% of the men who took it.

The Androgen Hypothesis Falls Apart

Why do young men with the highest testosterone and DHT have the best hair? Why does balding occur when the hormone levels are dropping with age? Why do women experience “male” pattern baldness? Medical practitioners tend to cling to explanations involving DHT or genetics in spite of the holes in these theories.

Dr. Peat and the Hair Follicle as a Mini Organ

Dr. Ray Peat is a prolific writer and thinker, and often challenges conventional thinking. Perhaps best known for his foundational research on progesterone, Dr. Peat’s work directs one to consider the hair follicles as mini organs.

Like other organs in the body, hair follicles depend upon the energy of the cells in their structure, and this cellular energy is produced by mitochondria. With time, stressors may diminish the function of the cells; hair follicles become clogged with mucopolysaccharides (mucin), calcification, impaired blood flow leading to low available oxygen, oxidative stress and finally, impaired function of the mitochondria.

Active Thyroid Hormone (T3)

Mitochondria need glucose and oxygen to produce energy. We get glucose with carbohydrates, but our bodies can also convert it from protein. Even more than glucose, however, energy production relies upon oxygen sources. A byproduct of cell energy production is carbon dioxide, which helps move oxygen from the blood and into the tissues and cells.

Active thyroid hormone (T3) stimulates the use of oxygen in breaking down the carbohydrates, fats, and proteins. This, in turn, yields carbon dioxide, which improves the oxygen transport to the cell. In individuals with low thyroid levels, the body produces mucin, a gelatinous substance that solidifies in the spaces between cells. When mucin becomes calcified it cuts off circulation to the scalp. Hairs become progressively wispier until the hair follicle is choked off entirely.

Graying and loss of hair are symptoms of declining mitochondria function, and thus loss of cell energy. If proper cell metabolism is compromised, functioning in all parts of the body is slowed down. Declining cell energy may be linked to a wide variety of diseases, such as:

  • Alzheimer’s
  • Atherosclerosis
  • Autism
  • Cancer
  • Chronic fatigue
  • Fibromyalgia
  • Heart failure
  • Epilepsy
  • Hypertension
  • Hypoglycemia
  • Depression
  • Infertility
  • Migraines
  • Non-alcoholic liver disease
  • Obesity
  • Sleep apnea
  • Diabetes
Estrogen (and Other Hormones) Can Cause Hair Loss

Progesterone depends upon thyroid function. If estrogen is not balanced by plenty of progesterone, hair loss may result. During menopause, progesterone levels decline while estrogen activity soars. Relatively high levels of estrogen may, in turn, also inhibit progesterone production, creating a vicious cycle.

Hair is affected by other hormones as well. The pituitary hormone prolactin increases with age in men and may inhibit hair growth. Cortisol levels from the adrenal glands increase with aging and may contribute to hair loss.

As it happens, not only do men without functioning testicles have low testosterone levels, but they are also low in estrogen. Perhaps the lack of this hormone further inhibits hair loss for them.


Hair Like a Fox contains many more chapters discussing serotonin, essential fatty acids, types of carbohydrates, proteins, and fats that produce cellular energy and contribute to hair growth. Rather than the simple cause-and-effect theory of androgen-induced baldness, the real key to maintaining hair follicle structure may be to maintain mitochondrial health. Optimizing how the body can best produce cell energy applies to every cell in the body, not just the tiny hair follicle organ. This may be a remedy for not only defying hair loss but also resisting those diseases associated with aging.

Additional Resources:

If you are wondering how Danny Roddy and his hair are doing, check out his blog at www.dannyroddy.com. This website is rich with information, but Roddy feels the quest is not over yet and there is always more to learn.

  • Roddy D. Hair Like a Fox: A Bioenergetic View of Pattern Hair Loss. The Danny Roddy Weblog, LLC: 2013. https://www.amazon.com/Hair-Like-Fox-Bioenergetic-Pattern-ebook/dp/B00GYX6QXC.

© 2019 Women’s International Pharmacy

Edited by Michelle Violi, PharmD; Women’s International Pharmacy

For any questions about this article, please e-mail

Carol Petersen at carol@womensinternational.com

Book Review – Hair Like a Fox by Danny Roddy2019-07-05T12:21:19-05:00

Book Review – Depression After Childbirth by Dr. Katharina Dalton

Book Review – Depression after Childbirth by Dr. Katharina Dalton

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

Dr. Katharina Dalton was a pioneer in women’s health, coining the term “premenstrual syndrome” (PMS) and recognizing that progesterone may relieve PMS symptoms. She then turned her attention to the complicated issue of depression after childbirth. Her book Depression after Childbirth: How to Recognize and Treat Postnatal Illness was first published in 1980 and categorized postpartum depression (PPD) according to its degrees of severity.

Causes and Characteristics of Postpartum Depression

As mothers experience hormonal fluctuations during and after childbirth, both their physical and emotional wellbeing are affected. Postpartum depression shares many symptoms in common with other forms of clinical depression, including:

  • Lethargy or unusual fatigue
  • Irritability
  • Increased appetites
  • Feel achy all over
  • Isolation
  • Increased risk of suicide
If you think you might be suffering from postpartum depression, contact your medical practitioner right away or go to the nearest emergency room.

In the mid-1960s, a group of physicians at the North Middlesex Hospital in London performed a survey of 500 of their pregnant patients before and after delivery. They found the women who were happiest, elated, and euphoric during the later months of their pregnancies had the highest risk for PPD. The mothers who developed PPD had two noticeable characteristics: a favorable attitude to motherhood, and labile emotions. Although PPD often begins early on after giving birth, it may also start when the mother stops breastfeeding, as another dramatic change in hormones occurs at that point. Postpartum depression may also occur after miscarriages, stillbirths, and terminations of pregnancies.

Levels of Severity in Postpartum Depression

Mild Postpartum Mood Changes: The “Blues”

Known as the “maternity blues,” “baby blues,” or “postnatal blues,” the mildest form of mood changes after a woman gives birth is also the most common. It often begins within three to ten days post-delivery but is usually subsides within one or two weeks. One of the main symptoms of the “blues” is excessive crying that begins suddenly and with no apparent reason.

In the early 1900s, women would usually stay in the hospital for 14 days after giving birth. This was generally enough time for this milder form of depression to fade away while having plenty of support from the hospital staff. Today, most women are sent home within 48 hours, often with little to no assistance unless family and friends pitch in.

Moderate Postpartum Depression: Postnatal Exhaustion, Depression, and Irritability

Tiredness and lethargy is another manifestation of PPD that may persist as long as six to nine months. Although difficulty in sleeping may be a symptom in other forms of clinical depression, women with PPD experience no problem sleeping and indeed, no amount of sleep seems to be enough. On the other hand, some patients may experience irritability that may be very difficult or impossible to control. The irritability may present in swings from anger to distress.

Dr. Dalton suspected that the plunge of hormones that occurs at delivery may be involved, and pointed out that low thyroid might be a factor along with low potassium and iron levels. A woman who has recently given birth should have her thyroid function tested if she exhibits one or more of the following symptoms:

  • Falling asleep at any time day or night
  • Experiencing lank and thinning hair
  • Feeling cold
  • Having a slow pulse

Fortunately, thyroid and other hormone levels can be evaluated by a woman’s healthcare provider, who may determine the use of hormone therapy necessary to correct any deficiencies or imbalances.

Severe Postpartum Depression: Psychosis

Psychosis is the most severe form of PPD that many times begins within two weeks after a woman gives birth. In psychosis, a woman may lose contact with reality and become unaware of her surroundings. She may have auditory hallucinations in which she hears voices or visual hallucinations in which she sees imaginary people, animals, or things. She may have ruminating thoughts, during which she can’t stop thinking about something.

Postpartum psychosis may require more drastic forms of treatment or even hospitalization. According to Dr. Dalton, progesterone therapy may prove helpful in addressing even these severe symptoms. As with any concern for mental wellness, it’s important to consult a medical professional in order to form a personalized treatment plan.

Similarities between Postpartum Depression and Premenstrual Syndrome

Dr. Dalton pointed out that the main features of PPD–tiredness, irritability, and depression–also characterize PMS. Both conditions also occur during a time of hormonal decline – prior to menses and following labor and delivery. Since these symptoms may arise from hormonal changes, proper supplementation with hormones such as progesterone and thyroid may provide relief. Dr. Dalton states: “The aim is to control the sudden drop in progesterone that normally occurs at delivery and prior to menses and convert it to a more gradual and slow fall.”

Another similarity between PPD and PMS is that fluctuations in blood sugar may occur. Low blood sugar brings on a surge of adrenaline (the “flight or fight” hormone), causing reactions such as fury or aggression. Appropriate diets may help stabilize blood sugar levels.

Preventing Postpartum Depression

Dr. Dalton concluded that the best practice for treating PPD is to prevent it from occurring in the first place. She suggested a treatment using progesterone (in injectable or suppository form) beginning at the completion of labor, and that progesterone supplementation should continue until a woman’s menstrual cycle resumes. Progesterone supplementation may be beneficial during breastfeeding, when the pituitary hormone prolactin increases, as excessive levels of prolactin may interfere with progesterone’s effectiveness.


Dr. Katharina Dalton correlated the similarities between PMS and PPD and argued that these were real medical conditions rooted in endocrine disorders. The marked mood changes a woman experiences after giving birth are not imaginary or “in her head.” On the contrary, Dr. Dalton’s groundbreaking work showed that these changes can be traced back to real physical causes, and may be remedied if the signs of postpartum depression are promptly identified and properly treated.

Additional Resources:

Postpartum Depression and the Potential of Allopregnanolone

For more information on depression and mental health in general, visit our Mental Health Resources page

© 2019 Women’s International Pharmacy

Edited by Michelle Violi, PharmD; Women’s International Pharmacy

For any questions about this article, please e-mail

Carol Petersen at carol@womensinternational.com

Book Review – Depression After Childbirth by Dr. Katharina Dalton2019-07-05T12:23:04-05:00

Postpartum Depression and the Potential of Allopregnanolone

Postpartum Depression and the Potential of Allopregnanolone

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

Postpartum depression (PPD) is a widespread complication of pregnancy and childbirth that can affect a woman’s emotional, mental, and overall health. It is characterized by feelings of sadness, anxiety, apathy, fatigue, and being overwhelmed with day-to-day activities, and can affect a mother’s ability to bond with her infant, cause her to lose interest in things she usually enjoys. This article outlines the possible causes and risk factors for PPD and explores a potential hormone therapy using allopregnanolone, a treatment recently approved by the FDA.

As with many forms of depression, PPD is not as straightforward as it may initially seem, presenting itself with various symptoms and levels of intensity. Many women experience mild and short-lived mood swings after delivery, in what often is termed as the “baby blues.” By contrast, PPD is usually more serious and prolonged; in one of its most severe forms, postpartum psychosis, suicide and homicide pose real dangers.

If you think you might be suffering from postpartum depression, contact your medical practitioner right away or go to the nearest emergency room.

A Possible Cause of Postpartum Depression

The sudden, dramatic change in reproductive hormones after delivery occurs is thought to be a cause of PPD, though some medical practitioners argue that this type of depression can occur during pregnancy as well as post-partum. Additionally, investigations show that blood levels of hormones in women with postpartum depression may not be so different from those women who do not suffer from depression after childbirth.

It’s possible that a more complex interaction of various bodily systems may be involved, including:

  • Thyroid function
  • The immune system
  • The signaling from the hypothalamus to the pituitary to the adrenal glands (HPA axis)
  • Hormones involved in breastfeeding
  • Genetics

All of these systems are affected by the reproductive hormones, specifically estrogens and progesterone.

Risk Factors

Many factors may predict post-delivery mood issues, including:

  • A family history of PPD
  • Depression after a previous birth
  • Depression during the pregnancy
  • Gestational diabetes
  • Little or no partner support
  • Instrumentation during birth
  • Cesarean delivery
  • Low socioeconomic status
  • Lower education
  • Single motherhood
  • Unemployment
  • Unintended pregnancy
  • Partner violence
  • Traumatic childhood
  • The number of previous pregnancies

Neuroactive Hormones

The hormones produced by the sex and adrenal glands and circulated throughout the body are only one part of the hormonal equation. Adrenal and sex hormones are also made in the brain and neuronal tissues, where they are used directly by the tissue making the hormones. The brain has the advantage of being able to use both the hormones it produces independently and those that are in general circulation. These hormones have an impact on brain function and mood.

A Potential PPD Treatment with Allopregnanolone

Allopregnanolone (ALLO) is a metabolite of the hormone progesterone. In fact, the levels of ALLO produced in the body parallel those of progesterone:

  • During the menstrual cycle – ALLO rises and falls in the same way progesterone does during the menstrual cycle
  • During pregnancy – ALLO and progesterone both rise to high levels during gestation and drop at delivery
  • In the brain – ALLO can affect the same receptors as progesterone

On March 19, 2019, the US Food and Drug Administration (FDA) announced the approval of an intravenous form of ALLO with the brand name Zulresso and the generic name brexanolone. This is the first drug approved by the FDA specifically for the treatment of postpartum depression. ALLO treatment involves an intravenous administration over 60 hours shortly after delivery. Because of concerns about serious risks, including excessive sedation or sudden loss of consciousness during administration, access to this treatment will be limited and strictly monitored.

Could Progesterone Have the Same Effect on PPD?

In 1980, Dr. Katharina Dalton published Depression after Childbirth. This book describes PPD’s identifying features and the possibility of treating it with progesterone. She was the first to consider the unpleasant symptoms that plagued some women just prior to menstrual bleeding as a syndrome, calling it premenstrual syndrome (PMS), Dr. Dalton argued that progesterone could be used not only to alleviate PMS symptoms, but she also found that it could help with toxemia of pregnancy (now known as preeclampsia) and PPD.

Even though ALLO is promoted as a breakthrough for PPD, progesterone might be just as useful. Studies have shown that progesterone administered orally increased ALLO levels in the body, and other studies have shown progesterone binds to many of the same receptor sites as ALLO.

Evaluating Postpartum Depression

The Edinburgh Postnatal Depression Scale (EPDS) illustrates the mood problems associated with postpartum depression. Below is an adaptation of their questionnaire.

Select the answer that comes closest to how you have felt in the past 7 days:

  • I have been able to laugh and see the funny side of things
    1. As much as I always could
    2. Not quite so much now
    3. Definitely not so much now
    4. Not at all
  • I have looked forward with enjoyment to things
    1. As much as I ever did
    2. Rather less than I used to
    3. Definitely less than I used to
    4. Hardly at all
  • I have blamed myself unnecessarily when things went wrong
    1. No, never
    2. Not very often
    3. Yes, some of the time
    4. Yes, most of the time
  • I have been anxious or worried for no reason
    1. No, hardly at all
    2. Hardly ever
    3. Yes, sometimes
    4. Yes, very often
  • I have felt scared or panicky for no very good reason
    1. No, not at all
    2. No, not much
    3. Yes, sometimes
    4. Yes, quite a lot
  • Things have been getting on top of me
    1. No, I have been coping as well as ever
    2. No, most of the time I have coped quite well
    3. Yes, sometimes I haven’t been coping as well as usual
    4. Yes, most of the time I haven’t been able to cope at all
  • I have been so unhappy that I have had difficulty sleeping
    1. No, not at all
    2. Not very often
    3. Yes, sometimes
    4. Yes, most of the time
  • I have felt sad or miserable
    1. No, not at all
    2. Not very often
    3. Yes, sometimes
    4. Yes, most of the time
  • I have been so unhappy that I have been crying
    1. No, not at all
    2. Only occasionally
    3. Yes, sometimes
    4. Yes, most of the time
  • The thought of harming myself has occurred to me
    1. Never
    2. Hardly ever
    3. Sometimes
    4. Yes, quite often

These ten questions are used to measure the severity of the depression using a range from 0 to 30, with 30 being the most severe form of depression. According to the EPDS, any score over 10 may be considered depression.


PPD can be complex, involving multiple hormones and body systems. Successful treatment is critical to the health of a new mother and her child. Treating PPD with ALLO is a great advance over antidepressant drugs because as a bioidentical hormone, it comes closer to addressing the root cause of the symptoms in a way that is natural to the body. While access to ALLO treatment is limited, based on the work of Dr. Katharina Dalton and others, progesterone might have the same positive effects for women struggling with postpartum depression.

Additional Resources:

Book Review – Depression After Childbirth by Dr. Katharina Dalton

For more information on depression and mental health, visit our Mental Health Resources page.

© 2019 Women’s International Pharmacy

Edited by Michelle Violi, PharmD; Women’s International Pharmacy

For any questions about this article, please e-mail

Carol Petersen at carol@womensinternational.com

Postpartum Depression and the Potential of Allopregnanolone2019-07-05T12:22:47-05:00

PCOS and Hormones

Polycystic Ovary Syndrome and Hormones

How Testosterone, Insulin, and Progesterone Affect PCOS

Written by Hershil Parekh, RPh – Women’s International Pharmacy

woman holding flower basketHave you struggled with excessive hair growth and acne, difficulty getting pregnant, weight gain, and chronic menstruation irregularities for most of your life? If you answered “Yes” to any of the above symptoms, you may be one of the 4-8% of women across the globe who suffers from Polycystic Ovary Syndrome (PCOS). It is often considered to be the most common endocrine disorder suffered by women of childbearing age in the United States. With no clear underlying cause, PCOS is a complex disorder encompassing many organ systems.

PCOS is usually diagnosed when a patient exhibits one or more the following symptoms:

  • High circulating testosterone levels
  • The presence of ovarian cysts (though contrary to what the name “Polycystic Ovary Syndrome” suggests, it’s possible to have PCOS without ovarian cysts)
  • Menstrual irregularities that lead to the inability to ovulate

Imbalances of the hormones testosterone, insulin, and progesterone play a critical role in the various symptoms of PCOS and the other conditions that may be associated with it. Managing PCOS involves treating these symptoms with lifestyle modifications and medications.

Understanding the HPG Axis and Its Role in Fertility

Regulation of the reproductive system starts in the hypothalamic-pituitary-gonad (HPG) axis. The HPG axis begins with the hypothalamus producing gonadotropin-releasing hormone (GnRH), which is then released in pulses to hormone receptors on the anterior pituitary gland. Depending on the rate of stimulation it receives, the anterior pituitary gland produces one of two gonadotrophic hormones: follicle stimulating hormone (FSH) or luteinizing hormone (LH).

  • During a woman’s menstrual cycle, FSH plays a key role in the growth and maturation of the ovarian follicle (a small fluid-filled sac in the ovary containing an immature egg) and estradiol production.
  • LH is responsible for the rupture of the mature ovarian follicle which releases an ovum for fertilization as well as the production of estradiol (in the first two weeks of the cycle) and testosterone and progesterone.

Abnormalities in LH and FSH production may lead to the inability to ovulate and also increases in testosterone production and decreases in progesterone production.

Hormonal Influences on PCOS Symptoms

Many of the problems associated with PCOS revolve around hormonal imbalances of testosterone, insulin, and progesterone.

PCOS and Testosterone

Testosterone is one of the many sex hormones made via the HPG axis and is considered an androgenic sex hormone. Androgens (from the Greek andro, meaning “male”) are found in higher concentrations in men than in women, and play a role in the development of male characteristics. Testosterone is produced when the reproductive system is stimulated by LH.

PCOS patients present with many adverse reactions associated with abnormally high testosterone levels:

  • Hirsutism (the growth of long, coarse, dark hair), develops in androgen-sensitive areas such as the chest, upper lip, chin, back, and abdomen.
  • Acne is caused in these androgen-sensitive areas when sebaceous glands in the skin begin to overproduce sebum (an oily substance secreted to moisturize the skin).
  • In hair follicles on the scalp, testosterone is broken down into dihydrotestosterone and results in male-pattern balding.

Another hormone called insulin exacerbates these symptoms when not utilized properly by the body.

PCOS and Insulin

Insulin is a metabolic hormone that helps the body exploit its main fuel source, glucose. PCOS patients commonly suffer from a weight-related metabolic condition called insulin resistance, where the body is not sensitive to insulin spikes after the consumption of food. Insulin is needed to help glucose penetrate cells of the body from the blood.

Poor utilization of insulin increases its levels in the blood and this may lead to increased testosterone in several ways:

  • Insulin may promote GnRH production in the hypothalamus, causing a more frequent stimulation of the anterior pituitary gland, which increases LH levels.
  • Insulin may also directly stimulate cells in the ovaries to produce more androgens.

Insulin may indirectly reduce transport proteins (called sex hormone binding globulin) which shuttle testosterone in the body. This increases the free testosterone that is available to circulate and activate receptors anywhere in the body and amplifies the testosterone response throughout the body.

PCOS and Progesterone

Dr. Jerilynn Prior, a Professor of Endocrinology and Metabolism, has spent her career studying menstrual cycles and the effects of the cycle’s changing estrogen and progesterone hormone levels on women’s health. She explains:

Progesterone is the hormone made by the ovary after an egg is released. Patients with [PCOS] have sporadic or absent ovulation, so they are not making progesterone for two weeks every cycle. This lack of progesterone leads to an imbalance in the ovary, causes the stimulation of higher male hormones, and leads to irregular periods and trouble getting pregnant. Progesterone is usually missing—replacing it therefore makes sense.

In an article for Gynecological Endocrinology, Dr. Helen Buckler et al. write that progesterone appears to normalize the heightened LH levels associated with PCOS. Raised LH is one of the mechanisms that stimulate testosterone production. In addition, Dr. Prior notes that progesterone inhibits the enzyme that allows testosterone to convert into dihydrotestosterone, the androgen that contributes to acne, hirsutism, and (as mentioned previously) male pattern baldness.

Treatment Options for PCOS

Multiple treatment options are available to control PCOS symptoms. Traditionally, PCOS has been treated with an array of medications that inhibit androgen hormones through various mechanisms. However, using progesterone in bioidentical hormone therapy is one alternative that replenishes progesterone levels and encourages the regulation of androgen production in a way more natural to the body.

Traditional Treatments

  • The anti-diabetic agent Metformin and a class of cholesterol-lowering medications called statins may be used for managing metabolism.
  • Anti-androgens (such as finasteride) may be used to control circulating testosterone levels and hirsutism.
  • Patients experiencing irregular menstrual cycles may be prescribed oral contraceptives containing progestins. However, synthetic progestins themselves may have negative effects on a woman’s health.
  • Clomiphene citrate may be used to induce ovulation in patients who are having difficulty getting pregnant.

Alternative Therapies

  • Compounded bioidentical progesterone may have a variety of benefits in the treatment of PCOS and its symptoms. According to Dr. Prior, progesterone signals to the HPG axis when to stop production of androgens, which prevents testosterone overproduction. If progesterone deficiency is addressed by supplementing compounded bioidentical progesterone for two weeks every month, it “may help the brain develop the normal cyclic rhythm that is missing in PCOS.”
  • Weight reduction with the help of a calorie-restricted diet and exercise is recommended to help decrease androgen levels and control glucose and insulin levels.


Controlling PCOS often requires a multifaceted approach. Treating individual symptoms decreases the development of associated conditions such as type 2 diabetes, cardiovascular disease, infertility, and endometrial cancer. Meanwhile, a combination of medications and healthy lifestyle habits may be used to address any underlying hormone imbalances that may exacerbate PCOS in the first place.

Additional Resources:

PCOS and Hormones2019-04-30T16:34:41-05:00

How Do Hormones Affect the Heart?

How Do Hormones Affect the Heart?

Written by Michelle Violi, PharmD – Women’s International Pharmacy

“How does hormone supplementation affect the heart?” This is a question that our pharmacists hear regularly. Much like the poor, maligned egg in the cardio-healthy diet, hormones have fallen in and out of favor with regard to their effect on the cardiovascular system over the years.

Although a number of studies examine hormonal effects on the cardiovascular system, these studies rarely distinguish between bioidentical and synthetic hormones. However, one study by Dr. Ferdinand Roefsena, Rebecca J. Yang, and Dr. Johannes Veldhuis looked specifically at the bioidentical hormones, estradiol, and progesterone, publishing their results in the Journal of the Endocrine Society. Let’s see what they found!

How Was the Study Designed?

Forty healthy postmenopausal women, ages 50-80, participated in the study. The women were divided into four treatment groups:

  1. Bioidentical estradiol (injection) and bioidentical progesterone (by mouth)
  2. Bioidentical estradiol (injection) and no bioidentical progesterone
  3. Bioidentical progesterone (by mouth) and no bioidentical estradiol
  4. No bioidentical estradiol and no bioidentical progesterone

After 23 days of using these therapies, the women’s blood was drawn and the researchers measured various markers.

What Did the Study Look At?

Because the study was only 23 days long, Dr. Roefsena et al. were unable to evaluate primary endpoints, such as heart attacks or strokes. Instead, they looked at various markers in the blood that have been associated with physical outcomes such as heart disease, stroke, and diabetes. The researchers looked at many significant markers, including:

  1. Total cholesterol
  2. Low-density lipoprotein cholesterol (LDL-C) (referred to as “bad” cholesterol by the American Heart Association)
  3. High-density lipoprotein cholesterol (HDL-C) (referred to as “good” cholesterol by the American Heart Association)
  4. Apolipoprotein B (Apo B)
  5. High sensitivity C-reactive protein (hsCRP)
  6. Adiponectin

With the exception of HDL-C and adiponectin, for which higher levels appear beneficial, decreased levels of the other markers listed above are generally considered favorable, according to the American Heart Association.

What Did the Study Find?

When compared to women who weren’t using any hormone therapies:

  1. Women who used bioidentical estradiol alone had lower levels of total cholesterol, LDL-C, and Apo B. They also had higher levels of HDL-C, which are considered beneficial differences. The researchers had expected this result, based on previous studies as described in the article The Bioidentical Hormone Debate: Are Bioidentical Hormones (Estradiol, Estriol, and Progesterone) Safer or More Efficacious than Commonly Used Synthetic Versions in Hormone Replacement Therapy? by Dr. Kent Holtorf.
  2. Women who used bioidentical progesterone alone had decreased adiponectin, but they were still well within the average reference range (below which would indicate risk).
  3. Women who used bioidentical estradiol and bioidentical progesterone together had lower levels of total cholesterol, LDL-C, Apo B, and HDL-C. While the reduced HDL-C levels are not considered beneficial, other studies, as discussed in Dr. Holtorf’s article, indicate that when synthetic progestins are used instead of bioidentical progesterone, the cholesterol and LDL-C-lowering effect of bioidentical estradiol is also blocked. Bioidentical progesterone did not block this effect!
  4. hsCRP levels were higher in women using bioidentical estradiol and bioidentical progesterone, but still well below the value above which indicates increased risk.

In Summary:

As the researchers expected, the women using bioidentical estradiol exhibited improved cholesterol levels (including decreased LDL-C and increased HDL-C). Even though the bioidentical progesterone was associated with reduced HDL-C levels, it allowed the positive effects of bioidentical estradiol on the other cholesterol levels to remain. Synthetic progestins have been seen to reduce the positive effects of bioidentical estradiol on cholesterol levels, as evidenced by the studies discussed in Holtorf’s article. These findings suggest that bioidentical hormones may be preferable to synthetic.

This study is not without its flaws, such as its short length and small group size. Its short length made it necessary to evaluate markers rather than primary endpoints, and the data was further limited by comparing the groups to each rather than evaluating the differences between the beginning and ending measurements. The patients in the bioidentical estradiol groups were treated with injectable bioidentical estradiol—a form which is rarely used in clinical practice—and used two doses ten days apart as opposed to the usual two- to four-week intervals.

Despite this study’s shortcomings, when we combine its results with information obtained in other studies, we see that bioidentical progesterone doesn’t appear to interfere with the positive effects estrogen has on cholesterol levels. By contrast, other studies have suggested that synthetic progestins do negate these effects. And this makes perfect sense! Why would we assume that a molecule that is similar, but not identical to what the body makes, should have the same effect in the body as a molecule that is identical to what the body makes?

Due to our differences as individuals, no study is perfect. Therefore, the question of whether hormones are good for your heart may never be answered definitively because the answer may differ from person to person. Through studies like that by Dr. Roefsena et al. and others, however, one thing is becoming clear: the difference between bioidentical and synthetic hormones may prove a significant factor in whether hormones are beneficial to the heart.

Additional Resources:

Women’s International Pharmacy has several other articles focused on how hormones affect heart health. Check them out at our Heart Health Resources page!

© 2019 Women’s International Pharmacy

Reviewed by Carol Petersen, RPh, CNP; Women’s International Pharmacy

How Do Hormones Affect the Heart?2019-03-14T12:28:58-05:00

How Is the Thyroid Gland Like a Car?

How Is the Thyroid Gland Like a Car?

Understanding the Complexities of Treating Thyroid Dysfunction

Written by Michelle Violi, PharmD – Women’s International Pharmacy

car driving through a forestThe thyroid gland is a butterfly-shaped gland located in the front of the neck. It is responsible for producing hormones, which are essential for normal growth and development as well as regulating metabolism. Thyroid hormone function has been found to correlate with body weight and energy expenditure.

The thyroid gland produces two main hormones: levothyroxine (T4) and liothyronine (T3). T4 is an inactive thyroid hormone that must be converted to the active thyroid hormone, T3, before it can be used by the body.

Health care practitioners use testing and symptom evaluation to determine whether a patient’s thyroid gland isn’t working as it should. If the results indicate low thyroid function (hypothyroidism), there are a number of options they may prescribe:

Type of Thyroid PrescriptionExamples of Medications
Levothyroxine (T4) Only
  • Synthroid
  • Levoxyl
  • Compounded capsules
Liothyronine (T3) Only
  • Cytomel
  • Compounded capsules
A Combination of Liothyronine (T3) and Levothyroxine (T4)
  • Thyrolar (as of this writing in January 2019, on long-term back order)
  • Compounded capsules
Desiccated Porcine Thyroid

Taken from the thyroid gland of the pig, this contains T3 and T4, as well as thyroid cofactors such as T1, T2, calcitonin, and trace amounts of iodine

  • NatureThroid
  • Westhroid
  • WP Thyroid
  • Armour Thyroid
  • NP Thyroid
  • Compounded capsules

Levothyroxine (T4) only is the most commonly prescribed thyroid medication. However, this might not be the right choice in every situation. Because the thyroid gland plays a complex role in the body, some cases of thyroid dysfunction may require more than a “one medication fits all” approach.

Compare thyroid dysfunction to a car. When a car stops running, is it because it’s out of gas? Perhaps. In this case, fill up the tank and get back on the road. However, think of all the other possible reasons the car may have stopped running. The car may not be able to use the gas put in it or not use it well depending on whether the car needs diesel, premium, or regular. The car may be full of rust. The car may need oil or antifreeze, not gas. The list goes on and on.

In the case of thyroid function, there are also a wide variety of reasons why a thyroid gland may not be working. The thyroid gland may not be able to convert T4 to T3. The thyroid gland may be inflamed or be the target of an autoimmune response. The thyroid gland may need iodine, selenium, zinc, or other cofactors. As with a car, the list goes on and on.

If a patient with hypothyroidism is prescribed T4 only, the body must be able to convert T4 into T3 in order for the body to be able to use it. However, if there is an issue with this conversion process, the body may not be able to use a T4 only medication appropriately. Depending on what is wrong with the thyroid gland, additional support in the form of T3 or other thyroid cofactors such as are present in desiccated porcine thyroid may be needed.

As with so many things relating to health, optimizing thyroid function is complicated. If you are taking thyroid medication and still aren’t feeling well, don’t give up! Work with your health care practitioner and pharmacist to find a solution that fits your individual needs.

Additional Resources:

For more information on the thyroid gland, hormones, and treatments, visit our Thyroid Resources page.

How Is the Thyroid Gland Like a Car?2019-01-25T11:18:05-05:00

Could Red Wine Prolong the Effects of Testosterone?

Could Red Wine Prolong the Effects of Testosterone?

Written by Hershil Parekh, RPh – Women’s International Pharmacy

red wine may help testosterone functionDoes that glass of red wine you enjoy with dinner affect your testosterone levels? A study published in the Nutrition Journal suggests that it may help prolong testosterone’s effects by slowing down how fast the body metabolizes it.

Testosterone is broken down in the liver by a process known as glucuronide conjugation. The enzyme involved in this process is called UGT2B17, and belongs to the UDP-glucuronosyltransferase (UGT) enzyme family. Certain medications—such as non-steroidal anti-inflammatory drugs (NSAIDS) which include ibuprofen and naproxen—and flavonoids (catechins in certain teas) have been shown to inhibit UGT2B17 when used with testosterone, thus increasing the availability of testosterone in the body.

A British study evaluated the inhibitory nature of the common phenolic components found in wine on the activity of the UGT2B17 enzyme. In a laboratory setting, Carl Jenkinson, et al. measured initial testosterone levels and then added evaporated red wine at concentrations varying from 2-8%. The study’s aim was to determine the extent to which wine inhibited the UGT2B17 enzyme in the body.

One and two hours after the addition of the red wine, Jenkinson, et al. analyzed the remaining testosterone to determine if there was any increase in testosterone concentration. The results from this portion of the testing showed glucuronidation through the UGT2B17 enzyme was reduced to 10-70% of normal activity levels. The highest level of reduction was seen after measuring testosterone levels two hours after adding 8% red wine.

The main phenolic components of red wine were found to be gallic acid, chlorogenic acid, caffeic acid, and quercetin. The reduction of glucuronidation of testosterone by the UGT2B17 enzyme was statistically significant for quercetin and caffeic acid, which reduced glucuronidation activity by 28.01% and 78.9%, respectively.

Even though these results were statistically significant, it is difficult to know if they are clinically significant because we do not know to what extent testosterone concentrations were altered. The results are promising, showing that testosterone metabolism was reduced by a wide margin from what is normally seen. Perhaps one day practitioners may recommend a glass of wine with a patient’s testosterone supplement, or (more likely) a quercetin supplement, which could lead to better testosterone availability for patients.

Jenkinson C, Petroczi A, Naughton DP. Red wine and component flavonoids inhibit UGT2B17 in vitro. Nutr J 2012; 11:67. doi: 10.1186/1475-2891-11-67.

Could Red Wine Prolong the Effects of Testosterone?2018-12-21T14:42:07-05:00

Sarcopenia: Age-Related Muscle Loss

Sarcopenia: Age-Related Muscle Loss

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

woman lifting weightsSarcopenia, the muscle loss related to aging, may start slowly in your thirties and continue progressing with growing rapidity into your seventies. It is not identified with definite biomarkers as medical practitioners prefer to use today. Sarcopenia tends to get an “I know it when I see it” sort of diagnosis.

Although this difficulty in diagnosing sarcopenia is understandable considering the mental picture of the frailty associated with aging, loss of muscle mass is a major health issue.

  • With a loss of muscle comes a loss of strength
  • It is more difficult to get around, climb stairs, or walk long distances
  • It leads to falls and serious injuries including broken bones
  • When injuries occur, it takes longer to heal
  • Surgeries may be less successful and infections take hold more readily

Unless measures are taken to stop it, sarcopenia may lead to prolonged hospitalizations, nursing homes, and possibly even death.

Anabolism and Catabolism

Our bodies are in the constant process of remodeling. We build and rebuild molecules, break down old cells and tissues to make way for the new, and dispose of or reuse the molecules. When we are young the rate at which we rebuild (anabolism) exceeds the rate at which we break down (catabolism). There are multiple factors that trigger more catabolism than anabolism as we age, including:

  • Changes in neurochemistry
  • Hormone imbalances
  • Production of inflammatory cytokine (cells produced by the immune system that act on other cells)
  • Inadequate nutrition
  • Environmental hazards
  • Declining physical activity

Satellite Cells

Muscle is composed of many different cell types. Muscle stem cells are called satellite cells. Satellite cells are located on the outside membrane of the muscle cells and next to the blood vessels. These cells are not active unless there is some stimulus from injury to the muscle or from the environment carried in the blood stream. When activated, these satellite cells become new muscle cells.

Estradiol and Testosterone

Sarcopenia develops with the decline of sex hormones. Research in the last decade reveals that the satellite cells have receptors for–and respond to—estrogens (such as estradiol) and androgens (such as testosterone). Studies support that estradiol has beneficial effects on muscle strength.

Most muscle cell types have receptors for testosterone, but testosterone receptors predominate in satellite cells. Administration of testosterone increases the number of satellite cells, and also directly inhibits inflammatory cytokines. Higher testosterone levels contribute to increased strength and mass; since women generally have less testosterone than men, this might explain why women tend to develop sarcopenia at twice the rate as men. 

DHEA and Human Growth Hormone

Adrenal DHEA, another androgen, also declines with age, and may affect muscle strength via a number of mechanisms.  DHEA is converted to estrogens and testosterone in the body, which may have a direct effect on receptors. Also, DHEA increases sensitivity to insulin, another anabolic hormone, which may also increase levels of IGF-1 (the active metabolite of growth hormone). Increased IGF-1 may indicate increased levels of growth hormone. Growth hormone has been shown to increase muscle mass in many studies.

The Triad of Frailty

In their article Frailty and the Older Man, Drs. Jeremy Walston and Linda Fried proposed looking at the concept of frailty in the elderly as a triad:

  1. With aging the hypothalamic responses to stress change, cortisol levels increase, and the signals to produce sex hormones and growth hormone decline
  2. The immune system is affected, producing fewer antibodies and more inflammatory cytokines
  3. Both of these effects contribute to sarcopenia

All three systems are interdependent: the endocrine system, the immune system, and the muscular system participate together in a spiral of decline.


Maintaining the health of the body requires collaboration between various factors. Our awareness of these factors gives us the tools to optimize our aging with strong bodies. Such factors include:

  • Eating well and ensuring our digestive systems work
  • Bolstering our metabolic processes with vitamins and minerals
  • Avoiding environmental challenges to our biochemistry

In addition to these factors, our health is profoundly affected by hormones. Sarcopenia illustrates how hormone deficiencies hinder us from achieving optimal health. Fortunately, our ability to supplement the hormones that decline as we age may help stave off the effects of sarcopenia and other age-related conditions.

A validated questionnaire called FRAIL can be used as a simple screen for sarcopenia. Three or more “Yes” answers are considered “frail,” signalling the possibility of sarcopenia.

  1. F. Fatigue: Did you feel tired all or most of the time in the last 4 weeks?
  2. R. Resistance: Is it difficult to walk up 10 steps without resting?
  3. A. Ambulation: Is it difficult to walk several hundred yards?
  4. I. Illnesses: Do you have more than four illnesses?
  5. L. Loss of weight: Have you lost 5% of your normal weight in the last year?
  • La Colla A, et al. 17 Beta Estradiol and testosterone in sarcopenia: Role of satellite cells. Aging ResRev. 2015 Nov:24(Pt B): 166-177. doi: 10.1016/j.arr.2015.07.011. Epub 2015 Aug 3.
  • Health Sciences Institute. This hidden disease will land you in a nursing home. February 2016 (20) 6.
  • Walston J, Fried L. Frailty and the Older Man. Med Clin North Am. 1999 Sept;83(5):1173-1193.
  • Balagopal P, Proctor D, Nair KS. Sarcopenia and Hormonal Changes. Endocr. (1997) 7:57-60. https://doi.org/10.1007/BF02778064.
  • Morley JE, Malmstrom TK. Frailty, Sarcopenia, and Hormones. Endocrinol Metabl Clin N Am. (2013)42:391-405. https://doi.org/10.1016/j.ecl.2013.02.006.
  • Morley JE, Malstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging. 2012 Jul;16(7):601-8.

© 2018 Women’s International Pharmacy

Edited by Michelle Violi, PharmD; Women’s International Pharmacy

For any questions about this article, please e-mail

Carol Petersen at carol@womensinternational.com

Sarcopenia: Age-Related Muscle Loss2019-02-13T09:53:55-05:00