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Simply defined, hormones are chemicals released into the blood by structures called endocrine glands whose job it is to coordinate processes throughout the body. Hormones regulate such essential functions as metabolism, the sleep-wake cycle, response to stress, the structure of the bones and reproduction. The most important hormones come from the ovaries, adrenals, pancreas, thyroid and pituitary. Though hormones are present in extremely minute quantities, they have the power to profoundly alter body processes.

Some of the most important hormones are:

Estrogen (estradiol is the main form)





T3 (tri-iodothyronine)

These are the ones most often involved in women’s hormone problems. There are many other hormones such as those which control the structure of the bones.  Because the amounts in the blood are minute, technology capable of measuring them dates back only to the 1970s. Unlike many other blood chemicals, hormone levels are not constant but fluctuate in complex patterns as they regulate the body’s rhythms. Without these fluctuations, there would be no menstrual cycle and no new human beings entering the world. But there would be no hormonal discomforts either. The basic difficulty is that hormones travel to all parts of the body and do different things in different places. The same hormone’s effects are often wanted in one place but not wanted in another.

Estrogen, the main female hormone has an essential nurturing effect on the body, widening blood vessels so that more blood flows through them to nourish and cleanse cells. Estrogen also soothes the walls of blood vessels, making them less vulnerable to scarring. The second female hormone, progesterone, prepares the body for pregnancy, protects against uterine cancer and sometimes helps sleep. Testosterone - yes, women have it too – strengthens muscles and bones and has some role in keeping a normal sex drive.

The thyroid hormones (thyroxine and T3) regulate the rate of metabolism and thus have important effects on energy, muscle strength, weight and over-all well being.

But each of these hormones can wear another face. Estrogen, especially when it suddenly surges or drops, can cause breast discomfort, nausea or migraine. Progesterone can cause bloating, and testosterone can spoil the complexion as well as making hair grow where it is unwanted. Hormones must stay in balance or be gently corrected when they don’t.

Hormones are chemicals but they are also sensations and feelings. They are the bloating many women feel before their periods and also the weepiness and irritability. I see the mission of my medical specialty of endocrinology as understanding the connection between these two aspects: hormones as complex molecules made up from carbon, hydrogen and oxygen and hormones as life experiences.

Many women come to feel that doctors do not understand their hormones and they are often right. Except in the subspecialty training of endocrinologists, hormones are covered only briefly in medical training.  They are considered a separate subject from the rest of medicine. Hence many excellent doctors in other specialties have only limited knowledge of hormones.

Why do hormones get short shrift? There are several reasons. We live in a materialistic culture and hormones cannot be seen or touched. Their effects usually do not show on MRI scans or with endoscopy. They can be measured with tests but interpretation of these tests is complex because normal ranges are not fixed. The proper levels of hormones vary with age, phase of the cycle, even the time of day. During the menstrual cycle, estrogen levels ebb and flow more than ten-fold. Testosterone levels fluctuate too, so that a woman may have a normal level in the morning and a high one in the afternoon. The word “hormone” comes from the Greek word for “wanderer” and like wanderers they can show up and disappear unexpectedly and can seem faintly disreputable.

Interpretation of hormone tests requires a knowledge of these vagaries. Often a considerable measure of intuition is needed over and above purely scientific knowledge to figure out what hormones are doing.  These inconvenient traits make some physicians feel uncomfortable when dealing with endocrine problems. Hormones affect both mind and body and mainstream medicine still tends to be uncomfortable with problems which involve both. Of course there are doctors who devote themselves to the study of hormones and become adroit at figuring out what is happening when they go awry. It is this sort of doctor you need to find if your hormones seem to be making their presence known in unwanted ways.


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