What to do with Sex Hormones

What Now?

If you are lucky enough to have a provider or an advocate that understands that your thyroid levels are appropriate, but your SHBG is too high and we know that this is a number’s game, then you can start considering systemic options.

Systemic hormones are the hormones that can be assessed when you do blood work.  These are the hormones going through your whole body system.  Supplementing with systemic hormones (of any kind) means that when you use that supplementary hormone long enough, you should see that the levels of that hormone change when you do blood work. 

For example, with high SHBG, you can counteract that by increasing your systemic testosterone.

Note that you can increase hormones locally too.  This would not act on your whole body system.  This would not create change on your blood work.

Ways to get more estrogen and testosterone systemically: creams, patches, pellets

There are several different ways to increase sex hormones systemically:  This is hormone replacement therapy (HRT).

 Estrogen can be increased systemically using a patch or an oral pill. 

 Testosterone can be increased systemically using a cream, pellets inserted into the fat of the buttock or an injection. 

Risks of supplementing estrogen and testosterone systemically

If you are a woman of reproductive age and want to consider using systemic testosterone, you must consider that this might affect your fertility options in the future.  This isn’t the case for everyone, but it is something that must be weighed heavily.

If you are a woman with a family history of estrogen dependent breast cancer, you will want to have serious conversations with your physicians about whether systemic estrogen benefits outweigh the possible risks.  While systemic estrogen does not cause breast cancer, those with a family history of estrogen-dependent breast cancer should still consult with their doctors. 

The key is to truly understanding if systemic or local estrogen use is what you need.  Local estrogen can be used mindfully even with women who have active estrogen-dependent or a history of estrogen-dependent cancer.  Local and systemic use are extremely different so a good understanding is vital to your quality of life.

But sex hormones aren’t just for sex.  They are for a healthy urinary experience too!  This is the part that is exciting to me.  This is the part that more people need to understand.  See, the lower part of the urinary system relies on having adequate amounts of estrogen and testosterone.  The parts we are talking about are the vestibule, the lining of the urethra and bladder.   Without proper sex hormones acting locally here, you might start experiencing urinary symptoms.

 These symptoms can be:

·      Urinating often day or night

·      Strong urges to urinate

·      Leaking urine

·      Burning with urination

·      Constant awareness of a need to urinate

·      Constant awareness of your bladder or urethra

·      Frequent urinary tract infections (UTI’s)

·      Frequent symptoms of a UTI, without having a real infection

·      Symptoms similar to Interstitial Cystitis (IC)

 The trick in this situation is that you will not necessarily be able to capture a local drop in sex hormones affecting the lower urinary tract via blood work.  Sometimes the drop in sex hormones is truly just a local drop. 

There are a few things that might create this situation:

·      Using soap to clean the vulva and/or the vagina

·      Frequent use of antibiotics

·      Vulvar skin issues

·      A basic diet

When I examine patients, I look at the vulva and I check everything that could be affected by a drop in sex hormones.  This top to bottom check helps me draw a complete picture.  There is no way to determine via any sort of lab testing if the lower urinary tract and vulva could use more sex hormones – this is done purely by a physical exam looking at the vulva and consideration of a patient’s report of their medical history.  The problem with this is that it takes an educated provider to know what to look for. 

Many physicians do not understand that using estrogen and testosterone locally will not affect blood levels.  Many physicians do not understand that sex hormones can affect lower urinary tract symptoms.  Many physicians do not understand what to even prescribe to supplement your local sex hormones.  This is a problem.  It’s one of the big Kahuna problems.  It’s why so many people have pelvic pain and feel so hopeless about it.  But this ain’t hopeless.