The Basics of ADHD in Adults

ADHD is the most common psychiatric disorder of childhood. It is classified as a neurodevelopmental disorder that may persist from childhood into adulthood. In childhood, it is associated with inattention, hyperactivity, and impulsivity. Symptoms often change as a person gets older and are associated with an increased risk of developing depression, anxiety, and substance abuse. However, recent studies have challenged the idea that every adult with ADHD had it as a child. The results of those studies show the following. First of all, ADHD often goes unrecognized throughout childhood. Secondly, families may help children develop good compensation strategies. The conclusions, therefore, remain that, indeed, ADHD in adults is still considered a continuation from childhood.

Attention-Deficit/Hyperactivity Disorder (ADHD) is often a disabling condition in adults. As just noted, a significant portion of patients is not diagnosed during childhood, as diagnosis of the syndrome can be complex, especially when other psychiatric conditions are also associated. As undiagnosed ADHD patients age, they are presenting to memory clinics with attentional and executive disorders. Neuropsychological examinations of these undiagnosed ADHD patients often reveal atypical cognitive profiles that complicate the usual diagnostic procedures for ADHD and increase the risk of misdiagnosis. Therefore, first and foremost, it is recommended that any explorations of cognitive and/or behavioral disorders in adults should systematically screen for ADHD. Let’s now explore adult ADHD symptoms, usual remedies, and then functional alternatives.

  • Is it possible for Adults to Develop ADHD out-of-the-blue?
  • What are Adult ADHD Symptoms?
  • Typical Medical Treatment for ADHD in Adults
  • How do the medications work?
  • What’s the problem, then?
  • Cortisol
  • Cortisol part deux
  • The gut-brain axis
  • Fixing the ravages of high cortisol
  • Repairing the gut lining
  • Repairing the Microbiome
  • Behavioral and supplemental interventions
  • The cool stuff: peptides
  • Miscellaneous “other”

Can Adults Develop ADHD?

Adults can have ADHD, of course.  About 4% to 5% of U.S. adults have it. But surprisingly, few adults get diagnosed or treated for it. Instead, they often end up being evaluated at memory care centers, as noted above.

Who develops adult ADHD? Every adult who has ADHD has probably had it as a child. Some may have been diagnosed and known it. However, some adults may not have been diagnosed when they were younger and only find out later in life due to having “life issues” crop up, which will be discussed below.

While many children with ADHD do outgrow it, about 60% still have it as adults. Adult ADHD affects men and women equally. Many questions of late-onset ADHD remain incompletely answered, and further research is necessary to understand better and explain the etiology and development of this late-onset disorder. One very important thing we are noticing, and reporting: CIRS patients all have difficulty concentrating and often come to me on Adderall.

What are Adult ADHD Symptoms?

If you have adult ADHD, you might have difficulty with the following:

  • Ability to concentrate and focus on tasks
  • Task organization
  • Following directions
  • Remembering information
  • Finishing work on time or deadline

If you have ADHD, you may have trouble with one or more of the following:

  • Anxiety
  • Mood swings
  • Procrastination
  • Poor organization skills
  • Low tolerance for frustration
  • Trouble concentrating when reading
  • Chronic lateness and forgetfulness
  • Impulsiveness
  • Depression
  • Chronic boredom
  • Depression
  • Trouble controlling anger
  • Low self-esteem
  • Substance abuse or addiction
  • Low motivation

What is the Typical Medical Treatment for ADHD in Adults?

In a word: Stimulants! Adults with ADHD have usually been prescribed stimulant medications. As a result, studies demonstrate that about two-thirds of adults with ADHD have big improvements in their symptoms, at least at first.

Typical medications used include:

  • Amphetamine/dextroamphetamine (Adderall, Adderall XR)
  • Lisdexamfetamine (Vyvanse)
  • Methylphenidate (Ritalin, Concerta, Metadate, Daytrana, Quillivant XR, and Methylin)
  • Dextroamphetamine (Dexedrine)
  • Dexmethylphenidate (Focalin)

Studies suggest that these drugs improve (the happy brain chemical)- dopamine transmission by increasing its levels in the striatal region of the brain. Researchers have found that most amphetamines promote dopamine release, while Ritalin blocks the transporters that remove dopamine, keeping levels up. Ritalin also seems to improve norepinephrine transmission as well. This is all well in good, but amphetamines stimulate the adrenal glands to produce more and more cortisol over the long term. So-what’s wrong with that? Plenty.

Let’s Talk about Cortisol

Cortisol modulates many of the changes that occur in the body in response to stress. These include things like blood sugar levels and blood pressure. Cortisol has firm control over proper immune responses. It has anti-inflammatory activity. It also activates our entire nervous system by being coupled with adrenaline (epinephrine) release. As a result, it has a role in sleep, mood, energy, anxiety levels, and more. Short term, it acts in a beneficial way to help us through stressful situations. However, long-term adrenal stimulation by amphetamines causes persistently elevated cortisol levels, which definitely can become a problem. Here’s why.

What happens with long-term high cortisol?

Cortisol helps us deal with stress by shutting down “unnecessary functions,” like reproduction and the immune system, to allow the body to direct its energy towards dealing with the stressor. These functions are supposed to be short-lived to deal with the stress. However, our modern lives are full of stress, and when stress is chronic or caused by amphetamines, this becomes a problem.

Cortisol partially shuts down the immune system when levels are high. It interferes with T-cell (a type of white cell) production and function, making your body more susceptible to pathogens like viruses, bacteria, and fungi. Ever notice how people who are constantly under stress are also always getting sick? This is why.

Cortisol also affects your muscles and bones. Cortisol is “catabolic.” It inhibits the uptake of amino acids into muscle cells, making it impossible to fuel muscle cells. It also inhibits bone formation and decreases intestinal calcium absorption. So when cortisol is high, there’s minimal to no bone growth and little muscle growth going on. And yes, there’s more when you have long-term high cortisol levels.

Adults with ADHD tend to have BDNF levels on the low side of normal for reasons still unknown. BDNF is “brain cell food,” so it’s important to continue neurogenesis throughout our lifetimes. Add high cortisol to the mix, and first, we see gut hyperpermeability. Why? High cortisol can cause the breakdown of your GI lining. It does this by slowing down both GI motility (peristalsis) and the process of digestion. When this happens, some people experience reflux, or “heartburn,” while others have absolutely no symptoms. Blood flow then decreases to all of the digestive organs. This results in a higher concentration of toxic metabolites, which then whittle away at your gut lining.

We then see a breach in the gut-brain barrier, the slow-down of conversion of neural stem cells into neurons, and the further lowering of BDNF needed for that process to happen. Cortisol has even been shown to be a direct neurotoxin!  The result=impaired cognitive performance in terms of memory, executive functioning, speed of thought, and so on. It usually all starts with a little “brain fog.”  More about the gut-brain barrier next.

In addition, we see dampened thyroid function, blood sugar imbalances,  insomnia, osteoporosis, blood pressure elevations, lowered immune function, and universally- increased abdominal fat

What happens to the gut-brain axis?

Much recent research shows that changes in gut microbiota could affect the brain’s cognitive, behavioral, and basically- all physiological functions. Although the exact mechanism of the connectivity of the gut-brain axis has not yet been elucidated, the evidence shows that gut microbiota plays an important role by producing immune factors, hormones, and metabolites that influence brain functioning.

Stress, meaning high cortisol, can significantly impact the microbiota-gut-brain axis. Recent studies have implicated the gut microbiota in many brain conditions, including anxiety, autism, Alzheimer’s disease, schizophrenia, and Parkinson’s disease. In addition, ongoing research implicates diseases such as obesity, heart disease, and diabetes.

Fixing the Effects of High Cortisol

When we finally stop someone’s amphetamines, we still have the carnage caused (often) by years of taking them with resultant years of high cortisol levels. We know cortisol is a direct neurotoxin, likely being a risk factor for Alzheimer’s disease. We know all of the things mentioned above. However, when we’re talking about the root cause of Ulcerative colitis, Crohn’s disease, or any autoimmune disease for that matter, we see the direct effect high cortisol has on the gut. As previously mentioned, sustained high cortisol can be the sole reason for having a leaky gut. But for adult ADHD symptoms controlled by the “traditional drugs” discussed previously, it often requires someone to actually experience cognitive changes to bring them to a doctor such as myself. So what do we do?

First, we lower high cortisol levels. Adrenal (herbal) adaptogens, glandulars, liposomal GABA, and certain aromatherapy oils are proven to lower cortisol levels. Stress-reducing techniques such as “vagal breathing,” meditation, and yoga are great practices to maintain overall health as well as lower cortisol levels. Finally, just activating your hypoglossal nerve (the nerve to the tongue and vocal cords) and, therefore, your adjacent vagal nerve to tone down your sympathetic nervous system will help. All you need to do is gargle, sing or do vocal exercises. We also always need to fix the gut lining and the microbiome. Here’s how we do it.

Heal the gut 

The pentadecapeptide BPC-157  (Gly-Glu-Pro-Pro-Pro-Gly-Lys-Pro-Ala-Asp-Asp-Ala-Gly-Leu-Val) has been demonstrated to counteract peritonitis, and heal upper intestinal lesions, heal colitis lesions and seal up a hyperpermeable gut lining.

Gastric pentadecapeptide BPC 157, now found to be effective in the upper and lower GI tract, is remarkably free of side effects, as are the other peptides being used in functional medicine. More about peptides to follow.

Re-Balancing your Disturbed Microbiome 

By definition, when you have gut hyperpermeability, you have more “toxic bacteria” than “healthy bacteria” populating your GI tract.  Use prebiotic fiber to feed the good bacteria and (if you are not in a “mold and mycotoxin situation” a little bit of “good yeast” (Saccharomyces boulardii) to begin to re-create a healthy gut microbiome. If you like un-ripe bananas, they make great prebiotic fiber. Other foods include asparagus, Jerusalem artichokes, red onions, and naturally fermented (not pickled) foods such as sauerkraut.

When your gut lining is coming together-usually the 2 to 3-week mark, add probiotics. Historically, we have recommended 50 to 100 billion probiotic CFU’s per day. A mixture (in your main probiotic) of Lactobacillus species and Bifidobacterium species is probably fine. Still, even more evidence supports the use of sporulating probiotics for an even better microbiome. These probiotics are species of Bacillus with b. subtilis and b. coagulans being the most studied. Start as low as 5 billion and increasing to as many as 25 billion CFU’s daily (best done under a doctor’s supervision if you have GI symptoms). But now that you’re weaning from ADHD stimulants, what do you do?

Food, Exercise, Sleep, Therapy, and Supplements 

Studies have associated poor attention and worsened  ADHD symptoms with diets full of the unhealthy things we tell you not to eat, such as refined sugar and fried foods. In addition, artificial food colorings and the preservative-sodium-benzoate may worsen ADHD-hyperactivity in children but otherwise hasn’t been studied for other effects or in adults.

According to some good clinical evidence, regular exercise may reduce adult ADHD symptoms. And I don’t believe I need to tell you that poor sleep quality impairs attention and other cognitive functions, worsening ADHD symptoms.

Cognitive-behavioral therapy has been shown to improve ADHD symptoms in adults. In addition, mindfulness-based therapies improved ADHD symptoms in multiple studies, mostly in adults as well.

Supplements that might be useful: ADHD patients tend to have lower magnesium levels than average, with the caveat that most of us not on MG supplementation are a bit deficient. At any rate, in two clinical trials, magnesium supplementation did indeed improve adult ADHD symptoms. Similarly, there is a higher prevalence of vitamin D deficiency in ADHD patients, and studies suggest that supplementation is helpful. Finally, fish oil supplementation appears to be quite promising, is anti-inflammatory, and is usually a good “health practice” anyway.

L-Tyrosine: This amino acid is being discussed separately because the data supports its use in adults with ADHD. A review of 15 clinical trials concluded that L-tyrosine (a dopamine precursor) boosts attention and cognitive performance in stressful and demanding situations in normal adults. These were not trials done with adult ADHD symptoms, but the extrapolation of that data to patients with ADHD has resulted in numerous clinical reports of the same benefits. There is less data on SAMe (S-adenosyl-L-methionine), but one study indeed suggested that it might be a useful way to increase dopamine and norepinephrine.

Peptides 

Peptides are small chains of amino acids that make up proteins and are available in every part of your body. Because peptides can be found in any part of the body, they each have particular functions. They act as messengers, signaling specific glands and proteins into performing specific tasks. These; essentially bioidentical substances have been isolated and replicated for use by Functional Medicine doctors. Since they are bioidentical, there are no side effects. They are an amazing addition to our arsenal of treatments, and there happen to be three that are quite useful for adult ADHD symptoms.

Heptapeptide Semax: (Met-Glu-His-Phe-Pro-Gly-Pro) 

Semax is considered a brain-enhancing or “nootropic” peptide due to its ability to increase BDNF:brain-derived neurotrophic factor, nick-named “brain fertilizer,” since it is the largest (neurotrophic) stimulator of neurogenesis. In addition, Semax has also been found to be a potent enkephalinase inhibitor. In other words, the enzyme that destroys the natural painkillers and anti-anxiety brain chemicals called enkephalins is blocked by Semax, which has been independently proven to reduce anxiety and, therefore, likely decrease cortisol. In addition, several studies demonstrate its ability to cause the brain to release both serotonin and dopamine, enhancing feelings of well-being and, more-than-likely (due to the dopamine boost) attentiveness.

The heptapeptide Semax is an analog of the N-terminal fragment (4-10) of ACTH (adrenocorticotropic hormone) but is absent any hormonal activity. However, it has been found to stimulate memory and attention in rodents and humans after intranasal application. In addition, evidence from animal studies reveals that Semax augments the effects of psychostimulants on central dopamine release.

As noted above, it stimulates central brain-derived neurotrophic factor (BDNF) synthesis. In addition, Semax is thought to improve selective attention and modulate brain development. Since ADHD is likely to be a neurodevelopmental disorder with disturbance in both dopamine and BDNF function production, it is proposed by many neuroscientists that Semax may have excellent therapeutic potential in ADHD. In Russia, this peptide is used as a common alternative for drug therapy for children with ADHD. In addition, functional doctors in the U.S. prescribe it for mood issues, adult ADHD symptoms, cognitive and pain issues.

Cerebrolysin  

This peptide is widely used in Europe and Russia but not approved in the U.S. However, it has been studied for many years and is a go-to for adult ADHD in other countries. Numerous studies show that this peptide increases cognitive functioning and attention with decreased impulsivity in children and adults with ADHD.

Dihexa    

Dihexa is a peptide derived from angiotensin IV-a metabolite of the potent, naturally occurring vasoconstrictor angiotensin II.  Angiotensin IV  has been shown to enhance acquisition, consolidation, and recall of memory and learning in animal models.  What’s more, the peptide Dihexa has been determined to be seven orders of magnitude more potent than BDNF. Thus, you first read about BDNF as the potent neurogenesis stimulant, but there’s more to it than simply being a cognitive enhancer.

Brain-derived neurotrophic factor is the most dominant neurotrophin in the CNS (central nervous system). It plays a crucial role in physiological brain functions via its two independent receptors: tropomyosin-related kinase B (TrkB) and p75. These two activities are critical during neurodevelopment. In addition, the disrupting of BDNF signaling has been documented in many neuropsychological diseases, including ADHD.

Dihexa is a first-in-class compound that is orally active, penetrates the blood-brain barrier, increases BDNF, improves memory consolidation and retrieval as well as concentration and neural processing speed.

Miscellaneous Functional Medicine tools 

Deserving of more than an honorable mention is functional medication likely to be helpful with adult ADHD symptoms. While definitive research is pending, the logic is compelling for the following.

Oral nicotinamide mononucleotide supplementation increases intracellular NAD+ concentrations, improving mitochondrial biogenesis and ATP (mitochondrial energy) output. It is well known that the brain has an enormous supply of mitochondria, so mitochondrial enhancement should, in theory, benefit all brain functions.

The peptide selank increases BDNF and decreases levels of anxiety by increasing concentrations of GABA in the brain. Due to the importance of BDNF enhancement and, in some cases, lowering anxiety to ameliorate adult ADHD symptoms, it makes sense to utilize this peptide. But, again, data is pending on these two measures.

 

How to tell if you have a Hormonal Imbalance

A hormonal imbalance is having too much or too little of any of the myriad of hormones I’ll be discussing in this article. Out-of-whack hormone levels can cause just about any symptom imaginable. You can have weight gain or weight loss, hair loss, or excess hair growth. You can become lazy or anxious, sleep too much, or have insomnia! It’s no wonder people scratch their heads trying to self-diagnose. When you receive a diagnosis, you often don’t receive a full explanation, right? Bottom line: If you think you need hormone replacement therapy, seek a physician specializing in hormone replacement. To begin, let’s define “hormones.”

What are Hormones?

Hormones are the body’s “chemical messengers” that transport information from the brain to the “target glands,” The target glands secrete their hormones to affect their target cells.

Next, the cells send their messengers back to the brain to regulate how much message the brain needs to continue or not continue sending. Our bodies contain about 60 trillion cells that must communicate to carry out hormonally based functions. For hormones to be in balance, everything needs to work together, much like a symphony orchestra.

Hormones enter the cells through receptor sites. This can be thought of as akin to a key unlocking a door. Once inside, they flip the switches that control growth, development, and mental and physical functions throughout life.

As we age, the hormones that work to keep us healthy begin to decline. Hormonal balance is lost, causing unwanted symptoms, disorders, and even diseases. In other words, the hormonal symphony plays out of tune and out of cadence.

The A-Z of Where Hormones are Made
  • Adrenals: Produces the hormones that control sex drive and the stress hormone cortisol, which controls salt and fluid in the body; aldosterone. DHEA is produced here too.
  • Hypothalamus: Responsible for body temperature, hunger, moods, and the release of hormones from other glands. Controls thirst, sleep and is the “master supervisor” endocrine gland.
  • Ovaries: Secrete estrogen, testosterone, and progesterone, the female sex hormones.
  • Pituitary: The other “master control gland,” which controls other glands and makes the hormones that trigger growth. This is what happens in the anterior pituitary. The posterior pituitary produces ADH, controlling thirst and urination. It also provides pain-relieving endorphins.
  • Pancreas: Produces the insulin that helps control blood sugar levels. Glucagon is secreted here too.
  • Parathyroid: Controls the amount of calcium in the body.
  • Pineal: Produces derivatives of melatonin, which affects sleep and more.
  • Testes: Produces the male sex hormone, testosterone, and produces sperm, obviously in males.
  • Thyroid: Produces hormones associated with metabolism.
  • Thymus: Plays a role in the immune system’s function and the thymus’s maturity and is the primary source for immune “fighter” T-cells early in life.

I’ll cover each of these hormones in alphabetical order, preceded by some basics about hormone replacement therapy and followed by the questions you will be asking yourself about whether or not replacing your diminishing hormones is a good choice for you.

Correct Hormone Replacement Therapy

A little known but important fact about hormone replacement is there are two types of hormones available for hormone replacement therapy: Bioidentical hormones and synthetic hormones. This is extremely important because of the side effects. While some non-functional doctors will “argue” and even publish books touting their opinion that “only FDA approved” hormones-the synthetic ones-are the only ones that should be used, those same doctors are (correctly) touting the effectiveness of the non-FDA-approved mRNA COVID vaccines. It’s a matter of common sense that you, my reader, have or you wouldn’t be reading this article. Here’s why.

Bioidentical hormones are made from natural substances using a compounding process that results in an exact biological replica of the substance produced by our bodies. This is why they do not produce undesirable side effects when administered properly.

In contrast, synthetic hormones are synthesized from a variety of chemicals and, although these molecules resemble those produced by our bodies, they are not biologically identical replicas. As a result, their use can result in severe side effects, as evidenced by the warnings on the labels and research and clinical studies.

Furthermore, in addition to avoiding the risk of side effects and thus being safe, bioidenticals have been shown by most clinical studies to be protective when administered properly. Meanwhile, the latest studies (many of which are listed in the references) refute prior claims that synthetic and bioidentical hormones are “the same.”

I did specify “when administered properly” because hormone replacement therapy is a complex and delicate balancing act that needs to be individually tailored to each patient, often requiring a combination of hormones in conjunction with other mitigating compounded medications. I cannot tell you how often I “clean up the mess” made by unqualified doctors prescribing hormones to patients who “want to save a buck.” Let’s explore whether or not your symptoms sound as if hormone issues cause them.

Do you have Hormone Imbalance Symptoms?

I receive new patient inquiries all of the time, with complaints listed such as decreased energy, sleep disruption, brain fog, and reduced libido. This is usually (at least partially) due to an imbalance (usually too little; not too much) of one or more hormones. However, to determine the problems, I have to “think through” every hormone and organ system—tying everything together like the symphony metaphor I used above. Rather than explain why you can’t self-diagnose your own hormonal imbalance issue or issues, below you’ll find a synopsis of hormone function. This will prepare you to ask the right questions when you see a specialist. As promised, I will go from A to Z, which means we’ll start with aldosterone.

What the heck is Aldosterone?

Most of you have never heard of this hormone, even though it plays an important role in cardiovascular health. The adrenal glands produce aldosterone. Aldosterone affects the body’s ability to regulate blood pressure. It signals the kidneys to increase or decrease the amount of sodium (salt) the body sends into the bloodstream or the amount of potassium excreted in the urine. Indirectly, aldosterone also helps maintain the blood’s pH and electrolyte levels.

Aldosterone is closely linked to two other hormones: renin and angiotensin—which is basically how your body uses the kidneys to regulate your blood pressure. When these three hormones are “out of whack,” your blood pressure can go up.

In addition, in severe adrenal “fatigue,” aldosterone levels can be reduced, causing worse fatigue as well as postural blood pressure changes, mimicking what is knows as POTS.

Anti-Diuretic Hormone (ADH)

The posterior pituitary gland secretes this hormone to work in conjunction with the kidneys, regulating what is called the osmolarity of your blood. Osmolarity is basically how much your blood and urine get concentrated as it passes through the kidneys. People with biotoxin illness (mold and mycotoxin illness and Lyme) often have low ADH issues, as do people with a history of head trauma. The symptoms are excessive thirst and urination—the same symptoms we associate with the onset of diabetes.

Calcitonin

Calcitonin is a hormone released by the C-cells in the thyroid gland. It opposes the action of the parathyroid hormone, which you’ll read about further down our list. Both hormones regulate the blood’s calcium and phosphate levels. While it can be used to treat severe osteoporosis, I choose to use the Parathyroid hormone instead. Calcitonin is also used to treat Paget’s disease of the bone.

Cortisol

You have heard about the fight or flight hormones cortisol and adrenaline, right? Cortisol increases under stress which is a good thing for your body in the short term. However, long-term high cortisol levels can lead to increased coronary plaquing, a depressed immune system with associated risks for an increased risk of cancer, and measurably impaired cognitive function, just for starters! In the intermediate term, high cortisol levels can zap your energy by interfering with mitochondrial function. It can make you feel fatigued, and it’s not just because high cortisol levels interfere with regular sleep patterns.

Cortisol causes symptoms I’ll call “annoyances” only because that is how individuals treat them. High cortisol can trigger sugar cravings. It can be the main “driver” of menopausal belly fat. If you are trying to build muscle, it does just the opposite: “catabolic.” It not only can decrease muscle mass, but it also reduces bone mass and can slow down your metabolic rate by interfering with thyroid function too. Lastly and disastrously, it can trigger leaky gut syndrome, a leading cause of systemic inflammation.  This is the only hormone that actually (for the most part) increases as we age.

It is necessary to bring cortisol levels down for people under constant stress and most individuals over 55-65 years of age and older for all of the reasons mentioned above. I usually do this with a combination of adrenal adaptogens (containing ashwagandha, rhodiola, siberian ginseng, and astragalus) as well as an adrenal glandular preparation. Sometimes I use peptides, integratives, or liposomal GABA. There is even a role for some scientifically proven aromatherapy blends. This is the one “hormone arena” where people who read about HPA axis dysfunction (popularly termed adrenal fatigue) can generally self-diagnose much of the time. Please note that you need a medical workup if you self-diagnose and supplement and do not get better within a couple of months.

DHEA (Dehydroepiandrosterone)

I don’t know why this hormone gets a weird “rap”—for instance; it’s linked to anabolic steroids. This wonderful hormone is either not well known or is unfairly demonized, in my opinion. DHEA will amp up your immune system and help calm inflammation. Studies show “older Americans” with good DHEA levels have less depression than those with low levels. Lastly, it’s super important for bone thickness and the prevention of osteoporosis. You wouldn’t detect a DHEA hormone imbalance or deficiency symptomatically, which is why everyone needs key hormones checked as they age. Recent “brain studies” show that DHEA causes brain stem cell stimulation (to produce new neurons), another reason I insist all patients have this hormone normalized.

This hormone is safe to take unless you have a male who has had a “male cancer” or a female who has had “female cancer” or PCOS. DHEA metabolites might be a problem. But, you can safely take the 7-keto form of DHEA, which has the added benefit of being a bit of a metabolic stimulant.

Since when is Vitamin D a hormone?

Vitamin D is a pro-hormone the kidneys produce, which helps control blood calcium concentration and immune system function. The amount of Vitamin D made when sunlight hits the skin and is converted to the active substance called calcitriol by the kidneys is insufficient for most people. Recent studies reveal many cancers are linked to low vitamin D levels.

A low vitamin D level is also related to other issues such as heart disease, autoimmune disease, and even depression. This loosely translates into a minimum of 5000 IU’s per day of vitamin D, which should be consumed with vitamin K for optimal absorption. This is another lab test that should be checked (at least) annually. Recent guidelines recommend levels of 75-80 ng/dl as ideal. If you have an autoimmune disease, the literature strongly suggests higher vitamin D levels as optimal.

Estrogen

Estrogen is responsible for the development of “female pubertal changes.” Most women who contact me are interested in what to do when they have symptoms of estrogen deficiency due to menopause. But please take note that night sweats can be from estrogen deficiency, cortisol excess, mold toxin illness, or infectious diseases, meaning don’t just assume your “hot flashes” are due to estrogen deficiency.

If you have gained “the menopause 25,” it is due to an imbalance of several hormones, including estrogen deficiency. Losing the menopause weight without bioidentical hormone replacement is hard. Poorly done estrogen replacement (and yes, I have seen this) causes weight gain. Estrogen replacement, replacement of other hormones, and balancing cortisol levels make weight loss much easier. Estrogen counters most of the signs and symptoms women find bothersome about menopause.

However, that’s not the only reason to replace your missing estrogen. Estrogen helps your heart, bones, skin, and brain. I don’t know why “length of treatment” remains a controversial topic—likely because dangerous synthetic hormones have clouded the collective thinking on bioidenticals.

I would be remiss if I didn’t touch on two not-uncommon “female illnesses” which are now totally controllable with functional medicine treatment. PCOS (polycystic ovary syndrome) can cause metabolic issues, menstrual abnormalities, symptoms of high testosterone, and generalized inflammation. It can be well controlled, and if hormone replacement therapy is utilized, it is most efficacious if bioidenticals, not synthetics (such as “the pill”), are used for treatment. It is filed here under “estrogen” because often, estrogen levels are low, and cycles are anovulatory.

On the other hand, endometriosis tends to be a disorder associated with high, sometimes super-high estrogen-particularly estradiol levels. The endometrial tissue secretes estradiol, independent of ovarian estrogen secretion, and control of this disorder is also well done in functional medicine therapy, where estrogen levels are brought under control, and new endometrial tissue formation is blocked. Further discussion of these two disorders will be done elsewhere. Now, let’s move on to the pancreas.

Glucagon

This hormone is secreted by the pancreas and directly impacts the liver to control blood sugar levels. Glucagon prevents blood glucose levels from dropping to dangerously low levels. It does this first by stimulating the conversion of stored glycogen to glucose in the liver. It also keeps the liver from consuming glucose. This allows more glucose to enter the bloodstream when needed. Lastly, glucagon is essential for a process called gluconeogenesis: the production of glucose from amino acids.

HGH (Human Growth Hormone)

This is another hormone that gets “maligned”—likely due to its misuse in professional sports. HGH is necessary for many bodily functions. It helps heal injuries. Remember how quickly a sprained ankle healed when you were younger? That’s due to human growth hormone. An M.D-patient of mine had been to several well-known medical centers because he had such fragile skin. He bruised or bled with even a touch from someone else. When he contacted me, he had the lowest HGH markers I have ever seen. Therefore, he had incredibly fragile skin, and that was why he had the problem. Within three months of hormone replacement therapy, his symptoms vanished.

The FDA approves HGH for treating specific problems. The “side effects” are what have made this hormone notorious. It hastens the shedding of body fat and the development of lean muscle mass. It increases bone density and improves immune system function, according to most studies. Overall, it gives people a better sense of well-being. In clinical studies, it increases the dermis thickness—the layer of skin that contains the building blocks of skin called elastin and collagen. In fact, HGH users report they look younger.

Human growth hormone is not to be used in active or recent (within 5 years) cancer cases, as it causes existing tumors or remnant cells to grow. Despite the controversy over whether it does or does not cause cancer, no studies show that it (de novo) causes cancer. But, I need to emphasize this controlled substance should only be used under FDA guidelines. mTOR is one of the pathways stimulated by a marker of HGH called IGF1, and “too much MTor stimulation” might be related to adverse health outcomes. That’s why it’s always a good idea to counteract mTOR stimulation with good health practices such as exercise, intermittent fasting, and correct supplementation. When we stimulate the anterior pituitary to release more HGH by prescribing peptides, we see the same benefits as prescribing HGH for a fraction of the price. Now-back to the pancreas!

Insulin

The pancreas secretes insulin. People with type 1 diabetes have insufficient secretion. It’s an autoimmune disorder, and some cases are completely reversible. People with Type 2 diabetes have inadequate or unresponsive receptors for glucose uptake. Most individuals with Type 2 diabetes are overweight or obese. The entity most doctors call pre-diabetes is as having a fasting blood sugar of 99 ng/dL. What is normal blood sugar? Your fasting blood sugar should be 75-85 ng/dL, or you are “glycating” (stiffening) your body’s cells-all of them.

Insulin is responsible for getting blood sugar into all cells. By doing so, it increases muscle mass and fat storage. However, if insulin levels are too high, there is an increased risk of diabetes, heart disease, Alzheimer’s disease, and cancer. We use insulin as a biomarker for inflammation tied to most if not all disease states and aging in general. This is one hormone you want to keep at a nice, low level—around 2-3 uIU/ml. If applicable, you can get this level down with weight loss, curcumin, omega-3 fatty acids, green tea, and toxin removal. Now, I’d like to discuss a hormone most people think is simply “for sleep.”

Melatonin

Melatonin is one of the most underrated hormones. Most of us need supplementation by the time we’re 30 to have profound, restful, and restorative sleep. You can protect your natural melatonin secretion by maintaining a good circadian rhythm which includes blocking blue lighting as the sun sets. There are apps for tablets and phones you can set to dim your screen at sunset, and I suggest you do so. I recommend slightly higher doses of melatonin than you may be used for patients and families based on research that I find exciting. Here is just a sampling of “what else” melatonin can do for your health.

It reduces oxidative stress (free radical damage), thereby decreasing inflammation. Research shows it also helps block the process, which shortens telomeres, likely affecting genetic aging. It further reduces inflammation by reducing pro-inflammatory cytokines.

It augments immune function by increasing CD4 cells and also increases what is known as natural killer cells. Doing so helps us fight infections and was recently made a part of most good functional medicine COVID protocols.

Melatonin helps preserve brain mitochondria, slows age-related cognitive decline, and inhibits beta-amyloid formation in the brain. In addition, an exciting discovery is that we still have stem cells in our brains, even as adults. And guess what? Melatonin turns on these stem cells. Due to all of the brain-healthy effects, inexpensive but powerful melatonin makes it to my must-have hormones list for everyone.

Oxytocin

In women, oxytocin is responsible for signaling contractions of the womb during labor. The hormone stimulates the uterine muscles to contract, so labor begins. Because of this effect, synthetic oxytocin is sometimes used to induce a woman to start labor if she cannot begin naturally. Once the baby is born, oxytocin promotes lactation by moving the milk into the breast. When the baby sucks at the mother’s breast, oxytocin secretion causes the milk to release so the baby can feed.

At the same time, oxytocin releases into the brain to stimulate further oxytocin production. Once the baby stops feeding, the production of the hormone stops until the next feeding. Oxytocin function is less important for men, but it does appear to affect testosterone production in the testes.

Recent studies show oxytocin is an important hormone that controls some human behavior and social interaction. Oxytocin triggers the bond between a mother and an infant, and it may also play a role in recognition, sexual arousal, trust, and anxiety between partners and friends. It is released when we interact with a loved one, including our dogs; yes, our dogs. A 2017 study proves that you can bond your dog more to you and you- to your dog by staring into your dog’s eyes. And there is leftover oxytocin for you to use with your partner, family, and close friends!

Other fascinating research reveals that oxytocin hormone may affect addiction and stress levels. It also helps people overcome sugar habits with varying success. Recent studies show that it may be useful in pain management regimens as well.

Parathyroid Hormone

In the intestines, parathyroid hormone helps with vitamin D metabolism. This allows the body to absorb more of the calcium it digests from food. The hormone stops calcium release in the kidneys through the urine (stones!) while also increasing vitamin D production. This is one of the hormones where excessive amounts are more common than a deficiency when we are younger, but as with every other gland, the parathyroid glands can fail as we age. Anatomically, these four glands are found on the flip side of the thyroid gland, in the neck.

Pregnenolone

This is another hormone you might not have heard about, but if you’re anxious, you’ll certainly want to see if you’re deficient. It helps repair brain and nerve tissue, decreases anxiety, improves sleep quality, improves general well-being, and is probably brain-protective too. Self-medication with small amounts is generally fine.

Progesterone

Low progesterone complaints are often mistaken for psychological symptoms as all-too-many progesterone-deficient women are handed prescriptions for pharmaceuticals to treat anxiety and depression. Lack of progesterone causes PMDD symptoms, anxiety, irritability, depression, and more. Peri-menopausal sleep issues are generally the result of a dip in progesterone—the first female hormone “to go.”

Adding oral progesterone to the nightly regimen helps with sleep initiation and maintenance. I said “oral” because progesterone creams don’t pass the blood-brain barrier. Please check the referenced article for details on low progesterone symptoms and treatment.

Regarding the role of progesterone replacement in menopause, note that the menopausal weight gain referenced in an earlier section is partially due to the loss of progesterone.

Lastly, if you are on bioidentical estrogens, you must also be on progesterone, whether or not you have had a hysterectomy. You must protect not just your uterus but also your breasts from “unopposed estrogens.”

Testosterone

Testosterone is the most important of all male hormones. We know what happens in puberty, so we’ll skip that part. In adulthood, testosterone is a major energy hormone for men. It increases bone density and is responsible physically for libido and quite a bit of sexual function. The right amount (not too much) is good for cholesterol levels, improving cardiac health.

Bad publicity based on poorly done studies about testosterone supplementation causing heart disease has been completely debunked; testosterone doesn’t cause heart disease. If you take it in massive doses, who knows? But that shouldn’t happen. It also helps prevents prostate enlargement (if aromatization is controlled) and probably helps prevent prostate cancer. It is neuroprotective and decreases the incidence of Alzheimer’s disease in both men and women. Further, it increases muscle mass and bone density in men and women as well. The testosterone that is available on the black market requires self-diagnosis and trust that the substances are safe. Please consult a hormone specialist and don’t treat yourself for “low-T.”

A side note about testosterone is that if you are young, with a low testosterone level, that needs to be investigated, not just replaced. As an example, young men with CIRS will have low testosterone levels due to anterior pituitary involvement. HCG or Clomid is a much more appropriate choice for those patients to augment their testosterone levels while detoxing.

One last thing: if you are a woman who has had estrogen-receptor-positive breast cancer, you should not use testosterone replacement therapy for at least five years after you are done with treatment and considered to be in remission. The reason I’m bringing this up is that I’ve had to repair the damage caused by unqualified doctors who have placed women on testosterone supplementation, not realizing that some of it would be aromatizing to estradiol and then triggering a flare of their breast cancer.

Thyroid hormone

The active form of thyroid hormone (T3) is made from the inactive form (T4), which needs an enzyme (deiodinase)  that requires quite a lot of minerals, so make sure you are on a good multi-vitamin-multi-mineral supplement. I often see labwork where the Free T4 is normal, but Free T3 is low, indicating decreased T4 to T3 conversion the majority of the time. Remember, T3 is the active form of thyroid hormone.

T3 increases energy, fat burning and helps control weight. It increases appetite and heart rate. Too little causes chilliness, a loss of the outer 1/3 of eyebrows, and a decreased morning basal temperature (below 97.3F). If you are looking to self-diagnose before having lab results, you can measure your morning temperature for a week. If it’s lower than 97.3, chances are you’re hypothyroid—no matter what your lab testing shows. Insist on the proper lab testing. Here’s what to ask for: TSH, FREE T3, FREE T4, reverse T3, TPO, and other thyroid auto-antibodies.

Why do Hormones Decline?

Hormonally and physically speaking, your body peaks around the age of 25. We often assume that things like a foggy memory, low libido, menopausal weight gain, hair loss, and wrinkles are simply a part of “getting older.” Worst of all, that’s what most doctors think too! But, we can relieve these symptoms with the use of bioidentical hormones.

However, before jumping into hormone replacement therapy, a good workup is necessary to rule out (or diagnose and treat) weight issues, inflammation, tumors, toxins, food allergies, head trauma, leaky gut, silent autoimmune disease, and excessive stress. A great form of natural hormone replacement is simply repairing the hormonal issue’s underlying cause (s). Once these problems are properly addressed, we can assess what truly needs to be replaced. Here are the basics.

In women, the symptoms of hormonal aging often first appear during early menopause (peri-menopause), when estrogen and progesterone levels begin to wane. Then they continue to decline throughout menopause. The hormone imbalance symptoms can begin as early as age 30.

Men usually experience a more gradual loss of hormones, mainly testosterone, which is called andropause. Unlike the sudden loss of estrogen that women face during menopause, the gradual loss of testosterone happens over time. It is often misdiagnosed or even dismissed as a “male mid-life crisis.” Both men and women usually experience weight gain, loss of energy, sleep disruption, and more during this time of life when (understandably!) most divorces occur.

Is Hormone Replacement Therapy Right for You?

In my opinion, most people benefit from melatonin replacement, and it’s “bad medicine” not to replace vitamin D.  It’s a good idea to monitor DHEA-S, estrogen, progesterone, thyroid function, insulin, and testosterone levels once you hit age 30-35. If you need treatment, I hope that you’ll “go with” bioidentical hormone replacement therapy.  I also hope you will find a well-trained specialist who doesn’t replace your primary care doctor but works with them. Please save this article to refer to in case you develop symptoms in the future.

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