Deficiencies, excesses, relative excesses and relative deficiencies of various hormones may be associated with numerous symptoms, including but not limited to:

·        fatigue

·        dry skin

·        constipation

·        mental fog 

·        lack of sex drive

·        impotence

·        painful intercourse

·        insomnia

·        difficulty waking up

·        osteoporosis

·        hot flashes


In our opinion, the key may be finding the right balance of hormones.  For example, in the peri-menopausal years, progesterone may decline more rapidly than the estrogens.  Furthermore, many women may experience menopause without any significant symptoms or stress, whereas others may have a poor quality of life.  In my experience, the difference may not in the sex hormones estrogen or progesterone, but may be associated with other hormones such as adrenal hormones pregnenolone, and cortisol.

Measuring a patient's "position" in aging with respect to the bio-identical hormones can be complex, but in my experience may be worth the effort.  Treatments may be more individualized. 

The female body produces three different types of estrogens:

  • Estriol or E3: is the weakest of the estrogens. Most prevalent estrogen in pregnancy.  Estriol is metabolized from 16–OH Estrone (mediated by iodine)

  • Estradiol or E2: more potent form of the estrogen

  • Estrone or E1: moderately potent estrogen.  Estrone is metabolized into 2Hydroxy Estrone, 16-Hydroxy Estrone, and 4-Hydroxy Estrone (4-OH E1)

In our opinion, the ideal approach is to measure these three estrogens and metabolites to see where the patient is at as an individual, and then adjust and balance hormones accordingly.  This is done in conjunction with a thorough health history, physical exam, baseline and other lab tests as indicated.  In our experience, sometimes recommendations will include nutrients, botanicals, dietary changes, IV therapeutics without recommending hormones, other times hormones may recommended, often in conjunction with these other therapeutics.   

In our opinion, as indicated as per history and physical exam findings, thyroid (blood) and/or adrenal (saliva, blood, or urine) assessment may be recommended.  

For example, for someone who is starting to feel very tired, run-down, and really has no motivation, we may consider looking at the thyroid hormones.   In conventional medicine, one thyroid related hormone is often used to screen for hypothyroidism, which is the TSH.  And one thyroid hormone is often used to treat low thyroid function, T4 (or Synthroid).  In my opinion, blood tests TSH, free T3 hormone, free T4 hormone, reverse T3 hormone may be recommended, to get more holistic picture of what is going on in the body. 

Heavy metal testing may also be recommended in cases of low thyroid function. 

In the adrenal realm, measurement of pregnenolone, morning cortisol and afternoon cortisol may be helpful in my experience.  Checking the rhythm of adrenal hormone secretion may be recommended through salivary testing at 4 times during the day.  Nutrition, IV vitamins/minerals, hormones and/or glandular replacement may be recommended as indicated.


Hormone workups may consist of the following:


·        androstenedione

·        estradiol

·        progesterone

·        cortisol (AM and PM)

·        DHEAS

·        DHT

·        Pregnenolone

·        Sex hormone binding globulin

·        testosterone (free, total, bioavailable)

·        TSH, free T3, free T4, reverse T3, TPO antibodies (blood)

·        fasting insulin



·        estradiol (blood or urinary)

·        estrone

·        estriol

·        estrogen metabolites (depending on which 24 hour urine panel run)

·        blood progesterone or urinary progesterone metabolite

·        pregnenolone

·        DHEAS

·        cortisol (AM and PM)

·        Sex hormone binding globulin

·        testosterone

·        TSH, free T3, free T4, reverse T3, TPO antibodies (blood)

·        fasting insulin

Note: DHEA and tesosterone may be tested (blood or urine), but these hormones are not prescribed by Naturopathic Physicians in BC.