Diane was a 48 year old financial advisor who had been in relatively good health. She had undergone a hysterectomy two years prior and used only bio-identical hormones. She ate a healthy diet, exercised on a regular basis, took the proper supplements, and slept well. You may envision Diane as a fit, happy, and healthy appearing person. However, it may surprise you to know that Diane was actually fifty pounds overweight, losing her hair, exhausted all day, depressed, perpetually cold, and having digestive problems. How can this be? She was doing all the right things. So why did she feel this way? The important missing piece of information was that Diane had felt great until one year ago when she and her husband of twenty years divorced. How is it possible for one stressful event to wreak such havoc? The answer: cortisol induced hormonal chaos.
Hormones are chemical messengers released by our organs is response to commands received from two main areas in the brain, the hypothalamus and the pituitary gland. These two ‘parental figures’ tightly control the acts and behaviors of the body’s ‘hormone children’ so that the family lives productively and harmoniously. The sibling hormone cortisol can be by far the most disruptive of them all. And since it is the most influential hormone in stressful situations, it alone can dictate the entire hormone family dynamic in a negative way. Cortisol is the body’s main stress hormone and is released by the adrenal glands in response to stress. As the primary ‘fight or flight’ hormone, cortisol is the only hormone we cannot live without. By design, we are able to mount a ‘healthy’ fight or flight response for short periods of time, say no longer than 30 minutes. However, when we defy the rules of nature and subject ourselves to chronic stress in its many forms, the body does what it can to preserve your life but not your health, sanity, or longevity.
Cortisol is the body’s major catabolic or ‘wear and tear’ hormone. Its role is to provide our cells with the necessary fuel to fight or flee. Other hormones including estrogen, testosterone, progesterone, and growth hormone are anabolic or ‘growth and repair’ hormones. In order for our body to function optimally, it is essential to maintain balance between the catabolic and anabolic hormones. So what happens if this balance is disrupted by stress? Essentially, the body will divert all its resources away from anything that does not ensure survival. Who cares about sleep, mood, sex drive, healthy digestion, or longevity when imminent danger abounds! Let’s discuss the effects of big brother cortisol on some of its other hormone siblings.
Cortisol and Estrogen
Estrogen has over 400 functions in the body which include maintaining a healthy heart, building bone, preserving brain function, and supporting reproduction. In the face of elevated cortisol levels, the production of the sex hormones, which include estrogen, go down. To add insult to injury, the action of estrogen and other sex hormones are ‘muted’ at the tissue level so essentially the hormones are present but the cells cannot see them. Consequently, delayed puberty, infertility, lack of menses, and miscarriage may occur. In aging women, cortisol typically rises, and it is believed this may be responsible for postmenopausal women’s propensity towards weight gain, mood disorders, inflammation and autoimmune disease, insulin resistance, and increased risk for heart disease.
Cortisol and Progesterone
In addition to the role it plays as a reproductive hormone, progesterone also serves as an anti-inflammatory, anti-muscle spasm, anti-anxiety, and anti-uterine cancer and anti- breast cancer hormone. Its capacity to also serve as a neuroprotective hormone (protecting and supporting the brain) enhances thought process, focus, and memory. Under normal circumstances, our bodies actually use progesterone to produce cortisol. However, during periods of acute and chronic stress, an interesting phenomenon called "the progesterone steal syndrome" may occur whereby available progesterone is funneled into cortisol production to meet the increased demand. This can cause premenopausal women to experience PMS symptoms or postmenopausal women (including those on bio-identical progesterone replacement) to suffer from worsening symptoms of estrogen dominance (irritability, sleep disturbances, weight gain, etc.) as the progesterone levels decline to fuel the rise in cortisol.
Cortisol and Testosterone
Testosterone plays as important a role in men as estrogen does in women. Studies have shown testosterone to be essential in maintaining heart health, optimizing blood sugar control, improving sexual function, and optimizing bone health. Testosterone is important in women as well serving to maintain energy levels, sex drive, mood, bone strength, and mental function. As is the case with other ‘feel good’ hormones, levels of testosterone take a nose dive in the face of cortisol dominance.
Cortisol and DHEA
DHEA is the other primary adrenal gland hormone and it rises along with cortisol during acute stress. Just as progesterone is the body’s natural ‘anti-estrogen’ hormone, DHEA is the body’s natural ‘anti-cortisol’ hormone. Its presence during acute stress prevents cortisol from causing widespread damage to otherwise healthy cells. Chronic stress results in a decline in DHEA. Therefore, DHEA is actually a better marker for early adrenal stress than is cortisol. Since DHEA is essential for immune function, heart health, bone building, and brain function, cortisol induced reductions in DHEA can lead to a host of signs and symptoms involving many different bodily systems. One unique sign that DHEA may be low is loss of hair under the arms, on the legs, and in the pubic area.
Cortisol and Thyroid Hormone
Thyroid hormone is instrumental in the metabolism of protein, carbohydrates, and fats, telling your cells what to do with each type of energy form. Thyroid hormone is also instrumental in maintaining the health of our cells, stimulating bone growth, and enhancing brain cell development. Like cortisol, thyroid hormone is a catabolic hormone. To preserve itself from spontaneous combustion, the body will put the brakes on thyroid hormone production and action if high levels of cortisol are present. Common symptoms of low thyroid hormone levels include fatigue, cold intolerance, constipation, depression, memory impairment, and weight gain. Since stress induced changes in thyroid hormone occur in an indirect manner, laboratory testing may fall ‘within the normal range’ in the face of hypothyroid symptoms.
Reestablishing Hormone Family Harmony
It may now be more apparent why Diane’s hormone balance was disrupted after she endured an extremely stressful ordeal. Since cortisol essentially negates the beneficial effects of the anabolic hormones, every organ system can be harmed by constant cortisol excess. It is important for your health care provider to test the integrity of your stress response system, which include cortisol levels, prior to initiating any hormone therapy, particularly if you already use other hormones. Remember, its sibling rivalry between cortisol and all the other hormones. This is especially important in people with normal or low cortisol. Replacing estrogen, progesterone, testosterone, DHEA, and thyroid hormone, especially simultaneously, can lead to symptoms including worsening fatigue, weight gain, depression, and chronic pain since these hormones will tip the balance out of cortisol’s favor.
I call stress ‘The Great Equalizer’ for good reason. Only in the company of a happy stress response system will the body function at optimal levels.