Beyond Estrogen and Progesterone: The Complete Hormonal Picture
In addition to estrogen and progesterone, it is important to monitor levels of the hormones pregnenolone, DHEA, and testosterone. Ideal bioidentical HRT goes beyond the mere suppression of symptoms caused by declining ovarian hormone levels. The real goal of Life Extension's approach to female hormone restoration is to restore hormones to youthful levels. Such an approach has wide-ranging benefits throughout the body and significantly enhances physical and psychological well-being.
DHEA. DHEA is a natural steroidal hormone secreted by the adrenal gland, gonads, and brain (Maninger 2009). Although women usually have less DHEA than men, both sexes lose DHEA over time, suggesting an age-related decline (Labrie 2010). Peak levels are typically reached when women are in their 30s, after which they begin to lose approximately 2% per year. Decreased levels of DHEA are associated with cancer, diabetes, lupus, psychiatric illness (Genazzani 2010), insomnia, pain, and disability (Morrison 2000).
DHEA has been shown to improve mood, neurological function, immune function, energy, feelings of well-being, and the maintenance of muscle and bone mass (Kenny 2010; Weiss 2009). A combination of DHEA and pregnenolone has been shown to improve memory (Ritsner 2010). DHEA may also improve insulin sensitivity and triglyceride levels (Genazzani 2010; Casson 1995).
Life Extension suggests that maturing women strive to keep their DHEA-sulfate (DHEA-s) levels in a range of 275 – 400 µg/dL to promote optimal health and vitality.
Testosterone. Like DHEA, testosterone levels in women gradually decrease with age (Schneider 2003). Loss of testosterone affects libido, bone and muscle mass, vasomotor symptoms, cardiovascular health, mood, and well-being (Simon 2001; Watt 2003). Testosterone in conjunction with estrogen has been shown to improve quality of life, vigor, mood, concentration, bone mineralization, libido, and sexual satisfaction (Al-Azzawi 2010; Simon 2001; Braunstein 2002; Cameron 2004). The combination has also been shown to reduce hot flashes, sleep disturbances, night sweats, and vaginal dryness (Guillermo 2010). Because DHEA converts into testosterone, it is possible to raise testosterone levels with DHEA (Cameron 2004; Schneider 2003).
Studies also suggest that testosterone, in the context of hormone restoration, may prevent or reduce estrogenic cancer risk in the treatment of women with ovarian failure (Dimitrakakis 2003; Zhou 2000). In addition, testosterone is effective in the treatment of low libido in women (Guillermo 2010).
Life Extension encourages females to maintain a total testosterone level of 35-45 ng/dL and a free testosterone level of 1-2.2 pg/mL.
Pregnenolone. As is the case with other hormones, a significant reduction of pregnenolone begins when women reach their early 30s (Havlikova 2002). As the initial hormone in the overall steroid hormone cascade, pregnenolone is derived from cholesterol. Pregnenolone deficiencies have been associated with diminished brain function and dementia (Mellon 2007).
Aging women should maintain a pregnenolone blood level of 130 -180 ng/dL for optimal performance.
It is very important that women have their hormone levels checked before beginning bioidentical hormone restoration therapy. To ensure safe and adequate levels, testing should occur one month after commencing HRT and then again two months later. Those women who wish to enhance their sexual desire and have already tried DHEA and pregnenolone therapy should consult with their physician about alternative options (e.g., small amounts of testosterone). Women should always consult a physician before beginning HRT, especially if they have had or are at high risk (e.g., first-degree relative with a diagnosis) of having hormone-responsive cancer (e.g., breast or endometrial).