Women's hormones play a crucial role in their overall health and well-being. From reproductive functions to energy levels, mood, and weight management, hormones are deeply interconnected with various bodily systems. However, hormonal imbalances are a common issue that can cause a wide range of symptoms, affecting women of all ages. To shed light on this important topic, we had the privilege of speaking with Dr. Elizabeth Yurth, the Founder and Medical Director of the Boulder Longevity Institute.
Dr. Yurth is a renowned expert in the field of hormone optimization and anti-aging medicine. With an extensive background in genomic interpretation and analysis, she has devoted her career to helping women understand and address their hormonal health concerns. In this comprehensive article, we will explore the root issues of hormonal imbalances in women and explore the effective treatments and strategies recommended by Dr. Yurth.
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The Importance of Addressing Hormonal Imbalances Early
One of the key messages Dr. Yurth emphasizes is the importance of addressing hormonal imbalances at a younger age. Contrary to the common belief that hormones become a concern only after menopause, she explains, "Unfortunately, your hormones actually are at their optimal at a very young age, and then they start changing. Even at a young age, we're doing a lot of things that are hormone disruptors."
Dr. Yurth highlights that hormonal changes can begin as early as the 30s, leading to issues such as weight gain, irritability, and difficulty conceiving. "One of the first things that starts happening at a very young age, really in your 30s potentially, is you start changing in terms of your progesterone levels. Your progesterone levels start dropping, and you become, what we call, estrogen-dominant," she explains.
The Delicate Balance of Estrogen, Progesterone, and Testosterone
According to Dr. Yurth, the key hormones for women's health are estrogen, progesterone, and testosterone. These hormones work in a delicate balance, and imbalances in their ratios can lead to various symptoms and conditions.
"If you have no progesterone to balance that out, your brain is not working quite as well, you can't settle things down, you end up putting on fat, your breast tissue gets bigger," says Dr. Yurth, describing the effects of estrogen dominance when progesterone levels are low.
Testosterone, often overlooked in women's health, is crucial for muscle building, energy levels, and overall well-being. Dr. Yurth notes, "Testosterone levels also start to drop at a pretty young age. Women now, if somebody says, 'Oh, you've got to go to the gym and exercise,' but they go to the gym and they exercise and they don't put on any muscle, they're like, 'This is worthless.' Then they stop doing their exercise because they're not getting any benefits out of it."
The Importance of Proper Testing and Interpretation
One key challenge in addressing hormonal imbalances is proper testing and interpretation. Dr. Yurth emphasizes the importance of going beyond standard testing methods and looking at a comprehensive panel that includes estradiol, progesterone, free and total testosterone, sex hormone-binding globulin, thyroid hormones (TSH, free T3, free T4), cortisol, and DHEA.
"Testing is really important, and really is. You just can't make guesses in medicine. You have to have information," Dr. Yurth states. She also highlights the importance of understanding optimal ranges rather than relying solely on "normal" ranges, which may not reflect optimal health and well-being.
"Normal ranges are designed for illness, meaning if you're outside that bell of curve, you are sick. When you look at that, I don't really want to be on this bell curve," explains Dr. Yurth. "The people who feel best are going to be in what we call optimal ranges. That's the range for feeling really good and building muscle and living forever."
The Role of Hormone Metabolism and Urine Metabolite Testing
In addition to standard blood tests, Dr. Yurth emphasizes the importance of understanding hormone metabolism through urine metabolite testing. This testing method, like the DUTCH test (Dried Urine Test for Comprehensive Hormones), provides valuable insights into how hormones are metabolized in the body.
"If you're young, if you're 25, and you're somebody who has a family history of breast cancer, very likely you have a metabolism pathway that's sending your estrogens down a bad metabolite. If we know that, we can do very simple things to change that metabolism," explains Dr. Yurth.
Addressing Root Causes and Underlying Imbalances
Dr. Yurth emphasizes the importance of addressing the root causes of hormonal imbalances, which often involve multiple interconnected systems within the body. She explains the intricate relationships between the hypothalamic-pituitary-adrenal (HPA) axis, the hypothalamic-pituitary-gonadal (HPG) axis, and the hypothalamic-pituitary-thyroid (HPT) axis.
"The adrenal glands are really important, especially for women in terms of our androgens. Where do we get androgens from? We don't have testicles. We get our androgens from the adrenal glands making something called DHEA, and then DHEA converts down into the androgen pathways into testosterone and then, ultimately, the androsterone, which is our most anabolic hormone," explains Dr. Yurth.
Stress, inflammation, and other factors can disrupt these delicate systems, leading to hormone imbalances like cortisol, DHEA, and thyroid hormones, impacting reproductive hormones and overall health.
Treatment Options and Hormone Replacement Therapy
When it comes to treating hormonal imbalances, Dr. Yurth emphasizes the importance of using bioidentical hormones and the appropriate delivery methods. She recommends using transdermal estrogen (creams, patches, or gels) to avoid the potential risks associated with oral estrogens, such as blood clots and liver toxicity.
"Transdermal, estrogen has no effect on blood clotting because it's the metabolite, once it's gone to the liver, that creates blood clotting. You absolutely have to use estrogens transdermally either as a cream that you can have made or as a patch or a gel, but you have to use them transdermally not orally," advises Dr. Yurth.
Similarly, she recommends using testosterone transdermally or through injections to avoid potential liver damage associated with oral testosterone.
Dr. Yurth emphasizes the importance of individualized hormone replacement therapy based on comprehensive testing and monitoring. "Even within our own selves, even with that optimal range, what's optimal for one person might not necessarily be optimal for another. Some women who feel horrible with the progesterone running on the higher ends, that's there in hog heaven, they feel wonderful. I think there's that personalized approach to it too," she says.
Beyond Hormones: Addressing Metabolism and Inflammation
While hormonal optimization is a crucial first step, Dr. Yurth acknowledges that some women may still struggle with weight management, energy levels, and other issues even after optimizing their hormones. In such cases, she recommends exploring other factors, such as inflammation, glucose control, and insulin resistance.
"If women still aren't losing weight, you've gotten all the hormones optimized, the thyroid looks great, and they're still like, 'I'm still fat, and I still have these thoughts of somewhat not getting any better,' then you got to look at other issues. Lots of times, those are inflammatory problems where there's a lot of inflammation going on," she explains.
Dr. Yurth may recommend monitoring glucose levels, using continuous glucose monitors, and potentially incorporating medications like metformin or GLP-1 agonists to help manage insulin resistance and promote weight loss.
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Advice for Women and Their Loved Ones
When asked for her advice for women and their loved ones dealing with hormonal symptoms or conditions, Dr. Yurth emphasizes the importance of finding a practitioner who will work as a team member rather than just a doctor giving orders.
"You really got to look for a practitioner that does that. We work with patients all over the world, and because of Zoom, it's easy now to do that," she advises.
Dr. Yurth also encourages women and their loved ones to educate themselves through resources like podcasts and online educational platforms. She states:
"If you can't find somebody like that, then you'll start listening to these podcasts. Start learning. You can actually order some of your own lab tests to look at them, but if you can find a team to put together, somebody who's going to sit there and talk to you and work with you, that's going to go such a long way. You can team with that person for the rest of your life, and that's how you're going to be 120 and still living well and doing all the things you want to do."
Dr. Yurth's educational initiative, the Boulder Longevity Institute Academy (bli.academy), aims to provide accessible and evidence-based information to help individuals understand the latest scientific developments in hormone optimization and longevity.
"Our goal with that academy is actually to teach you guys like doctors should be learning based on scientific data, help you guys to understand the evidence out there where I'm passionate about reading every two hours every night," she explains. "We're trying to get you the newest best thing, and then digesting it, sharing it with you guys so you understand where medicine is going because medicine is doing the same thing for 30 years, and you've got to be moving forward faster than that if you want to really be healthy."
Dr. Elizabeth Yurth's expertise and insights highlight the importance of addressing root causes, optimizing hormone levels, and exploring underlying factors like inflammation and metabolic imbalances, which can help women take control of their hormonal health and experience improved overall well-being. With the guidance of experienced healthcare professionals and a commitment to ongoing education, women and their loved ones can navigate the challenges of hormonal imbalances and achieve a healthier, more vibrant life.
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