can you please share a little more details as to why your endocrinologist prescribed HRT 5 years ago. And what exactly was prescribed and in what form (oral, transdermal, etc)? I’m assuming estrogen since you mentioned Yaz and Evra patch. What symptoms were you experiencing 5 years ago? Did the hormone therapy help?

 Ok, to really be able to help guide you better, please answer the following series of questions:

1. Is PCOS still present? Are you still menstruating? 
2. Has anyone ever checked your fasting glucose, HbA1C and fasting insulin levels?
3. Do you have any gut related symptoms like bloating, gas, constipation, IBS, etc? 
4. Do you have hormone test results you can attach/share? Was sex hormone binding globulin ever measured?
5. Briefly describe your diet. Do you consume enough protein?
6. Rate your overall stress level
7. What are your top 5 symptom complaints currently?

Please keep in mind that hormones are at the end of a linked chain. This is called the HPATG axis (hypothalamus, pituitary, adrenal, thyroid, gonads/sex hormones). Whatever happens upstream, will affect the downstream sex hormones.

In order to help you get to the root cause, we have start thinking more upstream with the brain, adrenal, thyroid and ovary communications.

 thanks for sharing these additional details. My reply is below:

1 & 2. Regarding PCOS and blood sugar status. I think it’s important to do proper testing to see if blood sugar dysregulation is at play, as this can be a major root cause for androgen dominance leading to PCOS dynamics and hormone imbalance.

->Here are markers to request: fasting glucose, fasting insulin, HbA1C

3. Hormone balance is not just about making hormones. But it’s also about hormone transport to the receptor, the health of the receptor and cell membranes, and the clearance of these hormones. So if you’re experiencing gut related symptoms, this will definitely affect hormone balance.

If there’s gas and bloating, chances are there’s likely dysbiosis and/or microorganism overgrowths. Depending on what is overgrowing or out of balance, enzymes can be produced that affect clearance of hormones. If you’re constipated, this will affect clearance of hormones, and should be your #1 priority and focus to address if you want hormone balance. What GI related symptoms are you experiencing exactly so I can help guide you better?

Here’s an explanation of the GI map test. If you don’t have time to watch it all, fast forward to 11:37 to hear me discuss the beta-glucuronidase enzyme.

4. Given that your main concern is sex hormone related, a thorough investigation of hormones is recommended:

-> cortisol, DHEA, progesterone (day 19-21 of your cycle), estradiol (day 1-4 of your cycle), testosterone, and sex hormone binding globulin.

If you’re in Dubai, I recommend making an appointment with Dr. Liliana Skorski for a proper work-up. She’s a functional gynecologist, MD who speaks the same language.

5. We produce sex hormones from proteins and healthy fats/cholesterol. So we need to ensure we’re bringing in the raw ingredients necessary to produce hormones. Please watch my VPF principle for dietary guidelines.

I can recommend Organegg and Greenheart Organic farms for eggs. They’re pricier than supermarket eggs, but the quality is superior. Perhaps you might be able to tolerate these brands.

If you’re having aversions to proteins, I would suspect hypochlorhydria (low stomach acid), which is so important for overall gut health.

If you don’t have the time to watch the full Gut Health Masterclass course, I suggest you start with this short video of the summary of how digestion works, and then the causes of low stomach acid. And then here are solutions for stomach acid support.

6. Chronic stress will cause such a downward spiral of symptoms. With regards to hormones, it can can lead to higher cortisol and insulin. It can increase sex hormone binding globulin and thyroid binding globulin, making these hormones unavailable for effect in the body (even though you’re producing them). It affects hormones needed for digestion. Stress really is a silent killer. I would prioritize stress reduction measures, do less, say ‘no’ more often, delegate more, do more things that you enjoy, start a gratitude journal, etc. Help your body feel as though it’s on vacation every day. We aren’t designed to be in a chronically stressed state.

7. Headaches – your magnesium is low. You can work on increasing your levels through food and supplements. Here’s a short video in the Mineral Balance course that can help.

A B complex is often needed for those taking oral estrogen based birth control as these medications deplete B vitamins, specifically vitamin B6. I like Thorne Basic B complex. This is available in B Better’s supplement dispensary here.

Bloating – please ensure you’re practicing eating hygiene first and foremost. As I mentioned above, working on gut health should be your focus and priority. Hormone balance often improves as a result.

Lethargy & weight gain – I would recommend a full thyroid panel, and cortisol given your high stress level. I like the DUTCH adrenal functional test for a thorough look at adrenal function.

->TSH (is only a brain hormone and not enough), Free T3, Free T4, Reverse T3, anti-TPO, anti-TG. Later on, you can add Total T4 and T3.

To summarize, the strategy would be the following:
-work on improving gut health, reduce stress & work on diet
-determine the status of adrenal function (cortisol & DHEA)
-determine the status of blood sugar regulation
-determine the status of thyroid function & sex hormone production now that you’re off oral birth control

Please make time to watch the videos I’ve shared and let me know if you have any questions.

Hey ,

I would still be interested to see fT3 as well. Iron is necessary to convert T4 into T3. Other nutrients are necessary as well like selenium, zinc, vitamins A & D, iodine, and magnesium.

Talking about Magnesium, I would test in the Red Blood Cells(RBC).  This isn’t done standard in conventional medicine, unfortunately, but maybe you can. RBC Magnesium reflects your magnesium intake from the last 3 months, while blood magnesium will be reflective of the last few meals you have eaten. RBC zinc I would test as well.

What is the DUTCH test?
The DUTCH test is used in the US and although it isn’t used standard, more conventional doctors are using it these days. Still, it isn’t a standard test and it is more used in the functional medicine world.

With the DUTCH test, you can see how much of the 3 estrogens you are making and how they are broken down. It also takes a look at stress hormones and metabolism. There are even clues to get from the test if your thyroid is working optimally.

Thyroid
You have shared your top 5 symptoms, but I was wondering if you still have symptoms that are related to a low thyroid like:
• Feeling cold
• Feeling slow
• Feeling fatigued
• Hair loss or Thinning of the outer parts of the eyebrows
• Constipation
• Depression
• Etc

If these are still at play, especially hair loss & constipation, I would run a full thyroid panel. Not only TSH, fT4, but also fT3, thyroid antibodies (these can be done usually in the conventional medicine setting, although where I live doctors are a bit hesitant to measure fT3 & thyroid antibodies) and reverse T3 or rT3 for short (which most doctors never heard of).

Reverse T3 can block the action of fT3, the metabolic most active thyroid hormone, and can elevate when there is a lot of stress at play. It also can elevate with infections, which your lab result from June shows signs of as well.

You mention you are using an iron supplement. Sometimes this can lead to constipation as well. If this is the case you could switch to a liquid iron supplement (click here to find one after you have made a profile on fullscript, which is a store for supplements the B Better platform uses)

If you were constipated to begin with using magnesium citrate in the right dosage can help as well.

Iron & Absorption
Iron is a bit of a stubborn element. It doesn’t get absorbed easily. It needs vitamin C in the stomach to activate the enzymes that cleave out the iron in your food. Inflammation in the gut can DEFINITELY reduce iron absorption by increasing a hormone called hepcidin.

Chronic gut inflammation should be addressed. I would recommend seeing if digestive enzymes cause some relief if you are experiencing bloating/gas/constipation/diarrhea.

SIBO and/or a microbiome disbalance called dysbiosis can cause inflammation in the gut. Enhanced intestinal permeability or a Leaky gut can be a reason for inflammation as well. With SIBO foods containing FODMAPs (Fermentable Oligosaccharides Monosaccharides Disaccharides And Polyols) can cause cramps, bloating, constipation/diarrhea and gas. An inexpensive (but maybe a bit overwhelming way, at least in the beginning) is to eat a low FODMAP diet, and see if you are experiencing relief. There are also tests for that available as well, although having a normal transit time makes this test much easier to interpertate.

Sometimes operations done on the gut can lead to malabsorption issues as well, did you have any?

Also, you mentioned you were in India, I assume you live(d) there? Travelling from 1 place to another, eating different foods with different species of bacteria, do you feel that problems became worse after travelling?

PCOS
High levels of insulin can cause high testosterone in women. I do believe fasting Insulin levels are a much better way to assess insulin resistance than HbA1c. Bernadette recommended an fasting insulin test, I would recommend this as well. Again, this test is available. It can be done in conventional medical settings, but it isn’t the protocol most of the time. At least not where I live.

Hopefully, some of this will be helpful for your appointment tomorrow!

I wanted to share an important note about iron supplementation and thalassemia. Those with thalassemia cannot make enough hemoglobin and RBCs. Since hemoglobin is an iron-rich protein, supplementing with iron (as food or supplements) can lead to iron toxicity since it’s not predominantly being used for making hemoglobin. Supplementation really needs to be monitored by your doctor. I usually recommend food sources like chicken liver which is always safer and more bio-available than supplements. I know you’re vegetarian but would you be willing to incorporate weekly chicken liver into your diet? Since iron is critical for T4 to T3 thyroid conversion this might make a big difference for you and is worth considering. Food for thought…