Weight Loss Tailored for Women. Ohan Karatoprak MD

to elevated cortisol. In is important to know that blood level of cortisol does not show us the activity and the level of the cortisol in fat cells. So if you have a normal cortisol level in the blood, this does not reflect the activity in the fat cells that is happening with 11-BHSD-1 activity. In obesity 11-BHSD-1 level accurately reflects the active cortisol levels in the tissues.

      DHEA (Dehydroepiandrosterone). DHEA is produced by the Adrenal Gland and its maximum concentration is achieved during the 3^rd decade of a person’s life. The level of DHEA from the 3^rd decade on, declines steadily and in oldest elderly the levels are only 10 to 20% of those seen in young adults. It is formed from cholesterol and is a precursor molecule to Testosterone both in men and women. Both DHEA and Cortisol is produced from Adrenal glands and their secretion is regulated by a hormone called ACTH (Adrenocorticotropic hormone) that is secreted from the anterior pituitary gland in response to corticotropin-releasing hormone from the Hypothalamus. ACTH induced secretion of DHEA is reduced in elderly subjects where as Cortisol secretion is increased. DHEA increases immune system response. In men, DHEA deficiency causes poor immunity, depression, low metabolic rate, low estrogen levels (because testosterone produces estrogen) and lower good cholesterol (HDL) levels. Excessively high DHEA levels in men causes high estrogen levels. In women DHEA deficiency can cause decreased libido, poor immunity, depression and low metabolic rate with weight gain. In excess causes acne, greasy skin, loss of scalp hair, facial hair growth and excess libido. In menopause you should get your DHEA level checked. If it is low discuss with your physician for DHEA replacement therapy.

      Aldosterone. Aldosterone is produced in the adrenal gland, and excess aldosterone is associated with insulin resistance, weight gain, as well as hypertension. The aldosterone antagonist (inhibitor) called Spironolactone has been shown to improve insulin resistance and cause weight loss from body fat. In menopause, if you have water retention, hypertension, and especially if you have sleep apnea with excess body fat you should discuss with your physician about treatment with Spironolactone for hypertension and water retention to decrease the elevated aldosterone level.

      Estrogen / Progesterone. Ovaries produce the principle female hormones. Parts of estrogens are produced in adrenal glands, especially after menopause. The three estrogens are, estradiol, estriol, and estrone. They are necessary for menstrual cycle, collagen synthesis, brain function and memory, bone mass and fat cell metabolism. In estrogen deficiency skin gets wrinkled due to collagen connection. Post menopausal women are prone to get short term memory impairment, bone loss, mood swing and hot flushes. An excess of estradiol and estrone has been linked to some overgrowth of ovarian, breast and uterine tissues and may cause cancer. Estriol has been called protective estrogen because it seems to inhibit the proliferative effects of the other two estrogens. Progesterone the other female sex hormone counterbalances the estrogens water retention effects and supports the building of new bone tissue. Progesterone has a calming effect on the brain and reduces the anxiety producing effects of estrogens. Excess progesterone may be converted to cortisol which causes rapid aging. Excess progesterone can cause PCOS (polycystic ovary syndrome) that causes insulin resistance, is characterized by obesity, excessive facial hair and lack of ovulation and menstruation.

      Thyroid. Thyroid gland produces Thyroxine (T4) hormone and this gets converted into Triiodothyronine (T3) hormone, with the help of the trace mineral selenium. T4 gets converted to T3 (the more active form thyroid hormone) in the liver and other parts of the body. The pituitary gland produces Thyrotropin (Thyroid Stimulating Hormone, or TSH) to stimulate Thyroid gland to produce T4 and T3. As we get older starting during menopause and andropause some people will have a sluggish thyroid gland and less production of T4 and T3, which causes sluggish metabolism and excessive fat accumulation. In evaluation of menopause and andropause hormonal imbalance the thyroid hormones, T4 and T3 should always be included and tested for by your physician.

      MENOPAUSE OVERVIEW

      What is menopause?

      Menopause is the time in a woman's life when her period stops. It is a normal change in a woman's body. A woman has reached menopause when she has not had a period for 12 months in a row (and there are no other causes, such as pregnancy or illness, for this change). Menopause is sometimes called, "the change of life." Leading up to menopause, a woman’s body slowly makes less and less of the hormones estrogen and progesterone. This change often happens between the ages of 45 and 55 years old.

      Just before menopause (perimenopause), a woman may have symptoms from hormonal imbalances. Many women wonder if these changes are normal, and many are confused about how to treat their symptoms. They may benefit from consulting with their physicians and getting proper medical advice.

      What are the symptoms of menopause?

      Menopause affects every woman differently. Stopping menstruation might be the only event. There may be other symptoms from hormonal imbalance. Common symptoms of menopause include:

      •Change in pattern of periods (can be shorter or longer, lighter or heavier, more or less time between periods)

      •Hot flashes (sometimes called hot flushes), night sweats (sometimes followed by a chill)

      •Trouble sleeping through the night (with or without night sweats)

      •Vaginal dryness

      •Mood swings, feeling crabby, crying spells (probably because of lack of sleep)

      •Trouble focusing, feeling mixed-up or confused

      •Hair loss or thinning on your head, more hair growth on your face

      In summary, menopause can cause deficiency of Growth Hormone, Melatonin, DHEA, Estrogen, Vitamin D3, and Thyroid Hormone. At the same time, there can be excess production of Aldosterone and Cortisol.

      A physician can check all of these hormone levels, and vitamin D level, and should be able to recommend appropriate hormone replacement for optimizing fat loss and promoting longevity.