Hormones are chemical messengers that keep the body functioning. From regulating metabolism and sleep cycles to controlling immune function and sex drives, they are key to how the body works — or doesn’t. Suffering hot flashes? That’s an easy one — blame them on hormones. But fatigue, dry skin, sleep problems, heart rate, anxiety, weight gain, constipation and much more can all be affected by changing hormones.
While there are numerous hormones in the body, there are several that have a big impact, including the thyroid hormone thyroxine, estrogen, testosterone and vitamin D — yes, vitamin D is a hormone.
Dr. Rebecca Adochio, an endocrinologist at Vail Health, says any hormone changes that we see with age can begin to develop at different times for different individuals. The average age of menopause in the U.S. is 51, but commonly occurs in the 40s and 50s. Hypothyroidism is most common in women over the age of 60.
“Both men and women can experience changes in thyroid function,” explains Dr. Adochio. “Although we see an increase in thyroid dysfunction with advancing age, it is not considered part of the normal aging process.”
Many individuals can acquire overactive, or more commonly, underactive thyroid related to a genetic predisposition, says Dr. Adochio, along with an infectious or environmental exposure — something which may have occurred decades earlier.
A decline in thyroid function can lead to lethargy, constipation, cold intolerance, dry skin and modest weight gain.
“These symptoms can certainly develop due to non-thyroidal causes, but if an individual has noticed such changes, he/she should discuss them with his/her medical provider and consider thyroid-function testing,” Dr. Adochio says.
An overactive thyroid can also lead to fatigue and exhaustion, along with muscle weakness, rapid heart rate, anxiety, tremors, heat intolerance and weight loss.
“However, elderly patients may not present with any of these symptoms other than fatigue,” Dr. Adochio says, “and thus it is often referred to as apathetic hyperthyroidism.”
Estrogen & Testosterone
Estrogen is produced by the ovaries and is regulated by the pituitary gland. As a woman ages, the ovaries eventually fail to produce estrogen and eggs — known as menopause.
“This is part of the natural aging process, but can lead to many undesirable symptoms for women, including hot flashes, night sweats, mood swings, hair loss and a change in body composition,” she explains.
Men also have estrogen, which primarily comes from the conversion of testosterone to estrogen. Testosterone is produced mainly by the testes in men, but there is also production by the ovaries in women and by the adrenal glands in both men and women.
“Although men can develop hypogonadism — loss of testosterone production — due to various causes, this is not part of the natural aging process and most men will continue to make testosterone throughout their lifetime,” explains Dr. Adochio.
Dr. Melvin Stjernholm, an endocrinology specialist at Vail’s Health’s clinic in Frisco, says hypogonadism symptoms can include a decreased interest in sex or decreased libido. Fatigue and loss of motivation often are associated with the decrease or loss of testosterone — there are many causes.
The hypothalamus is located above the pituitary in the brain. Gonadotropin-releasing hormone (GnRH) is made to stimulate the pituitary to make follicle-stimulating hormone (FSH) and luteinizing hormone (LH). In women, FSH and LH stimulate the ovaries to make eggs and produce estrogen, testosterone and progesterone. In men, they stimulate the testicle to make testosterone and sperm.
“If the hypothalamus is not working properly, then the ovaries and testicles will not work properly,” Dr. Stjernholm says. “GnRH has a cycle which makes the levels increase and decrease during the day and at night. If there is excess stress, this cycling may be normal, leading to decrease in FSH/LH and testosterone deficiency.” Young men in their 40s often present with decreased libido; a loss of interest in sex is sometimes associated with fatigue and decreased motivation, says Dr. Stjernholm.
Measurements of Total Testosterone and Free Testosterone can help in making a diagnosis of hypogonadism. If low, then the measurements will determine whether the problem is the hypothalamus, pituitary or testicle. Medications such as narcotics and corticosteroids — cortisone or prednisone — can lower the GnRH values and alter the normal cycling.
Vitamin D is an important hormone we make primarily from sun exposure, but Dr. Adochio says age-related declines in vitamin D are due to several factors. Low vitamin D levels not only affect bone quality, but can also lead to fatigue, muscle weakness, decreased immune function and an increased risk of falls due to instability — among other effects.
“As we age, our skin becomes thinner and our ability to make vitamin D from sun exposure declines,” she explains. “In addition, we tend to avoid sun exposure either by covering our skin or wearing sunscreen, which will block our ability to make vitamin D.”
When to see the experts
Changes seem inevitable, so what can you do? Dr. Adochio says the best approach is to maintain a healthy lifestyle and to seek evaluation from your medical provider when you are not feeling well.
“Thyroid dysfunction typically requires medical therapy and monitoring by a medical provider,” she says.
Hormone replacement therapy is an option for treating menopausal symptoms in some women, but others are not considered good candidates. Dr. Adochio says deciding on hormone replacement therapy should include a detailed discussion about the pros and cons of therapy for each individual.
“There are also non-hormone-based therapies that can help; some women find certain foods and dietary modifications can help alleviate their symptoms,” she says. “I think it is a good idea to screen for vitamin D deficiency, particularly in individuals who live at higher latitudes, have darker skin or who avoid sun exposure.”
And for men dealing with testosterone shifts, Dr. Stjernholm suggests a doctor visit.
“If you have symptoms of decreased sex drive, decreased motivation and lethargy, a testosterone measurement may be helpful in sorting out the cause of the symptoms,” he says. “If it is low, seeing an endocrinologist may be helpful in working out the problem.”
Vail Health endocrinologists Dr. Rebecca Adochio and Dr. Melvin Stjernholm diagnose and treat diseases related to glands and hormones. Dr. Rebecca Adochio sees patients in Edwards and Dr. Melvin Stjernholm sees patients in Frisco. Physician referrals are recommended. To schedule an appointment call 970- 477-5160 or for more information visit vailhealth.org/endo.
Bock: Difficulty breathing and expanded COVID-19 symptoms
This article was first printed in the Vail Daily on March 30, 2020. After seeing more than three...
Letter from Will Cook: Preparing for what is next
En Espanol Dear patients...
Preparándose para lo que viene
English Version ...