About Hormones with Dr. Michael Ambrose
Qualgen's podcast is about all things health and wellness related, including hormones, pharmaceuticals, health trends and ways you can help better your life.
INTRODUCTION: Welcome to Qualgen's podcast where we talk about all things health and wellness related, including hormones, pharmaceuticals, health trends and ways you can help better your life.
Jennifer: Hi everyone, thank you for taking time out of your day to listen in today, I am joined by Dr. Michael Ambrose, a board-certified medical doctor and chiropractor who specializes in bio-identical hormone replacement therapy and hormone optimization for men and women, peptide therapy, as well as, medical weight loss Dr. Ambrose, thank you so much for joining me today!
Dr. Ambrose: Absolutely. Thanks for having me.
Jennifer: I am happy to have you here. So, what is your background in medicine and what made you decide to get more into the integrated medicine field?
Dr. Ambrose: Yeah, so I have kind of a different path than most medical doctors. I actually went to chiropractic school and about halfway through chiropractic school, I realized that I wanted to become a medical doctor because, you know, being a chiropractor is very limited in how you can help patients. So, I ultimately, I worked for a year and a half as a chiropractor, then decided to go back to medical school and I decided to do a residency in internal medicine, which led me to starting my career as an internal medicine doctor in a hospital and also working in the hospital as a hospitalist. But, I just wasn't satisfied with the way patients, you know, had outcomes. They're throwing medicine at patients and people weren't getting better, you know, it just wasn't very satisfying. So, I ultimately came back into a middle ground between chiropractic and internal medicine and got into more of a functional medicine, nutritional approach and also hormone replacement therapy. And I found that you know, hormone replacement therapy is probably the biggest factor that helps patients feel better and gets them, you know, more satisfied with medicine in general. So that's how I ended up here.
Jennifer: You've really done it all.
Dr. Ambrose: Yeah. Absolutely.
Jennifer: Oh man. I know I feel like we've seen more and more chiropractic offices that have kind of moved into this, you know, almost like a med spa type of deal it’s the best of both worlds in my opinion.
Dr. Ambrose: Yeah, absolutely. You know, some of that as a as a business model that works for them. But I think as a chiropractor you're always trying to look for different things that can help patients as well.
Jennifer: When it comes to hormone replacement therapy. I know that there are so many different hormones that need to be looked at to be completely balanced. So, what hormones are your primary focus when someone comes in with symptoms of a hormone imbalance?
Dr. Ambrose: Yeah. So, for most of my similar but varies depending on your it's a man or a woman. But for women for example, I'll check all three of the estrogen hormones. So, there's a lot of doctors don't even realize this. But there's actually three types of estrogen, there's estrone or E2, E2 which is also estradiol or E3 which is estriol - I'll also check progesterone and testosterone and then I'll also check DHEA, which is a precursor to some of the sex hormones. And I'll also check cortisol and thyroid and some of my patients I'll check you know growth hormone and ILGF1 which is insulin like growth factor one depending upon what symptoms they're having. And in men I typically will check testosterone, free and total, and also their estrogen level and obviously thyroid and cortisol as well.
Jennifer: So, I feel like testosterone is the main hormone that everyone wants to look at and talk about and so many people don't realize how much it can control. Can you give a breakdown on testosterone what it controls and what symptoms can look like for women and/or men if they have low testosterone?
Dr. Ambrose: So, men it's easy you know if they're having fatigue issues, mental fogginess, aging of the brain, you know, feeling like they're just not their old self a lot of times will have erectile dysfunction or lack of libido. You know, those are the predominant symptoms that I see in men, low testosterone and for women most of my patients, you know are perimenopausal or in their late thirties - early forties something like that. There's really three different pathways predominantly two that they can you know go into menopause. So, we always define menopause as being one year without menses which is usually in 51, you know plus or minus age group, something like that, but women can have symptoms of perimenopause 10, 15 even 20 years earlier, and the predominant sex hormones for women are obviously estrogen, progesterone and testosterone, but most patients will actually drop their testosterone first, so they'll have very similar symptoms to men. You know, I hear mental fogginess a lot, or mental clarity issues, even trouble sleeping or insomnia, although that can also be a progesterone deficiency problem, but libido, sex drive, fatigue, weight gain. Those are all symptoms of low testosterone. So, a lot of patients, female patients in their thirties and early forties sometimes will need some testosterone to help minimize those symptoms. So, you know, the point I'm trying to make is that we think of menopause as being an estrogen problem having hot flashes and night sweats, which is accurate, but that's almost the last symptom that shows up. It tends to be the driver that gets people into the doctor's office. But 10, 15, 20 years prior to that, they may have some of these other testosterone-related symptoms and they need some testosterone therapy to help alleviate some of those symptoms.
The other component of this is low progesterone. And women as well, that's probably the second most common symptom that women will get prior to going into menopause and a lot of that could be anxiety, trouble sleeping or waking up frequently at night, sometimes some depression. So, a lot of those symptoms can be related to progesterone efficiency. So, the most common abnormality I see in perimenopause or early menopause is low T in women and also low progesterone before they even get to estrogen like symptoms, low estrogen symptoms like hot flashes and night sweats. So, it just goes to show you that balancing your hormones can start in your early 30s even, you know.
Jennifer: Yeah. I didn't realize that peri menopause could be caused that early. I am 29 and I actually had my hormones checked a while back this year and my testosterone was at 29, I think or something or 30. I don't know something along those lines. So, I did not know that's what it could be the cause of.
Dr. Ambrose: Yeah, and it depends on what your symptoms are and it depends on a lot of different things. The biggest thing that I've seen that screws up the hypothalamic, pituitary, ovarian access, which is the hormonal access is stress and that stress comes in multiple facets of life, whether it's poor nutritional content in our diet, highly processed foods, emotional stress, financial stress, work stress. All of those things tend to raise cortisol and decreased production of hormones. So I'd even I've seen patients in their mid and late twenties before with the testosterone of zero and when you take oral contraceptive pills for one reason or another that tends to screw up the hormone access as well. So synthetic hormones can do that.
Jennifer: Yeah, and I was on those for about 10 years.
Dr. Ambrose: That would explain a little bit of it there.
Jennifer: Yeah probably so. I've always wondered why providers when they're giving that to you know young women, why they never explain you know any of the long-term effects or any of the side effects at all.
Dr. Ambrose: Well a lot of a lot of times we're not taught that even in med school and residency and when I was in med school and residency and did my OBGYN rotation basically we had a 20 or 30 minute conversation on hormone replacement therapy for menopause and it was all based off of the women's health initiative study and it was just like use hormones sparingly, use them for severe cases and then try to get patients off them as soon as possible. When a lot of that information couldn't be further from the actual truth when treating patients.
Jennifer: Well, when you're dealing with, like you said, the synthetic hormones from years upon years ago that were causing issues compared to what we have now - It's a different story.
Dr. Ambrose: You got it.
Jennifer: So, what about estrogen, I know you mentioned it earlier - the different types. What are those different types? What do they do and what are the benefits of getting estrogen replacement?
Dr. Ambrose: Yeah. So, there's really three types. E1 which is estrone, E2which is estradiol and E3 which is estriol. So, we'll break those down independently here. Estrone is the predominant type of estrogen that's available in the body for women after menopause it's a weak estrogen to the cellular functions of the body. However, it's considered the bad estrogen. It's believed in some studies that this might be the estrogen that's related to certain types of cancer that women will get breast cancer, cervical cancer, things like that, or endometrial cancer – sorry. Later on in life, so it typically is the predominant estrogen that is in the body as women get older. E2, which is estradiol this is the highest concentration whenever you first go through puberty and then all the way up until menopause it's believed to be sort of neutral you know with respect to having estrogen related cancers, but it's also the strongest hormone that binds to the estrogen receptor in the cell. And then finally E3, which is estriol it has a weak estrogenic effect that seems to be protective against cancer. And it may help with converting some of that estrone which is E1 into a non-cancer-causing estrogen like molecule. So, really the only two types of estrogens that you want to be replacing in women is estradiol and estriol which is doing E3, and there's things you can do from a dietary standpoint and also a supplemental standpoint to help balance the bad and the good estrogens within the body. Number one is eating a healthy diet and lowering stress in your diet predominantly eating cruciferous vegetables, so broccoli, cabbage, lettuces things like that.
Jennifer: Everything, everyone hates.
Dr. Ambrose: Yep. All the stuff our parents and grandparents are trying to feed us when we were kids, you know, but that contains some different molecules in it like sulforaphane, DIM which I'm sure you've heard about before, in which is NI3C or indole-3-carbinol. It's been shown to help balance the negative effects of estro in the in the body, as well.
Jennifer: Oh wow. Have you seen the supplements where it's like the greens where it has apparently all of those supplements just like broken down into a powder that you drink? Does that actually work?
Dr. Ambrose: Yeah so I mean if you're getting so typically and all that they're doing is they're basically grinding up those fruits and vegetables that they're putting into a powder form and they're pulling off all the powder from that and dehydrating it out, taking out all the water content and yeah you are getting you know some of the good compounds in there like we discussed, but there's really no better way to do it than directly eating vegetables because you're getting a lot more fiber with it as well. And we now know that fiber itself is probably the biggest driver of healthy microbiome in your gut which can affect neurotransmitters and you know, depression and a whole host of things. It also helps, you know, sequestering toxins and preventing colon cancer. And do I supplement with some of these things? Absolutely. But the end of the day and the best way to get your nutrient products is from food.
Jennifer: Yeah, absolutely. I was just curious because I know that it's out there and I see it all the time and I've even used it myself a couple of times, but you know, in the back of my mind, I'm like, is this actually doing anything, is this actually helping?
Dr. Ambrose: The green and red formula that I use, and I recommend to patients, and you know, I'll mix it with the smoothie in the mornings with berries and stuff like that. So yeah, is it doing a whole lot? Who knows, but I think it's sort of peace of mind, you know.
Jennifer: Probably better than nothing.
Dr. Ambrose: Yeah
Jennifer: So back on the topic of estrogen, do men need estrogen at all?
Dr. Ambrose: So yes, here's why - men are predominantly driven by testosterone, but most of my patients that are on testosterone, I will put them on aromatase inhibitor which prevents the conversion of testosterone into estrogen and what I have found and it's also in some of the literature, which is scant is that patients, you know, men that have estrogen that's really, really, really low will sometimes have some moodiness because in relationship to the testosterone, it's low and the testosterone is high if that makes sense. So, we want to balance just like in women we want to balance all three hormones or mostly estrogen and progesterone and make sure their testosterone is okay. In men we’re trying to balance the testosterone and the estrogen think of them as sort of competing with each other on the same receptor, even though that's an oversimplification, there's a sweet spot of estrogen within men as well. If the estrogen gets too high, it will negate some of the positive effects of testosterone, or patients might experience erectile dysfunction or libido issues because the estrogen is too high compared to the testosterone or if it's too low, sometimes you get similar complaints or sometimes they get moody because the testosterone is really acting unopposed. But, there's some evidence and some early literature that supports if the estrogen level is too high, it might be a risk for developing prostate issues. You know BPH, I don't know that there's a link to cancer yet, but you want to make sure that that estrogen is in that sweet spot for men.
Jennifer: So, what happens if it's way too low, what can you do to supplement that?
Dr. Ambrose: So usually if it's way too low it's because the aromatase inhibitor that patients will get, which is called Arimidex, or anastrozole, is too high you just need to space that out or lower the dose.
Jennifer: And then the body will just naturally make it hopefully.
Dr. Ambrose: Yeah. So, when men there's the aromatase enzyme will actually convert some testosterone into estrogen.
Jennifer: Okay, what is the purpose of progesterone? And what can symptoms look like if some progesterone levels are imbalanced?
Dr. Ambrose: Yeah. So predominantly with women, that's what we're looking at. You know, this is a fairly common phenomenon, as well and I see this in younger female patients that aren't in menopause yet in the normal cycling female, the progesterone is there to help prepare the lining for pregnancy and then also the drop in progesterone along with the estrogen drop will also trigger menses in women. There's actually a higher concentration of progesterone receptors in the brain than anywhere else in the body. So, there's a lot of anxiety, depression, trouble sleeping, that can occur if the progesterone is out of balance or most of the time it's too low compared to estrogen and it's a condition called progesterone deficiency or estrogen dominance. So, by supplementing, I've had patients that come into my office and they're young and they're having these symptoms or even having some hot flashes and progesterone helps the estrogen receptor do its job. So, you give a little bit of progesterone, and they actually feel better with respect to their mental health, their ability to get a good night's rest and sleep appropriately and they just feel better. So, progesterone is probably one of the most overlooked hormones in the female patient, for sure. Another thing that progesterone can do is and helps with diaresis, so if patients, female patients off a lot of times with cycling issues or abnormal cycles, will retain water, notice that their ankles get puffy or their hands get puffy. If you take a little bit of progesterone, sometimes that will help have a diuretic effect and minimize some of that swelling and puffiness
Jennifer: Interesting - if you start supplementing progesterone for a woman that is pre-menopausal, would that affect the cycle at all?
Dr. Ambrose: So, you yes, you have to kind of, you know, know what you're doing with hormones. What I typically will do, you can sometimes use a low dose continuously, but you do want to make sure that females are having their cycle or having a breakthrough cycle - a lower dose 25, 50 mg, even up to 100 mg sometimes won't affect their cycle. But, what I will typically do if it's a cycling woman is I will just add progesterone either in the latter half of the cycle, where the progesterone tends to be higher and you want that balance between the progesterone and estrogen or you can do it between like day 7, 10 up to 28 something like that. It just kind of depends on each individual patient and communicating with them, making sure they're having a cycle at least every few months or cycling it where their progesterone would be the highest in their cycle naturally and then they stop it and take a holiday, have their cycle, and then go back on the progesterone.
Jennifer: That makes sense – again why It's so important to find a doctor who wants to listen to you and wants to help.
Dr. Ambrose: Yeah, you got that correct. That's for sure.
Jennifer: So, what are the thyroid related hormones and how important are they to keep balanced?
Dr. Ambrose: Yeah. So, I check my thyroid profile on every single patients and that includes total T3 and T4. So, the thyroid makes two separate hormones ones a T3 molecule and one's a T4 molecule and the T3 is more biologically active, tends to regulate metabolism a little bit more, T4 is more dormant or less active in the body. It tends to not drive metabolism as much. And the body has the capability in most people to convert T4 to T3 via an enzyme called deiodinases, but you want to make sure that T3 and T4 are balanced in the thyroid patient. So, I check free and total T3 and T4. Then I also check the TSH in all my patients and then based upon those levels, then I might recommend either a natural supplement like armor thyroid or NP thyroid or even synthetics depending on what the patient wants. You can use either use levothyroxine or tirosint or some sort of levothyrodine, which is a T3 molecule. So, and then follow up, you definitely want to make sure that the patient's TSH is not overly suppressed. I've had several patients come into my office that were seen by other functional medicine doctors that weren't as careful and their TSH was very suppressed, and they were tachycardic and having side effects and tachycardic is elevated heart rate. So thyroid medicine you just have to be careful with and not over treat and balancing your T3 to help patients feel the best.
Jennifer: Is it possible to have your, you know, say your testosterone, estrogen, progesterone, whatever you're looking at, is it possible for those hormones to be balanced if your thyroid’s imbalanced?
Dr. Ambrose: It's possible if you, especially if you're on treatment because you can do, you know, you can adjust those with medications, but they do feed off each other so the thyroid plays an important role in metabolism and also if you're on sex hormones, estrogen, progesterone testosterone, it can sometimes raise what's called sex hormone binding globulin, which can also deactivate some thyroid hormones. So that's why you never want to over treat and then you want to periodically make sure you're checking everything and re-dosing accordingly, you know, because other factors can play in this to where patients change their diet, they're less inflamed, they're less stressed. So, cortisol levels will fluctuate and now they're able to make more hormones, you know, it gets back to the personalization of hormone replacement therapy. It's fluctuates on a weekly, monthly, yearly basis and it really requires monitoring and understanding what you're doing to sort of tweak everything.
Jennifer: You keep saying cortisol, that's your stress hormone, right? I feel like that's what I've heard it referred to as.
Dr. Ambrose: Yeah, there's this phenomenon, adrenal fatigue that's out there and it's fairly well documented. I think it's controversial how we treat it. I don't get crazy in testing cortisol, but cortisol is clearly a stress hormone. And if you look at the hormone cascade, you know, all of these hormones sort of interplay with each other and based upon certain scenarios whether it's enzyme activation, enzyme deactivation, stress levels, toxins in the body, heavy metals, things like that. It can affect the way we synthesize and make hormones and it's really hard to figure out based upon blood work. But the idea is that these certain environments can really affect your hormone on a I don't want to say daily basis, but weekly, monthly, yearly basis. So, it's important to be monitoring patients that are on hormones they don't need. There's not a one size fits all treatment.
Jennifer: Yeah, absolutely. So, what are the benefits to having all of your hormones balanced?
Dr. Ambrose: You know, the biggest thing I hear is just improvement of all aspects of life. My classic patient is a female who's perimenopausal and is complaining of fatigue and lack of libido that's affecting her personal relationships with her spouse or boyfriend and lack of sleep which is affecting her ability to work and provide for her family or, or even with men with very similar types of symptoms and you balance hormones in these patients and then they have more energy, they have more motivation to start working out again, they tend to be more in tune with eating appropriate diets and listening to recommendations for that and it can really help patients change their life and in my opinion, live longer and live a healthier life. So, you know that the benefits are really numerous and affect all aspects of life.
Jennifer: Absolutely, I just hear stories all the time, all these success stories and it just makes me so happy that it actually works so well that it literally is changing people's lives.
Dr. Ambrose: Yes, absolutely.
Jennifer: Well, is there anything additionally you would like to add?
Dr. Ambrose: You know, I think we hit on a lot today. The only thing I would recommend for patients that are listening to this is to find a provider that's done this for a little while. You know, I've done this for going on 8-9 years and my learning curve, you know, in the beginning was very steep and dramatic and the longer I do this, the more I continue to learn and a lot of it is personalization. So, it's important and I've seen cases where patients were mismanaged or overly aggressive with hormones and I think the message needs to be start low and go slow and make adjustments as needed, but you know, from a patient standpoint, really find someone who's passionate about it and clearly has done the training and put the hours in to learn how to do this because no doctor in medical school or residency or no nurse practitioner was ever taught anything about this. And so just be careful in the providers that you choose, find someone that has a passion for it but also has put in a lot of time and has been doing it for years because you're going to get much better results and it's gonna be a heck of a lot safer put in the effort to find that provider.
Jennifer: Yes, absolutely. I think we all tell people all that too. And then just finding someone, like I said earlier that you trust and you can talk to that wants to help you without.
Dr. Ambrose: I've told patients in these podcasts and things before and over social media that find a provider or a physician that also addresses other aspects of your life and is not just a standalone hormone clinic because as we alluded to, you know during this conversation, diet, exercise, sleep, stress management, all of those things are just as important as giving somebody hormones in order for the benefits to be there. You really need to address all of those issues at once.
Jennifer: It's so much more than just hormones.
Dr. Ambrose: You got it. Yeah.
Jennifer: Well, thank you again for joining me, Dr Ambrose. If you all would like to learn more or about his clinic Performance Medical Clinic please visit www.performancemedicalclinic.com or on Facebook or Instagram at Performance Medical Clinic. Thank you again, Dr. Ambrose I've enjoyed it!
Dr. Ambrose: Yeah. Thanks for having me. I appreciate it.
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