Hormone Balancing and Testing with Dr. Carrie Jones

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In this episode of The Dr. Hedberg Show I interview Dr. Carrie Jones of Precision Analytical on hormone balancing and testing. We cover a lot of detail about reproductive and adrenal hormones including testosterone, estrogen, progesterone, cortisol, DHEA and more. Dr. Jones explains the causes of elevated and decreased hormone levels and some strategies on balancing these issues. We also discuss the best way to test hormones including the DUTCH test which is my favorite hormone test offered by Precision Analytical.

Dr. Carrie Jones, ND, MPH is an internationally recognized speaker, consultant, and educator on the topic of women’s health and hormones. She graduated from the National University of Natural Medicine (NUNM), School of Naturopathic Medicine in Portland, Oregon where she also completed her 2-year residency in women’s health, hormones and endocrinology. Later she graduated from Grand Canyon University’s Master of Public Health program with a goal of doing more international education. She was adjunct faculty for many years teaching gynecology and advanced endocrinology/fertility and has been the Medical Director for 2 large integrative clinics in Portland. She is the Medical Director for Precision Analytical, Inc, creators of the DUTCH hormone test.

Dr. Hedberg: Well, welcome everyone to the Dr. Hedberg Show. This is Dr. Hedberg, and I’m excited today to have Dr. Carrie Jones, on the show. I’ve been listening to her and reading her material for some time now. And I’ve also heard her speak in person. So Dr. Jones, is a naturopath and she’s definitely an expert on hormones, we’ll be talking about all the different hormones today. So Dr. Jones welcome to the show.

Dr. Jones: Thank you Dr. Hedberg, I appreciate you having me on, hormones is my favorite subject.

Dr. Hedberg: Great. So, why don’t you just fill everyone in on what you’re working on these days and your area of expertise.

Dr. Jones: Yeah, so like you said hormones is it. So I went to school and did my residency in all things women’s health, hormones and gynecology. And expanded a little bit into men’s health and hormones, just by default as women would bring the men in in their life, and they would say, “He has a hormone problem too.” So I always joke and my ongoing joke is that if something’s wrong with your child, don’t ask me. And if you hurt yourself, like you hurt your knee, don’t ask me that either. But if you’re a hormonal mess I can help you with that, that’s what I’m good at.

Dr. Hedberg: Right. So you work for Precision Analytical which is the lab that I use for hormone testing and they do the Dutch test. So why don’t we jump in and excuse me. Why don’t we jump into the first hormone which is, I always like to start with start with progesterone. So why don’t we start with cycling females. So when you talk a little bit about what may be some of the reasons why we would either see high or low progesterone, in a cycling female?

Dr. Jones: Yeah, and actually will start with a level because I think that’s well, a lot more common. So there are two reasons that a cycling female will be low. One is she does not ovulate. So when a woman releases an egg she has two sets of cells around her follicles, and they convert into a third set of cells called the lutein cells. And that’s what makes progesterone. So if she doesn’t release the eggs, then she’s not gonna get that little conversion and she’s not going to make progesterone. Now the other reason the second big reason is she may ovulate. She might release an egg, she feels it, she notices it, her mucus changes what have you. She does the you know, ovulation predictor kit from the grocery stores, it’s positive. And still her progesterone might be pretty low, pretty weak. And then the reason for that is that those cells that are supposed to make progesterone, they themselves are weak. And so we have to do something to pump up the cells.

So if you don’t ovulate and/or these cells are pretty weak you get low progesterone. And most women they’ll feel…well, let me tell you what progesterone does, progesterone is our calming, soothing, relaxing, kind of everything’s gonna be okay, hormone. So if you don’t feel calm, and soothed, or relaxed especially in that second half of your cycle then it’s potentially a low progesterone problem. Progesterone helps with sleep, it helps reduce anxiety, and it’s our pro-gestation hormone. So it helps with fertility and it’s one of the primers for the uterus, it helps with implantation. It helps maintain a fetus in the first you know, 6 to 10 weeks until the placenta is strong enough to take over. So we need progesterone but those are the two big reasons why it might be low. You don’t ovulate or your actual cells aren’t doing so well.

Dr. Hedberg: And where would you factor stress into that and how that might be affecting the pituitary. Wouldn’t that also be a potential factor?

Dr. Jones: Yeah, it will block ovulation…and not so much block, but it will…I mean in the body if it’s in fight or flight then reproduction is not it’s first thought. In fact there’s this really great quotes it’s probably one of my most favorite quote that I’ve read in the research. And it’s talking about norepinephrine, the hormone, which is also known as noradrenaline, it’s one of your adrenal hormones besides cortisol. And the quote says that if you are a norepinephrine dominant person, if you have a lot of stress in your life, then your body will direct you away from repair, maintenance and reproduction. And it will direct you towards mobilizing your resources to dealing with the stress, to running, you know, to handle the fight or the flight.

And I think that’s a really key quote because if you have a lot going on in your life, if you’re very stressed out, if you’ve you know, either physically or you know, emotionally. Or you know, you’ve got viruses and bacteria and things you’re fighting internally, the relationships you’re in, your body will direct you away from reproduction. And when you get directed away from reproduction you don’t ovulate well, often, regularly like you’re supposed to. So yes, stress can absolutely redirect ovulation.

Dr. Hedberg: So as far as I’m aware if progesterone is low in a cycling female as far as interventions other than using progesterone itself. I know Vitex, chaste tree berry, has been used. Are you aware of anything else that can help balance progesterone?

Dr. Jones: Yes. So a vitamin B6 is a really good one, that one is helpful for FSH and LH stimulation. If you’re not ovulating, obviously, trying to figure out why, is it a thyroid problem is it a brain problem. Are you taking something such as you know, a steroid inhaler, steroid medication, or steroid nasal spray that’s inhibiting ovulation. Are you on pain medications pain, pain medications will block ovulation. You know, there’s a huge number of factors for ovulation, but the chaste tree I love vitamin B6. I do use something called glandulars, do you use glandulars, do you like glandulars?

Dr. Hedberg: A few. Yeah.

Dr Jones: So people are more familiar with sort of adrenaline glandurals. But there are ovarian glandulars. And so I will use those, sort of more nourishing to the ovaries. And I also use some oils, so even in primrose oil which is a good one, borage oil, which is another good one. And then to support the cells themselves, the cells that make progesterone are called lutein cells. And they are collectively known as the corpus luteum or luteum. And lutein being they’re from your orange and your red family of foods. They’re high in lutein and you know, carotenoids, sort of beta carotene vitamin A, lutein, those sort of things. So I tell people you know, eat your orange and your red veggies, eat your tomatoes, eat your orange sweet potatoes, eat your apricots. Eat those things, your red and orange peppers because it can be really nourishing for those cells.

Dr. Hedberg: And let’s not forget about the guys, when it to comes progesterone. So throw your little curveball, maybe it’s an easy answer for you, but what are you thinking when you see high progesterone in men? I know it’s pretty rare, but I’ve seen it here and there.

Dr. Jones: On the Dutch tests we see high progesterone commonly associated with high estrogen and high cortisol. And then we see men get their estrogen under control and their cortisol goes down. Their progesterone tends to follow suit. I don’t know if you’re noticing that as well, but usually when people say, “What do I do about progesterone?” I say, “If you just address the estrogen and the cortisol in this man his progesterone will improve.”

Dr. Hedberg: Exactly, yeah, we see that quite a bit,.elevated estrogen and then elevated beta-glucoronides on their stool tests and things like that. So excellent, why don’t we shift into estrogen so we have estradiol, estrone, estriol. What are you thinking, let’s start again with the cycling female when you see highs and lows in those those hormones?

Dr. Jones: Yeah, so if I see high estrogen then a couple of things. One, she’s either…much like men, women make their estrogen from a conversion of testosterone which is called aromatization, testosterone converts into estrogen. But two, which I don’t think people realize, the you know, the estrogenic chemicals in our environment, the endocrine disruptors, research is showing that things like BPA, bisphenol-A, which are in our plastic water bottles and you know, with our thermal receipts and they line our cans or caned foods, can actually raise estradiol (E2) itself.

We used to think it was more just an endocrine receptor binder, but it will actually increase estradiol. So we need to be really careful there. And then the third thing I really think about is just core detoxification. So maybe you’re making totally normal levels of estrogen, but you can’t clear it, you’re phase one, you’re phase two in your liver and then you’re phase three in your bile and in your intestines. And like you said earlier beta-glucoronides which is an enzyme aren’t functioning properly. And so you get this back up of estrogen that can’t drain out of your body, that’s usually what I think of when I see high estrogen. Of course I’m assuming you’re not on estrogen too, you’re not taking something.

Dr. Hedberg: And for the guys it’s pretty much the same thing isn’t it?

Dr. Jones: It’s the exact same thing, men do aromatase, I see, you probably see it, I’m sure you see this too that bigger and stronger that aromatase enzyme is really high in fat tissue and it can be high in muscles as well. But primarily in fat tissue so, as men are you know, getting more body fat then they tend to notice their estrogen type symptoms, they’ll get even more body fat. They’ll get breast development, they’ll get sort of mood changes, depression, unmotivation, fatigue, they’ll notice erectile issues. So it all sounds very low testosterone, but really it could definitely be high estrogen as well. But men detox just like women do so, we have to look at their phase 1, 2, and 3, just like we do with women.

Dr. Hebderg: Exactly. And so with post menopausal women the progesterone, estrogen is going to be low. And I was talking to a doctor the other day and you know, there’s so many different camps about hormones. There’s you know, one camp that thinks that we should test our hormones when we’re older and basically get them to the levels they were when we were in our 20s. And there’s the other group that says well, it’s just a normal part of aging, women go into menopause and that’s a normal thing. And then there’s you know, kind of a gray area, just depends on the individual’s goals, and their symptoms and what they’re dealing with. So what do you think about that question of how specific and how much should we really focus on trying to get those hormone levels up to what they were when we were younger?

Dr. Jones: I’m definitely the gray area person. So what I’ve seen over the years is that so the camp that believes you know, menopause is just a natural way of life and your hormones should go down. I mean I actually believe that menopause you know, it’s real, it happens. But what I have noticed or what I’ve seen is even though we can’t test for the age at which a woman will go into menopause, there’s sort of this predetermined you know, when she’s out of follicles, when she’s sort of getting lower and lower and lower of her follicles on her ovaries and she’s losing the ability to produce estrogen and then subsequently progesterone like she used to.

So there’s sort of this pre-set age we don’t know collectively but her body, her ovaries seem to know. But what I see though is a variety of factors will speed the process along. So if internally a woman is supposed to go through menopause at 50. And I don’t mean premenopause but like she’s supposed to be done with her periods at 50. But yet through a variety of factors, environmental stress, you know, infections what have you, she’s speeding up her diet you know, lack of sleep, she’s speeding this up and she goes through it at 45.

That’s a big 5 year gap where she might say, “I’m very symptomatic, like I’ve got terrible hot flashes and night sweats, my memory is terrible, my joints hurt. And my anxiety is worse, I’m not sleeping.” And I think that’s not healthy. So that’s why I’m in the gray area. I mean yes, I totally agree when you know, once women get into their 40s and early 50s like menopause is inevitable. But it’s the crash and burn that I’m like whoa, this is this is not healthy, this is not good, this is increasing your risk when you lose out on all that hormone for you know, Alzheimer, cardiovascular disease. You know, everything sort of dries up, they get dry eyes, dry vagina, dry skin, loss of collagen. You know, all this stuff and then it just can be really shocking.

And so I fall into the gray area of it, “That’s you, let’s do something about it.” But I don’t personally subscribe to the belief that if I’m 50-years old I should have the hormones of my 21-year old self. I think I should be on enough to be you know, hormonal support whatever the support is that I’m relatively symptom free feeling good, doing good, having some prevention. But I don’t need to get my cycle back, I don’t need to get periods again at 50-years old if I’ve already lost it. And I definitely don’t feel I need to be that of a 21 year old. I know there are people who disagree with me, that’s just my own personal a gray area person.

Now if you’re 50-years old and you’re like you’re listening to this and you’re like, “Well I don’t have any symptoms I feel great, I went into menopause with no problem, I don’t have brain fog or joint pain or anxiety. I sleep great you know, my moods are great.” Then great, girl, just keep doing what you’re doing, you don’t have to do anything. Just like bottle up what you’ve got and sell that. That’s the camp that I fall into

Dr. Hedberg: Yeah, I do as well, I just like I mean that’s just kind of the the bedrock of functional medicine, is that it’s really about the individual. And what their needs are and what they’re going through. And you know, like you said everyone’s so different, I mean I’ve seen men in their 80s with robust you know, sexual function and health and good muscle mass. And maybe their testosterone isn’t what it was when they were in their 20s but why mess with it.

Dr. Jones: And then you’ve probably seen men in their 20s who have testosterone of an 80-year old you know, like what you would think. They come in to you at 20, 22, 24, 26 and say, “I’ve all these symptoms, what’s going on with me in my 20s?”

Dr. Hedberg: Oh, exactly, yeah.

Dr. Jones: That’s scary.

Dr. Hebderg: And then we’re seeing that more and more. So let’s talk about testosterone then. So, testosterone in women and you know, you may agree or disagree. But that’s the one hormone in women where I would definitely be the most cautious, and I may actually focus a lot more on using some dietary strategies and exercise strategies to increase testosterone before jumping to that. Because it is so strong, because I’ve seen so many women come in on testosterone and their voice has dropped quite a bit, even with just a really small amount and some other things as well. So what are you thinking when you see low testosterone in women? And then high you know, I was thinking things like PCOS and things like that?

Dr. Jones: Well, with low testosterone, well, testosterone in women is actually made in three places. Which I think people forget unlike you know, men primarily just make it out of the testicles. But in women we make it in our ovaries and we make it out of our adrenal glands. And then we can make it in our fat tissue. Unfortunately like the more fat tissue you have does not necessarily correlate to the more testosterone you have. So I do have women with low testosterone who do have excess fat tissue that say, “What’s the problem?”

But the adrenals and the ovaries both make testosterone. So I tell women if you are HPA if your hypothalamic pituitary adrenol acces is not great, if the communications not there, if your cortisol production is quite low there’s a chance that the layer that does your androgens like your testestrone will be low as well. Just like as women if their ovarian function is not that good either they are young and cycling, but they’re having trouble you know, they’re irregular or don’t have a period or maybe they’re menopausal and they don’t have a period anymore because of age, they’re not gonna be producing testosterone from those cells that are on the follicle.

And so I look to first see you know, where could the problem be, is it an ovarian issue, is that an adrenal issue, is it a both issue. And so I work from that standpoint so if they’re irregular cycles, or no cycles, or something is going on, I’m trying to get the ovaries back on track to bring that part of the testosterone production up. Same with your adrenal, focus on adrenal, focus on brain to adrenal communication. But then I do think like zinc you know, I do a lot of nutrient stuff for testosterone. I’ll do herbs like Maca which is a Caribbean herb I’ll do Tribulus which is a Bulgarian herb. I’ll do an Indian herb called shatavari. Just to help…they mostly help, they don’t necessarily help per se, raise testosterone, they kind of help alleviate those low testosterone symptoms and just make her feel good overall in that family of hormones. But zinc especially, I find zinc to be low quite a bit and that’s a huge one, and same for men, a huge one for making testosterone.

So that’s what I do with testosterone.Now I do I use testosterone in practice? I do I but I’m with you though, I don’t jump right into testosterone. And I definitely work with diet and get her lifting weights you know, get some muscle on her, get her muscle mass up there or try to. And I go that route first because I would see a lot of fallout from too much testosterone in my practice, especially, and I’m not against the pellet, but I’m very cautious about the testosterone pellet. I know lots of women love it, but I would see quite a number of women who were like, “I hate this. I have chin hair and I’m angry and you know, like what is going on, I have acne again and I’m you know 38 or 42 or 51 or whatever age they are, like what is wrong with me?” Because you have this big pellet of testosterone in you and your body is trying to quickly process it, it’s not doing very well. So you get all the bad side effects.

Dr. Hedberg: Right. I found with with men, one of the real keys to testosterone is sleep. And I think it’s probably overlooked more than a lot of things, but when you really dig with men and you figure it out that their sleep isn’t really optimal. You can I mean, you can significantly increase their testosterone levels just by getting the sleep.

Dr. Jones: Deep sleep in particular, right? It’s that slow wave sleep when men make testosterone. Yeah, actually, because I don’t do, like I said, I don’t do as much men’s health, but a really good friend of mine Dr Ralph Esposito, is a men’s health expert. And so he’s always teaching me these little things about men’s health, men’s testicles, sleep. And he taught me that

Dr. Hedberg: Men could definitely use some more help in the health care arena, that’s for sure.

Dr. Jones: I know, they get forgotten because women are so outspoken about their own health, but they have just as many hormone issues.

Dr. Hedberg: Right, plus we don’t talk about it, and we don’t go to the doctor if we have a problem.

Dr.Jones: That’s true.

Dr. Hedberg: And I mentioned you know, PCOS, insulin resistance, do you have any strategies for those women who have PCOS.?

Dr. Jones: Yeah, so that’s, when women have high testosterone, you have cells on your follicles, they are theca cells and they make your testosterone, when you’re looking at ovaries, and they’re heavily stimulated by insulin. So the more insulin you have if you’re insulin resistant then oftentimes the more testosterone you have.

So, if you can address your insulin diet…obviously, diet lifestyle you know, again that weight lifting, HIT training, high intensity, interval training, to try to burn up you know, the glucose, get your insulin better. But from a supplement point of view, my two favorites are inositol and berberine, which is my other favorite for insulin. To try to improve insulin resistance, and then along with that. I’ve been doing a lot of research into hormone leptin. Leptin is not tested on the Dutch test, but oftentimes when men and women have insulin resistance they often have leptin resistance.

Leptin is one of the hormones made out of your fat tissues and it helps tell your brain you’re full. But if you’re leptin resistant your brain never hears that you’re full and it doesn’t stimulate the process used to burn up energy and you know, improve the metabolism. And so people tend to keep hold of their fat tissue and in fact even expand it and grow more. So I usually work between those two hormones when it comes to PCOS. Now other herbs I really like though are peonyy like the flower, peony can be helpful. Licorice, peony and licorice together. There’s actually a lot of research on that especially in Chinese medicine, peony and licorice together. You have to be careful with licorice though for blood pressure and potassium. I had two patients in practice who did not stop their licorice and they put themselves on high doses and just stayed on it. And put themselves in the hospital unfortunately with low potassium..

So it’s very real, but it can help lower testosterone. And then as I said earlier and as we all talked about earlier, women, especially who have high testosterone and get all those symptoms, they don’t like you know, the dark chin hair, the mustache, the dark hair around the nipple, and the belly, cystic acne, anger, irritation, mood swings, male pattern baldness, what have you, it’s because your testosterone and the associated hormones, androgens, are going down the wrong pathway. They’re going down what’s called the Alpha pathway or the 5-alpha-reductase pathway and that 5-alpha is the one that kind of like really brings on the symptoms, acne, hair growth, male pattern baldness what have you.

And so in those women we try to again reduce insulin, reduce stress, reduce inflammation, because those things will stimulate that pathway. And then we try to use supplements that are specifically, we call them 5 alpha blockers generically. But again things like zinc is really helpful Saw palmetto, stinging nettle root, EGCG which is one the active ingredients in green tea. All can help sort of lower those symptoms, lessen that pathway, you know, take the gas pedal off. And I joke to women because of all the supplements that are in prostate formula so, I’ll have women say, “The title says prostate support.” I’m like, “I know, eat the stuff inside.”

Dr. Hedberg: Pumpkin seeds are good for you. I would also add in N-acetylcysteine for PCOS and then, I’ve gotten in the real difficult cases I’ve gotten excellent results with the ketogenic diet. And then if that’s, I mean that can be too difficult for a lot of people to follow for a long period of time. But there is some good information out there on the high protein diets for reducing 5-Alpha reductase. So let’s shift into the adrenals and talk about DHEA and DHEA is interesting you know, it was really popular, it was back in the early ’90s there was a lot of press about it as this anti-aging hormone. And a lot of people took it and screwed themselves up obviously. But so when you’re seeing a high or low DHEA what are you thinking?

Dr. Jones: Well, when I see a high DHEA, well, one of the reasons that can be is associated with PCOS. So you know, I look at other markers there. DHEA can actually increase by certain medications. So I check their medication list, so Wellbutrin which is an antidepressant, Xanax, which is an anti-anxiety, and some of the ADD, ADHD medications will actually inadvertently raise DHEA.

So it may be high because of medication, you got to be careful there. But DHEA will also increase in response to cortisol. DHEA can counter the effect of cortisol in the brain. And so if somebody has a lot of stress going on, they have a lot of cortisol being produced and their DHEA is high then I don’t actually worry about it as much, I’m gonna focus much more on their stress reduction efforts, lifestyle, even supplements if I need to to help get there cortisol back in check. And then oftentimes I’ll see the DHEA come down with it as well.

And then again assuming, this is assuming they’re not taking anything with DHEA in it to drive it up there. But I used to be really concerned when I saw high DHEA, but as I do more and more and more research into DHEA because of my job, just you know, out of nerd curiosity I’m not as concerned. It’s not damaging you know, like cortisol can be really damaging. Cortisol is good, we shouldn’t vilify it, it’s anti-inflammatory and good for the immune system and you know, good for blood sugar and all these things. But when it’s too high for too long then it can actually be damaging. And I want my DHEA to help protect my brain and counter its effects. So I tend to go more like why, what’s triggering it to be high and go that route instead. How about you?

Dr. Hebderg: That’s mainly, that’s what I see it as a response to stress. It’s elevated and it’s having just basically an adaptation to high cortisol levels, that’s mainly how I see it and then inflammation of course. But have you found anything, have you found good information on the conversion of DHEA into other hormones in men versus women, do you know which pathways it’s gonna be most likely to go down in each gender?

Dr. Jones: Well, I mean like if you give DHEA or like if you’re just making…

Dr. Hedberg: Yeah, if you give DHEA is it more likely to convert to testosterone or estrogen?

Dr. Jones: It is not, no, it’s actually, well, what we see at the lab and actually it was Mark Newman, who owns the lab. Pointed it out to me, he said, “Do you notice all these men on DHEA, their estrogen tends to go up?” So DHEA can convert into another hormone, androstenedione, especially in the fat tissue and then that gets aromatased into estrogen. And so we do tell practitioners you know, keep an eye on that man’s estrogen because if you’re gonna put him on 25 milligrams, 50 milligrams, 100 milligrams of DHEA and all these estrogen symptoms happen he’s getting that aromatasation action.

Now with women though I don’t see that as much, now women are much on typically much smaller doses, somewhere between one and 10 milligrams, 25 milligrams, tops. But usually the average woman is on 5 to 10 milligrams of DHEA. So it may be too you know, just a gender difference, she’s not going to take that, she’s got this bolus of a dose and make a whole lot of estrogen. And women’s aromatase, I think is a little bit different, it’s more concentrated in the ovaries. And that’s DHEA doesn’t get pulled in there, you know, if you take it orally it’s not getting pulled in the ovaries, that’s not how the biochemistry works. But I do see in women though, they are more prone to get that again that 5 alpha pathway.

So women will take DHEA and if you’re not watching that 5 Alpha pathway they will say, “I took that supplement and I got angry. I took that supplement and I got ache or anxiety, or whatever, my chin hair got a lot worse.” And so I see them stay more in the androgen field or go down that alpha pathway with women. So it’s interesting men get more estrogen and again not everybody not always. But women tend to get more of the men’s side effects you know, that angry irritated side effect.

Dr. Hedberg: That’s exactly what I’ve seen as men who take DHEA their androstenedione, and estrogen, tend to go up. And then women are most likely gonna have increases in androgens. And I’m glad you brought up the dosing because I’ve always used about 2 to 5 milligrams to start in women and 5 to 15 milligrams in men. And it’s never really understood or actually needed these really high doses 25, 50 milligrams of less. If it’s a really kind of disabled like rheumatoid arthritis or lupus patient then I would use levels that high. But just for general replacement don’t you think those doses are too high?

Dr. Jones: I do yeah, and I think people jump into them. I think what I will see is you know, they’ll jump into 50 milligrams, 75 milligrams,100 milligrams to start and I’m like, “Wow, we just slam that person. Why don’t we just ease into this like real nice like and see what happens.” And it’s the same with women when I give DHEA, I tend to…this is just personal preference, there’s a liquid DHEA that I like because they can literally do it by the drop. So I’ll say, “Start with one drop, just one.” And this is for women, I’ll say, “You know, got go up to two, go up to three.” And then you know the cap is usually 10 drops. And then they can decide for themselves like, “Wow I feel great at 6 drops, 7 I feel anxious or whatever. I broke out or that I can back out you know, some days I need 5 drops, some days I need 8 drops.” I’m like, “Great, that’s perfect, we can do these little tiny doses.”

And I mean, the same as you, I usually start women out on DHEA at about well, say like XY said one milligram because I’m usually starting out with one milligram. One to five is usually good. Unless it’s for fertility, there is some research with stubborn infertility and low follicle counts to do high dose of DHEA. In fact if memory serves I think the dose was 75 milligrams, which is a lot of DHEA for a woman, a lot, so be very careful. But there is some research for fertility purposes, specific fertility proposes to go much higher, but for the average woman I’m very low like you.

Dr .Hedberg: So one of the things I like about the Dutch test is the breakdown of cortisol. So we get the free cortisol, metabolized cortisol, cortisone and all the metabolites. So you get a lot of information there. So what are you thinking…well, obviously, stress is gonna kind of be at the bedrock a lot of these cortisol issues. But anything else like inflammation, insulin resistance, anything else to add here?

Dr. Jones: Yeah, for sure. So Dutch looks at like you said metabolized cortisol, free cortisol, and free cortisone. So, it answers the questions can you make it? What’s free and available and what’s getting deactivated? And so when I see a lot of metabolized cortisol then I start to think fight or flight reasons, infection, inflammation, obesity. You know, fat tissue can convert cortisone into cortisol. I start…hyperthyroidism will really increase cortisol. Insulin resistance, so all of those and “I” things. Infection, inflammation, insulin resistance those…well, absolutely, stress, high stress, will drive it up.

Now what drops it down when somebody might have low metabolized cortisol, believe it or not, the most common reason is a thyroid problem a slow, a hypothyroid problem. Whether overt, like they actually have you know, high TSH and low T4, T3, but even subclinical. We will see lots of sort of sub clinical sort of gray area thyroid problems. Thyroid starting to develop, auto immune starting to develop and it will absolutely directly immediately impact the adrenal access.

And so we’ll see it on the Dutch test and point it out to people, “Hey, if you haven’t yet, you need to consider doing a full thryroid panel because it’s starting to show up in the adrenals.” The thyroid is having an impact on the way the adrenals are producing and metabolizing the cortisol. But that’s not the only reason, again, all adrenal communication starts in the brain so I definitely had people with you know, history of traumatic brain injury, concussion, and if that affects the hypothalamus or the pituitary it’s gonna affect communication downstream as well. Slow it down possibly.

Certain medications, steroid medications I mentioned earlier so, whether it’s you know, you’re on the sort of black market steroids that you’re getting at your gym or if you’re on Prednisone or if you’re even doing like you know, you use inhalers, steroid inhalers for your asthma or steroid nozzle sprays for your allergies, steroid creams, for your you know, rash that will all impact, slow down the ability of your brain to communicate with the adrenals to make cortisol .

Accutane, which is the acne medication that people take in their teams and early 20s. There’s some research to show that it can impact the cells of the hypothalamus. And since I found this research, I actually found it through an endocrinologist. And as I tell people, I’ve had multiple men and women say to me, “Oh my gosh, I actually had a horrible experience with Accutane, I was so tired, I was so moody. I was not myself, I was absolutely impacted by it. I didn’t realize what you know potential effects on hypothalamus.” I’m like, “Yeah, there’s actually research to show this, you got to be careful.”

And so all this stuff will you know, will slow down or impact communication down to the adrenals. So it can actually, one, point to stress absolutely but it can also point to other issues like thyroid, like insulin, like inflammation, like the medication you’re taking. And show you what’s going on with the adrenals.

Dr. Hedberg: Right, and one kind of controversial term that’s used out there is adrenal fatigue. And let me give you my take on it and then yours. So this is a term that most patients are coming in using. And just because they’ve read about it online and then there’s been some books you know, called adrenal fatigue. Now there was a paper published, I think it was just a few years ago out of Europe and the authors you know, just sort of “debunked” adrenal fatigue. The way I see it is it’s a little bit more nuanced than that and if every single cortisol marker is in the tank and their DHEA ,and all the DHEA metabolites are in the tank then I’ll have that conversation and I might use that term, but I’ll explain to them that a lot of this has a lot more to do with your brain, then it does necessarily with the gland itself. So what is your take on that term and how do you look at it?

Dr. Jones: This is one of my most favorite topics ever besides estrogen detoxification. So I tell people unless it’s Addison’s…so Addison’s disease is autoimmune adrenal atrophy, which is when you truly can’t make cortisol. I am in the exact same camp as you so adrenal fatigue, just like you said, got very popularized because one, it’s easy to say, two, it’s sexy and thirdly, books have been written, quizzes are online, and you know, we all got, I got taught, adrenal fatigue is adrenal fatigue. Until you realize that the adrenals don’t just give out….again this is not Addison’s disease. This is just general your everyday person without autoimmune.

And so the adrenals, they’re not like the ovary. They don’t run out of cells, they don’t you know, they don’t go into menopause and they’re at the complete discretion of the brain. And so if the adrenals are not making cortisol or even DHEA or any of the hormones for that matter, they don’t think for themselves really and so it’s the brain that’s, the hypothalamus to pitutay is saying, “All right, make cortisol, make a lot of cortisol. Okay, slow down the cortisol.” And so if you have low cortisol production, low free cortisol, low DHEA, like you said, then I’m looking up, I’m looking higher. Because you don’t run out of cortisol. And you don’t run out of adrenaline, you don’t run out of noradrenaline, it’s produced.

So I’m looking up. I’m looking higher for sure of the brain. Yeah, that’s I’m in the same. So I understand, I tell people because people get very…and you’ve probably experienced this, they get very angry, when I have lectured or I’ve done some you know, YouTube stuff and other just education about adrenal fatigue. And they get very, very angry and they say, “No, I have adrenal fatigue, you’re wrong.” And I’m like, “No I like 100% agree with your symptoms. I’m not taking your symptoms away from you or devaluing them, I think they are legit. You are tired and you are you know, at your wits’ end and you’re having trouble coping and you’re feeling overwhelmed and you know I 100% agree with you.”

But it’s just the term adrenal fatigue. It’s more HPA axis dysfunction which is harder to say, not quite as sexy, and a lot more to write down. So it’s the concept, the symptoms I think are very real, the way we think about it. “Oh, your adrenal’s just run out of cortisol.” And I’m like, “Unless they have Addison’s, they don’t.” They really don’t, we have to look bigger and better and higher. And I think that’s changing and I think the more people like you and I that are you know, talking about it and as people are realizing the pathophysiology of it are going, “Oh, oops, it’s actually much bigger than we think and we need to think of it from the brain down.”

So I think it’s slowly changing, it’s just adrenal fatigue is easy to say and so people, I see a lot of people put it in air quotes now. You have adrenal fatigue air quotes, but you know what I mean. You know, and they’ll talk to me and they’re like, “My patient has adrenal fatigue, well you know what I mean like not, you know what I mean by that, right? I’m like, “Yeah, I know what you mean.” So there’s all the qualifiers now. So yes, symptoms are real, it’s we have to think bigger. higher.

Dr. Hedberg: Yes, it’s you know, and sometimes if someone has developed a particular belief or an attachment to a label or condition they have, then you challenge that, then it makes them uncomfortable. And it’s not just adrenal fatigue, it’s a lot of disorders.

Dr. Jones: Right, and I get to like, that’s why I qualify that now. I’m not taking their symptoms away, I fully believe their symptoms and I want to address their symptoms. I want them to get better, it’s just the notion that the adrenal cells don’t make cortisol or epinephrine or norepinehne or DHEA anymore. Again unless it’s Addison’s it’s just not how it works.

Dr. Hedberg: Right, exactly.

Dr. Jones: And that’s why it gets, this thing gets perpetuated and I’m like well, actually guys, real biochemistry and physiology, that’s not how it works. The wrong idea is getting perpetuated, we need to educate about these.

Dr. Herberg: So as far as testing goes, so obviously, you know, I like the Dutch tests. And for those people who don’t know this is a urine spot testing. So it’s urine test taken throughout the day and it’s been shown to be very, very similar to a 24 hour urine, without the inconvenience of going in a jug all day. And so basically we have urine testing, saliva and blood. And I know that the Dutch test now also does some saliva as well, when you do the test. And now there’s one hormone though that I’ll always do in the blood along with that and that’s free and total testosterone. Because that’s kind of the only one that I’m not 110% confident in. So can you talk about the different forms of testing and where you might wanna use one over the other?

Dr. Jones: Yeah, absolutely, and I agree with you about the testosterone. And I say that as the medical director, only because a lot of times you want the total, the free, and even the sex hormone binding globulin SHPG. Which you can’t get in urine or saliva for that matter, it’s long degraded. So you can only get that in the blood work. So with blood and with saliva you get it sort of in the moment. Because if you want a progesterone, if you want a testosterone if you want estrogen then you know, just that one single marker, then that’s when you get your blood drawn or that’s when you would do the saliva.

Now, saliva became popularized because of the cortisol aspect, if you wanted to see your cortisol pattern through the day then you obviously don’t want to get your blood drawn at 4 or 5 increments in the day, that’s annoying and painful. And so saliva became quite popular, because you could just spit in the tube in the morning, around lunch, around dinner, and before bed, and that was easy and not invasive. And than you would get your cortisol throughout the day. And now you could see, “Why am I tired you know, in the morning? Why can’t I sleep at night? Why do I crash the afternoon? You could follow your cortisol.

But now the issue with both the blood and the saliva is that you can’t get your pathways. So you can’t get your phase one or phase two estrogen detoxification which we talked about earlier. You can’t really get a look at where does your testosterone go, do you go down that 5-alpha pathway we talked about.

And so what people were doing was then taking blood work or taking saliva and adding in a 24 hour urine test, which is like you said you collect your urine for 24 hours in this big orange or big red jug. Which could become a problem if you have to go to work or run errands or you know, travel somewhere that you have to carry this big jug with you, It’s kind of awkward. So that entered in the spot urine testing where you could get your hormones, progesterone, testosterone, estrogen, but because it’s urine as well, you would get the pathway. So you would get your estrogen and then you could watch where it goes in phase one and phase two detox. You could get your DHEA, your testosterone and then you can watch the downstream pathways metabolites as we call it, are you going down the 5-aplha, the 5 beta.

And then with cortisol you could get your pattern through the day like you would get with saliva. But then again you would get…we give you cortisone, which is the inactive form. So it tells you are you keeping your cortisol active or not. Then we give you production which is called metabolized cortisol, and then on top of it we’ve added some other things like melatonin and a few other you know, nutritional and neurotransmitter organic acids.

So definitely if somebody says, “I just need to know my testosterone you know, I need my total, my free, my SHPG.” I’m like, “Yeah. Go get it in the blood, for sure.” When pregnant women call and they say, “I have a positive pregnancy test.” I’m like, “All right, go get your progesterone drawn in the blood because we don’t have time to wait for it to come back in the Dutch test. I need to know like your spot progesterone right away.”

Thyroid gold standard accuracy absolutely hands down is in the blood. We don’t do it in our urine test. There are some companies that are doing a few thyroid markers, we still feel there’s not enough research there and gold standard’s the blood. And it’s generally covered by insurance so go for it.

And so with the saliva, again, because it’s in the moment, we now have another test, it’s a combination urine-saliva. Because we wanted to look at something called the cortisol awakening response. So it’s the response your body has to making cortisol, to light coming in your eyes, and then producing cortisol first thing in the morning. And you do it every 30 minutes for an hour so as soon as your eyes open, 30 minutes later, 30 minutes after that. And so while some people could probably urinate on demand for 30 minutes it’s a pain. So we do these cotton swabs actually that you just stick in your mouth get wet and stick back in the tube. On waking 30 minutes later, 30 minutes after that. And we hyper focus on the first hour of your day. So now it’s a combination, you urinate on these little strips of paper, then you suck on these cotton swabs and we give you a whole lot of information.

Dr. Hedberg: And do you ever test for pregnenolone in the blood and when do you make the decision to use pregnenolone or not?

Dr. Jones: I actually don’t do it in the blood. I have mixed feelings on testing pregnenolone only because it’s usually so variable. Because it’s made by so many glands, it’s you know, it’s often in the mitochondria of so many glands. When the body wants to make a hormone it takes cholesterol and pulls it into the mitochondria and then converts it into pregnenolone, as it’s just one step on the way and moves on from there.

Now I will use pregnenolone, though. I use it with high stress, high anxiety, insomnia people. I will use it in especially women who have low progesterone, who have all those same symptoms. And I use it in an odd, you know, everyone thinks if you give pregnenolone, you’ll raise progesterone directly. And you don’t, you won’t. Because if you give pregnant alone, the supplement, the ovaries don’t pull up inside like, “Oh, hey look, pregnant alone,” and pull it in and convert it into progesterone. Again, it pulls cholesterol into the mitochondria and goes from there, but pregnenolone turns into something called ALLO, A-L-L-O not the plant but A-L-L-O.

And ALLO crosses the blood brain barrier and it affects GABA receptor, GABA is your big inhibitory, neurotransmitter. So it’s calming, it’s relaxing, it’s soothing, and so when people take pregnenolone they often feel less stressed more calm, more relaxed, they can sleep. And it just helps their stress response especially when you’re in that hyper stress response. And so I do like it, I do use it at smaller doses though I know some people will use…again it’s like DHEA, they’ll use 50 or 100 milligrams. And I’m like over here at 10, maybe 20. That’s when I was pregnenolone, and I’m not against testing it, I just don’t to be honest. How about you, what do you do?

Dr. Hedberg: I can’t remember the last time I actually tested it. But yeah, I’ll use it in the cases that you just described. So, why don’t we talk about application and your favorite methods of hormone replacement. So progesterone, estrogen, testosterone, do you like creams, injections, sublingual pellets.

Dr. Jones: I’ll be honest I don’t use pellets, I was never trained in pellet insertion. But I do have you know, a subset of patients who come in on pellets and if they love it then they’re just fine, they can stay on them. And then as far as application, it honestly it sort of depends on the person and the case. I don’t do necessarily the same thing every time except in a few things. So for example vaginal dryness, I will definitely use vaginal estriol, and sometimes a tiny bit of virginal DHEA with it. Because when it comes to dryness estriol is the estrogen of choice.

When it comes to chronic infections though you know, irritation…actually it’s estradiol, that’s the estrogen of choice there. But so I will use that one consistently when it comes to sleep so women who say, “As I’m heading into menopause my anxiety is worse, my sleep is worse,” part of the reason for that is they’re losing, they’re not ovulating any more and they’re not making progesterone.

And so when you take oral progesterone much like oral pregnenolone, progesterone also turns into ALLO, A-L-L-O or it can, some of it does. And again that crosses the blood brain barrier and helps quite a bit with sleep and anxiety and feeling calm. But research is showing that the oral progesterone, they don’t think it has the uterine protective effects. So if somebody is on estrogen and they’re taking oral progesterone, it may not necessarily counter against maybe uterine hyperplasia. I’ll be honest, I’ve never seen that in practice, when I’ve given estrogen and progesterone and if it’s oral progesterone, I’m not gonna…I don’t think I’ve had a patient yet who had uterine hyperplasia induced. But when I read some of these studies I’m like, “Apparently topical is better,” Topical progesterone is better for that.

But if she doesn’t have sleep issues or anxiety issues, I mean, I definitely like topical progesterone. Like I said earlier, with DHEA I tend to use the drops so that women can micro adjust the dose. But testosterone I do tend to use topical, and then if she doesn’t like topical or if she has little kids, or if she’s in a job or a position where she has to, like a massage therapist or physical therapist where her hands, arms, forearms are touching other people, then I may switch into sublingual hormones instead.

Because I find…well, I mean it just is, hormones they’re fat soluble and so when you rub them into your skin, if you don’t do a very good job of rubbing it in or you don’t wash your hands very well afterwards, you can just transfer it to the person next to you. Hormones are lipophilic, they like fat so, if you put them on their hormone and then hug your spouse, or hug your kids, and you can just transfer it skin to skin.

And we do see this quite a bit at the lab, especially hormone testosterone, men will rub their topical testosterone on and then, his wife’s testosterone’s through the roof. And I’m like, “Is your husband on testosterone?” “He’s going through it.” So I don’t really do a lot of injections unless it’s testosterone injections for men. I don’t do other injections.

And then with estrogen I mean, it’s a little, again it depends on the woman so there’s like the patch. Which you know, women who need that sort of steady state, or they’re having severe hot flashes that are really impacting their life, I may try to start with the patch. Now the patch is just estradiol, it’s not a combination estradiol, estriol. I do like sublingual, I do like topical, I mean with estrogen I’m not…again I guess it depends on the woman. But when it comes to the research for estrogen estrodiol, and dementia, Alzheimer’s, not cardiovascular, but not clotting, but like the good part of cardiovascular health, it’s all been an oral estradiol interestingly enough. Not so much on topical or sublingual.

But if you take oral estroldial and you have clot risk you have to be very careful because it will increase your clot risk.. So again I mean, I may sound all over the board, but it’s again it’s that sort of functional individual medicine. It sort of depends on the person and I mean you experience this, but people listening may say, “Well, I’ve been doing topical like you said and I feel no different.” And I’m like, “All right, well, it could be the dose is wrong or the administration is wrong, so switch it up, switch to sublingual. Or maybe you need oral or maybe you need the patch instead.” Every woman is different although women will come in and say, “Can I try you know, oral progesterone?” I’m like, “Yeah, if it fits, yeah sure.” And then they’ll notice nothing. I’m like, “All right well, you know, you don’t need it ultimately or oral is not for you, let’s sublingual or topical.”

Dr Hebderg: Right, unlike with men, I mean they’ll try a gel or a cream and feel nothing and then just a single injection and they’re like wow.

Dr. Jones: That’s not the truth, and I don’t know if you do this too. But I have men as well, who say, “I have kids at home or I’m a body worker, I’m a trainer, I’m a massage therapist. And then I don’t tend to do topical testosterone with them. I do tend to recommend injection instead because I just see the transfer so much that it’s concerning to me.

Dr. Hedberg: So why don’t we close with your favorite adrenal adaptogens. And when do you decide if you want to use phosphatidylserine or not?

Dr. Jones: Oh, that’s a good question. Well, I’ll say my favorite sort of adrenal in general is cordyceps. Cordyceps the mushroom, because it…research, especially in Chinese medicine has shown that it’s really helpful for hypothalamic pituitary communication. So again when we’re talking from the brain down I really like cordyceps because it affects the brain and supports the adrenal.

And cordyceps, it’s just good for so many things. And then I really like the mushroom food group. I put mushrooms on everything and in everything. So if you don’t like mushrooms then we should probably not hang out, because I put them on everything. But of course so cordyceps is probably my favorite at the moment. And then phosphatidylserine I do use especially when somebody has high cortisol at night. So I will use it when they do the Dutch test and I see their cortisol go up instead of down at night. And of course they’re complaining of sleep issues, insomnia, they wake often. And so I like phosphatidylserine because it helps slow ACTH. It helps improve cortisol receptors, it helps improve plasticity in the brain. So reminding the brain of this basic analogy like, “Hey, you know, like we sleep at night, we sleep at night, we sleep at night, like stop winding up, we need to wind down.” And so that’s when I’ll use phosphatidylserine.

Dr. Hedberg: Excellent. Well, this has been really great, Dr. Jones, anywhere you’d like people to find you online?

Dr. Jones: Yeah, so there’s two places, one of course is at dutchtest.com. And I should say Dutch is an acronym, we don’t test for Dutch heritage which I get asked. Dutch stands for dried urine test for comprehensive hormones. So dutchtest.com, I’m also super active, I do a lot, a lot of education on Instagram, because I’m a visual person so I like all the pictures. So my Instagram handle is dr.carriejones. And you can learn as much as you want about hormones because it’s all I post about.

Dr. Hedberg: Good. All right, well, this was excellent, thank you again for coming on.

Dr. Jones: Yeah, thanks for having me, this was lots of information, lots of knowledge dropped.

Dr. Hedberg: Yeah. So to all the listeners, go to drhedberg.com and I will have a transcript posted there and any links that we talked about in the article section. So take care everyone. And I will talk to you next time.