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Forum Name: Endocrinology Topics

Question: Too many Hormones


 step paul - Mon Jan 16, 2006 3:27 am

I am a 40 year old male with too many female hormones, an exhausted Adrenal Gland, I am low in B12 and my DHEA levels are also low. What can I do to over come this small hurdle and how did I get too many female hormones??
 Dr. Shank - Sun Jan 22, 2006 7:05 pm

Dear Step Paul:

Let me begin with the most straighforward part of your question.

Since B12 is produced by soil bacteria, it is virtually impossible not to get enough of B12 in your diet. However, many people lose the ability to absorb it normally from their food. It is very difficult to absorb B12 without a protein produced in the lining of the stomach, known as "intrinsic factor." Almost all B12 is absorbed in the last part of the small intestinge (the "terminal ileum"). Some people develop a B12 deficiency when this is surgically removed or severely damaged by an inflammatory bowel disease (Chron's disease or ulcerative colitis, both of which are "autoimmune" diseases, in which the body attacks itself), but this is pretty rare. Another cause that would be rare in the "developed" parts of the world is an infestation with intestinal parasites (like tapeworms) that take up so much B12 that it does not make it to the terminal ileum. Still another cause that is primarily seen in people with longstanding poorly controlled diabetes or certain surgical procedures (formerly commonly used for ulcers and now primarily used for weight loss), is overgrowth of bacteria in the first part of the intestines (the "duodenum"), again resulting in digestion of iintrinsic factor. Another autoimmune condition, variously known as "celiac disease," "non tropical sprue," or "gluten enteropathy" results in damage to the lining of the small intestines and poor absorption of B12 and other nutrients. Sometimes people lose intrinsic factor due to stomach surgery, such as for weight loss (an commonly in the past, for ulcers). B12 is stored in the liver, so you might think that liver diseases could cause B12 deficiency, but this does not appear to be the case. By far the most common cause of B12 deficiency is an autoimmune loss of the normal stomach lining resulting in deficient production of intrinsic factor. This is usually seen in the elderly, but is also common in people with other autoimmune diseases. Since you are young and the information you have given suggests that you may may have deficiencies in other glands, I suspect that your body is attacking itself and destroying the cells in your stomach lining that produce intrinsic factor, along with damaging other glands.

That was the easy part! Without lab results, the number of possible explanations for the remainder of what you describe is overwhelming. However, since I suspect that you have an autoimmune disease of one sort or another, I will concentrate on the possibilites that fit that mechanism. Whenever you find one autoimmune disease, you should look for others.

I have learned through painful experience with a variety of local and national labs not to trust a single set of low measurements of the main adrenal hormone, cortisol. Unless this is confirmed on a set of measurements run separately, the chance is greater for a falsely low than for a really low value. Assuming that you do have an adrenal insufficiency, however, I do not know whether your adrenal glands are not working because of a problem with them, or because of problem with the gland that controls them, the pituitary. I will mention in passing the possibility of a non cancerous tumor of the pituitary gland, most commonly producing too much prolactin, and sometimes damaging parts of the pituitary that control other glands. That would not help to explain your B12 deficiency, but I do think that at least a prolactin level should be checked, especially since you give a hint that your testes may not be working normallly, either. One of the many possible causes of adrenal insufficiency is autoimmune, which would fit with the most likely cause of your B12 deficiency.

DHEA comes from two sources, one of which is the pair of adreanl glands. That fits with what you said about your adrenal glands being "exhausted." The other source is the pair of gonads (testes in males, ovaries in females). If DHEA is low because of abnormal function of the testes (usually due to an abnormality in the pituitary gland or in the testes themselves, such as autoimmune damage to the testes), testosterone levels would probably be low, too. If DHEA is low due to abnormal function of the adrenal glands, DHEA-S (for "sulfated DHEA") should also be low.

How as the diagnosis of "too many female hormones" made? You did not mention enlargement of your breasts ("gynecomastia"), but that is the most common reason for diagnosing "too many female hormones." Unfortunately, most physicians do not actually measure the female hormones (estrogens). Since you did not mention testostorone levels, I suspect that estrogen levels were not measured, either. If you are obese, your fat cells will convert male-type hormones (such as testosterone) to female-type hormones (estrogens). If you have liver damage from toxins (such as alcohol abuse or carbon tetrachloride exposure), infectious diseases (such as hepatitis B or C), autoimmune disease (such as primary biliary cirrhosis or sclerosing cholangitis), or insulin resistance syndrome (fatty infiltration or cirrhosis known as "non alcoholic steatohepatis" or "NASH"), your liver may not be able to break down normal amounts of estrogens (produced from testosterone and other male-type hormones), so the levels may be high. There is a whole field dealing with so-called environmental estrogens, which are estrogen-like compounds used in pesticides (like DDT), plastics, and a wide variety of other applications, and then there are certain foods, like soybeans, which are naturally rich in estrogen-like plant substances ("phytoestrogens"), but I do not believe that these would have shown up, even if you did have standard laboratory tests done. Without more information, I cannot be sure that you are not describing "testicular feminization," but that would probably have been diagnosed early in life. Other rare causes of too much female hormones are tumors, such as an exraordinarily rare tumor called a "teratoma" (sometimes described as being like forming a partial fetus), testicular tumors, and a group of rare tumors known as "neuroendocrine" (such as carcinoid tumors). At your age, the most common causes of breast enlargement would be too little testosterone, durgs that block the effects of testosterone (such as spironolactone or cimetidine), or marijuana use (Sorry women--it won't work for you!).

Proper treatment is dependent upon proper diagnosis. Endocrinologists are the physician experts in hormones and metabolism. I strongly suggest that you see an endocrinologist. I am sure that The Endocrine Society of Australia (http://www.racp.edu.au/esa/index.htm) would be delighted to help you find an endocrinologist, but it does not list members on its website. The American Association of Clinical Endocrinologists does have a physician-finder (http://www.aace.com/resources/memsearch ... ion=doSrch), but it only lists 9 Australian members.

I trust that this is helpful to you.

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