Hormonal Imbalance Symptoms

Symptoms of hormonal imbalance are obvious, yet hard to fix. From giving you acne, irregular menstruation, low libido to blues, the hormonal imbalance wreaks havoc on your emotional and reproductive health. Behind the familiar symptomatic picture hides the health impact of hormone imbalance.

Hormonal imbalance affects both men and women since both of them have varied levels of more or less same sex hormones. For instance, do you know that a woman also has male sex hormones – testosterone – although the quantity is minute? Likewise, men have estrogens – called the female hormones – circulating in their blood.

Sex Hormones And Their Types

Both men and women share the same pathway of sex hormones development. The process starts with hypothalamus sending signals to pituitary gland to initiate, maintain and regulate the sex hormone production.

Think of hypothalamus as a boss; it sends orders to the manager – which is the pituitary gland – via gonadotropin releasing hormones (GnRH). The manager, in return, instructs employees – in this case, ovaries, testes and adrenal glands – to start working. The instructions come in the form of hormones called follicular stimulating hormones (FSH) and luteinizing hormone (LH) in females and LH in men.

Once instructed, each employee sets to work as per designation; the ovaries start producing female and male hormones; and the testes androgens; some of which is converted into estrogen later.

Let us now read about the hormones specific to either sex.

  • Male Sex Hormones

A male has following sex hormones in his body

  • Testosterone
  • Androstenedione
  • Dihydroepiandrosterone (DHEA)
  • DHEA-sulfate
  • Estrogen
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Collectively, all of the male sex hormones are called androgens. Of all the types, testosterone is most important and is involved in sexual and reproductive development.

  • Female Sex Hormones

The collective term for female sex hormones is estrogen which is a combination of three hormones called:

  • Estrone (E1)
  • Estradiol (E2)
  • Estriol

Of these, estradiol is most common. These sex hormones are produced by the theca and granulosa cells of ovaries. Other female sex hormones include:

  • Progesterone
  • Inhibin
  • Activin
  • Follistatin
  • Testosterone

From giving you a great sex appeal to making you shout like a raged lunatic – hormones have a great role to play in what and how you feel. One minute you feel like putting on a lipstick, the next you want to shove it down somebody’s throat and rip them apart into a thousand pieces.

A detailed feature on female hormones can be found here.

Here we will talk about symptoms of hormonal imbalance, how the imbalance develops, its types, the diagnosis and the treatment.

What Is Hormonal Imbalance?

Hormonal Imbalance as the name suggests, is a condition which happens when the subtle balance between various hormones in your body is disturbed. This balance is vital for your body to function properly and stay stable.

Hormones are chemicals that certain glands in your body (called endocrine glands), such as pituitary, thyroid, adrenal and ovaries etc., secrete. Once secreted, hormones swim down or up to the blood stream and reach all cells in the body where they perform specific function.

Each hormone has its own specific function, for instance, sex hormones decide what gender you will have at birth. Female Hormones called estrogens and progesterone – make your voice soft, shrill and feminine; helps develop breasts and prepares womb for copulation and conception. Male sex hormones, contrariwise, are responsible for the masculinity – beard, deep voice, and penile length, erection and libido.

Hormonal balance is akin to the spring of health and youth. Without it, you just cannot sail through life as a healthy being. An imbalance in hormones can make daily life feel like an uphill battle.

Hormonal Imbalance Symptoms In Women

  • Irregular or Absent Menstrual Cycle The biggest symptom of hormonal imbalance is when your periods go bonkers. You no longer ovulate monthly. Women with PCOS ovulate less than 6-8 times a year. When and if periods occur, they may be too heavy or last for more than 20 days. Alternatively, they can be so light that you will see is mere spotting.

Sometimes periods go missing for years – the condition is called amenorrhea.

  • Breast tenderness
  • Increased PMS
  • Abdominal obesity
  • Water retention
  • Painful or lumpy (fibrocystic) breasts
  • Chronic yeast infection – A 2000 study by Des Moines University, Iowa, found that estrogen (17-β-estradiol) increased the growth and survival of Candida albicans – fungus that causes yeast infection in women.

All of these symptoms indicate a higher than normal level of estrogen.

Other symptoms indicating hormonal imbalance in women are:

  • Vaginal dryness and painful intercourse
  • Hot flashes and night sweats
  • Lethargic depression
  • Urinary Tract Infections (UTIs)
  • Poor memory

These symptoms appear when you have estrogen deficiency.

Progesterone is one of the main sex hormones in women that prepare the uterus for conception and birth. Progesterone is released from the corpus luteum, which is a mature follicle that is ruptured after the egg is released. When progesterone levels are upset, following symptoms appear.

  • Early miscarriage
  • Insomnia
  • Irritability
  • PMS
  • Unexplained weight gain
  • Painful breasts
  • Infertility
  • Headaches

Other symptoms of hormonal imbalance in women include:

  • Acne
  • Hair thinning on the scalp
  • Hirsutism – excess hair on chin, upper lip, side burns, chest and navel
  • Infertility
  • Unstable blood sugar levels
  • Ovarian cysts

These symptoms indicate that your body has higher than normal levels of testosterone.

Excess of Androgen has following manifestations:

Hormonal Imbalance Symptoms In Men

Symptoms of hormonal imbalance in men include:

  • Decreased libido
  • Trouble obtaining and maintaining erection
  • Smaller, softer testes
  • Depression, mood swings, anxiety
  • Poor sleep
  • Fatigue
  • Difficulty with concentration, memory and cognition
  • Poor stamina
  • Weight loss
  • Decreased muscle mass and strength
  • Loss of hair
  • Osteoporosis
  • Pot belly
  • Infertility
  • Lack of deepening of voice
  • Impaired penis and testicular growth

If you have any or all of the above mentioned symptoms, you may need to schedule an appointment with the doctor because these symptoms indicate testosterone deficiency or hypogonadism.

In addition, following symptoms should also alert you:

  • Enlarged breasts
  • Prostate enlargement
  • Weight gain
  • Hair loss

These symptoms mean you have estrogen dominance in your body.

Symptoms Of Hormonal Imbalance That Are Common In Both Sexes

  • Sweating
  • Gassiness and bloating
  • Cravings for sugar
  • Poor sleep pattern
  • Anxiety, irritability, and depression

How Common Is Hormonal Imbalance?

You may think hormonal imbalance is what menopausal women experience as they reach the twilight of their life but you cannot be more wrong.

Hormonal imbalance also affects adolescents and young adults. It is more common than we think.

In most of the cases, hormonal imbalance leads to infertility. Infertility is a state where you cannot succeed in getting pregnant within one year of unprotected sex – six months if you are a woman above 35. Infertility is not just an inconvenience; it is a disease and affects both men and women worldwide.

According to the US Centers for Disease Control and Prevention (CDC), about 12.3% of women aged 15-44 years – 7.5 million –in the US have difficulty getting or staying pregnant. 6.0% of them are completely unable to get pregnant (infertile).

After one year of unprotected sex, approximately 1.0 million women fail to conceive naturally.

The National Survey of Family Growth says that during 2006-2010, every one in eight couples sought fertility treatments in the US.

Is Infertility Just A Woman’s Problem?

No! Infertility affects both men and women. If one-third of women are affected by infertility, the equation is balanced by one-third of male partners.

The remaining one-third of infertility cases are either unexplained or attributed to both partners.

The American Society for Reproductive Medicine (ASRM) has found that approximately 40% of the infertility cases are attributed to either male partner alone or both partners.

Data from 2002 National Survey of Family Growth shows that about 7.5% of men – 3.3 – 4.7 million – sought fertility treatment owing to sexual impairment. Of these, approximately 18% were diagnosed “infertile” and had semen problems (14%) and enlarged veins in the scrotum – varicocele (6%).

What Causes Hormonal Imbalance?

Your body is a perfect blend of chemicals, neurotransmitters, proteins and hormones. From puberty to menopause, your hormones are continually fluctuating. The balance is extremely delicate but is naturally maintained by your body.

But sometimes things can go wrong. The way we are living our lives and challenging our health with unnatural lifestyle and habits is taking a heavy toll on our health. Whatever we eat has an impact on our hormones. Stress messes our hormones, and the hidden toxins and disruptors tremendously bombard our body – and hormones. Sugary drinks continually fluctuate our hormonal levels.

Just so many things can affect your hormonal balance. These include:

  • Age
  • Diseases, heredity or congenital defect
  • Stress
  • Toxins and endocrine disruptors

Let us have a look at all the factors individually:

  • Age: As you age, your hormone production level begins to decline. The way target cells respond to sex hormones also compromises. Blood hormonal levels begin to fluctuate. Metabolism of hormones is also affected. All these changes manifest themselves as menopause in women and andropause (male menopause) in men.

What Is Menopause?

Once a woman crosses 40s, her periods start going amiss; gradually reducing to mere spotting, and ultimately leading to a menopause at around 50-52.

Menopause is a state of menstrual cessation that indicates that a woman can no longer conceive and have biological babies. This fluctuation is natural and indicates a transition from adulthood into old age.

Albeit natural, menopause is a cluster of unpleasantness – from causing hot flashes to giving night sweats to reducing libido – it plays dirty games with women. There is no escape, every woman has to go through the natural cycle. A recent University of North Carolina study has affirmed the widely-held belief that the transition into menopause could make women feel down and depressed by fluctuating estradiol (a type of estrogen) levels.

Women, as is already an established fact, are twice as likely to give in to depression as men. Menopause enhances emotional sensitivity and can increase depression threefold in susceptible women, the same 2016 study found.

Mounting evidence shows that your genes govern the time of menopause. A 2016 Universities of Cambridge and Exeter study, involving well over 70,000, women, conducted a genome-wide study and identified 40 regions in human genome that precipitate menopause. The study was published in Nature.

As men age, they too experience a drop in testosterone level. Once you cross your prime – 30 years – your body begins to decline in its function. Experts believe that for every decade, there is a 1% decline in testosterone level. In fact, a new 2016 study, published in the Journal of Endocrinology and Metabolism, has found that testosterone levels are declining in Americans over the past two decades.

Dr. Thomas G. Travison, Ph.D., professor at New England Research Institutes (NERI) in Watertown, Mass., and lead author of the study, says, “For men 65-69 years of age in this study, average total testosterone levels fell from 503 ng/dL (nanograms/deciliter) in 1988 to 423 ng/dL in 2003.”

Total testosterone concentrations in a healthy adult male, ranges anywhere from 300-1000 ng/dL.

A drop in hormones disrupts the intricate balance and may prompt imbalance.

  • Diseases, Heredity Or Congenital Defects

You may be genetically predisposed to conditions linked to hormonal imbalance such as ovarian insufficiency or have other diseases that markedly disrupt your hormonal balance.

For example, women may inherit or develop:

  • Polycystic ovarian syndrome (PCOS)
  • Premature ovarian failure (POF)

And men can suffer from hypogonadism that is manifested in hormonal imbalance either at the time of birth or later during puberty.

  • Polycystic Ovarian Syndrome (PCOS) 

According to Women’s Health – U.S. Department of Health and Human Services, PCOS is the leading cause of hormonal imbalance and infertility in one out of 10 women of reproductive age – that’s one in 19 million US women.

If you have PCO, your ovaries are filled with immature fluid-filled sacs (called cysts) barring the egg from maturing and releasing.

The exact cause of PCOS is not known but genetics and environmental factors have been said to play a role. Women with PCOS have higher than normal levels of male hormones (testosterone, androstenedione, dihydroepiandrosterone (DHEA) and DHEA-sulfate) in their body which explains why most of them have acne and excessive hair on their face, chest, lower abdomen etc.

The symptoms include:

  • Irregular periods – women with PCOS have fewer than six to eight periods per year. Some women with PCOS have regular menstrual cycle at the time of puberty which becomes irregular as they age or gain weight. Obesity is common with PCOS.
  • Weight gain
  • Insulin Resistance – women with PCOS have an increased level of insulin (hyperinsulinemia) which increases male hormones. Because PCOS is usually coupled with obesity, women develop insulin resistance (IR). IR is a condition in which your pancreas has to secrete more insulin to maintain normal glucose level. When blood glucose level is still not compensated with higher insulin, the condition is called glucose intolerance which is a pre-diabetes stage. Dr. Ehmann DA and colleagues of University of Washington found that women with PCOS are at an elevated risk of gestational diabetes and type 2 diabetes mellitus.
  • Hair Growth called hirsutism on upper lip, chin, sideburns, neck, chest, lower abdomen and inner thighs.
  • Acne
  • Infertility – women with PCOS do not ovulate regularly and take longer to become pregnant. An infertility evaluation is recommended after 6-12 months of trying to become pregnant.
  • Sleep Apnea – occurs in about 50% of women with PCOS. Obstructive sleep apnea (OSA) is strongly related to insulin resistance. Women who have both PCOS and sleep apnea have a threefold increased risk of pre-diabetes – a University of Chicago study found out.

David Ehrmann, MD, professor at University of Chicago (UC) and director of UC Center for PCOS, says: “Patients who have one or both of these conditions should be screened early for Type 2 diabetes and should be monitored regularly.

The US Endocrine Society Clinical Practice Guideline (2013) recommends:

“We suggest screening overweight/obese adolescents and women with PCOS for symptoms suggestive of OSA and, when identified, obtaining a definitive diagnosis using polysomnography. If OSA is diagnosed, patients should be referred for institution of appropriate treatment.”

PCOS is an ongoing condition that requires lifelong management. Women with PCOS are also at a risk of developing heart disease later in life. To complicate the matters, they are not even being prescribed the required screening tests for blood sugar and cholesterol – a recent New Jersey Medical School study found out. The study, highlighting the negligence of doctors putting women at high risk of health complications, was published in American Journal of Obstetrics and Gynecology (2016).

Nonetheless, with early diagnosis and effective management, women with PCOS can live a normal, healthy life.

  • Premature Ovarian Insufficiency (POI) or premature ovarian failure and early menopause -is a condition in which ovaries do not function normally in about 1% of the women younger than 40. In POI, your ovaries either stop releasing eggs completely or release them only intermittently. All female sex hormones – estrogen, progesterone and testosterone – are badly affected.

POI may have genetic basis – such as:

  • Turner syndrome
  • Fragile X syndrome and
  • Y chromosome in women

Studies suggest that 10-12% of women with POI have chromosomal abnormalities; of which 94% are X chromosome abnormalities (X aneuploidy).

  • Turner Syndrome

    is a genetic condition in which either of two X chromosomes is missing. Normally a woman is born with two XX chromosomes – one from her mother, the other from her father. Turner syndrome is the most common chromosomal defect in humans that leads to POI. Missing just a portion of X chromosome can cause POI.

Jiao, et al found in 2012 that women with primary amenorrhea are at higher risk of abnormal chromosomes (karyotype) – 21% than those presenting with secondary amenorrhea – 11%.

  • Fragile X (Fra-X) Syndrome

    is another genetic condition in which there is a defective gene on X chromosome. This syndrome is the main cause of mental retardation although it may not always be the case. If an intellectually sound woman whose POI is caused by a defective gene in X chromosome succeeds in becoming pregnant, she carries a risk of giving birth to an intellectually disabled baby.

X-linked conditions run in the family but “silently”. A 2011 University of Manchester study, published in Journal of Genetic Counseling, found grandmothers to be the silent carriers of Fra-X and suggested they be offered genetic testing and counseling when tests are carried out.

European Society of Human Reproduction and Embryology recommends Fra-X testing in all women with POI and their relatives.

  • Y chromosome in women

Women with a Y chromosome need to get their ovaries removed completely. This condition is rare in women but if it does exhibit, it causes severe hormonal imbalance and can lead to ovarian tumors.

POI may also be caused by radiation therapy, chemotherapy, and autoimmune diseases. Women with POI should get their thyroid and adrenal functions evaluated.

Women with POI have irregular periods before their menstruation disappears completely. According to uptodate.com, only about 5-10% of women with POI can conceive and give birth normally without any treatment. In once incidence, a 44-year women succeeded in conceiving 16 years after a diagnosis of ovarian failure. Remaining need estrogen therapy, and IVF if they wish to conceive.

POI is an emotionally draining condition.  It is incurable; causes severe depression in women and makes them go through the same agony of a menopause – hot flashes, night sweats, vaginal dryness and sleep disturbances. Women with POI require menopause treatment.

The American Congress of Obstetrician and Gynecology (ACOG) advises doctors to be mindful of the sensitive nature of the medical condition and the diagnosis, and offer psychological assistance.

“Psychologic counseling also should be offered because impaired self-esteem and emotional distress have been reported after diagnosis of primary ovarian insufficiency.”

Even if a woman does not desire to be pregnant, she needs estrogen for an overall wellbeing. A deficiency or lack of estrogen increases their risk of bone-thinning and osteoporosis. There is some controversial evidence that a lack of estrogen in premenopausal women can increase their risk of heart disease.

Male Hypogonadism

  1. Function of testes is decreased, and either or both conditions occur; sperm reduction or low testosterone level. Normal testosterone level in an average adult male is from 270-1070 ng/dL.

Testosterone is necessary for masculine growth and development at the time of puberty. You may be born with hypogonadism or develop later in your life. Hypogonadism has three types:

  • Fetal hypogonadism
  • Juvenile hypogonadism
  • Adult hypogonadism
  • Fetal Hypogonadism:

Develops when the fetus is still in the womb. Male sexual development starts between 7-12 weeks of gestation. The testes develop as a result of expression of various genes located on the shorter arm of Y-chromosome. Sex-determining region, called SRY gene complex, is also located on Y-chromosome #17.

If the body doesn’t produce enough testosterone during fetal development, it may result in impaired growth of genitalia in male infants. Such a child may be born with female or ambiguous genitals. If he develops male genitals, they may be underdeveloped.

  • Juvenile Hypogonadism:

Manifests at the time of puberty and can either delay puberty or lead to incomplete development. A male juvenile may exhibit feminine voice, impaired body hair growth and impaired growth of penis. He may also develop breasts.

  • Adult Hypogonadism:

    Becomes palpable in the form of infertility, erectile dysfunction, decrease in muscle mass, development of breast, and osteoporosis. Hypogonadism can result from disease of testes (primary hypogonadism) or disease of hypothalamus or pituitary gland (secondary hypogonadism).

Hypothalamus is the part of brain that signals pituitary gland to secrete FSH and LH that trigger testes to produce and release testosterone, may be inherited or acquired later in life as a result of injury or infection. Primary and secondary hypogonadism can co-occur and co-exist as well.

Primary Hypogonadism

  • Klinefelter Syndrome: A male child born with KS has three chromosomes – X, Y and X (XXY) instead of two normal ones – X & Y. The Y chromosome is the genetic chromosome that determines the male gender of the child. An extra chromosome results in abnormal development of testicles. This results in underproduction of testosterone.

Klinefelter Syndrome affects 0.2% of male population and is the most common cause of male hypogonadism. It accounts for 90% of numerical chromosomal aberrations (47 XXY).

Despite being the number#1 cause of male hypogonadism, Klinefelter Syndrome is extremely underdiagnosed, Dr. Anders Bojesen and co of Aarhus University Hospital, Denmark found in a study published online in Journal of Clinical Endocrinology and Metabolism in 2009.

  • Undescended Testicles: Testes develop when the male infant in still in the womb. First, they develop inside the abdomen which then descends into the scrotum at or around the time of birth. Sometimes either or both testicles may not descend – a condition which automatically gets corrected a few years after birth. If it does not, it leads to testes malfunction and requires surgical correction.
  • Mumps: If the infection spreads from salivary glands (mumps orchitis) to testes, testicular damage can ensue.
  • Hemochromatosis: Too much iron in your blood can result in testicular failure.
  • Injury to testicles
  • Cancer Treatment: Chemotherapy or radiation therapy can harm testes resulting in lower sperm or testosterone production. American Association of Clinical Endocrinologists (AACE) (2015) recommends “pre-treatment sperm banking” in men who desire fertility in future.

Secondary Hypogonadism

  • Kallmann Syndrome: Occurs when hypothalamus is abnormally developed. It is a congenital inherited disorder that is an X-linked recessive trait and occurs in about 1 in 10,000 male births.
  • Inflammatory Diseases: Such as sarcoidosis (an infection of lungs and lymph glands), histiocytosis (an abnormal increase in the number of immune cells – histiocytes) and tuberculosis can expand to hypothalamus resulting in reduced testicular function.
  • Pituitary Disorders: Can result in lower levels of FSH and LH.
  • HIV/AIDS: Can affect hypothalamus, pituitary or testes.
  • Postpubertal Mumps: Findings by Dr. Niall Davis and co of The Mater Misericordiae Hospital, Ireland, show that mumps that occurs after puberty can leave more than 50% men subfertile and infertile. These men have increased FSH levels coupled with absence or deficiency of sperms in semen (oligospermia) or lack of motile and viable sperms (azoospermia).
  • Aging: As you age, your testosterone level reduces.
  • Obesity: Can lead to low testosterone level at any age.
  • Concurrent Illness: Such as stress or surgery can temporarily shut down the reproductive system.
  • Stress: We are living in fast times; workloads have gone heavier and salaries lighter. Overall, stress has deepened. What’s more is that the generation Y, millennials and generation Z are suffering from electronic stressors – thanks to the incessant supply of smartphones, laptops and tablets.

These factors take a heavy toll on your overall health, including your hormonal balance. Stress hormone – cortisol – has a major role to play in upsetting hormonal balance.

Cortisol Is The Culprit Behind Stress

Cortisol is a steroid (glucocorticoid) hormone that is produced by the adrenal glands located at the top of both of your kidneys. It is made up of cholesterol and is released as a result of everyday events, such as waking up, exercising and stress.

The hormone plays essential role in your body; it regulates energy to meet the body’s physiological demands. This hormone is also the key chemical involved in “fight-and-flight syndrome” – a condition in which your body is alarmed and on the verge of making a decision. The energy production is increased at the expense of several bodily processes.

Dr. Mayer EA, a professor at Departments of Medicine and Physiology, UCLA, writes in a review in BMJ:

Stress, defined as acute threats to the homeostasis of an organism,be they real (physical) or perceived (psychological), and whether posed by events in the outside world or from within, evokes adaptive responses which serve to defend the stability of the internal environment and to assure the survival of the organism.”

Prolonged stress tears up our bones, melts our muscles, robs us of strength and energy, lowers our libido and overwhelms our immunities, putting us at serious risk for chronic illness and autoimmune disease.

When chronically elevated, cortisol brings havoc on your body; it tears up your bones, melts your muscles, robs your body of energy and strength, decreases your libido and seriously mars your immunity. Together all of this puts you at an increased risk of various chronic diseases such as:

  • Inflammatory bowel disease (IBD)
  • Irritable bowel syndrome (IBS)
  • Gastroesophageal reflux disease (GERD)
  • Type 2 diabetes mellitus
  • Depression

Various everyday stressors play in important role in spiking cortisol level. Evidence suggests that long working hours, night work etc. increase your cortisol level. A study by UCL Institute of Child Health, London, UK and University of British Columbia, found that extended work hours are particularly associated with an elevated level of cortisol among employees.

How Cortisol Messes With Your Hormones?

Here is how cortisol messes up your hormonal balance:

  • You face a stressor such as increased workload, sudden death of a relative etc.
  • Your body undergoes a cascade of hormonal and chemical changes – adrenal glands secrete cortisol; sympathetic neurons in your brain and spinal cord release adrenaline.
  • Both adrenaline and cortisol prepare your body for fight-and-flight syndrome. Adrenaline makes your heart beat faster; cortisol floods your body with glucose by inhibiting insulin production.
  • Cortisol narrows your blood vessels.
  • You become cognizance of the threat, address and resolve it.
  • Cortisol and adrenaline return to normal levels.

Effects Of Stress On Men And Women Hormones 

However, when you are chronically stressed, cortisol levels remain higher than normal and bring whole-body effects – one of which is a hormonal imbalance in women and men. Chronically stressed men often complain about erectile dysfunction in men; women of a disruption of menstrual cycle. Since androgens and cortisol are made in the same glands, elevated level of one hampers the production of the other.

A 2014 Ohio State University LIFE study, published in Human Reproduction, says stress can diminish a woman’s fertility and delay pregnancy. Lynch, director of reproductive epidemiology at the Ohio State University College of Medicine and the lead author of the study says that when you are stressed, an enzyme called alpha-amylase begins to secrete in your mouth that is directly related to your body’s stress system.

She studied the effects of stress in 500 couples trying to conceive. When stress was reduced, 87% of the women succeeded in becoming pregnant. Another study by National Institutes of Health and the University of Oxford confirms the belief that women with high level of stress hormones are less likely to conceive.

Yet another 2004 study by L Wang and co of Children’s Memorial Hospital, Chicago, IL, states that stress can cause significant pain during period (dysmenorrhea) in women. The study was published in BMJ.

Evidence further suggests that stress hormones suppress the release of gonadotropin releasing hormones (GnRH) – responsible for the release of sex hormones in both males and females. It is GnRH that signals release of follicular stimulating hormone (FSH) from ovaries and luteinizing hormone (LH) from testes. A 2015 Nature review by Nargun VH, consultant urological surgeon at Homerton University Hospital, UK, expands on the effects of psychological stress on male fertility. He says stress can affect the way sperms are produced in men. It can lead to reduced paternity and semen patterns. He says:

 

“The hypothalamic–pituitary–adrenal axis has a direct inhibitory action on the hypothalamic–pituitary–gonadal (HPG) axis and Leydig cells in the testes, which causes changes in Sertoli cells and the blood–testis barrier, leading to the arrest of spermatogenesis.  Stress as a causative factor in male infertility cannot be ignored and patients should be made aware of its effects on testicular function and fertility and helped to manage them.”

·        Toxins And Endocrine Disruptors

This is common knowledge that our planet is becoming a huge bin of litter – what with the omnipresent chemicals, pollution, toxins, contaminants and poisons. The makeup we use contains these hidden toxins. The plastic containers we microwave are rich in Teflon chemicals that can disrupt the delicate hormonal balance.

It has always been speculated that some of these toxins are basically endocrine disrupting chemicals (EDCs) and affect our hormonal balance.

EDCs Include:

  • Bisphenol – a chemical that lines food cans made of tin
  • Phthalates – used in cosmetics and plastic food containers
  • Polybrominated diphenyl ethers (PBDEs) – found in flame retardants. Flame retardants are chemicals added to furniture and packaging to reduce the risk of catching fire.
  • Pesticides – such as organophosphates and chlorpyrifos

EDCs mimic your body’s natural sex steroid hormones, and therefore interfere with the function of these hormones.

A 2012 European Environment Agency review has found that endocrine disrupting chemicals are present ubiquitously in cosmetics, pharmaceutical products and food and have the potential to upset the hormonal equilibrium in our bodies. EDCs can lead to:

  • Diabetes Mellitus
  • Obesity
  • Infertility
  • Cancer

A recent Lancet study by Dr. Leonardo Transade and colleagues, of Department of Pediatrics, New York University, USA, says that routine contact with plastic bottles, toys, flame retardants, and food cans, results in ingestion leading to a toxic EDC buildup that can transpire into a variety of hormonal complications, one of which is infertility in both men and women.

How To Reduce Effects of EDCs

To ward off the threat, Transande suggests, you should:

  • Eat organic food
  • Avoid using pesticides
  • Avoid consuming aluminum-can food
  • Avoid microwaving and machine-dishwashing plastic containers

Transade also suggests you “air out” your house every 2-3 days to remove chemical dust from chemicals and other materials.

  • Other Reasons For Hormonal Imbalance Are:
  • Hypopituitarism
  • Perimenopause
  • Anorexia nervosa
  • Extreme exercise or training
  • Hypopituitarism:

    Infection, injury or tumor of pituitary gland may result in pituitary insufficiency.

  • PerimenopauseA decline in estrogen levels before actual menopause occurs. Perimenopause symptoms include irregular periods, hot flashes, vaginal dryness and loss of libido. Some foods can help in reducing unwanted symptoms of menopause or even delay it. These include:
  • Legumes – soybeans, pulses
  • Fibers – cereal, beans, brans, sesame seeds, flax, cabbage, broccoli, strawberries and apricot.
  • Alfalfa and clover sprouts
  • Seeds – Fenugreek, fennel seeds, soy seeds
  • Anorexia Nervosa: Women with low body fat such as those who suffer from anorexia or are fashion models may not produce sufficient sex hormones and suffer from menstruation cessation.
  • Extreme Exercise Or Training:

    Constant stress of strenuous training – called psychogenetic stressor– prevents hypothalamus from stimulating pituitary gland. When this happens, FSH is either not produced or if it does, the quantity is too low to stimulate ovaries. As a result, periods either become irregular or absent in female athletes. This is called Athletic Amenorrhea.

Athletic Amenorrhea

Athletic women are at a risk of developing ovarian dysfunction as a result of hormonal stress. Furthermore, Female Athlete Triad (FAT) is relatively common among female athletes. FAT reflects three functional abnormalities in athletic women – menstrual dysfunction, low energy availability and decreased bone mineral density.

Extreme exercise can elicit athletic amenorrhea and FAT among female athletes by causing chronic metabolic stress. Such women have increased energy expenditure but lower, insufficient or imbalanced nutrient intake.

However, researchers from University of Granada found that female athletes playing volleyball and other sports can avoid athletic amenorrhea and maintain a hormonal balance by adopting healthy lifestyle and eating habits.

Who Is At Risk of Hormonal Imbalance?

If you have any or are exposed to any of the conditions mentioned above, you are at an increased risk of hormonal imbalance. Other risk factors in men and women include:

  • Smoking
  • Stress and Depression
  • Weight gain
  • Diabetes
  • Unhealthy lifestyle
  • Pregnancy
  • Menopause
  • Puberty
  • Puberty: Girls that have just hit the puberty undergo recurring bleeding episodes called menstrual cycle. Every month, their hormones surge and drop, which can either trigger or worsen hormonal imbalance.
  • Menopause

  • Pregnancy: During the nine months, a woman’s body undergoes a hormonal rush. A little disturbance, be it emotional or physical, can disturb the hormonal balance.
  • Unhealthy Lifestyle And Habits: Such as lack of exercise, poor diet and improper sleep. Living a life that is out of balance damages your hormones and overall health. It lowers level of progesterone which is essential for women to work properly and effectively.
  • Diabetes: Women with PCOS are at a heightened risk of diabetes in later years of life. If they conceive, they develop gestational diabetes in most of the cases.
  • Weight Gain: Over weight and obese individuals have more fat where cancer-causing toxins accumulate. Fat cells also contain an enzyme called aromatase which converts testosterone into estrogen. The more estrogen produced in your breast tissue (estrogen dominance), the more your chances of developing breast cancer. Estrogen that is not sufficiently balanced with progesterone is the biggest risk factor for breast cancer in women.
  • Stress And Depression: A great number of people suffering from depression have messed up hormones despite having healthy glands. The hormonal irregularities, in return, may be related to further aggravation of depressive symptoms.
  • Smoking: Both active and passive smoking has been linked to hormonal imbalance and infertility. Smoking can even hasten a menopause by 1-2 years in women younger than 50 years, says a large study published in BMJ.

If you are a smoker, you are at 14% increased risk of infertility and 26% increased risk of menopause, than a never smoker.

Your endocrine system is like a thermostat – it keeps hormonal levels from becoming too high or too low through a delicate process of feedback mechanism. Changes in brain chemistry, as happens in depression (where levels of serotonin – an excitatory neurotransmitter – that is mainly related to mood and well-being, are low), can alter endocrine system which is closely intertwined with the hypothalamus.

People who are depressed are prone to developing endocrinal disorder. Vice versa, people who have endocrinal disorders are likely to be depressed.

What Are The Potential Complications of Hormonal Imbalance?

As mentioned earlier, your body needs the delicate natural balance of hormones and chemicals in order to work effectively and stay healthy. Hormonal imbalance, common as it may be, is not natural. If the balance is not managed, it puts you in the front row of many chronic conditions.

Some of the conditions affect women; others affect men. Mostly though, hormonal imbalance affects reproduction in both men and women.

  • Hormonal Imbalance Complications In Both Men & Women

Complications of hormonal imbalance affecting both men and women include:

  • Infertility
  • Diabetes
  • Heart Disease
  • Cancer
  • Osteoporosis
  • Anxiety & Depression

 

  • Infertility

Inability to get pregnant despite trying is the biggest challenge women with PCOS and POF face, although pregnancy is possible through effective treatment in PCOS. In POF, however, the only option to conceive in through IVF.

A 2013 study by researchers from Karolinska University Hospital, Sweden, found that risks of adverse pregnancy outcomes are high in women with PCOS who conceive through assisted reproductive technology, particularly if they are obese.

  • Diabetes

Women with PCOS are at a heightened risk of diabetes in later years of life. If they conceive, they develop gestational diabetes in most of the cases.

  • Heart Diseases

Because obesity is coupled with PCOS, it can lead to diabetes which in return is one of the biggest risk factors for heart disease. It’s a vicious cycle. Weight loss and treatment can reduce the risk for this condition. Estrogen deficiency, too, can lead to heart diseases.

  • Endometrial And Prostate Cancer

If a woman does not ovulate regularly, the lining of her uterus, called endometrium – which keeps building every month – does not shed properly. It can result in overgrowth called endometrial hyperplasia which can lead to endometrial cancer.

Evidence suggests that lower testosterone and higher estrogen level push men towards prostate cancer. Hsing AW and co, of National Cancer Institute, Bethesda, report complex interactions between androgen metabolism and risk of various types of cancer, one of which is prostate. Androgens are essential in the normal development, differentiation and proliferation of prostatic tissue.

  • Anxiety And Depression

PCOS and POF led infertility to make many women anxious and depressed. Male hypogonadism, too, is emotionally devastating and falls heavy on men and their mental health.

  • Osteoporosis

POF and hypogonadism increase risk of osteoporosis in men and women. Estrogen helps in maintaining bone strength. Women with estrogen deficiency, such as those with POF, are at an increased risk of developing weak and brittle bones. Brittle bones have an easy breakability.

Hormonal Imbalance Complications Affecting Women

In addition to the complications mentioned above, hormonal imbalance can give women:

  • Miscarriage
  • Sleep apnea
  • Psychological disorders, such as dementia

Miscarriage: Hormonal imbalance almost always leads to high-risk pregnancy, if pregnancy occurs at all. If you become pregnant, you will be referred to specialist to provide extra monitoring throughout nine months.

Sleep Apnea: As per uptodate.com, about 50% of women with PCOS have sleep apnea. Sleep apnea is a condition where you breathing stops repeatedly during sleep. It’s little understood why women with PCOS experience sleep apnea. However, there is evidence that sleep apnea can increase risk of insulin resistance, diabetes, heart disease, and stroke. Sleep study can help diagnose the condition. Several treatments are available.

Dementia: Estrogen deficiency has also been linked to dementia in some patients.

Hormonal Imbalance Complications Affecting Men

Gynecomastia: Men with hormonal imbalance can develop enlarge breasts at any stage in life. The condition often goes on its own but for cases that persist, effective treatment is available.

Data shows that up to 70% of boys in early to mid-puberty experience gynecomastia due to hormonal surge. Gynecomastia is also common in middle-aged and older men and accounts for 65% of the cases.

  • Pubertal gynecomastia develops between 10-12 years of age and accounts for: 25% of cases. It usually resolves on its own within six months to two years.
  • Drugs (such as spironolactone, ketoconazole (antifungal) or H2 receptor blockers – cimetidine, ranitidine): 10-20%
  • Unknown causes: 25%

It happens when glandular tissue in breasts becomes enlarged resulting in discomfort and nipple tenderness.

  How Is Hormonal Imbalance Diagnosed?

Despite visible symptoms giving away the underlying medical condition, the hormonal imbalance needs proper diagnosis in both men and women. Only then the healthcare provider you the personalized treatment and management.

Tests vary with the gender and include:

  • Tests Required In Females

The diagnosis typical begins by taking a complete medical history and performing a pelvic and physical examination.

During a pelvic exam, your doctor checks your ovaries for swelling, cysts and tumor. Your doctor may also order a vaginal ultrasound.

The doctor will then run blood tests to measure the levels of estrogen, progesterone, FSH, LH and androgens. The table below shows the normal level of these hormones in both males and females.

Lab results indicate whether you have PCOS or POF. Further diagnostic tests are linked with your condition:

  • PCOS
  • POF
  • PCOS – Expert groups believe that women must meet two of the following three criteria to be diagnosed with PCOS
  • Polycystic ovaries on pelvic ultrasound
  • Irregular menstrual periods
  • Elevated androgen levels; including blood tests and symptoms such as hirsutism, acne, or male-pattern balding).

If PCOS is confirmed, blood glucose (oral glucose tolerance test) and cholesterol levels are checked.

  • POI: is usually diagnosed with the help of physical examination, medical history and an array of tests including blood tests (FSH, estradiol, prolactin), karyotyping and FMR1 gene testing.

FSH levels are almost always high in women with POI. High levels of FSH indicate that your pituitary gland is continuously stimulating ovaries to produce and mature an egg but the ovaries are not responding. Ovaries respond by releasing estrogen which lowers FHS level through a feedback mechanism. If FSH level is confirmedly elevated, your doctor will order further tests.

Karyotyping examines all 46 chromosomes for abnormalities. Whereas FMR1 examines both X chromosomes to make sure they are normal.

Because POI can be due to autoimmune diseases, the doctor may also order a test for autoantibodies against adrenal glands to determine whether you have ovarian autoimmunity.

  • Tests Required In Males

Male Hypogonadism: is diagnosed based on physical examination and blood tests. Blood tests are usually preferred early in the day when testosterone level is highest – before 10 AM.

If tests confirm that testosterone level is low, further diagnostic tests, including hormone testing, semen analysis, testicular biopsy, pituitary imaging and genetic studies are carried out.

Iron levels can also affect sex hormones. The doctor may also want to check whether you have anemia. Likewise, thyroid problems can also hint reproductive problems. Your doctor may also want to check your prolactin level. Prolactin is a hormone that develops breasts and secretes milk in women but this hormone is also present in minute quantities in men.

  • Diagnostic Test That May Be Required In Both Gender:

    If the doctor suspects you have a tumor in pituitary gland, ovaries or testes, he or she may order an MRI or a CT scan.

    How Is Hormonal Imbalance Treated?

Depending upon the underlying cause, there are several treatments available for hormonal imbalances. Your doctor will begin by:

  • Encouraging you to bring lifestyle changes. Research has shown that tweaking habits and lifestyle improves hormonal balance in many individuals. Who knows you may be one.
  • Prescribing medicines
  • Few non surgical and surgical interventions

Co Author : Saira Zulfiqar

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