I have just completed a letter to a friend's physician discussing the issue of hormone levels and what constitutes "normal." Sigh... I keep fighting the same battle over and over again.

As I explained to my friend's doctor, nobody in their right minds would tell us it's normal for a car's oil to run dangerously low after 20,000 miles, so you shouldn't replace it, or if you do replace it, just add a tiny fraction of what the engine needs to run properly. Yet that's exactly what the medical establishment tells us about our sex hormones...which, by the way, are about a whole lot more than sex. They keep our brains, hearts, bones and muscles (among other sexy bits) healthy and vibrant.

If we're talking about dull, boring hormones like cortisol, thyroid, or insulin, the answer to deficiencies is almost always to supplement the hormone until it reaches an ideal or optimal level and your body once again is operating the way it's supposed to. But when it comes to the sex hormones, the medical community behaves as if we were talking about recreational drugs, rather than substances our bodies were designed to run on.

The first place we get into trouble is with the definition of "normal." We typically get some kind of test, perhaps a blood test or a saliva test. The results come back and the lab flags any values that were either above or below their "reference values" as being abnormal. So that implies that anything within the reference range is normal.

But how do they determine the reference range? They test a bunch of presumed healthy people and set the highest and lowest scores as the top and bottom of the reference range. 

This seems like a reasonable thing to do, until you get into the touchy subject of sex hormones. And then the labs add a little twist: they set their reference ranges according to a bunch of "healthy" people in your age group. What that does is reset the numbers to show what's normal for people your age. But what if "at your age" most people are deficient in that hormone? Now the lab test is telling you that it's normal to be deficient. 

That's exactly what happens with hormones like estrogen, testosterone and progesterone. 

But even if they include all age ranges, they are still going to show that it's "normal" for some otherwise healthy folks to be at the bottom of the tank sucking fumes.

So when my friend's doctor told him his testosterone levels were good, he was comparing them to the reference values for men over 65...which are virtually always deficient! Instead he should be comparing them to the optimal values for the healthiest men in their prime.

What's equally important is the question of what's normal for you...or rather what's optimal for you.  In a perfect world, we should all have our hormones tested at various times in our lives, especially when we are at our healthiest, so we know what our body's chemistry looks like when we feel our best. Then as we get older, we can use those levels as benchmarks to know what we need to get back to.

But even that may be misleading, because, for example, research shows that the average testosterone levels in men of all ages have declined over the past few decades, presumably because of all the estrogen-like substances in our food supply and environment. So even at your youthful best your hormones may have been low or imbalanced.

Which brings us back to defining optimal ranges, and that may take a certain amount of art as well as skill to determine.  

The bottom line is that if you want to restore your body's chemistry to optimal levels, seek out a doctor who understands what that means and is willing to deviate from standard practice...in a responsible way...to get you back to where you need to be, both objectively and subjectively. And if you already have a doctor you really like and trust, encourage him/her to think outside the box. Perhaps print out this article for your next office visit. 

Life is too short to do things half way.  

You may be curious as to why I included certain physical conditions and a birth control hormone product in a post about hormone-related moods. Actually I hadn't planned on it, but as I thought about the subject--and my own experiences with it--I realized these things can all be related.

Despite what you might hear or read, high testosterone levels can fuel anger and sometimes rage. Or perhaps, like everything else, it may be more appropriate to assume this is about testosterone that is out of balance with the other hormones. I don't think we can say for sure at the moment, because to my knowlege nobody's researching the effects of hormone imbalances on moods.

When I was younger (before menopause), I had a terrible temper and I hated it. When my hormones went south during perimenopause, all my passions went away...including my anger. What's most important here is that when I tried supplementing testosterone, I did indeed get my creativity and passions back, including anger. I can remember the exact moment the testosterone kicked in: I was driving home when suddenly I felt what I used to call "ambient anger" (which I'd felt virtually all the time) suddenly come over me. Anger that was there for no reason at all...which I constantly had to fight to keep under control.

When I was even younger, and when all my passions were in high gear, I also had bouts with ovarian cysts. The condition is now called PCOS, or polycystic ovary syndrome. This too can be a symptom of excess (or unbalanced) testosterone.

And here are the last few pieces of the puzzle: I had seen ads on TV for the birth control pill called Yaz (or Yasmin). It claims to help not only prevent pregnancy but also reduce PMDD (premenstrual dysphoric disorder, or really bad PMS) and mild acne. Well guess what: high (or imbalanced?) testosterone is associated with acne and bad moods. If Yaz reduces PMDD and acne, maybe it does so by reducing testosterone (or increasing the offsetting levels of progesterone and/or estrogen).

And the last piece of the puzzle: The ads warn that those taking Yaz may end up with excessive potassium levels...which can cause leg cramps. Most online sources attribute this effect to the fake progesterone, drospirenone, in Yaz. And that may indeed be best place to attach the blame. However, I suspect it is less about the fake progesterone and more about how Yaz (and its fake progesterone) effects testosterone levels in your body. But since nobody's studying the connection, we don't know.

What I do know is that in using the exact same amounts of progesterone and estrogen every month as I've used for some 7 years, once I changed my hormone regimen to apply my estrogen in a spike once every 2 weeks, suddenly my testosterone levels went up on their own. I got some of my passions back...AND I started getting foot and leg cramps (the way I did when I was younger and passionate and angry and had bad acne).  The T wasn't terribly high and I didn't get angry or break out in zits all over, but the cramps have now become a regular part of my "cycles."

As it happens, when my cramps occur I can take a potassium supplement and the cramps subside. So you may be wondering how I connect my increasing testosterone levels with muscle cramps that seem to be caused by LOW potassium, when I've just said that Yaz may cause HIGH potassium levels that cause muscle cramps.  Well, as it turns out, potassium, like other electrolytes in your body, needs to be within a certain optimal range. Too high OR too low can cause many of the same symptoms, including muscle cramps. 

Bottom line: If you are young and still ovulating and have a bad temper and acne (and possibly leg/foot cramps), you may have too much testosterone and could be at risk for PCOS. To resolve this problem, you can try a product like Yaz if you need birth control anyway.  However, be aware that Yaz (and any other birth control hormones) can have their own side effects, including risk of blood clots and varying effects on your moods.
 
I hope that one day, doctors may be more knowledgeable about the impact of varying hormone balances and will be able to manage those balances to keep them in their optimal ranges. Until then, at least know you are not alone....