What's Happening?

Launching soon: Progress Your Hormones Community

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I always refer to us ladies as a symphony of hormones. We have A LOT of instruments playing, and when one (or more) are out of tune, well, we know what happens to the music.

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Men are different; they have one instrument in their orchestra LOL. But we ladies are complicated (so worth it), and when out of harmony, everything just feels off.

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That is why we are launching our 'Progress Your Hormones' Community in August (fingers crossed, early August).

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It is not a Facebook group or a bunch of people with no face, lots of opinions, or a lack of leadership. I am going to be the moderator. It is a place where you can connect with others, but also learn everything about hormones. Whether it's education/webinars/live office hours on genetics (partly my article below <3), hormonal hotseat, lab testing, HRT, perimenopausal and menopausal symptoms, or even your own personal questions, it is a safe space made for you.

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This is new, so as a founding member, we are all going to grow together, creating something meaningful, empowering women’s health to take the front seat, where it belongs.

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The founding group is going to be small and we are limiting the #, then closing new access.

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Only because I want to build the foundation with vibrant energy from thoughtful women who are ready to deep dive into hormones and health, creating an amazing space for us all.

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Founder’s waitlist

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Dr Valorie

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I do not have AI write my articles.

Who doesn’t love ChatGPT? I asked ChatGPT to write me a country song about Costco. And to take the song called Girls, Girls, Girls by Motley Crew, but call it Carbs, Carbs, Carbs. I’m still laughing.

But ChatGPT doesn’t write for me. I am sure that might be an easy, quick way to create articles, and more power to anyone who does it. But I don’t. I do use Grammarly when I have the patience (which is not often). So this is me in all my bad grammar and run-on sentences. Thank you for reading.

- Xo DrValorie

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Gene’s Gone Wilder - Genes-A-Blazin!:

How Your Genetics Influence Your HRT Results and Risk

When it comes to HRT, there is no one-size-fits-all. I have found after working with women for over 20 years for peri and menopause, that everyone is unique in what doses and types of HRT work for them.

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Some women respond perfectly within weeks of implementing HRT, such as estradiol, estriol, and progesterone. They are sleeping better, their brain is back, their mood is lifted, and hot flashes have vanished.

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HRT can be amazing for our mood, hair and skin, waistline, memory, sleep, libido, clarity, and focus. Not to mention helping prevent metabolic and chronic diseases, such as heart, brain, and bone health issues.

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But some women feel like garbage when starting HRT, struggling with even more weight gain, acne, swollen, tender breasts, bleeding, puffiness/water retention, and extremely moody/emotional. They can become discouraged, thinking they are not candidates for HRT. Then, spend a considerable amount of time trying different types, doses, and ratios of HRT to find the right combination for them.

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Plus, while hormones like estrogen do not cause cancer, they can exacerbate cancer. And everyone is worried about cancer, especially breast cancer. This makes women worried about what would happen should they get cancer, and should they even take HRT. Well, like I said, estrogen does not cause cancer.

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But our genes can tell us about how we respond to HRT, and whether our hormones could push us toward an increased risk of breast and reproductive cancers. And most importantly, how can we decrease the risk and improve our response to HRT?

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Our Genes Can Tell Us:

• How could we respond to HRT
• If HRT or our own hormones are increasing our risk for cancer
• How can we help decrease our risk of estrogen-sensitive cancers
• How can we improve our response to HRT

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Now there is so much to genetics, so much more than I can put in my way-too-lengthy articles. But for this article, I am going to introduce three genes that influence how we make estrogen and how our bodies process that estrogen in either a good way or a not-so-good way. I promise not to bore you. The fascinating part is that we can have control over our genes. That is when we know what genes we have.

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So, if any of you have a genetic report or one of the classics, like 23andMe, pull it out. However, use the old-school 23andMe, because the more recent versions have removed many snips and genes related to hormones.

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Now, many genes influence nearly everything, and I cannot go into them all. But this article, these are the genes I want you to meet:

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• CYP 17A1: How much estrogen do I make?
• CYP 1A1: Does my estrogen follow a protective pathway?
• CYP 1B1: Is my estrogen going down a risky route?

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Estrogen Metabolites:

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Let me take a step back and introduce you to our estrogen metabolites. You need to be aware of these metabolites to understand what our genes are doing.

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This is important because it will tell us more about:

• Your response to HRT,
• Why we feel crummy in perimenopause from our own hormones
• Your potential risk for breast, uterine, estrogen-sensitive cancers (from HRT or even our own hormones).

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Glinda the Good Witch:

2-OH estrogen is our Glinda. She is protective against breast, uterine, and other estrogen-sensitive cancers. And more of her means less of those wicked perimenopausal and menopausal symptoms.

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Elphaba the Wicked Witch:

While misunderstood, Elphaba is our 4-OH estrogen, and in our bodies, it can be truly wicked for increasing the risk of breast and estrogen-related cancers. Not to mention more Elphaba, I mean 4-OH estrogen, means more hormonal symptoms. Think, poor sleep, hot flashes, night sweats, PCOS, fibroids, cysts.

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Our goal here is to direct our estrogen to become metabolized into 2-OH estrogen and less to 4-OH estrogen. This is where your genes come in. Your genes will tell us which direction your estrogen is metabolizing to.

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Back to Our Players:

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• CYP 17A1: How much estrogen do I make?
• CYP 1A1: Does my estrogen follow a protective pathway?
• CYP 1B1: Is my estrogen going down a risky route?

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When you examine a genetic report, you will see the name of the gene and two letters; these represent your alleles.

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Now, can I complicate it more for you? The letters are part of the SNP (single-nucleotide polymorphism) that is on the gene. Basically, there is the gene, the location of the SNP (called ‘snip’), and your genotype of the SNP, which is two letters.

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You receive one letter from Mom and the other from Dad. This is where genetics is tricky; you didn’t ask for the SNPs, you were just handed them. Now our job is to either work with your SNP/genotype to make it work for you.

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Genes are just a blueprint. Later, I will show you how to increase your 2-OH estrogen and decrease your 4-OH to help decrease the risk of cancer and better respond to your HRT.

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Now the letters on your SNP can be ‘normal/wild-type’ or ‘variant’. Normal is more common and usually more beneficial. But not in all cases is being normal better. I will further explain this when we get to CYP 1A1.

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CYP 17A1: How Much Estrogen Do I Make?

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Gene: CYP 17A1

SNP: rs6162

Allele combinations: AA, AG, GG

A= normal allele: A is the normal allele.

G = variant allele: Variant is a nice name for something different or not as common. In this case, the G allele will increase the enzymatic activity of this gene, resulting in higher overall estrogen production levels. A person with a GG genotype is likely to have a high level of estrogen. And a person with an AG is going to have increased estrogen production, but more so between the AA and GG. But anyone with a G allele for the CYP17A1 can have a higher risk for:

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• PCOS
• Infertility
• Estrogen tissue-sensitive cancers
• Increased menopausal symptoms (when that estrogen goes from high, high to low, low)

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CYP 1A1: Going with Glinda–moving toward the protective 2-OH estrogen.

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Gene: CYP 1A1

SNP: rs260345

Allele combinations: AA, AC, CC

This is the case where you do not want the ‘normal’ type (A). The A-allele has less enzymatic activity. Less enzymatic activity means less good-Glinda, AKA, less 2-OH estrogen.

If you have one or two A alleles, that means you are making less protective 2-OH estrogen. Hence, you will be making more ‘bad’ 4-OH estrogen.

Or to make a long story short, you need to be careful taking HRT if you have AC and especially if you have AA. Because that estradiol HRT could be increasing your chances of cancer, and could be why you are feeling crummy on it anyway.

The C allele will help upregulate enzymatic activity to increase our ‘good’ 2-OH estrogen. That means redirecting your estrogen into the ‘better/positive/good girl Glinda’ metabolite 2-OH rather than the bad girl 4-OH estrogen. Better reaction to HRT and less risk.

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CYP 1B1: Good Girl Gone Bad: Heading in the wrong direction, 4-OH estrogen

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Gene: CYP 1B1

SNP: rs1056836

Allele combinations: CC, CG, GG

C is the normal allele. Meaning there is less enzymatic activity, resulting in less conversion of your estrogen into the ‘bad girl’ 4-OH estrogen metabolite.

The G variant can cause high levels of the 4-OH estrogens, which can increase your risk for estrogen tissue cancers, and you could have a negative reaction to HRT. If you carry the G allele variant, you should exercise caution when taking HRT and also take steps to counteract the conversion of our estrogen to the truly wicked estrogen metabolite 4-OH estrogen.

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Want to know what you can do right now to improve your HRT response and reduce cancer risk? Let’s dive deeper into each gene—plus actionable solutions you can start today.

Upgrade to the full newsletter here and get the rest of the story.

Simon Says:

Slow Down. The finish line isn’t going anywhere. Breath, stretch, rest and take a nap if you want. But only because you want to not because you have to

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What Labs to Check for Hair Thinning

Part 3 of a 3-part series on hair

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Part 3: What Labs to Check for Hair Thinning

This article is part three of a three-part series about hair thinning and shedding.

Part 1: Perimenopause and hair thinning (newsletter #7)

Part 2: Menopause and Hair Loss (newsletter #8)

Part 3: Lab Tests for Hair Loss (newsletter #9, this one)

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What Labs to Check for Hair Thinning

Hair thinning? Ponytail shrinking? Let’s not guess, let’s test.

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Hair is a tough one for us gals. For those of you who know me, I know you don't feel sorry for me because I have a lot of hair. Genetics? Good Luck? HRT? Maybe. I learned that Asian women can have their hair in the growth (anaphase) for up to 7 years. I know my Asian girls are rolling their eyes and saying, Um, that's not me. It wasn’t until I hit menopause.

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Menopause can really mess with your hair. Mix low hormones, lack of sleep, and sprinkle some stress, and there you have it, hair everywhere except your head.

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Now my peri-gals are like, what about me? Perimenopause can also be a time for, instead of it raining men, it’s raining HAIR!

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Now we cannot just blame hormones for everything from hair to climate change. I only say that bc it is like 80 degrees here in Washington, so it’s a HOT day! Yeah Yeah, my Vegas girls are laughing at me, because we all know Vegas in July.

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Anyway, my point is that there is more to hair loss than just our estrogen and progesterone. So let’s get to the hormones and lab testing that I like to run for hair loss/thinning. I will focus on blood testing because it is one of the most easily accessible tests for most women. However, saliva and urine are excellent tests for hormones. But, blood testing can be useful for a deeper dive into other factors causing hair loss, such as inflammation, iron storage, autoimmune conditions, and adrenal function.

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Unfortunately, the lab reference ranges for blood work are incredibly vast. Even if you are normal, you may not be ‘normal’ when it comes to hair thinning and loss.

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So let’s get to the tests! I am going to give you the tests that I like to check for hair loss. Then I will delve into what each means and where you want to be in terms of the reference level.

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When a patient tells me their hair is falling out, here’s what I check

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Hormones:

• Estradiol
• Progesterone
• FSH & LH (follicular stimulating hormone and luteinizing hormone)
• Total and Free Testosterone
• DHT
• DHEA-S
• SHG (sex hormone binding globulin)
• Prolactin
• Cortisol

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Thyroid panel:

• TSH
• Free T4
• Free T3
• Thyroid peroxidase antibodies
• Thyroglobulin antibodies
• Reverse T3

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Minerals and vitamins I find useful to look at:

• Iron panel
• Ferritin (Iron storage)
• Zinc
• Magnesium
• B12
• Vitamin D3
• Homocysteine

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Inflammation:

• CRP (c-reactive protein) or hsCRP (highly sensitive c-reactive protein)
• SED rate/ESR (Erythrocyte sedimentation rate)

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ANA testing for connective tissue conditions, such as Sjögren’s syndrome.

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Want to go deeper? Inside the complete guide, I walk you through what your lab results mean, as the typical reference ranges can be vast. So you might fall into what is considered 'normal', but it is not, when it comes to hair loss.

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Now that you have the tests. Let’s look at what each test means and what reference range you want to be in.

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→ Subscribe to the full version of the newsletter to read the rest.​

Well, it's summer, and that is when I start to hear about increased hot flashes and night sweats. Something about the change in seasons and the onset of hot weather can trigger an increase in hot flashes. However, there are other variables at play. Last week, it was warm, very warm here in Western Washington. It was 80 degrees. Now all my readers/friends/patients in the Southwest are laughing, because they are in the 100s. But here, 80 degrees is hot.

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So last week I woke up at about 3 am, and my legs were sweating, and the back of my hair was a little wet. I was really hot.

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Just to back up. When I went through menopause about 1.5 - 2 years ago, I didn’t get hot flashes. I can count on one hand how many hot flashes I had. Now I missed many periods, which actually were kinda nice, but not really hot flashes or night sweats. And I started rhythmic dosing HRT to mimic an ovarian cycle. Yes, now I get a period…every 26-28 days. Which is fine bc it’s pretty short and easy, but it was fun not to have one.

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So I wake up in the middle of the night, I’m hot, my legs are sweating, my hair is damp (and frizzy now). I start thinking why have the hot flashes started now, even though I am on HRT?

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But this can happen, women will contact me right around early summer when their hot flashes are back. I am not sure why this is physiologically. It has to do with the hypothalamus, our internal thermostat, and cortisol.

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Needless to say, it is not fun to wake up all sweaty in the middle of the night.

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But then I realized, I turned off the AC (bc who really needs AC in the Pacific Northwest aka: Val being cheap), it’s July in Washington (aka: hot), and it’s a down-comforter. So, before thinking it's my hormones/HRT, I should have thought about sleep hygiene.

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Thank you for reading,
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- DrValorie

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