Wrapping It Up: Hormones and Vaginal/Sexual Health
No self-respecting discussion about vaginal health and sexual health would be complete without saying more about steroid hormones to finish off the discussion. To recap, last month I started off talking about non-hormonal approaches to vaginal health, strengthening the pelvic floor, restoring neuromuscular pathways and stimulating circulation and collagen formation in the vulvovaginal tissues. In the last part of the month, I discussed the role of nitric oxide (NO) in erectile responses and improving circulation to the genitalia. I touched on steroid hormones by mentioning that the hormone estradiol plays a part in maintaining the blood supply to vaginal mucosa with a direct beneficial effect on the architecture of the tiny vessels in the vaginal mucosa and through supporting formation of NO, which keeps those vessels open for business.
The main thing that needs to be said about steroid hormones and sexual health is that the hormones aren’t a magic bullet specific to sexual function. Can judicious supplementation help restore or improve sexual health? Of course it can. But the same can be said for bone health, mental health, cardiac health, cognitive performance, skin health and so forth.
All the steroid hormones work together in any health context. Sexual health is no exception; we mustn’t look at them in isolation when we talk about sexual health, i.e. testosterone alone may not fix men’s sexual health issues and estradiol alone may not fix women’s sexual health issues.
To understand steroid hormones, we need to understand their network. I’ll talk more about steroids in a minute but I first want to talk about networks, in general, using a somewhat crude analogy. It’s not perfect but I think it works.
Here’s the list of free oxytocin-boosting strategies:
Consider this old flight map for one of the major commercial airlines. There’s redundancy and resiliency in that there are many ways to get from Point A to Point B because of the cross-connectivity. There’s constant communication between airports so If a plane is unable to take off or land at one location, this information can ripple through the network but it is generally dealt with fairly seamlessly.
Networks have hubs which are nodes that have a large number of connections. The hub airports are dense spots on the diagram where the lines converge. In the steroid hormone network. I like to think of the principal steroids as the hubs. If too many of those hubs fail, the network will crash, just as the commercial air transport network will fail if too many airports close.
If the main source of a hormone, such as the ovaries or testicles “dries up” there might be some backup contribution from another hormone. But if multiple hormone “wells” go dry, there’s trouble: not enough “backup.”
In the diagram above, pregnenolone (green oval) can be considered the parent of all the other steroids. DHEA, progesterone and testosterone (purple ovals) are fertile direct descendants that can spawn various other hormones farther down the paths, as you can see by the arrows. The hormones in the red ovals are less versatile in that they don’t convert to any other principal hormones.
In the specific instances where only one hormone “airport” shuts down, there might be partial compensation from elsewhere in the network:
If you’re female and your ovaries stop making estradiol, you might be able to compensate to some extent by making estradiol from DHEA (see diagram). Similarly, a male whose testicles stop making testosterone might get some testosterone from DHEA. Supplementation with DHEA might help these people.
If the adrenal glands aren’t making enough cortisol, supplementation with progesterone might help raise it, per the pathway on the diagram. Years ago, when I was a Family Doc, I gave topical progesterone to many, many women and they commonly reported more energy and a stronger sex drive as well.
There’s a bit of an art to managing hormones. I’ve often said it’s like making soup. You might need to layer in hormones bit by bit, tasting the “soup” as you go and an experienced Integrative Medicine practitioner is able to do that with you.
So. What things could take down the steroid network?
One is statin drugs. If you’re on a statin drug which has been aggressively dosed to pummel your LDL deeply into submission, there’s a good chance you’re going to be feeling poorly as you will be unable to make adequate amounts of the principal steroids. Ditto if you eat little fat and no sugar, you will lack the substrates needed to enough cholesterol to make steroids.
A lack of thyroid hormone can slow down everything. Thyroid hormone equals energy generation and if you don’t have enough energy, you won’t make steroid hormones. There’s no “gas” to make them do their work.
Toxins from environmental pollutants and molds can interfere with the enzymes that interconvert hormones. Prescription medications besides statins can also interfere with hormones, sometimes hogging the enzymes that interconvert the steroids or disabling them. If a woman is on a drug to block the conversion of testosterone to estradiol, often the case in the treatment of breast cancer, her estradiol may drop too low, as estradiol is made in the ovaries and fatty tissue from testosterone.
The other major recipe for overall poor hormone status is inflammation which can arise from nutrient deficiencies, food allergies/leaky gut, excess consumption of troublemakers like linoleic acid (Omega-6), trans fats, fructose and good old white sugar.
I maintain that if sexual health is an issue for you, you need to take a larger view. It’s rare that vaginal dryness or poor erections take place in the complete absence of other problems. What is your overall health? You need to look at your diet, your sleep, your exercise, your cardiovascular health. I talked about this recently, citing the impact of cardiovascular disease on people’s satisfaction with their sex lives.
The best way to get a picture of the hormone network is to do a urine hormone test which typically looks at 20 or more st
eroid hormones.
You also need to assess inflammation, thyroid status, nutrient status. For example, there is a specific test used at EvolveWell called OmegaQuant that can assess several dozen key fats in your body (Omega-6 fats, Omega-3 fats, trans fats, saturated fats) via a dried blood sample obtained by a fingerstick. This is a key test to uncover one cause of inflammation: too little Omega-3 fats relative to the Omega-6 fats.
And this is a great product to restore that balance if the Omega-6 fats are found to be low:
Long story short, dropping estrogen or testosterone into the picture without careful consideration isn’t your answer to better sexual health.
An experienced Integrative Health practitioner can look at the hormone network, see what pieces are missing, look at all the “air traffic” and determine what will be the best way to keep those hormone planes in the air.
Author: George Gillson, MD, PHD, CCFP
EvolveWell Medical Director