Could Hormones be the Cause of Your Fatigue Symptoms?

By Susan E. Sklar, M.D.
Fatigue symptoms are one of the most common things I hear from patients at the Sklar Center. They say, “I don’t have the energy to do the things I want to do,” or, “I just don’t have the oomph I used to.”

Many people notice a mid-afternoon energy dip or crash as their fatigue symptom.  Some people tell me they don’t feel rejuvenated even after a full night’s sleep.  That’s another fatigue symptom. In this article, I will explain a bit about hormones and their link to fatigue symptoms.

Conventional Medical System Approach to Fatigue Symptoms

The most frustrating thing for people is their interaction with the conventional medical system. When a patient complains of fatigue symptoms, often the approach is different for men than women.  An educational paper for doctors written by the American Association of Family Practice states “men typically say they feel tired, whereas women say they feel depressed or anxious.”[1]  In a very typical scenario for fatigue symptoms, the doctor prescribes an anti-depressant medication to help a woman with her fatigue symptoms. This, of course, hardly helps if she is not depressed. Here are some statistics on fatigue symptoms:

  • They account for 500 million patient visits a year and rarely is a cure found.
  • 38% of US workers and 7-45% of the general population are fatigued.[2]
  • In results of the 2006 NAHANES (National Health and Nutrition Examination Survey), only 20% of respondents in the United States say they feel energetic or fresh.  In fact, 80% feel average, tired, or exhausted.

Hormone Loss Causes Fatigue Symptoms

The one thing most healthcare providers don’t consider is hormone evaluation and restoration for fatigue symptoms.

There are many reasons for hormone decline leading to fatigue symptoms. The first reason is the hormone decline in DHEA, testosterone, and thyroid hormone that occurs with aging.  Another is the loss of hormones with the perimenopause and menopause transitions.

Low thyroid function due to nutritional deficiencies can cause fatigue symptoms at any age, even in young people.  Also, an autoimmune thyroid disease called Hashimoto’s thyroiditis is another cause of fatigue symptoms.

Surgery for removal of the ovaries in women can cause Androgen Insufficiency Syndrome with low sex drive, low motivation, and severe fatigue symptoms.

Stress is another cause of hormone loss with resulting fatigue symptoms.

Hormones are Safe for Relief of Fatigue Symptoms

Replacement and restoration of low hormones relieves fatigue symptoms. Hormones improve energy and vitality but concerns about safety sometimes get in the way.

There are safe ways to take hormones that do not increase risk of cancer and cardiovascular disease.  In fact, we now understand the protective effects of estrogen on heart disease and conditions like Alzheimer’s.

To answer safety questions, you need some background to understand the history of  pharmaceutical  development in the United States. Natural products such as estrogen, progesterone, pregnenolone, DHEA are not patentable.  This means that a drug company cannot patent it and thereby get a corner on the market.  These natural products are available to everyone to use.

For this reason, the pharmaceutical companies were not interested in the development and clinical use of natural hormones. They worked industriously to produce synthetic alternatives that were patentable. These synthetic versions have resulted in widespread risk to patients and untold suffering due to misunderstanding about hormone safety.

Drug Companies Use the Urine of Pregnant Mares

Natural estrogen is not patentable. So, the Wyeth Pharmaceutical Company developed Premarin. Premarin stands for “pregnant mares’ urine”.  Pregnant horses contribute their urine for the purpose of extracting estrogen-like components. Women take these pills made up of these components.

The problems with Premarin use are multiple. First, they contain estrogen that is natural to horses not humans. These estrogens are possibly riskier and more cancer causing.

In addition, women take Premarin in pill form by mouth. In this form, estrogen causes increased risk of blood clotting. This is because the liver must process oral estrogen.  This processing results in increased production of clotting factors. Increased clotting factors result in an increased tendency to have heart attacks and strokes. This showed up in older women in the results of the Women’s Health Initiative, a large study conducted by the National Institutes of Health.[4]

Substituting Provera for Natural Progesterone Causes Cancer

The other, very often prescribed synthetic steroid the pharmaceutical industry developed is Provera. This is a substitute for natural progesterone. Provera has some progesterone-like effects in a woman’s body, but it also has several undesirable effects.

The Women’s Health Initiative clearly showed an increased risk of breast cancer in women who used Provera.[5] The conclusion was that Provera, not Premarin, was the cause of an increased risk of breast cancer.

So, when you ask the question “are hormones safe?”, the answer is “yes”. Although it depends upon the hormones. Bio-identical hormones have a proven safe track record as seen in many studies.

Bio-identical Hormones are Safe for Relief of Fatigue Symptoms

Some doctors say that Bio-identical is a marketing term used to sell hormone products. There is a clear difference between Bio-identical hormones and other types of hormones. Bio-identical means that the hormones are chemically and molecularly identical to the hormones in the human body.

Why is this important? This is important because there is no increased risk with using Bio-identical hormones.

Non-bioidentical hormones are products developed by drug companies in order to patent them and profit by their sales. The non-bioidentical hormones include some naturally occurring horse ones such as Premarin made from pregnant mare’s urine.  There are also some completely synthesized ones such as Provera which does not exist anywhere in nature.

The safest way is to use hormones that are exactly like our own human hormones. Using balanced Bio-identical hormones maintains the benefits while eliminating possible side effects like cancer and heart disease.

So, you can see Bio-identical is far more than a marketing term.

Thyroid is Your Master Energy Regulator 

Your thyroid gland governs your metabolism, which is your body’s equivalent to your car engine. If your engine is sluggish, you move slowly. The speed of your engine affects how your body functions.

Every cell in your body is under the influence of the thyroid gland. The speed of the chemical processes in your body depends on instructions from your thyroid gland.

The less active your thyroid gland, the more sluggish your body. Your energy decreases and you experience fatigue symptoms. You may feel like you are moving slowly and through a very thick liquid because everything is so difficult. The thyroid is the master regulator of your metabolic engine and when it slows down, your body and mind suffer.

Fatigue Symptoms Due to Low Thyroid

When thyroid hormone levels are low, you experience fatigue symptoms. Thyroid hormone levels decrease through adulthood. Production of the two most important thyroid hormones, the active hormone T3 (triiodothyronine) and the precursor hormone T4 (thyroxine) decline with age.

In addition, aging causes lower T3 due to less conversion of the precursor T4 hormone into the active T3 thyroid hormone. This occurs even though blood tests may show normal levels of T4 and TSH (thyroid stimulating hormone), the tests most commonly done to evaluate thyroid.

How does this cause fatigue symptoms?

Every cell in your body depends upon thyroid hormones to regulate energy production. When thyroid hormone levels are less than ideal, your body produces less than energy. Thus, you have fatigue symptoms.

Low thyroid especially affects your brain. A scientific review article about declining thyroid levels and aging states: “Low thyroid function at any age causes brain function to deteriorate because hypothyroidism (low thyroid) prevents the brain from adequately sustaining the energy (glucose)-consuming processes needed for neurotransmission, memory, and other higher brain functions.”[3]

This means that with low thyroid function there is less fuel for your brain.  Your brain is tired and, as a result, your body is tired.

Some causes of thyroid decline can affect people at any age. Nutritional deficiencies of iodine, zinc, and selenium result in less production of your active thyroid hormone, T3.  Unfortunately, our diets are woefully low in these essential minerals.

In addition, stress will decrease the conversion of your inactive thyroid hormone T4 into the active, T3 form.

There are blood tests to detect levels of these important minerals. They are easy to replenish through diet and supplementation. Then your fatigue symptom will improve.

Autoimmune Disease a Cause for Fatigue Symptoms.

Another thing that can strike at any age is autoimmune disease. This means that your body is attacking itself.

Hashimoto’s thyroiditis is an autoimmune disease where your body attacks its own thyroid gland and gradually can destroy it. This results in fatigue symptoms in addition to many others such as weight gain, joint pain and constipation.

It is essential to discover the underlying cause of this autoimmune process. Tests for gluten sensitivity or reactivated Epstein Barr Viral infection will tell if these are the underlying causes.

Once you have the results, treatment can begin. This will calm the autoimmune process and prevent the thyroid gland from deteriorating further. Medications and supplements can also calm the autoimmune process. However, sometimes you will need to take thyroid replacement hormone because the autoimmune process has destroyed so much of the thyroid gland.

DHEA The Master Vitality Hormone Helps Fatigue Symptoms

DHEA is a natural substance produced in the adrenal glands, sex glands, and brain. Blood levels of DHEA decrease progressively from a peak at age 25 to less than 20% of that peak at age 70.  Also, blood levels are typically low in those with chronic diseases, such as cancer, AIDS, and heart disease.

The adrenal gland converts DHEA to other important hormones including testosterone and estrogen.  Some of the reported benefits of DHEA may be due its conversion to these other hormones. 

The testosterone converted from DHEA contributes to the benefits of DHEA in post-menopausal women. One such benefit is relief of fatigue symptoms. One study of adults from 40-70 years old showed a remarkable improvement in physical and psychological wellbeing with use of DHEA 50 mg a day for supplementation.[6]

Another study on Chronic Fatigue Syndrome evaluated the results of women taking DHEA.  Women with low levels at the start had improved symptoms when they took DHEA as a supplement.  They saw improvements in their fatigue symptoms, anxiety, thinking ability, and memory as well as relief of sexual problems.[7]

In women who have adrenal insufficiency, DHEA helps with vitality, fatigue symptoms and sexuality. DHEA supplements restored low hormone levels in these women into the normal range for young women.[8]

Want to know a trick to raise your DHEA level and relieve fatigue symptoms?  Exercise!

Studies show a significant increase in DHEA levels post-exercise. Along with that participants saw a decrease in fatigue symptoms, tension, depression, anger and an increase in positive mood factors. It worked as well in older as in younger adults. They also noted higher DHEA levels correlated with even better the moods in older participants.[9]

Androgen Insufficiency: A Cause of Fatigue Symptoms

Menopausal women and women who have had surgery for removal of their ovaries may develop Androgen Insufficiency Syndrome. The symptoms of this condition are low sex drive, persistent and unexplained fatigue symptoms, a decreased sense of well-being, and blunted motivation.

One common cause is low testosterone. Women whose testosterone blood levels are below the normal range or are in the bottom of the normal range should have treatment with testosterone. This is likely to relieve the fatigue symptoms as well as other symptoms such as decreased sexual desire, well-being, and motivation.

Loss of Progesterone and Estrogen Causes Fatigue Symptoms

Women in perimenopause and menopause often have fatigue symptoms. Also, some women have surgery that removes their ovaries. They have what we call surgical menopause. These women have more severe hot flashes than women who experience menopause naturally.

Estrogen is an important hormone that promotes resilience to stress. I often hear from women that they were able to juggle many things in life and multitask until they reached menopause. Then they feel overwhelmed by demands that previously were a breeze for them.

Animal studies show that the loss of estrogen at menopause and subsequent loss of stress resilience causes fatigue symptoms.

Loss of estrogen causes other problems during the perimenopause transition to menopause. Low estrogen levels cause hot flashes during this transition time for women. Hot flashes occur in 75-80 percent of perimenopausal and menopausal women in the United States.

Hot flashes and night sweats often disrupt sleep. The interruption in sleep is due to frequent awakenings. Often women perspire and soak their sheets and night clothes. The lack of sleep causes fatigue symptoms the following day.

Progesterone is another hormone that decreases during perimenopause transition. Progesterone is our most brain calming hormone. It helps us relax and sleep. The loss of progesterone causes loss of deep sleep leading to fatigue symptoms. In addition, progesterone has other sleep enhancing effects.

Scientific studies show that progesterone is a respiratory stimulant and might be helpful for both men and women who have sleep-disordered breathing or obstructive sleep apnea, two sleep disrupting conditions.[9]

These breathing difficulties at night cause fatigue symptoms the following day. They require treatment to improve breathing during sleep and relieve fatigue symptoms.

If you suspect you have one of these problems, you should look into having a sleep study to check your oxygen levels at night.  However, for most women, hormone restoration may improve sleep and relieve daytime fatigue symptoms.

A Program for Hormone Restoration Relieves Fatigue Symptoms

 As you can see, multiple hormones are involved in fatigue symptoms.  We replace, restore, and balance the missing and deficient hormones at the Sklar Center for Restorative Medicine. Patients feel great and have improvement of their fatigue symptoms when they are on a balanced regimen of hormones. If you have any questions or need a personal evaluation, give us a call today at 562-596-5196 to request a free consultation.

References

  1. THOMAS C. ROSENTHAL, MD; BARBARA A. MAJERONI, MD; RICHARD PRETORIUS, MD, MPH; and KHALID MALIK, MD, MBA, Department of Family Medicine, University at Buffalo, Buffalo, New York
    Fatigue: An Overview
    Am Fam Physician. 2008 Nov 15;78(10):1173-1179.
    LINK: Fatigue: An Overview
  2. Ricci JA, Chee E, Lorandeau AL, Berger J.
    Fatigue in the U.S. workforce: prevalence and implications for lost productive work time.
    J Occup Environ Med. 2007 Jan;49(1):1-10.
    LINK: Fatigue in the U.S. workforce: prevalence and implications for lost productive work time.
  3. M. E. Begin, M. F. Langlois, D. Lorrain, and S. C. Cunnane
    Thyroid Function and Cognition during Aging
    Current Gerontology and Geriatrics Research. Volume 2008, Article ID 474868, 11 pages. doi:10.1155/2008/474868
    LINK: Thyroid Function and Cognition during Aging
  4. Office on Women’s Health in the U.S. Department of Health and Human Services
    Largest women’s health prevention study ever – Women’s Health Initiative, May 17, 2019.
    LINK: Largest women’s health prevention study ever – Women’s Health Initiative
  5. Writing Group for the Women’s Health Initiative Investigators
    Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women
    JAMA. 2002;288(3):321-333. doi:10.1001/jama.288.3.321
    LINK: Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women
  6. Morales AJ, Nolan JJ, Nelson JC, Yen SS.
    Effects of replacement dose of dehydroepiandrosterone in men and women of advancing age.
    J Clin Endocrinol Metab. 1994 Jun;78(6):1360-7.
    LINK: Effects of replacement dose of dehydroepiandrosterone in men and women of advancing age.
  7. Mayo Clinic Staff
    Chronic fatigue syndrome
    LINK: Chronic fatigue syndrome
  8. Yosef Sonnenblick MA, Michal Taler PhD, Yaacov G. Bachner PhD and Rael D. Strous MD MHA
    Exercise, Dehydroepiandrosterone (DHEA), and Mood Change: A Rationale for the “Runners High”?
    IMAJ. Vol 20, June 2018.
    LINK: Exercise, Dehydroepiandrosterone (DHEA), and Mood Change: A Rationale for the “Runners High”?
  9. Anne Caufriez, Rachel Leproult, Mireille L’Hermite-Bale´ riaux, Myriam Kerkhofs, and Georges Copinschi
    Progesterone Prevents Sleep Disturbances and Modulates GH, TSH, and Melatonin Secretion in Postmenopausal Women
    J Clin Endocrinol Metab, April 2011, 96(4):E614 –E623
    LINK: Progesterone Prevents Sleep Disturbances and Modulates GH, TSH, and Melatonin Secretion in Postmenopausal Women

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