HERE'S WHY YOU SHOULD CHECK HORMONES WITH AUTOIMMUNE DISEASE.

Some disease, like Diabetes, have a discrete cause. The body is not properly responding to insulin. Other diseases, like cancer or autoimmune disease, are multifactorial- meaning we don't know exactly what causes them but can observe an accumulation of changes leading to the disease. One of the changes that we see leading to autoimmune disease is changes in hormones. Changes in hormones are also observed in autoimmune disease. For example, Rheumatoid Arthritis usually improves during pregnancy when sex hormones are high and worsens post-menopaussally when sex hormones have diminished. Contrastingly, elevated estrogens are believed to be a part of development of Lupus. In addition to elevated levels of estrogen and prolactin, decreases in the hormones testosterone, progesterone, and DHEA are observed in Lupus. The hormone DHEA is often used as a steroid like treatment in autoimmune disease. In animal and laboratory studies, testosterone appears to be protective from immune activation and development of auto-immunity. This illustrates that hormones out of balance in either direction contribute to the pathogenesis of autoimmune disease, as hormones respond to inflammation & modulate the immune system.

INFLAMMATION & HORMONES

Hormones are extremely sensitive to inflammation in the rest of your body. Hormone production can be interrupted at many levels.

Hormone production begins in the brain where a gland called the hypothalamus signals another gland called the pituitary to release hormones that communicate with individual endocrine glands. Once pituitary hormones reach those glands, they stimulate hormone production. For example the pituitary hormone TSH causes the thyroid to release thyroid hormones while the pituitary hormone FSH results in ovarian secretion of estrogen and progesterone. Inflammation in the body can interfere with production of hormones at the level of the hypothalamus, pituitary gland, individual endocrine organs, hormone activation, or hormone metabolism. Inflammation that an interfere with hormone can come from the six triggers of autoimmune disease discussed in my chronic illness blog as well as the triggers of oxidative stress discussed in my sleep blog.

HORMONES & IMMUNE SYSTEM

Much of the interaction of hormones with the immune system is mediated by estrogen, which can be activating or inhibiting. Estrogen can bind to two different types of cellular receptors. The first type of receptor is called an alpha receptor and when estrogen binds it, a stimulating activity is produced. The second type of receptor is called beta and when estrogen binds to it, an inhibitory action is produced. In the immune system, alpha binding increases immune activity and beta binding decreases immune activity. To maintain a healthy immune system, you want a balance of both stimulation and inhibition.

 Estrogen activation of the immune system stimulates cells that respond to infection and create antibodies as well stimulating chemical messengers involved in initiating inflammatory processes. Furthermore, excessive elevations in estrogen can lead to a process called “loss of tolerance,” in which the immune system begins to recognize your own cells as foreign and attack them. This is an important process in the initiation of autoimmune disease. Scientific studies have further demonstrated that immune cells have sex hormone receptors that, when bound, help determine the destiny of an immune cell.

In summary, the inflammatory triggers that create autoimmune disease also disrupt hormone function. Hormone dysfunction then amplifies the autoimmune process by contributing to over- activity of the immune system. However, balanced hormones can actually turn down the immune reactivity seen with autoimmune disease.

Ready to test your hormones? Here are my favorite hormone tests.

DUTCH Test: A comprehensive hormone panel evaluating estrogen, progesterone, cortisol as well as hormone metabolism

Thyroid Panel: A complete thyroid panel (instead of the TSH your PCP runs) that helps you determine whether your thyroid is performing optimally.