Let’s Talk Terminology

When is the last time you read an article, listened to a podcast or scanned a post on TRT, hormones or menopause and found yourself lost in acronyms or concepts you’re not familiar with. You don’t have time to pause a podcast and look up a term. If medicine wasn’t your field of study (and if we’re being honest, even if it was) you might not know what’s being discussed or how it fits in to the bigger picture. Bookmark this post to dip back and clarify some of the acronyms, blood tests, concepts, body parts and body systems. It is by no means comprehensive but it’s a good start. Please let us know if there’s something we missed!

• ADAPTOGEN

  • Plant or plant extract used to support overall health or components of health. Examples are ashwaganda, reishi, cordyceps, holy basil, and ginseng.

• ANDROGEN

  • A group of sex hormones that help start puberty and play a role in reproductive health and physical characteristics. Female and males make androgens but males make more, with testosterone being the most common. Testicles in males and ovaries in females make androgens as well as the adrenal gland in both sexes.

• Android

  • Fat distribution around the abdomen. When used together with GYNOID, this can help determine waist to hip ratio and estimate metabolic and cardiovascular disease risk.

• BMP

  • Basic metabolic panel is a blood test evaluating electrolytes like sodium and potassium, blood sugar and kidney function.

• CBC

  • Complete blood count is a blood test looking at white and red blood cells, platelets and blood concentration. This can help determine anemia or infection and includes HEMATOCRIT discussed below.

• CMP

  • Comprehensive metabolic panel is a blood test that includes all of the components of BMP and adds information about the liver and gall bladder.

• DEXA

  • Dual energy xray absorpitromety is a painless scan to measure bone mineral density and body composition (muscle and fat amounts and distribution). This is done fully dressed. It provides data on body composition, bone density, cardiovascular and diabetes risk. Radiation is much less than a standard chest xray or dental xray.

• ESTRADIOL

  • The primary female sex hormone that is responsible for effects on the muscle, bones, major organs, gastrointestinal system, skin and brain. It regulates menstruation and the reproductive cycle, secondary sex characteristics, and female fat distribution patterns. It is the primary hormone that diminshes after menopause.

• ESTROGEN

  • A category of sex hormones responsible for female sex characteristics. There are 3 major estrogen derivaties: E1 (estrone, a weak estrogen hormone), E2 (estradiol, the strongest estrogen hormone) and E3 (estriole, which is only present during pregnancy).

• FREE/BIOAVAILABLE/TOTAL TESTOSTERONE

  • A blood test used to determine how much testosterone is in the body. This test measures bound and unbound testosterone to determine how much is usable and acting on the body. It can help determine testosterone deficiency.

• FSH/LH

  • This is a blood test that measures the follicule stimulating hormone and leutenizing hormones. In women, these hormones help control the menstrual cycle and the growth of eggs in the ovaries. It is used in conjunction with other factors to determine if a woman is in menopause. In men, FSH and LH help control the production of testosterone and can be used to help determine low tesosterone production.

• GYNOID

  • Fat distrubution around the hips and thighs. When used in ratio with ANDROID, this provides a waist to hip ratio to help assess for metabolic disease risk and cardiovascular disease risk.

• HEMATOCRIT

  • Part of the CBC blood test and is a measure of the volume of red blood cells in your blood. Low values can indicate anemia or other red blood cell related disorders, and high values can indicate conditions like dehydration or too much red blood cell production. Standard hematocrit percentages are from 41-50% in men and 36%-48% in women.

• HPT AXIS

  • Hypothalmus-pituitary-thyroid axis. This is the metabolic process in which the hypothalmus and pituitary gland in the brain release hormones that are sent to the thyroid to make thyroid hormone. HPT is a negative feedback system in which too low thyroid hormone in the body triggers the brain to increase hormone production. The opposite is also true, too much thyroid hormone in the body signals the brain to back off or stop production. This generally results in high TSH and low T4 in hypothyroid patients and low TSH and high T4 in hyperthyroid patients.

• HPG AXIS

  • Hypothalmus-pituitary-gonadal axis. Like the HPT axis but the brain is stimulating the ovaries or testes to produce sex hormones (estradiol or testosterone). This system is also a negative feedback system.

• HRT (MHT)

  • Hormone replacement therapy or more accurately, menopause hormone therapy is the process of using synthetic hormone supplementation to ease the process of estrogen withdrawal or fluxations in the perimenopausal and menopausal body. This can help with hot flashes, fatigue, depression, anxiety, muscle and joint pain, menopause weight gain and bone density. MHT can be in pill, patch, gel, spray form, vaginal ring or vaginal suppository form.

• LEA

  • Low energy availability is the threshold of caloric intake at which negative effects on hormones, signaling proteins, bone density and the reproductive system occur. This is a calcultion that can be obtained by taking the FFM (fat free mass, which is available in the DEXA print out), converting it to kilograms (divide pounds by 2.2) and multiplying by 30. This value is the number of calories at and below which the body is significantly negative affected. Using 40 and 45 as a multiplier will provide the optimal calorie intake for metabolic and reproductive health.

• MENOPAUSE

  • The one day a woman has had no menstrual cycle for 12 consecutive months. While technically only one day, the word menopause is used generally to describe the several years before and after the actual date of menstrual cessation. It can be accompanied by a variety of symptoms assoicated with estrogen withdrawal.

• MENSTRUAL CYCLE

  • The roughly 28 day cycle in which natural hormonal changes occur in 2 phases that make pregnancy possible. This stops when a woman reaches menopause and there are is no longer egg production in the ovaries.

  • Menses is typically days 1-7 of the cycle marked by menstrual bleeding and low levels of estrogen, progesterone, FSH and LH. Bleeding is from the shedding of uterine lining after no implantation of a fertilized egg.

  • Follicular phase is usually days 7-14 and is marked by increasing levels of estrogen and FSH. Around day 14, LH surges and about 10-12 hours after the surge, ovulation occurs in which the follicle releases an oocyte (egg cell). This can live for about 24 hours without fertilization.

  • Luteal phase is around days 14-28 and is marked by a decrease in FSH and LH after ovulation, a drop in estrogen though not to menses levels and a rise in progesterone to a peak around day 21. High progesterone prepares the uterus for implanation of a fertilized egg. If there is no fertilized egg to implant, estrogen and progesterone levels drop significantly, and the uterus loses the previously prepared lining. Estrogen levels are at their lowest and the uterus sheds the lining, experienced as menstrual bleeding.

• OVARIES

  • The reproductive organs in the female reproductive system located in roughly the lower right and left quadrants of the abdomen, attached by fallopian tubes to the uterus. During the menstrual cycle, an ovum is released from an ovary, into the fallopian tube and into the uterus. Women are born with all the oocytes they will possessin their lifetime and do not make more. There are about 1 million oocytes present at birth, however only about 500 will ever ovulate. The oocyte reserve is constantly declining, with complete absence by a women’s early to mid 50’s marking the end of reproductive capablity. This age varies from early 40’s to mid 50’s.

• PERIMENOPAUSE

  • Transition years for up to 10 years before menopause in which a woman’s hormones do not always follow the menstrual cycle pattern and can be more erratic. Estrogen levels tend to be higher with wider fluctuations causing hot flashes, night sweats, changes in sleep patterns, changes in mood, energy and motivation. Hormone surges and changes can lead to vaginal dryness, changes in libido or sex drive, depression, anxiety and weight gain. Perimenopause can start for some women in their late 30’s but is more commonly experienced starting in early to mid 40’s and increasing in symptoms into the late 40’s and the date of menopause. Symptoms can be attenuated by both non-hormone adaptogens, changes to nutrition and exercise routines and MHT.

• PROGESTERONE

  • A sex hormone that prepares the endometrium (uterine lining) for a fertilized egg to allow implantation. When low, as in perimenopause and menopause, symptoms include depression, insomnia, anxiety, irratibility, headaches and irregularity in menstruation. Progesterone supplementation can help regulate mood and sleep.

• PSA

  • Prostate specific antigen is a blood test used to screen men for prostate cancer. PSA is a protein that is produced by both cancerous and non-cancerous tissue in the prostate. High levels might indicate prostate cancer however it can also indicate non-cancerous issues like an enlarged or inflamed prostate. PSA is only a screening test and is used in conjunction with other evaluations and examination techniques if prostate cancer is suspected.

• RMR

  • Resting metabolic rate. This is the amount of calories the body needs to meet daily energy expenditure. RMR differs from BMR or basal metabolic rate in that BMR assumes being at rest for the 24 hour period in which the caloric need is calculated whereas RMR includes movement of light activity such as walking, using the bathroom, eating and stretching. RMR will always be slightly higher than BMR. RMR should be close to or just higher than LEA calculation.

• SHBG

  • Sex hormone binding globulin is part of the testosterone panel blood test and measures how much tesosterone is bound or attached to testosterone. Testosterone that is tightly bound to SHBG is not able to enter cells and bind to receptors and activate. When evaluating for low testosterone, it is helpful to know how much testosterone is bound to SHBG versus how much is avaiable to receptors.

• TESTOSTERONE

  • The primary sex hormone and androgen in males. Testosterone plays a role in sex characteristics, muscle and bone mass, body hair growth, and sex drive or libido. Signs of low testosterone include weight gain, depressed mood, lack of morning erections, inability to put on muscle, fatigue, brain fog and low attention span. TRT can be used to attenuate the symptoms of low testosterone. Testosterone in men is associated with age related decline where as in women, the levels stay fairly even thoughout the life span.

• TSH

  • Thyroid stimulating hormone is a blood test to evaluate how well the pituitary gland in the brain is stimulating the thyoid to produce T4 and T3

• TRT

  • Testosterone replacement therapy uses supplemental testosterone to combat the symptoms of low testostersone. This is primarily done with injections but can be done with creams.

• T4/T3

  • The thyroid hormones released by the thyroid gland that are responsible for the regulation of metabolism. Thyroid hormones act on virtually every cell in the body. When not enough hormone is produced, people might experience fatigue, weight gain, dry skin, feeling cold, brittle hair and nails and low energy. When too much hormone is present, the opposite is true. Symptoms include feeling hot, sweating, hyperactivity, nervousness or jitteriness, fast heart rate and swelling of the thyroid gland in the neck.

• VO2 MAX

  • A test that measures the maximum rate of oxygen consumption attainable during physical exertion. It is a measure of cardiovascular fitness. As oxygen is inhaled during exercise, it is absorbed in the lungs and changed in to ATP (sorry for the Krebs cycle flashback) which powers the cells and helps release carbon dioxide on the exhale. The higher the VO2 max, the more oxygen the body can use during exercise and the more efficiently the body can use that oxygen to produce ATP energy. VO2 max is measured on a stationary bike, erg rower or treadmill with increasing intensity for about 15-25 minutes until exhaustion is reached. The test provides personalized VO2 max, heart rate zones, aerobic threshold and anaerobic threshold.