drOPsite Login                                                                 Healthcare Professional Registration

You are here

Hormone Optimization Symposium Recap

Written by Dr. George Gillson, MD, PhD

I was lecturing in Vancouver recently at the Hormone Optimization Symposium sponsored by A4M and PCCA Canada. PCCA is an organization providing equipment and chemicals to compounding pharmacists all over North America and they also provide education on a wide variety of hormone-related topics to pharmacists and the practitioners who prescribe compounded medications. Through PCCA/PCCA Canada, over the last 15 years I have had the opportunity to lecture to hundreds of captive practitioners, many of whom tell me they didn’t understand a word I said initially, but after they went over the talks a dozen or so times, the information tied everything else together for them.

That aside, I lectured on two topics. The first lecture was on the strengths and weaknesses of the various hormone testing tools we have at our disposal (saliva, blood, urine). Briefly, we have some wonderful testing tools available for measurement of hormones. They all work quite well when we make our own hormones, to identify low or high hormone production. 

When we start supplementing people with hormones, the tests now have to respond to many new variables such as the type of delivery (e.g. oral, skin, suppository), timing of supplementation relative to testing, formulation used for a given delivery system (e.g. timed-release vs immediate release for oral hormones, type of base used for skin-delivered hormones). Basically, we’re taking tests that work well when the hormones come from our gonads and asking them to do the same job when we try to turn our skin or digestive tract into an accessory ovary or testicle. It just doesn’t work seamlessly.

The bottom line is that there is no “one-size-fits-all, most accurate” hormone test that works in all supplementation situations. Practitioners still have to focus on the patient’s clinical condition first, and not rely on the hormone test results to make their decisions. They also need to have a firm understanding of the pitfalls of each type of test.  We can provide that for you!

The second lecture was about the transitory surge in the cortisol level in your saliva during the first hour after waking. This is known as the CAR or Cortisol Awakening Response. This CAR or cortisol surge is your brain’s way of “booting up” but also reflects your expectations, hopes (or fears) for what the coming day might bring.  The CAR also reflects the effect of long-term stress on the hippocampus, a critical brain structure involved in memory and planning. A well-documented flat cortisol response in the first hour after waking may indicate damage to the hippocampus which in turn may correlate to dementia, insulin resistance/Metabolic Syndrome, and exposure to toxic elements, just to name a few.

Measurement of the CAR typically involves at least three saliva samples in the first hour: one immediately on waking, one 30 minutes later and a third at 45 or 60 minutes after waking.  We studied the CAR extensively in 2005 (by coercing our employees and families) but decided against offering it to practitioners, as it was still too new. Twelve years later, the number of publications has increased significantly, and the principles involved in getting the best possible CAR data have been worked out.  I can say with confidence that RMA is now firmly on top of the literature in this field and I will be happy to answer any questions that practitioners may have about this type of cortisol testing.

Other speakers at the event who gave very informative talks included Pam Smith MD, Sahar Swidan Pharm D, Filomena Trinidade MD, and Wendy Davis ND. Unfortunately space doesn’t permit me to summarize their presentations on a wide range of topics which included hormones and mental illness, use of low-dose naltrexone, how salivary cortisol can help us work with depressed patients.  If you have a good relationship with a compounding pharmacist, you should considering asking him or her to take you along to the next Hormone Symposium!