TESTOSTERONE
The bulk of testosterone (male sex hormone) is produced by the testes; a smaller amount is produced by cells of the reticular layer of the adrenal cortex and during transformation from precursors in peripheral tissues. In women, testosterone is formed during the process of peripheral transformation, as well as during synthesis in the cells of the inner lining of the ovarian follicle and the reticular layer of the adrenal cortex. Testosterone ensures in men the formation of the reproductive system according to the male type, the development of male secondary sexual characteristics during puberty, is responsible for maintaining sexual function (libido and potency), sperm maturation, development of the skeleton and muscle mass, stimulates the bone marrow, the activity of the sebaceous glands, modulates synthesis of b-endorphins (“hormones of joy”), insulin. In women, it is involved in the mechanism of follicle regression in the ovaries and in the regulation of the level of gonadotropic hormones of the pituitary gland. Only free testosterone dissolved in plasma is biologically active, which in the human body plays the role of a protein anabolic, that is, it stimulates protein synthesis. It is for this reason that men tend to be larger and more muscular than women. In many structures localized (located) in the skin, testosterone supplied with the blood determines the male type of hair (beard growth, etc.) and excess sebaceous secretions (seborrhea). Testosterone levels in men increase during puberty and remain high until the age of 60 on average. During the day, the concentration of the hormone in the blood plasma fluctuates (max. - in the morning, min. - in the evening). In women, the maximum concentration of testosterone is determined in the luteal phase and during ovulation. In pregnant women, it increases by the third trimester, exceeding almost 3 times the concentration in non-pregnant women. Indications for the analysis: In both sexes: infertility, baldness, acne, oily seborrhea, adrenal tumors. In women: hirsutism, anovulation, amenorrhea, oligomenorrhea, dysfunctional uterine bleeding, miscarriage, polycystic ovary syndrome, uterine fibroids, endometriosis, breast neoplasms, hypoplasia (underdevelopment) of the uterus and mammary glands. In men: impaired potency, decreased libido, male menopause, primary and secondary hypogonadism, chronic prostatitis, osteoporosis. An increase in testosterone levels in the blood may indicate premature puberty (in boys), adrenal hyperplasia, or tumors that produce sex hormones. Testosterone levels are usually reduced in Down syndrome, renal, liver failure, and gonadal failure. Preparation for the study: on the eve of the study, it is necessary to exclude physical activity (sports training) and smoking. In women, the analysis is performed on days 6-7 of the menstrual cycle, unless other dates are indicated by the attending physician.
Prevention
The main conditions for stable hormonal levels are a healthy lifestyle, a complete abstinence from alcohol and cigarettes. Equally important is proper and nutritious nutrition, frequent consumption of fresh vegetables and fruits, regular consumption of meat and dairy products, and fish. Sports training, physical activity, and stress avoidance are recommended.
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SHBG (SEX HORMONE BINDING GLOBULIN)
Most of the testosterone entering the blood binds to a specific transport protein - SHBG. A decrease in SHBG synthesis leads to disruption of the delivery of hormones to target organs and the performance of their physiological functions. In men, SHBG secretion increases with age. This can lead to a decrease in active testosterone and an increase in the effects of estrogen, which is manifested by gynecomastia (enlargement of the mammary glands in men) and redistribution of fatty tissue according to the female type. In women, the SHBG content is almost twice as high as in men, since estrogens increase the level of SHBG synthesis in the liver, and androgens, on the contrary, reduce its production. Indications for the analysis: In both sexes: clinical signs of an increase or decrease in androgen levels with normal testosterone levels, baldness, acne, oily seborrhea. In women: hirsutism, anovulation, amenorrhea, polycystic ovary syndrome, prediction of the development of preeclampsia (SHBG is reduced). In men: male menopause, chronic prostatitis, impaired potency, decreased libido. An increase in SHBG levels can be observed with thyrotoxicosis, liver cirrhosis, taking estrogens and oral contraceptives. A decrease in SHBG levels can occur with hypothyroidism, obesity, acromegaly, Cushing's syndrome, hyperprolactinemia, polycystic ovary syndrome, and after taking androgens. Preparation for the study: on an empty stomach.
What does hormonal imbalance lead to in men?
With timely treatment, the prognosis is favorable. Otherwise, an early decrease in androgen levels can provoke:
- disruption of the cardiovascular system - pressure surges, tachycardia, heart pain, heart attacks, strokes;
- lipid metabolism disorders - high cholesterol, obesity;
- demineralization of bone tissue - bones become fragile;
- impotence and infertility.
If a deficiency of male hormones manifests itself in childhood and adolescence, the consequence of the pathology may be delayed sexual development with the formation of a eunuchoid body structure.
PROLACTIN
Prolactin is a hormone produced in the anterior pituitary gland; a small amount is synthesized in peripheral tissues, and during pregnancy it is also produced in the endometrium. This hormone plays an extremely important role in many processes occurring in the body, in particular, in ensuring the normal functioning of the reproductive system. Prolactin also contributes to the formation of sexual behavior. It regulates water-salt metabolism, delaying the excretion of water and sodium by the kidneys, stimulates calcium absorption, and has a modulating effect on the immune system. In general, prolactin activates anabolic processes in the body. The daily secretion of prolactin has a pulsating character. During sleep, its level increases. After waking up, the concentration of prolactin decreases sharply, reaching a minimum in the late morning hours. After noon, the hormone level increases. In the absence of stress, daily fluctuations in levels are within normal values. During the menstrual cycle, prolactin levels are higher in the luteal phase than in the follicular phase. From the 8th week of pregnancy, prolactin levels increase, reaching a peak at 20-25 weeks, then decrease immediately before childbirth and increase again during lactation. During pregnancy, prolactin supports the existence of the corpus luteum and the production of progesterone, stimulates the growth and development of the mammary glands and milk formation. An increase in prolactin levels is one of the common causes of infertility. Indications for the analysis: galactorrhea, cyclical pain in the mammary gland, mastopathy, anovulation, oligomenorrhea, amenorrhea, dysfunctional uterine bleeding, infertility, diagnosis of sexual infantilism, chronic inflammation of the internal genital organs, severe menopause, obesity, decreased libido and potency (men) , gynecomastia (men), osteoporosis. The analysis shows an increase in prolactin levels in diseases of the hypothalamus, pituitary gland, primary hypothyroidism, polycystic ovary syndrome, chronic renal failure, cirrhosis of the liver, adrenal insufficiency and congenital dysfunction of the adrenal cortex; tumors that produce estrogen and other conditions. The level of prolactin in the blood is usually reduced in case of pituitary insufficiency, true post-term pregnancy. Preparation for the study: Avoid sexual intercourse and heat exposure (sauna) 1 day before, smoking 1 hour before. Since prolactin levels are greatly influenced by stressful situations, it is advisable to exclude factors that influence the research results: physical stress (running, climbing stairs), emotional arousal. Therefore, before the procedure you should rest for 10-15 minutes and calm down.
FSH (follicle stimulating hormone)
FSH is a pituitary hormone that regulates the functioning of the gonads. In men, it is secreted constantly evenly, in women - cyclically, increasing in the first phase of the menstrual cycle. FSH promotes the formation and maturation of germ cells: eggs and sperm. The egg in the ovary grows as part of a follicle consisting of follicular cells. These cells, during the growth of the follicle, under the influence of FSH, synthesize female sex hormones - estrogens, which, in turn, suppress the release of FSH (negative feedback principle). Indications for the analysis: decreased libido and potency, infertility, anovulation, oligomenorrhea, amenorrhea, dysfunctional uterine bleeding, miscarriage, premature sexual development or delay, polycystic ovary syndrome, endometriosis, growth retardation, chronic inflammation syndrome of the internal genital organs. An increase in FSH levels may indicate insufficient function of the gonads, a pituitary tumor, primary hypogonadism (in men), ovarian wasting syndrome (in women), renal failure, dysfunctional uterine bleeding and other conditions. The analysis will show a decrease in FSH levels with hypofunction of the pituitary gland or hypothalamus, pregnancy, secondary amenorrhea, polycystic ovary syndrome, hyperprolactinemia. Preparation for the study: The analysis is done on the 6-7th day of the menstrual cycle, unless other dates are indicated by the attending physician. 3 days before taking blood, you must avoid sports training. 1 hour before blood collection - smoking. Immediately before taking blood, you need to calm down. Blood is taken from a vein on an empty stomach, lying down.
Estradiol norm in a healthy man
In a healthy male body, estradiol should be from 16 to 72 pg/ml .
These indicators were approved after many clinical studies and are considered the norm. But it should be borne in mind that some laboratories indicate lower values. Doctors call an increased level of female hormones hyperestrogenemia. It usually develops against the background of any diseases, or as a result of drug intake of estrogens into the body.
In order for the analysis results to be as reliable as possible, it is necessary to carefully prepare for the upcoming study. A few days (at least 3 hours) before donating blood, you need to stop smoking and avoid excessive physical activity. It is advisable not to have sexual intercourse. Consumption of alcoholic beverages is prohibited. Even sparkling water is not allowed on the day of the test. You can drink regular water.
It is imperative to stop ( with your doctor's permission ) taking steroid and thyroid hormones 48 hours before the test.
LH (luteotropic hormone)
In women, luteotropic hormone stimulates the synthesis of estrogen; regulates the secretion of progesterone and the formation of the corpus luteum. In men, by stimulating the formation of sex hormone binding globulin (SHBG), it increases the permeability of the seminiferous tubules to testosterone. This increases the concentration of testosterone in the blood plasma, which promotes sperm maturation. In turn, testosterone re-inhibits the release of LH. The release of the hormone is pulsating in nature and depends in women on the phase of the ovulation cycle. During puberty, LH levels increase, approaching values typical for adults. In the menstrual cycle in women, the peak concentration of LH occurs at ovulation, after which the level of the hormone drops and remains throughout the luteal phase at lower values than in the follicular phase. During pregnancy the concentration decreases. During the postmenopausal period, the concentration of LH increases, as does FSH (follicle-stimulating hormone). In women, the concentration of LH in the blood is maximum in the period from 12 to 24 hours before ovulation and is maintained throughout the day, reaching a concentration 10 times higher compared to the non-ovulatory period. In men, LH levels increase by 60-65 years. Indications for the analysis: hirsutism, decreased libido and potency, anovulation, oligomenorrhea, amenorrhea, infertility, dysfunctional uterine bleeding, miscarriage, premature sexual development or delay, sexual infantilism, endometriosis, monitoring the effectiveness of hormone therapy. An increase in LH levels is observed with insufficient function of the gonads, polycystic ovary syndrome, pituitary tumors, renal failure, and gonadal atrophy in men after testicular inflammation. A decrease in LH levels occurs with secondary amenorrhea; hypofunction of the pituitary gland and hypothalamus, genetic syndromes, anorexia nervosa, polycystic ovary syndrome, luteal phase deficiency, surgical interventions. Preparation for the study: 3 days before taking blood, you must avoid sports training. 1 hour before blood collection - smoking. Immediately before taking blood, you need to calm down. Blood is drawn on an empty stomach, lying down. The analysis is done on days 6-7 of the menstrual cycle, unless other dates are indicated by the attending physician.
Diagnosis of hormonal imbalances
The main diagnostic method is hormonal tests. They determine the full spectrum of hormones involved in the formation of male hormonal status. Among them:
- total testosterone
- gonadotropic, luteinizing hormone (LH);
- globulin binding protein (SHBG)
- estradiol;
- prolactin;
- follicle stimulating hormone (FSH).
Additionally, an analysis of thyroid hormones (TSH) is done, after which a complete picture of the hormonal background is obtained to confirm or refute the fact of endocrine disorders. If endocrine disruption is present, further strategies include:
- identifying the cause of the imbalance;
- determining the degree of violation;
- clarification of the individual characteristics of the patient;
- diagnosis of concomitant chronic pathologies.
Based on this, the doctor makes a final diagnosis and prescribes a course of treatment to restore the man’s hormonal activity and sexual viability, and also takes measures to eliminate the symptoms of the disease and improve overall well-being.
ESTRADIOL
In women, estradiol is produced in the ovaries, placenta and zona reticularis of the adrenal cortex under the influence of FSH, LH and prolactin. Estradiol is formed in small quantities during the peripheral conversion of testosterone. In men, estradiol is formed in the testes, in the adrenal cortex, but most of it is formed in peripheral tissues due to the conversion of testosterone. Estradiol ensures in women the formation of the reproductive system according to the female type, the development of female secondary sexual characteristics during puberty, the formation and regulation of menstrual function, the development of the egg, the growth and development of the uterus during pregnancy. It is also responsible for the psychophysiological characteristics of sexual behavior and ensures the formation of subcutaneous fatty tissue according to the female type. A necessary condition for the effects of estradiol to occur is the correct relationship with testosterone levels. Estradiol has an anabolic effect, enhances bone turnover and accelerates the maturation of skeletal bones; promotes sodium and water retention in the body, reduces cholesterol levels and increases blood clotting activity. Daily fluctuations in the concentration of estradiol in the serum are associated with the rhythm of LH (luteinizing hormone) secretion: the maximum occurs between 15 and 18 hours, and the minimum between 24 and 2 hours. In women of childbearing age, the level of estradiol in the blood serum and plasma depends on the phase of the menstrual cycle. cycle. The highest levels of estradiol are observed in the late follicular phase. During pregnancy, the concentration of estradiol in serum and plasma increases at the time of delivery, and after delivery it returns to normal on the 4th day. With age, women experience a decrease in estradiol concentrations. During postmenopause, the concentration of estradiol decreases to the level observed in men. Indications for the purpose of the analysis: diagnosis of disorders of the menstrual cycle and fertility (ability to produce offspring) of women, amenorrhea, oligomenorrhea, anovulation, hypogonadism, disorders of puberty, osteoporosis (in women), hirsutism, infertility, premenstrual syndrome, signs of feminization in men. An increase in estradiol levels is observed with hyperestrogenism; endometrioid ovarian cysts; tumors of the ovaries, testicles, liver cirrhosis, pregnancy, taking hormonal drugs. Estradiol levels are reduced during intense physical activity in untrained women, with significant weight loss, a high-carbohydrate, low-fat diet, in vegetarians, and in early pregnant women who smoke; for chronic inflammation of the internal genital organs, chronic prostatitis, insufficiency of the gonads and other conditions. Preparation for the study: on the eve of the study, avoid physical activity (sports training) and smoking. In women, the analysis is performed on days 6-7 of the menstrual cycle, unless other dates are indicated by the attending physician.
Norm
Estradiol levels in men vary depending on age. Normal values are in the range of 7.63 - 42.6 pg/m. In some laboratories, the data may vary slightly because different techniques are used. A doctor must interpret the results.
The norm of estradiol in men, boys from one to 10 years of age is up to 20 pg/ml, adults – 7.63 – 42.6 pg/m.
Table 1 - Estradiol norms in men by age. Photo: medicalka.ru
PROGESTERONE
Progesterone is a female sex hormone produced in the corpus luteum of the ovaries and adrenal glands. Outside of pregnancy, progesterone secretion begins to increase in the preovulatory period, reaching a maximum in the middle of the luteal phase, returning to its original level at the end of the cycle. The content of progesterone in the blood of a pregnant woman increases, doubling by 7-8 weeks, and then gradually increasing until 37-38 weeks. After ovulation - the release of an egg from the follicle - a corpus luteum is formed in its place in the ovary - a gland that secretes progesterone. It exists and secretes this hormone during 12-16 weeks of pregnancy until the moment when the placenta is fully formed and takes over the function of hormone synthesis. If conception does not occur, the corpus luteum dies after 12-14 days, and menstruation begins. Progesterone is determined to assess ovulation and the viability of the corpus luteum. With a regular cycle - a week before menstruation, when measuring rectal temperature - on the 5-7th day of its rise; with an irregular cycle - several times. A sign of ovulation and the formation of a full-fledged corpus luteum is a tenfold increase in progesterone levels. Indications for the analysis : identifying the causes of menstrual irregularities, infertility, dysfunctional uterine bleeding, assessing the condition of the placenta in the second half of pregnancy, differential diagnosis of true post-term pregnancy. An increase in progesterone levels is observed with adrenal hyperplasia, corpus luteum cyst, pregnancy, and delayed maturation of the placenta. The analysis will show a decrease in progesterone levels in the absence of ovulation, insufficiency of the corpus luteum, true postmaturity, placental insufficiency, intrauterine growth restriction, or threatened abortion. Preparation for the study: the analysis is carried out on the 22-23rd day of the menstrual cycle, unless other dates are indicated by the attending physician. Blood is taken in the morning on an empty stomach, that is, when 8-12 hours pass between the last meal and blood collection. You can drink water.
DEA-SO4 (Dehydroepiandrosterone sulfate)
DEA-SO4 is produced in the adrenal cortex. Its level is an adequate indicator of androgen-synthetic activity of the adrenal glands. The hormone has only a weak androgenic effect, but during its metabolism testosterone and dihydrotestosterone are formed in peripheral tissues. During pregnancy, DHEA-SO4 is produced by the adrenal cortex of the mother and fetus and serves as a precursor for the synthesis of placental estrogens. By puberty, the level of this hormone increases, and then gradually decreases as a person reaches reproductive age. The level of DHEA-SO4 also decreases during pregnancy. Indications for the analysis: adrenogenital syndrome, tumors of the adrenal cortex, ectopic ACTH-producing tumors, recurrent miscarriage, fetal hypotrophy, diagnosis of the state of the feto-placental complex from 12-15 weeks of pregnancy. Increased levels of DHEA-SO4 are observed in adrenogenital syndrome; tumors of the adrenal cortex; ectopic ACTH-producing tumors; Cushing's disease; feto-placental insufficiency; hirsutism in women; threat of intrauterine fetal death. The level of DHEA-SO4 is reduced in case of fetal adrenal hypoplasia (concentration in the blood of a pregnant woman); intrauterine infection; when taking gestagens.
17-OH-PROGESTERONE
17-OH-progesterone is a hormone responsible for human reproductive function. Produced in the adrenal glands, gonads and placenta. Indications for the analysis: diagnosis and monitoring of patients with congenital adrenal hyperplasia, hirsutism, cycle disorders and infertility in women; adrenal tumors. Most often, an increase in the level of 17-OH-progesterone is observed with congenital adrenal hyperplasia, tumors of the adrenal glands or ovaries. The level of 17-OH-progesterone is usually reduced in Addison's disease, pseudohermaphroditism in men. Preparation for the study: according to the instructions of the attending physician (in women, blood is usually taken for testing on the 3-5th day of the cycle), on an empty stomach. Our dictionary Galactorrhea is the discharge of milk, colostrum or milk-like fluid from the mammary glands. Amenorrhea is the absence of menstruation for 6 months or more. Oligomenorrhea is a menstrual disorder characterized by a short period of menstruation. Hypogonadism is a pathological condition characterized by underdevelopment of the internal and external genital organs and unclear expression of secondary sexual characteristics. Addison's disease is characterized by insufficient secretion of corticosteroid hormones by the adrenal glands. Symptoms of the disease: weakness, lethargy, hypotension, dark spots on the skin. Hirsutism is increased male pattern hair growth in women along the midline of the abdomen, face, chest and inner thighs. Adrenogenital syndrome (pseudogermaphroditism) is characterized by hyperfunction of the adrenal cortex and increased levels of androgens in the body. Anovulation is a change in the menstrual cycle characterized by the absence of an egg from the ovary. The luteal phase is the second phase of the menstrual cycle, beginning with the moment of ovulation and the formation of the corpus luteum. Duration – 12-16 days. Preeclampsia is a complication of pregnancy in which the function of vital organs, especially the vascular system and blood flow, is disrupted. Cushing's syndrome . The term is used to describe a complex of symptoms (a round, moon-shaped face that becomes reddish in color, fat deposits on the neck).
