By Leslie Price
Can you give an overview of what hormones are?
Hormones are the way we get our 30 trillion cells to talk to each other so the body is working in harmony towards a common goal. Hormones are chemical signals. They are released by a gland. You’ve heard of the thyroid gland, the adrenal glands, or the pituitary gland. These are all endocrine glands. They are like the transmitter, which releases a hormone. The hormone travels in the bloodstream to another part of the body and conveys the message. And when the message is picked up by those distant cells, they must follow that instruction. A very well-known hormone right now, GLP-1, is released by the gut after eating and travels in the blood to the brain with the instruction, stop eating, you’re full. Then we get a physical sensation of feeling full and it also elicits a behavior. We stop eating.
Hormones are pinging around the body like hundreds of thousands of text messages or emails. And they are very powerful. They are entirely fundamental to life. None of us would exist without hormones because for fertilization to take place, to grow a baby for nine months, for that baby to grow to a toddler, to a child, to an adult – all of that is driven by hormones. They’re responsible for our big milestones, but also for our day-to-day, moment-to-moment experience. And as you’ve read in the book, when they go wrong, people really feel it. Sometimes it can even be fatal.
Are there more hormones that we’re just not aware of? Or have we already discovered them all?
When leptin, the body fat hormone we were talking about, was discovered in 1994 – that was sensational. How did the brain know how much fat you’ve got stored? Fat is your body’s main fuel tank and we’ve discovered the fuel gauge. That’s brilliant. GLP-1s, that is a pretty modern story. Other gut hormones have been found. Possibly they’ll find more body fat hormones or gut hormones.
In the book, you share a shorthand for tired all the time, TATT, which is a common reason people visit an endocrinology clinic. (The case you describe ends up being adrenal failure, which is very serious.) A lot of women suffer from TAAT. Can you list off some typical reasons why women, especially in middle age, might feel that way?
Adrenal failure would be a rare outcome. It’s obviously one not to miss, as the chapter makes clear, but it’s unusual. And also, as we see with that patient, it’s associated with other symptoms: dizziness, weight loss, the tanning of the skin, and so on. We divide up tiredness, as I mentioned in the book, into a sort of … pathology and non-pathology. Pathological reasons why you might feel tired could be anemia, Vitamin D deficiency, iron deficiency – you might’ve had absolutely straightforward periods and suddenly they become very heavy in perimenopause, so iron deficiency is one to look out for.
I will always check things like B12, folate, other minerals, selenium, copper, and so on, because it’s important to look at diet. Blood glucose is super, super important. Someone might have undiagnosed diabetes and that’s making them feel tired. But also: Are you under stress? Are you moving enough? When you’re on a blood glucose rollercoaster for a lot of the day, you can have massive slumps that definitely feel like TATT.
The non-illness part…that’s where the history is fundamentally important. When life is coming at us all the time, we’ve got no head space, we’ve got no rest space, we’re not going to bed on time because we’re trying to cram lots and lots of things into the evening because the day is so busy or we don’t have enough help or problems within the family, difficulties at work and so on. But that shouldn’t be our default assumption. You still have to be open-minded, that yes, you can have all that stuff going on, but there could be other things at play.
Often women go in and say they’re feeling tired or not great, and it’s like, oh, well, you’re just getting older.
I push back on this assumption that as we age it’s normal to feel under par. Because conversely, I look after some patients in their 80s and 90s and they’re skipping into the consulting room.
I have a question about body fat and menopause. Why does our fat shift to the middle of our frame?
I think we become more insulin resistant, and that is the typical deposition – central adiposity. Insulin resistance becomes a problem through midlife, even if you’re not carrying a lot of extra weight. It’s important to keep up resistance training. But even when we’ve got a good muscle mass, the body is much more insulin sensitive.
What do you make about the hormonal zeitgeist we’re in right now?
On the one hand, it’s great that there’s public awareness. People are beginning to understand that hormones go beyond HRT and it isn’t just a “women’s thing.”
But I don’t want people to spend unnecessary money on things that make a lot of claims that probably don’t deliver. There is a lot of caution about starting hormones if you don’t necessarily need them. The body is so calibrated. If you’re a man and you’re feeling tired and somebody says, your testosterone is low-normal. You’ll take testosterone, but then your testicles will stop making testosterone. Then you might decide, well, the prescription’s expensive or I don’t think I need this anymore and it might take a year for your own testicles to kick back in.
You’re not going to get the care you deserve with a send-away blood or salivary test. Keep it in a formal office setting. I suppose one place where it has been very helpful is people are very now aware of their glucose and insulin resistance. In the UK, we think we’ve got about a million cases of undiagnosed diabetes because people didn’t think about it.
What recommendations would you give women who feel something is amiss and are seeking out an endocrinologist?
Personal recommendation is always a great place to start. If you know anyone who’s had a hormone condition, definitely ask them. It’s important to look at how long your appointment slot is. For a new-patient appointment, anything less than half an hour would be tricky.
You might have to go through a few doctors. So much of it is a human connection and whether you are being heard. In the UK, the GP will refer you to an endocrinology clinic in a hospital, not even to a specific doctor necessarily. Sometimes you connect, sometimes you don’t. As a patient, you have the right to ask to see somebody else.