Felice Gersh, MD

Female Hormones: an Integrative Approach

Aired on: July 7, 2023

Episode Description

Hormones are intricately interconnected and affect all parts of the body. Balanced female hormones are essential for healthy bones, joints, heart and brain health. With an integrative approach, this podcast will discuss female hormones, menopause, and hormone replacement therapy.

Happy Hormones: an integrative approach

Felice Gersh, MD

  • What is wellness?
    • It is not average lab values which are determined by 95 % of a very sick population
    • Means optimizing health at every stage of life so can have the life you want
      • Having vitality and joy in/of life (in work, relationships)
      • Have to work at reducing toxic pollution. Toxins in our food
      • Have to eat real foods with polyphenols, antioxidants, macronutrients and micronutrients with trace minerals
      • Need restorative sleep, sunlight, exercise, be in nature
      • Women need to optimize their hormones
      • Some toxins,
        • Artificial sweeteners can alter our DNA, destroy our gut microbes
        • xenoestrogens can interfere with production, distribution, receptor function, degradation and elimination causing metabolic chaos in body
        • dew on plants contain mercury in California
          • coastal mountain lions have 10 x mercury as they eat rabbits which eat the food
  • Many diseases of aging are diseases of estrogen deficiency
    • Estrogen receptors on all organs
    • Estrogen is about restoration
    • When there is no estrogen, cells are not getting instructions
      • What to do, what enzymes, proteins to make, autophagy (cell death
      • Immune system does not work as well.

Estrogens produced in the human body

  • E1 estrone in menopausal and obese
    • From ovaries, but predominately from adrenal androgens
      • These androgens are converted in fat tissue
      • This conversion increases in inflammation
    • Binds predominantly to the alpha receptor
  • E2 estradiol produced by ovaries; binds to beta receptor
    • Dominant in non-pregnancy
    • “metabolic glue” that links every organ together including
    • Vital for bone balance of bone turnover (new bone and rid of
    • Joints Osteoarthritis (women have more joint replacements than men)
    • In brain women have over 2 x Alzheimer’s disease because of need of estradiol
      • Receptors on cortex, hippocampus, hypothalamus, circadian rhythm all controlled by estradiol
    • Cardio Vascular system
      • By age 65. 75 % of women have high blood pressure
      • By age 65 women have more strokes and ruptured aneurisms than men
      • Women die from heart attacks more than men
      • During estrogen producing years, women have lower incidence of heart attacks and strokes than men
    • The GI system controlled by estradiol
      • Get changing in gut motility, absorption, lining cells of the gut
      • Results in poor digestion, absorption and nutrient deficiencies
      • Nutrient deficiencies lead to cellular dysfunction
    • Immune system
      • When women have estrogen, they survive infection, flu, sepsis traumatic brain injury more better
  • E3 estriol dominant estrogen produced by placenta during pregnancy
    • Binds predominately to beta receptor
    • Affects the immune system
  • E4 fetal estrogen
  • Man made estrogens have different effects
  • Hormones work through nuclear receptors are slower


  • Are estrogen receptors on every cell in the body
  • Estrogen receptor alpha (in nucleus and membrane)
  • Estrogen receptor beta.  (in nucleus and membrane)
  • Nuclear receptors are slow
  • Membrane receptors are rapid
  • E1 and Eb interact with each other
    • If a lot of action in the beta, down regulates the alpha receptor
    • A lot of action in the alpha, it affects the beta receptor
    • This is designed to optimize health during reproductive years and pregnancy
    • Different organs have different mixes of receptors
  • Various studies have mixed estradiol with different estrogens
    • This makes females fearing estrogen and bioidentical hormones


The ultimate stress test

If there are complications during pregnancy, there are likely to be health effects in the future.

            Metabolic dysfunctions may follow

  • Pregnancy complications or irregular periods may be red flag for cardiac complications
  • Fertility is a vital sign of a reproductively healthy woman

Menopause (moon; pause)

  • All eggs are there at birth and have an expiration date
  • Menopause stop making eggs; average age in US 45 -55
    • Late menopause over age 55
    • Early menopause 40 – 45
    • Premature menopause younger than 40
    • The younger menopause occurs, the worse are the health consequences because there were fewer years of hormones
  • Defined as the stopping of the lunar (period) cycle; “12 months without bleeding
  • She defines menopause as Loss of vital life hormones, “ovarian senescence”
    • Is ovarian aging
    • Every organ system takes a negative dramatic  “hit”
    • Is gradual process over years
    • Parallels decline in fertility
    • The beginning of a rapid aging of every organ system
    • Women are 80 % of individuals who get osteoporotic fractures


  • Testosterone is precursor to estradiol
  • Ovaries make estradiol by making testosterone, then in granulosa cells, testosterone is converted to estradiol via the aromatase enzyme
  • All different estrogens are made from androgens Made in ovaries and to a greater extent in the adrenal glands
  • The aromatase pathway is in the brain, skin, gut
  • In men aromatase is in each organ; androgens are converted to estrogen in a local organ where it stays as needed
    • During reproductive years, a man’s brain makes six times the estradiol as a woman’s brain (Men’s brain estradiol stays in their brains.  Women’s brains are not adapted to do that as they don’t need it)
    • Men don’t have estradiol deficiency because they continue to make it in their organs. Why they have fewer joint issues, less osteoporosis and Alzheimer’s Disease
    • Endocrine hormone made and distributed through out the body and circulates
      • Estrogen in women
      • Testosterone in men