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The human body is a complex machine. There are so many simultaneous things going on that affect metabolism, weight gain, fat loss, muscle mass, and well-being. While the rules of losing fat are simple, they're not easy - mostly because the body doesn't operate on an "if/then" statement. It's easy to think that "If I do X, then Y will happen." Unfortunately our meat-bag machines are too complex for that.
One of the many layers to this complexity are hormones. Often a buzz-word, hormones are blamed (or attributed) to a person's fat loss results. If someone is struggling to lose fat, it's because their thyroid hormones are out of whack. If someone has an easy time losing fat and building muscle, it's because they're full of testosterone, right?
But hormones are much more complex than that, and understanding the relationship between hormones and fat loss is important to knowing which strategies are right for your fitness goals.
So to get a better understanding of hormones and fat loss, I turn to Nick Gentry, MD. He's the owner of Rejuvinated Medical Spa and Maverick Male Medical in Fayetteville, Arkansas, a former ER doctor and current practitioner of functional medicine.
Here's my 30 minute conversation with Dr. Gentry about the role of hormones and their relationship to fat loss. Read below for the transcription of the questions.
Most people want to lose fat, build a little muscle, and overall look better. I suggest four things are needed to achieve this:
You need a nutrition plan to lose fat
A resistance training plan for strength and muscle
A cardio plan for health and endurance
A method of accountability to follow the plan
However, the human body is just so complex, and we hear all the time about the role of hormones like cortisol, testosterone, and estrogen.
Q: Can you give us (non-medical people) a brief rundown on the role of hormones and fat loss?
That' a pretty complicated question, but if you think of your hormones as a symphony, the thyroid is the conductor to set your basic metaoblic rate.
Testosterone is largely involved in muscle rebuilding and recovery, mental clarity, and fat loss.
It's not a "simple issue", all of the hormones act together and when you have an imbalance, it can lead to a domino effect that lead to imbalances of others.
Q: Can you speak more about the role of THYROID hormones and their effect on fat loss?
I can't tell you how many times someone comes into my clinic saying "I can't lose weight, something must be wrong with my thyroid." Well, maybe that's true.
The thyroid is the conductor of the endocrine system. If thyroid production is off, everything else can go haywire. The thyroid sets the basic metabolic rate for every cell in your body. From how fast you breath, to how fast your heart beats, to muscle growth and recovery. Pretty much everything relies on the thyroid hormone.
But if someone comes in and their 50lbs overweight, it's very unlikely JUST thyroid imbalance. Studies show that if you have an underactive thyroid, it's maybe 10-12% abnormal gain in body weight, but that's about it.
However, there is some thought that those of us in functional medicine are a lot more likely to treat what we call SUB-clinical-hypothyroidism. This means that if you go to your family doctor, your TSH is elevated and your thyroid hormones are low, your doctor will say "Okay, your thyroid hormone is low, here's some medicine for hypothyroidism."
I do things a little differently, in that I diagnose people in sub-clinical-hypothyroidism. They may have all the symptoms like cold intolerance, mental clarity issues, constipation, hair thinning, eyebrows thinning, dry skin, fatigue, inability to lose weight, can all be linked to hypothyroidism, EVEN if your blood tests are "normal".
I don't like to use the word "normal", I like to optimize these hormones for each individual.
Q: Other "buzzwords" of the fitness industry involve CORTISOL, the stress hormone. Can you tell us more about that and how stress can elevate and hinder fat loss?
Cortisol can cause abnormal glucose metabolism. Cortisol is something we need in the body, it's an anti-inflammatory hormone. If you've heard of steroid shots - cortisol shots - in the joints.
Boosts of cortisol are good - necessary in times of illness and stress.
However, chronically elevated levels of cortisol can lead to adrenal fatigue - adrenal glands releasing cortisol - and over time these chronically elevated levels can cause abnormal glucose metabolism and possibly even fat gain.
Your adrenal glands get fatigued and you may need to reset them.
Now this is more of a lab diagnosis - something I ask my patients about their stressful lifestyle - abnormal sleep patterns, high stress corporate job, lack of sleep.
I believe adrenal fatigue is far far under diagnosed in our society. Our grandparents worked very hard, but when they worked, they worked. They came home and left work behind. But now we no longer leave work behind. With email, phone calls, late nights, work follows us home and the stress levels are not necessarily HIGHER, but they're more PROLONGED.
This can lead to abnormal sleep patters, which causes further issues with cortisol. Now you can measure cortisol levels, but it's difficult and expensive to do so. Cortisol levels go up and down throughout the day, making it difficult to get an accurate measurement. Sometimes it's easier to just treat it than measure it - if you suspect adrenal fatigue.
The treatment for adrenal fatigue is the replacement of cortisol and herbal supplements like ashwaghanda and rhodiola.
Q: ESTROGEN and TESOSTERONE - The big ones. Can you give us a rundown on the role of estrogen and testosterone for fat loss?
For fat loss specifically, estrogen dominance in women (too much estrogen compared to progesterone and testosterone) can cause central obesity, or obesity around the abdomen and lower trunk.
In men, as estrogen goes up, testosterone goes down. Your ability to build muscle and recover is reduced, and we see an increase in central obesity.
Bodybuilders look at estrogen as the enemy. That's not the case at all. It's good for bone health, heart health, preventative against Alzheimer's and stroke, and some estrogen is needed for muscle production and erectile function.
A lot of bodybuilders getting huge fake levels of testosterone and neglecting estrogen could be a leading cause of heart disease in the bodybuilding community.
Q: In general, what’s considered “normal” for men and women?
I dislike the term “normal” when it comes to lab results. There is normal and then there is optimal for you individually. When a lab result is in the “normal” range, it basically means that it is within the range of 95% of a population without a disease.
For instance the Hemoglobin A1c range is 95% of the non- diabetic population. However, what they don’t tell you is that even if your level is “normal”, you may be at a very high risk of developing diabetes in the next 5 years. Most of the modern population is now overweight, obese, and at risk - so comparing "normal" levels is comparing yourself to them.
Well, with hormones the ranges are very large and there may not be any associated disease to eliminate abnormally low values. For instance, in women the accepted range for testosterone goes down to almost zero – I promise very few women with near zero testosterone are living happy and healthy lives.
Another example is that I may have 2 patients with the same thyroid lab values. One has symptoms of hypothyroidism and the other doesn’t. I would be much more likely to treat the one with symptoms with thyroid hormone and more likely to recommend nutritional supplements for the one without.
Q: Do hormones determine WHERE we store fat, or is it totally genetics?
Maybe a little bit of both. Low testosterone and elevated estrogen can make it go more toward the chest and abdomen, but a large part of that is genetics.
To further look into it - look at middle aged guys with large, firm bellies. This is visceral fat. The fat is between the organs pushing the abdominal muscles OUT. From a health perspective, this is the worst case scenario. The fat may not be as jiggly as, say, fat on the love handles. And they may have larger, more defined muscles, but that fat is all around their organs and can cause problems. You can't target an area.
This is why cool-sculpting and liposuction exist - you can remove fat in specific areas with these methods.
Q: What are some symptoms that your hormones are “out of balance”
Mental fog, fatigue, low libido or altered sexual response, depressed mood, thinning skin or hair, poor sleep, inability to lose weight- especially in the mid-section. For women: hot flashes, vaginal dryness
Q: When you measure blood, what are some deficiencies and areas that are most common in men and women?
Testosterone deficiency is increasingly common.
I use that term "deficiency" in a broad term. I have women who come in during their 30s and 40s who have no detectable testosterone.
The most common hormone treatment I prescribe is testosterone. Many men and women are within the normal range but have symptoms of testosterone deficiency such as poor sleep, reduced muscle and increased fat, poor recovery from exercise, low libido and mental fog.
I'm seeing men come in who are in their 20s who have low testosterone. Sometimes due to a medical condition, but a lot of this can be caused by lifestyle factors. I personally think having a cellphone in your pocket could lead to some abnormal testosterone production. Chronic stress and lifestyle, chemicals in foods, radiation from devices, can all contribute.
Women are much more likely to have iron deficiency due to menstruation.
Women are about 7-10 times more likely to have under active thyroid function.
Vitamin D deficiency is common in both. I would estimate 65-75% of my patients are low in vitamin D. Low vitamin D levels has also been correlated to insulin resistance and type 2 diabetes. We've known for decades that low Vitamin D could lead to depression, weak bones, and low mood. But now we're finding that Vitamin D can have anti-cancer effects and immune function.
I take Vitamin D3 with Vitamin K - I also take a supplement called TH1 support from Pure Encapsulations. I recommend 5000 - 10000 IUs of Vitamin D with 80-120 micrograms of Vitamin K. The Vitamin K helps prevent the buildup of calcium, which is triggered by the increased Vitamin D.
Be careful with your supplements. Many over-the-counter supplements have been tested and shown to have little to no active ingredients. Where you get your supplements is important.
I personally use Metagenics - which I sell in my clinics.
Q: Can female hormone imbalances cause a weight loss plateau?
Absolutely! This is especially true for estrogen dominant women who typically gain weight in the midsection.
Q: I often joke that Testosterone is a heck of a drug – and men have an easier time losing weight than women. What can women do to level the playing field?
I prescribe testosterone for women all the time. Are they going to build muscle like men? No, but we can definitely improve their ability to build muscle, burn fat and recover. Many of my treatments such as weight loss medications, HGH boosters, etc. are the same for men and women.
Another reason men can lose more fat than women is the larger baseline muscle mass. Men can have a higher baseline metabolic rate due to the larger percentage muscle.
Q: One of my younger male clients (35) recently asked me “When do we peak?” I semi-jokingly told him it’s all downhill from here. In your experience, when do we peak? Does exercise alone reduce the rate of decline?
Exercise does give you an advantage. However, from a hormonal standpoint, yes. Sadly, about age 25. Human Growth Hormone may start decreasing as early as age 20. Testosterone peaks at about age 25 for most people. Yes, exercise does reduce the rate of decline of the body in several ways. Resistance training may help preserve hormone production, improves bone and ligament/tendon strength, and increases muscle mass.
Exercise reduces obesity, diabetes, cholesterol, improves mood, and helps keep blood vessels healthy.
Q: On your mention of peptides - can you go into details on this? I know of some people who take them and you say it offers a benefit. What exactly are peptides, what do they do?
Yes totally different than testosterone. Growth hormone is a completely different pathway. Growth hormones peak when we sleep, but they start to decline about 1-2% per year after age 25. Our ability to heal and recover declines.
Peptides are just molecules that are technically too short to be called proteins. Insulin is a peptide.
Frequently used peptides now are all growth hormone secretegogues, meaning they stimulate your body to produce more growth hormones. They have also been shown to heal bone, muscle, and tendon injuries.
I believe peptides are a big portion of the future of medicine.
Q: Is there a relationship between obesity, overweight, and hormone imbalance?
Yes.
This is a complex topic and could also be argued as the chicken vs the egg but the basics are: Those with excess body fat are definitely at a higher risk for hormone imbalance.
Excess fat can lead to elevated estrogens and reduced testosterone. Also, excess estrogen or low testosterone can lead to increased body fat. The hormone imbalance can lead to or exacerbate the unhealthy body composition but frequently unhealthy lifestyle and diet can lead to both.
Q: I’m always fascinated with the discrepancy of clients who trained / exercised when they were young – and the clients 40+ who have never exercised and suddenly want to be a paragon of fitness. There’s a noticeable difference between their mental and physical learning curves – could this be a deeper issue too? In your experience, do people who “start young” have a biological or hormonal advantage over those who start later in life?
In my experience, those who were more fit during adolescence are able to regain that fitness easier than those who were never fit. I think this is due to a few variables (these are only my opinion)
1) Muscle memory/tendon strength – for instance someone who has done weight training for
years likely has stronger tendons than someone who has never performed weight training.
2) Mental preparation – they know how difficult it is to train regularly and to push themselves in training because they have done it before.
3) Often these patients seem to be less overweight to begin with.
There is something else not fully understood by research, but muscle "cell memory" is believed to be related to resistance training. Resistance training - especially when young -may make muscles cells grown new nuclei or form new cells. Even after periods of inactivity, you don't fully lose these number of cells, but they make shrink. This may be why it's easier for someone to grow muscle later in life, when they have had it before. This is why exercising in adolescence may be especially important.
Q: Let’s take two imaginary clients – one a young, 30 year old male and another older 55 year old male – both want to lose fat, build some muscle, and have more confidence. Let’s say both are in the“normal range.” What would you recommend to the younger client vs the older client as far as nutrition, supplements, exercise, and medical interventions?
Well, the biggest difference here is age obviously. The 30 year old will have a large advantage on endurance, healing, hormones, and so on.
Part of what I do is to help even the playing field by making the 55 year old have testosterone and growth hormone levels like that of the 30 year old. That isn’t to say that things can’t be optimized for the 30 year old but there may also be some limitations such as future children.
The other biggest difference will be risk of injury and disease. Many 55 year olds are at risk for heart disease whereas it would be very rare in a 30 year old. I would be more cautious from a cardiovascular perspective for the 55 year old and would likely not push training as hard initially because there is likely a higher risk of injury to tendon/ligaments or cardiovascular risk.
For a 30 year old (assuming they want children in the future) – I would use medications such as HCG/Clomiphene to boost his own testosterone production while preserving sperm production, CJC-1295/Sermorelin/Ipamorelin to increase HGH production and release. This would allow him to push harder for faster gains on muscle.
For a 55 year old, he would be able to start Testosterone Replacement Therapy without worrying about sperm production (assuming he's done having kinds) so testosterone levels will become optimized very very quickly. This would give him a competitive boost compared to a 30 year old. I would also start him on peptides CJC-1295/Sermorelin/Ipamorelin to increase HGH production and release.
Q: I know of many people who compare medically supervised hormone therapy to that scene from Rocky 4 where Drago is getting injected with a needle while Rocky is training in a barn. What do you tell people about the safety and efficacy of hormone replacement therapy?
Nothing I prescribe is intravenous. We don't inject anything into the veins. Most of them are intra-muscular or subcutaneous injections.
There is a big difference in hormone replacement therapy and taking illegal steroids.
I do think the stigma is going away.
I also think society as a whole is now a dichotomy of very healthy people and very unhealthy people. Two extremes. Just over the last 30 years, male testosterone numbers have dropped by 30% on average.
So I think to me, I want every advantage I can get to help prevent and slow aging and to give me the physical fitness I want. Sure, I go to the gym and workout, but I want my time in there to be as optimal as I can make it, and I want my results to be as good as I can get, safely.
Hormone replacement therapy is very safe when properly supervised. Much of my practice is bio-identical hormone replacement therapy, meaning these hormones are chemically identical to the hormones in your own body, and many studies actually show improved longevity as well as possible reduction in obesity, diabetes, dementia, and cardiovascular disease.
Q: What can people do naturally to optimize their hormones and maximize fat loss results?
1) Sleep 7-9 hours per day
2) Reduce processed foods and sugar intake
3) Moderate alcohol
4) Exercise at least 120 minutes per week
5) Proper nutrition/supplementation
Q: What’s your fitness routine like?
This is one reason why I wanted to get in touch with you. I struggle to keep things fresh and interesting. I don’t enjoy running and I have ADHD so it makes certain classes etc. very unappealing to me.
I enjoy the strength and muscle gains that I get from heavier resistance training but I also understand the health benefits of cardiovascular exercise.
Currently, with the COVID situation, I do moderately heavy resistance training for 45 mins 3 times per week – twice for upper body and once for lower body. I also do HIIT training mixed with elliptical twice per week.
Q: What supplements do you take?
Prescriptions:
Testosterone – I have tried cream, shots, and pellets. Each have their advantages but I probably prefer pellets.
Clomiphene: helps maintain some of my own testosterone production while taking testosterone
CJC-1295/Ipamorelin – this is a peptide that increases the production and release of Human
Growth Hormone
Supplements:
Vitamin D3/K
Vitamin C
Fish oil
Magnesium
Thyro-essentials - contains Ashwaganda, vitamins A/D/E, selenium, zinc, and B12
Uro-pro contains Pygeum bark, pumpkin seed, saw palmetto, grape seed extract and vitamins for prostate health.
TrueFit protein powder- contains 25g whey protein, 8g prebiotic fiber and no artificial
sweeteners
Th-1 support that contains berberine, chinese skull cap, zinc, broccoli extract, and ginger root – this is to help boost function of my T helper cells for antiviral activity during the pandemic.
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