The Lasting Effects of Long COVID on Hormone Health

0:00 Webinar Begins

6:30 Long COVID papers

8:10 So, who’s getting COVID? Who’s dying?

9:56 Endocrine Health Matters

11:48 COVID – Female Hormone Patterns

21:05 COVID – HPA-Axis Patterns

28:36 COVID – Androgen Patterns

35:21 COVID-19 Recovered Case Studies

45:49 Q&A Begins

1:09:23 Webinar Ends

 

0:00 Webinar Begins

So, without further ado, please join me in welcoming Mark Newman.

0:05

Welcome, Mark, and we love your tie.

0:07

Thanks. Thanks, Tim. Had to get in the holiday spirit here. This is actually an old hand me down.

0:14

My father-in-law used to always wear this for holiday parties and such, and so I'm carrying the torch with the holiday jacket.

0:23

So, I thought would… I'm dating this webinar a little bit in doing that, but I think it's worth it's worth the risk, so we got to get the holiday spirit. So, this is one of the most interesting webinars I've prepared for.

0:37

Easily the one where I had to check back in every couple of weeks and months after I finished this because the literature's just unfolding on, as life unfolds, as we're still in the middle of this COVID mess. And our providers and all of you are in this really key position of getting to pick up the pieces from people's lives that have been impacted by COVID. So, some complexities to this, some really interesting things that I did not know that I learned about both reproductive and adrenal hormones and how those are changing, thanks to COVID, so we're going to talk about that here today. There's going to be a bit of a difference between male and female hormones in males and females and how COVID impacts that.

1:23

So, we're just going to be referring to biological males and females and nothing more complicated than that.

1:31

You know, I made this before COVID, as I was just sort of thinking through the complexities that our providers have, that you all have.

1:40

When patients come to you and say, I'm tired, as an example.

1:43

Like, OK, well, we've got immune things going on, we've got reproductive things going on. We've got adrenal things going on, and they all make this big soup.

1:51

Then, you get to try to figure it out, right?

1:53

And now with COVID, it's become even more critical that we consider the intersection of these things, right?

2:00

And so, our job is to represent, as comprehensively as we can, the reproductive and adrenal components of that, so that you can take these complex problems, break them down, figure out what's dysfunctional and what solutions there might be for that. So functional medicine, before we came on the scene, was a lot of this, like to test some of your hormones and serum when you get the cortisol is… OK, I've got an out of saliva. And for that, because I want to see that up and down pattern of not just cortisol, but free cortisol throughout the day. So, we began our process and say, well, you know, maybe we can create a more comprehensive way to look at that. So, we started in terms of our investigation with some of the sex hormones and say, OK, if we can test,

2:40

not just estrogen, right? Not just estradiol, but also the metabolites. Let's look at E1 and E3.

2:45

Let's look at the phase one metabolites of 2 Hydroxy, 4 Hydroxy, 16 Hydroxy, let's look at methylation, which is part of Phase two.

2:52

We want to look at that, and then we want to put it to the test, right?

2:55

Put that data out in the peer-reviewed, so we looked at our assay versus serum. Strong correlation, our assay versus a true 24-hour jug of urine correlation.

3:06

Good, strong correlation, liquid versus dry. So, we put that out in the peer-reviewed literature, moved on from there, and looked at the other estrogen metabolites, the androgen metabolites, melatonin, the organic acids. So, we've taken all of these and really put them to the test and put that data out in the peer-reviewed literature so that you can have a lot of confidence in what we're doing, which created

3:27

this more comprehensive way to look at hormones.

3:30

The last piece of which, sort of conceptually is OK, can we look at the cortisol pattern? We can look at the cortisol pattern, that free up and down pattern throughout the day, in a urine sample. Now we've really got something comprehensive, and that's something that we've published, as well. It's looking at the up and down pattern in saliva. The up and down pattern and dried urine, with strong correlation, and we published that as well, which makes this a really complete way to look at hormones. And that was, our initial offering was the DUTCH Complete to look at all of these things, and with COVID, things like oxidative stress, and melatonin have become even more relevant to just overall health for some of these patients. As the literature evolved, then what we found, is that the up and down pattern of cortisol is a really critical piece. But there's another piece that we want to look even closer at the HPA axis and cortisol to see one more piece of the cortisol awakening response, right. And so, the literature says, that's relevant. We said, we agree, and so we developed, oh, 5, 6 years ago,

4:34

The DUTCH Plus, which is a combination of salivary collections, dried urine collections, to get even more comprehensive as it relates to cortisol, which is super relevant to our conversation today, related to COVID. Now, just by way of update,

4:50

Since then, we've also pushed into the clinical side of it, in terms of our publishing, looking at, initially, HRT which also relates to COVID, and we're going to talk about that, whether we should continue it, whether we should discontinue, well, it depends on what we're talking about, whether we're talking about estrogen, DHEA, different answers there. But we started with really critical question of, can we monitor patches, creams, gels? We've looked at that data and we published that data with NAMS and some abstracts showing that when you look at the dose, that's increasing for a patch. So, here's your lowest effective dose of zero point zero two five milligrams, which pushes our results often out of the post-menopausal range, and not into the premenopausal range.

5:35

That's the point at which we start to see clinical efficacy, and we see that linear dose-dependent response in our testing with both patches, as well as with gel.

5:45

So, again, the lowest dose that works according to the clinical data pushes your women up and out of that post-menopausal range, doesn't need to go into that luteal range. That's kind of that sweet spot that we're having people shoot for. Those nice to see, the data for that correlating in a way that made sense with the clinical data. So, we presented that this year at NAMS and that's there'll be some more exciting things to see from that in the future.

6:09

This as a full-blown manuscript is just getting ready for submission for publication here in the next couple of weeks. So, you can look for more of that.

6:18

All of that gives us, again, the most comprehensive way to look at reproductive and adrenal hormones, to see how that interacts with the complexities that are going on

 

6:30 Long COVID papers

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with COVID, because it's complex. So, here's a little paper where they're looking at people with COVID,

6:37

what's wrong with them afterwards, that may be related directly or indirectly to COVID. You can see that big one at the top. There is the one you probably see most in your practice, which is fatigue. But look at that list of all those other things that we're seeing a little bit in patients that have had COVID.

6:56

And, again, there's an overlap between whether those were linked to reproductive hormones, adrenal hormones. So, we need to take some time and go through that, which is what I've done, and some really interesting things

7:07

in the literature, here's another presentation from another paper, Long COVID Symptoms.

7:12

And again, you can see fatigue leading the charge, you know, here are your non COVID people and then, wow, lots of fatigue. Right? But then also some of these other things, depression and anxiety, to a lesser degree, but still things that you're dealing with.

7:28

The same paper looked at insomnia, right? Which is something that we really like to use that DUTCH Plus for, to look at cortisol in the middle of the night.

7:36

If you look at the baseline, there is not a huge increase.

7:40

But all of those groups are separated from the healthy controls in terms of struggling with COVID.

7:46

And of course, our job with the DUTCH test is to say, well you know we have a few rocks you can look under in terms of what might be the causal factor there. Is it too much cortisol at night? Is it not enough melatonin?

7:58

Those are things that we can look at with our testing as we start to explore the things that are coming up for your patients who are struggling in their recovery from COVID.

 

8:10 So, who’s getting COVID? Who’s dying?

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So, this is not going to be new information but who's getting COVID, and who's dying from COVID?

8:15

We know men are getting it more often, we know they have a higher fatality rate. So, here's one such study that shows, you know the men are leading the charge when it comes to getting COVID and also dying for COVID, but now this one's a little bit boring if you're really into the hormone side. So, I've got one that's much more interesting for you.

8:34

This study shows that men have higher fatality rates.

8:39

And what you can see, which is what drops us right into this hormone conversation, is, when does that, that gap start to close? Right in that 50 to 59 categories. So, what could possibly be going on, right about here, that's causing some sort of transition where the women are less separated from the men? Well, of course menopause, right? So, there's a hormone story that overlays with these fatality rates. And then we look at, this is, I found this really, really interesting.

9:09

You look at the prevalence of getting that disease, and you can see that pre-menopausal women are actually, this black line represents equal, right?

9:17

So right there, men and women are getting it about the same, right? And then as you get out, this gap here represents men getting COVID more than women.

9:27

And right here, you can see that at that phase of life, women are actually getting it more than men.

9:32

So, at menopause, you're getting this, this transition where men start to get it more and women started to die from it, the gap there, the protection of just being female in terms of mortality rates and COVID starts to cozy up. So, we're going to come back to this. This is a really interesting presentation, and we're going to unpack this a little bit for you.

 

9:56 Endocrine Health Matters

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Getting into the cortisol side, not going to get into the specifics of this study. But it just shows that for people that have severely compromised cortisol production, because we're not talking about people, or kids in this case, that have slightly low cortisol, right? We're talking about adrenal insufficiency.

10:12

And if a child happens to be in that camp, they're more likely to have a fatality as it relates to COVID, right?

10:19

So, endocrine health matters, right?

10:23

Reproductive hormones, adrenal hormones, like this stuff, is really inter-connected with how well people are dealing with COVID, and we need to again unpack that a little bit. While we're talking about children, I do want to just say this, this is one, and I talk about this unfolding, right?

10:37

This is one I just added today to my slide deck.

10:41

Is that children may experience long COVID symptoms. Yes, it's going to be a lower percentage, probably a much lower percentage.

10:48

But in this study, we're, where are we, Sweden, and they're talking about five kids, right? Out of how, how many kids, I don't know?

10:56

But when those, those individuals come to see you, you know, we need to know how just to start exploring solution for some of these patients, So COVID is an issue across all demographics, but, of course, much more likely in certain demographics.

11:15

So, the COVID endocrine patterns, what do we look the relationship?

11:20

It's bidirectional between COVID and Endocrine System.

11:23

It's occurring at multiple levels in the brain, let’s start there.

11:27

Men are going to have higher LH, but higher FSH, higher prolactin, lower TSH. So, the thing that's stimulating thyroid hormone, that's going to be lower ACTH, that's stimulating

11:38

cortisol production, also lower, growth hormone, lower.

11:41

So, we've got some interesting patterns that we're going to pick up there in our COVID patients.

 

11:48 COVID – Female Hormone Patterns

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Now, let's take a trip through the patterns that we're seeing in females. And we know women have been impacted more than men in terms of COVID itself just in the practicality of life, right? This second point I'm making, COVID has brought increased childcare challenges and the consequences of this have fallen disproportionately on women. I don't think we need a study to know that that's true in a lot of situations, right?

12:11

That the burden on, on women has been pretty significant in terms of those challenges, and of course, when you do that for years at a time, there can be an impact on your health, and those are the people that find their way into your practices. So, we want to look at the types of patterns that we're seeing now.

12:28

The literature doesn't describe, and I was really curious about this, just digging through as many papers as I could find to see, OK, what kind of patterns that we've seen in COVID people? There's not a huge impact directly on female reproductive hormones found. A couple of studies that say with Sars viruses, generally, you get slightly lower estrogen, and progesterone, but nothing that like, overt, and definitive in terms of huge patterns, right?

12:52

The bigger variable here, is just the stress, that all this is, all the impact of stress on our female patients.

13:03

So, we do find, is that women have more irregular cycles, because of COVID. Well, indirectly, right?

13:09

The anxiety and stress of COVID, and the impact of all of this, can lead to that. So, here's just a study with our concluding look.

13:17

The current study shows the association between pandemic induced anxiety, stress, depressive symptoms, and all of that leads to what? More menstrual cycle irregularity and this would happen to be a study in health care providers. So, there's something that you're going to find in your practice, is just whether it's COVID, or divorce, or whatever, if you've got like a serious stressor, and you can find irregular cycle. So, here's an example. I went and found two people that tested with us, that had COVID maybe, like, 6 or 9 months ago, right? Say, OK, what do they look like?

13:50

These are people who did cycle mapping with us, and I will use this as a little bit of a plug for the fact that, if you didn't notice, we updated our cycle mapping report. It looks like this now. So, we used to have E1 and E2 on the same graph, which is a little cluttered to pedestrian metabolites, same graph. different scales a little bit better. So, it looks like this now. What do you know?

14:11

It's with this woman is so that the normal range is between these gray spots here, right?

14:19

So, we're expecting an ovulatory surge, which we see, and then we kind of plateau in the Luteal phase, right?

14:27

So, that's pretty normal. Like, it's pretty picture perfect.

14:29

We're hoping progesterone gets up into this neck of the woods and both the metabolites do, so we know that this all correlates to serum, so good for her, she has actually recovered pretty well As it relates to a reproductive hormone, we'll see later that our cortisol is not in such good shape.

14:45

OK, so, just a one minute aside on what we've done slightly differently with the Cycle Mapping Report, is what we do that we, we didn't have before, district outlined very well in the cycle mapping report.

14:57

But now it's more explicitly stated is that when you look at this sample right there, there's a sample number eight, which the main pedestrian metabolite is the biggest.

15:07

So, that means that's what that is by definition luteal for her.

15:11

So, when you when you do a Cycle Map with a DUTCH Complete or with a DUTCH Plus, and you go to the estrogen/progesterone section of the DUTCH Complete, or the DUTCH Plus, it's going to be this day that we look at estrogen metabolites, all of them, and the progesterone metabolites, right?

15:29

We were finding luteal, then we're saying, here’s what she looks like in the luteal phase as it relates to those female reproductive hormones. And it's just stated a little bit more explicitly for you there with that purple color coding there.

15:44

So, a little bit nicer report, but again, this woman she did great, this woman, not so much.

15:49

Alright, so for her, crazy estrogen, then what does progesterone looks like?

15:54

Well, if I go over here, I can see ovulation was supposed to happen there. So, then you asked the question, but did the progesterone bump up?

16:00

Sure did, right, but not high enough. So, that's ovulation, but insufficient progesterone, right?

16:06

So now, again, we're looking at the max beta pregnanediol. That's the main progesterone metabolite, the one that's most in the literature, so we say that's the middle luteal phase that we can get and that's where your DUTCH Complete is based on, now why would you do a cycle map?

16:21

Well, this is a really good example, because on that day, let's say you collected on just Day 19, what you get is an estrogen that's, I mean, it's high normal, but it's normal.

16:31

Right? But you can see, on other days like she's making a lot of estrogen.

16:36

Right, and even more estrone, OK, maybe irrelevant for her. And what you find with progesterone this is what I really, really love about Cycle mapping, is did she ovulate?

16:47

Yes. Right. after we're the place where you expect ovulation. Do we get a wave of progesterone?

16:55

Yes, It's not a tsunami, but it's a wave. So, we say, well, what's your story? Your story is your estrogen… Kind of crazy.

17:01

But you are ovulating. And you have estrogen dominance. Why? Not because you're not obviously. But because you're ovulating, but not making as much progesterone as is ideal, right? So, there's something actionable, now, is that, due to COVID, is that due to stress?

17:18

You know, I don't know definitively, but this is the type of patient that you're looking for to say, OK, her dysfunction that she has following COVID, it may well be partially due to the havoc that the stress is wreaking on her cycle.

17:33

Now, we'll get back to both of these patients, and what the rest of their profile looked like towards the end, OK.

17:39

So, as we said, stress, irregular cycles, that's a thing, OK. Your women with PCOS, you're going to want to look at our androgen profile on that, right? Testosterone, DHEA, but also that five alpha metabolism, PCOS women are at higher risk of and from COVID.

17:54

There's some evidence that progesterone is helpful with COVID, meaning the higher your progesterone. The better you're going to weather that storm.

18:01

Estrogen has a really interesting and, complex, and somewhat paradoxical relationship with COVID. One fact that is interesting is that it can act on cellular subsets of the immune system, by epigenetic mechanisms, resulting in modulation of lymphocyte activity.

18:19

And so, all that to say, females may clear the virus better than males.

18:25

You know, and maybe that's something to think about for your patients on estrogen replacement therapy, but the, the complex nature of it, I think, is well stated with this picture.

18:37

OK, so estrogen has a permissive role on ACE 2 expression.

18:41

So, this thing right here is, allowing us, says pre-menopausal women with normal hormone levels to get COVID slightly more regularly then, or more easily than a man.

18:57

So, higher disease rates.

18:58

Slightly and lower rates compared to men when you get to the post-menopausal phase, when those levels go away.

19:06

But, and thankfully for our women, Ace two has a protective role against disease progression.

19:13

Alright? So, we have a lower mortality for, I mean, look at the difference here.

19:17

That is just huge, right? So, there's protection there from COVID, even though you're a little bit more likely to get it.

19:24

Then again, both of those trends head in the opposite direction, as soon as you hit the age of menopause really, really interesting. Right?

19:32

So, we need to think well about that.

19:34

Now, then that natural question is, well, then, what about HRT? They didn't address that in this paper. Haven't found a ton of data on HRT.

19:43

Here's one with some interesting stuff where they said women on HRT have lower likelihood of death.

19:49

They tested a lot of women.

19:51

We looked at data from a lot of women, but this is not peer-reviewed this, but this is somebody's data.

19:56

It's interesting. It's preliminary.

19:59

But when you add all this together, uh, I wouldn't say, I would say you cannot justify getting off of your female HRT, because of COVID and risks. I think you could make a stronger case to say, you should stay on it, and maybe you could even make a case that using that

20:20

as therapy, that's something people might be thinking about. Not sure we have enough data to really draw those connections and associations strong enough to say that. But it is interesting to see the types of trends that we're seeing and the protective role that estrogen seems to play it as far as outcomes with COVID.

20:41

I don't want to talk about this one, I just thought this was a pretty picture you might want to see as it relates to androgens, estrogens,

progesterone, and the types of impact, uh, that they have on the different sort of facets of what's going on with

20:57

COVID. OK, so that's female hormones, right, some interesting but complex connections going on there.

 

21:05 COVID – HPA-Axis Patterns

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Let's talk about cortisol.

21:08

I said, I've got two lists here, on the top, I've got the list of things I'm not going to talk about. But you might find them interesting.

21:14

So, you can read this statement and dig into that if you'd like.

21:18

Then we've got the bottom, the bottom of the list of stuff that’s really related to what we're doing with the DUTCH test. So, let's start with this top point that its sort of already, and that is, those with adrenal insufficiency are at higher risk of infection and higher mortality. And that second point I found in a few different papers, not a recommendation from me.

21:37

It's just stated in a few papers and say, look, if you're on hydrocortisone therapy, and you’re positive for COVID, a lot of those papers, they're recommending increasing that dose.

21:51

What's very relevant to us when we talk about adrenal insufficiency, this is a 2015 blog that I wrote on this issue of adrenal insufficiency induced by medications, and the data on this was really, really fascinating.

22:08

So, this is the paper that these blogs are based on. Feel free to read that. It's available online.

22:16

Couple of numbers that I want to point out.

22:18

We're talking about, you've taken something.

22:22

Doesn't suppress your cortisol, OK?

22:24

4%, glucocorticoid by nasal administration, about 7% in inhalation of corticosteroids, OK?

22:34

So, I've got these patients that are on products that, especially in allopathic doctors thinking about oftentimes the fact that those may suppress the person's endogenous production of cortisol. So, something you need to be thinking about is if you have patients on those things.

22:49

You don't know whether their cortisol suppressed, but what the data suggest is if it is suppressed.

22:54

That may be an issue for them, if they should get COVID in terms of their likelihood of having a successful outcome, right?

23:03

So, the other thing that this study showed is that people who have suppressed cortisol, do tostuff they're taking, it last for a long time, in a high percentage of patients, meaning a meaningful percentage of those patients that suppression lingers long after they stop taking the corticosteroids that were responsible for that.

23:23

So, another may be encouraged to ask a lot of questions, all right.

23:28

What if they took inhaler corticosteroids for a long time, but they stop six months ago?

23:33

Maybe they don't even tell you that, right, when they come to see you.

23:36

But six months is not long enough to be assured that if that suppress their cortisol, that they've necessarily bounce-back, right?

23:42

And again, with COVID, this becomes a more serious situation. So just be aware of that.

23:48

So those were the adrenal insufficiency, like that's a big deal in terms of COVID, though I'm going to skip by that next point. And let's just read through these bottom ones, because then that next point is going to be our biggest one, OK.

23:57

So, hypocortisol, happens a lot, hyperthyroid happens a little, but 5%, one out of 20, right? Where did those what are the twenty go, they go to you. Right? Thank you, to see you. say, I'm struggling, helping, right. So, you're going to see some of those, as well. We know that we don't test thyroid. We've always said, listen. You can test thyroid in urine. It's, you know, it's information, But it's never going to be as good as what you can get it.

24:20

So, when you're testing your patients with the DUTCH test, usually, do a thyroid test too, you're going to want that, OK? So, low TSH, low T three, T four, that's relevant because of thyroid, but it also impacts their cortisol. So, that's important. And then, I throw the melatonin on here as well, there is a relationship between Melatonin and this COVID story. Not going to get into that in any great detail, but it is a point of connection.

24:45

And this is the one that I really want to hone in on, let me just go to the paper.

24:54

40% had evidence of central mild hypo-hypothyroidism

25:02

follow this with me, OK, three months.

25:06

After recovery, 40% had hypocortisolism.

25:11

Here's an interesting point that's really important to tease out of this.

25:15

They didn't get glucocorticoids as treatment. Right?

25:19

So, we've all seen people who got COVID and taken it like Pregnazone. Right? So that's not that this is not people taking glucocorticoid. These are people, this is just an impact of COVID itself. It seems, right?

25:30

40% hypo Cortisol and hey, congratulations, over 60% of those people are well within a year. So, let's do the math one this.

25:40

61 people they studied, nine out of sixty one are still, think about this on cortisol after a year.

25:49

According to my phone, 50 million Americans have COVID, right?

25:54

So, we're talking a 961 that's over seven million Americans, right, that are sitting there.

25:59

And you know, whatever country you might be in, a lot of people that might be sitting there struggling to COVID nine months ago, 10 months ago a year ago, uh, and I'm just struggling. Like, I'm tired, that's the biggest thing, right?

26:14

Well, a lot of those people are, and these are not, these are just, normal people that get COVID in a year later. It's like, man, I'm tired. My cortisol's low. Right? That's a big deal.

26:25

Interesting to push further and ask the question, why and how.

26:29

Alright, so this is really interesting. From a mechanism standpoint, is OK, my cortisol low a lot.

26:36

These viruses have amino acids that mimic ACTH.

26:41

Right now, you are going to create antibodies that are capable of destroying your circulating ACTH. Remember ACTH is

26:48

that signal, brain gets stressed, brains spits out ACTH to your adrenal glands, sees it and goes, hey, time to make cortisol. Except where’d it go?

26:57

Right. Well, the antibodies got it. OK, so this paper, really interesting little graphic here, and we'll, we'll make these slides available, so don't feel like you got to do 94 screenshots here while I'm talking.

27:07

Let's look over here.

27:08

So, we've got COVID is central, ACTH mimicking stuff made by COVID.

27:15

And then how does your body respond antibodies towards ACTH, which is why I'm not saying this is the only reason,

27:24

but there's an actual, definitive mechanism there of what leads to lower cortisol in these patients. Right? And it can take a long time for these antibodies. Why say a lot that I have no idea.

27:35

Like, do they stick around for life, do they stick around for months? I'm not entirely sure on that, that’ll be interesting to track in the literature over time. But what we see is, there's a reason for low cortisol.

27:46

Now, what's the solution to that? I'm not prepared to tell you what the solution to that is. But just to know, that the consequence of that is going to fall on some of your patients, and they're going to come see you, and we got to deal with this, right? So that's a really interesting.

27:57

So, low cortisol is a really big deal, when it comes to, COVID, and there's no better way to explore the question of how's your cortisol doing?

28:07

Then, to do a DUTCH test, all right. Before this is now our transition point, let's transition to testosterone, testosterone is lower.

28:16

And while we're here, we can see that we're getting higher LH, right? We're getting direct effect light cells, and we're getting lower testosterone, OK?

28:26

This is really important, but it's not simple at all. So, let me just show you what I've found in the literature and then we'll talk about a little bit 'cause it's going to cut in both directions, OK?

 

28:36 COVID – Androgen Patterns

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We know men get more infections, worse outcomes, higher LH, OK? So, here's kind of the crux of kind of what's the middle of this, is the ace two receptors and the TMPRSS2 write these things, help SARS enter the cell?

28:54

They're abundant in the testes, right?

28:57

So, now, like, the testes has actually become like a viral reservoir for COVID.

29:03

So, there's a big piece of your difference between men and women.

29:07

And how they respond to COVID, is the way the testes work is, like, opening the door, come on it.

29:14

Right? So, LH is elevated, testosterone low. What does that look like?

29:19

That's that primary hypogonadism picture.

29:23

Right. As opposed to someone whose brain doesn't make LH. This is someone whose testes are up to the job. And so, the brain's like, hey, let's get going. I'm going to make you LH and the testes are like, oh, I'm kind of full of COVID, so, no. Thank you. Alright. So, the lower testosterone, OK.

29:41

Here's what to tell you, two stories that oppose each other.

29:46

I'm not necessarily going to solve this.

29:48

I just want you to see that one, it's complicated.

29:53

Two, we cannot dare, you know, whenever the picture is changing this path, cannot look at one study, and go, aha, I've got it, and then move forward confidently, right?

30:03

This stuff that's complicated, OK, Less COVID For those on prostate cancer-related anti-androgens. So, these are inhibitors of this TMPRSS2.

30:12

Right, and they seem to help COVID. So, that's like an anti-androgenic medication that’s meant for prostate, and then you look and go home they get less COVID, that's interesting.

30:22

Maybe the androgens are a problem, right, androgens have an immunosuppressant effect.

30:28

This guy that wrote this paper this Gabrin sign, if I remember this correctly.

30:33

Uh, Spain or Portugal, I forget, which he had androgenic alopecia, and I believe he died of COVID.

30:43

But what they noticed there, is people coming in hospitalized with

30:48

COVID have more androgenic alopecia, which means I'm going bald? Why? Because of androgens? Because I'm making lots of DHT, then COVID is worse? Hm. Hm. That's interesting.

30:58

Maybe low testosterone is good. Maybe it's bad. Right. There are sort of conflicting messages.

31:07

When because you have this androgenic effect causing this baldness, then I'm having worse outcomes with COVID, but to say, OK, it's high testosterone bad? Is low testosterone good? This one I just found today. So, this is like this stuff changing really fast, right?

31:23

Here's a paper that says five alpha reductase inhibitors in people without prostate cancer is normal people taking blockers of five alpha reductase,

31:35

Right? Lower risk for community-acquired COVID.

31:39

OK, so this adds to the story that says, let's just get rid of all these.

31:42

I mean, men are having problem, testosterone is part of the problem. So, if you just got rid of testosterone when we do better, well, there's the other side of the coin.

31:50

...

31:51

Testosterone has anti-inflammatory properties, good, and check this out, men with lower T from this study. Don't do well with COVID.

32:00

Alright, so here are your healthy controls, and here are your COVID patients mild, Moderate, and your fatality, right, now remember that COVID going right into the testes and doing damage, so there's this chicken or the egg sort of question that has to be asked, that doesn't necessarily have answered, yet.

32:23

Which is…

32:24

Am I dead because my testosterone low, and I didn't do as well, or do I have really, really bad COVID, which is really damaging my testes, turning my testosterone low, and I'm dead because of COVID and, coincidentally, have low testosterone, right?

32:40

Chicken or the egg, not entirely clear, OK.

32:44

Here's a study, here, on the right where they looked 10 weeks out, OK. And they said, oh, they have low testosterone, too. So, you say, oh. Well, testosterone’s low, and it continues to be low. Well, it's more complicated than that, but people with COVID have high LH.

33:00

Right. Like, primary hypogonadism.

33:02

In this study, they have

33:04

low LH, so, yeah, you got low testosterone 10 weeks out, but it's, like, it's different in terms of the why question.

33:12

Uh, so, and when this doesn't conclude with me, like, giving you an aha moment, like it's confusing.

33:19

And so, it's hard to kind of figure out, uh, you know, what's going on. So, let's ask this question. Well, look at another variable. What did you put men on testosterone?

33:29

So, this is interesting.

33:31

Recent report has evidence that testosterone supplementation can reduce COVID-19 Cytokine Storm effects thereby, suppressing it and inducing inflammation.

33:39

And this is two things, in opposite directions.

33:43

One, it's interesting.

33:46

And it tells you that it leans towards, hey, maybe testosterone is protective, right? So, OK. That's good. I'm going to put that in that balance of, I mean, I've got a pretty good list on both sides, of trying to figure out, like, what COVID’s role is.

33:58

But, here's the other thing, this is a warning to us as we dig through the literature. You see the reference there, right?

34:03

46, you go dig up that reference, it isn't the data. It references another study. OK, I'll go pick up that paper.

34:10

You dig up that paper, the reference is 2018, so there's a 2018 study about coronaviruses and testosterone supplementation where a conclusion is drawn, that testosterone is protected, then someone cites that.

34:27

Then someone cites that paper, and then they make this confident statement that says, testosterone supplementation can reduce COVID-19.

34:34

But that's not what that study showed that studies, before COVID was even a thing.

34:38

Right. So, we've got to be careful. This is just sort of a general warning that I sort of giving myself, as I'm going through these papers, is just be really careful about where this data comes from, that you draw conclusions before you go and implement it in your practice.

34:51

So, for testosterone, it's complicated, I kind of like the way these guys presented it, is it's kind of a double-edged sword, right?

34:58

So, they say, low testosterone levels in males have a direct correlation, with a high probability of ICU admission, low testosterone bad, right? On the contrary, high testosterone can lead to thrombosis, which is also one of the fatal manifestations of COVID nature, so they're saying, you know, what? Kind of cuts in both directions?

35:16

And that's what I found, is that it's complicated.

 

35:21 COVID-19 Recovered Case Studies

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So, really interesting stuff on female reproductive hormones, on testosterone in men, and especially with cortisol. So, I went back and just dug through a bunch of cases. The two cycle maps that I showed you, those are the two cases that I thought were sort of interesting. I'm going to go through, like, what else did those women look like? Who had COVID 6 to 9 months ago? Remember this one? This was the one that was really crazy. So, her cycle was impacted potentially by, you know, all this COVID-induced stress, and all of that.

35:49

That's an issue that you're going to have to deal with as a provider. If that's your patient.

35:53

What else did she look like? Testosterone was normal. I thought this was going to be this really interesting case of, like, patient. Look how much DHEA she makes. Thing is, she was on a bunch of DHEA, so she's taking DHEA.

36:08

But let's just stare at this for a second before we talk about DHEA, because there's something pretty interesting there.

36:13

Uh, we talked about low cortisol because you used to have COVID, right?

36:17

That is not this, that cortisol awakening response, if anything, is a bit on the big side. Right.

36:24

So, this the cortisol awakening response, if you're not that familiar with it, says this is the diurnal pattern, up and down, up and down.

36:32

But if you look in saliva, right, when you wake up and 30 minutes later, that gap, that's the cortisol awakening response that is an indicator of the resiliency of your stress response, and if that's flat, flatter than it should be, and you've had COVID, maybe

36:50

that's why. I write this patient, that's good and healthy. And maybe a little bit on the big side, I'd have to actually look at the range on that to see, but that's an independent corridor of HPA Axis function, that gap right there.

37:02

So, definitely not struggling with underactive HPA axis.

37:07

So, the total of all of those puts her the high normal side, one thing I will say, is, when the metabolites are on the lower side, and many of you are familiar with this sort of concept, if the free cortisol is high, and the metabolites are low, not necessarily out of range, but different than each other. What would you say? You say, well, they're not metabolizing cortisol, very well.

37:27

The word I like to use is, that's sluggish, cortisol clearance That correlates with hyperthyroidism. So that's someone I would definitely want to follow up and say, OK, how's your thyroid? Right? Because we know that can be an issue with COVID.

37:39

Alright? Getting back to this DHEA.

37:41

Why did you, why would you have a COVID patient on DHEA?

37:46

Maybe because they looked at this paper and said, probably not,

37:51

but patients suffer from DHEA-S insufficiency.

37:57

What they conclude, we propose that supplementation

38:00

of DHEA, right? Might improve COVID patient's ability to survive, like, Oh, OK.

38:08

So, if you have more DHE- S, then it's good for you. So hey, let's taking DHEA.

38:14

But if you continue to search, you'd see what these folks said, which is DHEA, widely used as an over the counter androgen supplement may exacerbate COVID-19.

38:23

So, oh, great, we're getting mixed messages here, right?

38:25

But they even went in to the mechanism, which is really interesting.

38:29

DHEA, that does not say DHEA-S, DHEA. DHEA is an extremely potent inhibitor

38:35

of G6PD, right?

38:37

This has relevance to COVID-19 because that deficiency has been demonstrated to be exceptionally sensitive to infection by human coronavirus.

38:46

So, they're saying, if you have too much DHEA, that bad for COVID, but the other thing said it’s good for COVID. But those are different things, right? So, DHEA is the free form of the hormone. And DHEA-S as a sulfated form.

38:58

Well, how would you get an imbalance of DHEA to DHEA-S?

39:03

Well take a truckload of DHEA and it's going to increase your DHEA levels. It eventually, that's probably going to get converted to DHEA sulfate largely. But it's going to create this imbalance, and DHEA-S is good for you,

39:14

and DHEA is not good for you, just as it relates to COVID, then taking DHEA might not make a lot of sense. Now, I'm not going to definitively tell you: you need to get all your COVID patients off DHEA.

39:26

I'm just saying, we need to think about this, and we need to think well about this, because it is complicated.

39:32

So, DHEA may be something we need to think about, uh, not using in that post-COVID time period. I don't know. That's interesting. So, when you go and search it, you're going to get both stories in terms of, like, it's good.

39:47

It's bad, so that's a little bit complicated, but good to know, OK. That was patient number one.

39:54

These are both young females. Here's Young Female, patient two, the one with a really nice, like that's perfect right there, that’s about as normal as it gets in terms of a cycle.

40:04

Maybe you'd want to progesterone to be a little bit stronger, but that's that's a pretty normal cycle, right?

40:11

So, progesterone not only gets big, but it's still big and going up on the tail end of the luteal phase, which is, that's really nice.

40:21

Uh, OK, so she's this classic thing we're looking for here, where she's not up in this normal range at all.

40:30

Like her cortisol Awakening response, there's some resiliency there. But we're on the low end across the board here, right?

40:36

So, the total for free cortisol, when even later in the day, she's hugging the bottom of that reference range, right? So, this is somebody that, yeah, she's tired.

40:45

Let's look at that now. That's where we got to be careful too with the ranges. She's young.

40:49

She's in her early thirties so she should be, in this part of the range for her age and what's DHEA? It's adrenal androgens, right? So adrenal cortisol production, not so awesome. Adrenal DHEA for her age, not so awesome. So that's something that we would want to look at in a patient like that, and of course, with the DUTCH test, we're going to also explore. You know, she had high estrogens.

41:15

So, we want to explore estrogen metabolism. Oh, that was the other one.

41:18

But we want to look also at the picture of how those hormones are being broken down. Both the androgens and estrogens and the cortisol to kind of round out that picture.

41:29

So where does this all take us? Proper hormone function is helpful. It's complicated, especially with some of these hormones. But being healthy on the hormone front is good for us, in terms of surviving COVID-19.

41:44

Patients with insufficient cortisol, may be at higher risk, especially if they've got that suppression thing going on, right?

41:49

So, pay attention to medications.

41:52

When you're doing the DUTCH test, the people that really have beat down their cortisol production, that's something to be really careful about.

41:59

Estradiol and testosterone, they're important, but their roles are complex as it relates to COVID.

42:07

Discontinue HRT, so for estrogen and progesterone therapy, doesn't seem to me, that it's justified in discontinuing it.

42:15

In fact, you know, there's some evidence there, that you're actually not having a neutral impact, but that you're helping your patrons if they're on HRT, so it doesn't seem to me that it would make sense to discontinue.

42:29

If you get COVID, but with DHEA.

42:32

You know, I think you can make a case there that we want to be really careful about not introducing a variable that's going to make it even harder for us to, for the patient to thrive in the time period after having COVID. So, Long COVID... And this is where the big questions, all right, well, what are we seeing with these long COVID patients?

42:51

And the literature is still rolling out with different patterns and things. Endocrine patterns are still emerging literature, right?

42:57

But hormone dysfunction definitely seems to play a role.

43:01

Low cortisol, low testosterone. I think those are of particular interest. Then, in the female, you know, that cycle pattern, it's also important.

43:09

So those are really important things to be looking at and that's, again, where the DUTCH test really shines, is that we want to look at comprehensively, right? If we've got these complex problems, we want to comprehensively look at reproductive and adrenal hormones, look at the intersection of that with immunity in the patients so that we have good answers for them. And again, this is where I think our testing really excels, that whether it's the DUTCH Plus or the DUTCH Complete, we're getting a really broad look at what's going on.

43:42

With these patients and their hormones, if they're female, I think throwing a cycle map in there can be really powerful to make sure that we're getting a comprehensive look at their hormones, you know, the cycle mapping is going to be more effort. It's going to be a little bit more money. If you're struggling with infertility, you know, for really complex cases. It makes a lot of sense ,for people that don't have that issue or aren't that complex,

44:07

it's really a matter of, you know, is it worth the extra effort and the extra money to be really sure of what that female pattern looks like?

44:15

And that, you know, just kind of depends on the situation, is sort of same as the DUTCH Complete and DUTCH Plus if you really have an adrenal issue. insomnia, no profound fatigue, I think doing the DUTCH Plus always makes sense. one thing to be sensitive of is, it's a little bit more in terms of collection. A little bit can be a little bit overwhelming for patients that don't have a lot of tolerance for anxiety and just being easily overwhelmed. And in those cases, the DUTCH Complete, it's so easy to do. It gives you a lot of data.

44:42

Or you're just missing that one extra point on the cortisol awakening response for the adrenal, I love it. But again, for patients that might struggle with compliance, maybe that's not the best the best answer, so DUTCH Complete, DUTCH Plus, and then the cycle mapping for where you need it. You're going to be in this for a while, right? Like COVID is not going anywhere and the impact from those patients.

45:04

If you could wave your magic wand, which peers did not exist in this case, and make COVID go away, we still have a year or years of dealing with the people whose health is going to be profoundly impacted for time to come.

45:19

So, we need to be ready to do that. I hope that the information in this talk has been helpful for that. It will continue to change, no doubt. There's a lot of data out there being generated right now, and I'm sure lots of papers are being submitted. Again, do be careful, because some of those papers are little, tiny populations of people that are really aren't that much like your population. So, when they say, you know, a certain conclusion, know that you got to look comprehensively and consider the context of the study before we go and have it impact, our practice.

 

45:49 Q&A Begins

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So, I am assuming we might have a question or two on this.

45:55

So, we've got, we've got, yeah, we've got some good time, for some questions, and that will also remind you, the cycle mapping data I've shown in this talk, is our new version of our, just how that those results are presented, which is new as of just a couple of weeks ago. So, if anyone has any questions on that, in terms of how in the world do I read that, or what's different with that, free to throw those in the chat as well.

46:20

And I think Tim or Alan is going to offer up questions if we have some, gentlemen. Do we have any questions?

46:30

We do have some questions. Thank you so much.

46:32

This has been fascinating.

46:34

One of the questions that came through was: Could you speak to the potential cause and treatment of hair loss after COVID?

46:41

Did you see anything in the literature, or what are your thoughts on that?

46:49

So, that's interesting, I have not heard that hair loss is worse after COVID, on an individual basis, if you've got hair loss that creeps up after COVID, then, of course, the culprit that we're usually thinking of there, or culprits I guess I should say the three things that always come to mind are you know an overt folate deficiency? Which is usually the issue, but you can play a role, and then low thyroid which, again, we don't do thyroid, but we recommend you always get it checked into patients when you, when you're getting started. And I would be a place to look, which is probably been on your mind, was asking that question, and then, of course, DHT.

47:28

So, DHT plays a role in that hair loss. If I turn testosterone into DHT, it's three times as potent.

47:34

A lot of that can happen there locally in the hair follicle where I'm taking testosterone and making DHT out of it, and boom, its causing hair loss, right?

47:43

So, then the question of whether COVID itself would push in that direction doesn't make a lot of sense to me.

47:52

But then you will look at the study that said, people who take five alpha blockers do better with COVID.

47:57

So, there may be some relationship there that hasn't yet been well defined.

48:04

And certainly, on an individual basis, you know, it's possible that there's something going on there. But those are the, whether it's directly related to COVID or not, it's those same culprits that we're looking at.

48:14

And that's where, in that particular case, the DUTCH test can be somewhat revealing to say, OK, do you have like, an overt five alpha preference?

48:22

Which means, in the cell there, you're going to get a lot of DHT, and potentially hair loss, and then, you know, dependent, whether you're a man or a woman,

48:30

you've got some solutions there, that you can deploy, those five alpha blockers or whatever.

48:37

But good to know, in the testing, whether that's, you know, a preference that, that the patient had, so could it be related? Absolutely.

48:45

I haven't seen anything of literature that says there's a shift in that direction after COVID, but there are some interesting connections between COVID, and those metabolic patterns that lead to hair loss.

48:56

So that's about as far as I could probably take that, OK. What if one is on corticosteroid when they get COVID?

49:05

Does the research address this or just having recently used corticosteroid, any thoughts on that, Mark?

49:15

There are so many different scenarios where that can be the statement that you make, that my patient was on,

49:21

you know, some sort of glucocorticoid type treatment.

49:26

And there's so many different ways that could look, you can be on a low dose local. I mean, the simplest version is, had a rash on my foot. And I put some hydrocortisone which is cortisol. Oh, my foot. So, you're not going to really get any treatment outside of your foot. It's like it shouldn't have hardly any impact.

49:41

And then you got people on full online prednisone, long term, to where when they get off of that, their cortisol can take a long time to bounce back. So those two patients are sort of your extremes and they're really been different from each other.

49:52

So, the questions that you want to be asking yourself is one, am I continuing to take this stuff? So, if you have to continue to take this stuff like, you have Addison’s disease, or some, something that's, that's leading, to long term glucocorticoid use. Then I wouldn't want to make a statement about you should or shouldn't do something. But you should definitely know that it's going to play a role both in what it does to your cortisol, but also, you know, as it relates to COVID itself.

50:16

I mean, if you're on heavy-duty prednisone, I mean, that's something they potentially could give your patient when they come and present with COVID. It's not necessarily common. But it is sort of in the mix of what some people are doing in terms of treatments.

50:30

So, so it's a complex story, you know. And I wouldn't want to give specific details in terms of what you should or shouldn't do.

50:39

But I think for, for us at a minimum we have to know that there's a strong relationship between what glucocorticoids do to your endogenous cortisol production,

50:50

and what endogenous cortisol means for getting COVID, surviving COVID, and then long COVID.

50:57

So, we've got to be considering all of those things as we treat patients on an individual level, in terms of, you know, what's best for them.

51:05

But, I mean, there certainly are some strong relationships there between, you know, what the patient's been taking, what their health looks like now as it relates to cortisol.

51:14

And then, you know, how they're going to survive and hopefully thrive, you know, coming out at COVID. So, it's, there's a lot to consider there. And, you know, it's not a paint by numbers sort of thing, where we can just say, if this, then that, it's, you know, those are going to be complex situation. As I mentioned, people that are on chronic glucocorticoids.

51:31

There were a lot of the papers that I've read, suggested that those are often increasing those doses, to sort of weather the storm.

51:40

So, we got to, you know, take each case, figure out what they're taking, what that means, maybe some testing. And then, as they come out of COVID is usually where our role more is, is than what do they look like?

51:52

Due to COVID and then trying to find, you know, the right solution?

51:57

OK, if you have patients, if patients are struggling with, you know, adrenal fatigue or fatigue after COVID, you know, is starting with the DUTCH Plus a good way to start or what, how do you put the process of elimination?

52:16

Um, so when we say adrenal fatigue, you know, as we, as we evolve our understanding there and we know that like, the what's going on with adrenals when we have low cortisol, is typically like that brain signaling thing.

52:30

Right, that the brain is not signaling correctly to cause cortisol to go where it should be going. And so, it's lower, so,

52:40

you know, having a hypocortisol state as a consequence of cortisol.

52:46

What do we do with those patients? Well, if you're talking about testing, then you're talking about someone who we don't yet know right. You know, they had COVID.

52:53

We know they're tired. We know their symptoms overlay with a picture of insufficient cortisol. Which could be this is why the DUTCH, that's why we like a comprehensive, right? You're tired and you have this overt B12 deficiency, well, that's going to contribute to that. That's why we have a B12 marker on there. If you're a guy, and you have really low testosterone, which we think about a man coming out of testosterone tired, or coming out of COVID is tired, could have low testosterone cut up, and he's got a B12 deficiency. Maybe cortisol is going crazy. Or maybe it's insufficient like, we want to test all of those things.

53:24

So, when you get to the cortisol piece of that, I like the DUTCH Plus the best because it's the most data.

53:32

You know, what am I looking at there? Well, I'm starting with the free cortisol. And I want to know what that up and down pattern is.

53:37

Again, can get that out of the DUTCH Complete. I can get that out of the DUTCH Plus, it's a little stronger out of the DUTCH Plus, and then it adds the cortisol awakening response, which is the stress response resilience.

53:47

And I, I would like to see that in my post-COVID case.

53:53

So, I think if your patient can handle it, if they don't mind a few extra bucks to go that route, then I think if you're going to explore this complex thing, and you're going to go comprehensive, I would go that extra step for me, to know that I've ruled out one more variable. Or I've found potentially at least one source of what the problem is. So, if someone has a normalish up and down pattern, but their car is really flat, and what does that mean?

54:21

It means that that's, that's that mini stress test, right?

54:25

The chemistry that goes on in our brain when you're stressed, is the same chemistry that goes on, like you wake up and if that's flat, then I know when life hits me, I'm not responding. The way that I used to, the way that they should. So, knowing that is really important.

54:40

So, when you have some and many low cortisol presentations, the DUTCH Complete or the DUTCH Plus will pick that up. But when it really is that cortisol awakening response, that reveals that that's when you're glad you did the DUTCH for us and we don't know until after we test. And so again, if the patient doesn't mind the compliance, they don't mind a few extra bucks.

55:03

I think it's $75 more, then that's the route that I like to go every time I can because I feel most competent and just knowing what their cortisol story is.

55:13

Absolutely. That makes a lot of sense.

55:16

How about have you seen any vaccine-induced cortisol or estrogen patterns similar to COVID disease trends?

55:28

I got to say no to that, I mean, we got to be really careful.

55:32

I think conclusions, we draw from anecdotes.

55:35

We test the sick, we test the sick of the sick, right?

55:40

So, we find so many, just, like, fascinating cases, some fascinating, sad cases, where, like, these pictures are really interesting. There seem to be connections between, know, this thing that may be causal and the symptoms that they have.

55:57

But that, and then looking at a larger population in a sophisticated enough way to draw a conclusion that, yes, there's a connection between, uh, between those two things.

56:09

I think, you know, I definitely wouldn't be in a place where I can say that, you know. So, yeah, I don't know.

56:19

I think it's going to take a lot of data before we see what sort of trends you might tease out of a vaccinated group and an unvaccinated group because then it's like there aren't even just two populations, right?

56:29

You have the unvaccinated group, and the vaccinated group of both have subpopulations of having COVID exposure. Right? And then with that, you have subpopulations of, I had COVID exposure three months ago. I had COVID exposure a year ago. Those are different populations.

56:46

I had COVID exposure and then got vaccinated. I got one dose of the vaccine, like two doses.

56:50

I got COVID in-between, where there's so many different subpopulations that know, when the patient comes to you, that the anecdote of that patient is all that matters in the moment, right.

56:59

But we have to be careful the conclusions we draw from that, because those are, I think, more sophisticated questions, that no.

57:05

And again, when I went to the literature and asked a single question about testosterone, for example.

57:11

You know, you'll get conflicting conclusions depending on which angle you're looking from or which subpopulation you're looking at. And often times, these papers are written about little subpopulations of particularly sick people or particular geographical areas or whatever.

57:25

So, it's, it's complicated, and I know time will tell whether some patterns emerge from the vaccinated crowd, and, you know, we don't have any strong data that that group is unique as it relates to any hormones yet.

57:44

That's, there's a lot of information coming across, and we really appreciate you, Mark, looking into all of these different things.

57:52

Couple more questions here, I think we have a few minutes left, we’re right about one o'clock, but I'm not going anywhere. People and questions are rolling in.

58:04

Do you know what impact COVID has on menstrual cycles? I know you kind of touched on that a little bit.

58:13

And so yeah, what the data says is nothing directly.

58:19

And that doesn't mean it doesn't, but that's not presented in the data that I've seen. And again, studies are kind of flying out left and right, so you can miss stuff.

58:28

But the central issue there is stress.

58:30

All right.

58:31

Again, COVID, divorce, COVID and divorce, like, be just stress, right?

58:36

The lockdowns all the what's going on with your kids and all that.

58:40

Just lots and lots of stress going on that stuff, stress impacts menstrual cycles, right? Makes them more irregular. Probably higher levels of an anovulatory cycles.

58:52

Let me just think about it from like an evolutionary standpoint of like, you know, when the Huns are invading, let's don't reproduce and have babies, right? So, when you've got all this stress, it doesn't matter where it comes from, know your biases.

59:04

I'm going to preserve that energy to, like, survive.

59:09

Right, so it doesn't, and, again, that stress can be the perceived bear that chasing you or the real bear that's chasing doesn't really matter. Your biochemistry is the same. And then if that’s severe enough, your body says like, we're not having a baby right now, so that can affect your, your menstrual cycles, it can affect whether you're actually ovulating or not. And if you're not, and you still have high levels of estrogen, then you know there's an estrogen dominant thing which doesn't make you feel very well. Then that's where they come to your office, those providers, for you to help fix them and the DUTCH test will give you a window into that. But we haven't seen, I haven't seen anything out of the literature.

59:43

That's very impressive, that says people who get COVID have this change, because of COVID to either their female hormones or the menstrual cycle itself.

59:52

The central issue there to me seems to be stress and anxiety and all tha,t OK?

59:58

Yeah, it seems like there's a lot.

1:00:00

I mean everybody's going through tough times with this pandemic and that makes a lot of sense.

1:00:07

So, I have another question here.

1:00:11

So, this provider has lots of patients reporting, excessive hair loss post-COVID, not all have thyroid issues, so wondering if there's some link to the HPA axis and DHT production.

1:00:27

However, we're also seeing this in many female patients also.

1:00:33

Right.

1:00:34

So, you know, that would be in the category of anecdotal, but there, when there become many anecdotes, then we become more suspicious.

1:00:43

And I think rightly so, uh, but I haven't found anything in the literature that spelled that out.

1:00:49

But, again, when you find papers where they're directly linking medical intervention, that affects five alpha metabolism and COVID. Like, there's potentially, you know, a relationship there that's going to fall out in the literature at some point.

1:01:07

You know, and when you can tell you, we've been, we've been working on publishing our HRT data, that data has sat in my hands for two years now.

1:01:18

And, you know, you've got these rounds of, you know, submitted here, and they give you feedback and you revise it, and all this kind of stuff. And it's going to get in the literature but it's going to take a while, right? So, COVID is a weird thing, and that it's moving so fast. And we all want answers, but that's not how the peer review process works. Or you end up with a bunch of crap in the literature, that gets, you know, pulled back and isn't true and all that. So, you got to be really careful with that, as an industry, that, the things that we state are true, are actually true.

1:01:46

So, I don't want to no state that, that there isn't a connection there.

1:01:51

I think it could be very likely that there is a connection between how testosterone is processed in a woman, uh, and the hair loss that comes from that and COVID, but it isn't well characterized in the literature that I found yet to say, that there's a direct relationship, there.

1:02:10

Now in one scenario there is and in one scenario there isn't.

1:02:16

But when the patient sits in front of you and there are there kind of a big five alpha metabolites are and they have hair loss.

1:02:23

In a sense it doesn't really matter where it came from, right?

1:02:26

It's our job to fix that, and we have tools for that, right? Like we can use five alpha blockers, like saw Palmetto and things like that.

1:02:34

We can certainly be checking in on what's going on with their insulin because we know insulin really pushes down that five alpha pathway, do they have PCOS, you know, the solutions may not change once someone publishes a paper and says, hey, look what we found.

1:02:49

If you had COVID and you have such and such and such and such a group, your five alpha metabolism can be stronger after COVID, watch out.

1:02:56

Alright, well, the solution is likely to be the same whether that's true because of COVID or true because of your insulin, or your this or that, or whatever it might be, uh, so, so, I'm fascinated to see, you know, what comes out in the literature as it relates to that?

1:03:12

And I think, you know, oftentimes, that's right where those things start, is observations of really smart providers.

1:03:18

Paying attention to patterns, like, making those observations, and then, you know, that, they choose to, the academics have to take it from there, and the academics, they don't move at lightning speed. So, so we'll see, you know, we may be ahead of the curve, and sometimes, you get surprised by that, that the trend that you expect to see

1:03:35

ends up surprising you, towards what's actually real, Once we tease through the data, and see, you know, what else is kind of going on there?

1:03:41

Yeah.  Did you run into any research, Mark, on cortisol levels after vaccination?

1:03:48

When you were, OK, no, I didn't want to be honest with you.

1:03:51

My search was for this talk was really focused on COVID itself. That’s a really interesting question.

1:04:00

No, I'm going to stimulate your immune system.

1:04:06

You think about what COVID does, like COVID wreaks havoc.

1:04:10

You get this inflammatory like state going crazy and then six months later, you don't make a lot of cortisol, so instead of that you intervene with a vaccination, it stimulates your immune system in a way that COVID does, but also in way, not in ways that COVID that, you know, some of the other things that COVID does.

1:04:28

If you're not getting from the vaccination, you're not living through, uh, the things that COVID, like sends people through when they get it.

1:04:37

So then six months later, know what it’s shocking anyone if some of those people have low cortisol because of that, that's a complex question to ask the literature and to ask the data. And I would imagine somebody is going to be on that.

1:04:50

You know, it’s not us, its my own in my job there, is to really pay attention to the literature.

1:04:55

And when someone, uh, is kind enough to ask that question, hopefully in good faith, and then just tell us what the data says, then we will see.

1:05:06

And again, with that, it may depend on subpopulations.

1:05:10

You know, if you've got people that have PTSD, and get COVID, PTSD and get vaccinated or they have a history of something else.

1:05:19

You know, they can have different outcomes as it relates to cortisol, which is why, it is why this whole thing about what we do is to get as comprehensive as we can because we know people are complex, problems are complex, and we want to be looking at as many different angles as we can. So that's, that's something that I'll be looking for in the literature over time. And when we find that, we will send it out.

1:05:41

Because no doubt, somebody's got to be. Got to be looking into that.

1:05:45

Yeah, absolutely. Great, Mark, and as we wrap up here, we just want to thank everybody for all these great questions.

1:05:52

There's a bunch of questions, still, you know, we probably don't have time to get to them all.

1:05:57

But, you know, thanks for listening and being a part of our webinar, and asking good questions.

1:06:03

And, and Mark, how would you know, kind of, wrap this up or summarize for our providers that are listening and curious about how to care for their patients, and during this pandemic and dealing with COVID?

1:06:18

I think it goes back to what functional and integrative medicine providers have been doing

1:06:24

for a very long time. Which is root cause analysis, right?

1:06:28

Is trying to figure out where these problems stem from how, they're interrelated, and what the, what best solutions we have at our disposal, and in the middle of that, is guessing.

1:06:40

Because we're always ultimately guessing to a degree of what's, how we characterize the patient best, in terms of what's dysfunctional, right, and that's why we like to give as much information.

1:06:51

I mean, if you have, if you have some interesting scene unfolding in the house, right. And I open one window halfway, and I'd say, take a look.

1:07:00

Tell me what's going on. Right, and I'd tell someone else.

1:07:03

Come in here, let me open all these windows. You got 6 of them, 6 different angles. You look inside this house.

1:07:09

You tell me what's going on, and what the solution to the problem is, you know, the person who has the most comprehensive look at where the dysfunctions coming from, is still ultimately guessing because they're not inside the house. Right. They can’t go in and really, you know, see everything. We can't see receptors. We can't see every piece of the picture, but the more windows of the house we can look in, that’s our passion is, listen, if you're only looking, you go back in time to old school life

1:07:37

serum testing with just cortisol, and then migrating to four-point salivary testing.

1:07:44

And some of those things is we're able to help people then, better than we could in the past, but still know, we run confidently in the wrong direction sometimes, because we don't have as much information as we can have today, and that's been our passion from the beginning, is these complex estrogen, androgen, cortisol stories that overlay into your patient's dysfunction? They're complex.

1:08:08

So, the more pieces of those puzzles that we can put in front of you as a provider, you know, mixed with the really great investigative work that they do in terms of where is all this stuff coming from. Where are these problems coming from? What’s the root cause analysis? I think taking that approach, whether it's COVID or a divorce, that stress, or whether it's, you know, exposure to something that messes up your estrogen, progesterone balance, or whatever, it might be, whatever that source is, we want to define those patients as well as we can,

1:08:40

as it relates to those hormone families,

1:08:43

so that you can be moving in the most productive direction that you can for your patients. And so, in that, I don't think things dramatically change, in terms of the philosophical approach of this. It's just a new problem, with new angle, new wrinkles. And we want to do as well as we can collectively. So that we're part of the solution because, again, 50 million people just in America and just the cortisol piece, just the cortisol piece,

1:09:07

that's seven million people, right. So, that's a lot of problems coming down that I think there are some good solutions to that, and I think our providers are really well-positioned to play an important role in that. So, we look forward to learning more.

 

1:09:23 Webinar Ends

Back to Top

Thank you, Mark, for doing a deep dive in the literature for us, and all the hard work and effort you put into just helping us know, take those steps and understanding how, long, because it impacts hormones. And for any new provider, we provide 50% off up to five, your first five testing kits.

1:09:42

And we have a great team of clinical consultants that will walk alongside of you, and help you with your COVID report, and help you look over it and understand it, so you can better help your patients.

1:09:56

So, thanks for joining us today. And thanks, Mark Newman, for everything you've done.

1:10:00

And we wish everybody happy, happy, holidays, and have a great day. Thanks for being here. Thanks, everybody.