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Key Topics at IFM's Hormone APM

IFM Educator Joel Evans, MD, discusses the takeaways from IFM's Hormone Advanced Practice Module (APM). You'll walk away with toolkit items like diagrams of the steroidogenic pathways to aid in patient education, as well as new strategies for lifestyle modification. Join Joel Evans and other IFM educators to learn more about assessing and treating hormone dysfunction at the Hormone APM.

Role of Stress in Long-Term Patient Health

Man_Anxious_DepressedToday’s world is stressful. An estimated 34% of Americans report feeling more stress this year than last year.1 More Americans are reporting that they are under “extreme” stress.1 Recognizing the ways in which stress impacts the health of your patients and providing treatments that can reduce the impact of stress can help patients with many chronic conditions regain their health. Even patients who are the picture of perfect health may be facing stress-related hormonal dysfunctions in their future.

The steroid hormone pathways are particularly prone to disruption by stress, including the cortisol steal (also called the pregnenolone steal). Because the precursor of many sex hormones is also the precursor to cortisol, stress lowers the availability of sex hormone precursors, and complex hormone-related symptoms may result.

Learn to navigate the steroidogenic pathways and help your patients with stress-related chronic diseases. IFM’s Hormone Advanced Practice Module (APM) solidifies your knowledge of hormone synthesis across the hypothalamic, pituitary, adrenal, gonadal, and thyroid (HPAGT) axis. Expert clinician educators will connect the dots so that you can help the many patients for whom stress contributes to the emergence or progression of chronic illness. In this video, IFM educator Patrick Hanaway, MD, describes why and how he evaluates stress for patients with hormonal concerns:

Understanding the biochemistry of hormone synthesis can guide you in knowing when to test for hormone deficiencies and what treatments are best to help patients deal with hormone-related dysfunction. Join us at the Hormone APM this July 13-15 in Chicago, IL and return to the clinic ready to recognize common signs and symptoms associated with dysregulation of the HPATG axis as well as with the tools to treat them appropriately.


  1. American Psychological Association. Stress in America: the impact of discrimination. Stress in America Survey. https://www.apa.org/news/press/releases/stress/2015/impact-of-discrimination.pdf. Published March 10, 2016. Accessed January 24, 2017.

Impact of PMS on Cognition and Mood

Cleveland_2017_14621_pfA recent meta-analysis found that globally, 47% of women of reproductive age have premenstrual syndrome (PMS) symptoms.1 Approximately 1.5 million women enter menopause each year, with not only familiar symptoms like hot flashes and disrupted sleep, but also potential cognitive and mood changes.2 Expanding to include women in perimenopause and puberty only highlights the need to understand female sex hormones and their interactions.

Without clinician education on how dysfunctions of female sex hormones appear in patients, those seeking relief from PMS or menopausal symptoms will continue to struggle with their symptoms. Though the root issue is hormonal imbalance, the impact of the symptoms is sobering.

IFM’s Hormone Advanced Practice Module (APM) provides a framework for understanding not only female sex hormones but also the complex web of hormonal interactions underpinning many aspects of health and wellness. Primary care clinicians will learn how to treat female and male patients with hormonal concerns safely and effectively. Bethany Hays, MD, describes the key takeaways of the Hormone APM in this video:

The many clinical takeaways of the Hormone APM will benefit the many patients with hormone concerns. Join us this July 13-15, in Chicago, IL and get the tools and techniques to treat patients with thyroid, sex hormone, and adrenal concerns in your primary care office.


  1. Direkvand-Moghadam A, Sayehmiri K, Delpisheh A, Kaikhavandi S. Epidemiology of premenstrual syndrome (PMS)-a systematic review and meta-analysis study. J Clin Diagn Res. 2014;8(2):106-09. doi: 10.7860/JCDR/2014/8024.4021.
  2. Santoro N, Epperson CN, Mathews SB. Menopausal symptoms and their management. Endocrinol Metab Clin North Am. 2015;44(3):497-515. doi: 10.1016/j.ecl.2015.05.001.

Nutrition & Thyroid Dysfunction: The Case for Selenium


When patients present with fatigue, mood disorders, weight gain, and/or sensitivity to cold, a range of clinical issues could be present. One consideration to keep in mind is subclinical thyroid dysfunction.1,2,3,4

One potential treatment for subclinical hypothyroidism is selenium supplementation. Findings from a recent cross-sectional observational study in China correlated low serum selenium with increased risk of thyroid disease.5 Daily and cumulative selenium intake varies based on diet. In regions with higher soil selenium, the prevalence of subclinical hypothyroidism and overt hypothyroidism is significantly lower.5 For patients with poor nutrient absorption, particularly older patients, subclinical hypothyroidism may be a concern even in regions with adequate selenium.

56064063-capsules-of-herbs-on-spoon-and-stethoscopeAs a population, Americans are generally not considered deficient in selenium.6 However, selenium levels have been decreasing over the past few decades,7 and therefore, selenium is becoming more of an issue in the US. Selenium supplementation may have beneficial effects for many, particularly if genetic variations are taken into account.8 Poor diet, Crohn’s disease, IBS, or other gastrointestinal issues may also lead to low nutritional uptake.9,10

Selenium is but one of a host of factors that affect thyroid function. In the Hormone Advanced Practice Module this July 13-15, you’ll gain a better understanding of the subtle symptoms of thyroid dysfunction, which tests to order, and how to interpret those tests. The module’s expert faculty will guide you through the interrelated biochemical cycles and how to treat underlying causes safely and effectively. The Hormone APM also emphasizes diagnosis and treatment for issues with male and female sex hormones and adrenal function.

Join IFM either via live stream or in Chicago, IL and come away with tools and strategies for treating all types of hormone dysfunction.

  1. Abalovich M, Mitelberg L, Allami C, et al. Subclinical hypothyroidism and thyroid autoimmunity in women with infertility. Gynecol Endocrinol. 2007;23(5):279-83. doi: 10.1080/09513590701259542.
  2. Cheserek MJ, Wu G, Shen L, Shi Y, Le G. Evaluation of the relationship between subclinical hypothyroidism and metabolic syndrome components among workers. Int J Occup Med Environ Health. 2014;27(2):175-87. doi: 10.2478/s13382-014-0240-5.
  3. Klein I. Subclinical hypothyroidism: to treat or not to treat - the cardiac perspective. Endocr Pract. 2010 Sep-Oct;16(Suppl 2):28-29. doi: 10.4158/EP.16.S2.1.
  4. Roy S, Banerjee U, Dasgupta A. A comparative study to evaluate the interplay of lipoprotein (a) with traditional lipid parameters in overt and subclinical hypothyroidism. Br J Med Med Res. 2015;10(10):1-11. doi: 10.9734/BJMMR/2015/20250.
  5. Wu Q, Rayman MP, Lv H, et al. Low population selenium status is associated with increased prevalence of thyroid disease. J Clin Endocrinol Metab. 2015;100(11):4037-47. doi: 10.1210/jc.2015-2222.
  6. USDA. What we eat in America, 2009-2010, data tables. US Department of Agriculture, Agricultural Research Service.http://www.ars.usda.gov/Services/docs.htm?docid=18349. Accessed January 24, 2017.
  7. Brown KM, Arthur JR. Selenium, selenoproteins and human health: a review. Public Health Nutr. 2001;4(2B):593-99. doi: 10.1079/PHN2001143.
  8. Rayman MP. Selenium and human health. Lancet. 2012;379(9822):1256-68. doi: 10.1016/S0140-6736(11)61452-9.
  9. Rannem T, Ladefoged K, Hylander E, Hegnhøj J, Jarnum S. Selenium status in patients with Crohn's disease. Am J Clin Nutr. 1992;56(5):933-37.
  10. Gentschew L, Bishop KS, Han DY, et al. Selenium, selenoprotein genes and Crohn’s disease in a case-control population from Auckland, New Zealand. Nutrients. 2012;4(9):1247-59. doi: 10.3390/nu4091247.

Breast and Prostate Cancer Screening: Why the Debate Matters

When patients express concerns about breast or prostate cancer, mammography or biopsy can be a logical next step. However, prominent clinicians and researchers have suggested that we need to consider potential harm before offering breast cancer screenings.1,2 A one-size-fits-all approach—and an under-advised patient population—can’t accomplish cancer screening in a way that reduces harm.

A recent review concluded that cancer prevention and screening recommendations are not presented in a way that informs patients about benefits and harms.3 In the case of prostate cancer, there are also known harms, and revisions to the standard of care are still being researched.4 In light of the conflicting evidence for and against many types of cancer screening,5 what can you do to work with patients concerned about breast or prostate cancer?

Bethany Hays, MD, discusses this controversy and how IFM’s Hormone Advanced Practice Module (APM) helps you to appropriately evaluate and manage patients:

IFM’s Hormone APM provides the deep understanding of hormonal networks so that you can appropriately work with patients around cancer prevention and screening. Given the debate over the potential problems with mammography and prostate cancer screening, understanding how to prevent cancer while minimizing harm has become more important to patients and clinicians. Learn the physiology that explains why some patients may not need cancer screening while others may be at higher risk.

Join us in Chicago, IL, this July 13-15. Return to the clinic ready to work with patients on complex hormone topics like cancer screening, male and female hormone replacement, thyroid and adrenal dysfunction, and menopause.

  1. Baum M. Harms from breast cancer screening outweigh benefits if death caused by treatment is included. BMJ. 2013 Jan;346:f385. doi: 10.1136/bmj.f385.
  2. Jørgensen KJ, Gøtzsche PC. Breast cancer screening: benefit or harm? JAMA. 2016;315(13):1402. doi: 10.1001/jama.2015.19126.
  3. Caverly TJ, Hayward RA, Reamer E, et al. Presentation of benefits and harms in US cancer screening and prevention guidelines: systematic review. J Natl Cancer Inst. 2016;108(6):djv436. doi: 10.1093/jnci/djv436.
  4. Lavallée LT, Binette A, Witiuk K, et al. Reducing the harm of prostate cancer screening: repeated prostate-specific antigen testing. Mayo Clin Proc. 2016;91(1):17-22. doi: 10.1016/j.mayocp.2015.07.030.
  5. Carter SM, Williams J, Parker L, et al. Screening for cervical, prostate, and breast cancer: interpreting the evidence. Am J Prev Med. 2015;49(2):274-85. doi: 10.1016/j.amepre.2015.01.009.

Explore a PCOS Case Study


What would you do if a 25-year-old female came to you reporting a possible case of polycystic ovary syndrome (PCOS) and years of hirsutism, acanthosis nigricans, cystic acne, and irregular and painful periods? What if that patient also had an elevated BMI with high abdominal adiposity, elevated testosterone, pre-diabetes, and a single cyst found in a pelvic ultrasound?

Potentially affecting 15-20% of women, PCOS is a complex endocrine and metabolic condition.1 It is a heterogeneous, heritable disorder that affects women throughout their entire lifetime.2 Insulin resistance is found in 50-70% of females with PCOS.1 Comorbidities include infertility, hypertension, type 2 diabetes, depression, menstrual irregularities, and more.1 In this full case study write-up, IFM Educator Kara Fitzgerald, ND, describes this patient’s history, treatment plan, and results. In so doing, Fitzgerald walks the reader through her process and rationale for using whole-system methods to address the patient’s chronic condition.

IFM’s Hormone Advanced Practice Module (APM) is a scientific educational program to enhance your knowledge of endocrinology and hormones. Like Dr. Fitzgerald, you can look upstream to treat root causes. Join us at the Hormone APM this July 13-15, 2017, to learn the evidence-based dietary modifications, nutraceutical supplementation, and other lifestyle changes to address hormonal dysfunction before using hormone replacement therapy.

  1. Sirmans SM, Pate KA. Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clin Epidemiol. 2013;6(1):1-13. doi: 10.2147/CLEP.S37559.
  2. Stein IF, Leventhal ML. Amenorrhea associated with bilateral polycystic ovaries. Am J Obstet Gynecol. 1935;29(2):181-91. doi: 10.1016/S0002-9378(15)30642-6.

Article by IFM educator Kara Fitzgerald, ND
Originally published at www.drkarafitzgerald.com

Dr. Fitzgerald received her doctorate of naturopathic medicine from National College of Natural Medicine in Portland, Oregon, and completed postdoctoral training in laboratory science at Metametrix Clinical Laboratory. She is a contributing author to numerous textbooks in Functional Medicine and peer-reviewed journals. An IFM Certified Practitioner, her clinical practice is located in Sandy Hook, Connecticut. Full biography.

Menopause and Hormone Replacement Therapy


By IFM Educator Shilpa Saxena, MD

IFM’s recent practitioner survey revealed an overwhelming majority of patients who visit Functional Medicine clinicians are women. With over 10 years of running a Functional Medicine practice, I can firmly state that perimenopausal and postmenopausal women are likely one of the largest demographic groups within my practice and most FM practices. Why?

Most other approaches do not address the two main hormonal goals for today’s women:

  1. Improving symptoms by addressing why each woman is uniquely imbalanced;
  2. Reducing risks with the safest options available.

The typical hormone replacement therapy (HRT) medical appointment aims to blunt symptoms and views women as a three-zone problem: bikini, breast, and brain. The goal: prescribe the lowest effective dose of HRT for the shortest amount of time in order to reduce cancer and/or stroke risks. This strategy fails to address one major problem: the underlying cause of the hormonal imbalance symptoms. Women are vastly different from each other, both biochemically and genetically, and their unique life stories play a major role in the underlying causes of their symptoms.

At the Hormone Advanced Practice Module, you will gain a greater appreciation for the most prevalent factors that contribute to both the annoying and the life-threatening set of symptoms so many women face. Throughout the course, IFM educators will detail the steroidogenic pathways for hormone production and metabolism, examine the evidence for the use of bioidentical hormone replacement therapy, and elucidate the other systems that commonly interplay with hormone health. This powerful way of thinking empowers clinicians to offer real, personalized treatment recommendations on Monday morning to their current patients and to the growing group of women who seek the same services from a Functional Medicine practitioner.

The Women’s Health Initiative, a major government-funded study, linked hormone replacement therapy with a number of health problems. It was later determined that the recommendations were inappropriate for younger women who took hormone replacement therapy for symptomatic menopause because most of the women studied were well past their early menopause symptoms. The truth is, we can no longer treat the statistical woman—she doesn’t exist. Helping women optimize the benefits of healthy hormones through the Functional Medicine model will be a vital step forward for women’s health.

How to Identify Adrenal Dysfunction

The adrenal hormone cortisol impacts nearly all body systems. Cortisol levels fluctuate throughout the day, normally peaking in the morning hours and bottoming out at night. In studies, deviations from this pattern are associated with signs and symptoms of adrenal dysfunction. One such dysfunctional pattern is a flat cortisol curve in which the amount of cortisol secreted (high or low) shifts very little throughout the day. In both seemingly healthy and clinical populations, a flattened cortisol curve has been robustly associated with a shorter lifespan and negative health indicators.
Results of one such study indicated that a flattened cortisol curve statistically predicted poor survival time in patients with metastatic breast cancer.1 Natural killer cell numbers and activity were also decreased. In the patients studied, 70 percent had flattened cortisol curves, presumably due to the physical and emotional stress of their diagnosis and treatment.1 Flattening of the cortisol curve also has been shown to predict early death from lung cancer and has been associated with low T-cell lymphocyte counts.2
In another study of healthy individuals, diurnal cortisol patterns were measured for 2 years, and then participants were followed for 6 to 8 more years.3 Participants were mostly middle-aged (average of 61 years). Flattened cortisol curves correlated with mortality from all causes, including cardiovascular deaths. 3
Measuring cortisol over the course of a day may predict health outcomes both for patients with diseases and for seemingly healthy individuals. Understanding the factors that affect cortisol secretion can inform appropriate treatment interventions. One interesting finding is that neighborhoods with more stressors are correlated with flattened cortisol curves for the populations who live there, suggesting that social status may be a factor in cortisol patterns.4

At IFM's Hormone Advanced Practice Module (APM), our experienced faculty will show you the best way to measure cortisol levels and help you understand the different types of dysfunction that can be identified from the results. You'll also get tools and techniques for applying appropriate lifestyle and nutritional therapies that address each type of dysfunction. Join IFM at the Hormone APM and come home with strategies for assessing and treating adrenal dysfunction as well as a host of other hormone-related conditions.

  1. Sephton S.E., Sapolsky R.M., Kraemer H.C. & Spiegel D. (2000)  Diurnal cortisol rhythm as a predictor of breast cancer survival. JNCI J Natl Cancer Inst 92 (12): 994-1000. Full text freely available: http://jnci.oxfordjournals.org/content/92/12/994.full Last Accessed 3/2015.
  2. Sephton SE, Lush E, Dedert EA, Floyd AR, Rebholz WN, Dhabhar FS, Spiegel D & Salmon P. (2013) Diurnal cortisol rhythm as a predictor of lung cancer survival. Brain Behav Immun. Mar;30 Suppl:S163-70.
  3. Kumari M, Shipley M, Stafford M, Kivimaki M. Association of diurnal patterns in salivary cortisol with all-cause and cardiovascular mortality: findings from the Whitehall II study. J Clin Endocrinol Metab. May;96(5):1478-85. Epub 2011 Feb 23. Full text freely available: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085201/ Last Accessed 3/2015.
  4. Karb RA, Elliott MR, Dowd JB & Morenoff JD. (2012) Neighborhood-level stressors, social support, and diurnal patterns of cortisol: the Chicago Community Adult Health Study. Soc Sci Med. Sep;75(6):1038-47.

Disclosure text is not available