Hormone Replacement Therapy: A Brief Review
Written by Devin Wilson, ND
As we age, our cells age. As we approach the later stages of life we slowly lose the abilities to repair, regenerate and produce new cells and maintain healthy levels of hormones, etc. Yes, the aging process is natural and some decline in function is too. However, the rate and extent of this decline that I see in patients is not natural.
Many factors determine the rate and extend of aging. Genetics is certainly one of them as is environmental factors including tobacco use or exposure, alcohol and drug use, heavy metals, stress, nutrition, exercise, etc., and biological factors such as acute and chronic disease. All of these need to be assessed and addressed for optimal health and response to treatment.
In younger patients with more ability to produce hormones on their own, hormone replacement therapy is generally not needed because supportive therapies can create the same outcome, healthy hormone balance. This is the fix and repair approach.
In older patients with less ability to produce hormones on their own, hormone replacement therapy is usually needed because they have lost their innate ability to produce these hormones. This is the replace approach.
There is of course a spectrum of this ability in the aging body and that is why I assess each patient individually in order to create a customized treatment plan for them.
…There is a time when you can repair and fix things and there is a time when you just have to replace things…
Brief Review…
Let’s take a minute to review hormones we’re talking about and why they are important for overall health.
Hormones are chemical messengers that are produced by various organs such as ovaries, testes, adrenal glands, etc., to regulate physiology. In short, hormones regulate many of our cellular functions. Some of these are listed below.
Some Functions of Hormones:
Growth and development of tissues including heart, brain, others
Repair of damaged or injured tissue
Metabolism of foods (Carbohydrate and fat metabolism)
Sexual function and reproductive capabilities
Cognitive function and mood
Maintenance of body temperature and thirst
Many, many more…
The hormones we’re specifically talking about here are the “sex hormones” which include estrogen, progesterone, and testosterone. These are the main sex hormones. There are many other hormones and chemical messengers that are part of this orchestra such as Human Growth Hormone (HGH), Insulin-Like Growth Factor-1 (IGF-1), etc., but we will focus mainly on the three sex hormones.
Let’s Define Our Terms…
As it pertains to this topic, we’re taking about hormone therapy involving the three primary sex hormones; estrogen, progesterone, and testosterone.
“Hormone Therapy” is the umbrella term for therapies that involve using a hormone as treatment.
“Hormone Replacement Therapy” involves using exogenous hormones (hormones made out side the body, i.e., in nature or in a laboratory).
“Hormone Support” refers to using substances to help support body’s ability to make hormones such as supplements, plant derived medicine, bovine or porcine derived materials, etc.
“Non Bio-identical Hormones” are hormones that are typically produced in a laboratory and have a different chemical configuration than those naturally made by your body. These include FDA approved products such as Premarin and Provera which come with an increase risk.
“Bio-Identical Hormones” are hormones that are chemically identical to the hormones our bodies produce naturally. “Bio-Identical Hormone Replacement Therapy” (bHRT) is a treatment using these bioidentical hormones in attempts to restore healthy levels to preserve health.
Progestogens and progestins are called progesterone hormone therapies. However, the progestin, Provera, is a non bio-identical hormone and has drastically different clinical affects as seen in recent research.
“Estradiol and progesterone demonstrated no increased risk of breast cancer. Synthetic estrogen (Premarin® ) and synthetic progestins (medroxyprogesterone and noresterone) all dramatically increased the risk of breast cancer”.
Breast Cancer Res Treat 2007;101:125-134
“The increased risk [of breast cancer] was associated only with taking the progestin (Provera®)...”
JAMA 2004;291(24): 2947-2958.
bHRT for Symptoms of Menopause and Andropause…
bHRT is indicated for men and women who experience symptoms of hormone deficiency or dysfunction including menopause and menopause. Men and women are often prescribed hormone therapy for a number of symptoms listed below. However, there are other, more clinically important reasons to use bHRT.
Common Symptoms of Menopause
Hot flashes
Night sweats
Irritability
Vaginal dryness or other sexual dysfunction
Low libido
Headaches
Fatigue
Memory issues
Common Symptoms of Andropause (Manopause)
Irritability
Memory issues
Erectile dysfunction
Low libido
Fatigue and low stamina
Weight gain
“Man boobs” Gynecomastia
Will a blood test assess my hormones?
Short answer is yes. But there are more accurate and reliable methods of assessing and monitoring your hormone.
Blood testing to assess hormone status is a common place to start to gain a general idea of hormone levels in men and women. Most conventional health providers prescribing HRT only monitor three hormones; Estradiol, Progesterone, and Testosterone.
To ensure correct dosing of HRT and to ensure overall safety, other markers should be routinely assessed and monitored.
Did you know there are two other forms of estrogen? Estradiol, also known as E2, is just one of three forms of estrogen found in the body. The other two forms are Estrone (E1) and Estriol (E3). These are distinctly different and are associated with different long term risks.
If you have been prescribed Testosterone, your provider is likely monitoring it in your blood but not monitoring the hormone, DHT. The body naturally converts Testosterone into DHT, which is much more powerful and can cause various symptoms including hair loss and acne.
What are the other testing methods to assess my hormones?
Blood testing to assess hormone status is a common place. However, once women begin hormone replacement therapy (HRT), blood testing is not as accurate or reliable as other methods of testing.
Urine and saliva testing are typically more accurate and more reliable to monitor women’s hormone levels while on HRT.
Both of these testing methods provide a greater amount of information on reproductive hormones including all the forms of estrogen, progesterone, and testosterone. These methods also provide information on how your body processes and metabolizes these hormones, also known as metabolites. Some of these metabolites are protective and some are dangerous and increase risk of cancer. Without completing the proper test, the doctor and patient alike will not be aware of the metabolites which potentially puts the patient at risk.
Understanding your entire hormone picture helps providers ensure your getting the best dose of HRT and your overall safety.
When initiating bHRT one can expect to retest every 3 months, and once hormone levels are balanced, retesting is recommended upwards of every 6-12 months.
Forms of bHRT…
bHRT medications are often not available from a local pharmacy such as CVS or Walgreens. They are made by certified compounding pharmacies and can be uniquely tailored for each individual. Every women’s dose is different and unique to their physiological needs. Note, that the term “Bio-identical” does not mean natural. Hormones that are bio-identical to ones in our bodies can be found in nature and can be made in a laboratory. The prescribed bioidentical hormones may be applied via a cream, spray, suppository, injection, or taken as a pill.
What to do now…
After you’ve read this article and hopefully perused some of the published data, one of the most important things to do is recognize that hormones are a critical component of your body and all the doctors who may have told you hormone therapy is dangerous and causes cancer, have been misinformed. Next, find a doctor who has been trained in bio-identical hormone therapy, who uses the most accurate and reliable laboratory testing and is well informed of the research and data regarding bHRT.