Bio-Identical Hormone Replacement Therapy
Bio-Identical Estrogen and Progesterone are hormones that exactly mirror the natural hormones produced in a woman’s body. They are molecularly identical and the effects they exert are the same as that seen with the hormones of ovarian production. Use of these hormones in a menopausal woman, will eliminate the symptoms of menopause and provide health gains.
Estrogen is responsible for the growth of specific tissues. It has over 400 functions in the body. Some of its benefits are: Prevents Alzheimer’s disease and Osteoporosis, helps maintain muscle, improves sleep and mood, reduces risk of cataracts, decreases arterial plaques, increases blood flow, decreases blood pressure, reduces over-all risk of heart disease by 40% – 50% and decreases risk of colon cancer.
Progesterone is responsible for the maturation of tissues. It is usually the first hormone to become deficient in the peri-menopausal years. Its benefits are many: Helps balance estrogen, improves sleep, lowers high blood pressure and cholesterol, increases metabolic rate, is a natural diuretic and natural antidepressant, increases scalp hair and may prevent breast cancer.
So why does the term ‘hormone replacement’ evoke such a response of fear? To dispel myths and unfounded dangers of bio-identical hormone replacement (BHRT) we must review the findings of the Women’s Health Initiative Study (WHI). This was a study which made use of synthetic hormones to assess presumed health benefits to post-menopausal women.
The Women’s Health Initiative Study
The WHI study began in 1991 and included about 162,000 women. Their median age was 63 and many had chronic health problems. WHI was designed to prove that increased risk of heart disease, cancer and osteoporosis (all which elevate post menopause), could be prevented with hormone replacement. Synthetic hormones were used and were given orally. There were two ‘arms’ to this study: 1) Women prescribed only Premarin (derived from pregnant mares urine) or 2) those prescribed the combination PremPro (Premarin plus Provera – synthetic progestin). In 2002 the researchers were alarmed to find an increased incidence of heart disease, stroke and breast cancer in the women taking PremPro. This arm of the study was abruptly stopped. In 2004, they found an increased incidence of stroke in the women taking Premarin. The study ground to a halt and it was concluded that hormone replacement was dangerous. Unfortunately, most doctors applied the findings of the WHI study of synthetic hormones to include all hormones. They condemned hormone replacement and deemed it unsafe even though bio-identical hormones were not studied. Thousands of women were left suffering.
While we recognize the hazards of prescribing synthetic hormones and the danger of using estrogen orally, we must also note the differences between synthetic and bio-identical hormones.
Regrettably, there were several flaws with the WHI Study: Synthetic hormones were used; estrogen was given orally; hormone levels were not measured; women 10 years post menopause were the subjects and many of these women had chronic health conditions which were themselves, a predisposition to cardiovascular disease and cancer.
In 2010, a New York Times article summed these flaws concisely: “It was clear that the trial had shown physicians something highly important about the perils of starting older, post-menopausal women on pills containing CEE and MDA”, [Premarin and PremPro].
So the question is: Do I or Don’t I? Should I consider hormone replacement as I enter menopause?
Hormone Treatment Criterion
If treatment is decided upon, these treatment criteria should be met: Only bio-identical hormones (BHRT) should be used and estrogen used only transdermally (through the skin) – never by mouth. The hormones should be prescribed in the physiologic range and individualized for each person. (One way to achieve this is through compounded, customized hormones as one size does not fit all.) Hormone levels should be closely monitored. (Saliva testing is most able to reliably measure the small amount of hormones that are used.) The treatment goal should be symptom management – not the matching of numbers to a lab value. It must be understood that hormone response is as unique to each person as their own fingerprints.
The ‘window of opportunity’ for bio-identical hormone replacement (BHRT) is within the first 10 years of menopause. It is here that the protective effects of estrogen and progesterone can be continued thus providing us defense against the frailty of old age.
In 2015, the American Association of Clinical Endocrinologists endorsed testosterone replacement therapy stating that testosterone therapy was a low risk, high reward treatment option. In the same year the results of a large, long-term Veteran Affairs Database study were published showing that men restored to normal testosterone levels were at a reduced risk of heart attack or stroke. This confirmed what many doctors had already observed and was welcomed by men suffering the effects of Andropause or ” low T”.
During puberty, testosterone builds muscles, increases size of testes and penis and deepens the male voice. In adulthood, testosterone is responsible for maintaining muscle and bone strength and interest in sex. After age 30, testosterone levels begin to decline. As this loss progresses, many (but not all) will experience symptoms. The typical “low T” male tends to have less muscle mass and strength and an increase of belly fat. He’ll commonly come home from work, eat dinner and promptly fall asleep. “Low T” also effects memory, concentration, energy and vitality however low sex drive or erectile dysfunction is usually what compels the man to seek help.
Blood or saliva testing will confirm a low testosterone level and therapy with bio-identical testosterone can be initiated. Modes of testosterone delivery are through creams, gels, injections or pellets. It is never given orally. Within weeks of beginning treatment, a significant improvement of symptoms is usually noticed. The goal of therapy is to restore testosterone level to that of a 30 year old male. Careful monitoring during treatment is necessary. Levels that are not physiologic (too low) will fail to be beneficial. Levels that are too high (supra-physiologic) have actually increased (rather than prevent) the risk of cardiovascular events in elderly men. Additionally, testosterone levels in the supra-physiologic range may paradoxically result in the return of symptoms as the testosterone receptors are ‘reset’.
Although decline of testosterone is a normal part of aging, replacing this hormone can be tremendously advantageous to a man’s physical, psychological, cognitive and sexual well-being.