• Hormone Replacement Therapy; the options, risks, benefits: who, why, where

    Date: 2011.10.04 | Category: Hormone Replacement Therapy | Tags: ,,,,,

    Hormone Replacement Therapy; the options, risks, benefits:  who, why, and where to go for help?

    Bio-identical Hormones (BHRT) v. Non-bio-identical hormones (HRT)

    1. Both used to alleviate symptoms of hormonal imbalance
    2. Bio-identical Hormone Replacement also used to correct the imbalance causing the symptoms

    Bio-identical Hormone Replacement (BHRT) – what are they?  Why all the HYPE?

    1. Bio-identical means that it is an exact copy of the hormones made by you naturally since birth.
    2. The body knows what to do with the hormone because the BHRT is “fully” recognized by the body.
    3. Balance of these hormones is important for optimal function, health and vitality.
    4. They are easy to measure before administering hormone intervention using creams, capsules, pellets and other, and then re-measure to monitor, thus improving the desired outcome.

    What are Non Bio-identical Hormones or frequently called “synthetic” hormones?

    1. Slightly different molecules from what your body makes
    2. The slight difference gives a very different response by the body
    3. The slight difference also allows the drug companies to patent their molecule.
    4. They are known to cause cancer
    5. Not easily measured and therefore not monitored by health provider
    6. Not used to correct imbalance because they are not normally found in the body and therefore they can only help to treat the symptoms of an imbalance

    Men and Women need balance

    Balance of all hormones in order to enjoy maximum vitality and wellness.

    1. Insulin
    2. Thyroid
    3. Estrogen
    4. Progesterone
    5. Testosterone
    6. DHEA
    7. Cortisol
    8. And MANY othes

    Signs and symptoms of hormone imbalance

    1. Fatigue
    2. Mood Changes
    3. Loss of energy
    4. Change in mental acuity
    5. Decreased muscle mass
    6. Increased Fat mass
    7. Decreased Endurance
    8. Constipation
    9. Sleep Disturbances
    10. Hot Flashes and Night Sweats
    11. Decreased sexual desire
    12. Premenstrual Syndrome (PMS)

    BHRT  and HRT Basics

    1. Most people (including doctors) use the words Progestin and Progesterone interchangeably.  The truth is they are VERY different.
    2. Progestins are non bio-identical “synthetic” hormones that have been shown to cause cancer more than non bio-identical estrogens alone (WHI study)
    3. Progesterone a bio-identical “natural” hormones have been shown to have cancer protection (many studies)
    4. Hormones such as estrogen, progesterone, testosterone, and DHEA are prescribed in many different forms (ie. Capsule, cream, drops, pellets, injectable and other).
    5. The different vehicles are used to customize the doses and effects.                          Example: progesterone cream may be given to help a woman with PMS re-establish balance because it has a strong affect on the lining of the uterus.  Where a capsule may be used in the case where a women with low Progesterone has trouble sleeping since its metabolites seem to have a calming and mildly sedating affect on the brain

    Testosterone – both Men and Women

    1. Testosterone in men is essential for optimal function, vitality and quality of life.  Replacing a man’s Testosterone when low most often has a very positive effect on both quality of life and physiology and disease prevention
    2. Testosterone is necessary for normal brain, heart, and bone health.  Cholesterol, blood sugar and body composition often improves when the Testosterone level is restored.
    3. In women, Testosterone is very important to brain, heart, bone health as well as libido, energy and general sense of wellbeing.  Testosterone replacement in women has many very positive effects.
    4. Most physicians trained in BHRT monitor levels 2-4 x a year to maintain balance and optimal result.

    Who, why, where?

    Men and women of all ages experiencing symptoms should be evaluated for hormone imbalances and may be candidates for some combination of BHRT

    1. Not just menopausal women and very old men
    2. Hormones are restored to optimal levels to restore health, wellness and vitality
    3. Make sure health care practitioner has been trained in the evaluation and treatment of hormonal imbalances using BHRT – www.bodylogicMD.com

    Cancer Scare!

    1. Synthetic Progestins, prescribed orally to balance estrogen replacement has been found protective against uterine cancer BUT shows a significant increase in breast cancer and cardiovascular diseases
    2. Natural Progesterone given to balance estrogen has been shown to protect against uterine cancer, breast cancer and cardiovascular disease.
    3. Breast cancer is often receptor negative, meaning that; the cancer is not thought to be caused by hormones.
    4. There is literature world wise that support the safe use of BHRT when prescribed and monitored by an expert.
    5. Hormone imbalance may be much more dangerous than properly administered BHRT

    Conclusion:

    • There are decades of research of both estrogen only and estrogen/progestin HRT. Estrogen replacement has been shown to relieve menopausal symptoms, improve bone and skin health and diminish long-term morbidity from cardiovascular disease.
    • However, when non-bioidentical hormone replacement is used, these benefits are accompanied by increased risks of breast cancer, blood clots, gallbladder disease, and endometrial overgrowth and cancer.
    • Addition of a progestin mitigates against endometrial problems but increases other risks, as demonstrated conclusively by the results of the WHI trial and other studies.
    • Patients have become increasingly aware of hormone replacements with bioidentical hormones and are coming to their physicians on a daily basis with questions about this more natural BHRT option.
    • Patient must seek a physician training in BHRT to get more complete information regarding pros, cons and treatment options – www.BodyLogicMD.com
    • We shouldn’t hedge and turn our backs on patients suffering from hormonal deficiencies while we wait for large trials to be conducted.
    • Moreover, we are not sure if large trials will be conducted or who will fund them, since bioidentical hormones are not patentable.
    • We should go back to first principles, think for ourselves, incorporate what we have learned from more than 30 years of steroid hormone research, and make our best call.
    • We have good indications from the literature about what types of estrogens we should use (estradiol and estriol), and we realize that transdermal delivery of hormones often offers advantages over oral delivery.
    • There is evidence that we should avoid certain progestins, and there is strong evidence to support both the oral and transdermal use of bioidentical progesterone.
    • Through testing modalities such as saliva, we are able to more closely monitor the delivery of hormone to tissue.
    • With good follow-up, good clinical judgment and good laboratory back-up, we have enough information about hormone replacement to offer BHRT as a viable option
    • As time goes on, we need to analyze new information and modify our approach as indicated.
    • Addressing the body as a whole to optimize total function is the primary concern of a Functional Medicine Physician.  Hormones are a tool to this end.  Diet and targeted supplementation are also valuable and necessary tools to optimizing the bodies function.