Bioidentical Hormone Replacement Therapy
Thomas Lee Abshier, ND
During young adulthood, the glandular output is greatest. As the body ages, glandular output gradually decreases. In the case of menopause, the output of estradiol and progesterone precipitously drops upon depletion of the ovaries’ supply of eggs. (With menopause and sex hormone secretion cession, the rate of bone loss increases significantly, as does risk of cardiovascular disease, and the increased risk of Urinary Tract Infections with thethinning of the vaginal and urinary mucosa.) The health/vitality/resilience of the body roughly tracks hormonal levels. Youthful vitality may return to a degree as the hormone levels are returned to their young adult optimums by Bioidentical Hormone Replacement Therapy (BHRT).
The hormones used in BHRT are synthesized from soy and yam. After synthesis, these molecules are identical to those produced and used naturally by the body. Some synthetic drugs use molecules similar to human hormones but modified slightly – these are foreign to the body, and not recommended.
Cellular metabolism is regulated by a symphony of hormones, including: thyroid (T3 and T4), testosterone, DHEA, estradiol, progesterone, hGH (human Growth Hormone), melatonin, pregnenalone, vitamin D, cortisol, oxytocin, and others. Deficiency of one hormone may cause symptoms. Replacing that single hormone may be effective in reversing a particular symptom. But, since the hormones all stimulate pieces of the metabolic network, the most holistic approach to health restoration is to supplement the entire suite of the major hormones to their youthful optimums.
Hormone Replacement Therapy:
- Assess hormone levels via blood serum levels of the entire suite of the major hormones. (Lipids, PSA, CBC are also followed.)
- Prescribing appropriate doses of Bioidentical Hormones
- Retesting hormone levels in 4-6 weeks
- Adjusting the prescribed dose
- Retesting again, etc. until the patient is both symptom free, and at optimal levels.
Considerations and Cautions in BHRT
- Some patients are sensitive to small doses of hormones, and their doses must be increased slowly.
- Some patients will experience symptoms of excess hormones at the optimal levels of young adulthood. Raise the dose slowly to full prescribed dose. Stop and reverse dose if any symptoms develop. Often the full dose will be tolerated after the body accomodates.
- BHRT will not solve all health problems. Any given symptom may also be due to toxicity, tissue damage, heredity, and/or nutrient deficiency. Given the central function of hormones in activating and controlling cellular metabolism, hormones are a vital piece of the metabolic puzzle. Every person should consider BHRT after age 40, at perimenopause, or when symptoms of deficiency arise.
- Since a wide variety of response to therapy is possible, each individual must participate in his/her treatment. Note how your body is responding, report changes, discuss symptoms, and adjust dosage.
The patients who are the most likely to benefit most from BHRT include:
- Anyone over 40 years old
- Menopausal symptoms
- History of strong stress
- Low libido
Testosterone Replacement for men may:
- Increase strength and endurance and muscle mass
- Decrease fat, reduce cholesterol
- Increase exercise tolerance, bone density, improve skin tone and collagen
- Improves healing rate after workout or injury
- Improve libido and satisfaction
- Protect against CV disease, hypertension, excess body fat, arthritis
- Enhance memory, improve cognition, reduce risk of Alzheimer’s
- Prevent and treat depression
- Decrease pro-inflammatory cytokines
- Improve cardiovascular health by decreasing thickness of carotid intimal media
- Contraindications: active prostate cancer, transference to pregnant woman or one who might become pregnant, and men with fertility issues
- Risks: 1) Blood viscosity – testosterone replacement therapy may increase the number of Red Blood Cells – blood donation may be required to keep within normal limits. 2) Gynecomastia: breast development, testosterone is broken down into estrogen when eliminated. Estrogen is important for men, and reduces/reverses osteoporosis, and reduces risk of heart disease. Treat with small amounts of anastrazole to reduce the amount of breakdown into estrogen – estrogen levels should remain at high normal at least. 3) Testosterone cream transfer to spouse (acne, hair growth). 4) Testosterone cream transfer to children (stopping growth). 5) Transfer to pregnant spouse (birth defects). Treatment: Avoid transfer by applying on areas that cannot be touched by children. Avoid intimate contact with spouse until after shower.
- Side effects: Weight gain, weight loss, fluid retention, acne, increased libido, hair loss, increase in RBCs, transfer to spouse
Testosterone Replacement for Women may help:
- Improve sense of well being, energy, strength, endurance, body composition, bone density, libido, sexual function, clitoral sensitivity
- Decrease visceral fat
- Maintain muscle mass and metabolism
- Increase collagen, skin thickness, improve texture, decrease wrinkles, decrease in fat deposition and cellulite
- Contraindications: hormone responsive cancer, pregnancy, planned pregnancy
Estrogen Replacement may help:
- Protect against: heart disease, strokes, colon CA, osteoporosis, UTI’s, Alzheimer’s disease, macular degeneration, cataracts
- Deficiency may result in: menopausal hot flashes/temperature dysregulation, bladder and vaginal atrophy, bladder infections, painful intercourse (due to vaginal introitus narrowing), heart disease, reduced libido, depression, mood swings, sagging skin and breasts
- When taking estrogen, reduce risk of breast cancer by taking antioxidants, CoQ10, soy, DIM/IC3 (increased conversion of estrogen to “safer”/non-free-radical metabolite), progesterone and testosterone. (Note: increased risk of breast cancer primarily due to estrogen replacement without progesterone, and/or estrogen replacement with synthetic progesterone.)
- Risk for breast cancer may increase may be due to synthetic progesterone, pesticides, excess fat, alcohol, tobacco, low exercise
- Possible side effects/risks of ERT: clots (use transdermal if at risk), weight gain (fluid retention), gallstones (adequate progesterone), fibroids (increase progesterone), headaches (increase progesterone), endometrial cancer (increase progesterone to stop endometrial proliferation)
- Symptoms of excess estrogen in post-menopausal women: breast tenderness, bleeding, bloating, breakouts (acne), moodiness/crying/irritable
- Reduce dose of estrogen if side effects, and/or increase dose of progesterone
- Progesterone neutralizes the estrogen induced multiplication of the breast and uterine cells, thus progesterone must be taken whenever doing estrogen replacement therapy.
- Menopausal symptoms: take estrogen multiple times per day after hot flash, before bed, and upon awakening with night sweats
HCG Therapy (Human Chorionic Gonadotropin):
- HCG is similar in effect and molecular structure to LH (Leutenizing Hormone).
- LH is the hormone secreted by the pituitary in response to low testosterone.
- LH stimulates the secretion of testosterone from the testes.
- LH drops when testosterone is given as a replacement therapy (e.g. injection or cream). Testosterone replacement will reduce LH, thus reduce the body’s own production of testosterone.
- HCG can be used to stimulate the secretion of testosterone
- HCG, when used in conjunction with testosterone replacement, can stimulate the testes and prevent testicular atrophy.
- HCG is the hormone of pregnancy, produced by the placenta
Melatonin Therapy may:
- Improve quality of sleep, Energize, Enhance moods, Increase Natural Killer cells
- Reduce nocturia (with deeper sleep, then not awakened by need to urinate)
- Add to antioxidant protection, acting as free radical scavenger of hydroxyl ion
- Contraindications: paradoxical (reverse reaction), sleeping pill addiction (high dose and taper down on melatonin, while tapering down sleeping pills)
- Adverse reactions: nightmares (titrate up slowly); morning grogginess (take earlier)
Oxytocin Therapy may:
- Produce a stronger sexual climax
- Enhance a feeling of connection/relationship/peace
DHEA Therapy may help:
- Reduce CV risk, by increasing lipolysis, which may decrease visceral fat
- Stimulate the immune system, improve sexual vitality, improve moods, decrease cholesterol, decrease body fat, help with depression
- Improve memory, increase energy
- Improve bone density, reduce risk of diabetes and heart disease
- Act as an antioxidant (by reducing lipid peroxidation)
- Precursor to the sex hormones (Testosterone, Estradiol, Progesterone)
- Side effects in women: hirsuitism and acne (excessive dose); increase estrogen levels in men
- Contraindicated in sex hormone responsive cancers (breast, uterine, ovarian, prostate)
Pregnenolone may help:
- Memory, by protecting cell membranes against neuronal injury by preventing deposits of lipofuscin and contributing to cellular repair
- Precursor to all other hormones, made from cholesterol
- Important for premenopausal women, perimenopausal women, post menopausal women, and pregnant women
- For treatment of PMS – high doses (headache and bloating)
- Perimenopausal symptoms, irregular periods, FSH still low
- Progesterone secreted by ovary - by corpus luteum, second half of period after ovulation.
- Progesterone must be given with estrogen to prevent buildup of endometrium in menopause, and to prevent proliferation/stimulation of breast tissue
- Progesterone may treat fibrocystic breast disease and may stop bleeding of fibroid tumors of the uterus
- Progesterone and estrogen important for stimulation of bones and prevention of osteoporosis
- Side effects: nipple tenderness (oral), sleepiness (oral); bleeding (if stop dosing)
- Produced by thyroid gland (under Adam’s Apple), Thyroid hormone release is stimulated by TSH (from the pituitary) when Thyroid hormone is low
- Thyroid hormone includes both T4 and T3; T3 is more active than T4
- T4 is mostly produced by the Thyroid gland and converted into T3 in the liver
- T4 and T3 can be bound by proteins and are inactive until released as free T4 and Free T3
- Symptoms of low thyroid may be: fatigue, unmotivated, poor memory, slow thinking, moody, weak, cold, thin hair skin and/or nails, weight gain
- Use Free T3 as the marker of deficiency, in conjunction with symptoms
- Supplement with natural thyroid (dessicated) which contains both T4 and T3
- Side effects: excessive dosage may create anxiety/tremor/nervousness, heart palpitation, racing heart, high blood pressure, sweating, aggressive (Treatment for symptoms of excess: reduce dose. When starting replacement therapy increase dosage slowly.)
I spoke with a person, not my patient, who had undergone the full suite of BHRT that changed his life. He had an onset of epilepsy which required drugs to control his seizures; that left him depleted and listless, barely able to function. After reaching the therapeutic target for his BHRT on all his hormones, his energy returned to full level, even though he was still taking the seizure medications.