Physiologic Bioidentical Hormone Replacement Therapy
Your hormones should exist in harmony with each other. When levels of each hormone are in the right proportions, body systems are stable. When balance is lost, hormone deficiencies and excesses can cause chronic symptoms and disorders, and raise risks of disease. Hormones in balance are critical to health and disease prevention. Hormones in balance protect against breast cancer. Conversely hormones out of balance contribute to an increased risk of breast cancer. Diet and lifestyle are critical to hormone balance and overall health. Stress negatively affects hormone balance. Estrogens, progesterone and testosterone control many aspects of cellular growth and function in all tissues. They maintain normal brain function, are important modulators of mood, cognition, pain, etc., maintain proper functioning of the immune system, skin, hair, bone, muscle blood vessels, and connective tissue.
Many symptoms may signify a hormonal imbalance:
- weight gain
- mood swings
- loss of sex drive (libido)
Though bio-identical hormones have been known for years, most practitioners are unfamiliar with them. There are several brand name versions now available for use in the kind of hormone replacement therapy ("HRT") typical of synthetic hormones. This is generally a one-size-fits-all dosage regimen.
Today sex hormones are available in bio-identical form, i.e. in the form they normally exist in our body. They can be given in different ways (orally, transdermally, sublinually or intrarectally). A man should make decisions regarding bio-identical hormonal supplementation with her physician based on results of the blood tests. The great appeal of bio-identical hormones is that they are natural, and our bodies can metabolize them as it was designed to do, minimizing their potential side effects. Moreover, the compounded bio-identical hormones can be matched to the individual needs of each man's needs-approach that is almost impossible with mass produced products. On the contrary, synthetic hormones often produce intolerable side effects. European medical studies suggest that bio-identical hormones are safer than synthetic versions. We must be cautious here though, because they have not been studied yet for long term use. I recommend them only with a complete risk assessment on the individual basis. I also do not support the notion that bio-identical hormonal therapy be used indefinitely as some kind of "fountain of youth".
Hormones constantly interact among themselves. The hormonal profile of every man is unique. This means that the amount of hormones taken is dependent on every individual and the dosage right for one man may be too high or too low for another. The need for hormones changes as we age. Therefore, interval tests to determine their current levels need to be undertaken.
There is no doubt that hormones prevent osteoporosis. Osteoporosis is a disease that is the result of a depletion of bone cells, making bones more fragile and susceptible to fracture. Sex steroid hormones also play a role in controlling and regulating your metabolism and blood sugar, your energy output, digestion, and the way your body stores and burns fat. They help to regulate fluid and mineral balance, thyroid function, dramatic mood swings that lead to food cravings, erratic eating and weight gain. Hormone replacement may encourage weight loss and support your body's insulin response, energy levels, and lipid profile. I think that the greatest success lies in an individual approach. I begin with laboratory test of hormone levels ("male hormone panel"). When warranted I then prescribe a precise dosage of bio-identical progesterone, testosterone or DHEA that is made up at a compounding pharmacy. Each patient is then monitored carefully through regular follow-up hormone panels to ensure adequate levels of hormones. Initially I do a hormone panel every three months. Once balance is restored, I perform hormonal panels once a year at the time of the annual exam.
Cortisol and melatonin are two additional hormones of paramount importance. When experiencing stress of any kind, your body releases cortisol, one of your steroid hormones, into your blood stream to help you cope. Cortisol is actually called the stress hormone and functions to help your body to mobilize the energy you need to manage the stressful experiences in your life. It also assists your body in maintaining blood pressure and suppressing reactions like pain, allergy and inflammation. Elevated cortisol levels can lead to abdominal weight gain, loss of memory, insulin resistance and type II diabetes.
Melatonin is the hormone responsible for maintaining the day and night cycle. Beginning in our thirties melatonin levels fall and in later years often manifests as insomnia. Melatonin increases killing of cancer cells and also makes us look younger.
A healthy lifestyle has been shown to be associated with higher hormone levels, and higher hormone levels induce a more active, healthier lifestyle. When hormone levels decline, we become less active and gain weight. As we gain weight, hormones are stored in fat and become unavailable to meet the body's demands. Lack of exercise, excessive alcohol use, and many diseases can reduce bioavailable hormone levels. For optimal results, it is vital that hormone replacement therapy be combined with adequate exercise, proper nutrition, and appropriate use of supplements.
Testosterone replacement therapy for men with low testosterone levels may produce a wide range of benefits including:
- increased muscle mass and body composition
- improvement in libido and sexual function
- preservation of bone mass
- increased strength and stature
- improvement in sleep and quality of life
- enhanced cognition, concentration and memory
- improvement in mood and depression
- decrease in cardiovascular risk (improves cardiac function, vasodilates, improves exercise tolerance and angina threshold)
Testosterone can improve:
- Osteoporosis - Gradual loss of testosterone is one of the major causes of osteoporosis in elderly men. Fracture occurs at a later age in men than in women because men's bones are denser at a baseline. Several studies have reported beneficial effects of testosterone therapy on bone in older men, showing an increase in bone mineral density and slowing bone degeneration
- Cardiovascular disease - According to most reports there is an increased risk for these diseases associated with low serum total testosterone levels. A number of studies have demonstrated that testosterone minimizes several important risk factors for the heart attack by:
The degree of atherosclerotic disease increases significantly with declining levels of free testosterone. Visceral fat accumulation is connected to increased vascular risk, and studies showed that androgen administration can decrease this fat accumulation.
- reducing cholesterol and triglycerides
- reducing blood glucose levels
- normalizing blood clotting
- decreasing visceral fat
- Diabetes - Low testosterone levels are associated with an increase in the risk for developing type II diabetes mellitus and metabolic syndrome and possibly a reduction in survival
- Depression - Depression is more common when levels of bio-available testosterone are low, perhaps because of an associated decrease in sexual function, irritability, and mood swings
There is overwhelming evidence confirming that 50% of those taking vitamin supplements will remain deficient.
Vitamin deficiencies are associated with the disease process and the overall condition of your health. Vitamin, mineral and antioxidant deficiencies have been shown to suppress the function of the immune system which can contribute to degenerative processes such as arthritis, cancer, cardiovascular disease, Alzheimer's disease, and diabetes, to name a few.
For a variety of reasons, nutrition has played a relatively minor role in modern medicine. A primary focus remains to be treatment versus prevention of acute syndromes and diseases. Relatively recent arrival of functional medicine and emphasis on healthy and longer living, has contributed to the interest in nutritional testing and supplementation of specific deficiencies. There is an increasing interest in preventive and individual medicine, and the role nutrition can play in disease prevention and treatment. Clinicians and patients are increasingly looking for alternative approaches to conventional medicine, in order to illuminate complex interactions between diet, genetic background and disease risk. Some of the diseases linked to nutrient imbalances include:
- arthritis and musculoskeletal disorders
- Parkinson's disease
- substance abuse
- behavioral disorders
- multiple sclerosis
- immune disorders
- infectious diseases, including AIDS
- macular degeneration
- cardiovascular disease
- chronic fatigue syndrome and fibromyalgia
- premenstrual syndrome
- Alzheimer's disease
These symptoms can be strong and you can feel out of control. If you tried but without success to figure out what is happening or you tried to be treated symptomatically in ways that do not seem to work, testing your hormones may be the first step to feeling better. Replacing all of our deficient hormones (i.e. these made by thyroid, as well as cortisol, testosterone, estrogen, DHEA and growth hormone) to levels we had in our youth is beneficial to both our health and quality of life. The rate and incidence of disease formation as well as the rate of aging are partially controlled by our endocrine and immune systems. The endocrine system regulates our body's temperature, reproduction, growth, aging, mental function and immune system. Communication between the nervous, the endocrine and the immune system makes it possible for us to adapt and survive in our environment.
It is through hormones that these systems interact to accomplish this mission. Hormones serve as messengers from the central nervous system telling our internal organs how to function. A decrease in the production of hormones begins in the middle age and continues to diminish in a linear fashion until old age. Our hormones decline through aging, menopause or andropause, disease, exposure to toxins or trauma. These molecules are manufactured in endocrine glands, which include the adrenal glands, ovaries, testes, pancreas, thyroid, pituitary gland and pineal gland. Whether the problem is low hormone levels or hormone resistance, the solution is optimal, balanced hormone replacement. Any decrease in stimulation of the receptor site will result in a decrease in stimulation of the cell, ultimately causing its destruction. Customized bio-identical hormone replacement therapy (BHRT) uses hormones that have the same molecular structure as those that are made by the human body. The molecular or chemical structure is the key to the actions or side effects that a hormone will have in the body. In order for the replacement hormone to fully replicate the function of human hormones, which are produced by the human body, the chemical structure must exactly match the original. Researchers have long held that there are significant differences between human hormones and synthetic, animal or plant derived preparations. A chemical structure of a hormone for instance may be modified to create a synthetic product that can be patented by a pharmaceutical manufacturer. A patented drug can be very profitable, and therefore a drug company can afford to fund research as to the medication's use and effectiveness. However, human hormones cannot be patented.
Main goals of physiologic hormone replacement therapy are:
- diminish the symptoms caused by the natural decrease in production
- give the protective benefits, which in the first place were provided by naturally occurring hormones
- re-establish a hormonal balance
Every person is unique. Therefore, it is important that a physician and a patient work together to provide customized BHRT in the most appropriate strength and dosage via the preferred route, acceptable to the patient. The precise components to each person's therapy are to be established after physical exam, medical history, symptoms, and laboratory testing. Periodic monitoring is essential to ensure that appropriate adjustments are made. Now, it is possible to produce bio-identical hormones that chemically match those produced by the body. We can improve many of the symptoms that we have come to associate with an old age.
Hormone replacement therapy, however, is not a panacea. It will not reverse aging. It will not keep us permanently at one age. We will continue to age and lose cells secondary to a process that is regulated genetically. With hormones we can slow the decline that occurs after midlife and maintain our good health. We will stay resilient, physically and mentally less aged. The key is to replenish all of the deficient hormones back to a more youthful balance.
Improvements seen are:
- decreased incidence of heart disease and atherosclerotic and reduced body fat
- decreased incidence of heart disease and atherosclerotic plaque
- increased energy and exercise capacity
- increased strength, duration and muscle tone
- increased breakdown of fat - weight loss
- improved vitality and quality of life
- improvement in appearance of hair, skin and nails
- improved sleep and well-being
- reduced levels of cholesterol and triglycerides
- decrease incidence of diabetes
Therapy should be individualized and multiple hormonal deficiencies addressed simultaneously in order to assure successful treatment. Intensive evaluations and follow-ups are required to address the entire spectrum of complex conditions. Ultimately every patient should have a maintenance program to remain symptom free and should feel rejuvenated. A delicate hormone balance is deeply connected to our stress level, the food we eat, the exercise we get, and the toxins we absorb. These factors critically impact our overall hormone picture, particularly at midlife as reproductive functions diminish over time, when hormone production is taken over by the adrenals (in inadequate amounts). Hormones not only regulate our immune system and response to stress, but also help to maintain bone and muscle mass, libido and energy levels. The importance of hormone balance cannot be understated. It starts with the everyday decisions we make. Lifestyle choices and appropriate nutrition and supplementation are critical for achieving optimal health. The following practical tips may help keeping your hormones and health in balance, but testing your hormone levels is the best way to understand what's happening in your body:
- limit exposure to pseudo-hormones
- limit exposure to disrupting chemicals
- get adequate sleep
- drink plenty of water
- do not smoke and limit alcohol
- be active (exercise is good)
- enjoy fresh food, eat a rainbow of colored vegetables every day, limit foods high in simple carbohydrates and those that processed
- try to maintain stable, good body weight and its composition
When we get older we become more financially stable. Our children are about to leave or already left our homes. Some of us even have grandchildren. We are ready for further adventures and the fulfillment of our dreams. We are the first generation that does not want to become "old". We have strived long to be physically and mentally attractive. Approaching this middle age we became wise, are able to maintain a clear perspective, and are more interesting, intelligent, charming and playful. Bio-identical hormones may again make our lives colorful, filled with positive energy, better quality of life, better health and looks. Since we live longer, we should also live better.
There is no proven increase in cancer seen with any of the bio-identical hormones.
ADD LIFE TO YEARS NOT YEARS TO LIFE!