Let’s delve into the hot topic of bio-identical hormone replacement therapy (BHRT). As people seek to live longer and with more vitality, many of my well-informed patients come into the office and ask about bioidentical hormones. My practice is based on a new model of medicine that fosters wellness and vitality, rather than treating disease. Our patients want to wake up every day feeling their absolute best, living long and healthy lives. Bioidentical hormone therapy can often be a crucial step in attaining this goal.
Hormone production increases during puberty and reaches a peak in healthy adults during their 20s and early 30s. Hormone levels start to decline in the mid-30s and early 40s and continue to remain at lower levels for the remainder of life.
Men lose 1% of their testosterone yearly starting at age 30. For some, this drop is more severe and men can have noticeable symptoms even in their mid-30s and early 40s. Common complaints included decreased libido, motivation, and energy, along with mid-abdominal weight gain. The term “andropause” is used when referring to male menopause.
Women lose about 75% of their progesterone and 25% of their estrogen in the 8 years before menopause. For many women, they can have hormonal imbalances in their 30s and after childbirth. These imbalances trigger symptoms like fatigue, insomnia, hot flashes, night sweats, vaginal dryness, foggy thinking, and thinning bones in the years before menopause actually begins.
Traditional physicians often treat menopause and andropause with anti-depressants, anti-anxiety drugs, sleeping pills, birth control pills/IUDs, and even hysterectomies. While these therapies may alleviate some symptoms, they do nothing to address the root cause of the disease.
Bioidentical hormone replacement therapy aims to restore hormone balance and alleviate all these symptoms without the use of pharmaceuticals. When done properly, BHRT is a precise and careful therapy that is tailored to the individual. In my practice, I often encounter women who have had had their hormones replaced in random ways, for example, being told to go to a health food store to get some progesterone cream to rub on their belly. Often, these women have not had their body’s hormone levels checked before or after therapy, and dosages are often not clear.
Every individual has unique biochemistry. It is crucial to begin with a thorough lab workup that measures all of the hormones including estrogen, progesterone, testosterone, DHT, and DHEA. The evaluation should also examine the adrenal and thyroid glands. Since there can be significant interconversion between hormones, it is important that both men and women be evaluated for this. For example, some men convert more of their T into DHT or estradiol, and strategies need to be employed to reduce that enzyme activity.
Many of the symptoms attributed to aging or menopause, like weight gain and fatigue, may actually be caused by other lifestyle factors. Conditions like nutrient deficiencies, a lack of proper sleep, and high amounts of emotional stress can all disturb hormonal balance and cause inflammation, well before menopause takes place. Preexisting medical conditions like cognitive impairment, heart disease, or osteoporosis impact the indication for BHRT. I spend hours with patients, reviewing their histories and symptoms and analyzing lab results before coming up with a custom-tailored plan that includes BHRT, nutritional therapies and other strategies to maximize well-being.
Several signs may indicate that a person’s hormones are shifting and help to identify candidates for bioidentical hormone replacement therapy. These center on:
- Difficulty sleeping, mood changes, and emotional instability with irritability and anxiety
- Heavy and irregular menstrual cycles
- Thinning hair, on the head and body (this occurs in most men and women, although usually more noticeably in men)
- Lowered sex drive and vaginal dryness
- Weight gain, especially around the stomach/abdomen
- Decreased energy levels and motivation
- Dry skin
- Hot flashes or night sweats
- Cognitive changes brain fog, reduced concentration, and poor memory.
Synthetic hormone replacement has been used for decades as a way to help people suffering from low T or menopause, but it’s not the only option on the market. In fact, there are several reasons why synthetics may not be the best option to restore proper hormone levels.
Patients often ask, “What do we mean when we say bioidentical?” Bioidentical hormones are identical in their shape, make-up, and structure to hormones made in the human body. This makes BHRT the perfect “key” to unlock the body’s receptor sites. Simply, it’s the shape of the molecule and not its source.
Traditional hormones like Premarin and Provera are technically “natural.” Premarin, for example, is derived from the urine of pregnant mares. This is considered “natural” if your native food is hay! Provera was created as a substitute for bioidentical progesterone. Pharmaceutical companies don’t invest in BHRT hormones because they cannot patent a naturally-occurring hormone.
BHRT isn’t and shouldn’t be scary. Estrogen itself has 400 functions in the body, so if we live without it, we live without 400 crucial functions that affect quality of life. Some studies have shown that men and women who use BHRT live longer than those who do not. It’s important to seek counsel of an experienced physician who is well versed in BHRT. The pre-BHRT evaluation should emphasize genetics, family history, and should include a thorough discussion on the benefits and possible risks. When I work with my patients, they are tested regularly and their clinical picture is re-evaluated at each visit to ensure that their bodies are handling the hormones and using them well. Often, we need to make adjustments to doses or methods of administration as time progresses. When hormones are done right, it can be a life changing experience.
Any holistic view requires that we look at the body as a whole, and not just a sum of its parts, as we do in traditional medicine. For example, regarding BHRT for women, some doctors feel that if a woman doesn’t have a uterus, then she doesn’t need progesterone. This view ignores the rest of a woman’s body. Progesterone travels throughout the body and plays many important functions including aiding sleep and giving a woman a sense of well-being. It is also important to balance the effects of estrogen to avoid a state of estrogen dominance.
Benefits of BHRT include:
- Reduced risk of osteoporosis and improved bone density
- Reduced incidence of hot flashes and vaginal dryness
- Better maintenance of muscle mass and strength
- Improved cholesterol levels
- Reduced risk of endometrial and breast cancer
- Reduced risk of depression
- Improved sleep
- Better mood, concentration and memory
- Improved libido
- Reduced risk of Alzheimer's disease
Each bioidentical hormone prescription is custom-compounded, based on the patient’s individual diagnostic results, and using the lowest doses necessary to achieve the desired effect. I base my methods on the best practices of the American Academy of Anti-Aging Medicine. BHRT replaces hormones with those of the exact chemical structure that our bodies make naturally. When levels are measured and followed carefully, this is the best and safest way to restore hormone balance.
**The information provided in this article is intended for your general knowledge only and is not a substitute for professional medical advice or treatment for specific medical conditions. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition.