Bio-identical Hormone Therapy
Written in 2016.
Current research on hormones has brought new information to the discussion concerning the safety of hormone replacement therapies. The outcome of the Womens Health Initiative in 2002 reported that estrogen therapy increased risk of heart disease, stroke, breast cancer, blood blots, with some decreased risk of colon cancer and osteoporosis. Because of that study, estrogen received a bad rap and a lingering fear of hormones remains. However, in the past 11 years, research has elucidated the difference between the animal derived estrogens and synthetic progestins previously used and bio-identical hormones. Bio-identical hormones are hormones with a molecular structure identical to our own. What is becoming clear is that the benefits of bio-identical hormone replacement therapy (BHRT) far outweigh the risks for the majority of women and men if used properly. Safety depends on what type of hormones, how they are taken, metabolism (detoxification), and the levels in relation to other hormones.
Hormone optimization, nutrition, stress reduction and exercise are all necessary factors for healthy aging. Hormonal treatment to correct deficiencies if used safely, can improves quality of life, decrease overall inflammation and provide anti-aging properties. Adrenal hormones, thyroid, progesterone, testosterone and estrogen must be balanced in relation to one another to function properly. In this article I will discuss the current research behind hormonal therapies, estrogen, progesterone and testosterone for both men and women.
Menopause
Perimenopause occurs in the years leading to menopause when women begin having hormone fluctuations. Lack of ovulatory cycles combined with stress will cause lower progesterone levels. Once menopause occurs and menstrual cycles cease, estrogen will begin to fall significantly. Women may begin to experience hot flashes, increased belly fat, weight gain, difficulty sleeping, lowered libido and other changes. Some women may be able to use supplements, lifestyle changes and herbs while others might choose BHRT.
Estrogen
Estrogen occurs in our bodies in 3 forms: estradiol, estrone and estriol. Estradial isthe most potent form of estrogen. Estrone and estradiol cause most of the risks associated with estrogen use. Estriol which has the weakest estrogenic effect has many benefits. Treatment involves giving estradiol alone or with estriol in a ratio 80% estriol/20% estradiol.
Recent research has been very promising for estrogen replacement therapy (ERT). A Danish study found, women beginning estrogen therapy at menopause have had significantly reduced risk of mortality, heart failure, myocardial infarction, cancer, stroke and blood clots. To add, early initiation and prolonged hormone replacement therapy did not result in an increased risk of breast cancer or stroke. Bio-identical estrogen replacement now appears to be most effective when replaced at menopause. Breast cancer and hormone replacement is the area where the most confusion lies. A study on 80, 377 postmenopausal women found no increase or decrease in breast cancer in women on bio-identical estrogen and progesterone. A Women’s Health Initiative researcher stated”, Being obese, not exercising or excess alcohol consumption confers higher absolute risks for breast cancer than HRT use. “
New research shows that hormone therapy taken soon after menopause has widespread beneficial effects on the brain. In women who took hormones before age 65, dementia risk was reduced by almost 50%. However, HRT began after 65 slightly increased risk of dementia in this study. Estrogen has been shown to protect the brain from oxidative stress, ischemic injury and damage by amyloid protein (the protein associated with Alzheimer’s) ERT was found to regulate serotonin pathways in the brain, decreasing serotonin breakdown. Serotonin being the neurotransmitter involved in both moods and sleep. Therefore estrogen can act as an antidepressant, and sleep aid. Research has also shown that among women over 65 those that have taken ERT perform better on cognitive tests. Estrogen increases acetylcholinewhich is critical to memory and markedly reduced in Alzheimers.
We now know that cardiovascular diseases affects more women than men and is responsible for more than 40% of all deaths in American women. For every 1 women who die of breast cancer, 10 die of heart disease. Researchers have connected this pattern to decreasing levels of estrogen during menopause. In 2008, results of a Danish study—the largest since the WHI study—showed that how and when women take HRT may affect their risk of heart attack. During a 6-year period, researchers looked at almost 700,000 healthy Danish women aged 51 to 69. Results of the Danish study showed that there was no increased risk of a heart attack in women who were currently taking HRT compared with women who had never taken HRT. Estrogen with progesterone actually resulted in a reduced risk of heart attack compared to women who had never taken HRT. Numerous studies have shown a 40-50% reduction in cardiovascular morbidity and mortality with hormone replacement therapy in women. The mechanisms involved are: 1) Improvement in arterial function independent of lipid effect. 2) promoting vasodilation 3) Lowering blood pressure 4) Faster repair of vascular wonds 5) Lowering fibrinogen levels which decrease coagulation 6) Decreasing inflammation.
Other benefits of ERT include; epidermal hydration, improved skin elasticity and skin thickness, reduced skin wrinkles, and osteoporosis protection. Vaginal estriol replacement improves both incontinence, vaginal dryness and has been shown to reduce recurrent urinary tract infections by 91%. A review of 12 studies determined intravaginal estriol did not cause endometrial proliferation and is not associated with an increased risk of uterine cancer.
Estrogen routes of administration should be via the skin as oral estrogen is associated with increased C-reactive protein, a marker for inflammation, increased triglycerides, elevated liver enzymes, increased gall bladder disease, increased risk of blood clots and lowered growth hormone levels.
Estrogen metabolism is another factor to consider if desiring estrogen replacement. We know there are genetic and acquired defects in the estrogen metabolism process. Testing can identify whether estrogen is being metabolized into the harmful forms of estrogen. Genetic polymorphisms (mutations) may impair estrogen detoxification. MTHFR and COMT are both methylation markers that should be checked if patients have familial risk factors such as fibroids, hormonal cancers, and endometriosis.
Many plants contain phytoestrogens which have an estrogen-like effect in the body and can be used if menopausal symptoms are mild. The highest phytoestrogen containing plants are: soy beans, red clover, flax seed and maca however many foods eaten have safe estrogenic properties.
Progesterone
In cycling women, estrogen dominance rather than deficiency is more common. Deficiency of progesterone leaves an excess of unopposed estrogen causing a myriad of symptoms including heavy bleeding, painful or fibrocystic breasts, mood swings, irritability, PMS, irregular menses infertility, headaches and shortened menstrual cycles.
Replacing progesterone or giving herbs that support endogenous production can relieve many of these symptoms. Estrogen dominance also occurs due to improper detoxification of natural estrogen or exogenous estrogens from the environment. Bioidentical progesterone also protects against: breast cancer, uterine cancer, coronary heart disease and osteoporosis. Women found to have the highest progesterone levels correlated with 88% decreased risk for breast cancer. In another study, women with lowest progesterone levels had a 5.4x higher risk of breast cancer and 10x as many deaths from all cancers. Progesterone also has significant cardioprotective effects such as decreasing blood pressure, relaxing coronary arteries, decreasing platelet aggregation, decreasing lipids, and decreasing coronary atherosclerosis.
The point of hormone “balancing” can not be overstated. Use of prolonged progesterone without adequate estrogen can also can have negative effects such as increased lipids, elevated cortisol, increased insulin resistance, depression, fatigue, decreased libido and weight gain.
Testosterone
Testosterone can be both beneficial for both men and women. As women experience menopause, men experience andropause, a decline in androgen production. Because it does not have a sudden onset similar to menopause it often goes un-noticed. The benefits of testosterone therapy include; improved mood, cognitive function and memory, decreased brain aging Alzheimers prevention, improved muscle, decreased fat, improved libido and erectile function, decreased inflammation, improved Growth hormone secretion and decreased insulin resistance. Low testosterone was correlated with increased mortality rates in 4 studies. In one 10 year prospective study, high endogenous testosterone was correlated with lower risks of cardiovascular disease and cancer. The men that had high testosterone naturally had no increase in prostate CA. Studies have shown that testosterone therapy does not appear to increase prostate cancer risk. In a study of 1000 male veterans over 40 with reduced serum testosterone levels, after 4 years of treatment mortality was 10% vrs 20% for controls. The rates of prostate cancer were 1.6% in the testosterone treated vrs 2.0 for the untreated. Testosterone improves both blood pressure and cerebral blood flow. Both estrogen and testosterone must be tested prior to testosterone therapy. If a man isn’t doing well on testosterone therapy it is often due to conversion to estrogen. If estrogen levels have increased, it is important to combine testosterone with an aromatase inhibitor such as anastrazole, clomid, chrysin, zinc or progesterone.
In men with low testosterone where fertility is of concern, HCG or Human Chronic Gonadotropin, the hormone women make when they are pregnant is used instead of testosterone therapy. HCG has been found to stimulate both testosterone and growth hormone naturally.
In both men and women, natural testosterone boosters include treating cortisol and DHEA deficiency, as well as zinc supplementation, stress reduction, weight loss, exercise and increased protein in the diet. Testosterone can be given transdermally in a cream, as a pellet under the skin or injected.
Hormone imbalance or deficiencies can occur naturally with age or become more severe due to prolonged stress, malnutrition, poor diet, chronic infection, toxic mold exposure, trauma, fatigue, insomnia, drug or alcohol abuse. Since the body always seeks a balance, one hormonal deficiency may upset the balance of the others. Since estrogen, progesterone and testosterone are not necessary for survival the body will choose cortisol production at the expense of the sex hormones. In your quest for good health, consider testing all the hormones and asking your doctor about natural supplements, herbs or bioidentical forms of hormone replacement.