Bio-Identical Hormones

Hormone levels decline as we age. Hormones are incredible chemical messengers in our body that affect our brain, heart, bones, muscles, and reproductive organs and are an essential part of the workings of every cell in the human body. If your hormones decrease or are out of balance, your body will not respond optimally to improved nutrition and exercise as it once did. As your hormones, nutrition, fitness, and lifestyle improve – you will begin to feel like your old self with improved energy, vitality and results. What are “bioidentical hormones?” A “bioidentical hormone” refers to a substance that has the exact same chemical structure as a hormone that is naturally produced in the body.

Hormone Levels In Men and Women as We Age Women suffering from early menopause symptoms looking to put an end to hot flashes, night sweats, memory loss, mood swings, weight gain, and low libido are turning to expert physicians to replace natural hormones. Bio-Identical Hormone Replacement Therapy (BHRT) physicians design individualized programs specifically for each woman suffering from early menopause symptoms, menopause, perimenopause, and severe PMS.

Men experiencing the male menopause who want to get a grip on weight gain, lost libido, fatigue, stress, energy, muscle mass, and body fat are also finding solutions through natural hormone therapy. For men, andropause (the male menopause) happens gradually and when diagnosed, the symptoms are successfully treated using bioidentical HRT.

Testing for Hormone Levels Women

It is important to look at all the hormones when testing a woman’s levels. Testing should be done for estradiol, progesterone, testosterone, DHEA sulfate, and morning cortisol. If any one of these levels is out of balance she may have symptoms in another area. For example, if a patient’s estrogen level is in range but her progesterone is low, she can have symptoms that are associated with both estrogen-dominance and estrogen deficiency.

Five of the key symptoms of estrogen dominance are vaginal dryness, weight gain around the middle, decreased libido, irritability, and breast tenderness. Other symptoms may be present as well like vasomotor symptoms or hot flashes.  There have been many women who have presented with these symptoms to their practitioner and been given a prescription for estrogen replacement without looking at her progesterone level. One of progesterone’s primary functions is to down-regulate estrogen. If the estrogen is not balanced with progesterone then the estrogen will increase in the tissues.  When the levels become too high, harmful metabolites are formed and other disease states may arise. Excess estrogen relative to progesterone is implicated in most breast cancers.

Estrogen – Estrogen or lack there of, is blamed for just about every symptoms associated with perimenopause and menopause. Although most think estrogen as a single hormone it is actually an entire group or class of steroid and sex hormones with similar properties. Estradiol, or E2, is the primary estrogen produced by the ovaries. Estrone, or E1, is made by the adrenal glands and also converted from estradiol in the intestinal tract. Estriol, or E3, is primarily converted from estrone in the liver. Estrogen is essential for bone health, cardiac health, and control of vasomotor symptoms, vaginal lubrication, proper cognitive function, sleep and so much more. Although not always solely responsible for these things, if a woman’s estrogen levels decrease, replacement can certainly improve her health as well as her quality of life.

Progesterone – Low progesterone levels can wreak havoc on a woman both physically and emotionally. She may become uncharacteristically emotional, anxious, irritable and nervous. It’s also possible that her sleep will be compromised. She may awaken multiple times during the night, unable to fall into a deep, restful sleep. As a result she will wake up feeling tired, which only adds to her emotional fragility. Many people confuse natural progesterone with synthetic, chemical progestins. In hormone replacement therapy synthetic progestins are primarily indicated to guard against uterine cancer and uterine hyperplasia. Natural bio-identical progesterone offers more therapeutic benefits than just protection of the uterus. Progesterone is the precursor of other hormones like estrogen and testosterone, it prevents acne and headaches, helps with PMS symptoms, improves thyroid function, improves cell oxygen level, normalizes blood clotting, blood glucose levels, and levels of zinc and copper, and restores libido. Being a natural anti-depressant, progesterone helps with all the mood type symptoms such as depression, anxiety and mood swings. It is a natural diuretic and can rid excess water weight.  Natural progesterone can aid in cardiac health as it is a vasodilator where progestins like medroxyprogesterone (Provera)  are vasoconstrictors. Natural bio-identical progesterone works synergistically with estrogens in regard to most peri-menopause and menopause symptoms. Estrogen is needed to prevent bone loss and progesterone helps to increase bone density. Progesterone aids in sleeplessness as it is necessary for the patient to fall asleep and estrogen is necessary to prevent early morning awakening. Probably the most important aspect of natural bio-identical progesterone therapy if it down-regulated estrogen and prevents estrogen-dominance.

Androgens – The androgens, testosterone and DHEA sulfate are very important to a woman’s health. Testosterone is involved in the maintenance of lean body mass, bone density, sex drive, maintaining proper vaginal lubrication and cardiac health. DHEA is the principle adrenal androgen and is the main precursor for hormone production. Proper levels contribute to bone health, mental clarity, energy, vaginal dryness, libido, immune function, and overall well-being.  Testosterone balance is also involved in the prevention of wrinkles and dry eyes, and preserving mood balance. It is important to keep the androgens in range. Low levels of androgen will cause symptoms to manifest and having levels that are too high may be indicative of potential insulin resistance, diabetes, metabolic syndrome, or adrenal fatigue.

Cortisol – The stress hormone, cortisol, is a product of the adrenal glands and is produced whenever there is stress. This may be endogenous stress such as hormone imbalance or it may be exogenous stressor such as life’s difficulties. If cortisol is elevated, it can block the hormone receptor sites form absorbing the hormones, even those that are produced in the body. This can result in symptoms of hormone imbalance. If the cortisol is too low, a patient may exhibit fatigue, a weakened immune system, chemical sensitivity, irregular blood pressure, or decreased metabolism. There is a gender bias when it comes to stress. Women tend to hold on to stress long after the stress has passed whereas men will let go of the stress as soon as a solution is planned and before it is carried out. This fact should be taken into consideration when assessing patients and making recommendations for stress management.

Thyroid Hormones– Some patients may complain of peri-menopausal or menopausal symptoms such as dry skin, hair or nails, decreased libido, depression, fatigue, change in weight, slowed metabolism, or constipation. These symptoms may be due to sex and steroid hormone imbalance but may also be related to a sluggish thyroid gland. The two major thyroid hormones, thyroxine (T4) and triido-thyronine (T3) are responsible for influencing metabolism in the cells. It is important to not only test for free T3 and free T4 but also thryoid antibodies as an increase in antibodies may produce symptoms when the free T3 and T4 levels are in range. Imbalance of the sex and steroid hormones can directly effect thryoid function and vice versa. The entire endocrine system should be evaluated when considering any type of hormone replacement therapy. If you are prescribed thyroid hormone replacement therapy, here are some tips for the best absorption and results:  take on an empty stomach in the morning; and do not take iron, anti-acids or calcium at the same time as these supplements will bind with your thyroid hormone medication. Note:  When estrogen and progesterone are not balanced, in the case of estrogen dominance, estrogen can block thyroid hormone action. So even though the thyroid itself may be functioning just fine, it cannot deliver its cargo to the cells, and the tissues go wanting.

Individualizing Therapy

While it is important to test and evaluate the levels of all these hormones in the body, the results should be used only as a guide when treating a patient. Each patient’s symptomotology and response to treatment must be considered, regardless of her lab values. The determined ranges for hormones levels are broad. If a woman has spent most of her life near the high end of the range and now finds herself at the low end but still in range, she will likely have symptoms and may benefit from a low dose therapy. A compounding pharmacy that employs a hormone consultant who works with the physician is invaluable.  This specially trained person will work closely with each patient and their prescribing physician to closely monitor and adjust doses appropriately. There is no better example of this “Triad” relationship between pharmacist, physician and patient than the one we have established with Saveway Compounding Pharmacy, Newark, Delaware.

Treatment Options and Dosage Forms

For hormone replacement therapy, topical cream is the ideal dosage form. Creams are applied to areas where a vein bed is present under the skin. For example:  inner forearms from wrist to inner elbow, inner thighs, and crease of the leg behind the knees. When compounded, a solvent such a propylene glycol or ethoxy diglycol is used to drive the hormones through the skin and into the bloodstream.  One major benefit of using creams is flexibility. If a patient is sensitive to hormones she can adjust the amount she is applying and titrate as tolerated. If the creams are dispensed in a calibrated topical syringe, the practitioner will know exactly how may milligrams are being applied and can adjust her therapy accordingly. Some patients, such as those with higher metabolism, will require sustained release capsule as they will metabolize the creams too quickly and not get full 24 hour coverage for their symptoms. Sublingual drops or troches are options that deliver the hormones directly into the bloodstream via the mucosal tissue in the oral cavity. Vaginal suppositories are another option. This dosage form is especially therapeutic when using progesterone in treating a patient for endometriosis, adenomyosis or uterine fibroids because the progesterone is absorbed and will circulate increasing the tissue levels where needed. Testosterone should be applied topically to the vulva because the androgen hormone receptor sites are located in the labia majora. Oral testosterone is not an appropriate dosage form for women since it can cover to estrogen in the blood stream. Also, due to the location of the androgen receptors, an oral dose would have to be substantial in order to be effective after traveling systemically. Many women who have tried oral testosterone complain of agitation, increased acne, and no improvement in libido. A vaginal cream can be compounded of estriol along with a low dose of testosterone to strengthen the vaginal walls. Estriol is the only estrogen proven to heal and repair vaginal tissues. This compounded cream is used for vaginal dryness and helps with bladder symptoms like urgency and frequency. Unlike some commercially available products, the amounts of hormones contained in this cream are so low that systemic absorption is very unlikely.

Conclusion

There are many form of hormone replacement therapy available to women today. As history has shown some of these forms and doses may have more risks associated with them than benefit. Oral estrogens have been proven to have undesired hepatic and cardiac effect. Topical application offers flexibility in dosing, avoids first pass liver metabolism, improves cardiac function, and may increase sexual function. Each woman is unique and should be evaluated by her individual symptoms, lab results and response to treatment. There is no exact treatment protocol to follow that will encompass every patient. Education, support and understanding are the keys to helping a woman as her body changes throughout her lifetime.

Hormones and Skin Health Skin health is a major concern, especially in aging women. It is no coincidence that the decline in hormone levels as people age parallels the decline in skin properties frequently associated with aging. A major culprit for the skin thinning, wrinkling, and dryness associated with aging is the decline in hormones such as estrogen and progesterone in women, and testosterone in men. Contact us today for an assessment.

Migraines and Hormones Migraine occurrences can be associated with changes in hormone levels, in particular, an elevation of estrogen and not enough progesterone to balance.  Either the progesterone fails to spike or does not spike enough or the estrogen level ‘over-spikes’.  Whatever the case, it is almost always a situation of estrogen dominance.  and increasing progesterone is the answer.  Besides down-regulating estrogen, it is also has a calming effect on neurotransmitters.

Gail R.- “Visiting Renove is always a “good” experience. Dr. Parsons and her staff are true professionals and they are knowledgeable. Highly recommend Renove and Dr. Parsons for BIO IDENTICAL panels.”