Bio Identical Hormone Replacement
October 31, 2018
Welcome to Wellness By Design, the Southeast’s premier hormone restoration center. We invite you to turn back the clock and improve your quality of life by restoring, rebalancing, and maintaining those hormone levels that made you so vibrant in your youth.
Aging Doesn’t Have to Mean “Getting Old”
Learn about the different essential hormones our bodies produce and their individual significance.
Both men and women need testosterone. Men produce their testosterone in their testicles and adrenal glands. In women their testosterone comes from their ovaries and adrenals. Although famous for improving sex drive and sexual function, testosterone has many other useful effects including relief of anxiety, depression, irritability, dry skin, poor focus, memory lapses, high cholesterol, osteoporosis, heart palpitations, achiness, fibromyalgia, chronic fatigue syndrome, restless leg syndrome, insomnia, migraines, low exercise tolerance and lack of energy. Even congestive heart failure can respond in part to testosterone therapy since the heart has more testosterone receptors than any other organ.
In some men, testosterone converts to too much estrogen, which counteracts the beneficial effects of testosterone. These men need to take an estrogen blocker to reduce the levels of estrogen and make the testosterone more bio-available.
ESTROGEN / ESTRADIOL
Estrogen is the hormone that creates the essence of femininity. Aside from creating the alluring curves that define womanhood, estrogen participates in over 400 essential functions in the body. This is why when woman go through menopause, they often no longer feel like themselves again.
Common signs and symptoms of estrogen deficiency include:
- Vaginal Dryness
Replacing estrogen can be tricky however as it must be balanced with the other hormones. Too much estrogen can cause tender breasts, fluid retention, headaches or even mood swings.
This hormone is vital to a woman’s well being. Progesterone is crucial for everything from brain function to skeletal function. This is the hormone that balances out estrogen and takes away its worst side effects.
Benefits of taking Progesterone:
- It acts as a natural diuretic.
- It relaxes, calms and protects the nervous system
- It can help with anxiety and irritability, treats insomnia and is a natural anti-depressant
- It enhances your body’s defenses against certain types of cancers and neurological disorders
- It improves the breakdown of fat into energy by helping the thyroid gland to function better
- It’s absolutely esential for women who still have their uterus. It prevents the uterus from building up a lining that would eventually cause bleeding. It also helps prevent uterine cancer.
BIO-IDENTICAL VERSUS SYNTHETIC:
Conventional, or synthetic, hormones are synthesized in a lab and typically derived from plant progesterone and animal estrogens (phytoestrogens). Synthetic hormones are similar—but not identical—to the molecular structure of the hormones produced within the human body. Women going through menopause often use synthetic hormones to treat symptoms such as hot flashes, mood swings, vaginal dryness, and low libido. The menopausal symptoms are generally the result of declining estrogen levels.
In many cases, the body interprets synthetic hormones as foreign toxins because it cannot metabolize the chemical make-up of the hormone. This often leads to a variety of unwanted side effects ranging from non-life threatening to more serious medical conditions.
Common side effects associated with the use of synthetic hormones include:
- Blood clots
- High blood pressure (hypertension)
- Cardiovascular diseases
The Women’s Health Initiative (WHI) studies reported that women who used conventional (synthetic) hormone replacement therapy were faced with a higher risk of developing breast cancer and heart disease. Soon after the WHI findings were released to the public, many women began seeking out natural alternatives to conventional hormone replacement therapy (HRT).
Unlike synthetic hormones, bioidentical hormones are structural replicas of the body’s natural hormones. Since bioidentical hormones share an identical molecular structure to the hormones the body produces naturally, bioidentical hormone therapy is a safer and more effective method of treating symptoms of hormonal imbalance, without hormone therapy side effects.
OPTION FOR HORMONE REPLACEMENT THERAPY
There are several options available for BHRT (Bio-Identical Hormone Replacement Therapy) for women.
The most popular and most effective are pellets. Pellets are sterilized cylindrical compressed pure hormones that are inserted under the skin of the upper outer buttocks in a painless 10 minute procedure. They start to release hormones almost immediately and the effects can be felt in as little as 48 hours although the average time is closer to a week. Women are given either testosterone or testosterone plus estradiol (depending on labs and symptoms) and are also given a prescription for natural progesterone capsules to be filled at a compounding pharmacy. (The amount of progesterone needed is too much to fit into a pellet so must be taken separately. Unlike estradiol and testosterone, progesterone is perfectly safe to take by mouth)
Pellets in women must be replaced every 3 months to maintain therapeutic blood levels.
The big advantage of the pellet compared to other methods is the steady state delivery or constant release of hormones. Once optimal levels are achieved, they are maintained 24/7. In women with osteopenia or osteoporosis, this is important because their bones are receiving constant signals to maintain or even improve bone density.
The main disadvantage to the pellets is that once the pellets are inserted, they cannot be removed. So the dose must be accurately determined in advance. Fortunately, here at Wellness By Design our providers have extensive experience in selecting the correct dose based on weight, symptoms and lab results.
Another method for women are troches. These are like gelatin based “gummy bears” that melt under the tongue at bedtime. Why bedtime? Because they have progesterone in them which helps with sleep. The troches are going to contain a balanced mix of progesterone, testosterone and usually estrogen—again, depending on symptoms and labs.
The advantage to troches is that the dose can be adjusted immediately. The disadvantage is that levels can’t be kept constant since the dose is just once per day so the hormone level cannot be kept in the therapeutic range 24/7. Therefore their efficacy can never match that of pellets. Another disadvantage is that the progesterone component is naturally bitter and some compounding pharmacies have a hard time masking that flavor. A solution would be to do the estrogen and testosterone only in the troches and the progesterone in capsules but that adds extra expense. (Progesterone is perfectly safe to swallow by mouth whereas the goal with the estrogen and testosterone in the troches is to have them dissolve under the tongue.) Despite the inferiority of the troches, they are FAR superior to doing nothing.
Yet another method for women are creams. These again are a balanced mixture of the needed hormones and are custom made in a compounding pharmacy. The cream can be applied to skin anywhere OR directly to the labia or even intravaginal. The advantage to vaginal or labial application is for women who have vaginal dryness or painful intercourse or even bladder problems such as urgency or incontinence. The disadvantage to creams applied anywhere is those hormones don’t make their way into the blood stream so we can’t “follow” progress or hormone levels with blood testing. Now patients have to submit saliva, urine or a capillary blood spot to assess levels. Those assay methods cost more and take longer—typically 2-3 weeks instead of 2 days. There is also less data in terms of how well topical creams protect bone health. So it’s just more costly and inconvenient to use a cream method.
Men also have options for Hormone Replacement Therapy. Like women, pellets are the preferred method due to efficacy and sustained blood levels. Unlike women however, men can often go 4-6 months between pellet inserts instead of the 3 month intervals that work best for women. The pellet insert is basically a similar procedure to that for women although it takes incrementally a bit longer as there are more pellets to be inserted.
There is another option for men and that is injections. The injectable testosterone however must be complexed to something called an “ester” side chain. Without that, men would have to do multiple injections per day! The ester side chain gives injectable testosterone the ability to last for a week making it much more convenient. We generally use Testosterone Cypionate for male injections—the Cypionate being the ester side chain. Men can either come into our clinic weekly or be taught home administration—either by themselves or a willing partner. Insurances are often more likely to pay for injectable as opposed to other methods.
Although topical testosterone gel is advertised incessantly on the media, most men who choose this method ultimately end up being dissatisfied. The gel has a distinctive (unpleasant) odor and it can transfer to other family members. So men using the gel have to be exquisitely careful about hand washing and even laundering their clothing after applying the gel. That coupled with the fact that it just doesn’t seem to work very well has led me to abandon topical testosterone for men.
Testosterone in troche form has not been shown to work well in men.
There is some promise to using Clomid—a drug that acts like Luteinizing Hormone (LH) in that it stimulates the testicles to make more testosterone. The usual dose is 50 mg and this is “off-label” so insurance never pays for it. I have a few men who have achieved therapeutic testosterone levels with this drug but they typically are younger men–< age 40.
Regardless of the method chosen, we are confident that we can help just about ANYONE reach their fullest potential to live a happy fulfilled life by maintaining therapeutic hormone levels.