Articles

General Hormone Replacement

“Aging is not an unalterable process of decline and loss. Hormones are now responsible for this change in attitude. Therefore, routine medical intervention programs offering long term replacement therapy with one or more hormones to delay the aging process, allowing us to live for a longer period in a relatively intact state are becoming popular.”Biomedicina 2000 Jan;Vol 3( 1):6-7.

“Hormone replacement prevents weight gain. HRT favors weight loss by increasing lipid oxidative, improves insulin response and lowers plasma lipids.” Maturitas 1999 Aug;16 32(3): 147 -53.

Menopause and Perimenopause

Menopause is a gradual, natural life transition from the reproductive years to the post-reproductive years. Some women pass through this stage with few symptoms, while others may be debilitated by them. Symptoms may begin during perimenopause, the time prior to or around menopause, which is officially diagnosed only after the final menstrual period. The most common symptoms include:

  • Hot flashes
  • Night sweats
  • Insomnia
  • Loss of libido
  • Vaginal infections and dryness
  • Dry skin
  • Mental fogginess
  • Headaches
  • Mood changes

As women age, the ovaries begin to decrease production of estrogens and progesterone, the menstrual cycles become more irregular. Eventually, ovulation and menstruation ceases and production of estrogens and progesterone declines dramatically. This process can span anywhere from 2 to 10 years.

During this transition, treatment may vary greatly, depending on the severity and duration of symptoms. Options typically include combinations of herbal and non-herbal remedies, dietary changes, exercise, yoga, meditation, and hormone therapy (bioidentical or conventional hormone supplements).

Menopause can also be artificially induced if one or both ovaries is impaired or removed (oophorectomy), or as a result of chemotherapy or radiation to the pelvic area.

“This manuscript presents a protocol for hormone replacement therapy with natural estrodial, progesterone, testosterone, DHEA and melatonin. Using the natural sex steroids which occur naturally in humans represents replacement to ensure attainment of pre-menopausal levels and adequacy of therapy. This is inexpensive therapy that gives relief of symptoms, is well tolerated, provides minimal side effects, protects the endometrium, and results in excellent compliance. This replacement of natural hormones is based on sound physiological principles that have been demonstrated to be the preferred method of hormone replacement.” Infertility and Reproductive Medicine Clinics of North America; 1995 October; Vol. 6 (4):653-675.

“Fear of breast cancer is the strongest factor limiting postmenopausal hormone use. The most powerful study to date definitively demonstrated that estrogen does not cause an increase risk for cancer. The increased risk was associated only with taking the progestin (Provera®) and not estrogen.” JAMA 2004;291(24): 2947-2958.

“Loss of hormones at menopause results in significant genital atrophy, vaginal dryness, introital stenosis, and painful intercourse.” Family Practice News 2005 March;58-59

“We must not forget the dangers of menopause and the deleterious consequences of estrogen deficiency. Estrogen protects bone, heart, brain, blood vessels, urogenital tissue, teeth and eyes. Observational data from around the world show estrogen has beneficial effects on mortality from all causes”. Consultant 2001July;Vol. 71:1085-1086

“North American Menopausal Society (NAMS) position statement: The WHI results do not apply to the majority of women. The WHI trial does not negate 40 years of study demonstrating HRT benefit. Five recent studies demonstrate overwhelming evidence that HRT prevents atherosclerosis.” Family Practice News 2003 Oct;1-2.

Progesterone Deficinecy

“The main reason women discontinue HRT is due to side effects. Synthetic progestin’s (Provera®) cause may side effects: breast swelling and tenderness, uterine bleeding, depression and mood disturbance, weight gain, bloating and edema. Natural progesterone has no side effects.” Female Patient 2001 Oct; 19-23.

“Progesterone should be administered to all women, hysterectomy or not.” Infertility and Reproductive Medicine Clinics of North America; 1995 Oct;Vol.6(4):653-673.

“Due to the side effects of synthetic progestin’s, natural progesterone is preferred. Progesterone has proven bio-availability and no side effects making it the preferred hormone for menopause.” American Family Physicians 2000;62: 1339-46.

“Estrogen and progesterone are neuro-protective against cerebral damage. These beneficial effects were blocked by MPA (medroxyprogesterone).” National Academy Science USA; 2003 Sept. 2;100(8):10506-11.

“Natural estrogen and natural progesterone offer substantial clinical benefit over the synthetic hormones and should be the agents of choice for menopause.” Obstetrics Gynecology 1989;73:606.

“The estrogen only arm of the WHI Trial demonstrated no increased risk of breast cancer with estrogen. This study therefore demonstrates that the breast cancer increase was due to medroxyprogesterone (Provera®) and not due to estrogen.” Family Practice News 2004 March 15;1-3.

“Progesterone reduces proliferation of breast cancer cells and induces cellular apoptosis (kills breast cancer cells) Maturitas 2003 Dec;46(1):555-58

“Due to the side effects of synthetic progestin’s, natural progesterone is preferred. Progesterone has proven bioavailability and no side effects making it the preferred hormone for menopause.” American Family Physician 2000; 62:1939-46

“Progesterone raises good HDL cholesterol, whereas MPA (Provera®), lowers good cholesterol. Progesterone increases estrogen beneficial effects whereas MPA reverses estrogen’s benefits. Progesterone has no side effects, whereas MPA has many” Obstetrics Gynecology 1989;73:606-611.

“Progesterone decreases Breast stimulation 400%, and down regulates breast receptor sites, thereby protecting against breast stimulation.” Fertility Sterility 1998;69:963-69.

“Mammary tumor stimulation was reduced both by progesterone and Tamoxifen, more so by progesterone by Tamoxifen which is the drug of choice to treat cancer.” Japan Journal of Cancer Research 1985June;76:699-04.

Female Sexual Dysfunction

At some point in their lives, many women experience a loss of interest or pleasure in sexual activity. Female sexual dysfunction occurs if these problems recur or persist to the extent that they cause distress.

There are many causes of sexual dysfunction and most are readily treatable. A thorough pelvic exam will reveal if there are physical changes that may be affecting sexual pleasure. Hormonal shifts, like those occurring after pregnancy and during menopause, can also lead to sexual dysfunction. While the role of estrogens is well known, imbalances in thyroid hormone, progesterone and testosterone can also affect sexual function.

Other causes include health conditions such as sleep apnea, diabetes, and depression. Also, many common medications dampen sexual response, including antidepressants and blood pressure drugs.
Symptoms may include:

  • Little or no desire for sex
  • Inability to become or remain aroused
  • Failure to achieve orgasm despite significant arousal
  • Painful sex

Treatments typically target the known or suspected cause of the sexual dysfunction, and include bioidentical hormone therapy, medication changes, lifestyle modifications, sexual therapy, relaxation techniques and pelvic exercises.

“Administration of testosterone to women eliminates hot flashes, lethargy, depression, incontinence, fibrocystic disease, migraine headaches, and poor libido. Testosterone also improves well-being, sexual desire, frequency and intensity of orgasm.” Consultant; 1999 August: 2006-07.

Testosterone Deficiency

Even though a woman’s “normal” amount of testosterone is only a minute fraction of that of a man’s, it is still vital for both sexes. Aside from its obvious roles in sexuality, testosterone is also essential for maintaining strong muscles and bones, and is important to cardiovascular health.

As we age, testosterone levels diminish, which can be particularly problematic for women because it is far less abundant to begin with. Common signs of a potential testosterone deficiency include:

  • Decreased libido
  • Vaginal dryness
  • Lack of energy, vitality and motivation
  • Loss of muscle tone, coordination and balance
  • Leaky bladder
  • Weight gain
  • Depression or anxiety

Women typically begin to experience these symptoms after menopause, as their hormone levels decline. However, pre-menopausal women can also be deficient in testosterone due to childbirth, endometriosis, or substance abuse. Even some medications, such as birth control pills, chemotherapy, and antidepressants, can interfere with the body’s ability to make use of the testosterone available.

Testosterone replacement therapy requires careful testing and monitoring because it typically involves other hormones as well. Bioidentical testosterone supplements are available as custom-compounded therapies in capsules, tablets, lozenges, injections, creams, gels and other forms.

 “Loss of testosterone causes loss of libido, energy, strength, sexual function, memory, cognition, muscle and bone. Testosterone replacement, as far as quality of life is concerned, is tremendous.” Medical Crossfire 2001Jan;Vol.3 No.1:17-18

“Symptoms of low testosterone may occur due to decreased serum levels or reduced receptor site sensitivity. In spite of normal blood levels patients will still feel and function better when testosterone is prescribed.” Medical Crossfire 2001 Jan;Vol.3 No. 1:17-18.

“Low testosterone levels are associated with an increased risk of diabetes, heart disease, and carotid atherosclerosis.” Diabetes Care 2003 June;Vol. 36, No. 6: 20-30.

“Low testosterone levels increase cardiovascular disease. High testosterone levels protect against cardiovascular disease.” Diabetes Metab 1995 Vol. 21:156-161.

“Testosterone replacement in women significantly decreases carotid atherosclerosis and cardiovascular disease.” American Journal of Epidemiology 2002;155: 437-445

“Higher testosterone levels increase cognition and memory.” Neurology 2005 Mar. 8; 64-5:866-71.

“Testosterone decreases cholesterol and raises HDL.” Atherosclerosis 1996 Mar;121(1): 35-43.

“Low testosterone levels are associated with higher cardiovascular risk. Testosterone supplementation reduces abdominal fat and improves insulin sensitivity. Testosterone lowers cholesterol also.” Diabetes Metab 2004 Feb;30(1):29-34

“Hormone replacement therapy in postmenopausal women and testosterone replacement in men reduce the degree of central obesity.” Obesity Review 2004 Nov; 5(4): 197-216.

“High doses of synthetic, anabolic steroids cause side effects. No such side effects have been observed using low doses of natural testosterone. Avoidance of supraphysiologic levels prevents any side effects.” Female Patient 2004 Nov; Vol.29: 40-45.

“Testosterone increases bone density in women. Testosterone protects against heart disease in women.” Journal of Reproductive Medicine 1999; 44(12):1012-20

“Low DHT (dihydrotestosterone) predicted a higher rate of cancer. Higher DHT levels were associated with a lower risk of cancer”. Brit.J.Urol 1990 Mar;77(3)443-37.

Osteoporosis

Osteoporosis is a progressive disease of the skeletal system in which bone density decreases and bone structure deteriorates. Eventually, bones become so brittle and porous that they can fracture from even mild stress. There are no tests to measure bone quality, so osteoporosis is diagnosed by measuring bone mineral density, usually through x-rays of the hip or spine.

While some illnesses and medications (especially corticosteroids) can cause bone loss, most people develop osteoporosis as a result of the aging process. In women, bone loss accelerates with menopause due to decreased production of estrogens and other hormones that contribute to bone health.

In early stages of osteoporosis, there are no symptoms. As bones become weaker, symptoms may begin to appear, including:

  • Gradual loss of height, accompanied by a stooped posture
  • Arthritis-like pain in the bones and joints
  • Fractures, especially of the wrists, hips and spine
  • Back pain, which can be severe if it results from fractured or collapsed vertebrae

Treatments that can slow down or even reverse bone loss include weight-bearing exercise, supplements, bioidentical hormone therapy and medications that inhibit bone breakdown.

“Estrogen deficiency greatly increases mortality from cardiovascular disease and osteoporosis. Over 90% of women will die from cardiovascular disease which estrogen can prevent”. Over 40 years of study have well documented the cardiovascular protective effects of estrogen”. Obstet Gynecol 1996 Jan;87(1):6-12

“The potential lethal consequences of osteoporosis are overwhelming. Estrogen is protective but only when certain serum levels are maintained.” Female Patient Oct. 2004;Vol. 29:40-46

“Long term high doses of thyroid had no adverse effect in causing osteoporosis or fractures” Cortland Forum July 2001:85-90

“Over 40 studies prove that thyroid replacement does not lower bone density or cause increase risk of fracture.” Cortland Forum; 2001 July:85-89

”The largest study to date, the Nurses’ Health Study, demonstrated a 100% decrease in heart disease and cancer for estrogen users. It is never too late to initiate estrogen therapy to arrest the progression of osteoporosis and hip fractures.” Female Patient 2004 Oct;Vol 29: 35-41.

Chronic Fatigue

As its name implies, chronic fatigue syndrome is a condition characterized by persistent, debilitating fatigue that doesn’t improve with rest, and may worsen with physical or mental exertion. Women are two to four times more likely to develop this condition, which can persist for years.

Symptoms typically start after an infection, viral illness, or stressful event. However, the syndrome can begin gradually without any obvious trigger.

Diagnosis is made only after all other causes of severe fatigue are ruled out, and if four or more of the following symptoms persist or recur for at least six months in a row:

  • Sore throat
  • Painful, mildly enlarged lymph nodes in the neck or armpits
  • Unexplained muscle soreness
  • Pain that moves from one joint to another without any swelling
    or redness
  • Headache of a new type, pattern or severity
  • Memory loss or trouble concentrating
  • Sleep disturbances
  • Extreme exhaustion lasting 24 hours after normal exercise

Although there is no cure for chronic fatigue syndrome, treatment to relieve symptoms includes exercise, massage, diet and lifestyle changes, counseling to address depression, antidepressants, pain relievers and bioidentical hormone therapies.

Fibromyalgia

Fibromyalgia is a chronic disorder characterized by intermittent “head-to-toe” pain, tenderness and fatigue. Fibromyalgia is more common in women, and the risk of developing it rises with age.

Symptoms vary in both number and intensity, and often co-exist with other illnesses, which makes diagnosis difficult. Symptoms often start after a physical or emotional trauma, and may include:

  • Pain in muscles, tendons and ligaments throughout the body;
    however, patients usually experience episodes of intense pain
    in the same “tender points.”
  • Muscle stiffness, usually worse upon awakening
  • Impaired memory and concentration
  • Fatigue and sleep disturbances

Although its cause is unknown, fibromyalgia seems to run in families and is often associated with other health problems, such as autoimmune disorders, chronic infections, and hormone imbalances.

Treatment options include massage, exercise, dietary changes, pain relievers, antidepressants, anti-seizure medications, and bioidentical hormone therapies.

“Fibromyalgia is frequently seen in hypothyroidism. There is now evidence to support that fibromyalgia may be due to thyroid hormone resistance (cellular hypo-function).” Medical Hypotheses 2003 Aug;21(2):182-89

Andropause

Andropause, more commonly referred to as "Male Menopause," is the gradual, age-related decline of hormonal function in men. The most dominant of the male hormones (or androgens) is testosterone, which plays a key role in many aspects of overall health. The androgens also include dehydroepiandrosterone (DHEA), androstenedione, and other hormones.

With the decline in testosterone and other androgens, men typically begin to notice changes around the age of 40, including but not limited to:

  • Decline in sexual function
  • Decrease in muscle strength and stamina
  • Increase in body fat, especially abdominal fat
  • Loss of hair on arms and legs
  • Lack of initiative or drive
  • Indecisiveness
  • Increased moodiness or inability to concentrate

Treatment of andropausal symptoms may include combinations of herbal and non-herbal remedies, an exercise program, dietary changes, and/or bioidentical hormone therapy.

 “Testosterone replacement improves muscle mass and strength, libido, erectile function, bone density, memory, cognition, myocardial function. It is unconscionable for physicians not to treat men with testosterone.” Medical Crossfire 2001Jan;Vol. 3 No.1:47-50.

“Testosterone levels have nothing to do with causing prostate cancer.” Cancer 1999, July 15;88(2):312-5.

“None of the 12 longitudinal population based studies, such as the “Physician’s Health Study,” found any increased risk of prostate cancer in men with higher levels compared to men with lower levels of testosterone.” New England Journal of Medicine 2004;350:482-92.

Hypothyroidism

Hypothyroidism is a condition in which the thyroid is under active. There are various symptoms of low thyroid function with the most common being:

  • Dry skin
  • Weight gain
  • Fatigue
  • Cold hands and feet
  • Low basal temperature

The treatment may include bioidentical hormone therapy, nutritional supplementation, and changes in diet and lifestyle.

“Combined T4 and T3 therapy resulted in improved symptoms, well-being and weight loss in comparison with straight T4 therapy. A decrease in weight resulted from using higher T3 levels.” J Clin Endocrinol Metab 2005 May;90(5):2666-74.

“TSH is a good test to diagnose hypothyroidism. However TSH is a poor measure of symptoms of metabolic severity. It is, therefore, the biological effects of thyroid hormone on the peripheral tissue and not the TSH concentration, that reflects the clinical and metabolic effects.” British Medical Journal Feb 2003;Vol. 326:325-326.

“Even exceptionally high doses of thyroid do not cause osteoporosis or fractures.” Normal Metabolic. Research 1995 Nov; 27(11):503-7.

“Even though the TSH is in the normal range, patients continue to have persistent symptoms despite adequate replacement doses. These patients are still symptomatic due to low T3 levels.” BMJ Feb. 2003; Vol 326:295-296.

“Patients that took a combination of T4 and T3 experienced better mood, energy, concentration and memory and improved well-being. Patients on just T4 experienced no change.” New England Journal of Medicine Feb. 1999;340:424-9

“Women with low normal thyroid levels had a 4-fold increase risk of heart disease. This increased risk was equal to the risk of smoking and high cholesterol. Low normal thyroid levels are a strong predictor for heart attacks.” Annals of Internal Medicine 2000; 132: 270-278.

“Low T3 levels are associated with increased heart disease and decreased cardiac function. Replacing T3 increases clinical performance and cardiac output. Adding T3 increases exercise tolerance and quality of life.” CVR & R 2002;23:20-26

“Low levels of free T3 in patients resulted in increased disability, depression, decreased cognition, and energy and increased mortality.” JAMA Dec. 2004; Vol. 292(2c): 500-504.

“Low normal thyroid levels result in increased cholesterol, increased heart disease, fatigue, low energy, depression, and memory loss. Thyroid replacement eliminates thee risks. No study has shown any harm or adverse effect of treatment.” Consultant 2000 Dec: 2397-2399.

“Long term thyroid replacement with high doses has no significant effect in bone density or fractures.” Lancet 1992 Jul 4; 340(8810):9-13.

“Thyroid levels should be raised to the upper normal range for a young person. This results in optimal cognition, memory, cerebral function.” Journal of Gerontology; 1999 Vol. 54:109-115

Hypoadrenalism 

Hypoadrenalism is low production of hormones from the adrenal glands or an imbalance among these hormones. The steriodal hormones primarily produced by the adrenal glands are cortisol (hydrocortisone) and DHEA. Some causes of hypoadrenalism may be immune system damage to the adrenal gland, or an insufficient amount of stimulation by pituitary hormones. There are many symptoms associated with hypoadrenalism with the common ones being:

  • Fatigue
  • Nervousness and irritability
  • Depression
  • Weakness
  • Salt and sweet cravings
  • Inability to concentrate
  • Allergies

A health practitioner may take a complete history, thorough physical examination, and lab tests to rule out other medical imbalances. Treatment for hypoadrenalism may include diet, nutrition, education, and bioidentical hormone therapy.

“DHEA administration reduces abdominal fat, decreases insulin resistance and protects against metabolic syndrome and diabetes.” JAMA 2004 November; Vol.292(18):2233-2247.

“Low DHEA levels are associated with depression and depressed mood.” J American Gerentology Soc.1999 June;47(6):685-91.

“DHEA is beneficial in treatment of major depression in women.” Am. J Psychiatry 1999 April;156(4):646-649.

“DHEA improves mood and fatigue.” J Psych 2000 Dec;85(12):4650-56.

“DHEA improves well being, sexuality, and cognition”. Endocrinology Research. 2000 Nov;26(4):505

“DHEA improves immune function and decreases mortality.” Critical Care Med. 2001Feb;29(2):380

Melatonin Deficiency

“Melatonin has been shown to slow the growth of some cancer, prevent some cancer and decreases side-effects of many chemotherapeutic agents.” Medical Hypothesis 1997 June; 49(6):523-35.

(Melatonin has become so popular that there is now a synthetic, chemically altered melatonin made by a pharmaceutical company to treat insomnia.)

“Use of melatonin in elderly patients with insomnia demonstrated improvement in sleep quality. This study is consistent with other studies.” Patient Care 2000 June:34-38.

“In this study patients were successfully weaned from benzodiazepines (valium), with the sleep regulating hormone melatonin: Melatonin was not associated with adverse effects or tolerance.” Archive of Internal Medicine; 1999 Nov 159: 2456-2460.

“Melatonin possesses strong antioxidant properties with increases in brain glutathione. Melatonin possesses potent anticancer effects, increases and improves immune defenses, inhibits tumor growth factor production.” Journal Pineal Research 1999 Aug ;23(i): 15-19.

“Night time administration of melatonin relieves migraine headaches.” Neurology 2004 August; 246-250.

Premenstrual Syndrome (PMS)

PMS affects close to 70% of all women in their reproductive years. It is characterized by symptoms that usually occur during the 7 to 10 days before menses, the most common being:

  • Water retention
  • Breast tenderness
  • Irritability
  • Emotional instability
  • Headaches

While controversy continues on what causes PMS, theories include poor nutrition, low levels of progesterone and/or the estrogen hormones, and thyroid disease. A health practitioner is likely to take a complete medical history and perform a physical examination to rule out other conditions such as endometriosis or ovarian cysts. A menstrual diary that correlates symptoms with the menstrual cycle also helps to differentiate PMS from other medical conditions.

Treating PMS may require a combination of solutions, including bioidentical hormone therapy, changes in diet, and other lifestyle modifications.

Infertility

Infertility is the inability to conceive a child and could be due to many different factors. One cause of infertility is luteal phase defect. This is inadequate progesterone production during the luteal phase of the cycle. Progesterone prepares the uterine wall for the implantation of a fertilized egg and supports the egg throughout a full-term pregnancy. Research indicates that "bioidentical" progesterone can raise the body's progesterone level and help women to conceive and carry a full-term pregnancy. When progesterone is low, there may be inadequate support for the fertilized egg which can result in a miscarriage.

Postpartum Depression

After the birth of a child, postpartum depression (PPD) can occur. PPD is characterized by frequent teariness or more extreme feelings of being unable to cope, rage, or the mother's fear that she may hurt herself or her baby. These feelings can occur anytime within the first year following childbirth. PPD has different levels of severity ranging from the "baby blues" to psychosis. Having the "baby blues" is characterized as a short period of anxiety and weepiness due to the shift in hormones immediately after birth. In the most severe case of PPD psychosis, mothers can experience extreme rage, severe depression, and delusions.

The treatment for these women may include a complete assessment of the individual's needs, including specific lab evaluations, psychiatric assessment, education, therapy, support, and medications, including bioidentical hormones, as needed.

Endometriosis

Endometriosis is a condition where the endometrial tissue normally found inside the uterus is found outside the uterus. These cells then implant themselves onto other organs in the pelvic area, where they grow and cause pain, infertility, and other problems. There are various treatments for endometriosis. Depending on the severity of the condition, where the endometriosis is located, and the age of the individual, treatment may include surgery, medications and bioidentical hormones, as needed.