Bio-Identical Hormone Therapy

Bio identical hormone therapy. Why would we even consider this a thing. Well that is a good question. There’s a lot to cover, and we’re not going to try to cover it all here. My goal is to make you understand why it’s a thing. I’m not going to try to teach you all the scientific information that proves that this is a helpful strategy for your long-term wellness. I’m just gonna share with you what I think are indisputable proven facts about bio-identical hormone therapy, and what I think are correct conclusions based on, a lot of scientific evidence that I think makes it most likely biologically possible strategy for maintaining our long-term health and wellness.

What is a hormone?

Hormones are molecules produced by the endocrine system. Organs like your thyroid gland, ovaries in a female, testicles in a male, the adrenal glands and the pancreas produce molecules that control the cellular function of other cells in the body. Just about every cell in your body has a receptor for just about every hormone that your body makes. There is feedback regulation on the organs so they produce these hormones at various levels, and thereby control cellular function. Here’s how it works. The hormone is a molecule that fits into a lock and key system called a receptor on the individual cell. Once bound, that receptor pulls the hormone into the cell. It’s delivered to the nucleus of the cell, which is where your DNA is contained. In there, the hormone actually turns genes on that make our cells work right. The goal of a Health and Wellness Longevity program should be to get your hormones back to youthful levels where you’re functioning at the highest capacity, and your cellular function is at its maximum. Hormones aren’t medicines, though this is technically medical therapy, because in order to be prescribed hormones, at least legally, you would have to see a doctor once a year and undergo an annual evaluation.

I will tell you that collectively, the failure to address the decline in our hormones, particularly our sex hormones, as we age, is probably the biggest debacle in modern medicine. I have my theories as to why we see this. Some of this is lack of education from the time doctors start medical school. Disease model physicians do not know and understand what I know. I wanted to learn more about Longevity, and staying healthy instead of just chasing disease after the horse was out of the barn. That pursuit lead me to the Science of Hormone Replacement, and once I learned this, I was astonished of the neglect of the Mainstream medical regime, in this Domain. In my opinion we should be addressing the decline in our testosterone, that begins in both males and females at around age 30 or so, and the precipitous decline in the female hormones that occur at the time of menopause very proactively. The evidence is clear that low levels of these important sex hormones leads to chronic disease. We noticed this in the observational models, where we see human beings, who were not given as good a hand by God. Some men have really low or absent Testosterone. And some women suffer early or surgical menopause. We can, and have observed their health outcomes in the natural environment, and we know that they have increased risk of bad metabolic diseases, obesity, cancer rates. Nearly everything “bad” is higher in these individuals, so it becomes pretty logical to guess that putting these levels back to youthful levels proactively, is probably going to be associated with a better outcome. Collectively, that’s what the science says. More recently, well designed double blind clinical controlled trials are supporting this hypothesis with great consistency. I will eventually provide access to the individual science, but that is not the venue here. I practice the medical application of hormone replacement in my patients, when appropriate, based on measurable deficiency and consentient symptoms. It’s what I would recommend for for all living creatures that don’t have contraindication, and what I would do for all, if I had the capacity.

We will start with testosterone, since it’s present in both the male and the female.

Facts:

  • We know that testosterone levels begin to decline by about age 30 and there’s a steady decline of about 1 to 3% per year.
  • We also know that testosterone has an affect in the sexual domain. It is the number one driver of the libido in both men and women.
Bio-Identical for male and female
  • Probable Truth: We know that testosterone is probably the most important hormone in women. It circulates in almost 10 fold higher levels than estrogen. Men have about 10 times amount of testosterone as women, but it’s important in both sexes.
  • When we replace testosterone it improves metabolic conditions. We know that it immediately enhances insulin sensitivity, which many clinicians in the disease model believe is the root of all evil and chronic disease. Low levels are associated with higher insulin insensitivity.
  • We know that testosterone will improve our ability to recover from exercise. Everyone knows that testosterone is anabolic, meaning it helps put on muscle. But we also know that testosterone is the DRIVE hormone. Not just the sex drive, but it’s the hormone that creates drive in all walks of life. It makes us want to get up out of bed and conquer the world. We know that we can enhance the exercise prescription by increasing our drive to and ability to recover from exercise. And make sure you understand, the Number 1 benefit in both the male and the female, of testosterone therapy, is it ability to enhance the exercise prescription. This is something I always stress to all of my patients.
  • Testosterone improves bone density in both the male and the female. This is paramount to avoiding frailty.
  • Testosterone reduces visceral fat associated with the inflammatory state.
  • Testosterone therapy does not cause Prostate Cancer. Prostate cancer rates are highest in men with the lowest levels of naturally occurring Testosterone levels in observational models.
These are all things that we know, if we prescribe testosterone and do it properly, we can improve these potentially evil situations, that result in development of chronic disease that will take away our ability to survive and thrive. So I encourage you to consider the possibility that you may be suffering from lower than optimal testosterone levels, and this might be an area where clinical medicine with careful follow up can lead to significantly improved health outcomes.

Estrogen and Progesterone

          The female hormones produced by the ovaries. Though estrogen does have an important role in the male counterparts of all species, for the purposes of this discussion, we are going to focus on its importance to the female. For females who hit menopause, it’s like falling off a cliff. So, where Testosterone levels slowly decline with aging, with menopause, Estrogen and Progesterone levels decline suddenly and precipitously. Until perimenopause levels are stable, and then swings in these hormones begin, and the women start to feel symptomatic. Typical symptoms might be hot flashes and night sweats (vasomotor symptoms), and also urogenital symptoms of vaginal dryness and pain with intercourse. At the same time a woman is likely to start to feel like some things are going awry with her metabolic system. She’ll start to notice changes in the way she stores fat, energy levels decline and collectively this is a wrecking ball that should just be automatically dealt with by modern disease model medicine, but I have no faith that that will happen. I believe this is in part because the Pharmaceutical/Industrial/Medical complex does not wish to see bio-identical hormone therapy as a standard of care. It will reduce the risk of chronic disease and reduce the risk of prescription medication molecules that are not naturally occurring and not bio-identical being used to try to deal with the maladies of health that are somewhat caused by the decline in our hormones. So if we can repair this issue and develop less chronic disease, we will have less reliance on the pharmaceutical industry. And that is a Profit Driven industry with a lot of control in this domain. Medications for chronic disease is not the strategy you want. You want youthful hormones.

I’m gonna tell you some facts and my perceived truths about female Hormone Replacement Therapy (HRT).

  • Estrogen does not cause cardiovascular disease. It prevents it. The WHI, which was the Women’s Health Initiative, had some misinterpretation of the early data that made it suggest that hormones caused risk of things like heart attack and stroke, and there was some truth in that, in that many of the women in that study were at advanced age, and they had significant blood vessel disease at the time that they were placed on hormones. The women in the treatment group, compared to the control group, those older than age 60, statistically had a higher risk of heart attack and stroke. And because so many of the women in that study were over 60 (average age women in that study was age 63) it looked like the hormone arm was a wrecking ball that increased mortality. One of the reasons this happened is the hormones used were not bio-identical, but that’s not the main reason. The main reason was they were delivered orally, something I almost never do. Orally delivered Estrogen is metabolized by the liver into molecules that make the blood sticky (Increase clotting). Because these older women already had establish cardiovascular disease, increasing blood clotting caused worse outcomes when the plaques from their blood vessel disease ruptured, as they ultimately do. Heart attack and stroke risk was higher in these individuals. But the story was much different for the treatment groups less than 60. They saw an overall reduction in mortality that was significant and less heart attack and strokes than the younger women who weren’t randomized to treatment. They also had less fractures and joint replacements when followed over time.
  • There is a TRIVIAL increase in breast cancer. Now, the other thing was noticed in the WHI, there was an increased risk of breast cancer. Part of this is due to the fact that hormone therapy was not bio-identical. The hormone therapies used, Premarin (conjugated pregnant horse urine) and Medroxyprogesterone acetate (the synthetic progestogen used in the study) have both subsequently been found to be carcinogenic. But even in newer double blind studies with Bio-Identical HRT, after about five years of combine therapy with Estrogen and Progesterone, there results a trivial increase in breast cancer. All other cancers are either neutral like ovarian cancer or significantly reduced like colon cancer.
  • Properly delivered HRT reduces OVERALL cancer risk. You are LESS likely to get cancer on HRT.

 

Opinion with substantial scientific support: We see a 30% reduction in cardiovascular disease and overall mortality with Bio-identical HRT delivered close to the onset of menopause.

 

  • Estrogen is the best treatment for weak or brittle bones, osteopenia or osteoporosis. I consistently show improvement in bone density, in all of my patients at menopause.
  • Estrogen will effectively treat Vasomotor symptoms. They just go away.
  • Estrogen will effectively treat Urogenital symptoms. This is very important in the sexual domain, as it will improve intimacy and reduce pain with intercourse. Regular sexual activity is an important part of the lifestyle prescription, benefiting both partners in improving longevity and preserving cognitive function.
  • Female HRT will have positive effect on body composition, moving fat away from the central unhealthy storage area of the gut and back to a normal female storage pattern.
  • Female HRT decreases risk of metabolic disease such as type two diabetes.

There are other hormones, that we look at in great depth and follow closely. Thyroid function also typically declines as we age, and at times there will be necessity for replacing thyroid hormones bio-identically. We will investigate Stress by following Cortisol and Growth Hormone by following IGF-1.

Though nothing will replace the importance of the Lifestyle Prescription and its impact on Longevity, Hormone Replacement Therapy can be an adjunct to adhering to the lifestyle prescription. With healthy, youthful hormone levels a person will be better able to execute the daily regimens necessary in stewarding this wonderful life we’ve been given. Though it’s not the largest cog in the Wheel of Wellness, it is a corner stone to my practice and you should consider replacing hormones to youthful levels in yourself, after you have had an appropriate and detailed examination. Please be diligent in finding a practitioner that is skilled in this domain, and understands the specific risks and benefits, contraindications and appropriate follow up necessary to perform this treatment properly for your best benefit.