Aug
10
2013

Bioidentical Hormone Replacement

In many previous blogs I have mentioned that bioidentical hormone replacement prolongs life. Here is a more detailed look at what such hormone replacement looks like for both women and men. Before I get into details I want to stress that I am talking about replacing what is missing and replacing only with natural hormones, not some artificial hormone derivative produced by a drug company. The reason this is immensely important is that hormone receptors in the body are distributed all over our vital organs including bones, blood vessels and the nervous system. If there is no lock and key fit (bio-identical hormone fitting the hormone receptor), there is trouble as the Women’s Health Initiative in 2002 has shown. Unfortunately they had used synthetic hormones for HRT that were not fitting the hormone receptors, and this caused many problems (heart attacks, strokes, osteoporosis, cancer).

Physiology of aging

As we age, we gradually produce fewer hormones in our hormone glands, but the various hormone glands deteriorate in their functions at different rates. Beyond the age of 30 we produce less melatonin and less growth hormone. As a result our sleep pattern may change, as melatonin is necessary for a deep sleep. The decreasing growth hormone production means that we are losing some of our muscle mass and accumulate more fat in the subcutaneous tissues. Our adrenal glands produce less DHEA at the age of 35 to 40, a hormone that is a precursor to our sex hormones in males and females. The gonads (testicles and ovaries) also produce fewer hormones, a process which already starts 5 years before menopause and about 5 years before andropause (the male menopause equivalent).

Typically a woman will get into menopause at the age of 45 to 55 at which time the periods stop and postmenopausal symptoms are interfering with her well-being.  Men get into andropause (the male equivalent of menopause) at the age of 55 to 65 at which time erectile dysfunction occurs and often the individual will become the “grumpy old man”.

Other hormones such as thyroid hormones are also affected by the slow down. Hypothyroidism is common in people above the age of 50.

Bioidentical Hormone Replacement

Bioidentical Hormone Replacement

Baseline laboratory tests

In order to know what is going on, the physician or naturopath needs to order a number of tests to assess whether there is inflammation, how your key hormone levels are; the cardiovascular system markers should also be checked, the liver enzymes and vitamin D3 level. Inflammatory markers are fasting insulin levels and C-reactive protein (CRP). Fasting cholesterol and subfractions (HDL, LDL, VDLP, small LDL) and fasting triglycerides are also measured. Thyroid hormones (T3 and T4, TSH) are measured to rule out over or under function. Typically hypothyroidism is found, which would have to be rectified by taking Armour (a mix of T3 and T4 thyroid hormones).

At this point I need to explain that long time ago the research by Dr. Lee has shown that progesterone hormone levels are notoriously unreliable when blood tests are done. All of the other sex hormones, and cortisol are also not that reliable with blood tests. For this reason the saliva hormone tests have been invented that conveniently report a panel of 5 hormones from one saliva sample: DHEAS (which is the storage form of DHEA), estradiol (the major estrogen in a woman), progesterone, testosterone and cortisol. The saliva hormone tests correlate very well with the actual tissue hormone levels. You can order the saliva tests through Dr. Lee’s website. Another longstanding lab in the US is Dr. David Zava’s lab. In Canada the Rocky Mountain Analytical Lab can process your saliva tests.

Women’s hormone replacement

Let us assume that a woman is getting postmenopausal symptoms and bioidentical hormone replacement is being discussed. The physician will want to first rule out that insulin resistance is not present by ordering a fasting insulin level. If this is normal and the other baseline tests are normal as well except for missing estrogen and progesterone, the physician will usually start to replace progesterone first using a bioidentical hormone cream to be applied once or twice per day. If estrogen levels were also low, the next step in 4 weeks or so is to add Bi-Est, a bioidentical estrogen replacement cream. After 8 weeks of hormone replacement the saliva hormone test is repeated to see whether the estrogen and progesterone levels have come up and also, whether the ratio of progesterone to estrogen is at least 200 or more. Dr. Lee has extensively researched this and found that women with a ratio of less than 200 to 1 (progesterone/estrogen ratio) were more prone to breast cancer. He also stated in this link that there are 3 basic rules with regard to bioidentical hormone replacement:

1. only replace hormones, when they were measured to be low.

2. use only bioidentical hormones (never synthetic hormones) and

3. only replace with low doses of bioidentical hormones to bring hormone levels to physiological levels (body levels that were experienced to be normal before).

Many women who are not replaced in menopause have estrogen dominance meaning that the progesterone/estrogen ratio is less than 200:1, which puts these women at risk of developing breast cancer. Women who are overweight or obese also are estrogen dominant (from estrogen produced in excess through aromatase in the fatty tissue, explained further below), which makes them more prone to breast cancer, uterine cancer and colon cancer. Without bioidentical hormone replacement inflammatory processes take place in the joints (causing arthritis), in the nervous system (causing Alzheimer’s and dementia) and in the blood vessels (causing heart attacks and strokes). Rebalancing your hormones to a youthful state by paying attention to the hormone levels and the hormone ratios mentioned will remove the inflammatory reactions and reduce the risk for cancer.

Men’s hormone replacement

Males enter andropause 10 to 15 years later than women are entering menopause. Typically testosterone production slows down leading to hair loss, erectile dysfunction, loss of muscle mass, osteoporosis and Alzheimer’s/dementia. Blood tests (bioavailable testosterone) or saliva tests are both reliable in determining a deficiency. Replacement with bioidentical hormone creams once per day is the preferred method of treatment. Overweight and obese men produce significant amounts of estrogen through an enzyme localized in fatty tissue, called aromatase.

Aromatase converts testosterone and other male type hormones, called androgens, into estrogen. Estrogen causes breast growth, weakens muscles, and leads to abdominal fat accumulation, heart disease and strokes.

Similar to women, where the progesterone/estrogen ratio is important, there is another ratio for men, called testosterone/estrogen ratio. This should be in the 20 to 40 range for a man to feel good and energetic. Unfortunately many men above the age of 55 have testosterone/estrogen ratios much smaller than 20. This makes them more prone to heart disease and prostate cancer (Ref.1).

However, a male also does need a small amount of estrogen and normal thyroid hormones as well as all of the other hormones for his “hormonal symphony” (mentioned in Ref. 2) to function at his best.

Safety of hormone replacement

There are still otherwise reputable websites that state that bioidentical hormones are not safer than standard synthetic hormones. This confuses the consumer and does not serve the public well. I much prefer the text of the Wikipedia, which is a more thorough review regarding safety of hormone replacement and explains what the issues are.

In the US there is a collective experience of about 25 years on thousands of patients, but there have not been any randomized studies, as Big Pharma that would have the money to finance such studies is not interested in proving that bioidentical drugs would be safer than their distorted synthetic hormone copies that will not fit the body’s hormone receptors. There are some noble exceptions as Big Pharma is producing bioidentical insulin and human growth hormone that had toxicity studies done and showed safety. In Europe bioidentical hormones have been used since the 1960’s, on a larger scale since the 1970’s. So the European experience of safety of bioidentical hormones is presently about 40 to 50 years.

The FDA is contributing to the confusion of the public as can be seen from this publication. One example where the FDA is confusing the consumer, is the progesterone product Prometrium, a bioidentical micronized progesterone capsule that can be taken by mouth. By law the manufacturer had to put a warning label on the package identical to progestin, which is the synthetic, non-bioidentical hormone having been shown to have severe side effects. As is explained in this last publication Prometrium should not have been required to have a warning label in it ; the paper explains what I have already stated above, namely that bioidentical hormones are the safest form of hormone replacement and administered in the right ratios will actually prevent cancer and prevent premature cardiovascular and joint deterioration. In other words, bioidentical hormone replacement can add many years of useful life when started early enough before permanent organ damage sets in from the aging process (which would be due to missing hormones).

Why bother about hormone replacement?

Nature has a plan of “knocking us off” to make room for the next generation. The only way that you can change nature’s plan of killing us prematurely through cardiovascular disease, arthritis, dementia and loss of your sexual life is by bioidentical hormone replacement. Of course you also need the other ingredients of known life prolongers such as healthy (preferably organic) foods, exercise and detoxification. Many women are scared to treat the hormone deficiencies that cause their menopausal symptoms because of the Women’s health Initiative results with synthetic hormones. Men who would benefit from testosterone are often anxious that they may get prostate cancer, when in reality it is the exact opposite: testosterone prevents prostate cancer (Ref.3).

Conclusion

I wrote this blog about bioidentical hormone replacement in order to clarify this often-misunderstood topic. Don’t get confused by the FDA, by highbrow medical websites (such as the likes I mentioned). Big Pharma has a powerful lobby that attempts to keep the medical profession in the belief that their products are better than those that nature has provided (I call it “defend your patent rights”). We are still in a flux state where anybody who tells the truth about hormones gets much criticism. In another few decades it will be an accepted fact and people will wonder why the Women’s Health Initiative was done without a control with bioidentical hormones. With bioidentical hormone replacement you can add about 20 years of youthful life without disabilities to the normal life expectancy. Exercise, detoxification and organic food with avoidance of wheat, starch and sugar can add another 5 to 10 years to your life. The baby boomers are lucky that they have this new tool to prolong life. I wonder whether they will put it to good use.

More information about bioidentical hormone replacement: http://nethealthbook.com/hormones/anti-aging-medicine-women-men/

References:

1. John R. Lee: “Hormone Balance for Men – What your Doctor May Not Tell You About Prostate Health and Natural Hormone Supplementation”, © 2003 by Hormones Etc.

2. Suzanne Somers: “Breakthrough” Eight Steps to Wellness– Life-altering Secrets from Today’s Cutting-edge Doctors”, Crown Publishers, 2008

3. Abraham Morgentaler, MD “Testosterone for Life – Recharge your vitality, sex drive, muscle mass and overall health”, McGraw-Hill, 2008

Last edited Nov. 7, 2014

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Jun
29
2013

Aging And Lack Of Hormones Matter, Not Evolution

Recently a story went through the media regarding the findings of a research group from McMaster University, Hamilton/Ont. that described that as men were dating younger women evolution took fertility away from aging women. It sounds to me that this research, which included computer modelling  was mainly driven by sociological observations. Some older males may seek out female partners that have the same age as their daughters, which seems to be considered “socially acceptable”. Contrary to that successful relationships of older females with younger partners are often met with less tolerance! It seems that medical facts like hormonal changes that are behind behaviors have not been taken into account. The following blog is meant to give you a background of hormonal changes for both sexes as we age and what can be done today to reset the clock for males and females alike to an age between 30 and 35, which creates a “level playing field”. It is a 101 on bio-identical hormone replacement.

Depleting hormones due to aging

Both men and women experience a slow decrease in hormone production beyond the age of 30, but the depletion occurs somewhat faster in women than in men. As a result women get menopause at the age of 45 to 55 (cessation of periods and postmenopausal symptoms) and men get into andropause (the male equivalent of menopause) at the age of 55 to 65. The main symptom of andropause is erectile dysfunction. These are acceptable simple physiological facts that have been known to endocrinologists since the 1950’s to 1960’s. Common sense would suggest that replacing missing hormones with bioidentical hormones should bring the body chemistry back to normal. However, this is not what conventional medicine has done. Instead, Big Pharma got wind of how powerful hormones were, and they developed hormone-like substances that could be patented and produced on a large scale. What they did not disclose initially was the fact that non-bioidentical hormones with side-chains and chlorine or fluoride atoms in the molecules would cause heart attacks, strokes and blood clots. An example of this is Premarin, an estrogen concoction that is derived from pregnant mares and Provera, a “progesterone-unlike” synthetic product, both of which were used for HRT (“hormone replacement therapy”).

Aging And Lack Of Hormones Matter, Not Evolution

Aging And Lack Of Hormones Matter, Not Evolution

Results of the Women’s Health Initiative (using synthetic hormones)

As there were conflicting reports about the benefit of hormone replacement after menopause in the medical literature, the National Institutes of Health funded a large study (the Women’s Health Initiative) to clarify what was going on with regard to side effects and effects of HRT. Unfortunately, synthetic non-bioidentical hormone products were used in these studies (Premarin and Provera) instead of bioidentical estrogen and progesterone. The results of the Women’s Health Initiative were devastating. In 2002 doctors  were warned that Premarin and Provera used as HRT would cause increased heart attack rates and breasts cancer, which led to premature death. Overall the placebo group did better than the experimental group and this is why the trial was prematurely stopped.  As a result of the wide publicity regarding the negative results of the Women’s Health Initiative postmenopausal women either do not see their physician for hormone replacement or are advised by conventional doctors that only small amounts of Premarin could be used for not more than 5 years for fear of causing breast cancer. Medico-legal considerations are at play and the whole issue of HRT after menopause has been politicized.

Facts about bioidentical hormone replacement therapy (BHRT)

The key with menopause or andropause is to accurately determine what the hormone levels are, which requires saliva hormone tests, not blood tests. The results are compared to what is normal for a 30 to 35 year-old person and missing hormones are replaced with bio-identical hormones as originally suggested by Dr. John Lee some time ago. Briefly, he mentioned 3 fundamental rules in bioidentical hormone replacement: first, only replace those hormones that are missing; secondly, use bioidentical hormones instead of synthetic hormones and thirdly, use the smaller doses that are enough to replace the normal hormone levels that the body had around your mid thirties, don’t over treat. He also stated that lifestyle issues like poor diets, excessive alcohol intake, stress and insulin resistance (from obesity) needed to be addressed. His recommendations are still valid today, as hormone facts have not changed.

So, the physician or naturopath needs to use common sense and replace what is missing with bio-identical hormones (not with synthetic hormone-like drugs that make the patient sick). If this is done properly, a normal sex life persists in both males and females and both age at a much slower pace without the development of heart attacks, strokes or osteoporosis. When hormones are rebalanced and a proper diet and regular exercise are also adhered to, diseases like diabetes, cancer, osteoporosis, heart attacks, strokes, arthritis or high blood pressure do not develop. In other words disabilities are prevented and you are able to enjoy an active life in vibrant health.

More info on bioidentical hormone replacement

Eventually all of us, male or female succumb to the hormone deficiencies that are associated with aging. As long as the hormones are still produced, males will have a normal sex drive, but 10 or 20 years beyond the point where their partners entered menopause erectile dysfunction will eventually set in. Just taking Viagra is no substitute for the missing testosterone and other hormones. Without paying attention to hormone restoration the biological clock is ticking and we will get the diseases mentioned above that lead to premature death. On the other hand with male hormone restoration (bioidentical testosterone) the body chemistry and physiological functions return to how they were in his 30’s. The same is true for female hormone restoration (using estriol/estradiol and progesterone).

The irony is that back in the 1960’s and 1970’s in Europe bioidentical hormone replacement was already suggested and practiced by a small number of physicians with amazing success. One of these doctors is Dr. Hertoghe, an endocrinologist in Belgium. They were able to show then that women could regain their sexual desire and their vitality with bioidentical hormone replacement (BHRT). For some reason (could it be greed?) Big Pharma and various government agencies were able to get the upper hand and suppress this knowledge all with the notion that factory produced hormones would be of a “higher quality” than bioidentical hormone creams from compounding pharmacies. Fortunately these lies have been exposed in numerous publications and the information is now more easily accessible through the use of the Internet. But Big Pharma still tries to intimidate and twist the truth! Here is a recently published prospective study over 3 years involving 300 women from Texas (Women’s Wellness Center, Tyler, Texas, USA) that showed anti-inflammatory effects and anti-anxiety effects with bioidentical hormone replacement. It also showed that no biochemical changes took place that would have caused changes in fibrinogen levels affecting clotting, inflammation to cause heart attacks or other indications to cause cancer. This confirms what Moskowitz had stated in 2006 about the safety of bioidentical hormones.

The irony is that for male hormone replacement with testosterone a lot of the hormone preparations produced by Big Pharma are actually bioidentical testosterone products. It is with women’s hormones that Big Pharma made substantial chemical modifications so that the final products did not fit the estrogen and progesterone receptors, causing heart attacks, blood clots and breast cancer.

Both women and men should get a saliva hormone panel test measuring DHEA-S (storage form of DHEA), estradiol, testosterone, progesterone and cortisol from one sample test tube when they become hormone deficient. Typically a woman should get tested first around the age of 35 to 40, a man around the age of 45 to 55. The treating physician or naturopath can then decide, whether bioidentical hormone replacement is necessary. If so, only what is missing is replaced with bioidentical hormone creams from a compounding pharmacy to the point where the hormone levels would have been around the age of 30 to 35 according to the principles by Dr. Lee. For A4M physicians this is a routine that is familiar. Your regular physician will likely feel uncomfortable, but many naturopaths will feel very comfortable doing this.

Discussion of the evolutional study of McMaster University

Although it may sound intriguing to rationalize that older men like to date and marry younger women, in my medical opinion these researchers got it wrong. As hormone weaknesses manifest themselves perhaps 10 years later in men than in women (in some men even 20 years later), older men may find themselves without a sex partner in their own age group, if women of their age do not use bioidentical hormone replacement. The McMaster team should have done their research including a control group with men and women who used bioidentical hormone replacement. They likely would have noticed that the sex drive of older women on bioidentical hormone replacement would still be the same as that of younger women in their 30’s. Also, the “aging clock” would have slowed down in these women, which in turn would probably have resulted in a different behavior pattern among the older males.

References

1. Why choose bioidentical hormones: http://www.empowher.com/menopause/content/bioidentical-hormones-vs-synthetic-hormones-what-s-difference

2. Anti-Aging Medicine for Women and Men: http://www.nethealthbook.com/articles/antiagingforwomenandmen.php

3. Menopause: http://www.nethealthbook.com/articles/menopause.php

4. Andropause: http://www.nethealthbook.com/articles/malemenopauseandropause.php

5. 2009 Postgraduate Medicine article on the bioidentical hormone debate: http://www.ncbi.nlm.nih.gov/pubmed/19179815

Last edited June 29, 2013

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