Hormone Balancing and Bio-Identical Hormone Replacement Therapy

Dr. Thaddeus Jacobs, Park City

Dr. Thaddeus Jacobs, Salt Lake City / Draper  ***INSURANCE ACCEPTED AT THIS LOCATION***

Bio-identical replacement therapy (BHRT) is the use of hormones, molecularly identical to those produced by the body, to achieve optimal hormone levels within the body and to alleviate symptoms associated with hormone deficiency. The naturopathic medical approach to hormone replacement is to use only the smallest dosage needed to treat deficiency-related health issues. Additionally, it is important to receive expert guidance when receiving this therapy, which is crucial to minimize risks and side effects.

In my opinion, healthy, safe and effective hormone replacement therapy hinges not only upon establishing healthy levels of hormones in the body, but also upon knowing the answer to two important and often overlooked questions.  First, it is important to know: Are the actually being used?  Second, it is crucial to know:  How the hormones are being used?  We learn the answer to these two important questions by looking at the product of when hormones are used up by the body's cells, the hormone metabolites.

I dare say almost all conventional doctors and the vast majority of alternative medicine doctors are oblivious to the idea of checking hormone metabolites.  Blood and saliva hormone testing are standard.  These methods are also sorely inadequate in providing useful information as to how your hormone system is functioning; in other words, just because your levels appear normal doesn't mean that your hormones are functioning optimally.

Many, many patients have come to see me claiming that their previous doctor said their hormones are normal, but I find that these patients still have classic symptoms of hormone deficiency despite being on hormone replacement.  Hormone deficiency, excess or problems with the intricate balance between the various hormones continue to be the problem.  I help patients solve their hormone problem so that they can get on with their life feeling great -even better than before!

Other important information that we get from hormone metabolite testing risk factors for various disease, such as female cancers, prostate cancer, hair loss and osteoporosis.  Your hormone metabolites can suggest either risk or protection from diseases.  Should your metabolites suggest risk, nutrition-based therapies are suggested to correct your body's hormone metabolism.  Using metabolite testing along with measuring hormone levels, an elegant treatment approach can be devised that can help balance your hormones, either with or without the use of hormone replacement therapy.

Balance Is the Goal

Yes, you can balance hormones either with or without hormone replacement therapy.  The approach I'm discussing here, which I've been using over the past decade, allows me to prescribe to patients the minimum amount of hormones needed to correct health problems.  Because the lowest effective dose is used, any risks associated with hormone replacement are maximally minimized.  In my opinion, this approach is not only effective, but is probably the safest, most conservative approach to hormone replacement that exists today.

If the information provided here does not answer all of your questions about hormone replacement therapy, then feel free to call me for a free phone consult so that I can provide you with the information you need. Should you be serious about pursuing an approach aimed at balancing hormones, including possible hormone replacement therapy, then call my office to schedule an appointment.

Bio-Identical Hormone Replacement Therapy: The Risks

The current, and incorrect, generally accepted conclusion about hormone replacement therapy is that it is associated with an increased risk of breast cancer. The conclusions mainstream medicine and the media have adopted are mainly from a misinterpretation of the findings from the famous Women's Health Initiative (WHI) study. This study is often referred to as being 'ground-breaking.' Although the scope and magnitude of the study is impressive, people just can't seem to wrap their mind around the math involved. (Studies strive to explain that a particular phenomenon occurred -or did not occur- with a high level of “statistical significance,” that is; the observed result was unlikely to have happened by chance).

Risks and possible side effects associated with HRT are listed below, followed by commentary on what the research actually showed.  Risks and possible side effects include the following: 

• Increased risk of endometrial cancer in women with a uterus if estrogen is taken without progesterone or a progestin.
• Slightly increased risk of breast cancer after 4 or more years of HRT, as shown in the WHI study that used continuous combined oral estrogen and progestin (Prempro). Estrogen alone did not increase risk.  Other HRT regimens using bio-identical progesterone have not shown increased cancer risk.
• Increased breast density, making mammograms more difficult to interpret and possibly increasing breast cancer risk. This appears to be an effect primarily associated with taking oral progestin continuously with estrogen (e.g., Prempro).
• Slightly increased risk of ovarian cancer.
• Slightly increased risk of blood clots, associated primarily with oral estrogens such as Premarin.  This effect is not seen with transdermal estrogens.
• Increased risk of gallbladder disease, associated primarily with oral estrogens such as Premarin.
• Slightly increased risk of heart attack or stroke, both in women with cardiovascular disease and in healthy women. This effect may be associated primarily with HRT using continuous combined oral estrogen and progestin (Prempro) or the daily use of an oral progestin such as Provera with estrogen.
• Breast pain (often a temporary problem).
• Nausea, associated primarily with oral estrogens. Bloating and fluid retention, primarily associated with progestins, e.g., medroxyprogesterone acetate.
• Negative effects on mood, primarily associated with progestins, e.g., medroxyprogesterone acetate.

Note: These side effects seem to be associated with oral estrogen and compelling evidence exists that these issues are not associated with the use of topical estrogen preparations.

Some women find that trying a different type of HRT, such as switching to bio-identical hormones, using a transdermal product instead of pills, or trying a different regimen, may reduce or eliminate side effects and work better for them.  This makes sense, because the hormone more readily uses the exact form of hormone that it produces naturally, as opposed to a synthetic hormones and it's unnatural and sometimes highly reactive metabolites.

Women with the following conditions are especially at risk for suffering serious hormone replacement therapy side effects:

• Vaginal bleeding of unknown cause
• Chronic disease of the liver
• History of breast or uterus cancer

• History of blood clots in the veins, legs, or lung

Feel free to scroll down to the HRT Benefits, below.  Should you like in-depth commentary on the WHI study, read on:

The WHI revealed that breast cancer increased at a rate of 0.4% per year of use of Premarin-plus-Provera. Premarin is a hormone preparation made from pregnant mare's urine. Provera is a synthetic hormone that looks similar to progesterone (a progestin) that has more androgenic and estrogenic effects than it has progesterone-like activity. Women in the WHI study who took only estrogen (Premarin) did not have an increased risk of breast cancer, they had a non-statistically significant decrease in breast and other cancers. On the other hand, women taking estrogen plus Provera had a non-statistically significant cancer risk increase. It appears that the decision to stop the study short was because of an observed trend, rather than hard evidence that harm was being done by giving Premarin and/or Premarin-plus-Provera.

What the WHI study did find was a marginally significant increased risk of vascular thrombosis, a condition that can have fatal consequences. Because this finding is consistent with the results seen in other oral hormone therapy studies, I recommend that oral estrogen therapy be avoided and other delivery methods be used instead.

Dr. Julie Taguchi, an oncologist at the Sansum Medical Center of Santa Barbara, California, has been conducting an observational study on women with breast cancer who have chosen to take BHRT to manage severe menopausal symptoms and to help improve quality of life. So far, Dr. Taguchi has followed more than 100 women and, so far, her findings suggest that BHRT does not increase the risk of cancer recurrence or progression, compared to women not taking BHRT. Surprisingly, this trend also appears to be true for hormone-sensitive cancers. Overall, it appears that BHRT not only provides major improvements in general well-being, BHRT may have -and this is even more surprising!- actually helped cause complete breast cancer remission in some patients.

Please be careful to realize the fact that Dr. Taguchi's research is still preliminary and more data collected from a larger number of patients is needed to confirm the trend she is seeing. Patients with hormone-sensitive cancers absolutely require close tumor monitoring so that hormone treatment can be stopped immediately in case cancer growth is stimulated. So, when looking at the mathematical facts the WHI data show, no absolute conclusion can be made regarding the relationship between synthetic hormone therapy and cancer risk.

Bio-Identical Hormone Replacement Therapy: The Benefits

Not only does BHRT help alleviate symptoms associated with female menopause and male andropause, it also offers many other significant health benefits. There is solid evidence that BHRT, when given to both men and women, substantially reduces the risk of Alzheimer's disease and other causes of cognitive decline. Other research has proven that BHRT significantly lessens risk of heart and blood vessel disease, osteoporosis, and chronic obstructive pulmonary disease (COPD) in non-smoking women. BHRT has also been proven to significantly reduce all-cause deaths in men. It is very likely that studies will soon prove that the same is true for women.

Another BHRT benefit is reversal and slowing of age-related changes in appearance. I have observed that men and women with hormone levels that fall within the normal to high-normal ranges, as determined in 20-35 year olds, look younger, are more energetic and have fewer age-related aches and pains. Women who have used BHRT for 5-10 years appear significantly younger than women of the same age who haven’t used BHRT. Their skin has much less wrinkling, is firmer and has much better coloring and hydration. Both women and men using BHRT also frequently report improved libido and a much more satisfying sex life.

Bio-Identical Hormone Replacement Therapy Benefits for Women

Advantages of bioidentical hormone replacement therapy for menopausal and peri-menopausal women include all of the well-known benefits of patented hormone replacement therapy-and often more without most of the unwanted side-effects and risks associated with traditional hormone replacement.

BHRT was prescribed for it's short-term benefits but, more and more, doctors and researchers are becoming aware of and prescribing BHRT for it's long-term benefits. BHRT is used to eliminate or reduce various problems and symptoms at different stages of women's lives, which may include:

• Premenstrual Syndrome (PMS)
• Premenopausal/postmenopausal symptoms
• Irregular menstrual periods
• Uterine bleeding
• Hot Flushes
• Osteoporosis (bone-density loss)
• Reduces risks of heart disease
• Accelerates fat burning for increased weight loss
• Reduces nights sweats and insomnia
• Enhances sex drive and libido
• Protects against fibrocystic breasts
• Helps improve memory lapses and foggy thinking
• Prevents vaginal thinning and dryness
• Increases energy and reduces depression
• Improves the skins elasticity
• Guards bones from osteoporosis and encourages bone growth

• Improves blood flow throughout the body, including the brain

Bio-Identical Hormone Replacement Therapy Benefits for Men

Andropause is a medical condition caused by low testosterone levels in men. Until recently, andropause received little attention by the medical community, as doctors attributed the symptoms to depression or old age. Andropause is a real condition and is best treated using specialized hormone testing to ensure that the treatment is safe and effective.

There is great variability among men as to timing and symptoms associated with andropause. Some men begin experiencing symptoms in their 20's, while most men have symptoms starting in their 40's. By the 50's, about 95% of men experience low testosterone symptoms.

The most common andropause problems for which BHRT can help resolve include:

• Depression
• Sweating and Hot Flashes
• Lowered Libido and/or Erectile Dysfunction
• Fatigue
• Poor Memory and Concentration
• Decreased Muscle Mass
• Sleep disturbance
• Bone Loss (osteopenia or osteoporosis)
• Increased Body Fat (especially abdominal fat)
• Aches and Pains

• Loss of Height

References

1.Anderson GL et al, JAMA 2004 Apr14:291(14):1769-71, Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial

2.Writing Group for the Women's Health Initiative (WHI) Investigators, JAMA July 17, 2002 288(3):p321-349, Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women: Principle Results from the Women's Health Initiative (WHI) Randomized Controlled Study

3.Patricia Kelly, PhD, Recent HRT Studies: The Findings in Perspective (9.2002/2006), WHI Study: One Year Later (2006), San Fransisco Medical Society Website

Dr. Thaddeus Jacobs, Park City

Dr. Thaddeus Jacobs, Salt Lake City / Draper  ***INSURANCE ACCEPTED AT THIS LOCATION***