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Hormone Replacement Therapy For Men and Women

Bio-Identical Hormone Replacement

Dr. Thaddeus Jacobs, Park City

Hormones play vital roles in the function and maintenance of our body's physical structures, including joints, muscles, heart and blood vessels and skin.  In addition, hormones play is crucial role in maintaining proper nervous system and brain function.  Mood, memory and mental sharpness hinge upon optimal hormone levels.

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.  In addition, newer reserch proves BHRT can actually treat and prevent many diseases associated with aging, including cancer. 

Dr. Jacobs has been providing integrative medicine and advanced hormone replacement and hormone optimization treatments since 1999 and is a leader in the cutting-edge applications of hormone replacement to prevent disease and combat aging.  

Should you wish to schedule an appointment to improve, increase stamina and mental focus and sharpness and regain an energetic, active lifestyle, don't hesitate to call to schedule an appointment with Dr. Jacobs.  

Men are also encouraged to visit my Testosterone Therapy for Men page.

1775 Prospector Avenue  Park City, UT 84060  435-215-7222
12340 S 450 E  Draper, UT 84020   801-748-3888  
***INSURANCE ACCEPTED AT THIS LOCATION***

Bio-Identical Hormone Replacement Therapy: The Risks and Benefits

The Risks

The current, and incorrect, generally accepted conclusion about hormone replacement therapy that currently plagues the media and the thinking of mainstream medicine stems from researcher misinterpretation of the original data from the famous Women's Health Initiative (WHI) study of more than a decade ago. At times, scientists who lead studies make statements about the data collected during a study and these statements are actually not supported by that data.   This is what happened when researchers of this study wrote their conclusions.  Unfortunately, physicians in general and the media didn't look at the data to confirm these conclusions (Who blames them really?  Besides, who has time to actually read the thousands of pages of research studies that are published each day?)  

This study is often referred to as being 'ground-breaking'  due to its impressive scope and magnitude.  It's just too bad very few individuals cared to read the publication, look at the data and wrap their mind around the math involved. 

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.

Many women find that switching from oral estrogens to a method that avoids direct metabolism by the liver, such as a troche (lozenge) or transdermal product, provides better hormone related benefits as well as minimizes any side effects.  

Women with certain medical conditions may not be a good candidate for BHRT.  These medical conditions include the following:  

  • 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

Although these conditions won't necessarily exclude you from the important benefits hormone replacement therapy can provide, proper diagnosis needs to be established prior to receiving hormone therapy.

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

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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

1755 Prospector Avenue, Suite 101, Park City, UT 84060  435-215-7222

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

12340 S 450 E  Draper, UT 84020   801-748-3888