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Overview of Bio-identical Hormones

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Are you feeling moody, irritable, and fuzzy brained? Are you losing hair, feeling down and feeling aged? Are you having irregular periods, getting severe cramps, getting headaches or feeling hot? Are you finding it difficult to lose weight or control your complexion? These are the signs of having hormonal imbalance. Patients Medical specializes in bringing your hormones under control with bio-identical hormone therapy.

It is almost impossible to turn on the TV these days or to open a newspaper and not hear or read something about the debate surrounding bio-identical hormones. Suzanne Somers has long been an advocate and has written several books about her wellness journey that tout the benefits of bio-identical hormones. Even Oprah has become a believer and has made the subject a frequent part of her show, inviting notable guest experts such as Dr. Christiane Northrup and Dr. Lauren Streicher.

But why all the controversy? What exactly are hormones? And is replacing them safe? Is a synthetic hormone any different from a bio-identical one? Is hormonal balance really that important to wellness? And if it is, what is the best way to achieve it? If you are confused about any of these questions, you are not alone! Let’s take a closer look at hormones and how balancing them may hold the key to unlocking long-term health and wellness.

Many of our physiological processes are regulated and mediated by a complicated, interconnected network of hormonal signaling pathways. If any of these become imbalanced due to age, disease, or medical treatments, hormone replacement therapies (HRT) are sometimes recommended to help rebalance body chemistry, eliminating symptoms or reducing the risk of developing complications. Modern HRT has been used in various capacities since the 1920’s.

Although some natural sources of hormones are used in replacement therapies, the vast majority of treatments are done using manufactured hormones. The hormone molecules are chemically synthesized and purified in laboratories, allowing dosages to be more accurately measured. Most drug companies design these synthetic hormones with subtle structural differences compared to natural hormones. Biological molecules cannot be patented, so changes must be made in order for these drug companies to profit from distribution of their hormone products. The alterations are typically made to portions of the hormones deemed unimportant for function. Some hormones used in replacement therapies are instead derived from animal tissues and then chemically modified.

In contrast, “bio-identical” hormones are synthesized such that they are structurally identical to their natural counterparts. Thus, these hormones offer the purity of manufactured hormones with the added benefits of being identical to what the body would normally produce. For these reasons, bio-identical hormones potentially offer the safest, most natural options for those undergoing hormone replacement therapies.

Diseases treated using Bio-identical Hormones

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Different kinds of diseases may occur when an imbalance of necessary hormones prevails in the human body. For example, an imbalance in estrogenic hormones may cause strokes, osteoporosis, vaginal dryness, atrophy, and Alzheimer’s disease.  A hormonal imbalance in Progesterone may lead to uterine cancer, breast cancer, and ovarian cysts.

Hormones perform five different types of activities in human body – Growth, Repair, Sexual reproduction, digestion and Homeostasis. Bio-identical hormones, when applied in the proper way and dosage, may also delay the aging process or may prevent early aging signs.  There are three major diseases associated with imbalance in the hormones.  These diseases are;

Replacement of the hormone insulin has been a mainstay of diabetes treatment since its therapeutic benefit was discovered in the 1920’s. Insulin is normally secreted by the pancreas to help balance blood sugar, which increases upon ingestion and breakdown of foods. The insulin attaches to cells and promotes uptake of sugar from the blood to fuel various metabolic processes. Mediation of this process also keeps the blood clear of excess sugars, which can potentially cause other severe health complications. Diabetes typically results from a lack of insulin secretion from the pancreas or insulin resistance of the cell receptors. For most diabetics, supplementation of insulin is a routine part of treating and managing their condition.

Menopause is another common condition for which hormone replacement is considered. During menopause, ovarian function ceases, depriving the body of estrogen and progesterone, both of which are vital for helping balance many aspects of physical, mental, and sexual health. Estrogen replacement therapies have been part of menopause treatments since the 1930’s and are intended to alleviate many of the common symptoms, such as hot flashes, mood disturbances, and the atrophy of uterine and vaginal tissues. In addition, the supplementation of estrogen and progesterone can help ward off osteoporosis and many types of cancers that appear to strike more frequently due to the physiological changes that occur during menopause. These treatments not only extend a woman’s life, but improve the quality of her health and well-being during the later years.

Low level hormone replacement can also be quite helpful in reducing the symptoms of premenstrual syndrome (PMS). As progesterone and estrogen levels fluctuate during the menstrual cycle, some women experience anxiety, depression, mood swings, headache, acne, breast tenderness, and other discomforts. Many of these symptoms can be relieved through nutritional modification, but should dietary changes prove ineffective, hormonal supplements may be considered.

In men, levels of the hormone testosterone naturally begin to decline after age forty. Unlike with menopause in women, production of this sex hormone does continue, but some men experience noticeable changes in their more masculine traits. Beard growth, muscle tone, and libido may all become reduced. The perceived loss of virility, as well as reduction in testosterone, can lead to anxiety, self-consciousness, and other emotional symptoms. Because there is still sufficient testosterone for the male body to remain healthy, hormone replacement therapies for men in this context are somewhat controversial.

The thyroid gland releases hormones that control the speed and efficiency of metabolism. An overactive thyroid (hyperthyroidism) that secretes too many hormones can put the body in overdrive, causing hyperactivity, increased heart rate, and shortness of breath. This state can deplete the body’s energy sources more quickly than a person can replenish them, leading to extreme weight loss, fatigue, and other chronic conditions. Conversely, an underactive thyroid (hypothyroidism) results in lethargy, low blood pressure, weight gain, and sensitivity to cold. Treatment of low thyroid hormone conditions (hypothyroidism, or to compensate following aggressive treatment of hyperthyroidism) is very effectively handled through replacement with synthetic thyroid hormones.

Adrenal disorders are also candidates for hormone replacement. The adrenal gland is mainly involved in the secretion of hormones related to the body’s stress response, such as cortisol and adrenaline. Insufficiencies of these hormones may be due to medical conditions such as Addison’s disease, autoimmune adrenalitis, or adrenal tumors. More often, however, the causes of adrenal insufficiency are unknown. Some cases are thought to be caused by a syndrome known as adrenal fatigue, in which the adrenal gland has become worn out due to chronic stress, causing lower levels of hormone to be released. In all of these cases, adrenal hormone replacement can be helpful for alleviating the many symptoms, which may include dizziness, nausea, weakness, fatigue, low blood pressure, and muscle pains.

Many travelers take the hormone melatonin to help recover from jet lag. Melatonin is a hormone secreted by the pineal gland that helps regulate the daily cycles of sleeping and waking. Levels of this hormone naturally increase in response to darkness, eventually peaking in the middle of the night and tapering off as the morning hours approach. Upon traveling to another time zone, travelers may take melatonin to become sleepy at more appropriate times, adjusting their bodies to the local daily schedule. People that must quickly change their sleep schedules for work (if they must start working the night shift, for example) may also take melatonin. Although distribution of melatonin-containing products is prohibited in some countries, they are available in the US and considered safe for short term use.

The Truth about Bio-Identical Hormones Therapies

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Because bio-identical hormones are structurally the same as biological hormones, their use has long been supported by health professionals committed to providing natural health care for their patients. Although compelling clinical data for some of these treatments were still unavailable, these doctors stood by the logic that bio-identical hormones would be metabolized in the same ways as biological hormones, thus producing byproducts the body would recognize. Bio-identical hormones seemed the best way to maximize the health benefits of hormone replacement while minimizing the risks of side effects and complications.

Those skeptical of the benefits of bio-identical hormones were quick to point out that these new hormone therapy protocols were untested and unsupported by conventional medicine. They boasted the safety profiles of many commonly prescribed synthetic hormone therapies and made accusations about the lack of FDA approval for bio-identical hormones. As it turns out, there are quite a few bio-identical hormones on the market that are FDA approved (and have been since the early 1990’s), and researchers have continued to investigate their potential for many years.

In a peer-reviewed study published in January 2009, hormone replacement researcher Dr. Kent Holtorf revealed his comprehensive analysis of the available studies on bio-identical hormones. (Please see Postgraduate Medicine, vol. 121, issue 1, Jan. 2009.) Specifically, he examined whether bio-identical estradiol, estriol, and progesterone were safer and more effective in hormone replacement therapies for menopausal women. He compared the impact of the hormones on patient symptoms, the physiological responses that occurred, and the risks of cancer and heart disease. His conclusion:

  • “Based on both physiological results and clinical outcomes, current evidence demonstrates that bioidentical hormones are associated with lower risks than their nonbioidentical counterparts. Until there is evidence to the contrary, current evidence dictates that bioidentical hormones are the preferred method of HRT.”

Bio-Identical Hormones Risk Factors

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The risks of hormone therapy vary greatly depending on the particular hormone being replaced. As described in the previous section, short term use of melatonin for jet lag poses a low risk. Thyroid hormone supplementation is considered one of the safest of the long term treatments, given that the activities of the hormones are regulated in the body through feedback mechanisms. Typically, thyroxine (T4), the precursor form of the active thyroid hormone is replaced. The body can convert this prohormone to its active form, triiodothyronine (T3) whenever thyroid hormone activity is needed. This conversion ends when there is sufficient thyroid hormone available, limiting the risk of thyroid hormone overdose.

Insulin treatments for diabetics also have an excellent track record, though such long term treatments require vigilance from the patient. Both the timing and the quantity of the insulin dose are critical for properly controlling blood glucose. Dosages must be adjusted on an individual basis, selecting the route and concentration based on how quickly the insulin should act. Food intake, exercise, and any illnesses can all require adjustment of dosages, as well. If not enough insulin is available, the diabetic will suffer the effects of their high blood sugar. Too much insulin can potentially be lethal, so managing doses carefully and knowing how to respond in an insulin emergency are critical for all diabetics and their families.

Adrenal insufficiencies such as Addison’s disease are normally treated through replacement of adrenal hormones, such as cortisol. Daily doses are formulated to mimic the natural levels of this corticosteroid hormone, which fluctuates during the day and has a wide variety of effects on other aspects of body physiology. Insulin efficacy, immunity, inflammation, electrolyte balance, blood pressure, and bone formation are just some of the bodily processes that can be affected by adrenal hormone levels. Low levels of adrenal hormones may also be prescribed for more moderate adrenal insufficiencies, such as those related to adrenal fatigue. If the adrenal gland is still functional, special care must be taken to regulate dosage to avoid side effects, such as immunosuppression, which can leave a person susceptible to infections and illnesses. High blood sugar, bone loss, weight gain, and loss of muscle mass are also risks. The adrenal gland may additionally decrease output if the hormones are externally supplemented for extended periods of time, so dosages should be appropriately tapered toward the end of treatment to avoid withdrawal.

Testosterone replacement for men that have lost testicular function due to cancer or other diseases has long been accepted as an appropriate way to maintain the strength of secondary sex characteristics and healthy “maleness.” There is has been much discussion regarding the appropriateness of testosterone replacement for aging men, however. The effects of reduced testosterone as a natural part of aging lead to thinning hair, weight gain, sexual problems, and other symptoms that many men would rather not face. Although restoration of testosterone can somewhat reverse these effects, it is important for patients to thoroughly discuss their cases with their doctors to determine whether there are other acceptable options. Low testosterone as a result of aging does not, in itself, pose health risks. Testosterone replacement therapies, however, may raise blood pressure, thicken the blood, raise cholesterol levels, and increase the risk of prostate cancer.

There have been many warnings in recent years surrounding the replacement of estrogen and progesterone in women experiencing menopause. While there are certainly significant benefits to relieving symptoms and promoting well-being, a 2002 report called into question whether these benefits outweighed the potential for side effects and complications. Although osteoporosis rates were lower, the incidence of stroke, heart attack, and blood clots were modestly higher in women taking synthetic estrogen and progestin (the synthetic replacement for progesterone used in conventional protocols). Breast and uterine cancers were also slightly more prevalent than in women not receiving these hormone replacements.

Following these reports, hormone replacement ceased to be the default for menopausal women. It was concluded that further study was needed to more closely examine the risks and benefits of these conventional hormone therapies, as well as the emerging protocols involving bio-identical hormones. Given the recent data regarding the increased safety and efficacy of bio-identical hormones, many women are now choosing these over traditional synthetic hormone mixes.

Next Steps:

While you may find this medical information useful, as the next step we strongly recommend that you make an appointment to see one of our physicians to ensure that your health issues are properly addressed.

To schedule an appointment with our physicians, please call our patient coordinator at 1-212-679-9667, send the form below or an email to: info@patientsmedical.com. We are currently accepting new patients and look forward to being of assistance.

We are located at: Patients Medical PC, 800 Second Avenue, Suite 900 (Between 42nd & 43rd Street), Manhattan, NYC, New York, NY 10017.

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Article Last Updated: 08/26/2015