Hormone Replacement Therapy Medicine is one of the fastest growing specialties in the medical field. With vast numbers of Baby Boomers reaching middle-age, interest in maintaining optimal health and vitality has never been greater. Hormone Replacement Therapy offers a renewed sense of well-being and good health by utilizing a medically-supervised program of hormone replacement, nutrition, and exercise.
What are bio-identical hormones?
Bio-identical hormones are identical to the hormones that we make in our bodies and are sometimes called “natural” hormones even though they are made in a laboratory; they come from plant sources before being altered to be like human hormones.
There are two ways to use bio-identical hormones: trans-dermally and orally. Trans-dermally means the hormone goes directly through your skin by the use of a cream, gel, patch, sublingual preparation, or suppository. Orally means taking a pill or capsule that contains the hormones. The other method is pellet implant that are inserted under the skin in a minor procedure. MORE about pellet implants
Transdermal - Hormones are never meant to be metabolized by the liver, which is what happens when you swallow a pill or capsule. Normally, the human body releases its hormones directly into the bloodstream. The transdermal method does exactly that. The disadvantages are that absorption can differ between women, hormones can be transferred to other people from the skin, and hormones can accumulate over time in the fatty tissue.
Oral - The oral method requires the hormones to pass through the digestive system and be metabolized by the liver. This puts a burden on the liver. Plus, it is very inefficient because only a small amount of the hormone will actually make it into the bloodstream.
There is not just one estrogen. There are three estrogens that naturally occur together in a woman's body: Estrone (E1), estradiol (E2), and estriol (E3). Estradiol is the strongest estrogen and is dominant in non-pregnant women until menopause. Estriol is the primary estrogen during pregnancy, and estrone is the most prevalent estrogen after menopause. A compounding pharmacist can make a cream or gel containing one, two (bi-est), or all three (tri-est) of these bio-identical estrogens.
Progesterone Gels and Sub-Linguals
Bio-identical progesterone gels, and sub-lingual tablets come only from a compounding pharmacy and need a prescription from a doctor.
What is menopause?
Menopause is a natural stage in a woman’s life. Some symptoms such as hot flashes can go away in a few years; others, such as vaginal dryness, often do not go away. Many treatment options exist for problems that come with menopause. If you're having a tough time with symptoms of menopause but worry about how hormone therapy will affect your heart, talk with your doctor to put your personal risk into perspective.
Consider these points by Mayo Clinic staff:
The risk of heart disease to an individual woman taking hormone therapy is very low. If you are in early menopause, have moderate to severe hot flashes and other menopausal symptoms, and are otherwise healthy, the benefits of hormone therapy likely outweigh any potential risks of heart disease.
Your individual risk of developing heart disease depends on many factors, including family medical history, personal medical history and lifestyle practices. Talk to your doctor about your personal risks. If you're at low risk of heart disease, and your menopausal symptoms are significant, hormone therapy is a reasonable consideration.
Risk differs for women with premature menopause or premature ovarian failure. If you stopped having periods before age 40 (premature menopause) or lost normal function of your ovaries before age 40 (premature ovarian failure), you have a different set of heart and blood vessel (cardiovascular) health risks compared with women who reach menopause near the average age of about 50. This includes a higher risk of coronary heart disease. If you have premature ovarian failure, you'll likely be given hormone therapy to protect against heart disease.
Menopausal hormone therapy risks may vary depending on:
- Whether estrogen is given alone or with a progestin
- Your current age and age at menopause
- The dose, type of estrogen and route, or how you take it (oral, transdermal, trans-vaginal)
- Other health risks, such as your family medical history and cancer risks
If you've already had a heart attack, menopausal hormone therapy is not for you. If you already have
heart disease or you have a history of blood clots, the risks of hormone therapy have been clearly shown to outweigh any potential benefits.
Unlike women, men do not experience a major, rapid (over several months) change in fertility as they age (like menopause). Instead, changes occur gradually during a process that some people call andropause.
Aging changes in the male reproductive system occur primarily in the testes. Testicular tissue mass decreases. The level of the male sex hormone, testosterone stays the same or decreases gradually. There may be problems getting an erection. This is a general slowing, instead of a complete lack of function.
Fertility: The tubes that carry sperm may become less elastic (a process called sclerosis). The testes continue to produce sperm, but the rate of sperm cell production slows. The epididymis, seminal vesicles, and prostate gland lose some of their surface cells. But they continue to produce the fluid that helps carry sperm.
Urinary function: The prostate gland enlarges with age as some of the prostate tissue is replaced with a scar-like tissue. This condition, called benign prostatic hypertrophy (BPH), affects about 50% of men. BPH may cause problems with slowed urination and ejaculation.
In both men and women, reproductive system changes are closely related to changes in the urinary system.
Some men may have a lower sex drive (libido). Sexual responses may become slower and less intense. This may be related to decreased testosterone level. It may also result from psychological or social changes due to aging (such as the lack of a willing partner), illness, chronic conditions, or medications.
Erectile dysfunction (ED) may be a concern for aging men. It is normal for erections to occur less often than when a man was younger. Aging men are often less able to have repeated ejaculations. ED is most often the result of a medical problem, rather than simple aging. 90% of ED is believed to be caused by a medical problem instead of a psychological problem.
Medicines (especially those used to treat hypertension and certain other conditions) can prevent a man from getting or keeping enough of an erection for intercourse. Disorders, such as diabetes, can also cause ED.
PRINCIPLES OF HORMONE REPLACEMENT THERAPY
- Aging is the product of the long term, and permanent decline of all of the hormones in the body. This means that many of the symptoms of aging can be stopped and even reversed by correcting all of the underlying hormonal imbalances.
- Each hormone as it declines with the aging process produces physical changes in each patient that can be found by doing a thorough physical exam. These changes are important clues as to the underlying hormonal deficiencies and imbalances present.
- All hormones in the body work in concert with all of the other hormones. It is therefore of the utmost importance to treat all hormonal imbalances in the correct sequence and in the correct dosage and form.
- The dosage of each hormone used should be guided by the reversal of the symptoms and the reversal of the physical changes that the deficient hormone has created and not just on blood tests alone.
- The interactions of diet, intestinal health, and vitamin deficiencies on hormonal health.
As we age, many of the natural hormones produced by the human body begin to decline. By age 40, most adults experience deficiencies in the levels of natural hormones such as:
- Human growth hormone (HGH)
The result is a loss of energy, level bone strength and muscle mass, increased body fat, loss of skin elasticity and the onset of osteoporosis. Men and women can experience gender-specific symptoms:
- Hot flashes
- Mood swings
- Inability to focus
- Lessening of libido
- Male erectile dysfunction
Thyroid hormone is the most essential hormone produced by the human body. There are T3 thyroid receptor sites in every cell and tissue of the body. Also, adequate thyroid hormone allows other hormones to work properly. All hormone systems are interdependent and must work in concert to create optimal health and wellness.
Traditionally, physicians have used certain laboratory tests to measure the level of thyroxin to determine if a deficiency exists, then treat with levothyroxine (T4) to normalize levels. However, in many cases, despite normal levels of T4 and TSH, symptoms of hypothyroidism persist. It is important to go one step further and check free T3 levels (the active form of thyroid hormone) and if deficient to supplement with T3. Often, as we age, it becomes more and more difficult for the body to convert T4(storage hormone) to T3 (active hormone.) Once these hormones are balanced, symptoms disappear and the benefits of hormone replacement can be attained.
AGE RELATED COGNITIVE DECLINE
Today, “health” can be defined as a state in which all your senses and faculties are alive and functioning at peak performance.
As our population ages, more attention has been placed on understanding and preventing age-related cognitive decline. This term encompasses everything from simply “forgetting” to Alzheimer disease.
We know that the brain needs to be nourished to flourish. And we know that the declining hormone levels, especially thyroid and testosterone, that come with age can have a profound effect on the brain’s ability to function.
Early intervention is more critical in preserving brain function than in any other health concern one might have. Specific brain supplements are proving to be both preventive and restorative in the early stages of age-related cognitive decline.
At Quality of Life Age Management we will be offering in the near future exciting programs to test and evaluate cognitive function.