I have consolidated some useful information in an effort to help you better understand Bio-identical Hormone Therapy (BHT). While bio-identical hormones have been approved and available for use in the U.S. since the 1930s, the use of bio-identical hormones has been slow to increase despite general agreement in the scientific literature that bio-identical hormone replacement is far better than using non-human hormones. The technology now exists that allows us to place time-release pellets of approved human hormones in the fat under our skin to deliver more youthful hormone levels directly into the bloodstream. While I am quick to admit that this therapy is not a "fountain of youth," I am very confident that it can dramatically improve many people's quality of life and health in measurable ways based upon hundreds of recent scientific studies. It is vitally important that you continue to see your regular medical doctor for your usual health care, tests, and routine health maintenance. I am not replacing your medical doctor.
What exactly are hormones?
Hormones are the body's chemical messengers, secreted into the bloodstream and/or used locally, that affect cellular functioning. A hormone affects only specific cells called target cells that have unique receptors for that hormone. Think of it as a lock and key. Cells which do not have the specific receptor for a certain hormone cannot be influenced directly by that hormone. Some cells go even further, and regulate their own internal production of a needed hormone. For example: Estrogen is made inside every cell that utilizes Estrogen (brain, bone, heart, etc.) from Testosterone through a process called "aromatization."
The goal of Bio-Identical Hormone Therapy with BHRT, most patients will experience:
What is meant by bio-identical, and why is non-bio-identical "bad?"
Bio-identical hormones have the exact same molecular structure as hormones that are made by the human body. The difference between the "identical human" (or bio-identical) hormone versus synthetic non-bio-identical is in the molecular structure (sharp) of the hormone. In order for a replacement hormone to fully replicate the exact functions of a hormone which we naturally produce, the chemical structure must exactly match the natural, original molecule. It is the structural differences that exist between human bio-identical and non-bio-identical hormones that are responsible for many of the side effects and health risks that occur when non bio-identical hormones are used by humans.
What is the goal of bio-identical hormone therapy (BHT)?
The goal of Bio-identical Hormone Replacement Therapy is to provide an adequate supply of a deficient hormone in a form that is molecularly identical to that which your body produces. Logically, this should result in the hormone's normal healthy physiologic effects being restored. Every person is unique. Therefore, it is sensible for you and I to work together to customize a BHT program based upon your individual symptoms and hormone levels. The precise dosing of each person's therapy will be determined after consultation and evaluation of laboratory blood tests, and symptoms. Periodic adjustment may be needed as symptoms dictate, keeping in mind that tissue levels, not blood levels, are what matter for symptoms.
Testosterone is vital to the health and well-being of BOTH men and women. Testosterone in men is mainly produced by the testicles and in smaller quantities by the adrenal glands. In women, testosterone is produced in both the ovaries and the adrenal glands. Testosterone contributes to muscle mass, strength and endurance, decreased fat, increased exercise tolerance, enhancement of the sense of well-being and psychological health. Studies have shown that testosterone protects against cardiovascular disease, breast cancer, prostate cancer, and reduces blood sugar. It can lead to improved lean muscle mass, increased bone density, decrease in total cholesterol, improved skin tone, improved healing capacity, and increased libido and sexual performance. It enhances the quality of life for both men and women by decreasing the diseases of aging. Cells that require estrogen use testosterone to manufacture estrogen inside the cell by a chemical conversion that uses an enzyme called aromatase. Testosterone is present and extremely important in both women and men. Therefore, adequate tissue levels are very important for health in both sexes. (It goes without saying that women require substantially less of it!)
There can be nutritional deficiencies encountered in the BHT patient that may affect BHT effectiveness. Examples include iodine, and other trace mineral and vitamin deficiencies. If this is suspected, inexpensive non-prescription supplements may be recommended. Iodine appears to be critically necessary for the transportation of testosterone in to the cells. Almost every non-supplemented patient I tested has been found to have low iodine levels!
There are other delivery systems for BHRT, however, each has advantages and disadvantages. Creams require daily application and are often not as effective and can be transferred to loved ones. Each person is unique and we recommend consulting our trained practitioners for the best choice for you.
Follow-up: If you choose pellets, approximately one month after your first insertion, you will be asked to get another blood test and return to discuss what you have experienced regarding symptom relief. We will decide whether any adjustment needs to be done to your future dosage based on your blood test and symptoms. I will also encourage you to further enhance your own health by using the new found energy from restored hormone levels to exercise regularly and eat well. In your first year of treatment, expect to have 3 or 4 insertions. Typically, men require insertion every 4 months and women require insertion every 3 months. You can stop this BHT treatment at any time, which will cause your hormone levels to drift back to your pre-treatment levels and all your pre-treatment symptoms to return. There is no age limit on treatment. Though it is uncommon, patients as young as 25 (such as those with ovaries removed) as well as men and women in their 80s or older have had wonderful benefits from this therapy.
Nicholas E. Sherock, DO
The opinions expressed below are those of certain experts in the medical field. They do not necessarily reflect my opinions.
Compounding pharmacies are independent labs which dispense bio-identical hormones along with custom mixed medications for conditions like asthma, pain, hospital intravenous medications, etc. Compounding is the original form of dispensing drugs that existed before the drug companies came into being. Bio-identical hormones are an FDA approved form of hormone therapy that is available in both commercial forms and individually compounded forms.
Candidates for BHRT include women who have had hysterectomies, who have personal or family histories of cardiovascular disease, osteoporosis or Alzheimer's, and women with peri-menopausal symptoms that affect their quality of life.
The most commonly reported symptoms of menopause are hot flashes, night sweats, fatigue, vaginal dryness, mood swings, tender breasts, fluid retention, memory lapses, sleep disturbances and decreased libido.
Patients experience very few, if any, side effects while taking Bio-identical HRT that is prescribed in physiologic doses. Oral progesterone can cause drowsiness in about 2% to 5% of women who use it, an outcome of how it is metabolized by their hepatic systems. It is therefore usually taken orally at bedtime. Bio-identical hormones prescribed in non-physiologic doses can cause minor symptoms related to excessive supply, such as increased breast tenderness and headaches with too much estrogen or reversible mild acne or hair growth with too much testosterone.
The advantages of BHRT are that it is individualized, well-tolerated and produces exceptional symptom reversal in most cases. The only possible disadvantage of compounded BHRT is that prescribers must commit themselves to a new level of learning and creative problem-solving as they step beyond the basics taught in medical school.
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