Hormone depletion is a major cause of aging. Despite the medical establishment’s recent stance against hormone replacement therapy, there are major benefits derived from the careful prescribing of bioidentical hormones. The highly publicized adverse effects of hormone replacement relate to the use of synthetic or non-bioidentical formulations given by suboptimal routes of administration.
At the Institute for Progressive Medicine we utilize the following hormones:
Human growth hormone
Menopause is defined as beginning with the last menstrual period. Blood tests will reveal low estradiol levels and high FSH. Menopause is characterized by hot flashes, night sweats, depression, insomnia, weight gain, reduced libido, vaginal dryness and atrophy, and skin changes. Many women are spared severe symptoms. Other medical conditions are initiated with menopause, including osteoporosis, cardiovascular disease manifested by heart disease and stroke, and memory and cognitive loss.
Estrogen replacement resolves most menopausal symptoms, reduces osteoporosis, and in numerous studies has prevented cardiovascular disease and cognitive decline. We avoid oral estrogens because of evidence for increased blood clotting factors with oral administration. We order sublingual drops, and transdermal creams or gels. These are usually obtained through a compounding pharmacy, which can prepare formulations in specific dosage. Initially they are prescribed twice a day, but eventually can be taken once a day.
Estrogen increases bone density, maintains vascular elasticity, produces collagen in the skin to prevent wrinkles, and likely supports cognitive function. There is perhaps a slightly increased risk of breast cancer with estrogen therapy, but this is reduced by using bioidentical formulations only and keeping with a lower dose. Indole 3 carbinol and calcium D glucarate are nutrients that direct estrogen metabolism away from carcinogenic metabolites. Adding estriol to estradiol may also provide protection against breast malignancy.
Testosterone declines in some women at the time of menopause, while in others the level is maintained by adrenal production. In men, testosterone declines gradually with age. Testosterone replacement maintains bone density, increases libido in both men and women, raises the blood count, and increases muscle strength and athletic performance. It is usually taken as a transdermal preparation, sublingual drops or an oral troche. Men often administer testosterone as an injection into the buttocks, given every 1-2 weeks. Testosterone may not be used in men who have prostate cancer unless the cancer has been effectively treated. In some men we have also prescribed human chorionic gonadotropin, an injection that stimulates the testes to increase testosterone production.
We have also use subcutaneous estrogen in women, inserted as tiny pellets under the skin of the buttock. Pellets last 3-4 months, and have the advantage of maintaining stable blood levels throughout the day. They are inserted through a small incision made under local anesthesia, during an office procedure requiring about 5 minutes. Estrogen pellets are particularly effective in preventing and reversing osteoporosis.
Women who have not had a hysterectomy will also require progesterone replacement, in order to avoid an otherwise increased risk of endometrial cancer. Progesterone may be taken as a capsule, and has the additional benefit of enhancing sleep. It is also available as a transdermal cream, and may be combined with estrogen.
Testosterone may also be inserted as pellets under the skin of the buttocks, providing an even blood level for 3-4 months. The dosage in men is several times higher than in women.
Learn more about HRT using subcutaneous hormone pellets.
DHEA is a testosterone related hormone that declines with age in both men and women. Levels decline further in people on steroids and in sicker patients. DHEA increases libido, supports bone density, controls blood sugar, supports immune function and prevents depression. It is often taken as an oral supplement, 5-10 mg daily in women, and 25-50 mg in men. It is usually avoided in circumstances of prostate cancer.
Thyroid hormone levels are often low in both men and women, though more often in women. The thyroid gland is frequently involved in autoimmune processes, and is also very sensitive to environmental toxins and to radiation. We provide thyroid in oral formulations combining T3 and T4, usually using the TSH level to guide the dosage. Frequently iodine deficiency is present. This can be diagnosed through a urine test to measure excretion of a known iodine dose. Low urine excretion indicates deficiency. Iodine is then given in oral dosage, about 12.5 mg daily.
Human growth hormone also declines in both sexes with age. Growth hormone deficiency causes osteoporosis, depression, reduced energy and strength, increased abdominal fat and reduced muscle mass. IgF-1 levels are measured to assess the body’s production of growth hormone. Low IgF-1 levels are associated with heart failure, the major cause of hospitalization in older people. Growth hormone is usually administered in a dose of 1-2 units daily by subcutaneous injection.
We have experience in directing hormone replacement therapy in thousands of patients. Every patient is different, and it is important to make individual assessments to assure proper treatment.