In all the hullaballoo about hormone replacement therapy, not enough has been said about the profound effects of estrogen and testosterone on the brain. I think that if all the other benefits of hormone replacement were disregarded, the beneficial effects on brain function alone would justify prescribing them.
Women in menopause often develop depression, irritability, insomnia, memory loss, and a sort of cognitive disorientation. These symptoms can be severe, and psychiatric medications like sedatives and antidepressants are often inappropriately prescribed. Proper hormone therapy starts to improve these symptoms within two weeks.
Mental and emotional symptoms may persist long after other menopausal symptoms, like hot flashes and night sweats, have resolved. I recently saw a 65 year old woman who had been started on antidepressants years before to manage her depression. Her depression continued, and did not improve until she started hormone replacement therapy. A stronger hormone method completely resolved the depression and allowed her to discontinue antidepressant drugs. These were hormone pellets implanted under the skin of the buttocks. They maintain constant blood hormone levels for 3-4 months, without fluctuation, therefore provide stronger effects than creams, tablets, or patches.
Loss of libido is a common menopausal symptom, and likely contributes to emotional difficulties through the loss of intimacy. Both estrogen and testosterone restore sexual interest. Women have told me their marriages were saved, and their lives were changed, through hormone replacement.
The brain has both estrogen and testosterone receptors. These hormones cross the blood-brain barrier, and are also produced within brain cells from cholesterol. Estrogen supplementation has been shown in studies to improve memory in post-menopausal women. The level of endogenous estrogen in post-menopausal women also correlates with cognitive function. Those women with the lowest estrogen levels had greater declines in cognition.
Why are physicians not routinely prescribing hormones to menopausal and post-menopausal women? The main concern has been a possible relation of estrogen to breast cancer. However, statistics indicate that the risk of breast cancer does not decline, but actually rises, from the age of 50 to the age of 85. This cannot be an estrogen effect, but rather the effect of suboptimal diet, overweight, lack of exercise, impaired immune function, and environmental toxicity.
To be safe, we carefully monitor women on hormone replacement therapy with breast examinations and mammography or other evaluation techniques, such as thermography, ultrasound or MRI. We recommend lifestyle changes known to reduce risk, including weight loss, exercise, organic diets, and increased vegetables and fruits, especially cruciferous vegetables.
Testosterone has similar cognitive effects in men. Men with Alzheimer disease have lower testosterone levels than normal men. Higher testosterone levels are associated with higher global cognition, and better memory, executive function and spatial performance.
Testosterone levels decline slowly in men, falling by about one percent yearly after the age of 40. Low levels are thought to be below 300 ng/ml. Yet many men have symptoms of testosterone depletion even with low normal levels. These include fatigue, loss of sexual performance and libido, memory loss, and impaired endurance and athletic performance. It is surprising how many men have abnormally low testosterone, and respond to hormone supplementation. Stress, alcohol, prescription drugs, recreational drugs, and impaired sleep all affect testosterone production.
Even in men with normal testosterone levels, a trial of therapy for the above symptoms is worthwhile. I have seen depression and fatigue resolve in men with lower normal testosterone, with better performance at work and improved relationships. This is a simpler and more effective approach than using psychiatric drugs.
Testosterone can be taken as a transdermal cream, sublingual tablet, injection, or subcutaneous pellet. We always monitor the blood count, since testosterone stimulates the bone marrow to make more blood. We also watch the PSA, since testosterone can make the prostate grow. Testosterone does not cause prostate cancer, but can stimulate already existing cancer.
If you have symptoms like those noted above, consider testing hormone levels, and a trial of hormone supplementation. It’s about more than sex.
Call our office to see if you can benefit from Hormone Replacement Therapy
Allan Sosin, MD