Hormone Replacement Therapy for Women
Unraveling the confusion
After the negative outcomes of the WHI study in 2002 and others, millions of women have not had clear guidelines on what to do about taking hormones for menopausal issues. Recently, studies published are helping us make better informed decisions on using hormones.
After decades of being pushed to take them, women starting in 2002 were told to stay away from hormone replacement therapy (HRT) and/or take drugs for their menopausal symptoms. Many women already did not want animal and chemical hormones even before the studies.
So was HRT really a bad concept? We do not think so and were not surprised by the results of these studies.
Many reasons but the most important are probably the type and doses of hormones that were used.
For instance when the media usually says “estrogen” is bad, the question is which one are they talking about?
- Human estrogens?
- Proprietary chemical formula look-a-likes?
- Horse urine derivatives? (Pregnant mare urine= Premarin)
The media is usually only talking about the last two.
So when doctors and the media talk about hormones they talk about substances that have little in common with your own.
FWSI refers to human hormones as: natural, bio-identical, bio-equivalent, iso-molecular, or ortho-molecular. It all means the same thing— using hormones manufactured chemically as close as possible to your own stuff.
Stop for a minute and really think about that. Nature is very strict on chemistry. Even at a gross level, if you had blown a part in your car, would you go another maker to replace it? If you filed one door key tooth, would your door open? Or if you changed one digit dialing home, would your family answer?
Along with the British doctor, Sir Charles Dodd, who developed the first ARTIFICIAL chemically non-human estrogens in 1938, FWSI believes that administering these man-made proprietary chemical formula look- a- likes and/or horse-derived substances is fraught with danger. Sir Charles Dodd said it clearly. It took from 1938 to 2002 to prove it.The technology to create identical human hormones was present back then. In 1939, bio-identical hormone pellets were already in use in the United States, and to this day they have not found their way into the mainstream of American medicine.
WHY? Pellets are created in a laboratory, the formula is human, and therefore natural (to humans). Pellets, consequently, cannot not be patented. This historically prevented pharmaceutical companies from owning the rights that would cause them to heavily promote and sell their products. That said, recently some pharmaceutical companies have started to market testosterone pellets. Pellet therapy has been studied and researched, particularly in Australia and England.
Interestingly pharmaceutical companies market biodentical hormones all the time. These usually are estradiol patches, creams and gels. They also market natural progesterone and testosterone. All these can also come in oral forms. They usually can market bioidentical hormones because they patent the delivery systems.
Most of the concerns about use of “natural hormones” from mainstream medicine, revolve around the fact that compounding pharmacies manufacture bioidentical hormones. Issues of quality control and inconsistencies in the products are cited. When pharmaceutical companies manufacture bioidentical hormones, which in fact they routinely do, they usually meet with the approval of mainstream medicine. We believe that it is in the best interests of the patients that practitioners involved in natural hormone therapy take great care in making sure of the quality and reliability of the hormonal preparations used, either manufactured by pharmaceutical companies or compounding pharmacies.
- We help patients who do not have enough hormones. They have run out or are low enough in their levels to have adverse health effects.
- Patients with hormonal imbalance problems and normal levels usually do not need hormone therapy (BHRT). They need to clean up their diets (it is known that the chemical structure of human estrogens can change based on a person’s diet), exercise, stop bad habits, improve their hormone detoxification systems such as their liver and the CYP 450 superfamily of enzymes , and possibly take hormone modulators like phytonutrients, essential fatty acids, and some vitamins.
- Patients with hormone levels low enough to cause symptoms and problems such as those related to osteoporosis and/or its prevention, and who desire to be treated, are considered for natural HRT.
- People should not have too little hormones, and they should not have too much hormones. They should have enough to do the work to keep them healthy.
- We determine if there is a need for BHRT, and then develop a customized strategy.
- We also always look to administer the smallest doses that achieve the goals.
What is the process for me?
- An initial questionnaire is filled out to evaluate your personal history, needs and goals.
- Blood work results of hormonal levels done in advance are reviewed at the first appointment.
- Therapy will begin, if deemed appropriate, and the pellet insertion will be performed during this appointment.
- 3 weeks after insertion, another blood test will be performed to reassess the hormone levels. An appointment will be scheduled to discuss these results and how you are feeling.
- Approximately 4-6 months after insertion or when symptoms begin to recur, a new blood test must be completed followed by another appointment to review the results and subsequent pellet insertion.
What are some ways FWSI collects information about you?
- Estrogen Detoxification Genetics
- We perform genomic testing on the estrogen detoxification makeup of our patients. Some people have unfavorable mutations called SNPs ( Single Nucleotide Polymorphisms) in their enzyme families that clear dangerous estrogen. For some women, these variations can create higher risk of developing breast cancer. If they have these glitches, which we identify with a saliva swab, we work with their diets and give them supplements to help correct them.
- Estrogen Metabolites Identification
- The word estrogen represents a class of compounds that number in the hundreds.
- It helps to think of estrogen this way:
- Estrogens made in the human body
- Estrogens in the food we eat
- Environmental estrogens we are exposed to
All these estrogens are split in 2 general categories by the body’s metabolic work:
- Estrogens take many different forms. Safe and Harmful. Every person does this based on their genetics (which now we can test), diet, exercise and stress management. Some estrogens that are more dangerous than others. On the other hand, some are more desirable to have. We measure these forms in EVERY WOMAN. We are able to test estrogen metabolites in our patients before and after the interventions. If the patient has abnormal results, we work very hard to change that. We do this by changing diet and using specific supplements that work on how the body changes estrogens for the better. One specific supplement we use “Lucentia Peak for Her” has been recently published on the Journal of Translational Medicine. We believe this to be so important that if a woman cannot obtain a favorable ratio of safe to toxic estrogens we may advise her not to be doing estrogen therapy.
- Fatty Acid Ratios
- N-6/N-3 are important ratios in overall health and also breast cancer prevention. We check them. If they are unfavorable, we teach women how to create a healthy ratio.
- Heavy Metal Toxicity
- Some heavy metals can be dangerous. For example, cadmium is a heavy metal with strong estrogen like activity. We can check for that and others.
- Family History
- We collect relevant information about your family history.
- Customized Care
- We see each patient as a person and unique individual. We make no assumptions. We do our detective work. That is why we check the patient’s genetic make-up and also what they are actually doing with it. We give you the best we have to offer. We monitor our patients one by one.
Which hormones do I take and how much?
You want to use the same hormones you were born with. Bio-identical means that the hormones are exactly the same ones produced in your body. Their chemical formula is 100 percent human. They are NOT simulations, or variations on the theme.
The dosages of hormones through this approach are usual smaller than with the other alternatives. We decide your dose based on your blood work results, age, weight, risk factors, and metabolic characteristics. It is tailored to you with the goal of making the lowest dose work for you.
It is very likely you will also be on natural progesterone. The three hormones lost at menopause— estrogens, progesterone, and testosterone—are replaced in physiological dosages.
How do I take the hormones?
For the method of delivery, we prefer the pellet insertion to other form of orals, creams, gels, patches, and injections. We do however work with every patient’s preferences.
- Hormones taken by mouth may damage the liver, require much higher dosages, and give a roller coaster effect in the blood.
- In our experience, creams, gels, and patches work, but can be erratic, difficult to use, and sometimes do not deliver enough of the goods. Patients report mixed results, and we can confirm that by checking hormone levels in the blood. However, if the patient desires these methods , we incorporate them into the treatment plan.
- We do not believe in hormone injections.
- The pellet is built in a tightly compressed manner that allows the hormones to release slowly. That’s why it lasts 4 to 6 months. It does not go through the liver first. It does not produce surges and ups and downs, but rather a nice steady state that the body needs. Furthermore, your body uses the pellets as a reservoir of hormones to draw from whenever necessary. People do not have to remember to take anything. The pellets do their job every day similar to what the ovaries used to do before menopause. Pellets are about the size of a grain of rice and are placed shallowly right beneath the skin using a mild, local anesthetic typically in the buttocks area of the body. There is no pain. The procedure takes about 10 minutes and is repeated every four to six months. The incision is so small it does not even require a stitch. You wear a special band-aid for 4 days. There may be some soreness at the spot of insertion for a few days after.
How do I monitor their efficacy?
The efficacy of hormone therapy is monitored through the following methods.
- Clinical results
- Blood work
- Bone density scans as needed
When patients start to be relieved of their symptoms, they are the first ones to know and tell us. Women are enthusiastic about the way they feel. Many women significantly decrease the quantity of supplements they were taking for their symptoms. Sometimes they do not need them any more. Eventually as the hormones are used up, patients notice that and call saying it is time for another pellet insertion. We also carefully check blood levels that give us medical confirmation that things are where they are supposed to be. For osteoporosis, we order DEXA scans at the beginning and then annually to exactly quantify the improvements in bone mass.
How do I monitor their safety?
There are well-known safety concerns about artificial HRT.
What about natural BHRT?
There is increasing literature that supports the use of bio-identical hormones. The KEEPS ( Kronos early estrogen prevention study) and the ” Danish Study” both published in 2012 are helping to gain understanding and scientific data in this field and they are showing bioidentical hormones do not seem to be associated with adverse outcomes like cardiovascular disease and cancer.
Interestingly the same WHI study which blew the whistle on HRT has now shown that some women on estrogen alone have LESS risk of breast cancer.
Science is showing more and more that one size does not fit all. Increasingly, quality health care requires tailoring treatments to the individual with all their quirks and genetic variations. There are no two equal people, and not even identical twins.
We also believe that if certain formulas have been used by Nature in humans for a few million years, there has to be a reason why.
Our natural BHRT therapies are grounded within available published literature and experiences from colleagues.
More studies are needed to confirm the safety of natural BHRT over longer periods of time. The reality is that health care is often lacking definitive answers. That is when the physician and patient sit together and make decisions based on the best available information.
According to the General Accounting Office of the United States, only 15 percent of standard allopathic medical practice has a clear scientific basis. That is: standard allopathic medicine, and not alternative medicine.
We continue to monitor the scientific literature to collect more data in our constant quest to evaluate and refine our best practices. We keep in close contact with our colleagues offering similar types of health care.
FWSI employs all available methods to ensure safety.
For more information, FWSI recommends the following resources.
Dr. Bazzan’s lecture on ” Hormone Therapy: an Integrative View” at the Marcus Institute of Integrative Health
Dr. Bazzan’s lecture on ” An Integrative approach to Osteoporosis” at the Marcus Institute of Integrative Health
- The Great Life Makeover by Daniel A. Monti, MD and Anthony J. Bazzan, MD
Hormone Replacement Therapy in the Geriatric Patient: Current State of the Evidence and Questions for the Future. Estrogen, Progesterone, Testosterone, and Thyroid Hormone Augmentation in Geriatric Clinical Practice: Part 1
- The Sexy Years by Suzanne Somers
- The Greatest Experiment ever Performed on Women by Barbara Seamans