As our bodies age we notice many changes. One of the most important debates in health care involves the effects of decreasing hormone effects and what to do about it. I have been treating young and old, men and women alike with hormone therapies for more than 15 years.
Hormones include vitamin D, estrogen, progesterone, testosterone, DHEA, pregnenolone, thyroid, cortisol and more. Many people just think of hormones as related to sexual function. Some think that if they are no longer sexually active this entire issue is not important. Others feel differently and prefer to be sexually active through their older years. In actuality there may be much more at stake than even sexual function. Not only do these chemicals help our bodies regulate the function of many different organs and tissues, they may also help preserve function as we age.
We generally think of hormone therapies as answers to symptoms of hot flashes in women and erectile dysfunction in men. While these issues may have the most awareness, they are only the beginning of this education.
Deficiency of a hormone called progesterone may be the primary cause of menstrual migraine in teenagers and young adults. Giving these young women supplemental progesterone during the last two weeks of their cycle may prevent these headaches.
As we age, our hormone levels decline. Our bodies were not designed to live much beyond menopause and we were not designed to live without hormones. In addition, our bodies were not designed to handle the degree of toxic environmental exposures experienced today. Some of these disrupt hormone production and some effect the receptors on every cell that trigger a biologic response. It is almost impossible to live today without doing hormone therapies yourself. Every time you drink from a plastic water bottle the phthalates in the water act like estrogen in you body. Perhaps the estrogen effect from one small plastic bottle of water is more than the effect of what estrogen a grown man will make in one week. And then there is glyphosate from pesticides in produce that has contributed to infertility in young and old alike. As your body decreases production of its own hormones, receptors become proportionately more influenced by the hormone effects of these chemicals in our environment.
Other reasons to consider hormone replacement therapy include brain health and preventing dementia, maintaining bone health, and preventing osteoporosis. You will find there is a lot known about these issues as you research these headings more thoroughly.
Some people have been led to believe that hormone therapy in older age can be dangerous. There is considerable evidence that hormone analogs made by pharmaceutical companies may contribute to cancer. One of the more significant examples is a medication called “Provera,” a progestin type of drug that is not progesterone but has some progesterone like effects. Research has shown that taking hormones identical to what your body makes does not carry this danger.
People have also been led to believe that all you need for treatment is the hormone that is missing. A significant argument against this is that our body is always in a delicate balance, and hormone replacement therapy should help maintain and not interfere with this equilibrium.
Different Hormone Therapies
As you consider hormone therapies, it might be helpful to better understand how our physiology is designed to work. First our brain signals to our hormone producing glands and lets them know that levels are low, and more hormone needs to be made and secreted directly into our blood stream. From there, these signaling chemicals (hormones) then circulate throughout and touch and influence receptors on every cell in our body. Lastly circulation takes them to the liver where they are deactivated. Moreover, our body pulses hormones through the day and night. We are not designed to have the same level of circulating hormones several days or months in a row. Neither were we designed to have a huge dose today by injection and another dose next week or the week after.
When hormone therapies are prescribed, some are made by pharmaceutical companies and can be picked up at most any pharmacy. Others will need to be made especially for you by a compounding pharmacy. One of the buzzwords is the term “bio-identical.” BHRT refers to Bioidentical Hormone Replacement Therapy. These hormones are synthesized to be identical in structure and function to the hormones your body used to make.
After a decision has been made to utilize BHRT in your body, there are still several choices. How will you get them into your body? These choices include pills, pellets, skin creams, vaginal creams and suppositories, injections, and a troche. Each has advantages that may include price, ease of administration, and efficacy. At heart, is the consideration of avoiding a pass through the liver before they circulate through the body. When hormones are taken orally and swallowed, they will pass through the liver before circulating. Skin, pellets and troches deliver to blood stream before liver. Each of these choices will affect results of treatment.
Hormones Creams and Patches
The advantages of cream/patches and pellets may include ease of administration and production. Creams are easy to make, and pellets provide more income for the doctor. Many people find success and enjoy how their bodies feel with both of these choices. Pellets however maintain more constant hormone levels for up to 3 months at a time, and creams/patches deliver only about 5% of their drug, leave a reservoir of active hormone underneath the application, and the fat under skin will metabolize and change some of what is applied.
Oral and Vaginal Hormone Applications
Vaginal application and the oral “troche” (dissolves from mouth through membranes of gum and cheek) applications provide hormones directly to blood stream. Vaginal application is not convenient during the day, and troche will invite some swallowing of the ingredients and adds the issue of taste.
Choosing Between Hormone Replacement Therapy Options
So, what will you and your doctor choose? What preferences might you have considering your body and your research. Are you a man looking for testosterone? Injections can be effective, but large doses every two weeks may leave you out of balance and then very low the second week. In addition, the high initial blood levels may lead to shrinkage of testicles, and size may be important to your appearance. A troche will allow for twice per day dosing and may provide needed benefit without this effect. If you are a woman who is sensitive and understands her body, a hot flash or PMS moment in the afternoon can be effectively treated in less than 10 minutes with a small part of your troche. Many women prefer this level of ease and flexibility. Neither of these issues can be solved with creams or pellets, and vaginal application may be less than convenient.
At the Blatman Health and Wellness Center we look at laboratory studies, symptoms, individual needs, and then help you understand these options before making an initial choice. If you have concerns about these issues, make your appointment today and let us help you balance your hormones to recover and maintain your body.