david r md

There is so much confusion these days about hormone replacement that it is difficult to decide what the intelligent choice is for adults interested in maintaining optimal health. Should one use hormone replacement, and if so, what kind? Or, is it best to abstain from all hormones completely? Are there safe alternatives to the traditional treatments?

Part of the challenge stems from the fact that people are living longer, leaving us without enough precedents as reliable reference points. If we go back 40- to 100-thousand years, human beings were identical to modern humans. But the life expectancy at that time was no more than thirty years. Therefore, our evolution was mostly designed to survive infectious disease and parasites – not menopause or the equivalent hormonal changes in men as they age.

The good news in all of this: These days 30 years old is considered the beginning of adulthood rather than old age. The bad news: We now have to deal with a variety of chronic degenerative diseases, such as Alzheimer’s, heart conditions, diabetes, hypertension and osteoporosis.  Hormone levels generally begin to drop during the decade of our 30s. Since they play such a crucial role in our health, how do we deal with steadily declining hormone levels over the 40 to 60 years of additional life expectancy that most of us will likely enjoy?

To help answer these big questions and make informed decisions, there are eight basic tenets to be aware of when it comes to hormone replacement therapies:

  • BIO-IDENTICAL HORMONES:    Bio-identical hormones refer to replacing hormones with exactly the same hormones, molecule for molecule, that our bodies produced in the first place. Using synthetic hormones produced in a test tube and never previously seen in human beings is irrational and potentially dangerous.  The vast majority of studies of hormone replacement  therapy for women have been done with synthetic hormones or hormones derived from pregnant horses. Over the last million years, through evolution, all the bugs have been worked out regarding the hormones that are supposed to be in human females. It is arrogant of the medical community to disregard this fact.

 

  • PROPER HORMONAL BALANCE FOR WOMEN:   When we look at the ratio of the three main estrogens in healthy women, estriol, estrone and estradiol, we find that estriol is the most abundant. Henry Lemon, M.D. found that if you add estrone and estradiol and divide them into the amount of estriol, women with higher results (that is greater than one, with higher estriol) were more likely to be long-term survivors after breast cancer.  Most studies show that estriol has anti-cancer properties or is neutral, while estrone and estradiol are understood to have a stronger carcinogenic potential. Epidemiological studies show an inverse relationship between estriol and breast cancer: the higher the estriol, the less cancer found.  There are various ways to increase the amount of estriol, including the use of iodine. Iodine can increase the amount of healthy estriol from an unhealthy form of estrone. Unfortunately very few doctors measure all three hormones. When hormones are replaced it is advantageous to administer them in the proper ratio.  A good examples of this is the popular Bi-Est formula, which contains 80% estriol and 20% estradiol.  Dosing for each individual woman is determined by testing and monitoring of hormone levels until the optimal point is found.

 

  • TESTOSTERONE REPLACEMENT FOR MEN:  Just as with women, men also experience hormonal changes as they age, this is sometimes referred to as “andropause”.  They experience a decline in testosterone production, though the process is slower and more subtle than that which women typically experience with perimenopause and menopause.  Replacing the testosterone that is being lost produces beneficial effects for men such as:  increased muscle mass and strength; improvement of psychological well-being and mood; preservation of bone mass; and last but certainly not least a marked improvement in erectile functioning and a man’s libido. Testosterone therapy may also slow or stop the progression of metabolic syndrome into such serious conditions as diabetes and/or cardiovascular disease.  Dosing for each individual man is determined by testing and monitoring hormone levels until the optimal point is found.

 

  • OPTIMAL  DELIVERY:   Hormones are optimally administered in a trans-dermal or trans-mucosal manner. This means through the skin, rubbed on the arms, legs, or abdomen.  They can also be administered by means of pellets placed under the skin with a simple procedure.   Hormones such as estrogen and testosterone  have to pass through the liver before entering the blood stream. When hormones are released naturally from the glands they go to organs first and only go to the liver on the second time around, called the second pass.  When taken orally, they can be metabolized into undesirable products, some of which include substances called inflammatory cytokines, which increase inflammation in the body. Inflammation has been implicated with many chronic degenerative diseases, such as arthritis, heart disease and cancer.  Progesterone can be administered in either capsule or trans-dermal form, depending on the patient and her individual needs.   In certain cases, testosterone can also be given by injection.  Estrogen and testosterone can also be administered via pellets that are place under the skin.  The advantages here are ease and convenience, as the pellets remain active for a three to six month period, and do not require the daily application of a cream, taking of capsules, or receiving injections, etc.  The pellets also release the hormones into the body on a physiologic basis,  more in tune with the body’s needs  and daily rhythms, rather than a static, once or twice a day dosing.

 

  • PROPER METABOLISM OF ESTROGEN:   When hormones are eliminated from the body they are metabolized in the liver and excreted in the urine. Leon Bradlow, M.D. developed a test to determine the risk for developing breast cancer, which has been called the 2/16 ratio. Estrogen, for example, can be metabolized into 16-hydroxyestrone and 4-hydroxyestrone, which can be dangerous, or it can be metabolized into 2-hydroxyestrone, which is safe.This is one of the important reasons why some women respond poorly to estrogen replacement and others do very well with it. If you divide the total amount of the 16-hydroxyestrone into the 2-hydroxyestrone, the result should be greater than 1. If the result is less than one there is an increased risk of breast cancer. This seems to apply to pre-menopausal women but does not work for postmenopausal women. The ingestion of cruciferous vegetables, such as cabbage and broccoli, increases the amount of the healthy 2-hydroxyestrone. If you are like most of us and don’t eat enough of these vegetables, you can take supplements of indole-3-carbinol and DIM (diindolymethane) to do the same thing.

 

  • TESTING:   Obtaining hormone levels prior to starting replacement and monitoring levels after the initiation of therapy is vital. I like to keep the levels where they were around the age of 35 years old. There are different ways to monitor hormone levels; in my practice I use blood, urine, and saliva testing. A 24-hour urine comprehensive profile allows for the most accurate way of measuring all hormones and their metabolites in both women and men. With this urine test, both the beneficial and harmful estrogens can be measured, as well as levels of both testosterone and the adrenal hormones.  Since all humans are unique in their metabolism, this allows for the individualization of the hormone prescription.  Many times hormones are given without monitoring the levels; proper monitoring of hormones prevents high and dangerous levels from developing.

 

  • ORCHESTRA EFFECT:   There are many hormones in the human body and they all need to interact together like well-tuned instruments in an orchestra. Giving only one hormone without considering how it works together with the other hormones will give poor results.  In an orchestra, if the horns are playing too loud, it can crowd out the strings.  Likewise if one hormone is given and the other hormones are not taken into consideration, you can produce a state of disharmony. When hormones are properly balanced you can often use lower amounts of each, and prevent serious side effects from developing.

 

  • STRESS:   Stress plays a major role in the regulation of hormones. There are anabolic hormones that build up the body, like DHEA, testosterone, and growth hormone, and hormones that break down the body like cortisol. In healthy women and men, these building hormones should be present in greater amounts and more active than the breaking-down ones.  During a stressful or dangerous episode, these breaking-down hormones dominate in order to prepare the body for fight and flight.  For our ancestors, these times of danger or stress were relatively infrequent, subsequently their bodies had more time to return to a “normal” state.  To achieve optimal health, it is necessary to find ways to reduce or manage stress, such as moderate exercise, a meditation and/or yoga practice, participating in enjoyable activities such as playing an instrument, dancing, or another fun hobby, or simply making enough time to enjoy with family and friends.  It is also crucial to get enough good quality sleep on a regular basis, as the body does a lot of its “repair work” at night while we sleep.

 

In our busy, crowded (and often chaotic and anxiety-provoking) modern world, with hectic 24-hour-a-day lifestyles, the stresses now seem to be more chronic and continuous. This is causing a situation in which our bodies tend to be continually in this breaking-down mode.  To complicate things even more, as we age the building hormones begin to naturally decline.   So as we mature, repair and maintenance of the body becomes more difficult.

Another factor that can deplete hormones is, interestingly enough, too much exercise! You can often see this in the faces of female endurance athletes as they reach their 40s and 50s. Before this time there was plenty of estrogen to go around, no matter how much exercise was done. As they age, the estrogen that is available is used for the muscles during exercise leaving insufficient amounts for the skin and other organs. Moderating your stress and doing appropriate amounts of exercise help maintain the proper hormone balance.

Hormones are one part, and certainly a very important part, of the total health picture. These substances are very powerful, and need to be given with care and knowledge. When prescribed properly, they are a very important part of maintaining our energy and vitality as we age, and also in preventing the chronic degenerative diseases which tend to manifest from midlife onwards.

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Dr. Allen gives free lectures at the Library three to four times each year, on topics of interest from the cutting edge of integrative medicine.  If you would like to be added to our mailing list for these lectures and his other speaking engagements, please email da@davidallenmd.com.

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