Bioidentical Hormone Replacement Therapy (BHRT) at Beleza Medspa
1. What is BHRT?
BHRT seeks to restore to the body what is missing in the face of stress or imbalance. It makes use of hormones that are identical to what the body produces in contrast to pharmaceuticals and herbals. Drug companies cannot patent bioidentical hormones so they synthesize artificial replacements. These commonly prescribed pharmaceuticals function differently from natural hormones. These differences lead to side effects and decreased potency. There is precedence for bioidentical hormones, as both Insulin and thyroid hormone are commonly used natural hormones.
2. Where do these bioidentical hormones come from?
Most natural hormones are extracted from plant sources. Since they are not manufactured by drug companies, we depend on compounding pharmacies to secure them. At these facilities, professional pharmacists produce natural hormones in different delivery systems. These compounds are then available by prescription for replacement therapy.
3. How do you know which hormones need to replaced?
We utilize salivary testing to measure hormone levels. Besides being pain free and easy to collect, salivary testing gives us a better picture of what your tissues see. Most of these hormones are steroids and function by being absorbed by cells and used up. So if you try to measure them in blood, you are only seeing what has not been used. This does not give you an accurate picture of what the body is producing. Furthermore, most of the steroid hormones in blood are bound to proteins. These bound hormones are inactive and are the only ones measured in the blood. Hormones measured in saliva directly reflect the amount of hormones that the salivary glands see. Used for more than 40 years, salivary testing offers an accurate assessment of basal hormone production.
4. Are these hormones safe?
Synthetic hormones have many extra components that can increase the risks of certain cancers and blood clots. Bioidentical hormones lack these extra components and are as a result, safer. Just like pharmaceuticals, BHRT requires the same cancer screening procedures (mammograms, pap smears, etc.). Furthermore, BHRT utilizes close monitoring of tissue levels. Instead of relying on symptoms, salivary testing allows the smallest possible doses of hormones to be used.
5. What hormones can we measure and replace?
We commonly measure estrogen, progesterone, testosterone, cortisol, DHEA and thyroid hormones. There are many other precursors and metabolites that we can also test for.
6. What about female hormone BHRT?
Estrogen and progesterone levels and their balance regulate the female reproductive system. The first two weeks of the menstrual cycle are dominated by estrogen and the last two weeks by progesterone. An excess of estrogen relative to progesterone, can explain many symptoms in reproductive age women including endometrial hyperplasia, premenstrual syndrome, fibrocystic breasts and uterine fibroids. The term ‘estrogen dominance’ reflects the constellation of symptoms due to either too much estrogen and/or too little progesterone. This explains why many of the symptoms of PMS and menopause are similar. These include breast tenderness, hot flashes, headaches, mood swings, water retention, depression/anxiety/fatigue, and weight gain. Estrogen dominance can also lead to cancers of the breast and uterus as well as blood clots. In menopause, estrogen and progesterone both decline, adding new symptoms including hot flashes, night sweats, vaginal
dryness, foggy thinking, insomnia, rapid skin aging, and bone loss. Adequately maintaining levels of estrogen balanced with appropriate progesterone is necessary to maintain health at any age. Women also produce small amounts of testosterone in their ovaries and adrenal glands. Like men, testosterone helps with sex drive, energy, and muscle strength and may need to be supplemented.
7. So how do we balance estrogen and progesterone?
Oral contraceptives and Premarin/Prempro are commonly used pharmaceuticals to treat PMS and menopause. These are high potency foreign compounds that over stimulate receptors and suppress natural hormone production. They also increase binding proteins that effect other hormones and have metabolites that are carcinogenic. Natural estrogen consists of 3 subtypes. E1 is carcinogenic and BHRT typically uses a combination of E2 and E3. This combination is more potent and safer than synthetic estrogen. Synthetic Provera is not progesterone. Provera has many deleterious side effects. Natural progesterone lacks these effects and is actually protective for cancer.
8. What about testosterone and andropause in men?
Testosterone in men is produced in the testes. Levels begin to decline by the 40’s by about 1% a year. Testosterone in men reduces osteoporosis and cardiac risk, improves libido, maintains muscle mass and promotes emotional well-being and mental sharpness. Dihydrotestosterone is a metabolite of testosterone that is implicated in baldness and prostate cancer. Estrogen in males is produced by the conversion of testosterone in fat. Estrogen in men can promote breast growth and prostate enlargement but is also necessary to balance testosterone. Men also produce small amounts of progesterone that balances estrogen. Andropause is due to declining testosterone levels in middle age. Symptoms include fatigue, loss of muscle mass, increased fat, depression, moodiness and loss of mental sharpness. Salivary testing is used to directly measure testosterone levels as well as estrogen, progesterone and DHEA. Replacement is not as simple as just
testosterone. Proper treatment may require supplementation with progesterone and cortisol as well as reducing estrogens. Testosterone replacement has not been shown to cause prostate cancer but PSA levels must be followed.
9. Tell me about Adrenal Fatigue and cortisol?
The adrenal glands produce multiple hormones including the steroids, cortisol and DHEA. These hormones are produced throughout the day and are increased by various stressors. Cortisol has a wide range of effects on the mind and body and interacts with the immune, reproductive and thyroid systems. It suppresses other hormones and regulates blood sugar. There is a spike in cortisol release in the morning and levels trend downwards toward night (wakes us up and winds us down). When stress either mental or physical is prolonged, cortisol levels can remain elevated. This can lead to susceptibility to infection, poor sleep, weight gain, increased blood sugar, bone loss and depression. Treatment for high cortisol includes stress relief, a balanced diet and various supplements. Exposed to chronic stress, over time the adrenal glands may develop an impaired response to stress (adrenal fatigue). Cortisol levels are low causing fatigue (can’t
get out of bed), mental fogginess, carb and salt cravings and irritability. Bioidentical replacement with hydrocortisone is available and is used to support adrenal gland function. Vitamin support is also necessary. Unlike other hormones, cortisol supplementation is only continued 3-6 months until the adrenal gland heals. DHEA is a steroid hormone also produced by the adrenal glands and is a precursor to estrogen and testosterone production.
10. Thyroid dysfunction.
Thyroid hormone stimulates cellular metabolism and maintains body temperature. The thyroid gland produces inactive T4 which is converted to active T3 in the tissues. A stimulating hormone (TSH) is used to regulate thyroid production. If not enough active thyroid hormone is produced, hypothyroidism is present. Symptoms include weight gain, cold temperature, sluggishness and low energy. Blood testing is used to measure T3, T4 and TSH. Replacement is available with synthetic T4 (bioidentical), desiccated animal thyroid and T3. Various combinations of these hormones may be necessary to balance thyroid levels.
11. How are these hormones delivered to the body?
Estrogen, testosterone and progesterone are applied via transdermal creams. This avoids ‘first-pass’ metabolism through the liver which can cause carcinogenic metabolites and loss of potency. Thyroid hormone and cortisol are taken orally.
12. Who should be tested?
Both men and women of all ages can be helped by BHRT. Anyone over age 40, or who suffer PMS or menopausal symptoms, fatigue, weight problems, insomnia or cold intolerance are ideal candidates. After filling out a symptom questionnaire, a salivary kit is issued and testing is completed by the patient at home. When the results are available, a follow up appointment is scheduled to correlate symptoms with measured hormone levels.
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