Bioidentical Hormones – BHRT
What is BHRT?
This is the cornerstone of anti aging medicine. Rather than treat diseases as we do in traditional medicine, this is an evolving field that treats “quality of life”.
Hormones are the regulators of our bodies. When they are out of balance, or change due to adolescence, pregnancy, PMS, menopause or andropause, we develop symptoms due to this imbalance. Common symptoms associated with PMS, menopause and andropause include mood swings, irritability, insomnia, loss of libido, depression, thinning hair and skin, decreased memory, decreased energy levels and lack of general well being.
Bioidentical hormones, compared to synthetic hormones, are hormones that are synthesized from plant extracts and are identical in molecular structure to the ones we make in our body. BHRT( Bioidentical Hormone Replacement Therapy) is designed to treat each individual in a customized fashion based on each patient’s blood and/or saliva test results. A compounding pharmacist that specializes in custom compounding prescriptions will make the prescription in a delivery system and dosage according to the physician’s specifications. They are usually made in the form of a cream or gel that result in a better absorption than a capsule or suppository. Since the prescription is individual, it can be altered according to the patient’s response and continually changing body biology. The typical hormones prescribed are variants of Estrogen, Progesterone and Testosterone.
A thorough hormonal consultation (1-1/2 hour consultation) will be necessary prior to determining the exact combination of hormones required. A follow up visit will be required once the result of the tests is received. The clinic will then arrange for the compounding pharmacist to prepare the formulation necessary for the patient.
This approach will allow patients to age in a healthy and balanced fashion and feel good while doing so.
Hormone Replacement Therapy, commonly referred to as HRT should perhaps be called Hormone substitution therapy, since most hormone replacement uses synthetic hormones which do not match exactly the hormones made by your own body. Synthetic hormones can be used in a safe manner, but as research and the use of bioidentical hormones becomes more widely utilized, both women and men are opting for use in the modality of bio identical, compared to the use of synthetic hormones.
The trend away from the use of synthetic hormones is coupled with the trend to use organic food, as well as the use of alternative medicine to treat ailments.
Since the WHI study (Women’s Health Initiative) was abruptly stopped in 2002,women became afraid of using conventional HRT to treat menopause, specifically Premarin (fabricated from the urine of pregnant mares) and Provera (a synthetic hormone). This large-scale study, which included over 16,000 women, was abruptly halted 3 years before its termination owing to a significant increase in the risk of breast cancer, and premature cardiovascular related deaths in the women taking active hormones.
I remember this well. I was always a hormone advocate for my symptomatic menopausal female patients. I was just coming back from maternity leave with my third child, when the WHI study was halted. It made widespread public headlines in the news. All my patients suddenly stopped their hormones cold turkey due to the news regarding the WHI study. About 2 months later, they all came back to me crying that they missed their hormones and were miserable.
I needed to find a solution to help them. But how? With what?
Are you feeling tired?
Do you feel you lost the energy you had when you were 25?
Are you looking for a natural solution using bioidentical hormone replacement therapy to treat your PMS, perimenopause, menopause, andropause or any other hormonal imbalance?
Having trained with leading experts in New York and Europe, Dr. Stolovitz together with her clinical nurse specialist can successfully treat you using bioidentical hormone replacement therapy.
What are Hormones?
Hormones are chemicals released by a cell or a gland that sends out messages that affects all parts of the body.
No organ in the body can go unaffected by hormones.
The complicated part about hormones is that they cannot be seen like an organ or a body part.
They are intangible.
When we talk about diabetes, people understand it because the disease affects various visible body parts.
Hormones are different.
Imagine you are ten years old and are a competitive gymnast.
You don’t get your period or grow breasts until you are 15 or 16 years old. Your mother thinks something is wrong with you. You visit the pediatrician and you are told you have delayed puberty because your exercise has postponed your ovulation.
Imagine you are 21 and are a full-fledged female.
You land a job in a high-powered firm where you are expected to perform. Approximately, 1 week before your period, you become a “basket case”. You become increasingly emotional, volatile, irritable and you cry for nothing.
Imagine you are 32 years old; you have a husband, a child, a home, and a good job.
You deliver your second baby without any complications, yet you are miserable. You have no reason to be upset; your life is perfect, yet you can’t stop crying. You are diagnosed with post partum depression.
Imagine you are 48 years old.
Your kids are grown up, and you don’t have to be the constant driver. Your children are now going to college; and they can make their own meals. You have full productive days at the office and are exhausted when you come home. You can’t wait to go home to sleep. But you can’t sleep. You wake up every hour because you are having hot flashes, or simply because you can’t fall back asleep. You wake up just as exhausted as you did the night before.
Imagine you going on a 20-year wedding anniversary trip with your husband.
You can’t wait to rekindle all those lost years when you were busy raising kids, working and running the household. But sex is hard and painful, and your vagina hurts and it is dry, and your libido is gone.
Imagine you are the man of the house. You just turned 50 years old.
Your whole life you were considered the “rock of Gibraltar” that held things together. You had energy and vitality.
You could outsmart all your colleagues at work with your wisdom, strength and memory skills. You have been exercising religiously for the past 20 years.
But lately no matter how much you exercise, you can’t seem to get rid of the belly you have recently developed.
Your muscle mass is decreased. You don’t feel you have the “get-up and go” you used to have 10 years ago.
Your libido is decreased and you need the help of a little “blue pill” to help maintain your erections.
These stories are so common; I hear them every day in my practice. You do all the blood tests and regular examinations and you find nothing wrong. Do your patients feel vindicated? You haven’t solved their problems.
Have you failed them as a doctor?
What are you missing?
The answer is Hormones.
Over the last decade, numerous studies as well as a detailed look at the studies using synthetic hormones have been re-evaluated. Also little distinction has been made in the public eye comparing the use of synthetic oral hormone replacement with the use of transdermal bioidentical hormones.
In women, hormone use is indicated for the use of menopausal symptoms including vasomotor symptoms of “hot flashes”, vaginal dryness, vaginal atrophy, sleeplessness, bone density loss, irritability, and loss of libido.
In men, hormone therapy is indicated for the use of andropausal symptoms including lack of energy, loss of muscle mass, decreased libido and erectile dysfunction.
The positive effects of hormone replacement or hormonal balance are that it slows down the aging process. When you are young you abound with hormones. As you age, your body produces less hormones. By replacing these hormones, not only do you help with the symptom relief, you also help maintain a sense of well-being.
Hormones are important for memory and brain aging. Hormones are responsible for body strength, agility, muscle mass, bone strength and good skin tone. Unfortunately, since we all must age we want to age well, with vitality in this new era of medicine.
Our grandparents accepted getting old and becoming less active with every decade. Our generation is not content with giving up so easily.
Replacing these hormones gives each individual a positive outlook towards combatting aging.
Hormone therapy can be custom compounded and can be titrated both to symptom response and blood test results.
Synthetic Bioidentical Hormone
What are Synthetic Hormones?
Non-bio identical estrogen products, also known as CEE (conjugated Equine Estrogen) are derived from the urine of pregnant mares. Other non-bioidentical hormone derivatives are commonly used in oral contraceptives. It is formed using a chemical modification of Estradiol making it a very potent estrogen. Although many FDA approved hormone products contain non-bioidentical hormone preparations, many others contain bio identical components.
What is Bioidentical Hormone Replacement therapy or BHRT?
Bioidentical hormones are identical to hormones produced naturally in our bodies. They are synthesized through chemical extraction derived from plants such as yam or soy. In the case of HRT, theses include Estrone, Estradiol, Estriol, Progesterone and Testosterone. We must also include Thyroid hormone into this equation since all these hormones intertwine in order to create hormonal balance.
Estrogen, progesterone, and testosterone.
Both men and women have all three of these hormones; the difference between men and women is in the different concentrations of these hormones circulating in the body. Estrogen and progesterone are the dominant hormones in women, while testosterone is the dominant hormone in men.
Estrogen is made in the ovaries, the corpus luteum(the follicle transformed after ovulation), the adrenal gland and the fat cells. Estrogen is a group of molecules divided into 3: Estradiol, Estriol, and Estrone. When we refer to Estrogen we refer to its three components as one. Estrogen is responsible for preparing the lining of the uterus for pregnancy, breast growth for breast feeding and keeping the vagina well developed and moist. It also prevents bony destruction as well as keeps cholesterol in check.
Estradiol is the most active form of Estrogen and is the one most responsible for female reproduction. Estrone is the form of estrogen, which increases after menopause and is secreted in the adrenal glands when the ovaries start to fail producing Estradiol. This is the hormone that is abundantly converted into subcutaneous fat (the so called abdominal fat), explaining why heavier women may have a higher level of estrogen than thinner women. Estriol is considered the “weakest “ estrogen and is primarily responsible for maintaining vaginal moisture.
During the aging process, once the ovaries start to fail, overall estrogen levels fall.
Progesterone is made in the corpus luteum and is a precursor to most sex hormones. In the ovary, progesterone production is activated at ovulation. If pregnancy occurs, progesterone production increases rapidly and is taken over by the placenta. If pregnancy does not occur, progesterone production disappears together with estrogen production resulting in menstruation. Progesterone is responsible for preparing the uterus for fetal implantation and ensures the survival of the fetus. It is also the hormone that creates a calming effect on the body, restoring sleep, maintaining sex drive as well as keeping insulin in check.
Progesterone begins to decrease after the age of 35 when the ovaries begin to deteriorate. The last half of the female menstrual cycle, also known as the luteal phase is dominated by Progesterone. When Progesterone levels begin to fall, this results in a luteal phase deficiency producing heavy and irregular periods, as well as premenstrual syndrome.
After menopause, progesterone levels fall substantially.
Testosterone is made in the testes and the adrenals in men and in the adrenals, corpus luteum and ovaries in women. Testosterone is responsible for muscle strength, exercise endurance, libido and energy levels.
Testosterone levels decline gradually with age in both men and women sometimes to less than half the levels seen at premenopausal and preandropausal levels.
Signs and symptoms of reduced testosterone are loss of libido, decreased muscle mass, reduced sense of well being, erectile dysfunction and reduced bone density.
DHEA or Dihydroepiandrosterone is a precursor of Estrone, Testosterone and Estradiol. DHEA is a precursor hormone and is also known as a neurosteroid. It is 30 times more prevalent in the brain tissue than in the blood.
There is an age related decline in DHEA in the fifth and sixth decade of life.
This hormone can also be replaced in low doses but must correlate with blood levels.
Thyroid hormone is produced in the thyroid gland. It is responsible for general metabolism and temperature control. Imbalance of the thyroid results in symptoms of fatigue, weight gain, cold intolerance, depression, hair loss and dry skin.
All of these hormones are intertwined and work together in a certain balance. When any or all of these hormones are out of balance, you get symptoms related to this imbalance.
Bioidentical Hormone Preparations
Bioidentical hormones are manufactured to be molecularly identical to the hormones found in the human body. They are available in both commercially and compounded forms. The commercial forms are available as gels or oral tablets.
The compounded forms are available in tablets, gels, suppositories and creams according to the physician’s specifications. Theses are not manufactured on a large scale and can only be produced for the individual patient as specified by a physician or health care practitioner with in depth experience in prescribing hormones.
Serum blood levels are most available to practitioners, while saliva testing is commercially available through a variety of labs. Saliva testing is popular because it is easy to use and relatively inexpensive. There is some evidence that saliva levels correlate with serum blood levels.
Currently there is no standard practice for measuring hormone levels. Traditional conventional medicine in both family practice and gynecological practices do not routinely test estrogen and progesterone levels in the treatment of menopause.
The goal of BHRT is to restore the balance of hormones in the body. Without knowing what imbalance exists, it becomes vey hard to come up with a strategic plan of action for these patients. Therefore it becomes important to use the results of the laboratory testing, accompanied witha list of clinical symptoms in order to determine and individualize the patients’needs and establish a specific regime for each patient. We monitor side effects and risk for cancer in our BHRT program.
This is about individualized therapy. The shotgun approach of the 80’s and 90’s is “passé.” Our present society is educated and wants more. Our baby boomers are active and still have many productive years ahead of them. They want to live their lives feeling strong, energetic, and try to defy the effects of aging the best way we know how.
Diet, Exercise and Lifestyle
While we are all in the search of a magic pill, a magic hormone solution, or a magic food or supplement, let me remind you one thing.
There is no magic answer.
If you are lucky enough to be given a good set of genes and you are able to maintain an active and balanced lifestyle, through diet, exercise, and a balanced hormone program, you can live your life to its fullest.
Don’t be afraid to give yourself a challenge.
Use the knowledge and the tools we have to find a happy solution at all ages of your life.
Remember, if 40 is the new 30, then 60 is the new 20, then 80 must be the new ???!
We look forward to meeting with you in our clinic.
** Not covered by RAMQ