We all are getting older, but we at EG Healthcare believe that you should feel your best as you do it.
Some symptoms we tend to think of as “normal aging” are an imbalance in hormones or are caused by the body’s inaccurate response to chronic stress. These symptoms often can be corrected by the use of Bioidentical Hormone therapy.
What is Bioidentical Hormone Replacement Therapy (BHRT)?
This therapy is a precise process of replacing what hormones the body is missing due to age, chronic stress, or both, to restore balance and correct unnecessary symptoms.
Hormones, such as estrogen, testosterone, progesterone, DHEA, and the adrenals regulate an enormous range of body functions, and when they are under or overproduced, we can experience unwanted symptoms. With the use of bioidentical hormones, we can balance these hormones to restore our levels and feel better. Bioidentical hormones are derived from plants and are similar in molecular structure to the hormones produced naturally by the human body.
Male Hormone Balance
Testosterone does not have a dramatic age-related decline associated with fertility. Instead, testosterone decline can be gradual over time, most commonly starting at age 40, and is referred to as andropause (“male menopause”). Often, it is seen along with imbalances in adrenal and thyroid function, so testosterone replacement therapy alone is not enough to feel better. Testing all hormone levels and adrenal function is necessary, as is a correction of all hormone imbalances, without over-dosing. Over-dosing testosterone will lead to more symptoms, an estrogen production, and an increased risk of estrogen-dependent cancers.
What can testosterone replacement therapy help to relieve?
Some symptoms common in andropause include:
- Change in muscle strength
- Bone loss
- Weight gain
- Limited energy
- Hair loss
- Low sex drive
- Mood swings
- Poor concentration
- Memory loss
How are bioidentical hormones given?
Although there are many ways to get bioidentical hormones, including pills, injections/shots, and implanted pellets, we use creams/gels as they are the safest form of replacement therapy with the least risk associated with administration.
Hormone Pellets vs. Other Hormone Administration Methods
Oral medications have to go through the liver to be available for use by the body, which is called the “first-pass” effect. This effect can cause high concentrations of estrogen in the liver, which can lead to some unwanted side effects, including the excess risk of venous thromboembolism (VTE). Venous thromboembolism is a blood clot that can be transferred to any part of the body and cause very serious side effects. Other side effects associated with oral use of hormone replacement include:
- increase in blood pressure
- increase in triglycerides
- increase in estrone
- increase in the occurrence of gallstones
- increase in liver enzymes
- increase in a binding hormone that can actually decrease testosterone levels and an increase in carbohydrate cravings
Hormone pellets for replacement therapy are small pellets placed into the skin for a few months, which dissolve slowly over time, releasing hormones for tissue use. This method sounds appealing, offering convenience, as once you have it inserted, it does not require any daily management. However, each pellet requires a small surgical procedure every visit, as it is inserted into the fat under your buttocks, hip or stomach with a small incision, which increases cost, and adds the risk of infection and bleeding with each placement. Also, with pellet use, there is usually a peak in hormone rise around the first month, and then there is a drop for the next few months, causing a return of symptoms around 3-4 months. Correct dosing of hormone replacement does not always happen the first time. Once the pellet is implanted, there is no way to alter or adjust the dosage. You will get that prescribed dose for the next few months, so if you are under-dosed, you will have an ineffective pellet, and not feel any changes. If you are over-dosed, you will have unwanted side effects until the pellet wears off, which can mean several months. The pellet also cannot be removed, and it starts to dissolve once placed and cannot be removed from the skin.
Injections share some of the same aspects as pellets, such as convenience. You will not need to apply this method daily, but instead, be injected on a weekly or biweekly basis. However, injections for hormone therapy carry the same risks such as infection at the time and also do not offer the flexibility of adjusting doses easily. Once you are injected with the dose, you will have that dose until it wears off.
Transdermal hormone replacement therapy (creams) bypasses the first-pass effect, which does not increase the risk of VTE as oral therapies do. Doses are very easily adjusted. One of the disadvantages of creams is the potential to transfer to family members and pets, but the risk is minimal with proper usage. Another risk specific to cream usage is possible redness at the site of application.
What are the side effects of bioidentical hormones?
Bioidentical hormone therapy should have limited side effects, as we are just replacing what has been missing. However, side effects can occur when a dose is first given, as the body adjusts to the new level of hormones. Most of the time, side effects are linked to inadequate dosage, and as your hormone levels improve, your dosage may need to be adjusted. Contact us right away if you notice any side effects.
Some common side effects you may see include:
- Sleep apnea
- Breast swelling or tenderness
- Water retention, bloating
What to Expect
At your first visit, your symptoms and concerns will be discussed, and a comprehensive review of symptoms, medical, family, and personal history will be done. You will be given a kit for you to perform Salivary Hormone testing. Salivary Hormone testing is necessary to determine what hormones you need to replace. The level of hormones in the saliva is more accurate than venous blood to show the amount of hormone available to the tissues, where the hormones will be used. The levels of Cortisol, DHEA, Estrogens, and Testosterone will be checked.
At your second visit, your results will be reviewed. If needed, you will be prescribed bio-identical therapy in the form of a cream that will be compounded from a specialty pharmacy and can be delivered to you. Sometimes supplements and vitamins will also be prescribed.
After beginning hormone therapy, subsequent hormone levels will be checked to assess your response, every year, and with any change in medication dose. Doses are adjusted according to your symptoms and needs, with the goal of keeping the dose to the minimum required to achieve your goals. The treatment is to replace the hormones that have been lost with the hormone therapy. As a result, hormone levels will increase, and symptoms will improve. The length of treatment also depends on your individual needs and how you are feeling – some people may require hormone therapy indefinitely. At the same time, others many only need hormones until their symptoms have subsided.
Have realistic expectations
Testosterone replacement therapy is not a fountain of youth, and there is no guarantee that it will restore you to the level of physical fitness or sexual function of your youth, but it will improve your symptoms. If your erectile function has been a problem, testosterone therapy might not fix it, and it may require different evaluation, medication, and therapy to fix it.
Adrenal fatigue is the result of chronic stress. Symptoms can include mental fog, overeating, weight gain, inability to fall asleep, body aches, fatigue, anxiety/nervousness, sleep disturbances, and digestive problems. Most of the time, only a single symptom is addressed, leaving the root of the problem, subtle elevations and depressions of adrenal function are left ignored. Salivary testing will measure the amount of cortisol at four different points of time throughout the day to adequately assess adrenal function.