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Bioidentical Hormone Replacement Therapy:
Myth vs FactWhat you really need to
know
Mark D Filidei, D.O.Director of Integrative Medicine
Amen Clinics
The two main principles of Bio-identical Hormone Therapy (BHRT):
The two main principles of Bio-identical Hormone Therapy (BHRT):
1) Use of natural (human bio-identical) hormones: exactly like those produced in the body 2) Physiological replacement to levels of a young adult
Many doctors are unaware they are prescribing BHRT!
Vivelle Estrace Estraderm Femring Femtrace Climara Alora Prometrium
Hypothyroidism is an epidemic
The Colorado thyroid disease prevalence study:25,000+ participants
CONCLUSIONS:
“The prevalence of abnormal biochemical thyroid function reported here is substantial and confirms previous reports in smaller populations. Among patients taking thyroid medication, only 60% were within the normal range of TSH. Modest elevations of TSH corresponded to changes in lipid levels that may affect cardiovascular health. Individual symptoms were not very sensitive, but patients who report multiple thyroid symptoms warrant serum thyroid testing. These results confirm that thyroid dysfunction is common, may often go undetected, and may be associated with adverse health outcomes that can be avoided by serum TSH measurement.”
Signs and Symptoms of Low Thyroid
Fatigue Increased sensitivity to cold Constipation Dry skin Unexplained weight gain Puffy face Hoarseness Muscle weakness Elevated blood cholesterol level Muscle aches, tenderness and stiffness Pain, stiffness or swelling in your joints Heavier than normal or irregular menstrual periods Thinning hair Slowed heart rate Depression Impaired memory
Standard ranges for thyroid testing (Labcorp):
Free T4 0.82-1.77Free T3 2.0-4.4 >3.50TSH 0.45-4.50 <1.50
With co-morbidities use:fT3/rT3 >20
D1 (but not D2!) is suppressed and down-regulated by:
Physiologic and emotional stressDepressionDietingWeight gain/Weight LossInsulin resistance and DiabetesObesityInflammationAutoimmune diseaseSystemic illnessChronic fatigue syndromeFibromyalgiaChronic painExposure to toxins, mold, heavy metals, and plastics
Thyroid hormone replacementThyroid hormone replacement
T4 only (most common) Synthroid, levothyroxine
Natural thyroid (Armour, Westhroid, NP thyroid) contains natural ratios of T4 and T3
T3 only (Cytomel, compounded T3)
The Three Forms of EstrogenThe Three Forms of Estrogen
Estrone: Produced in peripheral tissues; implicated in some cancers (breast, uterine)
Estradiol: Secreted by ovaries; most active form, supports cognitive function and mood, higher levels associated with youthful appearance. Deficiencies associates with osteoporsis, dementia, heart desease
Estriol: safest and weakest form of estrogen; may have anti-cancer effects, useful for vaginal dryness and MS (reverses brain lesions)
Signs of Low Estrogen(From Unleash the Power of the Female Brain)
Weight gain Bladder incontinence and infection Mood changes/depression Insomnia Low libido Heart palpitations Osteoporosis Painful intercourse Foggy headedness Irritability Fatigue Weepiness Hot flashes Pain
Signs of Excess Estrogen (From Unleash the Power of the Female Brain)
Puffiness Heavy bleeding Fibrocystic breasts Low libido Cravings for carbohydrates Weight gain around the hips Vaginal or oral yeast (thrush) Mood swings/easy to tear Tender breasts Headaches or migraines
Benefits of Estrogen replacementBenefits of Estrogen replacement
Helps reduce/eliminate menopausal symptoms
Can help maintain bone density Anti-Aging benefits May decrease risk of Alzheimer’s and
and other brain related problems Supports cognitive function and
mood (serotonin function)
Estrogen enhances brain function
“Authors suggested this study supports previous results showing that the effect of estrogen therapy on mood may be independent of antidepressant effects mediated by alleviation of vasomotor symptoms and that estrogen therapy may be of benefit to perimenopausal women experiencing moderately severe depression.”
Short-term use of estradiol for depression in perimenopausal and postmenopausal women: a preliminary report. Am J Psychiatry. 2003 Aug;160(8):1519-22.
“Estrogen in a therapeutic dosage alters brain activation patterns in postmenopausal women in specific brain regions during the performance of the sorts of memory function that are called upon frequently during any given day. These results suggest that estrogen affects brain organization for memory in postmenopausal women.”
Effect of estrogen on brain activation patterns in postmenopausal women during working memory tasks. JAMA. 1999 Apr 7;281(13):1197-202
Premarin Pregnant Mare Urine
Premarin Pregnant Mare Urine
Conjugated estrogens, from the urine of pregnant mares (50% equine hormones, not found in humans)
Predominantly E1 (estrone)
Natural Estrogen ReplacementNatural Estrogen Replacement Bi-Est: 80% estriol, 20% estradiol
in oral or transdermal form Estradiol only Transdermal is recommended to
avoid “first pass effect” and coagulation issues of oral use
Should always be balanced with natural progesterone in women with an intact uterus
Estrogen MetabolismEstrogens convert into several metabolites. Estrone, for example, may convert into three different forms:
• 2-hydroxyestrone, protective against cancer • 4-hydroxyestrone, promotes cancer • 16-alpha-hydroxyestrone, promotes cancer In women on HRT, the 2/16 ratio should be >2. Lower ratios are associated with breast and ovarian cancer.
March 30, 2013, 9:54 p.m
“Study upholds breast cancer mortality for hormone replacement” Though it was generally agreed that woman who took the two hormones to curb their hot flashes and night sweats upped their chances of developing the disease, many studies suggested that the cancers the women developed were less likely to be deadly.
A new analysis of data from the Women's Health Initiative now casts doubt on those findings. The study, published Friday by the Journal of the National Cancer Institute, concludes that the prognosis for cancers related to hormone replacement therapy is just as dire as for other breast cancers. As a result, women who turn to the treatment are more likely to die of breast cancer than their peers who don't take hormones.
“The new findings apply only to women who take estrogen and progestin, a synthesized form of the natural hormone progesterone. Women who have had hysterectomies can take estrogen alone, a regimen that doesn't seem to increase breast cancer risk. But those who still have a uterus must take both estrogen and progestin to avoid developing endometrial cancer.
And hidden much further down in the article we find this:
Hormone therapy for Breast Cancer Survivors?
“We observed lower risks of recurrence and mortality in women who used HRT after breast cancer diagnosis than women who did not” …the results suggest that HRT after breast cancer has no adverse impact on recurrence and mortality”J Natl Cnacer Inst 2001 May
“Continuous combined HRT was associated with reduced risk of death from primary tumour and all cause mortality.”Med H Aus 2002 Oct
“Over a mean follow up of 30 months 17 of 214 users experienced recurrence (4.2% per year), compared with 66 of 623 controls (5.4% per year). HRT did not seem to affect breast cancer recurrence risk”J Clin Oncology 2001 April
“Estrogen replacement therapy apparently does not increase either recurrences or mortality rates. Adding progesterone may even decrease recurrences. Women with early breast cancer should be offered hormone replacement therapy…Am J Obstet Gynecol. 1999
Hormone replacement therapy after breast cancer: 10 year follow up of the Stockholm randomised trial.
“The number of new events did not differ significantly between groups, in contrast to previous reports. The increased recurrence in HABITS has been attributed to higher progestogen exposure. As both trials were prematurely closed, data do not allow firm conclusions. Both studies found no increased mortality from breast cancer or other causes from HRT. Current guidelines typically consider HRT contraindicated in breast cancer survivors. Findings suggest that, in some women symptom relief may outweigh the potential risks of HRT.” Eur J Cancer 2013 Jan
Synthetic Progestins
Provera (medroxyprogesterone acetate) most popular “progesterone” drug
Dozens of adverse effects: decreases blood flow to heart, lowers HDL, and causes edema, weight gain, insulin resistance, insomnia, and, if taken in early pregnancy, birth defects
Natural ProgesteroneNatural Progesterone
Protects against estrogen’s proliferative effects on endometrium
Helps alleviate PMS symptoms Reduces fibrocystic breast
disease May elevate libido and mood May promote bone formation
Natural progesterone
Supports GABA - a major calming neurotransmitter
“natures Valium” Levels drop with low thyroid, chronic
stress, vitamin deficiencies and refined sugar
Symptoms of low progesterone
Anxiety/depression Poor sleep Fibrocystic breasts PMS Premenstrual headaches Postpartum depression
Progesterone ReplacementProgesterone Replacement
Oral micronized progesterone, 100-300 mg at bedtime
Transdermal natural progesterone creams, 1/4-1/2 teaspoon daily
Available both OTC and prescription
Testosterone for Women (?)Testosterone for Women (?)
Yes! Declines with age, just like in men Increases libido, elevates mood and
energy level Improves ratio of fat to muscle Replacement: Natural testosterone
in transdermal cream or gel. Implanted pellets.
Testosterone for MenTestosterone for Men
Levels fall gradually with age; ”Low T” syndrome
Low levels herald andropause Symptoms include loss of libido,
fatigue, depression, loss of muscle mass, osteoporosis, anhedonia,
“I lost my mojo” Testosterone replacement can be used
for men with history of prostate cancer if they are disease free.
Testosterone ReplacementTestosterone Replacement
Injections: 200mg wk, 100mg 2x/wk SQ or IM
Topical in gel or cream: 50-100mg/day
Troche Implanted pellets Avoid oral testosterone HCG injections
DHEA –adrenal hormoneDHEA –adrenal hormonePrecursor hormone Low levels associated with
depression, weight gain, heart disease, diabetes, autoimmune disorders, immune dysfunction, obesity, cancer, osteoporosis, memory loss
Replacement improves sense of well-being, mood, memory, immune function, and in women libido
DHEADHEA
“DHEA was associated with a remarkable increase in perceived physical and psychological well-being for both men (67%) and women (84%)...› Morales, AJ et al. Effects of replacement dose
of dehydroepiandrosterone in men and women of advancing age. J. Clin. Endocrinology and Metabolism, 1994; 78(6):1360-1367.
DHEADHEA "... an increase in DHEA-S of
100 mg/dl was associated with a 36% reduction in mortality from any cause and a 48% reduction in mortality from cardiovascular disease."› Barrett-Connor, et al. A perspective
study of dehydroepiandrosterone sulfate, mortality and cardiovascular disease. NEJM, Dec. 11, 1986; 315(24):1519-1524.
DHEADHEA
Average doses: › 5-25 mg women › 25-50 mg men
Check blood levels of DHEA-S to determine optimal dose
Use with caution in patients with hormone-sensitive cancers, such as breast or prostate cancer*
DHEA may protect against breast cancer
Dehydroepiandrosterone (DHEA) has a protective role against cancer…These results suggest that the mechanism of DHEA actions against breast cancer involves the inhibition of cell proliferation and the suppression of migration, indicating that DHEA could be useful in the treatment of breast cancer.
Eur J Pharmacol. 2011 Jun 25
The DHEA metabolite 7β-hydroxy-epiandrosterone exerts anti-estrogenic effects on breast cancer cell lines
Steroids. 2012 Apr;77(5
Human Growth HormoneHuman Growth Hormone
After 6 months of treatment: Increase in muscle mass (8.1%) Reduction of body fat (14.4%) Increase in bone density (1.6%) Rejuvenation of skin (7.1%)
› Rudman, D et al. Effects of human growth hormone in men over 60 years old. New Engl J Med, July 5, 1990; 323(1): 1-6.
Human Growth HormoneHuman Growth Hormone “The effects of 6 months of
hGH on lean body mass and adipose-tissue mass were equivalent to the changes incurred during 10 to 20 years of aging.”› Rudman, D et al. Effects of human
growth hormone in men over 60 years old. New Engl J Med, July 5, 1990; 323(1).