As we age, sometimes even starting as young as in our 30s, our bodies may begin to show symptoms of hormonal imbalance. Unfortunately, this is often perceived as an inevitable aspect of getting older. These symptoms can lead to changes in our physiology and affect our quality of life and well-being.

Demystify some of the misconceptions surrounding hormone therapy.

"Testosterone in men causes heart attacks"

There are over 40 years of randomized control trials and observational studies that support the safety and efficacy of testosterone. In fact, low testosterone has been implicated in a a myriad of adverse cardiometabolic effects such as inflammation, insulin resistance, elevated cholesterol, and atherosclerosis.

Fear was instilled in the public from one poorly designed observational study that appeared in the Journal of the American Medical Association (JAMA 2013;310:1829-36). There was gross mismanagement of the data and the numbers that they published actually proved protection against heart attack, not increased risk that they published.

Backed by 40 years of studies, not only is there no increased risk in men on testosterone therapy, there are significant benefits. Men with low levels of endogenous testosterone are at an increased of cardiovascular disease. The benefits of testosterone don't stop there.

Testosterone helps protect against osteoporosis, diabetes, coronary artery disease, and hypertension. It improves cognition, muscle mass, and metabolism.

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Death-by-Testosterone-We-Think-Not.

Low serum T and mortality in male Vets.

Association of Testosterone and Estradiol Deficiency with Osteoporosis and Rapid Bone Loss in Older Men.

Endogenous sex hormone levels and cognitive function in aging men's there an optimal level.

Men's health low T and diabetes individualized treatment.

Relationship between low levels of anabolic hormones and older men.

"Testosterone causes prostate cancer"

In fact, not only is this statement completely false, we know that low testosterone levels increase your risk of prostate cancer.

In simplified terms, the saturation theory proposes that androgens (testosterone) have a maximum ability to stimulate prostate tissue, whether it is cancerous or benign. However, prostate tissue requires androgens for growth. The saturation model suggests that when testosterone levels are low, it ultimately binds to androgen receptors in the prostate. However, once these receptors are fully occupied, any further growth in the prostate happens regardless of the serum levels.

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Goodbye, Androgen Hypothesis, Hello Saturation Model.

"Testosterone causes hair loss"

Testosterone converts into Dihydrotestosterone (DHT) by way of an enzyme called 5-alpha reductase. DHT is 5 times more potent than testosterone, and is found in skin, hair follicles, and the prostate. Why is DHT important? Well the actions of DHT and the sensitivity of hair follicles to DHT is what causes hair loss.

In men, the same saturation model theory applies for hair loss as it does for prostate growth. The hair follicle becomes maximally saturated at a certain point regardless of the receptor being stimulated. Meaning, that any hair loss in men is either attributed to a low level of testosterone to begin with, or genetics. Not the testosterone itself.

In women however, it relates to a sensitivity to the hormone. If women experience this undesirable side effect, treatment in women is usually to stop the testosterone and restart it at a lower dose, and/or alternatively counter it's effects with another medication given the benefits of therapy (improved energy, sexual function, strength, bone density etc. ) far outweigh the risks for some women.

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Testosterone therapy in women myths and misconceptions.

"Estrogen causes breast cancer"

This statement persists over 20 years later and results from one study, The Women's Health Initiative Study (WHI), published in 2002.

The WHI found that women prescribed HRT(synthetic) had an increased risk of breast cancer. This study made headlines all around the world and changed the landscape for treating menopausal symptoms to this day. Millions of women and doctors feared hormones. Hormones were virtually "black-listed," and women were ripped off hormone therapy.

But let’s look deeper into this study and see whether the results' interpretations were accurate and applicable.

This large clinical trial, involving thousands of women, compared many different health outcomes of women taking HRT vs those who did not. The estrogen prescribed to women was synthetic, conjugated equine estrogen derived from pregnant mares' urine. As we learned earlier, this is not the same as bioidentical estradiol and progesterone. Some women also received the synthetic form of progesterone, progestin.

The study reported a whopping 24 percent relative increase in the risk of breast cancer among women taking HRT. Sounds very scary right? Nobody seemed to care that the absolute risk (the probability of an outcome occurring in a specific group) was minuscule. About 5 out of 1000 women in the HRT group developed breast cancer, vs. 4 out of 1000 women in the control group (no HRT). This equates to an absolute risk of 0.1 percent. This means that HRT was potentially linked to 1 additional case of breast cancer in every thousand women.

The numbers were reexamined years later and not found to be statistically significant, meaning that one extra potential case of breast cancer could have been due to chance.

Most of the women in the study were not experiencing any menopausal symptoms. Most women enrolled in the study were many years out from menopause. Most age-related diseases, cardiovascular, cancer, metabolic, and neurodegenerative manifest in women on average 10 years after menopause. How applicable then are these findings to women who are <60 years of age, or within 10 years of menopause?

There are countless evidence-based data from randomized control trials that are reassuring that compared with placebo, risks associated with menopausal hormone therapy are rare (<10/10,000 women) when initiated <60 years old, or within 10 years of menopause. The possible risks of breast cancer, stroke, and venous thrombosis (clot) are rare and comparable and not unique to hormone therapy.

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The Controversial History of Hormone Replacement Therapy.

Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women randomized trial.

Menopausal hormone replacement therapy and reduction of all cause mortality and cardiovascular disease it's about time and timing.

Oral micronized progesterone on quality of life in postmenopausal women.

The mortality toll of estrogen avoidance an analysis of excess deaths among hysterectomized women aged 50-59.

"Hormone therapy is only for post menopausal women"

Evidence suggests that women experiencing the adverse effects of PCOS and the extreme hormonal fluctuations in some perimenopausal women can significantly benefit from hormone therapy.

The fluctuations in progesterone and other hormone levels in our 30s and 40s can impact a woman's mental, physical, and emotional health.

Evaluating a women's health from a holistic approach and individualizing treatment has been shown to improve symptoms of PMS, mood, sleep, energy, strength, sexual health, and acne, and helps with weight loss.

Click here to learn more.

Perimenopausal progesterone.

Progesterone- friend or foe.

The Pharmacodynamics and safety of progesterone.

Myo-inositol for insulin resistance and PCOS.

Progesterone for the prevention and treatment of osteoporosis in women.

Individualized therapy for hypothyroidism is T4 enough for everyone.

Patient experience and perceptions associated with the use of desiccated thyroid extract.

As with anything in life, carefully considering the potential risks vs benefits is crucial. And nowhere is this more important than as it relates to our health.

The current standard of care is that all patients are treated the "same." We follow evidence-based medicine guidelines precisely and apply those research finding averages back to individuals. The problem with this mindset is that no patient is specifically "average, and one person's standard may not be another's.

Therefore, we must use the findings of evidence-based medicine to help guide our practice and consider each patient as unique while weighing the risks and benefits is paramount.

"All hormones are made equal"

This couldn't be further from the truth! Synthetic hormones, routinely prescribed in conventional practice, are manufactured chemicals made to mimic our hormones because they have a different chemical structure; the risks, forms, and benefits are not the same as bioidentical hormones.
Bioidentical hormones are derived from yams and soy, and once extracted, they are processed by a specialty compounding pharmacy into tailor-made doses and form for a specific patient.

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Counseling Postmenopausal Women about Bioidentical Hormones: Ten Discussion Points for Practicing Physicians.

Understanding Our Female and Male Hormones

Estrogen

Estrogen is a class of hormones produced in women's ovaries, adrenal glands, and fat cells and is the primary female sex hormone. There are three types of estrogen found in a female’s body, estrone (E1), estradiol (E2)growth, and estriol (E3). Estradiol (E2) is made from our ovaries on the way to ovulation. We also make Estrone (E1) from adipose fat tissue and the number of estrogen metabolites in your gut. Estradiol is your most potent and best estrogen and stimulates tissue growt.

Together with progesterone, Estradiol carries out essential roles: building muscle and bone, maintaining the health of our brain and heart, maintaining a healthy metabolic weight, and ability to lose fat around our waist; these act as natural appetite suppressants. This is why we feel less hungry on days leading up to ovulation and more hungry when it drops off before menstruation. It enhances insulin sensitivity and helps prevent insulin resistance and diabetes.

At the onset of menopause, our hormone levels drop dramatically. Losing estrogen at menopause removes the estrogen “protective factor” and increases our risk of insulin resistance and abdominal weight gain. Estrogen helps protect us against vaginal atrophy, urinary tract infections and incontinence, heart disease, stroke, osteoporosis, Alzheimer's disease, and memory loss.

Click here to learn more about Transdermal Estradiol and the risk of developing Type 2 DM.

Who may benefit from Estradiol?

Menopausal women who experience the signs and symptoms associated with menopause. Menopausal hormone therapy is the most effective treatment for symptoms related to the hormonal changes of menopause.

Progesterone

Progesterone is a hormone secreted by the ovaries. It has several functions, but its primary function is to thicken the endometrial lining to prepare the uterus to implant a new embryo. It promotes the development of tissue. If an egg is not fertilized, progesterone temporarily stops, and the uterus sheds its endometrial lining. Therefore, progesterone’s primary roles are regulating menstruation and supporting pregnancy. Natural progesterone works in synergy with estrogen to maintain hormonal balance.

Natural progesterone has been shown to help protect against breast cancer, heart disease, and osteoporosis. It is essential in reducing the symptoms of PMS, perimenopause, and menopause. Combining natural progesterone and estrogen gives women energy and overall well-being. This contrasts with progestins, the manufactured steroid found in the birth control pill, where progestins mostly have adverse effects.

Click here to learn more about Progesterone for the prevention and treatment of osteoporosis.

Who may benefit from Progesterone?

Menstruating women with low progesterone, perimenopausal, and menopausal women with OR without a uterus. Low levels of progesterone may cause abnormal periods or infertility. Women with PCOS, severe symptoms of premenstrual syndrome, stress, natural aging, and hormonal decline may all benefit from natural progesterone.

Testosterone

Testosterone is a hormone secreted by the ovaries and adrenal glands in women. Contrary to popular belief, men and women require optimal amounts of Testosterone to function. Serum testosterone levels decline with age, as does our receptor site sensitivity and resistance, with the most significant fall being before menopause.

Testosterone is an essential part of the Renewed Health BHRT program. Testosterone is necessary for strength, endurance, bone health, skin, mood, energy, and libido. Testosterone increases collagen and decreases wrinkles. Testosterone has been shown to help protect against cardiovascular disease, diabetes, Alzheimer's disease, and dementia.

Who may benefit from Testosterone?

Peri-menopausal and Menopausal women experience symptoms of low testosterone, such as decreased energy and stamina, thinning bones and muscles, increased visceral fat, depression, impaired sexual function, or urinary symptoms.

Click here to learn more about Sarcopenia and menopause.

DHEA

Dehydroepiandrosterone is a steroid hormone secreted primarily by the adrenal glands. Under normal physiologic conditions, DHEA is an endocrine precursor transformed into estrogen and testosterone. DHEA levels peak in our early 20's, then steadily decline 3% yearly. By age 75, men and women have around 10-20% of young DHEA levels. Research has shown that DHEA supplementation can improve mood and well-being, memory, and sleep, increase energy, restore sexual vitality, maintain bone health, reduce fat mass and maintain lean body mass, and is effective at supporting immune function.

Low levels of DHEA have been associated with an increased risk of premenopausal breast and ovarian cancers in women. There is perhaps no better hormone that is associated with youthfulness and aging.

Who may benefit from DHEA?

Peri-menopausal and menopausal women with low DHEA-S lab values and experiencing any of the abovementioned signs and symptoms.

Click here to learn more about DHEA-S levels associated with more favorable cognitive function in women.

Melatonin

Melatonin is a natural hormone secreted by the penial gland. It is also synthesized in multiple other non-endocrine organs and tissues. It is the primary hormone involved in the control of the sleep-wake cycle. The levels are higher at night, are suppressed by bright light, and decline as we age. Melatonin promotes restful sleep and affects the thermoregulatory and cardiovascular centers. The primary role of melatonin both in health and disease is associated with its antioxidant and anti-inflammatory effects.

Who may benefit from Melatonin?

Anyone with sleep concerns and who want to promote an antioxidant and anti-inflammatory effect.

DISCLAIMER

The information is presented for educational purposes only. It is not intended to diagnose or prescribe for any medical or psychological condition nor to prevent, treat, mitigate, or cure such diseases. The information contained herein is not intended to replace a one-on-one relationship with a doctor or qualified healthcare professional. Therefore, this information is not intended as medical advice but rather a sharing of knowledge and information based on research and experience. Renewed Health encourages you to make decisions based on your judgment and research in partnership with a qualified healthcare professional.