Bio-Indentical Hormone Introduction
While bio-identical hormones have been approved and available for use in the US since the 1930s, the use of bio-identical hormones has been slow to increase despite general agreement in the scientific literature that bio-identical hormone replacement is far better than using non-human hormones.
What exactly are hormones and what do they do?
The word hormone comes from the Greek word “excite”, thus linking our hormones to our emotions. Of all of the systems in the body, the endocrine system which is responsible for hormone production, is perhaps the most complex and least understood. Hormones are the body's chemical messengers, either secreted into the bloodstream or used locally, that affect the functioning of other cells. A hormone affects only specific cells called target cells that have unique receptors for that hormone. Think of it as a lock and key. Cells which do not have the specific receptor for a certain hormone cannot be influenced directly by that hormone. Some cells go even further, and regulate their own internal production of a needed hormone. For example: Estrogen is made inside the cells that utilize Estrogen (brain, bone, heart, etc.) from Testosterone.
What is meant by bio-identical, and why is non-bio-identical bad?
Bio-identical hormones have the exact same chemical structure as hormones that are made by the human body. The difference between the "human body made" (or bio-identical) versus synthetic non-bio-identical is in the molecular structure (shape) of the hormone. In order for a replacement hormone to fully replicate the function of the hormone that we naturally produced, the chemical structure must exactly match the original. It is the structural differences that exist between human bio-identical and non-bio-identical hormones that are responsible for side effects and health risks that occur when non bio-identical hormones are used by humans.
Why are people taking non bio-identical hormones?
Bio-identical hormones are naturally produced in humans, they cannot be patented regardless of their source. Therefore, large drug companies cannot significantly profit off the use and sale of bio-identical hormones. The pharmaceutical industry's main hormone drugs are produced by using animal hormones (often collected from pregnant mare urine) to create products that are structurally different than human hormones and yet bind to human receptors – often much too strongly. The drug Premarin binds to human estrogen receptors almost 20 times stronger than natural estrogen. Mass production of non-human type hormones by drug companies is very profitable despite the serious health issues and side effects caused by them. Conversely, bio-identical hormones (especially well studied testosterone) have not been shown to have any serious side effects. Bio-identical hormone replacement therapy had few powerful advocates until recently when Oprah aired two shows in January of 2009. The quality of life and health benefits of bio-identical hormones are huge for those with deficient levels… which will include most of us eventually!
What hormones are replaced?
Testosterone is vital to the health and well-being of BOTH men and women. Testosterone in men is mainly produced by the testicles and in smaller quantities by the adrenal glands. In women, testosterone is produced in both the ovaries and the adrenal glands. Testosterone contributes to muscle mass, strength and endurance, decreased fat, increased exercise tolerance, enhancement of the sense of well-being and psychological health. Testosterone protects against cardiovascular disease and reduces blood sugar. It leads to improved lean muscle mass, increased bone density, decrease in cholesterol, improved skin tone, improved healing capacity, and increased libido and sexual performance. It enhances the quality of life for both men and women by decreasing the diseases of aging. Cells that require Estrogen use Testosterone to manufacture Estrogen inside the cell by a chemical conversion that uses an enzyme called Aromatase. Testosterone is present and extremely important in both Women and Men, making adequate tissue levels very important for health in both sexes. (It goes without saying that women require substantially less of it!)
Estrogen refers to a group of similar hormones produced in the body. Like testosterone, Estrogen is a required hormone for the health of BOTH men and women. The main three are estrone (E1), estradiol (E2), and estriol (E3). Estrogens are believed to be protective against heart disease, stroke, osteoporosis, Alzheimer's disease, and memory disorders. It also protects against vaginal atrophy, urinary incontinence, and prevents symptoms of menopause, including hot flashes and poor temperature regulation (e.g. "hot Flashes"). It can improve balance by the "visual somatosensory" system in the central nervous system. Estrogen deficiency is linked to: urogenital atrophy, incontinence, increased skin wrinkles of the face, fatigue, depression, mood swings and decreased libido. However, the vast majority of women we treat need only testosterone pellets (see above) as their body, like men's, makes all the intracellular estrogen it needs from testosterone, thus avoiding the serious problems that can occur with high circulating estrogen levels in the blood. While estrogen supplementation is rarely necessary, it is important that any estrogen prescribed be a bio-identical estrogen and not a non-human estrogen. The non-bio-identical synthetic estrogens bind nearly 20 times stronger to your cell's receptors and have been proven to be harmful.
Progesterone is primarily produced in the ovary just prior to and after ovulation. It is also produced in large quantities by the placenta during pregnancy and in small quantities by the adrenal glands. If you are on bio-identical estrogen, you should probably be on this hormone as well. It seems to protect against uterine and breast cancers, fibrocystic disease and ovarian cysts. Unfortunately, most U.S. women are prescribed a synthetic horse derived progestin (Provera) which can cause side effects such as bloating, headaches, fatigue, weight gain, and heart disease. Bio-identical progesterone does not have these side effects.
There can be nutritional deficiencies encountered in the BHRT patient that may affect BHRT effectiveness. Examples include iodine, and other trace mineral and vitamin deficiencies. If this is suspected, inexpensive non-prescription supplements may be recommended. B-12 injections are offered monthly to those BHRT patients who so desire. Many feel it helps.
What is the goal of bio-identical hormone replacement therapy (BHRT)?
The goal of Bio-identical Hormone replacement therapy is to provide an adequate supply of a deficient hormone in a form that is molecularly identical to that which your body produces. Logically, this should result in the hormone's normal healthy physiologic effects being restored. Every person is unique. Therefore, it is sensible to customize a BHRT program based upon your individual symptoms and hormone levels. The precise dosing of each person's therapy will be determined after consultation and evaluation of laboratory blood tests, and may be adjusted if needed.
Further goals of bio-identical hormone replacement therapy include:
Alleviation of the symptoms caused by decreased production of hormones. (Examples include: sleep problems, mood swings, increased body fat, decreased libido and sexual function, hot flashes, night sweats, anxiety,etc.)
Re-establishing the protective benefits which were originally provided by higher levels of your naturally occurring hormones. (Examples include: bone density, cardiovascular health, immune function, balance, etc.)
Reversal of diseases associated with aging (Examples: osteoporosis, loss of strength, fatigue, exercise intolerance, decreasing muscle mass, mental clarity, etc.) Enhance the enjoyment, sense of well-being, and quality of life over the long-term.
Hormone Balance & Women's Health
Today Millions of women are suffering from hormonal imbalance and experiencing the signs of early menopause or menopause. The frequency and severity of symptoms can vary greatly among individual women. The most common symptoms are:
- Weight gain
- Hot flashes
- Night sweats
- Decreased libido
- Mood swings
- Vaginal dryness
- Memory fog
- Bone Loss
Hormones are very powerful substances that affect every cell of our body. It is not surprising that we experience a myriad of unpleasant symptoms and conditions when our hormones become imbalanced or deficient. The ovaries produce many hormones. Chief among them are estrogen, progesterone, and testosterone. Diet, nutrition, stress level, exercise and family health history are also important factors in determining your overall hormone health. The importance of hormone balance has been ignored for far too long. For years, many physicians have been misguided about the truths and effects of hormone balance. For women, estrogen and progesterone work in tandem along with testosterone. Primarily thought of as the "male" hormone, testosterone is just as important to a woman's hormonal function as it is to a man's. Testosterone is classified as an androgen hormone and has significant effects on libido, mood, sexual function, depression and is thought to be vital in the preservation of bone, and for maintaining energy levels.
What is BHRT & Testosterone Replacement?
Testosterone therapy for women is based on personal hormone test results to determine the testosterone dosage that fits the needs of you. No two women are alike and hormone needs will differ from woman to woman. A Biologically Identical Hormone Replacement program that includes estrogen, progesterone and testosterone actually helps address the cause of a hormone imbalance...not just the side-effects, while offering a combination of additional long term health benefits.
Hormone Balance and Men's Health
As men grow older, levels of free testosterone decrease and estrogen levels increase. The average 60 year old male has more circulating estrogen in his blood than the average 60 year old female. As if the decline in testosterone weren’t problematic enough, new research has shown that even small increases in estrogen may have detrimental effects on men’s cardiovascular health.
What is Andropause?
Andropause arrives in a man’s life when there is a drastic drop in hormone levels. Although total testosterone may not drop drastically, free testosterone, or the active form of testosterone, drops significantly with age. When levels of testosterone fall, the condition is called hypogonadism (hypo-=low, gonad=testis). This age related decline in free testosterone levels may result in the following symptoms.
- Loss of Muscle Mass
- Reduced Sexual function
- Decreased Libido
- Prostate Health
- Weight Gain
- Memory Fog
- Bone Loss
What is BHRT & Testosterone Replacement?
Testosterone therapy for men is based on personal hormone test results to determine the testosterone dosage hat fits the needs of you. No two men are alike and hormone needs will differ from man to man. A Biologically Identical Hormone Replacement program that includes testosterone actually helps address the cause of a hormone imbalance...not just the side-effects, while offering a combination of additional long term health benefits.
FAQ: Testosterone Hormone Implants for Women and Men
Data supports that Testosterone hormone replacement therapy with pellet implants is the most effective and the most bio-identical method to deliver hormones in both men and women. Implants, placed under the skin, consistently release small, physiologic doses of hormones providing optimal therapy.
What are Pellets?
Pellets are made up of testosterone that is pressed or fused into very small solid cylinders. These pellets are slightly larger than a grain of rice. In the United States, the majority of pellets are made by compounding pharmacists and delivered in sterile glass vials. There is also a commercially produced ‘FDA approved’ 75 mg testosterone pellet.
Pellets deliver consistent, healthy levels of hormones for 3-5 months in women and 4-6 months in men. They avoid the fluctuations, or ups and downs, of hormone levels seen with every other method of delivery. This is important for optimal health and disease prevention. Pellets do not increase the risk of blood clots like conventional or synthetic hormone replacement therapy.
In studies, when compared to conventional hormone replacement therapy, pellets have been shown to be superior for relief of menopausal symptoms, maintenance of bone density, restoration of sleep patterns, and improvement in sex drive, libido, sexual response and performance.
Testosterone delivered by a pellet implant, has been used to treat migraine, PMS, and menstrual headaches. It also helps with vaginal dryness, incontinence, urinary urgency and frequency. In both men and women, testosterone has been shown to increase energy, relieve depression, increase sense of well being, relieve anxiety and improve memory and concentration. Testosterone, delivered by pellet implant, increases lean body mass (muscle strength, bone density) and decreases fat mass. Men and women need adequate levels of testosterone for optimal mental and physical health and for the prevention of chronic illnesses like Alzheimer’s and Parkinson’s disease, which are associated with low testosterone levels.
Even patients who have failed other types of hormone therapy have a very high success rate with pellets. There is no other method of hormone delivery that is as convenient for the patient as the implants. Pellets have been used in both men and women since the late 1930’s. There is more data to support the use of pellets than any other method of delivery of hormones.
How and where are pellets inserted?
The insertion of pellets is a simple, relatively painless procedure done under local anesthesia. The pellets are usually inserted in the upper buttocks through a small incision, which is then taped, closed. The experience of the health care professional matters a great deal, not only in placing the pellets, but also in determining the correct dosage of hormones to be used.
Are there any side effects or complications from the insertion of the pellets?
Complications from the insertion of pellets include; minor bleeding or bruising, discoloration of the skin, infection, and the possible extrusion of the pellet. Other than slight bruising, or discoloration of the skin, these complications are very rare. Testosterone may cause a slight increase in facial hair in some women. Testosterone stimulates the bone marrow and increases the production of red blood cells. A low testosterone level in older men is a cause of anemia. Testosterone, delivered by implants or other methods, can cause an elevation in the red blood cells.
After the insertion of the implants, vigorous physical activity is avoided for 48 hours in women and up to 5 to 7 days in men. Early physical activity is a cause of ‘extrusion’, which is a pellet working its way out. Antibiotics may be prescribed if a patient is diabetic or has had a joint replaced. However, this is a ‘clean procedure’ and antibiotics are usually not needed.
Why haven’t I heard about Pellets?
You may wonder why you haven’t heard of pellets. Pellets are not patented and have not been marketed in the United States. They are frequently used in Europe and Australia where pharmaceutical companies produce pellets. Most of the research on pellets is out of Europe and Australia. Pellets were frequently used in the United States from about 1940 through the late 70’s when oral patented chemically altered estrogens and testosterones were marketed to the public. This is changing! Currently, some of the most exciting data on hormone implants in breast cancer patients is out of the United States. Even in United States, there are clinics that specialize in the use of pellets for hormone therapy.
Do men need hormone therapy?
Testosterone levels begin to decline in men beginning in their early 30’s. Most men maintain adequate levels of testosterone into their mid 40’s to mid 50’s, some into their late 70’s to early 80’s. Men should be tested when they begin to show signs of testosterone deficiency. Even men in their 30’s can be testosterone deficient and show signs of bone loss, fatigue, depression, erectile dysfunction, difficulty sleeping and mental decline. Most men need to be tested before 50 years of age. It is never too late to benefit from hormone therapy.
What if my primary care physician or my gynecologist says that there is ‘no data’ to support the use of pellet implants?
He or she is wrong. There is a big difference between ‘no data’ and not having read the data. It is much easier for busy practitioners to dismiss the patient, than it is to question their beliefs and do the research. Patient’s need to make an informed choice. After pellets are inserted, patients may notice that they have more energy, sleep better and feel happier. Muscle mass and bone density will increase while fatty tissue decreases. Patients may notice increased strength, co-ordination and physical performance. They may see an improvement in skin tone and hair texture. Concentration and memory may improve as will overall physical and sexual health. There is data to support the ‘long term’ safety of hormones delivered by pellet implants.
Do pellets have the same danger of breast cancer as other forms of hormone replacement therapy?
Testosterone pellets do not carry with them the increased risk of breast cancer as oral estrogens. In fact, there is evidence that bio-identical testosterone pellets decrease the rate of breast cancer. Data supports that testosterone is breast protective.
Testosterone, delivered by pellet implantation, has been shown to decrease breast proliferation and lower the risk of breast cancer, even in patients on conventional hormone replacement therapy. Clinical studies show that bio-identical testosterone balances estrogen and is breast protective. This is not true of oral, synthetic methyl-testosterone found in Estratest, which gets converted to a potent synthetic estrogen, which stimulates breast tissue. In the past, testosterone implants have been used to treat patients with advanced breast cancer. In 1940, it was theorized that treating patients with testosterone implants earlier, at the time of diagnosis, would have an even greater benefit, preventing recurrence. Androgens have also been shown to enhance the effect of Tamoxifen therapy in breast cancer patients. (References supporting these statements can be found in the data section of the website www.hormonebalance.org in the ‘Breast Cancer Folder’. A power point presentation ‘Nov 07’, summarizing the full text references, may also be viewed.)
Will hormone therapy with pellets help with hair loss?
Hormone deficiency is a common cause of hair loss and treatment with testosterone implants can help to re-grow hair in many women. Hair often becomes thicker and less dry with pellet therapy
How long until a patient feels better after pellets are inserted?
Some patients begin to ‘feel better’ within 24-48 hours while others may take several weeks or two to notice the first changes. Diet and lifestyle, along with hormone balance are critical for optimal health. Stress is a major contributor to hormone imbalance and illness.