Bio-identical hormone replacement has recently experienced an explosion in public-awareness, largely in part to Suzanne Sommer's book on her own experience with natural hormone therapy. Holistically and preventively-minded physicians have also had long experience in the use of hormone replacement with not synthetic, one-size-fits-all drugs, but rather with individualized, bio-identical hormone formulas based on each individual patient's biochemical and hormonal profile.

 

One of the main biochemical signs of aging is the trend towards excesses of certain hormones and deficiencies in others, leading to symptoms that can be as numerous as:

 

  • fatigue
  • dry skin
  • constipation
  • mental fog 
  • lack of sex drive
  • impotence
  • painful intercourse
  • insomnia
  • difficulty waking up
  • osteoporosis
  • hot flashes

 

The key to the symptoms is the fact that the hormones are out of balance, as opposed to outright being deficient.  For example, in the peri-menopausal years, progesterone can decline more rapidly than the estrogens, and thus just using the estrogens can make things worse. Furthermore, many females experience menopause without any significant symptoms or stress, whereas others have a very poor quality of life.  The difference is often not in the sex hormones estrogen or progesterone, but in the adrenal hormones DHEA, pregnenolone, and cortisol.

 

Measuring a patient's "position" in aging with respect to the bio-identical hormones can be complex, but it is well worth the effort.  Treatments are much more individualized, and the goal is to get back to a younger hormonal profile, as opposed to simply blindly using a synthetic hormone to cover symptoms.  For example, for a patient who is suffering from poor quality of life due to menopause, the conventional approach is to simply give conjugated equine estrogens and sometimes a synthetic progestin called medroxyprogesterone acetate.  The major problem with this is that the female body actually produces three different types of estrogens:

 

Estriol or E3: is the weakest of the estrogens, but has shown some anti-cancer effects and         protective effects

 

Estradiol or E2: is the most potent of the estrogens made by the body

 

Estrone or E1: actually may directly contribute to cancer through its 4-OH metabolite

 

Thus, the use of synthetic hormone derivatives, although powerful, cannot be considered to be putting the body into balance.  The ideal approach is to measure the three estrogens and see where the patient is at as an individual, and then adjust and balance hormones accordingly.Sometimes this can be done without hormones, and sometimes hormones are needed.  Many female patients were taken off of the synthetic HRT by their family doctors because of a recent Women's Health Initiative study; however that study used synthetic hormones without regard to a patients individual, comprehensive hormone profile.  As such, it cannot be compared to natural bio-identical replacement.  Furthermore, there is some evidence, although the studies are small, that certain hormones actually protect against the risks of cancer and heart disease which were increased with the synthetic hormones.

 

By far the most important anti-aging, health-promoting hormonal assessment and optimization that can be done involve the thyroid hormones and the adrenal hormones.  Once again, in functional and biological medicine we look at the actual hormone levels and then treat accordingly.  

 

For example, for someone who is starting to feel very tired, run-down, and really has no motivation, we may consider looking at the thyroid hormones.   In conventional medicine, only one thyroid related hormone is used to screen for hypothyroidism, which is the TSH.  And only one thyroid hormone is used to treat, T4 (or synthroid).  Ideally, the TSH, free T3 hormone, free T4 hormone, reverse T3 hormone are all checked to get a better, more holistic picture of what is going on in the body.  Natural means to increase thyroid function are used, and natural thyroid hormones can be used also.  Sometimes simply helping the conversion of the T4 (whether produced by the body or if the patient is taking synthroid) into the far more active T3 is enough to get the patient feeling much more energetic.  It is always also checked to see if heavy metals are impairing thyroid function, as often once the metals are removed thyroid function improves on its own.

 

In the adrenal realm, measurement of pregnenolone, morning cortisol, afternoon cortisol, and morning DHEAS can give a wealth of information as to whether or not unhealthy age-related changes can affect how much stress, anxiety, and energy a patient is feeling.  In complicated cases, checking the actual rhythm of adrenal hormone secretion is done through salivary testing at 4 times during the day.  When the health of the adrenal glands in improved through nutrition, IV vitamins, hormone and glandular replacement, patients feel more energy and less frequently feel anxiety and stress.  Sugar control improves. Quality-of-life, and health in general improves.

 

In the realm of bio-identical hormone replacement, it is very important that a proper baseline assessment be done.  Sometimes all the symptoms are present but there is no indication of an imbalance and there is actually another cause to be found.  Importantly, the assessments are done at specific times of the day, and sometimes of the month (for cycling females).  Most of the tests are non-conventional and need to be sent to specialized labs.  Good anti-aging workups will consist of the following:

 

Males:

  • androstenedione
  • estradiol
  • progesterone
  • cortisol (AM and PM)
  • DHEAS
  • DHT
  • Pregnenolone
  • Sex hormone binding globulin
  • testosterone (free, total, bioavailable)
  • TSH, free T3, free T4, reverse T3, TPO antibodies
  • fasting insulin
  • IGF-1 or growth hormone
  • melatonin

 

 

Females:

  • estradiol
  • estrone
  • estriol
  • progesterone
  • pregnenolone
  • DHEAS
  • cortisol (AM and PM)
  • Sex hormone binding globulin
  • testeosterone
  • TSH, free T3, free T4, reverse T3, TPO antibodies
  • fasting insulin
  • IGF-1 or growth hormone
  • melatonin

 

This is quite the comprehensive work-up, and in no way would we run all the tests for every patient. If a patient was simply sick and needed to get better, from the history and physical we streamline our approach and possibly look at toxicities also. However, in anti-aging approaches, for prevention and optimization of health, we want a very holistic and comprehensive picture.  As such, for thegenerally healthy patient who just seems to be aging faster than he or she should, this type of approach gives us the power to see what is going on individually and then we can treat accordingly.

 

If you are interested in a hormonal approach to your health (or for anti-aging purposes), please call the office and book an appointment with Dr Ward.  She has recently updated her knowledge at the International Hormone Society meeting in Las Vegas and will be able to help assess from an anti-aging perspective.