The simplicity of hormone replacement is shrouded in confusion and misconception. Our goal is to offer the simple facts and dispel a lot of the myths so that you can decide for yourself if this therapy makes sense for you. No one is required to replace hormones in their body but as you will learn, to go through life without them or with low levels will greatly reduce the quality and even the length of your life. When used properly by an integrative physician trained in their use, bioidentical hormones reduce your risk for diseases that involve your heart, brain, bones, and immune system. Bioidentical hormones are natural and normal part of your body’s ability to perform, repair, and excel. Bioidentical hormones are not drugs – they are YOU.
Women & Hormones
Let’s reduce confusion first by learning a few basic terms. If you believe that birth control pills are hormones or that classic “Hormone Replacement Therapy” used hormones, then you would be wrong. Doctors in medical school training are taught to use drugs in REPLACEMENT for actual hormones. We are not taught to engage actual bioidentical hormones to replace missing hormones. This is the first concept that creates confusions. You can find all sorts of articles and studies in the medical literature showing the potential problems that emerge when drugs are used to replace hormones. Medical school teaches doctors to use drugs and only drugs as much of our education is funded by the pharmaceutical industry. Drugs have their place and can be a useful adjunct but like any tool they have their limits and their problems. In medical school, we aren’t even taught how our diets can alter our hormones. But we will address that here and create a clear path of understanding so that you make an informed decision for yourself.
Allow me to offer a simple analogy. Think of any sugar substitute such as saccharine, aspartame, Nutri-sweet, Stevia or others. Are these compounds the same thing as sugar? Of course not. They don't have the same chemical structure and don't have the same effect on your body as actual sugar. Now apply that thinking to birth control pills and traditional hormone replacement. Historically traditional medicine dispensed drugs and not hormones. Drugs behave differently than hormones and create side effects like breast cancer and blood clots. Hormones don’t behave this way. Hormones are compounds made by your body and as such it knows how to use them and more importantly how to regulate and excrete them. The biggest fork in the road of understanding is, “are we discussing drugs or hormones”.
There is a common misbelief that estrogen causes breast cancer. That is too simple an idea to be true. If every woman on the planet makes estrogen, then why doesn't every women get breast cancer? The simple answer is because estrogen does not cause breast cancer. That needs to be understood because this myth will drive anxiety that is unnecessary. The fact is estrogen has been used for decades and is still being studied today as a treatment for breast cancer. Allow me to draw another analogy. Is drinking one glass of wine, two nights per week a problem? I think most of us would logically conclude that this is not in fact a “problem”. Is drinking one bottle of wine 7 days per week a problem? Hopefully you see the obvious issues that arise with this statement. Estrogen is in fact a wonderful element that supports bone health, heart health and brain performance. Let’s not make it out to be some evil compound. But if I have excess estrogen, and I lack its balancing partner progesterone, and I oxidize (damage) the estrogen, and increase inflammation in my breast by gaining excess weight, and overconsume caffeine and alcohol, and stress my body while experiencing troubled sleep . . . that's a lot of “AND’s”. This is the true nature of breast cancer. It is not just estrogen. Many women get breast cancer with normal or low estrogen levels. In fact, women with the lowest estrogen levels are the ones at greatest risk – post-menopausal women. We will explore more information on breast cancer elsewhere, but I mention it here as this is a topic that drives the most fear and is riddled with the most misinformation when it comes to hormones.
Provera is one of the worst drugs ever thrust upon women. Provera is the drug made to replace progesterone but it increases a women’s risk of breast cancer by 26%. Provera is a drug not a bioidentical hormone. Doctors are pretty bright people and know a lot about drug therapy, but most know little or nothing about the differences between hormones and Provera. The picture below shows immediately how they are different chemically.
Notice the black circles attached to the molecule of Provera that represent how this molecule of drug is very different from the molecule of progesterone. Now consider that in order to get pregnant and maintain a healthy pregnancy a women needs to make boat loads of progesterone. By contract, Provera causes birth defects. These are obviously very different. Progesterone reduces a women risk for breast cancer while Provera increases breast cancer risk. Progesterone is heart healthy while the use of Provera increase risk of heart attacks. Provera increases the risk of abnormal blood clots while progesterone does not. These 2 molecules couldn’t be more different yet we are taught in medical school and even in OB/GYN residency that they are essentially the same thing. Are you starting to get a sense of the confusion in this field? The vast majority of OB/GYN’s are taught precious little about hormones and don't engage them in practice. Your OB/GYN is a brilliant clinician with a huge skill set but hormones may or may not be one of those skills. Don’t assume. Clinicians educated in the art of true bioidentical hormone replacement attend fellowship courses beyond residency.
Using bioidentical hormones post-menopause, if appropriate for you, can serve to reduce the risk of many chronic inflammatory diseases:
- Heart attack risk is reduced by 50%
- Osteoporosis - improve bone density
- Cognition / Alzheimer’s - enhance cognitive function and memory and reduce risk of Alzheimers disease
- Brain health – better sleep, better mood, less anxiety.
- Immune function – more balanced immune response to reduce auto-immune risk
- Glucose & Cholesterol – healthier metabolism, balanced function
- Longevity – living not only longer but in better health
This is a very large field of study with thousands upon thousands of medical studies exploring the potential and risk. There is no ONE article that can cover this topic in its entirety. Engage a skilled practitioner in this route of treatment to explore your safest use and best potential.
Men & Hormones
In a study from 2010, nearly 2000 men were tracked over time and found that the men with the lowest testosterone had more heart disease, more diabetes, were more overweight and died sooner. Multiple studies have shown similar findings. Simply put, a man’s body behaves younger and functions more efficiently and effectively with testosterone at healthy levels. Note that I said “healthy levels” and not extreme overdosing. Testosterone needs to be in BALANCE. Too much can be as harmful as too little.
Testosterone is involved in all of our bodily systems and impacts our blood glucose, cholesterol, joint repair, brain function and energy levels. Testosterone is not simply a hormone for sex drive and performance in the bedroom. In fact, in men with low testosterone levels, sex drive and sexual performance are usually some of the last symptoms to emerge. Earlier symptoms often include fatigue, mental dullness, emotional instability (yes men get bitchy too), and poor recovery from exercise.
There are a host of ways to restore a man’s testosterone and that will be discussed in great detail elsewhere LINK but what is classically overlooked is answering the question, WHY! Why is my testosterone low? It is not normal for a man’s testosterone to substantially drop. You may read that a man’s topterone decreases as he ages but if you look into the studies of male physiology the level of drop shouldn’t be more than 10-15% and that shouldn't occur until a man is over the age of 60. So why am I seeing 30 and 40 year olds with low testosterone?
Exploring the WHY
There are a host of combined changes that have affected men’s testosterone levels over the past 4 to 5 decades. We have seen dramatic change in lifestyle diets and toxin exposure that begins to explain a good deal of this change:
- Increased consumption of sugar and fructose (high fructose corn syrup)
- Increased consumption of plastic as we drink from plastic bottles and store our food in plastic containers. Plastic kills hormone function.
- Weight gain will decrease performance of the testicles to produce testosterone.
- Lack of sleep, as we make most of testosterone overnight as we slumber
- Stress out of control will shut down the healthy repair and restore signals.
If these issues are explored and addressed, then restoration of NORMAL function can often be accomplished without sentencing a man to a lifetime of external testosterone replacement. Use of externally applied testosterone as a cream, inserted pellet or injection are perfectly fine options but once these treatments are initiated, they are for life. It is often possible to restimulate a man’s natural production without giving him testosterone and this approach is easier, simpler and far less expensive. A smart integrative doctor knows these options well and can guide you to the best therapy for your specific age and situation.