As we age our natural hormone levels decrease, which often results in less energy, weight gain, osteoporosis, depression and a slew of other side effects and conditions. Many doctors and patients feel this is the way it should be. Thousands of others have been unwilling to accept this, and have chosen to put back the hormones they have lost, and as a result, feel more like they used to when they were in their prime. This all-natural hormone replacement is called bioidentical hormone replacement therapy (BHRT).
Hormones 101
Testosterone
If you are depressed, your energy level is low, and your sex drive in nonexistent, you may have a low level of testosterone. If so, restoring your body’s optimal level of testosterone could quickly solve that problem.
Estrogen
If you are suffering from hot flashes in menopause, mood swings, and night sweats, more than likely, a natural estrogen supplement would help. There are 3 estrogens used in BHRT: estrone (E1), estradiol (E2), and estriol (E3).
Progesterone
If you frequently have insomnia, migraines, anxiety, or vaginal dryness, low progesterone levels may be the culprit.
Thyroid
If you are tired all the time, can’t stand the cold, and have trouble thinking clearly, your thyroid hormone levels could be low. Other symptoms include dry skin, constipation, depression, and high cholesterol.
Thyroid hormone supplements contain two active ingredients, liothyronine (T3) and levothyroxine (T4). Many doctors prescribe levothyroxine by itself, which is marketed under the name Synthroid or Levoxyl. However, T3 is the more active form of the two active ingredients. If your body cannot convert T4 into T3, taking all the levothyroxine in the world won’t do you much good.
BHRT for Women
A woman’s body makes all the above hormones, including testosterone. The benefits of testosterone supplements for women include increased energy, stronger bones, and increased libido.
BHRT for Men
A man’s body also makes all of the above hormones. However, there isn’t any real good reason to give men supplemental doses of estrogen. Progesterone, on the other hand, can help prevent some prostate problems and will induce much deeper sleep.
Hormone Dosage Forms
Thyroid
Thyroid and liothyronine are available in tablets or a sustained release capsules. If your thyroid supplement gives you plenty of energy in the morning, but seems to peter out by late afternoon, you could possibly benefit from a sustained-release capsule.
Estrogens
Estradiol and estriol can be put into creams, capsules, and sublingual tablets or troches. However, many practitioners won’t prescribe estrogen in a capsule because of a rare carcinogenic metabolite that can occur if taken orally, but not topically.
Progesterone
Progesterone is prescribed in capsule form for those who have difficulty getting deep sleep at night. However, this effect does not occur if taken sublingually or applied topically in a cream. Some use both dosage forms to obtain the proper level of progesterone without becoming too drowsy.
Testosterone
Testosterone is not effective and is hard on the liver if taken orally. So, creams, sublingual troches, or injections are the available, effective dosage forms.
BHRT Pellets
All of these hormones, except for thyroid, can be put into a pellet that is injected underneath the skin. It slowly dissolves, giving you a steady stream of the medicine. It is very convenient and lasts about three months. The disadvantage of pellets arises if side effects occur from the dose being too high. It is not exactly feasible to cut the pellet out, so typically one has to wait three months for it to completely dissolve and the side effects to end. Doctors who prescribe pellets are aware of this and careful not to give high doses.
Side Effects of Bioidentical Hormone Replacement
Bioidential hormones are just that: exactly like the hormones your body makes. Why would a healthy body make something that is harmful for itself? So, typically side effects only occur when a dose is too high or too low.
People who have high thyroid hormone levels because their dose is too high, will often have a hard time falling asleep and feel unusually warm. Once the dose is lowered, these side effects go away.
Common estrogen therapy side effects from a dose that is too high may include weight gain, headaches, or cramps. If the dose is too low, returning hot flashes are the first thing most people notice.
If Progesterone is too high, spotting or abnormal cyclic bleeding may occur.
If Testosterone is too high acne and unwanted facial hair is most commonly experienced. This goes away once the dose is lowered.
Risks of Bioidentical Hormone Replacement
As noted above, it isn’t risky to take a substance that is identical to one the body makes, provided it is given when that substance is lacking, and done at the right time with the right dose, except for estrogen. If a woman has estrogen receptor positive breast cancer, then any form of estrogen replacement is a bad idea. High levels of estrogens can also cause clotting, and smoking increases that risk. So caution is advisable in female smokers.
There has been some controversy over female hormones, which may be from information that came out of the Women’s Health Initiative. This was a 15-year study that began in 1991 to study the poor quality of life in postmenopausal women. You can read about it here: www.nhlbi.nih.gov/whi. Many women dropped out of the study because of side effects. What you may not have heard is many of the women were taking Premarin, a popular synthetic estrogen that is derived from the urine of pregnant horses. (Hence the name PREgnant MARes urINe.) However, just because women don’t tolerate horse estrogen well, doesn’t mean they can’t benefit from human estrogen.
Cost of Bioidentical Hormone Replacement
More and more insurance companies are recognizing and paying for compounded hormones. If you have insurance, be sure to provide your compounding pharmacy with that information.
If you don’t have insurance, creams are usually the least expensive, and troches are usually the most expensive. The cost of a compounded bioidentical hormone is usually around $20 to $30 a month per item.
If you are taking multiple hormones, at times it is possible to have all the hormones combined into the same cream or troche to save money. However, if you are just starting hormone therapy, you may want each hormone separate at first, in case you need to decrease the dose of one but not the others.
Conculsion
For more information about options, dosage forms and insurance coverage, feel free to stop by the pharmacy and talk with our on-call pharmacist.
To Find a List of doctors who know and understand BHRT in your area go to www.worldhealth.net/pages/directory and type in your country, city, or zip code.