Hormone Replacement Therapy (HRT) is any form of hormone therapy where a patient receives hormones, usually as a supplement for the lack of naturally occurring hormones.
Many men and women who might be considering Hormone Replacement Therapy do not know where to begin. Family Practitioners are not always familiar with HRT, or at least how to prescribe it in an individualised way, or where to start. The next best approach is to research a health care provider who specialises HRT or BHRT (Bio identical Hormone Replacement Therapy).
Hormones are regulatory biochemical that are produced in the glands and carried by the circulatory system to their targeted organ and they regulate a variety of physiological and behavioural activities. The glands are part of your body’s Endocrine system. Hormones are secreted from the endocrine glands directly into the blood stream.
Some of the major glands are:
- Pituitary gland, which is located in the brain and controls, and in a sense ‘oversees’ other endocrine glands.
- Pineal gland, which is also located in the brain and secretes melatonin, a hormone involved in the regulation of sleep. More recent research suggests it may play a key role in regulating “biological clocks” i.e. ageing itself.
- Thymus gland, which is located in the chest, produces a hormone called thymosin, which assists in the body’s immune system.
- Thyroid gland, which releases the thyroid hormone that affects metabolic rate.
- Adrenal glands, which are located above the kidneys, produce a variety of hormones which regulate several bodily functions including stress response, inflammation, water/salt balance, heart rate, blood pressure, and the immune system.
- Pancreas, which is located near the stomach, produces the hormones insulin and glucagon and regulates the level of glucose in the body. Malfunction of the pancreas can lead to Diabetes Mellitus.
- Testes, which secrete male hormones, including testosterone, which regulates sexual function.
- Ovaries, secrete female hormones including oestrogen and progesterone, which regulate menstruation, fertility, and help build strong bones
These glands secrete hormones in very small amounts, therefore even a slight increase or decrease of a hormone can lead to a compromised state of health.
Some of the more common diseases of the glands are:
Diabetes– when the pancreas does not produce enough insulin or when insulin that is produced does not work optimally
Acromegaly– the pituitary gland produces too much growth hormone
Addison’s Disease-when the adrenal gland is damaged or diseased and does not produce enough cortisol an aldosterone
Cushing’s Syndrome– when the adrenal gland secretes too much cortisol
Grave’s-when the thyroid gland produces too much thyroid hormone
Hashimoto’s-this involves the decreased production of thyroid hormone, hypothyroidism, and results from the immune system attacking the thyroid
Prolactinoma-pituitary gland makes too much prolactin which produces breast milk
Zollinger-Ellison Syndrome– this is a rare condition where tumours develop in the pancreas. These tumours, gastrinomas, producing large amounts of gastrin which then leads to excess stomach acid.
Natural occurring hormones regulate different bodily functions and processes.
Some of these include:
- Development and growth
- Metabolism and energy storage
- Cognitive function and mood
- Sexual function and reproductive growth and health
- Maintenance of body temperature and thirst
Some of the symptoms of sex hormone imbalance are:
Low energy: Menopausal women are more at risk as the oestrogen levels decline. Without adequate oestrogen, which also regulates sleep and stress, they are more prone to daytime exhaustion. Progesterone deficiency also leads to anxiety and disturbed sleep.
Decreased sex drive: this can occur in both females and males. During menopause, not only do oestrogen levels decrease but testosterone levels also decrease and this can lead to women no longer having the same level of sexual arousal as before. In males, there is also an age-related decline in testosterone but the cause may also be due to medications such as SSRI- type antidepressants and antihypertensive drugs prescribed for high blood pressure.
Moodiness: during menopause oestrogen and progesterone levels will decline but continue to fluctuate. The mood swings are due to the fluctuation of oestrogen, progesterone and possibly also of serotonin (the chemical in charge of moods).
Increased body fat: low oestrogen causes weight gain for a variety of reasons. As oestrogen levels decrease the body holds onto the fat reserves, and even begins to turn muscle mass into fat.
Erectile Dysfunction (ED): this is characterised by the inability to or maintain an erection during sexual performance. Besides testosterone deficiency, common causes are cardiovascular disease, and drug side effects.
Hot flashes: the exact cause is unknown, but generally accepted reasons are a malfunction of the hypothalamus and the body’s autonomic nervous system (the body’s heat regulator). Hormonal imbalance can trigger the hypothalamus to dysregulate body temperature control.
Decreased sense of well-being: when oestrogen levels fall, serotonin (mood regulator) levels also decrease, putting women going through menopause at greater risk for depression.
Other side effects of decreased hormones are difficulty concentrating, memory lapses, hair loss, sleep disorders, anxiety, migraines and headaches.
Bioidentical Hormone Therapy is created by a specialised Medical Doctor who can prescribe a custom therapy to address your specific symptoms. To achieve optimal results the physician must be knowledgeable in the intricacies of hormone imbalance.
Laboratory tests can measure the hormone levels in your blood, urine, and/or saliva. Along with your symptoms a diagnosis of hormone disorder can be made. Stress, infection and changes in your body’s fluid and electrolyte imbalance can also influence hormone levels.
In males, testosterone “puts hair on a man’s chest”. It also keeps a man’s muscles and bones strong and maintains his interest in sex. After age 30, the testosterone levels gradually decrease. This can contribute to depression, low energy levels and cardiac disease. Some causes for low testosterone besides age can be: hormonal disorders, HIV/AIDS, infection, obesity, chronic liver or kidney disease, and diabetes. These should be ruled out before starting hormone therapy.
Forms of hormone replacement therapies.
Pills, Patches, Pellets, Injections, Creams / Gels, Vaginal Rings, Intrauterine Devices
Types of Hormonal Replacement
Cyclical HRT: Involves the daily administration of oestrogen, with progestin (a synthetic progesterone) administered 10-14 days out of the month.
Continuous HRT: Both oestrogen and progesterone taken daily.
The route of administration depends on the intended effect. For example, a vaginal ring would be more effective for vaginal dryness as the oestrogen is administered locally. Memory lapses and hot flashes will have better results from other forms of hormones.
BioIdentical Hormone Replacement
These are usually administered in cream, gel or oral form. Oral forms can be pills or troches (which dissolve under the tongue).
Testosterone replacement therapy comes in several forms
Skin patch (transdermal) Worn on the arm or upper bodyGels: Testosterone is absorbed directly through the skin when the gel is applied daily. Some brands also come in pumps.
Mouth patch: This is a tablet that sticks to the roof of the mouth, applied twice daily it releases testosterone into the blood through the oral tissues.
Injection: Testosterone can be directed injected into the muscle.
Pellets: This is a bioidentical hormone that is placed into the soft tissues. Your body slowly absorbs it into the bloodstream.
Natural Alternative HRT
Studies from around the world support the use of many natural alternatives to hormonal replacement therapy. Natural progesterone creams have been used widely in the treatment of menopausal symptoms.
The idea that certain herbs might reduce menopausal symptoms is not far-fetched considering that many of our modern day medicines are herb based. Soybean is the main active ingredient in Provera, the top-selling HRT progestin. The root of the wild Mexican yam has been used as a progesterone source in birth control pills.
Diets that also contain oestrogenic plant compounds may also help reduce menopausal symptoms.
For those individuals desiring sex reassignment surgery, Hormonal Replacement Therapy is necessary. This involves taking oestrogen for male-to-female transition and testosterone for female-to-male transition. To obtain the physical appearance of the desired gender the appropriate HRT is needed.
Benefits and Risks of HRT
The major pro is when used for the discomforts of menopause. These can consist of:
*Hot flashes *Night sweats *Irritability *Mood swings *Vaginal dryness *Sleep problems
HRT is considered the treatment of choice when women are experiencing one or more of these symptoms.
Osteoporosis: HRT is very effective in reducing the risk of osteoporosis. It is also a good substitute for those women who cannot take other medication that protect bone health.
Dysfunctional Uterine Bleeding: In this case, oestrogens can be an effective treatment. They can be given in pill form or by intravenous route. This causes the uterine lining (Endometrium) to have a rapid growth which in turn can stop the heavy bleeding. Sometimes women are prescribed oestrogen and progestin to help regulate the menstrual cycle and reduce heavy bleeding.
Endometrial Cancer: Progestin therapy has been used on cancer cells that respond to hormones. This type of therapy blocks the action of hormones and can slow down or stop the growth of certain cancer cells.
Increased risk of heart disease, stroke or blood clots
Increased risk of breast or uterine cancer
The risk of gallbladder disease may be increased
Not recommended for women with liver disease
As in females going through menopause, men can experience some of the same symptoms such as lack of energy, loss of libido although the decline in hormones is not as abrupt as it is in women. Men that develop gynaecomastia, which is breast enlargement, attend to have a hormonal imbalance of oestrogen and testosterone and this most often occurs after the age of 50.
Low testosterone: This is called Andropause, male menopause. Many men with low testosterone levels who are treated with testosterone say they feel better and have more energy and sex drive.
It supports muscular growth and definition
Osteoporosis: Testosterone has been used in men to help prevent osteoporosis. It slows the bone thinning process and reduces calcium loss.
Reduces the risk of: There is some evidence that it reduces the risk of cardiovascular disease
Reduced risk of Heart disease, Type 2 diabetes, abnormal cholesterol, high blood pressure, and stroke
According to different studies the risks and side effects seem to very low compared to females.
Bioidentical and Synthetic Hormones
Synthetic hormones are completely different than your own natural hormones. They tend to have more side effects.
Bioidentical hormones have the same structure as your own hormones. The side effects are much less since they seem to be more naturally accepted by the body. These can be compounded to match the needs of each individual woman or man.
Hormones after a Hysterectomy
Menopause (video) is a natural occurring process in women. With certain medical conditions a surgical procedure, hysterectomy, may be performed to remove the uterus and ovaries. This is also known as a “surgical menopause”. This can produce a rapid onset of symptoms as experienced with natural menopause due to the sudden hormonal decline after removal of the ovaries.
Progesterone and oestrogen are the two main hormones made by the ovaries. The ovaries also produce a small amount of testosterone.
There are 3 types of oestrogen that are normally produced in the body.
Estradiol (E2): the most common form of an oestrogen. This form is the oestrogen that declines with menopause. Estrone (E1): This oestrogen becomes the primary one after menopause or a hysterectomy. It is synthesised by the fat cells.Estriol (E3): This is the main oestrogen produced during pregnancy. It is produced in the placenta.
Conventionally, oestrogen therapy alone is used for those who have had a hysterectomy. Oestrogen and Progestin Combination is recommended after a hysterectomy if during surgery endometriosis is observed. Although Integrated doctors tend not to give unopposed oestrogen since there are both oestrogen and progesterone receptors in many other tissues of the body
The hormone progesterone is produced during pregnancy and means “for gestation”. It causes a calming effect, helps in regulating blood sugar levels, and promotes thyroid function.
Bioidentical hormones are compounded to meet the needs of the individual. Some are FDA approved and some are made by compounding pharmacies as customised hormone doses. Most doctors who prescribe bio-identical hormones do so only after testing a person’s blood, urine or saliva levels of hormones. These same tests tend to be used for monitoring a person to get the hormone dosages correct for them as an individual.
Is There A Connection Between Weight Gain And Hormones?
Hormone imbalance can directly affect body weight.
Oestrogen: This hormone influences the metabolism of lipids in females and male. A decline in levels leads to an increase in fat reserves, especially the abdomen. This can lead to a weight gain.
Progesterone: In males and females, progesterone influences appetite and weight.
Testosterone: When the levels of this hormone fall, there is a loss of muscle mass, the metabolic rate is slowed which leads to weight gain.
Thyroid: A reduction in these hormones can lead to hypertension, fatigue, lethargy and weight gain.
Hormone replacement therapy can be a challenging decision that should only be made under the direction of a medical advisor. There are different types of replacement -Bioidentical or Synthetic.
The endocrine system is a very complex network of glands, each functioning interdependently and sending messages across the body to the desired organ and into the blood stream.
Make an appointment today to speak to one of our specialists.
Watch Dr Eccles Answer Questions About HRT
Click Here To Watch Dr Nyjon Eccles Answering Frequently Asked Questions About Natural Hormone Replacement Therapy (BHRT)