Bioidentical Hormone Replacement Therapy

In addition, hormones should be used within their physiologic ranges to minimize risk. There is very little data available concerning the risks of using long-term higher-dosed hormones.

It is our contention that symptomatic improvement without the excess risk (seen with non-bioidentical hormone treatment) is attainable but is complex and requires proper monitoring of multiple factors as outlined.

We feel that it is important to appreciate that BHRT (bioidentical hormone replacement therapy) needs to be properly integrated into a comprehensive approach. There are multiple metabolic systems that interrelate with hormones and influence their levels, potential toxicities and effects.

• Physiologic Dosing 
• Proper Monitoring of Hormone Metabolism 
• Risk Abatement protocols 
• Basic Functional Medicine Principles 
• Better Balanced/Lower Risk Hormone Therapy and Happier Patients

FoundationMED and Bioidentical Hormone Therapy

Sure – all of us have seen the flashy websites and ads promising to “cure” aging, and promise to improve a large list of symptoms with hormone replacement. And it is quite true that providing hormones for menopausal women and/or men with low testosterone can be very helpful. The devil, as they say, is in the details – details that commonly go unaddressed.

Hormones are what we at FoundationMED consider “leveraged” – what we mean by this is that hormones are very powerful and interact in multiple complex ways within your body.

Using hormones, you can (and often do) obtain fabulous symptom reduction however proper monitoring can ensure the most benefits with the fewest possible risks.

Your hormone therapy will be specifically tailored to your personal physiology, and take into account numerous physiological functions such as your methylation status, estrogen metabolic status, as well as the status of other associated hormones, your general detoxification function and status, as well as external influences such as unknown exposure to hormone-mimetics and other toxins. In addition, your prescribing FoundationMED physician will be actively monitoring you at all stages of hormone implementation.

It is clear that hormones play a crucial role in physiologic processes that maintain health and wellness (homeostasis).

Hormones are proteins that are produced by endocrine organs such as the pituitary, adrenal, thyroid, testes, and ovary.

Imbalances in the true end-organ sex hormones – estrogen, progesterone, and testosterone very often lead to rather distressing symptoms and disease.

• Symptoms may include hot flashes, mood swings, anxiety, depression, insomnia, bloating, hair loss, memory problems, sexual indifference and many more.

• Diseases include osteoporosis, cardiovascular disease, and dementia. As an example, it has been shown that susceptibility to cardiovascular disease, which dramatically increases with menopause, is significantly reduced with proper hormonal balancing.

Bioidentical Hormones for Women

Synthetic Hormones (ie the conventional “hormones”) do NOT precisely match the hormones your body produces – sometimes it is quite different (ie Premarin is actually horse URINE containing equine (horse) estrogen and equine estrogen metabolites as a mixture). Medroxyprogesterone (ie “Progestin”) is not precisely the same as your body’s progesterone and is metabolized differently in your body than your own progesterone.

Since Conventional Hormones (ie Synthetic) do NOT match the precise structure of your own (endogenous) hormones, this increases the risk of several potentially fatal diseases, especially when combined with medroxyprogesterone (progestin).

The Women’s Health Initiative (WHI) study, done in 2002 demonstrated that the combination of synthetic estrogen + medroxyprogesterone (progestin) = higher risk of breast cancer, coronary artery disease, stroke, and blood clots. Yikes!!

The WHI rightfully frightened physicians and patients and so many stopped using synthetic HRT (hormone replacement therapy). Statistics the following year showed a drop in overall breast cancer rates as well as estrogen-sensitive breast cancer rates.

Lesson learned? FoundationMED only uses bioidentical hormones and uses physiologic dosing (ie amounts that your body naturally produces) rather than the high doses often found in hormone protocols.

Symptoms of Hormone Decline in Women

• Reduced/eliminated Hot Flashes and Night Sweats
• Reduced Vaginal Dryness
• Reduced Endometrial Cancer risk
• Reduced Breast Cancer risk
• Improved Libido
• Reduced Osteoporosis risk
• Better Muscle Mass/Strength
• Improved Cholesterol Levels
• ReducedAlzheimersrisk
• Better Mood, Concentration and Memory

Estrogen is made in the ovaries but is also made in the corpus luteum, adrenal glands, and fat cells. Once the ovaries stop producing estrogen on a regular basis, the adrenal glands become the main source of estrogen (primarily as E1).

Estrogen is actually available in 3 forms – estrone (E1), estradiol (E2), and estriol (E3). The production of the various forms of estrogen and estrogen metabolism depends on your age, cycle, genetics, and other factors. Suffice it to say that the various estrogens have different potencies and effects.

In menopause, the absolute levels of estrogen and progesterone are affected, but it is also important to consider the relative levels of estrogen as it relates to progesterone (i.e. estrogen dominance vs estrogen deficiency). Failure to attend to the proper balance of estrogen to progesterone can lead to worsening symptoms.

Estrogen, progesterone, and testosterone do not act in a vacuum but intimately interact with other hormone systems such as the thyroid and adrenals (cortisol). Hormones must be considered a web with rather complex interconnections that must be properly monitored and adjusted as needed. Remembering that systems such as the methylation system are intimately involved in the detoxification system reminds us that it is important to consider hormone use in the context of a systems approach rather than to treat hormone therapy as an isolated therapy.

Proper monitoring and management of hormone therapy is paramount.

Estrogen is metabolized into substances that may increase the risk of breast cancer (if not properly identified and managed). If you are currently on hormone therapy (or even if you are not) you should be aware if your metabolic products of estrogen metabolism are within a safe range (easily measured with a urinary estrogen metabolite test). Sadly, monitoring such data is not the norm. Equally important is the status of your detoxification systems, your toxin exposures (even if unwittingly) and so on.

Adding estrogen (hormone therapy) when your estrogen is being metabolized in such a way as to increase your breast cancer risk is obviously something that should not be done – but if you are not assessing and addressing your estrogen metabolism, how will you even know you are at risk?

Thus, it is important to identify and correct any questions about proper estrogen metabolism and detoxification sufficiency prior to (or concurrently with) adding estrogen therapy. Focusing solely on hormone implementation is not recommended – patients are strongly advised to make sure you are being treated and appropriately monitored by a properly trained physician.

Not all hormones are alike. Bioidentical hormones are, well…. identical to the hormones your body produces. This seems to be an appropriate approach (and it is the one that we strictly adhere to – using only bioidentical hormones) but many are still being treated with hormones that are not bioidentical (such as Premarin – derived from horse urine, and medroxyprogesterone – Provera – a chemical analog of progesterone that is absolutely NOT the same as your own progesterone). The Women’s Health Initiative study showed the risks involved with artificial progesterone (Provera), and artificial estrogen (Premarin).

Once a year goes by without menstrual bleeding, menopause is said to be present. In menopause, estrogen and progesterone levels are dramatically decreased (but are not completely gone). Incredibly, the peri-menopausal period can start up to 15 years before actual menopause is seen. Learn more about Menopause and Perimenopause

Hormone Therapy for Men: Understanding Bioidentical Options

Bioidentical Hormones and Male Hormone Replacement Therapy

Men experiencing a decline or imbalance in natural hormone levels can benefit from Male Bioidentical Hormone Replacement Therapy. Hormonal changes can result from aging, genetic factors, exposure to toxins, and other reasons.

Hormones, which are produced mainly by endocrine glands, act as chemical messengers within the body. They are highly influential in regulating physiological functions, often creating significant effects even in small quantities.

The body synthesizes hormones in response to specific signals, usually from other hormones. Once produced, hormones typically bind to receptors to activate various processes before being broken down, often in the liver. Testosterone, for example, is mostly bound to Sex Hormone Binding Globulin (SHBG) in the blood, leaving only a small portion available to interact with receptors. The level of SHBG thus impacts the availability of active testosterone.

Due to their potent effects, hormones must be carefully monitored and managed.

Bioidentical vs. Synthetic Hormones for Men

There is a critical difference between bioidentical and synthetic hormones. Bioidentical hormones have an identical chemical structure to those naturally produced by the body, whereas synthetic hormones do not. Synthetic hormones are chemical analogues and can disrupt the body’s intricate hormonal processes, potentially leading to adverse effects.

At FoundationMED, we exclusively use bioidentical hormones for our male patients. We ensure physiologic dosing, continuous risk assessment, and advanced monitoring to minimize any risks.

Typical Timeline of Male Hormone Imbalance and Decline

Testosterone is a key hormone affected by aging and other factors, playing a crucial role in male characteristics such as voice depth, bone strength, muscle mass, hair patterns, genital development, sperm production, sex drive, and energy levels.

Testosterone levels typically begin to decline around age 40, with total testosterone decreasing by about 1% per year and bioavailable testosterone (free and weakly bound) by approximately 2% per year. Aging also brings changes like reduced bone density, muscle mass, energy, and sexual activity. For more on low testosterone and symptoms of male andropause, read further.

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Read more about Low T and male andropause symptoms.