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

Bioidentical Hormones for Men

Male Bioidentical Hormone Replacement Therapy is used to help men find relief from the decline or imbalance of natural hormone levels. Declining or imbalanced hormone levels can be due to a variety of causes – including natural aging, genetic issues, toxins, and others.

Hormones are chemical messengers (signaling molecules) that are produced typically (but not always) by specialized glands of the endocrine system. They are powerful chemical influencers of your underlying physiology – in fact, I consider hormones to be “leveraged” due to the fact that a small amount of hormone can cause a relatively enormous response.

Hormones are signaled (often by other hormones) to be synthesized by your body, then they typically activate a process by binding to a receptor that itself is synthesized and regulated, and then are metabolized or broken down by specific processes, often in your liver. To make things more complicated, some hormones (including Testosterone) are mostly bound to protein molecules in your blood (for Testosterone, it is SHBG – Sex Hormone Binding Globulin) which in effect makes the bound hormone unavailable to your body – leaving ONLY the unbound hormone and “weakly bound” (non-SHBG bound) testosterone available to act upon its receptor. Thus levels of this binding protein affect the availability of active hormone in your body.

Hormones are powerful, and are to be respected, monitored, and managed with care.

Bioidentical Hormones vs. Synthetic Hormones for Men

Synthetic hormones (often used by physicians) are NOT the same as bioidentical hormones. The chemical structure of a bioidentical hormone is, well, identical to the given hormone as synthesized naturally by your body. This is not true for synthetic (non-bioidentical) hormones – which are NOT chemically identical to your natural hormones and thus not actually hormones at all – they are in fact chemical analogues.

Many times the beautifully complex processes that involve hormones (ie synthesis, activity, breakdown, regulation) are not the same with non-bioidentical hormones (vs bioidentical hormones) and because of that fact can cause significant negative consequences on your physiology and underlying well being.

It is for this reason that FoundationMED will only use Bioidentical hormones in treating our male patients.

In addition, we are always exquisitely mindful of using physiologic dosing (not high dosing that sometimes is used in some protocols), ongoing risk reduction, and advanced monitoring to insure the absolute minimization of risk.

What is the typical timeline for Male Hormone Imbalance and Decline

As you probably know, testosterone is considered the primary hormone of concern (and the most powerful androgen) as men age and develop male hormonal imbalances.

Testosterone/Androgens are responsible for male traits including deeper voice, strong bones and muscle as well as male hair patterning. Testosterone drives male genital development at puberty and sperm production as well as sex drive and sexual performance, erections, energy, and aggressiveness.

With increasing age (although there can be other causes) testosterone levels fall – often Total Testosterone falls about 1% per year starting at age 40 or so, and Bioavailable Testosterone (Free + Weakly Bound) falls even more – about 2% per year.

With aging, male physiology changes. Bones “thin” (reduced bone calcium), declines are seen in muscle mass, body fat increases, energy levels go down and sexual activity can go down as well. Read more about Low T and male andropause symptoms.