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August 31, 2011

Hormone Replacement Therapy Alternatives – Synthetics, Natural or Bioidentical HRT, and HRT for Men and Their Side Effects

Hormone replacement therapy
Image via Wikipedia

What is Hormone Replacement Therapy (HRT)?

Hormone replacement therapy (HRT) is a medical treatment involving the administration of estrogen alone or in combination of estrogen and progesterone, to supplement the body when the ovaries no longer produce adequate amounts of these hormones. Hormone replacement therapy can be carried out in various drug forms ranging from pills to skin patches and needles and vaginal gels. HRT are usually given in the smallest dosage.

There is no stopping from getting old and part of aging is the cessation of “mens” or menstruation.  Menopause occurs when there is cessation of the production of female hormones estrogen, along with aging. This is also experienced during perimenopause as well as in the postmenopausal stages where hormonal variation either surges or declines and finally comes to a stop.  Menopause can either be natural or brought about by surgical intervention such as hysterectomy. HRT comes into play by helping women deal with these uncomfortable changes effectively through replacement of these declining hormones.

There are 2 main types of hormone replacement therapies:

>Estrogen Therapy
Estrogen is taken alone. Estrogen is prescribed in a low dosage as a pill, patch or cream.

>Progesterone/Progestin-Estrogen Hormone Therapy
Also termed as combination therapy, it combines estrogen and progesterone. An example is FemHRT.

Bioidentical Hormone Replacement Therapy (BHRT) or Natural Hormone Replacement Therapy

The recent surge in the popularity of this therapy has been largely due to big names in showbiz such Suzanne Somers who is into bioidentical HRT herself. According to Suzanne, bioidentical HRT is one of her 8 anti-aging steps, as revealed in her book ‘Breakthrough’.  Unlike synthetic hormones such as Premarin, (which are derived from the urine of pregnant mares and patented for human use), bioidentical hormones or bioequivalent hormones, are alternative options for treatment. BHRT are derived from herbal plants, such as soy beans, wild yams, red clover and black cohash.  Its molecular structure is said to be identical to the estrogen, progesterone, or androgen hormone produced by the body, hence, the term bioidentical or bioequivalent.

BHRT is processed through compounding,  a method wherein a compounding pharmacist mixes up a hormone blend of “bioidentical” hormones according to an individual’s needs. This is indicated by a blood or saliva test done by a doctor. Compounded formulation come in many forms such as in capsule, skin cream or gel, or tablet to dissolve under your tongue, suppository, or nose spray. A commonly prescribed bioidentical estrogen and progesterone is Estrace (estradiol). Doctors caution the public, however, about the risks for taking bioidentical HRT drugs as this is not yet well understood and may have the same risks for breast cancer, stroke, blood clot, heart disease, and dementia that synthetic HRT has. Pros and con on the use of bioidentical HRTs should be discussed with your doctor as well as the cost.

In order to go for the Natural Hormone Replacement Therapy, the patient must first get a hormone analysis done. A sample of the blood or saliva to determine which hormone is lacking in the man’s body. Once determined,  the physician will come up with the ideal program for hormone replacement therapy.

Some of the benefits of natural hormone replacement therapy are:

In men:
    Increased muscle mass
    Lower body fat
    Improved libido
    Improved concentration
    Greater energy levels
    Less frequent episodes of mood swings

In women:
    Smoother, healthy looking skin
    Free from discomforts of hot flashes and night sweats
    Reduced risk of osteoporosis
    Better sex drive
    Increased energy levels
    Free from mood swings

Hormone Replacement Therapy For Men

Just like women, men can also suffer from a condition called andropause, a condition similar to woman’s menopause. In this condition, male hormones like testosterone, thyroid and adrenal hormones start declining due to various reasons such as AIDS, excessive alcohol intake, infection in the testicles, or chemotherapy. Natural testosterone is the precursor for DHEA (or dehydroepiandrosterone, a hormone that’s produced in the body and is converted into male and female hormones), cortisone, estrogen and salt-regulating aldosterone. These hormones provide the body the raw materials from which all other steroid hormones are made and create a balance in body functioning. Deficiency in these hormones is said to develop symptoms.  This can be between the ages of late 20s and early 30s, however, other age groups may also be affected.

Male Hormone Replacement Therapy – Testosterone Hormone Replacement Therapy

Recent studies have demonstrated that low testosterone levels in men is strongly associated with metabolic syndrome, type 2 diabetes, cardiovascular disease, and an almost 50% increase in mortality over a 7 year period . Male hormone replacement therapy is recommended if symptoms that signify the onset of andropause are experienced such as:

    decrease in mental alertness
    loss or lack of interest in sexual activity
    tiredness and low energy levels
    weight gain
    mood swings
    sleeping disorders

Restoring testosterone results to an increase in insulin sensitivity, reduction in total cholesterol, fat mass, waist circumference and pro-inflammatory cytokines associated with atherosclerosis, diabetes, and the metabolic syndrome. Testosterone therapy also improves erectile function and improved physical activity in men with heart failure. However, HRT in men is not without side effects. Some of the common side effects of HRT in men are:

Fluid Retention
> Swelling usually occurs in the ankles or legs. Most often, this is accompanied with high blood pressure or congestive heart failure.

Sleep apnea
> A condition wherein an individual stops breathing for a period of time during sleep. However, studies on testosterone replacement therapy associating it with sleep apnea are weak and require further study.

Spermatogenesis
> Instead of getting excess levels, the testes begin to stop producing natural testosterones altogether either temporarily or permanently.  This is why doctors most often apply only to men who already have children because the risk is not only a possibility but rather, proven to be absolute for all those under this form of medication.

Tender breasts or enlargement of breasts
> Taking supplemental doses of testosterone converts testosterone to estradiol. This results to feminized characteristics in men such as enlargement of breasts or “gynecomastia”.

Liver Toxicity
> Oral testosterone replacement is reported to develop liver problems in a significant number of men.

Polycythemia
> It is the increase of blood cell mass that can lead to the possibility of heart attacks, strokes or peripheral clotting in the veins, particularly in older men taking HRT.

Prostate Growth
>  Physicians are not certain why prostate enlargement occurs in HRT. It is believed that it may be due to its excess.  Prostate growth can cause problems with urination or at worse, may promote the growth of cancerous prostate cells.

Hormone Replacement Therapy In Menopause

There are various menopausal treatments available today namely Hormone Therapy Replacement (HRT), Bisphosphonates, Selective Estrogen Receptor Modulators (SERMs) as well as Tibolone (Livial) therapy, parathyroid therapy, Vitamin D and calcium supplements and much debated “Bioidentical” hormone therapy or BHRT.

While HRT helps many women get through menopause, there is no single treatment that would go well for all women. Moreover, HRT  treatment, just like any prescription medications are not without risks or dangers and has raised a lot of concerns.  WHI or Women’s Health Initiative continually seeks relevant information based on research  study and statistics to shed new light on the risks and benefits of  HRT.
Estrogen is prescribed to relieve:

    Hot flashes
    Vaginal dryness that can result in painful intercourse.
    Other problematic symptoms of menopause, such as night sweats and dry, itchy skin.

Other benefits of taking HRT include:

    Reduced risk of developing osteoporosis and reduced risk of bone breakage.
    Improvement of mood and overall sense of mental well-being in some women.
    Decreased tooth loss.
    Lowered risk of colon cancer.

What Are The Known Hormone Replacement Therapy Side Effects In Women
1. Nausea and Vomiting
>Similar to morning sickness, this is associated with the estrogen hormone.

2. Breast Tenderness
> Breast tenderness or enlargement is associated with increased estrogen levels .  Estrogen dominance over progesterone during peri-menopausal may also be associated with breast tenderness.

3. Vaginal Bleeding
>Irregular, unexplained vaginal bleeding and spotting is associated with use of oral estrogen.

4. Skin Discoloration
>Spotting or darkening of the skin that is more prevalent on the face.

5. Headaches
>Migraine type headaches is associated with oral progestins.

6. Depression
>Associated with synthetic progesterone (progestins).

7. Anxiety, Nervousness, Irritability
>Attributed to synthetic progesterone (progestins).

8. Fluid Retention and Bloating, Swelling of the hands and feet
>Associated to estrogens

9. Acne and greasy skin
>Attributed to synthetic progesterone (progestins).

Hormone Replacement Therapy After Hysterectomy

With the contradictory headlines regarding the use of HRT in recent years,  deciding to get HRT after surgical menopause is no doubt difficult. You have to consider a lot of different factors such as your age, family history, and your habits. You may also need to consider the following factors before getting HRT.

1. Your menopausal symptoms aren’t bothering you, or other treatments work fine. A lot of women who underwent hysterectomy don’t have very severe symptoms.  Even if you do have acute symptoms, HRT is not the only way to control them. Other drugs or lifestyle changes can help

2. You’re 50 or older. Women who go into surgical menopause at 50 or older decide not to get HRT. This is because at this age, the natural time of menopause is taking place and estrogen would naturally drop during menopause anyway. Also, there is some evidence that the older you are when you start HRT, the higher the cardiovascular risks , at least on the initial stage of use.

3.  Liver disease. Just like any drug, estrogen pills can put a lot of stress on the liver. Alternative ways of getting estrogen  like patches bypass the liver and would be the safer option.

The use of MTF HRT by “transgen” has raised numerous debates on its ethical use. MTF or male to female HRT cause the development of the secondary sex characteristics of the desired gender (such as growth of breast tissues, body fat, etc). According to Wikipedia, “Hormone replacement therapy for transgender and transsexual people changes the balance of sex hormones in their bodies. Some intersex people also receive HRT, either starting in childhood to confirm the gender they were assigned, or later, if this assignment has proven to be incorrect. Some cisgendered men may use HRT to have a hair-free body, as a result of less testosterone in their bodies. “

Despite the controversy, transgender clinics can be found in major cities across the United States such as Michigan, Los Angeles, Atlanta, Florida and Dallas.

It’s essential though to know what treatment alternatives are available. A visit to your doctor can answer many of your questions such as whether hormone replacement therapy is best or whether it’s a better course of action to head the natural treatment route.

See related articles.

“Low Estrogen Symptoms: Who Wants Them?”

“What is Hormone Replacement Therapy and What it Does”

“How Natural Hormone Replacement Therapy Differs From Traditional HRT”

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Dr. Joe Jacko


Dr. Joe is board certified in internal medicine and sports medicine with additional training in hormone replacement therapy and regenerative medicine. He has trained or practiced at leading institutions including the Hughston Clinic, Cooper Clinic, Steadman-Hawkins Clinic of the Carolinas, and Cenegenics. He currently practices in Columbus, Ohio. Read more about Dr. Joe Jacko

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