Hormone Replacement Therapy

In recent years, our hormone replacement therapy in Mesa AZ has gained in popularity amongst andropausal men and menopausal women to improve their hot flashes, sexual function, mood, sense of well being, muscle density, bone mass and strength.  In addition, some hormone therapy has been found to be beneficial in preventing heart disease, diabetes, and Alzheimers Disease.  There is a growing trend over the last decade for both men and women opting for the use of bioidentical, compounded natural hormones for the treatment of andropause and menopause, respectively.

 The testosterone, estrogen, and progesterone used in the bio-identical hormone replacement therapy (BHRT) is identical to that produced in the human body.  Although  BHRT have long been utilized in other countries, the United States has predominantly used synthetic hormones for the past 40-50 years beginning with the introduction of oral contraceptives in the early 1960s.

The uniqueness of the compounded bio-identical formulations are what makes it so attractive to prescribers and users alike.  The ability to alter the dose to each individual does not compare to the two to maybe three options that pharmacies can offer to relieve the same symptoms for everyone. Each formulation prescribed by your physician is easily altered to increase the dose when needed to help ease symptoms or reduce levels easily if someone is looking to go off of the hormones.

What is also the most unique to these formulations in women, is the utilization of both estradiol with estriol.   Estriol is well known for its weak estrogenic activity compared to the more potent estrogens the body produces, estradiol and estrone.  The advantage of including estriol in your hormonal formulation is that it has the ability to bind with the estrogen receptors on the breast cells more weakly than estradiol.  Therefore, it can actually block the stronger estrogens from binding to the breast cells and subjecting them to the higher estrogenic activity which can put some women at risk for cancer.

Are labs required?

Before men or women start with hormone replacement therapy, laboratory tests are necessary to determine if there is a physiological need for hormone replacement. For men both free and total testosterone are measured, along with dihydrotestosterone(DHT) and sex hormone binding globulin (SHBG), Prostate Specific Antigen(PSA), DHEA-S, and Cortisol.

For women, we like to check a hormonal baseline before administering hormones. We often test for estradiol, estrone, progesterone, total testosterone, free testosterone, cortisol AM and DHEA-S amongst other general labs if they haven’t been completed.  For women, a risk assessment for estrogen and progesterone sensitive cancers must be considered and an exam performed, if not up-to-date before beginning hormone replacement therapy.

If hormone levels come back within normal limits, hormone replacement therapy is not likely necessary and they may be a better candidate for other therapies.  However, if a man or woman is experiencing symptoms of andropause or menopause and they have low levels of hormones, hormone replacement therapy may be initiated.

ROUTES OF ADMINISTRATION

The methods of administration of hormone replacement therapy include oral administration, application of topical creams, intramuscular injections, and the implantation of pellets under the skin.  The route of administration determined is based on the individual’s personal history and symptoms, blood work and personal preferences.  Below is a brief description of the options available.

Oral Administration

Capsules- The most common hormone prescribed orally is progesterone, although estrogen can also be prescribed this way.  The least favorable route to receive estrogen replacement therapy is oral as it has been associated with increasing risks for clotting disorders, like deep vein thrombosis, where the topical options are not.

Lozenge/Troches- Lozenges are a combination of oral and sublingual absorption which allows hormones to release in small doses into the bloodstream.  Common hormonal combinations include estradiol, estriol, testosterone and/or progesterone.

Topical Administration

Creams and gels are the most favorable route of administration of BHRT, due to lack of discomfort of an injection, and ease of application.  They work best if applied daily on a particular schedule and are applied to the thin skin of certain areas of the body, with the preferred site the posterior scrotum.  These are the most effective as they avoid the pass through the liver and are absorbed directly into the bloodstream.  In addition, they seem to mimic the natural rhythm of testosterone secretion that occurs in the human body throughout the day.   Common hormonal combinations include estradiol, estriol, testosterone and/or progesterone.

Intramuscular Injections

Testosterone is the only hormone that is injected and it is a great option for those who have low testosterone on their blood work and symptoms of low libido. This combination of blood work and symptoms can warrant testosterone replacement which can be made easy with weekly injections.

Pellets 

A great option for both men and women is hormone pellet therapy. Hormone pellet therapy is customized to the needs and labs of each patient. Patients have the pellets placed every 3-6 months and do not have to think about a daily application. The theory behind this method is that the body will draw from the pellets what it needs creating a stable balance of delivery. The pellets are about the size of a piece of long grain rice and are placed just under the skin in the gluteal region.   Estradiol and testosterone are the two hormones that come in pellet form.