As we age our production of sex hormones (estrogen and testosterone)
dramatically declines. In many men and women, lower levels of sex
hormones can lead to a myriad of symptoms that are simply intolerable.
In women, these symptoms which typically manifest after the menstrual
cycle ceases, are called menopausal symptoms (e.g. hot flashes, night
sweats, fatigue, insomnia). A similar phenomenon, which has only more
recently been recognized in men, is termed Andropause.
For years conventional doctors have treated menopausal symptoms with
synthetic hormone replacement therapy. The theory is simply; to add back
those hormones, which are no longer being produced in sufficient
quantities.
Recent large studies have made it clear that synthetic hormone
replacement therapy significant increases the risk of breast
cancer and heart disease.
Fortunately, natural hormone replacement therapy appears to be a safer and
more effective alternative to synthetic hormone replacement.
What is the difference between Natural Hormone
replacement and conventional hormone replacement therapy?
Conventional hormone replacement generally consists of synthetic forms
of estrogen, progesterone and testosterone. These drugs are similar to
the hormones our body naturally produces, except they have been
chemically altered. Synthetic hormones also have altered actions in our
tissues, compared with naturally produced hormones. For example,
synthetic estrogens persist in the body longer and become stored in the
tissues to a much greater extent than natural estrogens.
Natural hormone replacement, as the name suggests, consists of the
natural forms of estrogen, progesterone and testosterone. In other
words, these hormones are identical in structure and function to the
hormones that the human body produces. This is where to term
“Bio-Identical” comes from.
Why do conventional medical
doctors use synthetic hormones?
They mostly don’t even realize there is a choice. Synthetic hormones are
chemically altered making their structures unique. This means the pharmaceutical
companies that created them can patent these unique structures. Exclusive patents enable
drug companies to earn substantial profits which also finance the research and marketing of synthetic
hormones. Conventional doctors learn about medications through the
medical journals that publish the research funded by drug companies as
well as their sales and marketing efforts. Thus, they are the only
medications these doctors are
familiar with.
Are Natural/Bio-identical
hormones safer than synthetic hormones?
The short answer is yes. However, I do not agree with some advocates of
Natural hormones who claim there is no risk. While it’s true that
synthetic hormones have been found to increase the risk breast cancer
and heart disease, there are no similar studies looking at the effects
of Natural hormones. However, it is not unreasonable to conclude that
Natural hormones are safer for some very basic reasons.
Firstly, research has shown that the body easily metabolizes natural
hormones. On the other hand, synthetic hormones remain in the blood
longer and are stored in our tissues to a far greater extent.
There are conventional preparations that contain natural estradiol.
However, the dose of estradiol is 2 to 4 times greater than what an
experienced Naturopathic physician would typically use. Studies
have shown that much lower doses of conventional hormones
are just as effective as the standard dosing used by conventional
doctors. However, this information has not been commonly adopted by the
average physician.
Further, synthetic hormones are metabolized by the
liver in an unfavorable way in comparison to Bio-Identical hormones.
When estrogen is broken down by the liver it becomes either
2-hydroxy-estrone - which is protective against breast and cervical
cancers - or 16-hydroxy-estrone - which promotes these cancers.
Synthetic hormones almost exclusively are metabolized to the harmful
16-hydroxy from of estrogen.
I typically use a formulation called “Bi-Est” which
contains Bio-identical estriol (80%) and estradiol (20%). These forms of
estrogen are produced naturally by the body. Estriol is a much
weaker form of estrogen and makes up the majority of the “Bi-Est”. There
is some evidence that estriol is actually is protective against cancer.
Cancer prevention
While there is good reason to believe the cancer risk with Natural
hormones is significantly less compared to synthetic hormones, I think
that it’s essential for anyone on hormone replacement therapy be on a
cancer prevention protocol as well.
For example, a simple dietary change can very
dramatically alter the metabolism of estrogens in way that can
significantly reduce the risk of breast and prostate cancers.
Additionally, there are a few essential dietary supplements that research
has shown to be dramatically effective at preventing cancer and heart
disease.
My approach
I do not prescribe natural hormones for every man or woman with symptoms
suggestive of hormone deficiency. For woman with mild to moderate
menopausal symptoms, complete relief is easily achieved with the
appropriate diet and lifestyle changes in addition to specific herbal
therapies.
However, in my experience, woman with more severe
symptoms typically do not find adequate benefit from nutritional
approaches. In these woman Natural hormone replacement is nothing short
of a godsend.
In men with symptoms of Adropause I wouldn’t consider prescribing
hormones without documenting a hormone deficiency on blood tests and
ruling out any significant risks for prostate cancer.
When assessing hormone levels I only use blood testing. I realize that
many "authorities" on natural hormone replacement therapy recommend saliva
testing. They even claim that it’s superior to blood tests. However, I
can only conclude that these "authorities" have never actually treated any
patients. I have found saliva testing to be highly inaccurate and no
longer use this method.
In patients that are candidates for natural hormone replacement therapy
I use the lowest dose of hormones that relieves their symptoms. When
it come to the issue of osteoporosis, there are better and safer
therapies than unnecessarily high doses of estrogen.
In additional, I place all of my patients on a cancer prevention
protocol. This protocol addresses diet, lifestyle and nutritional
approaches that research has shown to be protective against hormonal
dependent cancers and heart disease.
