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 significantly increases the risk of breast
cancer and heart disease.
Fortunately, natural hormone replacement therapy appears
to be a safe and more effective alternative to synthetic hormone replacement
for those suffering from menopause and andropause.
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 these 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?
In 2005 the
International Journal of Cancer published a
large study looking at various hormone preparations used by over 54,000
women and the incidence of breast cancer among them. They found that women
who used estrogens combined with synthetic progestins had a 40% increase in
their risk of breast cancer. These results confirmed those found in the
landmark 2002 Women's Health Initiative study. However, this more recent
larger study also looked at women taking a combination natural estrogen and
natural progesterone. They found the risk of breast cancer was actually
reduced by 10% among women using natural hormone preparations.
Int J Cancer.
2005 Apr 10;114(3):448-54.
There are several reasons why natural hormone replacement
doesn't appear to increase the risk of breast cancer the way synthetic
hormones do. 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 conventionally
trained 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. Dozens of studies
show increased risk for breast and cervical cancer in women with higher
levels of 16-hydroxy estrone.
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 treatment I use the lowest dose of hormones that relieves their
symptoms. When it comes 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.
