HORMONE REPLACEMENT THERAPY

Hormone Replacement Therapy (HRT) of sex hormones began in 1949 with the introduction of Premarin- a conjugated estrogen prepared from pregnant mare’s urine. In the past 50+ years, our knowledge about HRT has evolved greatly. It is quite remarkable that until July 2002, the overwhelming choice for Estrogen Replacement Therapy (ERP) by physicians remained Premarin. Unquestionably, Premarin and other non-human forms of HRT have medical benefits, which have been elucidated through numerous studies in the past 20+ years, but the Women’s Health Initiative (WHI) study first published in July 2002 has forever changed the way we look at HRT as a whole. The study, conducted by the National Institute of Health, cost US tax payers over $800 million over a 6 ½ year period and has been discontinued due to the risk involved in Premarin and Prem-Pro compared to placebo.

It is unfortunate that the $800 million was not spent on Bio-identical (human) Hormone Replacement Therapy (BHRT) studies because the risk profile is different. Bio-identical refers to the molecular make-up of the hormone- meaning it is exactly the same structure as the natural hormones that we all have made for years. Our bodies recognize the hormone as "self," and we have the enzyme systems naturally in place to metabolize the hormones in a physiologic manner. Thus the hormone doesn't linger in our bodies and do harm as horse or other non-bio-identical hormones can. We have had the capability of using BHRT for some time now, but powerful marketing by the makers of traditional therapy, non-BHRT, have influenced most MD's to continue prescribing these non-human hormones. It would seem logical that we humans probably would have a more physiologic response to a human hormone than a horse hormone!

At Carolina Healthspan Institute, we use nothing but BHRT for all replacement regimens. The exact type and dose of hormones is individualized based on a thorough analysis of one's evaluation parameters. Our patients feel better, look better, perform at a higher level and are safer than on traditional HRT.

Bio-identical Hormone Replacement Therapy for Men

Testosterone

Testosterone levels in men peak at around age 17 and decline steadily thereafter. By age 55 approximately 75% of men have been shown to be "testosterone deficient." This deficiency is generally secondary to decreased formation of testosterone as well as an increase in binding proteins which basically deactivate what testosterone is available.

Testosterone replacement therapy (TRT) has given a bad name because of misuse of "anabolic steroids" by athletes to enhance performance. These so-called "anabolic steroids" are synthetic non-bio-identical hormones, which are made more potent and can have significant adverse consequences.

There is no evidence in the literature that bio-identical testosterone replacement increase the risk of prostate cancer or prostate enlargement. In fact, there is reason to believe that TRT can actually reduce the risk of cancer & enlargement of the prostate.

Benefits of Testosterone Replacement Therapy

• boosts libido
• decreases incidence of erectile dysfunction
• decreases risk of heart attack
• increased muscle strength
• improves appearance
• increased sense of well-being

Bio-identical Hormone Replacement Therapy for Women

Estrogen (estriol, estradiol, estrone)

• responsible for normal growth & development of female sex organ
• maintains secondary sex characteristics
• protects against diseases of aging – osteoporosis, heart disease, Alzheimer’s disease, colon cancer, urogenital atrophy
• reduces vasomotor symptoms – hot flashes, night sweats

Can be given as estriol(E3), estradiol(E2), or estrone(E) or a combination of all three. Estriol is the weakest of these and is the primary estrogen of pregnancy. Recent studies have shown that estriol may be protective against uterine and breast cancer.

Estradiol is the primary estrogen produced by the pre-menopausal ovary and is the bio-identical estrogen in patches. Estrone is the most abundant estrogen in post-menopausal women and the estrogen, which has been shown to have a metabolic pathway, which can lead to breast cancer.

Progesterone

• produced by the ovary in response to ovulation
• produced in massive amounts by the placenta during pregnancy
• prepares the breast for lactation
• stimulates osteoblast- mediated new bone foundation increasing bone mass & density
• protects against endometrial hyperplasia resulting from estrogen therapy
• metabolized to other hormones
• natural anti-depressant & tranquilizer
• the great protector of breast & uterus

Most women who are on estrogen replacement therapy (ERT) also benefit from progesterone therapy (Pg). Pg protects the woman from the potential adverse effects of ERT by maturing or modulating the effect of estrogen. Estrogen stimulated cells than undergo a natural life cycle, which prevents out-of-control growth which can lead to adverse side effects and even cancer.

Androgens

• enhances libido
• provides cardiovascular protection (lowers cholesterol)
• provides bone remodeling (increases bone formation)
• improves energy & sense of well-being
• increases muscle mass
• improves immune function

Although androgens are thought of as a male hormone, testosterone and DHEA are key hormones in a woman's hormonal make-up. Compared to a man's level, women's levels are low, but they need to be in balance to provide support for bones, muscle, libido and the immune system.