These studies used standard doses of powerful synthetic hormones for women of different ages and weights, without evaluating each woman’s levels of various hormones either before or during treatment. Conventional HRT likewise usually uses hormones in a continuous or sequential manner. In this case, hormones were administered throughout the month or estrogen was recommended for the first two weeks alone and together with progestin for the next two weeks. Because hormone levels are constantly changing, however, the body’s physiology needs estrogens and progesterone on a daily basis, and doses must be customized to suit each woman’s particular requirements. The “one-size-fits-all” method of HRT used in the HERS II and WHI studies seems likely to generate side effects or long-term problems by not accounting for or addressing the unique needs of each participant.
Thus, current problems with conventional HRT can be summarized as follows:
- The majority of studies have used only one or two agents (estrogen or estrogen/progestin replacement therapies are most often used).
- Conventional HRT generally does not attempt to mimic the physiology of the menstrual cycle by administering hormones cyclically. (Normally, levels of estrogens and progesterone rise and fall throughout the menstrual cycle, while menopausal women experience a similar but less pronounced cycle.) Most conventional HRT dosing is based on a “one-size-fits-all” approach, since most FDA-approved hormone analogs are manufactured in fixed doses.
- Conventional HRT generally uses hormones that are not bioidentical to those found in humans.
- Serum hormone levels are not used to guide treatment recommendations.
- Most physicians and studies use only orally administered hormones. When a woman takes a hormone orally, the liver will metabolize and modify this hormone such that it may no longer exert the desired effect in the body. Transdermal delivery systems (gel or cream) allow administered hormones to bypass the liver’s metabolic effects and exert their desired effects without biochemical conversion to other hormones.
Principles of Hormonorestoration
The chemical structure of the hormones used in hormonorestoration should be identical to human hormones. Normal ratios among hormones in each hormone group (for example, the estrogen group) are maintained. Triest, which includes all three major estrogens—estriol, estradiol, and estrone—is the preferable form of estrogens. The combination of all deficient hormones—pregnenolone, DHEA, progesterone, estrogens, and testosterone—should be used instead of just one or two hormones, the method often employed by conventional medical practitioners. Using a combination of hormones allows us to use smaller doses of each and provide hormonal balance.
While many of the patented prescription hormones available in pharmacies are bioidentical, not all of the crucial estrogens are available as patented drugs. For example, estradiol is a bioidentical hormone available as a patented prescription drug, but if it is used without estriol and estrone, serious problems may result. Since estriol is not currently available as a patented “estrogen” drug, it can be obtained only by filling a doctor’s prescription at a compounding pharmacy. Thus, it may be impossible to achieve the optimal balance of estrogens using only patented prescription medications.
When using the term “bioidentical,” it is important to specify that these hormones are bioidentical to those naturally found in humans. The prescription drug Premarin®, for example, contains conjugated estrogens that are “bioidentical” for horses, but not for humans.
The preferable delivery system for administering bioidentical hormones is topical gels containing highly lipophilic molecules of low molecular weight that can be readily absorbed through the skin. This delivery system allows for individualized doses.
Thus, some basic principles of hormonorestoration include:
- Using hormones that are bioidentical in structure to human hormones
- Using individualized doses
- Dosing in a cyclical manner
- Using larger doses of hormones in the morning
- Using poly- or multi-hormonal therapy as the optimal approach, as opposed to mono- or bi-hormonal therapy, which is usually inadequate.
- Hormone replacement in women should begin as soon as hormone levels have diminished below the optimal levels of a 20- to 30-year-old woman. As with other health problems, it is advisable to address and treat hormonal imbalance as soon as possible.
- Among the important questions to ask your physician when considering a hormonorestorative program to help protect your cardiovascular health are these:
- Should I have my blood tested to determine whether I need to take hormones, and what tests are appropriate?
- How can I know if hormono-restorative therapy is appropriate for me?
- How many hormones do you generally prescribe as part of hormone restoration therapy?
- Do you prescribe hormones that are bioidentical to human hormones?
- What is the prescribed formula for estrogens and who would prepare it?
- How are the hormones administered (oral, transdermal, injections, pellets) and why?
- How will you monitor the optimal dosage of hormones during treatment (clinical symptoms, blood, saliva, or urine test)?
- Do you use individually modified doses?
- Do you prescribe programs of hormone therapy that mimic the physiology of the menstrual cycle?
- If I suffer from other health problems, can I use hormonorestorative therapy, and which form of medication should I take?
- Who should not use hormones, and why?
- What are the benefits of hormone restoration? What are the risks?
- What side effects can I expect?
- How long should I be on hormone restorative therapy?
Blood tests are essential in developing a safe and effective hormonorestorative program. When your doctor considers prescribing insulin, he first checks your glucose level. A similar approach should be employed for hormonorestoration. Dose recommendations for different patients should be determined by serial testing of serum hormone levels. Doses can be individually modified during treatment to produce ideal youthful physiological serum levels.
While physicians can prescribe a hormone restoration program, patients may need to adjust dosages as their clinical symptoms change. After a few months on hormono-restoration, most women are able to do this by themselves, making their own minimal changes in dosages according to their needs. When you are under stress, exercising, or performing intensive mental work, your body may require more hormones. While blood tests are important, they should always be evaluated in a clinical context. For example, we have observed that progesterone does not work always exactly as might be expected. If, during replacement therapy, you use a larger dose than your body requires, progesterone may be converted first to androstenedione and then to estradiol. This could lead to stimulation of the sympathetic nervous system, and instead of a diuretic and relaxing effect (for example, improved sleep), the opposite effect may occur.
As previously noted, several risk factors contribute to the onset of CHD. If a physiologically based approach to hormone restoration helps to eliminate several of these risk factors, the risk of CHD should decrease. As also noted earlier, recent studies have found that conventional HRT actually increases CHD risk.19,20 In our experience, however, the appropriate use of hormonorestorative therapy with bioidentical hormones actually decreases several CHD risk factors.
In the two cases we are about to describe, we achieved complete control of blood pressure, glucose and cholesterol levels, and psychosocial symptoms. We believe that individualized hormonorestoration of five essential steroid hormones, based on clinical symptoms and blood tests, is a more effective strategy for decreasing CHD risk than is standard HRT using two synthetic drugs. For optimal safety and efficacy, physicians and patients must monitor hormone levels regularly, usually three months after beginning treatment and then every six months thereafter.
The following two cases demonstrate how an anti-aging program featuring physiological hormonorestoration can help women reduce their CHD risk factors.