What are hormones?

Hormones, at the most basic level, are chemical messengers that help all the cells in your body communicate with one another. They are produced and distributed via the endocrine system, which includes your thyroid, pancreas, and adrenals. When everything is working like it should, you look and feel great. But when hormones get out of whack, it’s as if the Internet has gone down, your body goes offline, and it doesn’t know what to do.

There are 5 major classes of hormones:

Estrogens

Progestogens

Androgens

Mineralocorticoids

Glucocorticoids

What is bioidentical hormone replacement therapy (BIHRT)?

In regards to BIHRT, we generally are talking about estrogens (estrone, estradiol, estriol), progesterone (micronized progesterone specifically), testosterone, and dehydroepiandrosterone (DHEA) that are given to treat levels of hormones that are not optimal.

Bioidentical hormones are defined by the Endocrine Society as compounds that have exactly the same chemical and molecular structure as hormones that are produced in the human body.

We occasionally use prescription options of bioidentical hormones. However, more often, we use compounded bioidentical hormones, which allow us to fine tune and tailor the dosing more precisely to each individual’s needs. The main difference between prescription and compounded bioidentical hormones is that the prescription hormones are one-size-fits-all doses that drug companies produce on an assembly line, and compounded versions are made from scratch by a pharmacist based on a medical provider’s desired formulation. Of note, the prescription medications have gone through the FDA while compounded medications have a different screening process.

Hormone replacement therapy that contains synthetic conjugated estrogens, or progestin, (which are derived from the urine of pregnant mares), are NOT bioidentical to our endogenous human sex hormones.

Hormone Imbalance

What causes a hormone imbalance?

Hormone Replacement Therapy

As we age, normal cellular function starts to decline, and in turn, you see a decrease in hormone production. This is called andropause or menopause. Menopause is defined as the permanent cessation of menstruation that results from loss of ovarian function; this can occur naturally, surgically, or as a result of medical intervention. The process begins with a decline in hormones before you reach true menopause; this is called perimenopause.

There are other factors which may contribute to abnormal hormone levels. Stress, lifestyle, smoking, exercise, disease states (specifically anything involving the GI tract), alcohol use, poor sleep, poor nutrition, and many, many more can affect optimal hormone levels.

What are some signs/symptoms I may notice that are possibly related to a hormone imbalance?

Signs of hormone deficiency in women:

  • fatigue
  • weight gain
  • brain fog
  • hot flashes
  • pain with intercourse and vaginal dryness
  • decreased libido
  • thinning/dry skin, hair, nails
  • joint pains
  • irritability/mood swings
  • anxiety and/or depression
  • changes in urination, including UTI’s

Signs of hormone deficiency in men:

  • fatigue
  • weight gain
  • brain fog
  • loss of muscle mass
  • decreased libido
  • erectile dysfunction
  • hair loss
  • anxiety and/or depression
  • irritability/mood swings

About 75% of women experience menopausal symptoms.
About a third of those women experience severe symptoms which have a negative impact on their day-to-day lives.

How do I check for a hormone imbalance?

It’s important to see a qualified practitioner to assess hormone levels. For some hormones, we look at the serum (blood), while others we will utilize salivary testing. Occasionally a urine test is used, but within our practice, we generally prefer the salivary test.

What does treatment look like?

We customize treatment based on both your individual test results and your subjective complaints and concerns. For instance, if you are experiencing hot flashes, fatigue, poor sleep, weight gain, loss of muscle or decreased libido, we will address those specifically.

We may utilize a topical compounded cream, oral capsule, sublingual (under the tongue) troches/lozenges, injections, or pellets inserted just below the skin. Your provider will discuss these options with you in depth and find the right method for you.

What about the risks?

As with anything in medicine, nothing is devoid of risks. That said, when prescribed and monitored correctly, BIHRT is relatively low risk and can often help to decrease the risk of other disease states (cardiovascular disease, osteoporosis, type 2 diabetes and dementia).

Topical estrogens are not associated with an increased risk of venous thromboembolism (blood clots), as compared to oral estrogens. This allows us to safely treat women with a history of migraine headaches, gallbladder disease, diabetes, and obesity.

There is little to no risk of breast cancer for the first 5 years of taking bioidentical estrogen with micronized progesterone (when dosed and monitored correctly).

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