Bioidentical Hormone Replacement Therapy

The body’s metabolism is very complex.  Many systems have to work together to create healthy function.  In order for these interdependent systems to run smoothly, a communication system is required.  Hormones are a critical component of that communication system, and thus have an important role in directing many important functions of the body.   

Usually we live our lives unaware that hormones are busy helping our body function.  It is only when there are changes in the hormone levels or their ability to function properly, such as at menopause, that we start paying attention.

There is not a system in the body that does not require hormone input to function.  So, it does not surprise us, for example, when we see that the list of menopausal symptoms is long and varied – hot flushes and sweats, insomnia, mood changes, dryness of eyes, skin and hair, vaginal dryness, joint and muscle pain, weight gain, fatigue, osteoporosis, migraine, etc.  

Menopause is a time of rapid changes because that is the time when the ovaries stop producing the level of estrogen required for optimal functioning.  Sometimes it happens overnight and sometimes it stutters along over several years.  Mother Nature’s intent was for the adrenal system to take over many of the functions of estrogen.  However, in today’s high pressure, toxic world the adrenal system is already overloaded and cannot replace what the premenopausal levels of estrogen were able to do.  

Below is a graphical representation of the changes in hormone levels a woman may experience during this period of transition. 

Hormone changes in men are usually gradual, if there are changes at all.  There is no biological time clock that determines hormonal changes in men in the way there is in women.  If there is a loss of hormones in men, it is most often due to the cumulative toxic effect of life impairing glandular function in some way.  

Bio-identical hormone therapy, BHRT, can help women and men regain their day-to-day function.  In fact, studies are finding that it can do much more than that.  BHRT can prevent bone loss and in some cases help the bones re-mineralize.  We can eat a healthy diet and take supplements with calcium and other minerals to support our bones, but we need hormones to tell those minerals what to do.  Studies have also shown that estrogen therapy reduces the risk of postmenopausal heart disease and dementia.  We need estrogen for the tensile strength of muscle fibres to maintain muscle tone.  Estrogen and testosterone are important to balance our mood.  The urinary bladder needs estrogen to function properly.  Testosterone is important in normalizing blood glucose in people with type 2 diabetes.  So, you can see that hormones have many important roles in the body.  


What Are Bio-Identical Hormones?

As mentioned already, the body metabolism is complex, so clear, concise communication is critical for everything to work right.  There is a lock and key type system of receptors, located on the cell walls, in which a hormone can bind to a specific receptor, like a key fitting into a lock.  This allows it to pass along its message to the cell.  If a hormone tries to bind the wrong receptor, it doesn’t fit properly, and either nothing happens, or the effect is less or even distorted.  When a hormone finds its own specific receptor, the cell receives the message and is able to respond accordingly.   

Because natural molecules and substances cannot be patented, pharmaceutical companies have created synthetic versions of hormones.  This means that the molecular structure of the natural hormone is changed enough so that it can be patented as synthetic, but still has some of the activity of the natural hormone.   

The synthetic hormones are designed to work in a similar way to the body’s own hormones and can function in an adequate way.  But what we find is that the synthetic hormones never provide the full beneficial effect that the natural hormones give.  The precise lock and key system requires exact molecular structure for the hormone to work optimally.  The synthetic hormones do not have that exact structure.  

Also important, is that the body has a system of metabolic pathways that break-down the hormones into different forms called metabolites.  Many of these metabolites have their own role to play in the body on their way to being broken down and disposed of.  The metabolism and disposal of the hormones requires the correct molecular structure for the process to work optimally.

Bio-identical hormones are hormones made in a lab so that they have the exact molecular structure as the body’s own hormones.  Bio-identical hormones fit into the metabolic pathways perfectly, so they can work optimally, and the body can dispose of them correctly.  To make bio-identical hormones, the lab uses plant sterols, usually from soy or wild yam, because they are the easiest to change into the correct bio-identical structures.  


Is Bio-Identical Hormone Therapy Safe?

This is an excellent question and should be asked of any kind of therapy.  We only started asking this question regarding hormone therapy in 2002, when the Women’s Health Initiative, WHI, trial began reporting results.  This was a large trial, funded by the US government to look at hormone therapy in women.  The hormones used were Premarin, which is estrogen derived from horse urine, and Provera, a synthetic form of progesterone.  The trial was supposed to run for 9 years but after 5 years, it was stopped.  Doctors were told to stop prescribing hormones immediately because it was found that the women on Premarin and Provera had a 28% increased risk for invasive breast cancer.  Since then, further, important information has slowly become available.  For example, one group in the trial was composed of women who had had a previous hysterectomy and so were only taking Premarin.  They did not take Provera.  This group was not stopped but continued for another year.  It was found that these women had a 23% decreased risk for invasive breast cancer.  The 23% decrease was considered not statistically significant, but clearly the Premarin alone did not increase cancer risk.  

That was the beginning of the fear of HRT, in doctors and also patients.  It has taken years of examination of the WHI trial data to recognize that there was a lack of evidence to support claims, as well as unethical reporting.  The resulting damage to healthcare for women is still being felt today.  Doctors are still afraid to prescribe estrogen and women are afraid to take it.  Dr. Avrum Bluming, Oncologist and Dr. Carol Tavris, PhD have written a book called “Estrogen Matters” in which they examine most of the major studies done on HRT and provide an intelligent, common sense look at the risk and benefits of HRT.  They include a scathing and damming review of the WHI and a full endorsement of HRT.

This does not mean that we can take hormones without proper consideration.  Mother Nature has a system of hormone balance and if we don’t keep that balance when taking BHRT, we can feel worse, not better.  Estrogen and testosterone are best taken transdermally (through the skin) because whenever we swallow something, it goes through the liver first before it reaches the rest of the body.  Taking estrogen orally creates a mild increase in the risk of blood clots and has been shown to increase markers for inflammation.  Oral testosterone can cause problems for the liver itself.  Testosterone by injection avoids liver problems as well.  

Estrogen should always be balanced with progesterone because estrogen receptors require progesterone to be activated.  Also, estrogen alone increases the risk of endometrial cancer if the woman has a uterus.  Both estrogen and progesterone work better if they are cycled.  Blood levels of estrogen and progesterone normally increase and decrease at various points in the menstrual cycle.  These changes signal the body to refresh the hormone receptors, so they are available for the hormones to work.  Cycling BHRT can be as simple as stopping the hormones for a few days once per month, so the blood levels dip down and then come back up when the hormones are re-started.  The natural cycling of testosterone is more subtle but does have a daily cycle, being highest in the morning.

Besides proper application of the BHRT, the thyroid and adrenal systems must be considered.  If out of balance, either of those systems can prevent estrogen and testosterone from working properly.  Stress is the most common block to healthy hormone function.  The “fight or flight” form of hormones is perfect for the 15 or 20 minutes that you are fighting a tiger.  But, when stress becomes part of our lifestyle, we do not have the full benefit of our amazing hormone system and we are vulnerable to many chronic illnesses plaguing our society today.    

As part of caring for our health, BHRT can improve quality of life as well as prevent or slow some of the chronic conditions that cause problems as we age.  


By Dr. Karla Dionne, MD
Balance Medical Center