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The Basics of Bioidentical Hormone Replacement (BHRT)

April 20, 2021

Both women and men suffer from a wide array of symptoms that occur when our hormone levels naturally fall as we age. Synthetic pharmaceuticals prescribed as “hormone replacement” therapy are among the most widely prescribed medications in the U.S. They are prescribed most commonly at menopause for symptoms, such as hot flashes and night sweats, but have been recommended as a preventive measure for osteoporosis and other health problems that occur with aging as well. There are side effects and concerns about the long-term safety of taking these synthetic hormone replacements, information that is readily available on the package insert included with any prescription. Many women with perimenopause and menopausal symptoms refuse therapy they might otherwise benefit from, fearing the possible negative consequences of being treated with hormones. The field of bioidentical hormone replacement has emerged to address these safety concerns.

Why Bioidentical Hormones?
When being treated with bioidentical hormones, a person’s low hormonal levels are improved by a prescription of the same hormone that the body naturally produces, which has become deficient. When a person’s hormones become too low, there is a long list of associated symptoms that may occur. The problem of hormone deficiency is important not just for women but for men as well. Consider how many symptoms overlap between the sexes:

  • Low libido
  • Depression
  • Forgetfulness
  • Sleep disturbances
  • Aches and pains
  • Weakness
  • Fatigue
  • “Burned-out” feeling
  • Thinning skin
  • Headaches
  • Bone loss
  • Decreased stamina
  • Sex-specific symptoms
    • For men, prostate problems and erectile dysfunction
    • For women, vaginal dryness and painful intercourse

In his classic book Natural Progesterone, John Lee, MD, enumerates the following effects of natural progesterone for women prescribed not just in menopause but pre-menopause for PMS and associated menstrual difficulties as well.

  • Natural diuretic
  • Natural antidepressant
  • Improved libido
  • Facilitates thyroid hormone action
  • Stimulates osteoblasts for bone building
  • Helps protect against the formation of fibrocystic breasts
  • Helps normalize blood sugar regulation
  • Helps prevent against clotting
  • Helps use fat for energy

Doctors practicing BHRT utilize the benefits of progesterone and its ability to balance estrogen, whereas in common gynecological practice estrogen is often given alone. Additionally, a bioidentical hormone prescription may be ordered from a compounding pharmacy and tailored to the exact dose the doctor is prescribing for the patient. Not only are bioidentical hormones prescribed individually, but it is the general practice of doctors using BHRT to occasionally monitor the patient’s hormone levels and adjust doses, if needed, for the patient’s maximal results and benefit.

Testing for and Treating Hormone Imbalance
What are the hormone imbalances that should be checked? As a practitioner, I routinely check the following before starting treatment: the bioactive levels of estrogen, progesterone, testosterone, DHEA, and cortisol. The best approach takes into account not just each hormone level, but the balance between them. In particular, the balance between estrogen and progesterone is very important. Estrogen dominance, a condition and concept of great importance that describes what millions of women suffer, displays as estrogen hormones being too high relative to the progesterone levels. Estrogen dominance can occur even when a woman develops estrogen deficiency at the start of menopause, causing symptoms such as hot flashes. This can happen because even though the production of estrogen is dropping, the production of progesterone drops even more, resulting in comparatively more estrogen than progesterone circulating in the system. It is the balance between these hormones that needs to be addressed, as well as their basic levels standing alone, and addition of progesterone to estrogen is even more crucial in this situation.

When estrogen becomes the dominant hormone and progesterone is deficient, estrogen can have the following harmful effects on the body:

  • Water retention
  • Breast swelling
  • Fibrocystic breasts
  • PMS
  • Decreased libido
  • Uterine fibroids
  • Weight gain
  • Cravings for sweets

Response to Treatment and Disease Prevention
Most people will see the benefits of bioidentical hormones quickly. Within several days a patient will begin to sleep better, and hot flashes and night sweats will start improving. Libido will begin to return and weight control will be noticeably improved over time.

Follow-up by the physician should include monitoring the person’s response, retesting for hormone levels after a reasonable period of time, and adjusting the treatment on an individualized basis. The compounding pharmacy can then be instructed by the doctor to change prescriptions as per the unique needs of each patient.

Ideally, a BHRT regimen is accompanied by improved nutrition and fitness as well as lifestyle changes. If hormones are deficient and/or out of balance, the body will not respond as well as it will when these lifestyle measures are implemented. Taking all of these factors into account enables an individual to feel rejuvenated, with a better opportunity for healthy longevity.

Dr. Sobo is a member of A4M—The American Academy of Anti-Aging Medicine, The Age Management Medicine Group, and is also a pioneer member of the new medical organization, the Clinical Peptide Society.
 
For more information see: www.drsobo.com or call 203.348.8805.

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