From the Blog…
Bio identical hormones are the essence of life, chemically regulating bodily processes—growth, aging, reproduction and metabolism. As we age, our hormone levels fluctuate and decline. Because we are living longer—but not necessarily better—there is currently much interest in how we might enhance the body’s functions as we grow older by slowing, or preventing, aspects of the aging process.
Dr. Nunley on Bio Identical Hormones:
The decline in hormone production plays a major role in the decline of overall function in the human body. Depletion in testosterone in men leads to a decline in strength and endurance as well as emotional instability. Men also have a lower incidence of dementia, suggesting that testosterone also plays a role in maintaining cognitive function. For women, perimenopause and menopause bring an abrupt decline in essential hormones: estradiol, progesterone and testosterone. Deficiencies of these hormones as well as growth hormone, thyroid hormone, cortisol, melatonin and DHEA all lead to a decline in optimum health and contribute to a loss of cellular integrity that is associated with many of the unpleasant changes in aging bodies. Generalized weakness, poor balance, decreased cognition, sagging skin and aching joints are but a few of these changes. These functional declines match the stereotypes for men and women as we age: grumpy old men and shriveled old women. Balancing and replacing hormones with the bio identical hormone equivalent for both men and women is an effective way to delay some of the unpleasant aspects of aging. In my geriatric fellowship, we were taught that aging is characterized by the body becoming “fatter, drier, shorter, slower.” These physiological changes are considered “normal aging.” However, disease is not necessarily “normal.” Many conditions—such as obesity, diabetes, cardiovascular disease, cancer, dementia, osteoporosis, physical weakness, arthritis and chronic pain—are ultimately a result of the choices we make in what we eat, how we live and our declining hormones.
Bio identical hormone therapy is not a cure-all. But in conjunction with positive changes in nutrition and lifestyle, bio identical hormone replacement therapy—the supplementation of hormones to more youthful levels with hormones bio identical to the ones your body makes—can provide a viable alternative to pharmaceutical therapies and can restore people to their former vitality.
In order to achieve balance, it is wise to look at all the main hormones—estrogen, progesterone, DHEA, testosterone, cortisol, thyroid and pregnenelone—as the hormones work together and need each other to provide maximum benefit. In women, studies suggest that it is important to start bio identical hormone replacement early, as bio identical hormone replacement actually decreases the risk for stroke and heart attack when started prior to the onset of cardiovascular disease.
An abundance of literature exists to support the benefits of bio identical hormone replacement therapy. Please see my blog posts discussing the various bio identical hormones that are replaced in a bio identical hormone replacement program. “How to Achieve Healthy Aging,” by Neal Rouzier, MD, is an excellent resource.
Bio identical hormone therapy can be administered orally, topically, by injection or with subcutaneous implants. All are effective but certain rules apply as to what route should be taken. Estrogen can be given orally, topically or via pellet implant. Bio identical micronized progesterone is most efficacious when given orally or sublingually. Testosterone is given topically, by injection or via subcutaneous implant.
Hormone pellet implantation is an FDA-approved procedure for hormone replacement that has been around since the 1970s. It is convenient and has comparable efficacy to pills, injections, creams and gels. Hormone pellets are bio identical and are administered subcutaneously. They are slowly released directly into the bloodstream over a period of weeks or months. In women with cardiovascular disease, or women over 60, it is best to bypass the gastrointestinal tract, as studies have shown increased risk for cardiovascular events in women who are given oral synthetic or bio identical estrogen, and all progestins (Provera or medroxyprogesterone).
Testosterone is administered as pellets to both men and women. It has been shown to have neuro-protective effects and has been helpful in patients with neurodegenerative diseases and dementias. Low testosterone levels are associated with increased risk of some diseases and conditions, like Parkinson’s disease. Topical or subcutaneous testosterone does not affect the liver, does not increase blood clots or the risk of prostate cancer, and is cardio-protective.
Testosterone pellet therapy is particularly effective in perimenopausal women. By the time a woman is 40, her testosterone is less than half what it was when she was 20. She may still have adequate estrogen, and testosterone—along with bio identical micronized progesterone—can be very effective in relieving the symptoms of perimenopause. Testosterone, of course, can be given topically, but the pellets offer a nice alternative for men and women who want the convenience of not having to use creams or gels.
Testosterone pellet therapy is effective for women suffering from endometriosis, uterine fibroids, dysfunctional uterine bleeding or migraine headaches and can help with the emotional upheaval that generally occurs in women in their late 30s or 40s. Testosterone can be combined with anastrazole (an aromatase inhibitor which blocks the formation of estrogen). Using this combination is very effective in managing estrogen overload syndromes like uterine fibroids and endometriosis.
For both sexes, bio identical hormone testosterone pellet therapy includes relief of depression and anxiety, improved sleep, increased muscle mass and bone density, improved memory and concentration, relief from aches and pains and increased libido and performance. Side effects may include increased facial hair growth and acne in women and testicular shrinkage in men, with no attendant effect on sexual performance. Testosterone hormone therapy can affect fertility, however, and should be used cautiously in young men wanting to preserve fertility. Women who are still fertile must be careful not to get pregnant, as testosterone can cause masculinization of a developing fetus.
Testosterone and estradiol pellet therapy in men and women is an effective alternative for bio identical hormone replacement. Insertion is a simple office procedure, requiring insertion of the pellets beneath the skin every 3 to 5 months.