Hormones are responsible for many of the functions of our bodies, including our immune, metabolic and reproductive systems. As we age, our hormone levels naturally decline. However, "normal" levels of hormones are not optimal. Doctors have been taught and trained to treat disease, not to optimize health and well-being.  It is now possible to change that.

​

Many of the symptoms we associate with aging, such as fatigue, depression, poor quality sleep, loss of muscle mass, and poor sex drive are dramatically improved when hormone levels are optimal. In addition, optimal hormone levels offer protection against heart disease and osteoporosis.

 

Bioidentical hormone replacement therapy (BHRT) is well documented in peer reviewed journals, but this evidence-based medicine is ignored by mainstream medicine. With optimal levels of hormones, evidence shows a decrease in morbidity and mortality from heart disease, cancer, dementia, degenerative arthritis, and osteoporosis. Studies also show we are able to preserve independence, to increase healthspan, not just lifespan, to add life to years, and hopefully years to life.

​

The focus is on prevention: of debility, chronic illness, cognitive impairment. Studies show we are able to increase strength (up to 14% even without exercise), increase memory, concentration, and creativity.

 

Our goal is to achieve the highest quality of life, reduce disability, compress major illnesses into a narrow range, and add years to life. Aging is physiologic and unavoidable, but it can be slowed. Most/all primary prevention studies of hormone replacement therapy find a decreased risk of coronary events, contrary to conventional wisdom from mainstream medicine and the public.  

 

Testosterone is responsible for the sex drive of both men and women. As testosterone diminishes with age, so does our sexual functioning. When testosterone is at an optimal level, this does not occur. Studies have shown that optimal testosterone levels result in less visceral fat, increased muscle strength and lean body mass, improved sexual response, reversed impotence and improved body composition. Studies also show that testosterone at optimal levels considerably improves the therapeutic response to PDE-5 inhibitors (Viagra, Cialis, Levitra).  Studies also show optimal levels can reverse osteopenia and prevent osteoporosis, arthritis and degenerative joint changes, and increase HDL (good cholesterol) and lower LDL (bad cholesterol). Additional studies show an improved sense of well-being and mood, improved memory and cognitive function, and protection against heart disease in both men and women. Optimal testosterone has also been shown to protect skin against wrinkles and loss of elastin and collagen.

​

Testosterone

There is no evidence of an increased risk of prostate cancer or BPH when testosterone levels are optimal. Over 40 years, in hundreds of studies, not one shows an increased risk of cancer from raising testosterone (or estrogen). These journals include the NEJM, JCEM, J Urol, and J Cancer.

 

Low testosterone levels are associated with increased cancer risk.  High testosterone levels are associated with lower cancer risk. Low testosterone levels are associated with increased risk of prostate cancer and increased aggressiveness of tumor.  If diagnosed with a low risk prostate cancer, and if in remission, studies show it’s ok to give testosterone therapy.

 

Several studies document the benefits of testosterone therapy.  The following summarize some of the more important ones.

• Low testosterone levels are associated with increased mortality in male veterans.

• Age associated decline in anabolic hormone levels is a strong independent predictor of mortality in older men.

• Testosterone insufficiency in older men is associated with increased risk of death over the following 20 years.

• Free testosterone levels are lower in men who developed Alzheimers.

• Low testosterone levels are associated with an increased risk of all-cause and cardiovascular disease related deaths.

• High serum testosterone predicted a reduced 5 year risk of cardiovascular events in elderly men.

• Testosterone levels in the highest quartile is associated with reduced cardiovascular risk compared to lower levels.

• Androgen deprivation therapy in prostate cancer patients increased cardiovascular risk.

• In men with low testosterone levels, testosterone treatment is associated with decreased mortality compared with no testosterone treatment.

 

For women, optimal testosterone levels lower the risk of breast cancer.  Testosterone therapy in women is NOT associated with increased breast cancer risk.  In summary, studies show optimal testosterone levels in women do not have an increased risk of uterine or breast cancer.

 

Thyroid hormone is a hormone secreted by the thyroid gland that regulates temperature, metabolism and cerebral function, resulting in increased energy, temperature and warmth. It increases fat breakdown, causing weight loss. It protects against heart disease by lowering cholesterol. It improves cerebral metabolism and prevents cognitive impairment. It also relieves symptoms of thin, sparse hair, dry skin, and thin nails. Thyroid hormone is indispensable. As we age, conversion from T4 (produced by the thyroid gland) to T3 (the active form) is less effective. In addition, our cells don't respond as well to the T3 as they did before. Correcting this with bioidentical thyroid hormone (T3 and T4) will improve metabolism, resulting in less fatigue, provide more energy, improve hair loss, increase hair growth, and increase hair thickness, help prevent heart disease, cause weight loss, and improve cognition and memory.

 

There is a concern that taking exogenous thyroid hormone when your levels are “normal” (specifically TSH level) is harmful. Nothing could be further from the truth.  All the research studies that show harm from suppression of TSH were in Graves Disease. The harm is from the autoimmune antibodies formed.  If we suppress TSH with exogenous thyroid hormone, no harm is done.  There is a lot of psychiatric literature that show benefit of exogenous thyroid hormone supplementation. None show any harm.

 

Studies show that estrogen makes women not only feel better but healthier. Estrogen makes women feel more youthful and energized. They have improved muscle tone, fewer wrinkles, stronger, shinier hair, and a more enjoyable sex life after menopause. Women who take estrogen stand taller and straighter as they do not suffer from osteoporosis. They also enjoy lower rates of heart disease, strokes and dementia. They also do not suffer from hot flashes, insomnia, vaginal dryness, atrophy and the accompanying infections, sagging skin, sagging breasts, fatigue, depression, and mood swings.

 

Some medical literature (specifically the WHI study) suggests that estrogen causes an increased risk of heart disease, strokes, breast cancer and blood clots. This is misleading as those hormones are not biologically identical hormones. They are synthetic hormones, such as Premarin (conjugated equine estrogen), Provera (medroxyprogesterone), and PremPro (a combination of Premarin and Provera). They have the potential to cause harm. Biologically natural (bioidentical) hormones (estradiol and progesterone, among others) do no such thing.  

 

The WHI study was biased and had major design flaws: 50% of the women had hypertension, 50% had high cholesterol, 40% smoked and 33% had diabetes. In the WHI study, the only significant increased risk of coronary heart disease was in women who were already 20 years post-menopausal at the time of enrollment, and they took Prempro. The risk was only for the 1st year of the study, and was due to plaque rupture.  After that 1st year, their risk of heart disease was decreased.  In younger women (average age 53), there was no increased risk of heart disease.

 

The WHI study showed an increased risk of breast cancer, but again, they took Prempro!  In the estrogen-only arm of the WHI, there was no increased risk of coronary heart disease and a decreased risk of breast cancer.  The postulate is that it is the synthetic progestin Provera (medroxyprogesterone) that causes harm.  There are more than 60 studies that show estrogen therapy alone is safely given to women with a history of breast cancer. In the WHI, when estrogen was given alone, there was a 9.4% chance of recurrence. But when not used, there was a 20.3% (higher!) chance of recurrence.  Remember, there is always a risk of breast cancer recurrence, but its lowered if women take estrogen.

 

In a cohort study in France, in over 50,000 post-menopausal women, (a very powerful study given the number of women enrolled) there is an increased risk of breast cancer if given estrogen + synthetic progestin (like Provera), similar to the results of the WHI. But there is no increased risk of breast cancer if given estrogen and progesterone.

 

In the WHI study, the risk of a blood clot  is very low (0.8/1000 women years) and is from Prempro. Again, the culprit is felt to be Provera, the synthetic progestin. What is not well appreciated is the fact that this risk of a blood clot is similar in other commonly used medications.

 

In the WHI, estrogen therapy reduces hip fracture risk by 34%. There are >340,000 hip fractures per year. 25% will die within 1 year, usually from pneumonia. 50% never again walk alone. 40% move to a long term care facility.

 

The number one reason women don’t take estrogen therapy is fear of breast cancer. There is no evidence that taking estrogen (or progesterone) causes breast cancer or breast cancer recurrence. The benefits of estrogen far outweigh any (supposed) risks.  The results of the WHI study do not apply to the vast majority of women who would benefit from BHRT.Several studies show that estrogen therapy safely and effectively reduces total mortality and coronary artery disease in recently post-menopausal women.  In contrast, neither aspirin or statins have demonstrated reduction in coronary heart disease mortality in women. In addition, in five randomized controlled trials, there is a 33% increased risk of breast cancer associated with statin use (eg, Lipitor). A study showed that preservation of ovaries until at least age 65 was associated with higher survival rates. Another study showed bilateral oophorectomy (removal of ovaries) at less than age 45 was associated with higher cardiovascular mortality. In another, estrogen therapy improves cognitive deficits and decreases the incidence of Alzheimers. In another, bilateral oophorectomy increased the hazard ratio for all-cause mortality, coronary heart disease and strokes. In another study, women who never use estrogen therapy, bilateral oophorectomy at less than age 50 had an increased risk for all-cause mortality, coronary heart disease and strokes. In another, estrogen therapy decreases the risk of fatal colon cancer.  In another study, if more than one year out from uterine cancer, it is safe to take estrogen.  In the NHI study, a very powerful study, estrogen therapy decreases deaths from heart disease and even cancer.  One study showed estrogen replacement therapy prevents tooth loss. (Something to smile about!)  Another study shows estrogen therapy given to women without evidence of coronary artery disease retards progression of subclinical atherosclerosis.Nowhere in the literature, including multiple randomized controlled studies, is it shown that taking estradiol is harmful.

 

In summary, taking estrogen reduces the risk of 1) coronary heart disease, 2) breast cancer, 3) Alzheimers, 4) colon cancer, and 5) hip fractures (from osteoporosis). And there is no increased risk of blood clots.

 

Progesterone protects against uterine cancer, ovarian cancer, breast cancer, osteoporosis and heart disease. Provera, or medroxyprogesterone, is a synthetic hormone, is chemically different from progesterone, and can cause harm. It is often confused with progesterone, which does not cause harm. Most physicians do not understand the difference and therefore, will prescribe medroxyprogesterone (harmful) and not progesterone, which is beneficial. Progesterone is as equally important for women as estrogen. It can safely and effectively relieve menopausal symptoms, protect against cancers, prevent osteoporosis, help stabilize mood and improve overall well-being. The lack of progesterone causes similar processes as the lack of estrogen: osteoporosis, heart disease, decreased libido and diminished quality of life. The combination of natural estrogen and progesterone can prevent a downward spiral by keeping women feeling young, vital, strong and vigorous.

 

Studies show that maximum protection against tumor recurrence of breast cancer is taking progesterone and testosterone.  Another study showed that elevated serum progesterone levels are associated with a significantly decreased risk of breast cancer.

 

DHEA is a hormone produced by the adrenal gland and is derived from cholesterol. DHEA is the building block necessary to produce testosterone, estrogen and progesterone. Studies have shown that low levels of DHEA were associated with a higher mortality from heart disease and cancer, yet high levels were protective against heart disease and cancer. DHEA improves the function of the immune system, improves brain function, lowers stress and is a very potent anti-cancer supplement. It also increases energy and reduces body fat and cholesterol, thereby protecting against heart disease. DHEA was shown to improve the quality of life and patients were better equipped to handle stress.

 

Melatonin is a hormone produced by the pineal gland. It regulates our circadian rhythm and the deep stages of sleep. The pineal gland's main role is to control the production and use of energy throughout our body through the release of melatonin and other compounds. It directs energy production so that it goes wherever it is needed at the right time, to repair or respond to injury, or make hormones, enzymes or antibodies. Melatonin directs the cells to do whatever it takes to keep the body running optimally. Melatonin has powerful antioxidant effects, the potential to prevent and treat cancer, immune enhancing properties, and the ability to promote improved sleep and avoid jet lag.