Hormone Restoration and Support As a doctor with a strong interest in functional medicine, I strive to help my patients to achieve optimal health in the best ways I know how. This encompasses a combined, evidence based approach using the best of both what complimentary and conventional medicine can provide. While, I am a big believer in the power of nutrition and lifestyle in achieving these goals, sometimes additional help still seems to be required. I have had numerous patients in recent months who fit this description. Some come to see me with their diet and lifestyles seemingly dialled into perfection. This has left me sometimes wondering what else we can offer. Increasingly, women in particular, have been asking me about bioidentical hormones. What are Bio-identical Hormones There is sometimes a misconception that bio-identical hormones are natural products. With the exception of desiccated thyroid hormone, this is not exactly true. So, what is the difference between conventional hormone therapy and bio-identicals? Conventional hormone therapy typically means synthetic hormones or animal-based hormones that are slightly different chemical configuration from our own hormones. This potentially can have unwanted or adverse consequences and may account for some of the risks that have been associated with hormone administration. Bio-identical hormones, while still synthesised in a lab, are biochemically the same structure as the ones in our own bodies. Why someone might need to consider hormone restoration The following is a list of some of the symptoms that may potentially improve with addition of bio-identical hormone therapy Fatigue Depression/Anxiety Hair Loss Unwanted weight gain Muscle Atrophy Insomnia Mood Swings Hot Flushes Night Sweats Low Libido Vaginal Dryness and Discomfort Bladder Problems
Are they Safe? There has been much controversy about the use of hormone replacement in general particularly in post-menopausal women. This arose primarily from the Women s Health Initiative trial. The Women s Health Initiative (WHI) was a massive study. A portion of the study ended after five years (three years early) because of a clearly greater risk of invasive breast cancer, heart disease and strokes among women using PremPro [Premarin (equine estrogens) plus Provera (a synthetic progestin). Interestingly the WHI found that oestrogen alone did not increase the risk of developing breast cancer. The Breast Cancer Detection Demonstration Project, part of a nationwide breast cancer screening program, and it showed that estrogen-only hormone replacement (ERT) increases the overall risk of ovarian cancer by more than 3-fold. A study in The Lancet (August 8, 2003) involving over a million women in the United Kingdom gives new types of evidence that conventional HRT (estrogen and progestin combinations) is associated with a substantially greater risk of breast cancer and a greater risk of dying from it. This is the largest study of its type, and the first to report an increase in risk of death from breast cancer for HRT users compared with women who have never used HRT. Based on these studies, one might make the conclusion that any form of hormone replacement poses unacceptable risks in postmenopausal women. However, it is important to understand some more recent studies looking at different types and different routes of administration for HRT. For example the French Cohort Study was a large study of 3175 postmenopausal women comparing the effects of transdermal estradiol plus progesterone on the risk of developing breast cancer. No increased risks were found with this combination. The E3N-EPIC study assessed the risk of breast cancer associated with HRT use in 54,548 postmenopausal women. In this study, HRT containing synthetic progestins showed a significant increase in breast cancer risk while HRT containing micronized progesterone actually reduced the risk. How are they used? There are a broad range of possibilities for the administration of bioidentical hormones. There are different troches (lozenges), oral capsules and creams applied to various regions of the body. Oestrogen is thought to have a safer risk profile when administered transdermally.
Progesterone can be applied in different ways depending on the clinical situation. Testosterone is usually used as a cream. Thyroid extracts are given orally. Lab Testing This is an evolving area with many different opinions. I have formed my own conclusions but they are likely to change based on evidence as it becomes available. I do appreciate that specialised hormone testing can be expensive but I wish to make the use of BHRT as safe as possible. Currently, I feel that establishing a true hormone deficiency is a necessity. This is best done by a combination of a comprehensive symptom assessment and using an initial serum hormone level screening. Once BHRT is commenced I think the DUTCH Test (a dried urine hormone test looking at metabolites ) offers some advantages for monitoring and preventing potential adverse outcomes. How I use them in clinical practice and how my approach may differ. The control system for hormone regulation is a delicate and complicated feedback loop, known as the HPA axis (the hypothalamic-pituitaryadrenal axis or more broadly, the HPATG, the hypothalamic-pituitaryadrenal-thyroid-gonadal axis). Careful consideration of the hormonal feedback system is required, as is an understanding downregulation of hormone receptors. For this reason, I think a comprehensive look at the patient on multiple levels, is much more useful than simply replacing an identified hormone deficiency. With this in mind, we have developed a 3 step process to help enhance potential outcomes and prevent unwanted side effects. Step 1- Addressing Lifestyle Issues As an initial measure I always prefer to tackle lifestyle measures that effect hormone balance. Some of these include: Nutritional deficiencies Exposure to toxins Lack of exercise Chronic stress Endocrine disorders Malnutrition Sleep disorders Lack of sunlight Certain prescription and over-the-counter medications
These factors go a long way in tackling and targeting HPATG The Microbiome Given my particular interest in gut health and the microbiome, I thought special mention in this area is warranted. Often overlooked, is the interaction of gut health as it relates to hormone regulation and production. There are multiple ways this can occur. For instance, dysbiosis can lead to increased intestinal permeability and 2ndy inflammation. Chronic inflammation is reported to supress the function of the hypothalamus and pituitary in the brain. This in turn can effect the production of hormones like oestrogen and cortisol. Inflammation can also cause hormone resistance in some circumstances. Additionally, there is a relatively new concept described as the estrobolome. This refers to the aggregate of enteric bacterial genes whose products are capable of metabolizing estrogens. Essentially what this means is that that abnormal gut bacteria may predispose or promote the downstream metabolism of oestrogen into toxic forms which may promote the development of malignancies such as breast cancer. These are only some of the reasons why I believe this deserves to be addressed appropriately. Step two - Nutritional Support and herbal therapies. This area is where I think I feel like our integrative approach at Fresh Holistic Health stands out. I like to work collaboratively with our naturopath Danielle in most cases. I rely on her extensive knowledge of supplements and herbal remedies for optimising hormone function. In some instances, this may mean that nothing else is required. If we still feel that patients will benefit from BHRT then having these measures in place will only add to successful outcomes. Step three - Bioidentical hormone therapy, If after steps 1 and 2 are fully addressed, then a trial of BHRT may be warranted. The principle I ideally wish to follow would be using the lowest dose and for the shortest duration of time. The goal is improving your overall health. With the right support, hormones to some degree should come along for the ride naturally, correcting themselves and restoring homeostasis. Of course this 3 step process is only a rough guide. Sometimes, depending on a particular clinical situation a trial of BHRT may be necessary to provide more rapid relief from symptoms. Lifestyle
measures can still occur simultaneously and the need for further BHRT can be re-evaluated somewhere down the line. How can I find out more? There are several ways you can find out more about hormone restoration and support. You can mention your interest with our reception staff. Secondly and perhaps the most holistic approach you can do, is to book an appointment with Danielle our Naturopath who can discuss and perform a comprehensive hormone assessment prior to your appointment with myself. Additionally, we can discuss potential hormonal issues at the time of your appointment and arrange appropriate testing.