Category Archives: Hormone Replacement

The Truth Surrounding Hormone Replacement Therapies

Earlier this week, JAMA published findings surrounding the uses and consequences of menopausal hormone therapy: a subject that has been considered contentious and controversial for several decades–in large part due to the outcome of the Women’s Health Initiative Study, which was halted prematurely in 2002 because of data that indicated the combination of Premarin (estrogen) and Provera—an artificial form of progesterone known as progestin—increased heart disease and breast cancer.

Yet the results are far more complex and nuanced: most people are unaware of the fact that women who had hysterectomies only received the premerin, while other women received the combination pill. The only increase in breast cancer that occurred was in the latter group; when estrogen is combined with progestin, the ability of estrogen to cause stimulation of breast tissue is increased—yet estrogen alone does not. The group who only received estrogen actually showed a decreased risk of breast cancer; moreover, the estrogen was protective even when women were diagnosed with breast cancer.

Jennifer Landa, MD, Chief Medical Officer of BodyLogicMD, has dedicated her practice to bioidentical hormone therapy and preventive medicine, in order to assist men and women resolve menopausal and andropausal symptoms. Dr. Landa explains that results are often contingent upon the ways in which hormones are administered, in addition to the fact that not all hormones are created equally. “Only someone trained as an expert knows the good and bad, and really understands the studies. When we talk bioidentical, it is a way of saying the same exact chemical structure of what is in our body naturally. People do not realize that there are already plenty of prescriptions with bioidentical hormones.”

Bioidentical hormone replacement therapy technically refers to the use of hormones that mimic the endogenous hormones produced by our bodies. Landa clarifies that much of the hormone literature is inaccurate, because most of the studies are conducted with ‘bad’ hormones, like progestin. Landa further discusses a study at Yale, years after the 2002 study—after which women came off of hormones in droves—in which researchers and scientists state that the women only taking estrogen should have stayed on it, and that many more women died of heart disease because they were taken off of their hormones. After retrospectively analyzing and assessing the data of the Women’s Health Initiative study, it was found that women who began hormones during menopause had decreased risks of heart disease. Landa terms this the ‘timing hypothesis,’ stating: “Timing is of the essence in hormone therapy. Unfortunately, many doctors are still not schooled properly in this area. Even the American College of OBGYN has agreed that we should not be taking older women off of hormones, as symptoms will likely recur.”

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BHRT Basics: The Myths & The Facts

While there is no magic bullet or cure to effectively reverse or stall the aging process, many experts believe that bioidentical hormone replacement therapy (BHRT) comes close. BHRT technically refers to the use of hormones that mimic the endogenous hormones produced by our bodies, with the ability to restore normal physiological pathways with optimal bodily responses. Because aging results in a myriad of declining health issues, BHRT has the potential to restore declining hormone levels, while slowing the aging process, preventing chronic disease, and restoring vigor and vitality.

Kenneth Orbeck, DO practices bioidentical hormone therapy at his integrative and functional medicine practice in South Carolina, citing that hormonal therapy is in large part effective because it requires doctors to have routine contact with patients. This, in turn, delivers optimal results, as patients are not simply receiving prescriptions, but rather being continuously monitored by physicians. “I have no rejections, no infections…it does take training, and you have to understand the therapy, but this ensures a very consistent, linear delivery.” Dr. Orbeck’s patients have been treated for a range of symptoms often associated with aging, including hot flashes, night sweats, decreased libido, fatigue, and irritability.

Jennifer Landa, MD, Chief Medical Officer of BodyLogicMD, has likewise dedicated her practice to bioidentical hormone therapy and preventive medicine, in order to assist men and women resolve menopausal and andropausal symptoms. Dr. Landa explains that results are often contingent upon the ways in which hormones are administered, in addition to the fact that not all hormones are created equally. “Only someone trained as an expert knows the good and bad, and really understands the studies. When we talk bioidentical, it is a way of saying the same exact chemical structure of what is in our body naturally. People do not realize that there are already plenty of prescriptions with bioidentical hormones.” Like Orbeck, Landa’s patients have continuously experienced positive health and wellness through hormonal balance and preventive medicine, in large part to customized BHRT therapy.

Landa clarifies that much of the hormone literature is inaccurate, because most of the studies are conducted with ‘bad’ hormones, like progestin. Landa further discusses a study at Yale, in which researchers and scientists stated that the women only taking estrogen should have stayed on it, and that many more women died of heart disease because they were taken off of their hormones. Landa states, “Timing is of the essence in hormone therapy. Unfortunately, many doctors are still not schooled properly in this area. Even the American College of OBGYN has agreed that we should not be taking older women off of hormones, as symptoms will likely recur.”

Sahar Swidan, PharmD, President & CEO of Pharmacy Solutions in Ann Arbor, Michigan—a uniquely personal, educational specialty pharmacy—and Clinical Associate Professor of Pharmacy at the College of Pharmacy at University of Michigan, explains that while we continue to lump bioidentical hormones with synthetic hormones, they are physiologically extremely different—“Yet you cannot pick up a medical article without clumping them together. Estrogens are not all the same.” Swidan describes the process of hormone therapy as highly individualized, and that physicians must understand their patients’ levels before prescribing hormones. “The earlier we start hormone therapy, the better people do. I tell people: I promise you, you don’t have a Prozac deficiency…you probably have a progesterone deficiency.”

Thierry Hertoghe, MD comes from a family that has worked with bioidentical hormone therapy for four successive generations. Like Swidan and Landa, he believes that BHRT represents the most powerful tools in order to stay healthy, and maintain physical appearance. He elucidates that BHRT has the capacity to treat causes, conditions, and not solely consequences; more importantly, Hertoghe firmly believes that BHRT is both safer and more efficient. “It is personalized, and I can vary the doses. In standardized pharmaceutical medicine, you have one or two doses—but you certainly do not have the possibility of 15-20 doses, depending on the patient. BHRT allows us to fine-tune treatment.” Hertoghe further illuminates the ability of hormone therapy to treat several types of disorders: both physical and psychological, that stem from hormonal imbalances.

A4M/MMI will be hosting a BHRT Symposium in Chicago, from September 14-16. During the three-day workshop, experts will analyze the medical evidence surrounding BHRT, while participants can learn from instructors actively practicing this specialty: Dr. Hertoghe will discuss the ways in which to identify signs of hormonal deficiencies in patients, and how to subsequently treat imbalances. Sessions will ultimately allow attendees to gain the information needed to safely and effectively merge BHRT into practice. Attendees will receive 23 CME credits. Register now.

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Benefits of HRT in Bone Health

A new cross-sectional analysis, coupled with research published last week in the Journal of Clinical Endocrinology & Metabolism, indicates that hormone-replacement therapy (HRT) can improve both bone-mineral density and bone mass/structure, with benefits that have the potential to continue up to two years after the discontinuation of treatment.

HRT is a form of therapy during which a patient receives hormones, for the purpose of supplementing a lack of naturally occurring hormones, or in order to substitute other hormones for naturally occurring hormones. Its use has been consistently studied and assessed in observational studies, case-control studies, meta-analyses, and randomized clinical trials; its applications have gradually expanded and been implemented.

Ample evidence and research further suggests that HRT is an effective first-line treatment for the prevention and treatment of osteoporosis due to its anti-fracture efficacy, primarily among young postmenopausal women—and can be continued for up to a decade. These findings are specifically significant because of the inherent downfalls of current drugs and pharmaceuticals, which have demonstrated less than optimal effects on bone microarchitecture.

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