Category Archives: Hormone Replacement

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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The Importance & Application of BHRT

Bioidentical hormone replacement therapy (BHRT) has been a contentious and hotly contested topic in the medical field since its inception. Using hormones that are molecularly and chemically identical to endogenous hormones—those produced in the body—was first conceived in the 1930s, as a potential treatment for menopausal symptoms. Because BHRT is not technically manufactured with FDA oversight, many critics pounce upon the lack of regulation. Yet compounding pharmacies that have implemented proper quality assurance procedures, while using the requisite equipment and tactics, will often exceed any FDA standards for mass-produced medications. Moreover, if bioidentical hormones were widely used, the pharmaceutical and drug industries would face massive profit losses and sales.

Conventional hormone replacement therapy (HRT) differs from BHRT in several ways: BHRT utilizes hormones that are chemically identical to human hormones that the body makes, and customizes dosages for the individual patient. While the primary objective of BHRT is hormone balance, the goal of HRT is to prevent disease.

The idea of achieving a natural hormone balance can serve a host of diagnoses and medical issues; many people, particularly later in life, experience hormone imbalances that can contribute to HPA axis dysfunction, thyroid disease, cardiovascular disease, as well as sexual dysfunction. In attempting to treat the causes of symptoms, while simultaneously restoring depleted hormone levels, hormone replacement therapy has functioned as a solution for many who felt that they were out of options.

A recent article discussed a publication that focused on the ways in which HRT could mitigate the risk factors in developing dementia: senior author Dr. Jill Goldstein of Harvard Medical School articulated that the condition—and initial memory less—could likely be triggered by lowering levels of estrogen, during the period of menopause. The study’s clinical trials found a strong correlation between women with lower levels of estrogen and memory/cognition problems.

Dr. Goldstein further expressed the critical importance of maintaining a regular and consistent level of estradiol (the type of estrogen that has the great effect on brain function), as it has significant potential in limiting the development of Alzheimer’s.

Learn more about BHRT at our upcoming symposium in March.

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