Category Archives: Hormones

Women’s Hormones: The Safety of Bioidentical Hormone Replacement Therapy 

The field of hormone replacement therapies, and in particular bioidentical hormone replacement therapy (BHRT), has received considerable attention in recent years as it may offer a potential natural alternative treatment for hormonal balances affecting both men and women. While BHRT has been most commonly prescribed for the treatment of menopause symptoms, it can also be used to improve symptoms related to cancer treatment, insulin resistance, thyroid disorders, and many other health conditions. The use of this therapeutic method is increasing in popularity as awareness of the natural alternative grows and patient preferences continue to change.

The Benefits of BHRT

Chemically identical to hormones produced by the body, bioidentical hormones are derived from plant estrogens and come in a variety of forms including pills, gels, and injections that allow for ease of use that strengthens treatment adherence. BHRT is often prescribed as patients age and their hormone levels begin to decrease, especially in the case of women who enter perimenopause or menopause to improve the moderate-to-severe symptoms associated with this transition. Furthermore, hormone replacement therapies have been found  to reduce the risk for diabetes, tooth loss, as well as cataracts while potentially improving skin thickness, hydration, and elasticity. For post-treatment cancer patients with decreased estrogen levels, BHRT has shown efficacy in improving general wellbeing and overall quality of life; it may also alleviate some treatment-related symptoms such as migraines and insomnia.

Associated Risks

Nonetheless, this class of therapeutics has been tied to side effects with current research showing that hormone replacement therapy in general may increase the risk of certain conditions including blood clots, stroke, heart disease, and breast cancer. Additionally, BHRT therapy has been associated with acne, bloating, weight gain, fatigue, and mood swings as common side effects, which may deter some patients from the treatment. The risks and potential for side effects should be evaluated on an individual basis as they vary among women depending on their health history.

Compounded Bioidentical Hormones and FDA Regulation

Custom made by pharmacies per physicians’ orders, compounded bioidentical hormones typically include ingredients combined or altered to meet the specific needs of an individual patient. While such formulations may be effective when tailored correctly, it is important to note that the FDA has not approved any custom-compounded bioidentical hormone therapies to date. Also, many bioidentical hormones are manufactured and sold with limited safety, quality, and purity controls. As such, clinicians are encouraged to maintain caution in prescribing compounded bioidentical hormones.

To safely and effectively prescribe bioidentical hormone replacement therapies and other similar therapeutics, clinicians are invited to join the upcoming Women’s Hormones online course taking place from October 5-17, 2021, expertly designed to build clinical confidence and prepare practitioners for any patient scenario.

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The Role of Hormones in Immunocompetence 

The growing importance of hormonal health is becoming an integral component of modern medicine especially as the focus shifts toward maintaining and boosting immunocompetence in the population. Many plausible benefits of hormonal factors on autoimmunity have received growing attention in recent years from the scientific community. Research has been conducted investigating the relationship between immune system function and sex hormones testosterone and estrogen.

Importantly, the immune systems of men and women are known to function differently with 80% of autoimmune diseases occurring in women who tend to show stronger immune responses than their male counterparts. Stronger immune responses in women produce faster pathogen clearance and improved vaccine responsiveness while also contributing to their increased susceptibility to inflammatory and autoimmune diseases.

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Estrogen & COVID-19 Severity in Women

Growing clinical evidence reveals that the intensity of COVID-19 infection and incidence of related complications are more prominent in male patients. Current data suggests that men experience a greater risk than women for more severe COVID-19 symptoms and poorer outcomes regardless of their age. These burgeoning findings signal that sex may function as a determinant of COVID-19 infection severity.

While the body of evidence examining sex differences in virus outcomes is lacking, researchers believe the functional modulation of angiotensin-converting enzyme 2 by estrogen may explain disparities in morbidity and mortality. Further reasons for higher male sex-specific COVID-19-related mortality are likely multi-fold and may include lifestyle differences such as higher rates of tobacco smoking and alcohol consumption as well as innate immunity. The mounting evidence suggesting sex-based differences in clinical outcomes emphasizes the need for an assessment of sex-specific hormone activity – in particular, estrogen – in COVID-19 pathogenesis.

Sex-Specific Differences in COVID-19 Outcomes 

A recent study conducted by researchers at the Wake Forest Baptist Medical Center attempts to elucidate the mechanisms underlying these notable differences. Led by Leanne Groban, MD, professor of anesthesiology at Wake Forest School of Medicine, a team of researchers conducted a review of published literature to determine whether sex plays a role in COVID-19 outcomes by examining pre-clinical data on sex-specific hormone activity.

Beneficial Impact of Estrogen

The study’s authors reported that angiotensin-converting enzyme 2 – attached to cell membranes in heart, arteries, kidneys, and intestines – acts as a cellular receptor of the coronavirus responsible for COVID-19 infections and helps the virus gain access to cells of those organ systems. According to the researchers, their review also pointed to estrogen’s impact on ACE2 levels in the heart; the hormone lowered ACE2 levels. This may modulate the severity of COVID-19 in women, while higher levels of ACE2 present in tissues could account for why the disease presents worse in men.

“We know that coronavirus affects the heart and we know that estrogen is protective against cardiovascular disease in women, so the most likely explanation seemed to be hormonal differences between the sexes,” said the lead author of the review, Dr. Groban told ScienceDaily in an interview.

“We hope that our review regarding the role of estrogenic hormones in ACE2 expression and regulation may explain the gender differences in COVID-19 infection and outcomes and serve as a guide for current treatment and the development of new therapies,” Groban said.

An enhanced understanding of the role of estrogenic hormones in ACE2 expression and regulation may not only help uncover potential mechanisms that explain sex differences in COVID-19 clinical outcomes, but also guide future disease management techniques and spur the discovery of novel therapeutic methods.

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