As mentioned earlier hormones do not exist by themselves, and there are checks and balances, our bodies have to each one. One of the most important checks and balance to estrogen is progesterone. In healthy women, progesterone rises in the middle of their menstrual cycle preparing the egg for fertilization. If fertilization does not happen, progesterone drops (bleeding begins) until the next cycle starts. Progesterones balancing of estrogen plays a significant role in any hormone replacement treatment. Bioidentical progesterone has not only been shown to relieve all symptoms of menopause but, to combat against breast and other cancers. These effects are NOT shown in progestin (non-bioidentical progesterone). It is crucial to remember that unlike non-bioidentical hormones, bioidentical ones have the same molecular makeup as ones naturally produced in our bodies. Because our bodies can not distinguish the difference between the ones we naturally make and that of bioidentical ones prescribed, these hormones are properly metabolized, used and excreted by our bodies.
To complete this balancing act, a qualified practitioner will also monitor and prescribe if necessary Thyroid hormones, pregnenolone, DHEA, and testosterone. We will only very briefly touch upon these hormones in this article. Ideally, we just don't want to suppress the symptoms of menopause but, restore our hormones back to youthful levels. Thyroid health goes well beyond just checking thyroid stimulating hormone (TSH) and thyroxine (T4) which is standard in mainstream medicine. An experienced practitioner will look at a complete picture which would include not just TSH and T4 but, also the active thyroid, autoimmune and stress markers. We do not have time to go over each in depth as this is a long subject and probably deserves its own article. Suffice it to say doctors who do not do these tests are only looking at the very tip of the thyroid iceberg. A complete thyroid test would look something like this: TSH, FT4, FT3, RT3, TPOAb, TgAb, and iodine. DHEA is considered one of your master hormones, meaning it is metabolized or converted into another steroid (sex) hormones (see chart 1). Like many hormones DHEA usually peaks in our late twenties early thirties then decreases each year steadily after that. Low levels have been associated with many illnesses including cancer, diabetes, autoimmune issues, and inflammation to name a few. Pregnenolone; the forgotten hormone is also considered a master hormone, like DHEA it metabolizes or converts into other hormones. Pregnenolone also peaks in our late twenties and starts to decline each year. Stress plays a significant role in this hormone as chart 1 shows pregnenolone converts into cortisol which is one of the main stress hormones. Low levels of pregnenolone have been associated with diminished brain function of all kinds. Testosterone like the rest of them declines in our thirties. Low levels of testosterone can affect sex drive/libido, muscle mass, bone density, heart health and overall well-being. Because DHEA converts to testosterone it is possible by increasing DHEA, testosterone would also rise.
When we discuss the different types of hormone replacement therapy, we are not talking natural versus synthetic, what we are talking about is bioidentical versus non-bioidentical. Bioidentical hormones have the same exact molecular structure as the ones our bodies produce and, in fact, no distinguishment can be made between the two. While many associate bioidentical hormones with being natural and non-bioidentical as synthetic, this is not true. Many non-bioidentical hormones come from natural sources. For instance, Premarin is a natural hormone made from pregnant mare's urine, but it is not bioidentical to human estrogen or Cenestin which is made from plants but is also not bioidentical. When it comes to safety and effectiveness, what matters is whether or not the hormones are exactly identical to the ones we naturally make. Many studies show non-bioidentical progestin significantly increases estrogen-dependent breast cell growth, whereas several studies have shown the opposite to be true when using bioidentical progesterone. In fact, research has demonstrated that bioidentical progesterone in combination with bioidentical estrogen eliminated any increased risk of breast cancer when compared with non-bioidentical progestin. In essence, bioidentical progesterone appeared to protect against breast cancer. To complicate the issue further, both bioidentical and conventional hormones fit like pieces of a puzzle into the hormone receptors. It is this fact that has many laypeople as well as conventional doctors thinking there is no real difference between the two methods. Where one of the biggest differences lie, is non-bioidentical hormones act as a dam, blocking the downstream ‘flow' of hormone conversion and metabolite production. By blocking the natural ‘flow' of hormones certain metabolites and certain gene expressions never happen. For instance, progestin (non-bioidentical progesterone (Provera / Prometrium)) block a pathway that would normally stimulate the p53 gene that stimulates apoptosis (programmed cell death). The lack of p53 gene can lead to the overexpression of estradiol. This overexpression leads to the stimulation of the BCL2 gene causing rapid cell growth, whereas bioidentical hormones allow the ‘flow' as mother nature intended. While this is an oversimplified example of a complex function you get the point, non-bioidentical hormones do not allow the proper checks and balances bioidentical ones do.
The delivery method of certain hormones also makes a difference. When Estrogen, even bioidentical estrogen such as Estrace is given as a pill, it must pass through the liver. Once it enters the liver, estradiol is converted into estrone. Oral estrogen can also stimulate proteins that have been associated with heart disease and stroke. When given as a patch or compounded into a transdermal or transmucosal cream/gel, the same dosage has no effect on these same proteins. It is important to note here that women using bioidentical estrogen such as Biest and who still have a uterus have great success using micronized bioidentical progesterone pills such as Prometrium.
There is an abundant amount of research often overlooked by mainstream health care showing that women can safely benefit from a customized dose of bioidentical progesterone and estrogens. Lifestyle and dietary changes are also largely overlooked or completely ignored in hormonal health and overall well-being as we age. While such simple measures as making sure we have sufficient vitamin D levels is slowly creeping into the consciousness of conventional medicine, much more education needs to be done, not just to the public but, to the health and medical professionals so they could truly be a knowledgeable source for health and wellness as we age. The benefits of using bioidentical hormones are not limited to and don't stop with the reduction or elimination of menopausal symptoms. For better bones, healthy hair, tighter skin, reduced cellulite and an active libido, bioidentical hormone replacement may be the missing piece to the puzzle. Find a qualified healthcare provider with experience in bioidentical hormone replacement and start the conversation. After all, we just don't want to survive, but we want to THRIVE as we age.
Disclaimer: I AM NOT A PHYSICIAN, AND THIS POST IS NOT MEANT TO REPLACE PROPER MEDICAL TREATMENT. Make an appointment today for your personalized nutrition consultation. I will create a customized functional nutrition program for you and together we will start we will start you on your wellness journey. If you live in the NYC or LONG ISLAND, you can contact me for physician names qualified to help in BioHRT