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Hormone Replacement Therapy

Our doctors at Whole Health Center Houston are among the best at treating hormone deficiencies and diagnosing hormone-related illness.  Read below for specifics on our hormone treatment philosophies.   


Natural vs Synthetic Estrogen


We prefer to use bioidentical hormones, either estriol alone or in a combination formula called Tri-estrogen. Tri-estrogen is composed of 80% estriol and 10% each of estradiol and estrone, the same ratios as produced naturally by the body. Although Tri-estrogen is not sold by drug companies it is available through compounding pharmacies with a prescription.

 

We Avoid Premarin

As its name implies, Premarin is derived from the urine of pregnant mares. Although it exerts estrogenic effects in humans, horse estrogen is not the same as human estrogen, and is not necessarily as safe or as effective. The cruel torture that pregnant horses are put through in Premarin “factories” has also led many women to seek another source of estrogen.

Sometimes, We Use Estrace

Estrace is a synthetic version of 17-beta-estradiol, which occurs naturally in the human body. However, Estrace is not a balanced form of estrogen, because the human body also manufactures two other compounds: estrone and estriol. There is evidence that estriol, although a relatively weak estrogen, does not promote cancer, and may actually prevent it.

Natural Progesterone vs. Synthetic Progestins

There is only one progesterone, the specific molecule made by the adrenal glands or by the ovary as a consequence of ovulation.
First and foremost, natural progesterone is essential for the survival and development of the embryo and throughout pregnancy. On the other hand, Provera, the most commonly prescribed synthetic progestin, carries the warning that its use in early pregnancy may increase the risk of early abortion or congenital deformities of the fetus.
Because progesterone is a natural hormone, the body is normally able to produce it, use it, and eliminate it as needed. The synthetic progestins, on the other hand, are not well processed by the body. Their activity is prolonged, creating reaction, in the body that are not consistent with natural progesterone.
Progestins bind to the same receptor sites in the cell as progesterone, but from that point on they carry a different message to the cell. This undoubtedly explains the alarming array of listed warnings, contraindications, precautions and adverse reactions to progestins, all of which are uncharacteristic of natural progesterone.

Estrogen and Progesterone

In a normal functioning premenopausal woman, estrogen is made from progesterone and/or androgens within the cells of the body. After menopause, estrogens are converted from adrenal-produced androgens (DHEA), primarily in body fat. Estrogen and progesterone are, in many ways, antagonistic; yet each sensitizes receptors for the other. A key to hormone balance is the knowledge that when estrogen becomes the dominate hormone and progesterone is deficient, the estrogen becomes toxic to the body; thus progesterone has a balancing or mitigating effect on estrogen.


Estrogen is responsible for the maturation of young women at puberty. Estrogen causes the accumulation of fat that gives the female body its contours, but in excess or when it is not in balance with progesterone can contribute to excess fat accumulation. When women consume considerably more calories that what is needed, estrogen production increases proportionately to supernormal levels and may set the stage for estrogen dominance syndrome and exaggerated estrogen decline at menopause.


It is clear that excess estrogen, when unopposed or unbalanced by progesterone, is undesirable. Many of estrogen’s undesirable side effects are effectively prevented by progesterone. A new syndrome is being recognized: that of estrogen dominance. This syndrome, commonly occurs in the following situations:

  • Estrogen replacement therapy

  • Premenopause (early follicle depletion resulting in a lack of ovulation and thus a lack of progesterone well before the onset of menopause)
  • Exposure to xenoestrogens (foreign chemicals that have an estrogen effect in the body that causes early follicle depletion)
  • Birth control pills (with excessive estrogen component)
  • Hysterectomy (can induce subsequent ovary dysfunction or atrophy)
  • Postmenopause (especially in overweight women)
  • Estrogens used in the meat industry


Thanks to a nearly universal misconception in Western medicine that estrogen deficiency brings about all menopausal symptoms, it is the custom to prescribe unopposed estrogen for women who do not have a uterus (i.e. have had a hysterectomy). Equally unfortunate is the fact that premenopausal estrogen dominance is simply ignored.
A peculiarity of Western industrialized societies is the prevalence of uterine fibroids, breast and/or uterine cancer, fibrocystic breasts, PMS, ovarian cancer, premenopausal bone loss, and a high incidence of osteoporosis in menopausal women. Most of these may be due to estrogen dominance.

Symptoms that can be caused or made worse by estrogen dominance:

  • Acceleration of aging process
  • Miscarriage
  • Allergies
  • Osteoporosis
  • Breast tenderness
  • Premenopausal bone loss
  • Decreased sex drive PMS
  • Depression
  • Thyroid dysfunction mimicking hypothyroidism
  • Fatigue
  • Uterine Cancer
  • Fibrocystic breasts
  • Uterine fibroids
  • Foggy thinking
  • Water retention, bloating
  • Headaches
  • Fat gain, especially abdomen, hips and thighs
  • Hypoglycemia
  • Gallbladder disease
  • Increased blood clotting
  • Autoimmune disorders such as lupus
  • Thyroiditis and Sjogren’s Disease (increased risk of strokes)
  • Infertility
  • Irritability
  • Memory loss

 

In the United States and most industrially advanced countries, diets are rich in animal fats, sugars, refined starches, and processed foods. This provides calories in excess to the bodies needs and leads to estrogen levels in women twice as high as those in women of the more agrarian third-world countries.
In this context, it is worthwhile to compare the physiological effects of estrogen versus progesterone:

Our hormones play a major role in how fast we age. In part they act to advance the life cycle according to the biological plan. Alternatively, they may go haywire, promoting disease states associated with the aging process.
Since hormones influence the rate at which we age, considerable research is underway to evaluate the feasibility of “replacement therapy” to forestall the aging process and the degenerative changes that accompany it. “Replacement therapy” has been around for some time in the treatment of menopause. Many gynecologists advocate the use of estrogen and progesterone in the alleviation of menopausal symptoms. The use of testosterone, the adrenal hormones such as DHEA, pregnenolone, and melatonin are now just being investigated.
Lets take a look at these various hormones, and contrast some of them with their synthetic counterparts.

Pregnenolone

Pregnenolone is made in many organs and tissues of the body. The most common of these organs are the adrenal glands, liver, skin, and gonads (testicles and ovaries). The amount of Pregnenolone made depends on how much cholesterol is brought into the mitochondria. The mitochondria are the chemical factories of a cell that also produce the energy molecules of the body.


Pregnenolone can be easily converted into DHEA. DHEA can then be converted into androgens, estrogens, cortisol and other steroids within the body. There is one other pathway that Pregnenolone can take which distinguishes it from DHEA and that is Pregnenolone can be metabolized into progesterone which DHEA can not. DHEA has often been called the “Mother hormone”… so I guess that would make Pregnenolone the “Grandmother hormone”.


Because of the wide number of hormones that can be made by the body from Pregnenolone, it has a long list of conditions that can be effected by supplementing. A few of the conditions for which Pregnenolone can be helpful are: brain function including mood and memory and thinking, Alzheimer’s, sleep, Chronic Fatigue, Immune System, Lupus, Multiple Sclerosis, Premenstrual Syndrome, Psoriasis, Rheumatoid Arthritis, Scleroderma, and stress.


Dr. Gregory Pincus and Dr. Hudson Hoagland were even confident of Pregnenolone’s safety back in 1944 when they wrote: “We would like to point out that we have encountered no deleterious result in connection with the ingestion of Pregnenolone in our studies involving several hundred men and women who have taken the medication; in some instances in doses of 100mg per day for as long as four months. The substance (Pregnenolone) is nontoxic.

Testosterone

Testosterone is a naturally occurring hormone which, in addition to being responsible for developing adult male physical characteristics during and after puberty, is also critical for erectile function, libido, muscle mass and normal energy level and mood. The last three functions are not only critical in men but also in women. Testosterone treatment is indicated in women who suffer from low sex drive, low muscle mass, and weakness.

Melatonin

Melatonin is a natural hormone make by the pineal gland, which is located in the brain. Melatonin helps to set and control the internal clock that governs the natural rhythms of the body. Each night the pineal gland produced melatonin which helps us fall asleep. Research about this hormone has been going on since it was discovered in 1958. But it only in the last few years that much attention has been paid to melatonin. Close to one thousand articles a year about melatonin are now published worldwide. One reason for this growing interest is that we are realizing that deep sleep is not the only byproduct of melatonin. We are learning that it has a significant influence on our hormonal, immune, and nervous systems. Research is showing melatonin’s role as a powerful antioxidant, its anti-aging benefits, and its immune-enhancing properties. It is an effective tool to prevent or cure jet lag, an ideal supplement to reset the biological clock in shift workers, and a great medicine for those who have insomnia. Melatonin also may have a role to play in the treatment of prostate enlargement, as an addition to cancer treatment, in lowering cholesterol levels, in influencing reproduction, and a more delightful bonus is that melatonin can promote vivid dreams.

Dosages 

For estrogen replacement we recommend Tri-Estrogen. Tri-Estrogen is composed of 80% estriol, 10% estrone and 10% estradiol. These levels closely mimic the body own natural production. Tri-Estrogen is roughly 1/4 the strength of Premarin. Therefore if you were taking Premarin at a strength of .625 then you would take Tri-Estrogen at a strength of 2.5 mg, which is the most common starting point for most women.


The natural progesterone is made from wild Mexican yams or soybeans. It can be given either transdermally or orally. We recommend that if the progesterone is taken orally, it be placed in a sustained release base which will give a sustained release of the progesterone in the blood by protecting it from stomach acid degradation. The common starting dosage for an oral capsule is 25 mg. The dosage of the transdermal creams varies depending on the strength, but usually average about 25 mg per dose.


The most common dosages of DHEA are 10 mg, 25 mg, and 50 mg capsules. We recommend the lower dose of 10 mg for women and 25 mg for men to start. The most common dosages of Pregnenolone are 10 mg, 25 mg, and 50 mg capsules. We recommend the lower dose of 10 mg to start.


For testosterone replacement for women we recommend a oral dosage of 2.5 mg per day. For men generally we recommend starting out at 75 to 100 mg per day increasing gradually to 200 mg per day. The level of testosterone as well as the other hormones should be checked periodically to keep them within the physiological levels. If men experience any urinary difficulties, we suggest that they take a natural prostate health formula containing Saw Palmetto and/or Pygeum Africanus extract and have their PSA levels checked every 6 months.


Melatonin for insomnia the suggested dosage is quite variable. We suggest a starting dosage of a 1 mg, 2 hours before bedtime and titrate up to 3 mg if needed. For jet lag we suggest trying 1 mg for every hour time difference up to 6 mg. If you use 6 mg split them into two doses 2 hours and 1 hour before bedtime.


If you are planning to take any of the above mentioned hormones regularly for longer than a month, we highly recommend that you do it under supervision of a holistic doctor familiar with the interaction of the various hormones and the proper supplementation of these hormones.

Adrenal Hormones

DHEA is a natural hormone that is made by the adrenal glands. It is a natural substance made by the body, therefore it cannot be patented and made into a drug. As such, it is not FDA approved since the FDA does not approve natural substances only synthetic substances which are not made in the body and have inherent side effects. DHEA is short for dehydroepiandrosterone, a hormone made by the adrenal glands.


More than 150 hormones are known to be synthesized by the adrenal glands. However, the most abundant hormone made by the adrenal glands is DHEA. After DHEA is made by these glands it goes into the bloodstream, travels all over the body and goes into our cells, where it is converted into male hormones known as androgens, or female hormones, known as estrogens. Whether DHEA gets converted predominantly into androgens or estrogens depends on the person’s medical condition, age and sex. Every person has a unique biochemistry. The only hormone class that DHEA cannot make is Progesterone and its sister hormones Cortisol and Aldosterone.


From the studies that have been done so far, it seems that DHEA helps fight disease by boosting your immune function, improves mood and energy (many people say they have an increased sense of well-being), boosts your sex drive and influences longevity. It has been shown in some studies to reduce the risk of cardiovascular disease in men, help lupus, rheumatoid arthritis, and multiple sclerosis as well as diabetes and some forms of cancer.


Whenever doctors talk of safety of a medicine they separate it into short-term safety over a few days or weeks, and long term safety over months and years of use. Dr. Nestler, a researcher at the Medical College of Virginia/Virginia Commonwealth University in Richmond, gave 1600 mg of DHEA a day for 4 weeks to healthy young men without any serious side effects. At this dosage there was a lowering of cholesterol and a decrease of body fat, with a greater response in obese individuals. Most DHEA supplements on the market are less than 50 mg.


As to the safety of using DHEA for 5 10, 20 years or longer, no formal human studies have been published; then again, few if any long-term human studies have been done for any medicines, hormones, or nutrients.

 

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