Transcript NATURAL HORMONE REPLACEMENT THERAPY

1) Use of natural (human bio-identical)
hormones: exactly like those produced in
the body
2) Physiological replacement to levels of
a young adult
Vivelle
 Estrace
 Estraderm
 Femring
 Femtrace
 Climara
 Alora
 Prometrium
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 Thyroid
 Estrogen
 Testosterone
 Progesterone
 Dhea
 Growth
Hormone
The Colorado thyroid disease prevalence
study:
25,000+ participants
CONCLUSIONS:
“The prevalence of abnormal biochemical thyroid function
reported here is substantial and confirms previous reports in
smaller populations. Among patients taking thyroid medication,
only 60% were within the normal range of TSH. Modest elevations
of TSH corresponded to changes in lipid levels that may affect
cardiovascular health. Individual symptoms were not very
sensitive, but patients who report multiple thyroid symptoms
warrant serum thyroid testing. These results confirm that thyroid
dysfunction is common, may often go undetected, and may be
associated with adverse health outcomes that can be avoided
by serum TSH measurement.”
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Signs and Symptoms of Low Thyroid
Fatigue
Increased sensitivity to cold
Constipation
Dry skin
Unexplained weight gain
Puffy face
Hoarseness
Muscle weakness
Elevated blood cholesterol level
Muscle aches, tenderness and stiffness
Pain, stiffness or swelling in your joints
Heavier than normal or irregular menstrual periods
Thinning hair
Slowed heart rate
Depression
Impaired memory
Standard ranges for thyroid testing
(Labcorp):
Free T4 0.82-1.77
Free T3 2.0-4.4
TSH
0.45-4.50
>3.50
<1.50
With co-morbidities use:
fT3/rT3 >20
D1 (but not D2!) is suppressed and down-regulated
by:
Physiologic and emotional stress
Depression
Dieting
Weight gain/Weight Loss
Insulin resistance and Diabetes
Obesity
Inflammation
Autoimmune disease
Systemic illness
Chronic fatigue syndrome
Fibromyalgia
Chronic pain
Exposure to toxins, mold, heavy metals, and plastics
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T4 only (most common)
Synthroid, levothyroxine
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Natural thyroid (Armour, Westhroid,
NP thyroid) contains natural ratios of
T4 and T3
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T3 only (Cytomel, compounded T3)
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Estrone: Produced in peripheral tissues;
implicated in some cancers (breast,
uterine)
Estradiol: Secreted by ovaries; most
active form, supports cognitive function
and mood, higher levels associated with
youthful appearance. Deficiencies
associates with osteoporsis, dementia,
heart desease
Estriol: safest and weakest form of
estrogen; may have anti-cancer
effects, useful for vaginal dryness and
MS (reverses brain lesions)
Signs of Low Estrogen
(From Unleash the Power of the Female Brain)
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Weight gain
Bladder incontinence and infection
Mood changes/depression
Insomnia
Low libido
Heart palpitations
Osteoporosis
Painful intercourse
Foggy headedness
Irritability
Fatigue
Weepiness
Hot flashes
Pain
Signs of Excess Estrogen
(From Unleash the Power of the Female Brain)
Puffiness
 Heavy bleeding
 Fibrocystic breasts
 Low libido
 Cravings for carbohydrates
 Weight gain around the hips
 Vaginal or oral yeast (thrush)
 Mood swings/easy to tear
 Tender breasts
 Headaches or migraines
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Helps reduce/eliminate menopausal
symptoms
 Can help maintain bone density
 Anti-Aging benefits
 May decrease risk of Alzheimer’s and
and other brain related problems
 Supports cognitive function and mood
(serotonin function)
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“Authors suggested this study supports previous results showing that
the effect of estrogen therapy on mood may be independent of
antidepressant effects mediated by alleviation of vasomotor
symptoms and that estrogen therapy may be of benefit to
perimenopausal women experiencing moderately severe
depression.”
Short-term use of estradiol for depression in perimenopausal and postmenopausal
women: a preliminary report. Am J Psychiatry. 2003 Aug;160(8):1519-22.
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“Estrogen in a therapeutic dosage alters brain activation patterns in
postmenopausal women in specific brain regions during the
performance of the sorts of memory function that are called upon
frequently during any given day. These results suggest that estrogen
affects brain organization for memory in postmenopausal women.”
Effect of estrogen on brain activation patterns in postmenopausal women during working memory
tasks. JAMA. 1999 Apr 7;281(13):1197-202
Conjugated estrogens,
from the urine of pregnant
mares (50% equine
hormones, not found in
humans)
 Predominantly E1 (estrone)
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Bi-Est: 80% estriol, 20% estradiol
in oral or transdermal form
 Estradiol only
 Transdermal is recommended
to avoid “first pass effect” and
coagulation issues of oral use
 Should always be balanced
with natural progesterone in
women with an intact uterus
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Estrogens convert into several metabolites.
Estrone, for example, may convert into three
different forms:
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• 2-hydroxyestrone, protective against cancer
• 4-hydroxyestrone, promotes cancer
• 16-alpha-hydroxyestrone, promotes cancer
In women on HRT, the 2/16 ratio should be >2.
Lower ratios are associated with breast and
ovarian cancer.
“Study upholds breast cancer mortality for
hormone replacement”
Though it was generally agreed that woman who took the two
hormones to curb their hot flashes and night sweats upped their
chances of developing the disease, many studies suggested that the
cancers the women developed were less likely to be deadly.
A new analysis of data from the Women's Health Initiative now casts
doubt on those findings. The study, published Friday by the Journal of
the National Cancer Institute, concludes that the prognosis for cancers
related to hormone replacement therapy is just as dire as for other
breast cancers. As a result, women who turn to the treatment are more
likely to die of breast cancer than their peers who don't take hormones.
And hidden much further down in the article we find this:
“The new findings apply only to women who take
estrogen and progestin, a synthesized form of the
natural hormone progesterone. Women who have
had hysterectomies can take estrogen alone, a
regimen that doesn't seem to increase breast
cancer risk. But those who still have a uterus must
take both estrogen and progestin to avoid
developing endometrial cancer.
Hormone therapy for Breast Cancer Survivors?
“We observed lower risks of recurrence and mortality in women who used HRT
after breast cancer diagnosis than women who did not” …the results suggest that
HRT after breast cancer has no adverse impact on recurrence and mortality”
J Natl Cnacer Inst 2001 May
“Continuous combined HRT was associated with reduced risk of death from
primary tumour and all cause mortality.”
Med H Aus 2002 Oct
“Over a mean follow up of 30 months 17 of 214 users experienced recurrence
(4.2% per year), compared with 66 of 623 controls (5.4% per year). HRT did not
seem to affect breast cancer recurrence risk”
J Clin Oncology 2001 April
“Estrogen
replacement therapy apparently does not increase either recurrences
or mortality rates. Adding progesterone may even decrease recurrences. Women
with early breast cancer should be offered hormone replacement therapy…
Am J Obstet Gynecol. 1999
“The number of new events did not differ significantly between
groups, in contrast to previous reports. The increased recurrence
in HABITS has been attributed to higher progestogen exposure.
As both trials were prematurely closed, data do not allow firm
conclusions. Both studies found no increased mortality from
breast cancer or other causes from HRT. Current guidelines
typically consider HRT contraindicated in breast cancer survivors.
Findings suggest that, in some women symptom relief may
outweigh the potential risks of HRT.”
Eur J Cancer 2013 Jan
Provera (medroxyprogesterone
acetate) most popular
“progesterone” drug
 Dozens of adverse effects: decreases
blood flow to heart, lowers HDL, and
causes edema, weight gain, insulin
resistance, insomnia, and, if taken in
early pregnancy, birth defects
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Protects against estrogen’s
proliferative effects on
endometrium
 Helps alleviate PMS symptoms
 Reduces fibrocystic breast disease
 May elevate libido and mood
 May promote bone formation
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Supports GABA - a major calming
neurotransmitter
 “natures Valium”
 Levels drop with low thyroid, chronic
stress, vitamin deficiencies and refined
sugar
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Anxiety/depression
 Poor sleep
 Fibrocystic breasts
 PMS
 Premenstrual headaches
 Postpartum depression
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Oral micronized progesterone, 100300 mg at bedtime
 Transdermal natural progesterone
creams, 1/4-1/2 teaspoon daily
 Available both OTC and prescription
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Yes!
 Declines with age, just like in men
 Increases libido, elevates mood and
energy level
 Improves ratio of fat to muscle
 Replacement: Natural testosterone
in transdermal cream or gel. Implanted
pellets.
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Levels fall gradually with age; ”Low T”
syndrome
 Low levels herald andropause
 Symptoms include loss of libido,
fatigue, depression, loss of muscle
mass, osteoporosis, anhedonia,
 “I lost my mojo”
 Testosterone replacement can be
used for men with history of prostate
cancer if they are disease free.
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Injections: 200mg wk, 100mg
2x/wk SQ or IM
 Topical in gel or cream: 50100mg/day
 Troche
 Implanted pellets
 Avoid oral testosterone
 HCG injections
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Precursor hormone
 Low levels associated with
depression, weight gain, heart
disease, diabetes, autoimmune
disorders, immune dysfunction,
obesity, cancer, osteoporosis,
memory loss
 Replacement improves sense of
well-being, mood, memory, immune
function, and in women libido
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“DHEA was associated with a
remarkable increase in perceived
physical and psychological wellbeing for both men (67%) and
women (84%)...
› Morales, AJ et al. Effects of replacement dose of
dehydroepiandrosterone in men and women of
advancing age. J. Clin. Endocrinology and
Metabolism, 1994; 78(6):1360-1367.
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"... an increase in DHEA-S of 100
mg/dl was associated with a 36%
reduction in mortality from any
cause and a 48% reduction in
mortality from cardiovascular
disease."
› Barrett-Connor, et al. A perspective study
of dehydroepiandrosterone sulfate,
mortality and cardiovascular disease.
NEJM, Dec. 11, 1986; 315(24):1519-1524.
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Average doses:
› 5-25 mg women
› 25-50 mg men
Check blood levels of DHEA-S to
determine optimal dose
 Use with caution in patients with
hormone-sensitive cancers, such
as breast or prostate cancer*
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Dehydroepiandrosterone (DHEA) has a protective role
against cancer…These results suggest that the mechanism of
DHEA actions against breast cancer involves the inhibition of
cell proliferation and the suppression of migration, indicating
that DHEA could be useful in the treatment of breast cancer.
Eur J Pharmacol. 2011 Jun 25
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The DHEA metabolite 7β-hydroxy-epiandrosterone exerts antiestrogenic effects on breast cancer cell lines
Steroids. 2012 Apr;77(5
After 6 months of treatment:
 Increase in muscle mass (8.1%)
 Reduction of body fat (14.4%)
 Increase in bone density (1.6%)
 Rejuvenation of skin (7.1%)
› Rudman, D et al. Effects of human
growth hormone in men over 60 years
old. New Engl J Med, July 5, 1990; 323(1):
1-6.
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“The effects of 6 months of
hGH on lean body mass and
adipose-tissue mass were
equivalent to the changes
incurred during 10 to 20 years
of aging.”
› Rudman, D et al. Effects of human growth
hormone in men over 60 years old. New
Engl J Med, July 5, 1990; 323(1).
Speeds healing after surgery and
recovery from severe illness
 Excellent therapy for heart
failure: increases cardiac output
and exercise capacity
 Given by SQ injection
 Oral “Secretagogues”do not
reliably increase IGF-1
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