Estrogen

There is a great deal of fear and confusion when it comes to menopause and hormone supplementation. First, the term Hormone Replacement Therapy or HRT can conjure up the image of a cancer, stroke, and heart disease causing cocktail of synthetic hormones.

Next there is the “alternative,” Natural Hormone Replacement Therapy (NHRT). There is no Natural Hormone Replacement Therapy. Hormones for use in humans need to be synthesized from something. While many use the term, it is the sometimes favorite of internet sites selling “hormones,” and thus an easy target for critics who still favor the use of horse hormones and point to the “NHRT” websites as those making unsupported claims and being medically dangerous.

Sometimes, but incorrectly added to the latter group are the aptly and descriptively named “Bio-Identical Hormones.” Bio-identical Hormone Replacement Therapy (BHRT) is not “natural” hormones and should never be referred to as that. Their sources are natural, being derived from plant sources, but, they must be chemically altered to exactly match the hormones produced in the body.

This is where the “natural” confusion comes in. Bio-identical Hormones are engineered to exactly match the natural hormones present in the body, but they themselves are not “natural” but indeed, bio-identical.

I would like to point out here that NOT every woman coming in with peri-menospausal, menopausal or post-menopausal complaints is put on hormone therapy at our clinic and there are no studies that clearly show that bio-identical hormones are any safer than synthetic hormones.

Sometimes the desired results a women wants can be achieved by quitting smoking or drinking, altering a diet to avoid foods that could aggravate symptoms, such as coffee, sugars, and foods loaded with chemicals, getting more exercise, reducing stress, reducing exposure to caustic elements and more.

There are options to Hormone Replacement Therapy and these can and should be discussed with a physician knowledgeable in understanding all the options available to the peri-menospausal and menopausal woman. Just because Grandma went through menopause naturally, doesn’t mean she was the better for it!

Hormone replacement, peri-menopause and menopause
For over four decades doctors freely prescribed synthetic estrogen replacement to women in the throes of menopause to alleviate the myriad of symptoms associated with the “Change of Life.” It was an easy thing to do. A women would come in with “hot flashes,” “mood swings,” and “fatigue,” among other complaints and the doctor would simply give them estrogen. Why not? The women who took estrogen seemed to be more youthful, enjoy life more, and “had control of their bodies.”

The problem became supplying the demand for estrogen. To which “Estrogen Farms,” were set up to capture the urine of pregnant mares (where the name Premarin comes from (Pre=Pregnant, Mar=Mare, In=Urine) to glean the estrogen from it.

Synthetic horse-urine estrogen replacement was now the vogue and over 10,000,000 women were “in style.” Physicians felt comfortable putting women on this estrogen, since many studies proclaimed the vast benefits of estrogen replacement therapy. In fact, once on horse-estrogen, many women refused and still refuse to give it up!

Happy with horse estrogen

After menopause, estrogen levels in a woman’s body declines.

Estrogen Replacement Therapy (ERT) alleviated the familiar symptoms of menopause for many women.
With this decline often comes the familiar symptoms of:
1. Vaginal dryness, painful intercourse
2. Vaginal mucosal atrophy
3. Hot flashes
4. Night sweats
5. Fatigue
6. Mood swings and memory problems
7. Fluid retention
8. Sleep problems
9. Decreased libido
10. Involuntary loss of urine (stress incontinence)
11. More frequent urinary tract infections

It seemed like an idyllic world. Women wanted estrogen, the doctors were eager to comply, and the pharmaceutical industry was happy to produce.

Then on July 12, 2002, the world of synthetic estrogen replacement abruptly collapsed and panic filled women across the world. The Journal of the American Medical Association (JAMA) reported that Hormone Replacement Therapy was too dangerous to research!

Estrogen Segments 1 2 3

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The Use of Testosterone with Estrogen and Progestogen and It’s Effect on Breast Cell Proliferation

Researchers writing in the medical journal Menopause say “Addition of testosterone may counteract breast cell proliferation as induced by estrogen/progestogen therapy in postmenopausal women.”

Hofling M, Hirschberg A, Skoog L, Tani E, Hagerstrom T, von Schoultz, B. Testosterone inhibits estrogen/progestogen-induced breast cell proliferation in postmenopausal women. Menopause. 13 November 2006

Conclusions: Addition of testosterone may counteract breast cell proliferation as induced by estrogen/progestogen therapy in postmenopausal women.

Women, Testosterone and Cardiovascular Disease

Researchers writing in the medical journal Coronary Artery Disease say that their study “could suggest that the development of cardiovascular disease after menopause is due not only to estrogen decline but also to androgen decline.”

Montalcini T, Gorgone G, Gazzaruso C, Sesti G, Perticone F, Pujia A. Endogenous testosterone and endothelial function in postmenopausal women Coron Artery Dis. 2007 Feb;18(1):9-13.

OBJECTIVE: It is well known that coronary heart disease incidence increases in women after menopause. This phenomenon was related to reduced levels of female sex hormones. Estrogen decline, however, is not the only hormonal change during the postmenopausal period and estrogen administration did not protect women from cardiovascular disease. Therefore, it is justified to explore other hormonal changes. The role of androgens is still controversial. The aim of the present study was to investigate the relationship between endogenous sex hormones and endothelial function, measuring the brachial artery flow-mediated dilation.

METHODS AND RESULTS: Sixty postmenopausal women were consecutively enrolled and underwent a clinical and biochemical examination. Brachial artery flow-mediated dilation was also evaluated by ultrasound. After correction for confounding variables, testosterone was positively correlated to flow-mediated dilation (beta=0.277, P=0.03). Indeed, women in the lowest testosterone tertile had a flow-mediated dilation smaller than that in the highest tertile (P=0.02).

CONCLUSIONS: This result could suggest that the development of cardiovascular disease after menopause is due not only to estrogen decline but also to androgen decline. More studies are needed to evaluate the role of androgen replacement therapy on postmenopausal women with low level of this hormone.

Testosterone in Post Menopausal Women

An article in the medical journal Current Opinion in Obstetrics & Gynecology says that testosterone therapy is a promising option for treating women with HSDD (very low libido or desire)

Somboonporn W.Androgen and menopause.Curr Opin Obstet Gynecol. 2006 Aug;18(4):427-32.

From the article abstract:

PURPOSE OF REVIEW: Androgen therapy is being increasingly used in the management of postmenopausal women. The most common indication is to improve sexual function. The aim of this review is to evaluate current knowledge pertaining to testosterone and sexual function in postmenopausal women.

RECENT FINDINGS: The change of testosterone levels during the menopause transition remains controversial. A correlation of endogenous testosterone levels and sexual function is still inconclusive. A Cochrane Review and recent randomized control trials have, however, consistently demonstrated that short-term testosterone therapy in combination with traditional hormone therapy regimens improves sexual function in postmenopausal women, particularly surgically menopausal women with hypoactive sexual desire disorder.

An adverse effect on the lipid profile has been identified which appears to be mostly associated with oral methyltestosterone. Data for other effects of testosterone and long-terms risks are lacking. Testosterone may act in a variety of ways in different tissues. This is, however, an area that requires further investigation.

SUMMARY: Testosterone therapy is a promising option for treating women with hypoactive sexual desire disorder after surgical menopause. Two remaining questions need to be answer: who is most likely to benefit from testosterone therapy and what are the long-term health risks?

Testosterone For Women Studies and News

Testosterone and Libido in Post Menopausal Women
Researchers writing in the medical journal Gynecological Endocrinology say that there is emerging evidence that androgens are significant independent determinants affecting libido and satisfaction, as well as mood, energy and other components of women’s health.

Testosterone in postmenopausal women
An article in the medical journal Current Opinion in Obstetrics & Gynecology says that testosterone therapy is a promising option for treating women with HSDD (very low libido or desire)

Testosterone enhances libido and decreases depression
Researchers reporting in the Journal of Neuropsychiatry and Clinical Neurosciences say Testosterone enhances libido and decreases depression.

Schutter, et al. J Neuropsychiatry Clin Neurosci.2005; 17: 372-377. Depression Administration of Testosterone Increases Functional Connectivity in a Cortico-Cortical Depression Circuit.

From the abstract: “Increasing evidence suggests that the steroid hormone testosterone (T) enhances libido and decreases depression. Even a single administration of T (0.5 mg sublingually) in healthy young women is sufficient to enhance physiological sexual responsiveness….” Read the abstract

Testosterone For Libido Loss In Women
September 19, 2005’s Washington Post reported “a position statement from the North American Menopause Society (NAMS) and published in its journal, Menopause,” that testosterone therapy may aid many post-menopausal women dealing with loss of libido. You can read the Washington Post article here.

Study: An overview of testosterone deficiency and supplementation in women.
Davis SR, Androgen treatment in women. MJA 1999;170:545-549.

The researchers state: “Women reporting loss of libido may find physicians insufficiently empathetic, and a biological cause for sexual dysfunction in women is rarely sought. However, it is gradually becoming more accepted that androgen deficiency in women may underpin a variety of symptoms and pathophysiological conditions and that, in selected women, androgen replacement therapy is of clinical benefit.”

“Testosterone insufficiency in women: fact or fiction?”
Guay, A, Davis SR. Testosterone insufficiency in women: fact or fiction? World Journal of Urology 2002;20(2):106-10.

The researchers state: “Androgen deficiency is a true medical condition in both pre- and post-menopausal women. The most important recommendation is to listen to the patient and consider androgen deficiency when the symptoms are present, even if they seem non-specific…Treatment with androgens has to be monitored carefully because of the possible harmful effects of excessive levels of testosterone.”

Bone Loss and Testosterone in Women with Anorexia Nervosa
A study is being recruited, Anne Klibanski, M.D., Principal Investigator, by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the National Center for Research Resources (NCRR) to determine among other things if low dose testosterone will be a benefit in preventing bone loss in women with Anorexia Nervosa.

From the abstract: “Women with Anorexia Nervosa have been found to have low bone density. The study will determine whether administration of low doses of a natural hormone, testosterone and/or risedronate, a medication to help prevent bone breakdown will improve or prevent bone loss in this condition.”

Testosterone Beneficial for Libido and Cholesterol
Researchers reviewing the current medical literature on the role of Testosterone in enhancing libido in post-menopausal women say; “The available evidence is that adding testosterone to estrogen therapy, with or without progestin, appears to be effective in improving sexual function in postmenopausal women and is associated with a reduction in high-density lipoprotein (HDL) cholesterol.”

The findings appear in The Cochrane Library, read the abstract and summary of this article .

HRT, Testosterone and Post Menopausal Women – Problems of Sexual Dysfunction
Researchers writing in the medical journal Maturitas say that HRT along with testosterone supplementation helps postmenopausal women who complain of problems related to intimacy.

Women, Testosterone and Cardiovascular Disease
Researchers writing in the medical journal Coronary Artery Disease say that their study “could suggest that the development of cardiovascular disease after menopause is due not only to estrogen decline but also to androgen decline.”

The Use of Testosterone with Estrogen and Progestogen and Its Effect on Breast Cell Proliferation

Researchers writing in the medical journal Menopause say “Addition of testosterone may counteract breast cell proliferation as induced by estrogen/progestogen therapy in postmenopausal women.”

Testosterone for Women

Testosterone is the male sex hormone, but, it is also an important sex hormone for women. A woman produces testosterone in her ovaries and adrenal glands and obviously produces a lot less than a man because women do not grow the muscles or facial and body hair characteristic of higher testosterone levels.

Girls begin to produce testosterone as they approach puberty for use as a precursor to estrogen. A woman will have peak testosterone levels in her mid-twenties and then suffer a steady decline to half those levels in her forties. In my practice, however, I frequently see some women in their thirties producing an insufficient amount of testosterone (especially after child birth).

Additionally, if a woman has a hysterectomy, testosterone levels can drop quickly and significantly.

Signs of testosterone deficiency in women:
1. Low or no sex drive
2. Lack of energy
3. Obesity, especially abdominal fat
4. Loss of muscle tone
5. Reduced bone mass
6. Increased fracture risk
7. Fatigue
8. Wrinkles
9. Hot flashes despite estrogen therapy

The importance of blood tests
Not all women in perimenopause or menopause will be testosterone deficient. Some of the symptoms listed above could be caused by other hormonal problems or health issues. This is why blood, saliva, or urine testing is so important and why self-medication with “testosterone enhancers” or Testosterone itself based on symptoms alone is dangerous.

We order a blood test for total testosterone, as well as free testosterone. While both levels are important to watch, we want to pay special attention to the “Free Testosterone” reading because it is the active hormone.

When a physician orders a total testosterone reading alone, it is possible to get back a “normal,” “within range” reading on a patient who exhibits clearly defined symptoms for testosterone deficiency. How is this possible?

Because most of the testosterone in the body is linked to proteins, the smaller remaining portion is “free” to make itself available to the cells of the body. Free Testosterone or the lack of it is most responsible for symptoms or alleviation of symptoms associated with testosterone. That is why monitoring its levels are so important in testosterone supplementation therapy.

Many scientific papers, some listed below, have cited the following benefits possible to women taking testosterone.

1. Increased sexual desire
2. Relief of menopausal symptoms
3. Reduction of bone loss / osteoporosis
4. Increased vitality
5. Reduced body fat
6. Improved skin tone by stimulating collagen growth
7. Enhanced “quality of life”

Testosterone supplementation risks
It is important to understand that not all women will benefit from Testosterone supplementation. The goals, realities, and risks of Testosterone supplementation should be discussed, at length, with your physician prior to onset of treatment.

You, Aging, and Hormone Supplementation Therapy

Studies show that when we restore endocrine balance by augmenting hormone levels to their optimal ranges, quality of life improves and degenerative diseases decline.

Is hormone supplementation and age management medicine right for you?
Hormone supplementation has been practiced for decades. Commonly we hear of people who have been on “Thyroid” for over 30 years, and millions of women have been prescribed estrogen.

The typical patient who wants their hormones optimized are healthy middle-aged people that have started to notice some declines in their level of energy, who maybe for the first time in their lives “just didn’t feel like having sex,” who had lost some of the ambition and drive that they enjoyed only a few years ago.

They also notice that their waist line was getting a little wider and that things were sagging lower than before.

Is hormone replacement therapy right for you?
This is a decision you need to make with your physician. Before entering into hormone supplementation, please discuss the benefits, realistic goals, risks, dangers, and side-effects with your physician.

Hormone Supplementation Parts 1 2 3

Hormone Replacement

Hormone Supplementation

What are hormones?
What is hormone supplementation?
How does it enhance vitality even as we age?

Hormones are chemicals within our bodies responsible for many things including the regulation of our metabolism, immune function, blood pressure, sugar levels, body temperature as well as a host of other things including regrowth and repair of damaged tissue. They are produced by our glands, namely the Thyroid (Thyroid), Adrenals (DHEA, Pregnenolone), Pituitary (Human Growth Hormone (HGH)), Ovaries (Estrogen, Progesterone, Testosterone) or Testes (Testosterone), and Pineal (Melatonin). After about the age of 30, our body’s hormone levels start to decline. Many cite this decline with the “normal” aspect of aging and its familiar characteristics of fatigue and loss of energy, problems of memory and mood, lack of ambition, loss of libido, weight gain and muscle loss and much more that add up to a sense of poor health. This hormonal decline continues as we age, and usually becomes problematic in our 40’s and 50’s, although, it can create issues at an even younger age. An example are the statin drugs that can cause a dramatic decrease in testosterone even at a young age. With testosterone decline, we find incidence of erectile dysfunction.

Giving “pause” to thought We have all heard of and embraced the term menopause to describe a decline in the female sex hormones, but there are other “pauses” that are becoming more recognizable as house-hold names. Doctors have coined the terms “andro-pause” to describe the decline of male sex hormones in men, “somatopause” to describe the decrease in human growth hormone, “adrenalpause” to describe a decline in DHEA, and “pinealpause” to describe a decline in melatonin.

In the opinion of many doctors, maintaining optimal hormonal balance is our best opportunity to enhance vitality into “old age” and overcome these “pauses” in life. Some doctors however believe that aging is inevitable and that nothing can be done about it except to accept it gracefully. This is a stigma of modern medicine. On one hand, medicine is proud, and rightfully so, of enormous jumps in life expectancy ages, but on the other hand, they are skeptical about enhancements in quality of life. Therefore some doctors may be reluctant to treat hormonally deficient patients because they see this as a normal result of aging, and something they can’t do anything about.

In other words a 70 year-old man presents himself to the doctor’s office with complaints of loss of sex drive, fatigue, and inability to lose weight. It is likely that his doctor will say, “You are 70 years old, and this is normal for your age!”, rather than take blood tests of hormone levels. If the patient was insistent about getting his hormones checked the doctor may see “normal” results, that are the normal ranges for a man 70 years old and tell the patient that he is normal. But the patient isn’t “normal,” that is why he went to his doctor! He doesn’t want the hormones of a 70 year-old man, he wants the hormones necessary to have sex drive, muscle tone, strength, ambition, joy, and his vitality back. He also wants a good chance to be free of heart disease, diabetes mellitis, and other diseases of aging. Why not check his c-reactive protein, fasting insulin, and homocysteine levels, along with many other markers of hidden disease?

Hormone Supplementation Parts 1 2 3

Testosterone and Ischemic Heart Disease

Researchers writing in Cardiovascular & Hematological Disorders Drug Targets examined lower testosterone levels in patients with ischemic heart disease. The researchers noted recent studies showing that testosterone level is lower in patients with ischemic heart diseases, and testosterone treatment alleviates the symptoms and there is increasing evidence to suggest testosterone confers cardioprotection by direct action on the myocardium.

Tsang S, Liu J, Wong TM. Testosterone and cardioprotection against myocardial ischemia. Cardiovasc Hematol Disord Drug Targets. 2007 Jun;7(2):119-25.

The researchers noted recent studies showing that testosterone level is lower in patients with ischemic heart diseases, and testosterone treatment alleviates the symptoms and there is increasing evidence to suggest testosterone confers cardioprotection by direct action on the myocardium.

Hypoandrogen-Metabolic Syndrome in Men

Gould DC, Kirby RS, Amoroso P. Hypoandrogen-metabolic syndrome: a potentially common and underdiagnosed condition in men. Int J Clin Pract. 2007 Feb;61(2):341-4.

Researchers writing in the International Journal of Clinical Practice say Men with (Hypoandrogen-metabolic syndrome) and symptoms of androgen deficiency may be managed by, in the absence of contraindications, testosterone replacement therapy along with weight reduction and other measures to normalize glucose, lipid and blood pressure control.

The researchers noted that symptoms of androgen deficiency (hypoandrogenaemia (hypogonadism, hypotestosteronaemia) may be a common accompanying factor in men with the metabolic syndrome and when androgen deficiency and metabolic syndrome are present together “they may be considered as a specific entity, the hypoandrogen-metabolic (HAM) syndrome.”

The researchers concluded: “The prevalence of both hypoandrogenaemia and the metabolic syndrome increases with age and the clinician will frequently attend to men in their middle to advanced years with obesity, low androgen levels and metabolic syndrome.

These conditions place men at an increased risk of cardiovascular and coronary heart disease and type 2 diabetes and can be simply investigated with weight, waist and blood pressure measurement and blood sample analyses.

Men with HAM and symptoms of androgen deficiency may be managed by, in the absence of contraindications, testosterone replacement therapy along with weight reduction and other measures to normalise glucose, lipid and blood pressure control.”

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