The Hormone Whisperer: Clinical Observations on Bioidentical Hormone Replacement Therapy

hormonesWhile my job description includes many things, I mostly “do hormones.”  Hormones are not just women’s hormones that need replacing at menopause, but women’s hormones that are out of whack for years before menopause begins, men’s hormones that may be on the decline sooner than they are prepared to handle it, and pretty much everyone’s thyroid and adrenal glands.  Even when people come to me for other reasons, hormones are almost always assessed because they have to be.  So, is it your hormones?  Probably, yes

What distinguishes the work I do from most primary care providers and OB/GYNs, is that I am a naturopathic physician.  I went to four years of med school, took my board exams, have a license which I update yearly with continuing medical education, and a DEA number to prescribe.  In Arizona, I am fully trained to do just about everything your primary care provider will do, and then some.  I integrate all of regular “western” medicine with Chinese medicine, herbal medicine, acupuncture, nutrition and physical medicine.  I even include meditation when necessary.  I look at you, the patient, coming to me with your problem, and ask a lot of questions. I ask the ones you didn’t think would be relevant.  Apparently, for many of my hormone patients, I appear to be a psychic, because I seem to be able to get what they are talking about before they have said all of it themselves.  It’s not that each patient is not unique, it is that hormone problems are so predictable when you look at the larger picture.  This means history, and this also means personal habits.  What astonishes me, is that for many women our visit is the first time it has been reflected back to them as the picture of one person, rather than the mini pictures of different problems they see several different doctors for. 

Recently, it was announced that possibly 70,000 women had died early or unnecessary deaths because they had stopped estrogen replacement during and after menopause.  This is causing alarm among women who did stop hormones due to doctors’ advice warning them that the Women’s Health Initiative (WHI) had indicated that women taking hormone replacement died too frequently compared to their non-HRT (hormone replacement therapy) counterparts.  What is the deal?

Retrospective analysis is good at looking back at trends among a community of people who have self-reported symptoms and habits.This is not the highest level of health study, but it is important because we can’t put everyone in a controlled clinical trial. Unfortunately, during the time of the study, certain questions are routinely asked, and the patient is asked to be honest and have a fair, self-critical assessment in their life, and good recall.  Many important factors are ignored because they weren’t considered relevant, or the patient didn’t think it mattered.

The results of the WHI study have been routinely debunked from being useful, as the application of hormone replacement therapy included all hormones, of all kinds, for all women, of all ages, with all habits, with all possible schedules of replacement.  This is not a good picture, as that included estrogens like conjugated equine estrogen (extracted from horse urine, such as Premarin), which is not native to the human body and can act up to 1000 times stronger on receptor sites than native estrogens such as estradiol, estriol, and estrone.  It included progestins such as MPA (medroxyprogesterone acetate, in Prempro) as well as native progesterone.  A quick Google search of MPA vs. progesterone shows that the “same” chemical family has completely different biological and physiological effects.  MPA is great for birth control, but it’s also the primary cause of blood clots, strokes, heart attacks and some cancer for women taking it that developed these problems.  Other versions of these progestins carry the same risk.

Progesterone is native only to humans, and carries essentially the anti-risk of these drugs.  It’s pretty fascinating, really, because most doctors will not actually know the difference between the two and assume they carry the same risk.Women routinely have their uterus removed, and are told they no longer need progesterone.  Had they had progesterone earlier, they might have avoided the hysterectomy, the anxiety meds, the sleep meds, and possibly developing  breast cancer.  If your doctor doesn’t understand what progesterone deficiency and pregnenolone steal syndrome look like, this will not be addressed at all.  I have fixed this imbalance with a simple and safe (to most) prescription, I have even fixed it with herbs and vitamins.   

So, what’s up?  For one, there are at least six major hormones that need to be balanced, in different ratios for women than for men, and that balance is also specific to a woman’s personal history and individual tolerance.  There are clear side effects from too much or too little of any hormone.  If a woman is still menstruating, it makes a difference.  If she has had a hysterectomy but her ovaries intact, it makes a difference.  If she has had a complete hysterectomy at 30 because of fibroids and ovarian cysts vs. natural menopause at 51, it makes a difference.  How many symptoms she had before and after “the change” makes a difference.  If she is obese, it matters; if she smokes, it matters; if she drinks alcohol, it matters; if she exercises, it matters; if she works long days or night shifts, it matters.  Her symptoms tell us how her body handles the hormones she makes, which ones are deficient, and why she started having certain problems.  In my experience clinically, with hundreds of patients, problems usually start about six to ten years before seeking treatment. 

These six hormones — pregnenolone, progesterone, DHEA, estradiol, estrone, and testosterone  — are the main players on routine labs.  There are other metabolites of these, and a urine sample is a different picture than serum labs. Unfortunately, lab reference ranges vary among labs.  If you have a doctor unschooled in the nuances of what lab ranges mean, and they get back your labs, chances are you are normal.  But normal can mean post menopausal levels to fertile Myrtle.  Most “normal” ranges include feeling really lousy at either end.  Synthetic hormones, the ones not native to the human body, cannot even be measured with labs.

So where to go?  Well, for one, deciding to take on HRT should not be decided lightly.  It is only done well with a commitment and awareness.  Taking hormones when you have a lot of health issues will not resolve them if you are not willing to handle the whole picture.  You will hear the full gamut from friends, those who had no hot flashes to those who had them for ten years.  Those who never did hormones and did just fine, and those who did them and got cancer.  Those who never did hormones and got cancer and those who did them and felt awesome.  Hormones are not a requirement, but hormones make us feel younger, happier, healthier, more vital in many ways because they (when applied safely and appropriately) have an anti inflammatory and anti-aging effect.   Done correctly, they reduce the risk of cardiovascular disease and cancer, prevent bone and muscle loss, protect the brain from atrophy.  They impact mental and physical health on every level, as they are active on every cell in the body. 

Why do hormone replacement?  Most women I know don’t expect to be old at 50.  They are working full-time, many in demanding careers, maybe married, usually still raising children or helping their adult children who are struggling with adulthood and child rearing themselves.  They want to be physically and sexually active, they want to sleep through the night, and they want to remember things they just talked about earlier that day.  Hormones have an effect on all of those things.

Major stress is usually the huge interrupter of healthy hormone balances, typically starting in the mid to late 30s, early 40s but clinically I am seeing this start in the 20s for some women.  This disrupts sleep, mood, menstrual cycles, weight control, and fertility.  It is only addressed when one of these things or more starts to require a lot of medication or disrupts their lives, often after years of problems.  It may be sex hormones, it may be adrenal and thyroid hormones, but all of these things impact health.  Diet and exercise play in, and let me be the first to say that diet soda is the same as a “cigarette in a can,” in what it can do to your mental, metabolic, endocrine (hormonal) and cardiac health.  Energy drinks are no laughing matter.

Until physicians and patients wake up to the reality that the diet and life choices of young women are negatively impacting their hormonal health, these problems will continue to show up much earlier in life than menopausal symptoms.  While no one has to go on hormone replacement therapy, the same risks for cancer, heart disease, diabetes and Alzheimer’s exist with or without hormones —  it is what you do with your body, what you put in your face most of the time.  With bio-identical hormones, the aging process seems to slow, and these risk factors may be diminished, and damage slowed or reversed.  Even with genetic risk factors, how you live will have the largest impact on how your hormones are handled by your body.  The worse it is earlier in life, the worse it is later. 

As a practitioner, I am always hopeful and I am always helpful.  There is not a patient I see that I cannot help, even if that just means cleaning up their diet and nutrition while they are facing the reality of breast cancer.  I don’t believe that all hormone replacement, managed well with a lot of oversight, is dangerous even for women who have had hormonal cancers.  Unfortunately, the fear generated in them is enough to make them stop looking for help when they still have many issues to resolve that will make a huge impact on their health future.  Our high stress and high toxin environment doesn’t make menopause a safe or easy time for any women.   With a well-informed practitioner, hormone replacement should hopefully make it a little bit better.

Guest contributor Dr. Christine Hicks, NMD practices in Phoenix and Mesa, AZ, specializing in hormone replacement, weight loss, digestive disorders, pain management and general health.  Visit her at www.drchristinehicks.com. You can follow her on Twitter at @DrChristineNMD.

** This article is not intended to dispense medical advice with respect to abstaining from or seeking medical treatment from a qualified health practitioner.  Dr. Hicks does not endorse taking hormone replacement therapy for any person without a full health history and physical exam, from a trusted practitioner and prescriber, and using a reputable compounding pharmacy.  Any opinions expressed here are the opinion of Dr. Hicks from direct clinical experience, and may conflict with the advice from your family physician or specialist, or the National Institute for Health. **

Image via isSockphoto/marekuliasz

  • Sheila Luecht

    Very interesting. I am sorry that I am not closer to you geographically. I would be interested in what you had to say and recommend. There is a link now established between poly cystic ovaries and diabetes. If hormones are not in balance I wonder what role this plays in the development of the disease. Interesting too is the digestive issues and obesity. I think there is a relationship between all three. Many women are fertility patients and have certain issues which can now be traced to genetics and disease pre disposition. It would be interesting to know the hormone and thyroid relationships to all this and what actually is causing it, diet, genetics, certain pre dispositions and other analysis would be beneficial. Women’s health has long been on the back burner in science. Pharmaceuticals were originally only tested on men. Now we have politicians interfering with women’s health. Wouldn’t it be great to actually focus on healing women and doing so without the influence of big pharma and politicians and religious nit wits? Thanks for writing this.

    • Dr Christine

      Sheila- there is an absolute link between PCOS and insulin resistance, which leads to Metabolic Syndrome (Syndrome X) and ultimately diabetes. High fructose corn syrup and gluten (yes, it acts on insulin receptors) are two of the major players in that, but so are aspartame and sucralose. Plus, the millions of xenoestrogens in our food, beauty care and plastics. There are studies, they tend to be small and don’t find their way into the news. You have to follow the money on those. Turns out, studies on diet and weight control also always done on men until recently. Did you know that women are not the same as men? Who knew?

      • Dana

        I have reason to believe stevia also affects the body. Everyone praises it because it’s natural. I never had a problem with sucralose. After I replaced it with stevia my weight started creeping up. It might have done that anyway given other choices I was making at the time, but I’m suspicious. I will have to experiment on myself to find out for sure.

        The experiments they’ve done with sucralose, they did not make clear whether it was bulked. If it was bulked then they did not control for the maltodextrin or dextrose they were using to carry the sucralose. Those are often made from corn, and if it’s not organic corn it may be GMO. Very important detail to be overlooking.

        I do NOT believe that natural is always better, especially in someone whose body is already out of balance. Praise “natural” sugars all you want, they all make me sick in high enough doses, and I’m already in the midst of metabolic syndrome, some of which symptoms I control with diet. For being over 200 pounds my blood pressure is very good and my HDL and trigs are at better than normal levels. They get even better when I don’t do the sugar.

        Presently I’m in the middle of a Whole30 cycle (Google it) so I am not even using the stevia. I’m motivated; I want a month where my body gets to take a break from it. I deviated a tiny bit last night because apparently my body doesn’t like more than a small serving of tomato-based food at a go, especially in the evenings, so I took an antacid. It was that or not sleep, and it had sweetener added. But that’s as far as I go. It shouldn’t be a setback. (I do make sure to get the ones that don’t have mineral oil or talc added to them–yuck!)

        Oh and there are other animals that make progesterone. It may be a slightly different molecule since it’s not us making it, and their cycles look different than ours do, but… there you go.

  • Lezlie Bishop

    I have a friend who suffered total ovarian failure in her 30s. She has sought help from doctor’s like you — naturopaths/MDs — and has been taking a hormonal cocktail ever since. I can’t imagine what her life would have been like without HRT. She will soon be 50.

    Lezlie

    • Dr Christine

      I am glad she found help early and from the right people who could help without causing more harm. It’s always a delicate balance. What saddens me is how many young women in their 30s and 40s are getting counseled to get hysterectomies, and some even suggest taking the ovaries out while they’re in there. The quality of their lives so often diminished when the surgeon or follow up doc doesn’t know how to keep their hormones in check.

  • Anna

    I developed POF in my early 30’s and have been on hormone replacement using Estring since having my last child 4 years ago (donor egg, IVF). I am now 45 and at my last annual check-up, the gynocologist made me feel like I’m putting my health at risk by continuing to use the Estring. She gave me the impression that I’ve been on it too long now and that I could be at risk of developing uterine or breast cancer. I have no particular family history of either. She is a new MD in the practice, and the other two that I’ve been seeing for years have always told me that Estring is safe and I could stay on it for as long as I liked. I’ve stopped using it and the hot flashes and other symptoms have returned. I’m completely confused as to what I should do, but I know I’m not ready to feel ‘old’ yet.

  • Dana

    Something everyone seems to overlook when it comes to female reproductive health is the role of vitamin A. I mean the real stuff, not beta carotene. They’ve been using A to relieve menorrhagia in women living in developing countries since the late 1970s. I found it useful for my own heavy periods. I’m also suspicious that I have endometriosis attached to my sigmoid colon or very near it, and I can tell I haven’t had enough A in the past month if I start getting twinges there the day or two before my period starts. It’s like having a big stitch in my side. Doctors tend to cause more problems than they fix in trying to diagnose endo, so I haven’t pushed for it, but I’ve had this problem for well over ten years, and it got worse after my second child was born (almost 9 years ago) and my period came back postpartum, so I doubt it’s cancer–I’d be dead by now.

    But I hear about women with endo managing the symptoms with vitamin A or with cod liver oil. And I wonder how many women have gone on hormones or gotten hysterectomies who just needed to eat a little liver a couple times a week. So many people now believe it’s a bad food because it contains cholesterol and because of the myth that it contains toxins. They’re also afraid of real vitamin A for some reason I cannot fathom. Our kids are suffering the consequences. I have reason to believe that at the least, urinary tract defects are caused by vitamin A insufficiency in the prenatal period–and they are the most common class of birth defects in the United States, according to the Mayo Clinic. We’re also seeing a lot of kids in glasses, eye development also being influenced by vitamin A. And babies with rotting teeth, which has been blamed on bottles. Tooth enamel development is mediated by vitamin A. This doesn’t get enough attention, in my opinion.

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