Frequently Asked Questions About Bioidentical Hormone Replacement
Utah Bioidentical Hormone Therapy Specialist Ray Andrew, M.D. of Hormone Centers of Utah offers important answer regarding Bioidentical Hormone Replacement Therapy.
Q: What happens when the ovaries stop functioning optimally?
A: They fail to produce adequate testosterone, progesterone, and estradiol for the body’s needs. This can happen during the postpartum period, premenopause, perimenopause, or menopause. This loss of hormones leads to both immediate manifestations (symptoms) and increased risks of chronic degenerative diseases.
Testosterone deficiency is an important cause of Heart disease, Diabetes, Dementia, Fatigue, Depression, Muscle weakness, Difficulty with orgasm, Lack of motivation, Loss of mental sharpness, Diminished feeling of well being, Loss of sexual sensitivity (nipples/genitals), and Dry skin. Progesterone deficiency causes Insomnia, PMS, Mood swings, Endometrial Cancer, Dementia, Osteoporosis, and Heart Palpitations. Estrogen deficiency can cause Hot flashes, Night Sweats, Insomnia, Mood swings, Memory loss, Vaginal dryness/atrophy, Headaches, Irritability, Painful intercourse, Dry skin, Heart palpitations, Poor concentration, and increased Urinary Tract and Yeast infections. All three deficiencies contribute to Anxiety, Depression, Loss of Sex Drive, Poor Concentration, Breast cancer, and Osteoporosis.
Q: Do men need hormones?
A: Yes. Due to a number of factors, the average male testosterone level has decreased by 200mg/dl in the last 20 years! Increasingly we are finding men experiencing significant testosterone deficiency, some even in their 30s. We also treat men in their 90s. Men with testosterone deficiency (aka andropause) often notice an inability to maintain their muscle tone, poor sexual performance (including erectile dysfunction), malaise, and a loss of their zest for life. For some, the decline they experience is so insidious that they don’t recognize it. Instead, they gradually reduce their physical activity level and expectations for themselves, chalking it up to getting older, or assuming that their interests have simply “matured” over time. But there is much more to testosterone than physical strength, energy, and keeping the sexual juices flowing. As noted above, testosterone plays important roles in mood, physical strength, energy, sense of wellbeing, and avoidance of prostate cancer, dementia, osteoporosis, diabetes, and heart disease.
Q: Isn’t hormone replacement unnatural?
A: Sure, just like taking vitamin C is unnatural. It’s your choice—let nature run its course, or acknowledge the fact that you are outliving your body’s ability to produce some of the critical hormones you need. If you lack them, you are guaranteed to suffer any one or many of the degenerative diseases listed above, even if you have no immediate symptoms of menopause or andropause.
Q: Are there any side effects to hormone replacement?
A: Many men and women experience greater desire for intimacy. In fact, most men who present to our offices do so because they suddenly have a hard time keeping up with their wives, who now have their hormones back! As for other side effects, when a woman first starts hormone therapy, there may be mild, temporary breast tenderness and/or water weight gain. These resolve on their own. Hormone receptors can take time to adjust. The body will tone up, as bone density and muscle mass increase and fatty tissue decreases. Some women have too much of an enzyme that converts testosterone into dihydrotestosterone, causing some facial hair and/or acne. This can be remedied with an over-the-counter supplement. Dr. Andrew has yet to have a patient say she no longer wants testosterone due to facial hair or acne. Men may notice a darkening of their gray chest hairs, but we likewise have yet to find a man who stops testosterone because of it.
Q: At what age should I stop taking hormones?
A: When do you want to stop living? The concept that one must take the lowest possible dose of hormones for the shortest possible time period comes from studies of drugs, not human hormones. You can stop taking hormones any time you like. However, if you were to take a look at graphs of every major killer in America (prescription drugs, heart disease, cancer, diabetes, osteoporosis, Alzheimer’s, etc.) across the lifespan, you will notice that there is a strong correlation between disease and the loss of hormones. Ever stop to ask yourself why, for example, pregnant women (who have the highest levels of hormones) rarely get breast cancer while women in their 50s and 60s (who have pathetic levels) develop the disease at an alarming rate? It’s not a coincidence.
Q: I want to try hormone replacement. Can I take a pill?
A: Excellent question. Doctors who do not specialize in hormone replacement often prescribe pills, sometimes even “bio-identical” estradiol. Unfortunately, oral estrogens and testosterone increase breast cancer, heart disease, stroke, and liver cancer. Similarly, doctors prescribe “one-size-fits all” synthetic testosterone injections for men, unaware that this route of delivery causes widely fluctuating hormone levels, requires close lab monitoring, and increases one’s risk of liver disease and liver cancer.
Q: So, what form of hormone replacement do you recommend?
A: The overwhelming majority of our patients prefer subcutaneous pellet therapy, often called “The Ultimate Hormone Therapy.” Hormone pellets are the best, most natural way to deliver hormones in both men and women who no longer produce enough on their own. Implants, placed under the skin, consistently release small, physiologic doses of bioidentical hormones. Pellets are made up of either estradiol or testosterone. The hormones are pressed or fused into very small solid cylinders. These pellets are larger than a grain of rice but smaller than a ‘Tic Tac’. In the United States, pellets are made by a compounding pharmacist and delivered to the physician in sterile glass vials.
Q: What are the benefits of Pellet Therapy?
A: Pellets deliver consistent, healthy levels of hormones for 4-6 months. They avoid the ups and downs of hormone levels seen with every other method of delivery. It is the fluctuation in hormones that causes many of the unwanted side effects and symptoms of other hormone replacement methods. Estradiol pellets maintain the normal ratio of estradiol to estrone, reducing the risk of breast cancer. Testosterone pellets improve cholesterol, whereas testosterone creams and gels make it worse.
Q: If pellets are so good, why haven’t I heard of them?
A: Another excellent question. Pellet therapy was pioneered in the United States in 1939, but is much more common in Europe and Australia today. There is more data to support the use of pellets than any other method of delivery of hormones. Unfortunately, medical education in North America is controlled by drug companies. Most physicians decry bioidentical hormone replacement because they know nothing about it, except perhaps the propaganda they have received from the drug companies and the specialty journals. Medical schools and residency training programs only teach us how to use patented drugs. A small percentage of us spend the additional time and money obtaining specialized training in human hormone replacement. Fewer still learn how to use pellets because there is a lot more to it than merely writing a prescription or even performing a surgical procedure.
For these reasons, many of our patients have approached their physicians about pellets and been disappointed. Don’t lose faith in your physician merely because he (or she) has not taken the time to search out and read the studies about pellets. Unless he specializes in it, he is not going to have the time (and be willing to spend the money) to learn about it, practice it under the guidance of a pioneer in the field, and perfect it in his own practice.
Q: Where do the pellets go?
A: Pellet insertion is a relatively painless procedure done under local anesthesia. The pellets are usually inserted in the hip through a small incision which is taped closed. Experience of the health care professional is important, both in determining the correct dosage of hormones to be used and in their placement.
Q: What are the risks of pellets?
A: Complications from the insertion of pellets include minor bleeding, bruising, discoloration of the skin, infection, and possible extrusion of the pellet. Other than slight bruising, or discoloration of the skin these complications are uncommon. Even though you can shower the next day, you need to avoid tub baths, hot tubs, and swimming for 3 days while your wound heals. Vigorous physical activity is avoided for 3 days in women and 7 days in men. You want to minimize blood flow to the hip and buttock while the implant site is healing. The more blood flow, the quicker the hormones will be absorbed into the bloodstream (and therefore used up). Once the site has healed, you can exercise all you want. If this sounds like a lot of hassle, it’s only because you’ve never experienced pellets. Our patients who have used creams or troches before discovering pellets never go back.
Q: What can I expect after pellet implantation?
A: Everyone is different. Some patients begin to feel better within 24-48 hours, while others may take a few weeks. You may notice that you have more energy, sleep better and feel happier. Muscle mass and bone density will increase while fatty tissue decreases. You may notice increased strength, coordination, and physical performance. Your skin tone and hair texture may improve. Concentration and memory may improve, as will overall physical and sexual health. The bottom line is that hormone replacement improves health and wellbeing to the extent that the deficiencies are responsible for the problems in the first place. In other words, if you are still tired once your hormone levels have been optimized, we need to look for other causes of fatigue.
Q: How do you know when to take the pellets out?
A: We don’t take them out. They dissolve and get used up. They consist of pure hormone, so there is nothing to remove. Pellets usually last between 4 and 6 months in both men and women. If you are pleased with the results, then you undergo repeat insertion.
Q: If bioidentical hormones don’t come from horses (like Premarin does) and they’re not drugs (like birth control pills are), where do they come from?
A: They are converted in the laboratory from plant hormones into human hormones. Unfortunately, the human body does not have the enzymes necessary to make this conversion itself. This is why yam and soy products provide very limited hormonal benefits to humans.
Q: Do I need progesterone?
A: We recommend progesterone for all women. U.S. medical schools continue to perpetuate the myth that progesterone is only necessary for pregnancy and prevention of uterine cancer. At the same time, it is well documented that there are progesterone receptors throughout the body, especially in the brain, breasts, and bones. Doctors with advanced training in bioidentical hormone replacement know that progesterone plays important roles in promoting health and preventing disease, as explained above. On the other hand, the body has no receptors for progestins (chemical drugs used to replace progesterone while making profits for drug companies). Provera was the progestin that was found (in the infamous Women’s Health Initiative) to INCREASE breast cancer, heart attacks, blood clots, and strokes, exactly the opposite effects of human progesterone.
Q: Can I get progesterone in the implants?
A: Unfortunately, this is not feasible for two reasons. Women require far more progesterone than estradiol and testosterone combined. That would be a butt-load of progesterone, so to speak. Secondly, the body was not designed for continuous progesterone stimulation. You need to take a break from it, usually weekly or monthly. The length and frequency of the break depends on multiple factors and will be determined during your consultation appointment.
Q: So, how will I take progesterone?
A: This will also be determined during your appointment. Fortunately, oral progesterone does not carry the risks that oral testosterone and estrogens do. Some women do best with oral capsules, some with topical or vaginal creams. Depends on your circumstances.
Q: Can pellets be used before menopause?
A: Absolutely. Women at any age may experience debilitating hormone imbalances that benefit from replacement. Pellets are useful in severe PMS, postpartum depression, menstrual or migraine headaches, and sleeping disorders. Pellets may also be used to treat hormone deficiencies caused by birth control pills.
Q: How do you know how much of each hormone to give me?
A: Unlike the standard approach utilized with drug company substitutes for hormones, bioidentical hormone replacement is customized for your needs and circumstances. Your doses are determined based on your blood levels, symptoms, health conditions, and response to previous implants. Blood levels are checked before and one month after the first implants. Levels are rechecked a few months later, in anticipation of the next implants. After 12-18 months, levels are checked less often. In men, blood counts and PSA are monitored every 6-12 months.
Q: How does the cost of this therapy compare to the mainstream approach?
A: When compared to the cost of drugs to treat the individual symptoms and complications of hormone decline, pellets are very cost-effective. There is more data on the effectiveness of pellets for preventing and treating osteoporosis, for example, than there is for any chemical drug on the market. Surgery for a hip fracture alone costs tens of thousands of dollars. A single osteoporosis drug (poorly effective anyway, and riddled with long-term risks) costs $100-130 per month. Consider also the staggering cost and number of drugs used to treat insomnia, depression, sexual dysfunction, obesity, diabetes, high blood pressure, heart disease, Alzheimer’s dementia, and many other conditions. Add to that the numerous side effects and interactions between patent drugs and you can quickly see that bioidentical hormone replacement is actually a bargain. Moreover, it’s just what your body was made for.
Q: I want pellets. When can I start?
A: We want to ensure that your consult and implantation visit go smoothly, especially if you are traveling from out-of-town or out-of-state. To facilitate this, Dr. Andrew reviews all of your paperwork in advance. Call the office to schedule your appointment, after which you will be sent the necessary forms and instructions. Returning the forms and having your blood drawn as soon as possible will ensure you the best results and experience.
*Although the statements in this document have been substantiated by numerous studies worldwide, they have not been evaluated by the U.S. FDA. Because drug companies can’t patent what is found in nature, there is no incentive for them to pay hundreds of millions of dollars for approval of bio-identical hormones that any compounding pharmacy can make. This product is not intended to diagnose, treat, cure, or prevent any disease.