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Hormone Replacement Therapy

The area with perhaps the most recognizable and immediate impact for the average person is the correction of hormone deficiencies. The hormone therapy most widely recognized by the general public is treatment of hypothyroidism with thyroid hormone. Women have been receiving Hormone Replacement Therapy (HRT) for many years, and similar therapies for men are becoming much more common. With the increase in awareness of the concept of “anti-aging,” more costly and potentially dangerous Hormone Replacement Therapies such as hGH (human Growth Hormone), have become more desired.

HRT can be safe or careless. Overly aggressive HRT of any type (thyroid, estrogen, progesterone, testosterone, DHEA, or hGH) can be dangerous. Physiologic HRT is best done through a physician, and should include a well-recognized method of measurement. The goal should be balanced physiology at the lowest dose of hormone without side effects.

With HRT, more is definitely not always better. Hormones work through receptor sites on the cell membrane. Too much of a hormone causes the specific receptor sites to recede. Frequently, the response is to increase the dosage of the hormone, which only further decreases the available receptor sites. This defines the classic case of “resistance” to a hormone.

Hormones bind to a receptor site on the cell membrane and are then carried to the cell nucleus where they exert their particular function. Hormones are carried in pairs on specific carrier proteins. For instance, thyroid and cortisol are carried together, one molecule of each per carrier protein. If there is an over-abundance/overdose of either cortisol or thyroid, the balance of the two hormones can be disrupted. It is imperative that hormones be supplied in balance and not over-prescribed to achieve a sought after effect.

There is an ongoing debate about the differences (if any) between synthetic hormones (Premarin/Provera) and hormones that have the same molecular structure as the hormones produced naturally by the body, so-called ‘bio-identical’ hormones. The US Food and Drug Administration has challenged the use of the term ‘bio-identical’. A more accurate description might be ‘molecularly identical’, meaning that the molecule is the exact same geometric shape with the same construction as the hormone made by your body. Thus, Synthroid actually is a molecularly identical form of thyroid hormone and, technically, would be a ‘molecularly identical’ mode of HRT. Synthetic hormones such as Premarin (made from horse urine) can bind to hormone receptors and trigger activity, but cannot be converted to other human hormones or be metabolized in the same way as hormones produced within your body.

Hormone testing can be done in multiple ways, and is most frequently done through blood testing. This method is time-tested, allows for predictable interpretation, and is covered by most insurance policies. Other methods include urine and salivary testing, and each has its advantages and disadvantages. Most important is that the practitioner is experienced in hormone assessment and HRT, and is comfortable with the testing methodology used. Hormones can be delivered by creams, troches (sub-lingual), pills, or injections. They are individualized for the person and their unique physiology.

For men, we test for total testosterone, free-testosterone, estradiol, and PSA (prostate) to assess the functional levels of testosterone. However, we also test DHT and LH when necessary and indicated. There are many ways to balance testosterone, but they divide into two classes: supplying the testosterone directly or helping the body increase its own production of testosterone. Replacement of testosterone in men is less about sexuality and more about creativity, initiative, sense of self, body strength, and an overall mental and emotional sense of well-being. The goal is to find a physiological balance as opposed to an extreme. HRT should always be geared toward obtaining an optimum level for the particular individual, usually near the center of the often broad standard reference ranges that are used for disease. Follow-up testing should be done within the first two months of initiating therapy to ensure both an adequate response and to be certain that the PSA has not risen. The only side effect from testosterone that is dangerous is activation of an already existing prostate cancer.

Female hormones are similar, yet different. We test estradiol, progesterone, DHEA and testosterone, and again look to find a balance. The treatments are varied, and can range from prescription hormones using standard pharmaceutical dosages to using compounding pharmacies that can create personalized dosages. In the latter case, more precision is possible, making it easier to create combinations appropriate to the individual.

Author: Dr. David Luce

W. David Luce, M.D., P.C. is a Board Certified Internist in private practice in Boulder, Colorado. He is recognized as a innovator and thought leader in the integration of Western medicine with complimentary therapies.

Dr. David Luce | MD

W. David Luce, M.D., P.C. is a Board Certified Internist in private practice in Boulder, Colorado. He is recognized as a medical innovator, educator, public health advocate, and a leader in the integration of evidence-based Western medicine with complimentary therapies. Educated at Dartmouth, Harvard and Yale, Dr. Luce has over 20 years experience designing and implementing innovative treatment programs that restore health and wellness to his ...

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