Understanding BHRT

By: Carol Land MS, RD, LDN

Why do I need BHRT and how can I get started? Each of us are unique, with our own genetic codes and environmental stressors, requiring  a customized program to help balance our hormones in order to achieve optimal health. When our hormones are in balance, the quality of our lives will improve because living out of balance takes a toll. As we get older, our hormone levels naturally decrease and this decrease is one of the causes of aging. The sex hormones help serve as antioxidants and help prevent oxidative damage caused by cortisol, which becomes elevated with stress. Oxidative stress accelerates aging. A good place to start, to potentially help slow this process, is to provide the body with the necessary nutritional and physical elements it needs to produce hormones in order to determine if this will provide adequate assistance to our systems. Lifestyle factors that we can control include: proper diet, adequate rest and relaxation, exercise, sleep, drinking enough water, social interactions, and detoxification. These are foundational factors that need to be in place to provide support for our hormonal production.

Do I need a prescription from a doctor or is there something at the pharmacy I can try first? At  CCNP, we have hormonal support formulas developed by Dr. Joseph Collins to improve the function of hormones via herbs that interact with hormone receptors and/or assist or mimic co-activators for hormonal reactions. There is an established protocol for the use of these formulas which can be used prior to starting BHRT or as an adjunct to BHRT therapy to improve effectiveness.
We also carry some hormonal formulas that can help your body produce the sex hormones. The body manufactures hormones from cholesterol through a relatively complicated process. Pregnenolone is the first hormone made from cholesterol and progesterone is the second. Taking these replacement hormones provides the body with assistance in hormone production because the first and second step will be bypassed. Further down the hormone pathway is DHEA, which is also a precursor to several sex hormones. Your physician will be able to guide you, based on your test results, on appropriate levels and forms to take.

I’ve been afraid to take BHRT because of side effects but since going through menopause, I’m having such a problem with hot flashes, night sweats, poor memory, decreased sex drive, muscle loss, weight gain, insomnia, joint pain and depression; that I’m getting desperate. Studies that have been done, like the Woman’s Health Study, were done on synthetic hormones (i.e. Premarin, Provera, Prempro) because these are manufactured by pharmaceutical companies and have a profit margin large enough to fund research.  One of the outcomes of the Woman’s Health Study that was not widely published to the general public was that the use of individualized transdermal hormones, that resemble the ones in our body, should be considered a good alternative to the synthetic hormones. The bio-identical hormones are similar to the hormones in our bodies and are made from plants. Less research has been done on BHRT because they can’t be patented and there is not the profit motive that existed with the synthetic hormones but the preliminary research has been promising.

Should I take my hormones as a transdermal cream or can I just take them in pill form? Testosterone must be taken in the transdermal, skin cream form or sublingually because if it is taken by mouth and enters the stomach, it will be digested and pass to the liver rendering it inactive. Oral forms of estrogen (estradiol) are available but oral preparations are not necessarily predictably absorbed and will first pass through the liver where they are metabolized and will develop unwanted side effects. Oral estrogen that passes into the liver effects an increased production of C-reactive protein, which causes inflammation and is a predictor of heart disease.  Among other studies, the journal of Arteriosclerosis, Thrombosis and Vascular Biology, 2004, reported adverse effects on predictors of heart disease, affecting HDL levels, with oral estrogen but not with the transdermal form.

The journal, Menopause, reported a study result in March/April of 2009, that oral estrogen demonstrated increased risk of blood clots in menopausal women but that the transdermal form showed no increased risk of blood clots. Alternative routes of administration have been developed, such as transdermal creams, which bypass the liver before primary target organs are hit.

Progesterone may be taken orally if it is micronized (a very small particle size to speed up absorption), produced in a waxy matrix to cause a slow rate of absorption or as a transdermal cream. If oral progesterone is not micronized, it will not be absorbed in a bioactive form.

How do I apply the creams or gels that I get from CCNP? The prescription should be applied about the same time every day. Read the syringe carefully to apply the amount prescribed and rub it into the skin until the skin is dry. Usual sites for application are the inside of the upper arm or inside the thigh where there is no hair to interfere with absorption. It is recommended that you rotate the sites with each application. Check with your doctor to determine their preferences for use.

Do men need hormone replacement therapy, too? Absolutely! Men experience andropause and don’t often know it because it may occur very slowly. They have more vague symptoms than women undergoing menopause because men’s symptoms gradually encroach on their lives. Men produce less testosterone as they age and some of the symptoms of low testosterone levels include: increase weight (fat stores) gain, loss of muscle, fatigue, loss of energy, anger, irritability, depression, increased risk for sleep apnea, trouble with memory, decreased libido, and decreased self esteem. Between 40 and 55, men start to experience a drop in bio-available testosterone and some experts have estimated that by the age of 55, 50-75% of men will be low in bio-available testosterone.

Can you recommend some doctors to help me get my hormones balanced? At our office, we have a list of all the doctors in the area that provide these services. Please call or stop by for a complete listing. You will need a doctor’s prescription to get your hormones.