As we age, our hormone production declines in predictable fashion; and it begins earlier than you might think. By the time we are in our thirties and forties our production of sex hormones may be low enough to cause serious symptoms. Although both genders produce all of the sex hormones, men produce predominantly testosterone and women produce predominantly estrogens and progesterone. The sex hormones are familiar to most people as the hormones that determine our gender, our secondary sexual characteristics as we mature and many aspects of our fertility.
But did you know that virtually all of our organs and tissues have receptors for the sex hormones, which means that these tissues respond to the sex hormones. Testosterone, estrogen and progesterone have profound effects on the health of the muscles, bones, cardiovascular system, brain, eyes and other endocrine systems, to name a few. So, not only do we have unpleasant symptoms with hormonal decline, but also it is detrimental to our health.
Until 2002 women were prescribed the synthetic hormone Premarin, conjugated equine estrogens or CEEs, derived from the urine of pregnant horses; Provera, the synthetic medroxyprogesterone acetate or MPA; or Prempro, a combination of the two. Usually, this prescription was issued long after menopausal symptoms had been evident, and usually without any lab testing. One dose was prescribed for every woman.
In 2002 the Women’s Health Initiative (WHI), a study led by the National Institutes of Health looking at the effects of Prempro on cardiovascular health, osteoporosis and cancer, was abruptly terminated just 8 years into the study. The study already showed an increase in the risk of heart attacks and stroke and breast cancer. These study results were widely publicized in the popular press with the result that millions of women suddenly stopped taking their hormone replacement either by their own decision or on the advice of their doctors. Hormone replacement has come to be viewed with fear, and women are basically told you just have to “tough it out.” (Often antidepressants are prescribed.) This is much like telling a diabetic to “tough it out” without insulin.
As for men, symptoms of hormonal decline are often not discussed, not addressed and are largely ignored. Men might be given a prescription for erectile dysfunction, but this does not preserve muscle, bone, heart and endocrine health the way testosterone would.
For women, is there an alternative? And, if so, is it really any better or safer than the out of favor synthetic hormones? The short answer is yes, bioidentical hormones or hormones that are natural versions of human estrogens and progesterone are very different form the synthetics and are more safe. They are usually prescribed on an individual basis, i.e., different dosing for different needs of different women, with lab testing to determine the level of need and the response to therapy.
First of all, women feel better on the bioidentical hormones. Secondly, there are numerous studies showing that bioidentical hormones are protective for the cardiovascular system in several different ways (increased coronary artery blood flow, decreased arterial plaque, decreased arterial spasm, and a favorable influence on lipids), thereby decreasing the risk for heart attack and stroke. Additionally, the synthetic, MPA, has been shown to increase insulin resistance (type II diabetes) compared to bioidentical hormones, which adds to the cardiac risk. Also, because bioidentical estrogen is given transdermally, there is not the increase in clotting factors, inflammatory proteins and risk of thromboembolism (blood clots) seen with synthetic CEEs given orally.
Perhaps most alarming is the known increased risk of breast cancer in women on MPA and the known carcinogenic (cancer causing) components and metabolites of CEEs. The natural estrogen, estriol, has been shown both experimentally and clinically to be associated with a decreased risk of breast cancer. Bioidentical progesterone has an anti-proliferative effect on breast tissue, meaning it has an anti breast cancer effect, which is opposite to the effect of the synthetic, MPA.
The results of the WHI study make sense intuitively—one glance at the path by which our sex hormones are made reveals that small changes in the sex hormone molecules can completely change their function and effects. It should come as no surprise, then, that synthetic hormones that differ from our natural ones have completely different effects on the various tissues of our bodies.
There are many other good reasons for both women and men to be on bioidentical hormone replacement therapy including preservation of muscle and bone health, prevention of Alzheimer’s disease, prevention of eye disease, preservation of urinary tract health, and preservation of libido and zest for life!
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