There are three different types of estrogen found in women, including estrone, estriol, and estradiol. Estrone is the predominant form found in menopausal women, while estriol is the predominant form of estrogen in pregnancy. These are weak estrogens and there is no data to show one is safer than the other.
Estriol, which is used by many doctors who prescribe bioidentical hormones, is really a weak breakdown product. Biest, a combination of estriol and estradiol, was thought to be protective against breast cancer but this was never proven and, in fact, lowers the cardioprotective effects of estradiol. Estriol’s benefit is that it can effectively alleviate hot flushes and is used to treat vaginal dryness.
Estradiol is the most biologically active form of estrogen, which means cells that are sensitive to any form of estrogen respond the most to estradiol. Estradiol production significantly diminishes in menopause but can be replaced either as an oral or topical preparation. Each has its advantages and disadvantages.
Oral estrogen, derived from soy, can be offered at the onset of menopause to women in good health without a family or personal history of blood clot formation. There are at least six excellent randomized trials or studies that confirm there is no association with oral estradiol and breast cancer, stroke, blood clot formation and hypertension.
Aside from all the benefits of symptom relief, oral therapy has one unique advantage over topical preparations: many studies have shown oral estrogen reduces the risk of heart disease by as much as 50 percent, something topical estrogen cannot do. The advantages of a major reduction in heart disease are a compelling argument for estrogen replacement therapy considering almost 90 percent of women will die from a cardiovascular event.
On the other hand, women taking topical estrogen will have all the benefits of symptom relief and medical advantages of estrogen without the extent of heart disease reduction afforded by oral medication. Anyone with heart disease, hypertension or diabetes or who is more than ten years past menopause wishing to start bioidentical hormone replacement therapy can benefit. Topical preparations can be used if one is concerned about coronary artery disease and early plaque formation.
Progesterone is the second predominant female hormone made by the ovary during ovulation throughout the reproductive years. At menopause, ovulation ceases and progesterone levels are almost undetectable. It is imperative to couple the use of natural progesterone with estrogen replacement for several important reasons.
It protects against breast cancer by competing with the stimulatory effect of estrogen on breast tissue. Natural progesterone blocks estrogen’s ability to stimulate the growth of the lining of the uterus (synthetic progesterone or Provera® will protect against uterine cancer but will not protect against breast cancer). In addition, Provera® is highly inflammatory and has been implicated as a major factor in triggering heart attacks and strokes. Bioidentical progesterone, derived from yams, is not only cardio protective, but is essential to prevent bone loss as well.
Natural progesterone achieves the highest level of protection when taken orally. In this form its main side effect can be put to good use: many women become sleepy so it can be taken at bedtime. Progesterone can also be taken under the tongue as a daytime treatment without making you drowsy and be highly absorbed. Many physicians advise applying progesterone to the skin, but it is hard to achieve optimal blood levels for protection against breast and uterine cancer using this route.
DHEA, or dehydroepiandrosterone, is one of the most abundant hormones in the human body. Made in the adrenal gland from cholesterol, it interplays with the formation of estrogen, progesterone and testosterone. Like most other hormones its production decreases with age. Studies demonstrate a direct correlation between longevity and elevated DHEA levels. Low levels of DHEA are associated with impairment of the immune system, insulin resistance with the potential for diabetes, and increased risk for heart disease and cancer. This has been borne out through hundreds of published scientific reports, while harmful side effects have not been seen.
Chronic stress affects cortisol levels and lowers DHEA levels, which increases the risk to your health. Cortisol release in times of acute stress is important for survival, but chronic stress and continuous release of cortisol leads to adrenal fatigue and increases the potential for illnesses.
DHEA supplementation can improve quality of life and diminishes the effects of aging, especially weakness and fatigue. It is well known to have a positive influence on sexual desire, arousal and enhances orgasm. Although it is available without a prescription and can be found in many health food stores, pharmacies, and supermarkets, its quality is uncertain. The half-life or effectiveness of over-the-counter preparations is only six hours, so it is important to use pharmaceutical grade DHEA, micronized for maximum absorption, and produced in a sustained release form for maximal 24 coverage. This formulation can only be obtained from a dedicated compounding pharmacy recommended by a physician.
Although most people associate testosterone with men, less well known is that women produce testosterone as well. It significantly improves libido, sexual desire, arousal, orgasm, and overall sexual performance at any age. Testosterone is produced in small but equal amounts in the ovaries and the adrenal glands and less so from conversion of other steroids in the body’s fat cells. It plays an extremely crucial role physiologically and psychologically in a woman’s life, from maintaining muscle mass, bone strength, supporting connective tissue and decreasing abdominal body fat. Testosterone has been shown in excellent scientific studies to decrease the adverse cardiovascular effects of aging and to reduce the risk for Alzheimer’s disease.
Like other hormones, testosterone production diminishes with age, along with its beneficial effects. Most women will actually lose about 8% of their muscle mass each decade starting from their 20s, paralleling the drop in testosterone. This leads to fatigue, diminished skeletal support and increased fracture risk from falling when you get older. Sexual desire is a very complex issue, effected not only by decreased testosterone but by general medical health, medications, the stress of rearing children, interpersonal relationships and financial pressure. In no way is testosterone supplementation the cure-all for lack of sexual interest or responsiveness. However, by returning testosterone to the levels that existed when you were twenty years old will have an incredible impact upon your sex life.
When natural testosterone is carefully administered, in small amounts and over time with close laboratory monitoring, adverse side effects are minimized. It takes time to become effective. Symptoms such as acne and very rarely hair growth can be prevented or minimized by starting at a low dose and gradually increasing over time.
Testosterone is usually made by a licensed compounding pharmacist under the direction of the prescribing physician, based upon your baseline hormone levels, sensitivity, genetic background or your previous experience with the medication. It is formulated as a cream and a very small amount is applied every evening to the large outer lips of the vagina, which is the site of greatest absorption. Each month blood levels of testosterone, along with estrogen, progesterone, DHEA and thyroid hormone are monitored until optimal levels are reached and you feel more energetic, younger and sexually responsive.
Thyroid hormone is one of the most critical hormones in the body and influences virtually every cell and organ system. You can think of it as the overall regulator or thermostat which affects virtually every bodily function. As with all hormones, aging results in a deficiency, or more accurately an insufficiency inactive thyroid hormone. This leads to well-known symptoms of hypothyroidism such as lethargy, fatigue, depression, lack of concentration, hair loss, skin dryness and nail changes, weight gain, cold intolerance, and constipation. In addition, there can be an elevation of triglycerides and cholesterol, with their implications for increased risk of heart disease.
Although production of thyroid hormone remains relatively stable during your lifetime, as you age the ability of your body’s cells to convert thyroid hormone to its active form, Free T3, diminishes. So there is really is no failure to make thyroid hormone, only the decreased ability of your body’s cells to convert it to the active form. Routine thyroid function blood testing does not usually measure the active hormone Free T3. This explains why men and women can have normal standard tests of thyroid function yet still be clinically hypothyroid.
But the matter gets even more interesting. Many people who are diagnosed as hypothyroid are prescribed synthetic thyroid hormone such as Synthroid®, Levothroid®. or Levoxyl®. However, this still fails to address the body’s decreased ability to convert the synthetic thyroid to the active form Free T3, which explains why so many people on replacement therapy still have symptoms of underactive thyroid. The matter is solved by either supplementing their prescriptions with T3, commercially known as Cytomel®, or by replacing their medications with natural thyroid hormone compounded by a pharmacist or sold under the brand names Armour Thyroid® or Nature-Throid®. These naturally derived compounds have the proper proportion of all forms of thyroid to provide the correct amount of hormone replacement to fully treat symptoms. Thyroid hormone activity is affected by many variables such as iodine, selenium, ferritin (iron reserve), cortisol and stress.
Like all natural hormone replacement therapies, thyroid function must be closely monitored with periodic laboratory testing and consultation until ideal symptom relief and blood levels have been achieved. This requires a fine orchestration of all hormone replacement to reach the correct balance to feel better, look better and reduce your risk for heart disease, cancer and many of the degenerative diseases discussed earlier.
Vitamin D, or cholecalciferol, is not a vitamin but actually a hormone. Medical professionals are only now discovering the many benefits of this substance, which is primarily acquired through sunlight and certain foodstuffs. Long known for facilitating the absorption and metabolism of calcium to maintain bone strength, researchers are learning Vitamin D plays an important role protecting the heart and in cancer prevention.
Maintaining mid to higher range levels of Vitamin D has been shown in many studies to decrease the risk of breast cancer in women. Comparable anti-cancer benefits remain to be seen with men, however, studies indicate a high degree of cardiovascular protection in both sexes.
When mid-range blood levels are maintained there are no adverse side effects, but too much Vitamin D can raise the serum levels of calcium. Like all other replacement hormones, Vitamin D therapy needs to be monitored.
Almost 80 percent of the population of the Northeast in the US is Vitamin D deficient. Their blood levels fall below the low end of the normal range. Furthermore, the use of sunscreen to prevent sunburn and skin cancer filters out much of the production of the natural hormone. The only foods that truly provide substantial natural replacement are cod liver oil and wild Alaskan salmon.
Virtually all other foodstuffs and food additives are woefully inadequate. Most people who live in this region require substantial supplementation in the form of gel caps or liquid ranging from 1000 units to 5000 units daily. In cases of severe deficiency, prescription doses of Vitamin D at 50,000 units once or even twice weekly are necessary to bring blood levels up to an ideal range.