Preparing for Hormone Replacement Therapy

When men and women are in their early twenties, their primary hormone levels of estrogen, testosterone, thyroid and DHEA are at their peak, and start to decline thereafter. This loss of hormone volume and activity results in loss of function over time and directly impacts the aging process, impacting a person’s cardiovascular health, cognition, and sexual vitality as well as opening the doors to heart disease, dementia, diabetes and degenerative disease.

Optimizing these hormone levels with natural, bioidentical hormones, restoring them to their original levels, which in many cases reverses the effects of aging, is the goal of therapy. Any individual looking to undergo such treatment should consult with a doctor to learn more about the potential of hormone replacement therapy.

Preparing for Treatment

At the initial consultation patients will be asked a variety of questions, including:

  • Why are they here?
  • What do they want to accomplish?
  • If they have had any previous experience with hormone replacement (natural or synthetic), and the outcome of that treatment

Individuals should also be prepared to give a detailed medical history, understand comprehensive laboratory testing will be done, and agree to a follow-up consultation where a doctor will review all lab tests and management of replacement therapy will be discussed.

Patients should bring any medical records, recent laboratory test results and a list of medications they are currently taking to an initial meeting with a doctor for hormone replacement therapy. An individual will need to state their experience, good or bad, how they were monitored, and how responsive their previous practitioner was to their calls. It is just as important to know what a patient did not take as it is to know what they did take.

Points to Note

Patients need to understand the rationale for hormone replacement therapy, as well as the scientific basis of using randomized controlled studies proving cause and effect and not simply association. That means recommendations are based on studies that show repeated solid outcomes and confirm that optimization, or maximizing hormone replacement will give the best result.

Patients also need to understand the difference between natural or bioidentical hormone replacement therapy and synthetic hormones. An individual should know not only the benefits but the potential side effects of therapy and how they can be avoided in order to be properly prepared for hormone replacement therapy.

KRONOS Study

The KRONOS Early Estrogen Study, known as the KEEPS study, used natural and synthetic estrogen in combination with natural progesterone to assess the risks and benefits of coronary artery disease by measuring plaque formation on the coronary arteries. Over four years, it did not show any change in coronary artery circulation to the untreated group.

The positive findings, however, were that blood pressures remained normal, there was an increase in the good cholesterol (HDL), a decrease in the bad cholesterol (LDL), and a backing off of the risk for developing diabetes and improved cognitive function. This was accomplished with oral estrogen, not topical estrogen. Long term benefits could not be assessed due to the short duration of the study.

Common Misconceptions

Many men and women considering hormone replacement therapy have been subject to long-term misconceptions, emanating from the poorly designed and executed Women’s Health Initiative (WHI) Study of 2002. That widely read and accepted study gave the public, medical media, and even medical professionals the impression that hormone replacement causes an increase in heart attacks, stroke, dementia and breast cancer. This is far from the truth.

With the use of bioidentical hormones, properly monitored, heart disease can be reduced by almost 50 percent, Alzheimer’s disease and vascular dementia 50 percent and 83 percent respectively, and no increase in incidence in breast cancer, and in some studies a signifying decrease. The incidence of prostate cancer can also be significantly reduced. There are many international well-constructed studies that validate these findings.

Benefits of an Experienced Doctor

A doctor who is fully committed to treating men and women for hormone replacement therapy needs to have the academic credentials, experience, and passion for motivating patients to take charge of their health proactively. That means they need to have a thorough knowledge of all aspects of replacement therapy such as the action and potential side effects of all medications, how to monitor their use with laboratory testing, and constantly upgrade their knowledge with evolving scientific evidence.

It takes a lot of time for a physician to consult and convey this to patients. It cannot be done in a practice that is part of a managed care system which can provide very limited therapy, i.e., unmonitored topical estrogen/progesterone treatment. The system simply does not allow for the time and energy needed for a comprehensive program to flourish. When preparing for your hormone replacement therapy, an experienced and thorough physician is necessary.