There is much confusion about hormone therapy in the media and a lot of this comes from the definitions that have been used and what exactly do these terms mean. BHRT is short for Bioidentical Hormone Replacement Therapy and HRT is short for Hormone Replacement Therapy. Their definitions and the connotations of their meanings vary, so I would like to describe these to clear the air.
BHRT essentially means hormone therapy that uses hormones identical to those hormones present in the human body, in amounts representative of those seen in humans. These include hormones such as estradiol, estrone, estriol, progesterone, testosterone, DHEA, and others. The molecular structure of the hormones used in BHRT are identical to the structures of these hormones, and therefore are considered “natural” hormones.
Unfortunately, BHRT has received a bad rap from some people, including many physicians, lay-people, those in the FDA, and many others. Many just remember the older articles that suggest an increased risk of breast cancer and strokes are associated with hormone therapy, but just don’t take the time to really read and evaluate the current literature that actually suggests the opposite when given correctly.
In addition, many physicians who use BHRT really don’t understand it well either. For instance, most of the studies suggesting health-improving benefits of hormone therapy have utilized estradiol. When used over time, estradiol (and estrone) have been shown to decrease your risk of developing heart disease, Alzheimer’s disease and osteoporosis, while estriol has not. Many doctors still use estriol, but there is little evidence that it’s use does what using estradiol does. In fact, using estriol instead of estradiol does not confer these preventive benefits, so why use it when you can use the good stuff estradiol?
The FDA has suggested that when women need hormone therapy, they should receive the smallest dose for the least amount of time. However, those who use BHRT have a different philosophy. The FDA’s rationale is based on HRT, which they say should be limited as we discuss below. However, because hormone therapy, when performed correctly as in BHRT, can give many protective benefits to the body, why would you want to limit it’s use when it is so beneficial?
HRT has several definitions depending on who is using it, and this is another very confusing problem. HRT is typically associated with traditional hormone replacement therapy that has been used for years. This usually includes us of an estrogen, such as estradiol or Premarin (estrogens from horse’s urine), with or without a progestin added (usually medroxyprogesterone).
In 2002, the WHI study came out and created a mass of confusion regarding HRT. The WHI study is discussed in another blog article. Essentially, it stated there was an increased risk of breast cancer, but only in those women who took the combination of estrogen (Premarin) and a synthetic progestin (medroxyprogesterone). Plus, they said they had no benefits to decrease heart disease. They did state that, in the estrogen only group, there was no increased risk of breast cancer.
Another bad press was that those who took the hormones in either group had a higher risk of developing strokes. However, the only preparations used were pills that were taken orally. We know now that oral ingestion of estrogen goes through the liver once absorbed. In the liver the estrogen stimulates the production of clotting factors. Thus, with increased clotting factors, you get an increased risk of clots and increase in stroke occurrence.
Unfortunately, these problems gave HRT a bad connotation, so many women don’t want to use them. However, HRT really includes two methods of hormone administration: 1) only using estrogen in some form, and usually orally, and 2) use of the synthetic progestin with the estrogen. The confusion is that many think of both these methods into one group: HRT, which has caused even more confusion.
Hormone Pellet Therapy
We know now two things: 1) If you use natural progesterone and estrogen (estradiol), or only use estrogen, there is no increased risk of breast cancer, and 2) if you use the transdermal route of administration of the hormones, i.e. through the skin, there is no increased production of clotting factors by the liver and no increased risk of stroke.
Consequently, the idea of BHRT came about, because it just used the natural hormones and not the synthetic ones, and it was administered transdermally. In addition, the idea of giving each woman a different individualized dose of hormones also developed with BHRT, yet the FDA stuck with the same concept as before the WHI that women should take the same dose, i.e. the least amount for the shortest period of time.
In summary, HRT can mean different therapies. If HRT is estrogen combined with a synthetic progestogen, it may increase the risk of breast cancer and does not confer benefits of heart disease reduction. If HRT means estrogen alone, it is safe and can decrease heart disease and other benefits or hormone therapy as follows.
Health benefits of Hormone Therapy
Hormone therapy, when given correctly, can provide many health benefits to a woman when given over time. These include reductions in the risk of developing heart disease and Alzheimer’s disease if used for over 10 years. However, using them for less than this time may not confer these benefits right away.
There has been confusion here too, for many studies state that hormone therapy does not provide these benefits, that there is no reduction in the risk of developing these chronic medical conditions. However, these studies were not studies that went for over 10 years. Many only went 5 years or even less, including the WHI study. You may not see a decrease in chronic medical problems that quickly.
Hormone therapy is preventive for the chronic medical issues noted above and others, but you must use it consistently way before you develop them. The studies suggest use of them for greater than ten years to see these benefits. However, clinically, when women use them, they feel so much better that it is not difficult for them to start taking them early for their symptoms, and then continue the therapy for years. This will allow them to embrace these beneficial effects, long term.
Hormone Therapy Improves Quality of Life
Not only does BHT and HRT provide healthy benefits, they also help decrease many symptoms that occur as you age. In both men and women, hormones of estrogen and testosterone decrease every decade of life. When you’re young you have high levels, but they go down as we age.
In men, when the testes stop producing adequate testosterone it is called Andropause. In a woman, when the ovaries stop producing them at all, it is called Menopause. Both men and women can have multiple symptoms from the fall in hormone therapy.
Do you think you may have a hormone deficiency? Do you suffer from low energy and fatigue, low sex drive, mood changes, loss of motivation, weight gain, foggy brain, or insomnia? If you’re a woman, do you have hot flashes or cold sweats? If a man, do you have erectile dysfunction or performance issues? All these can be symptoms suggesting you have a hormonal deficiency. Both women and men can experience these symptoms that can be very debilitating and can ruin your quality of life.
All these symptoms can be relieved with hormone therapy. At TrueMD, we prefer using hormone pellet therapy because we believe it is the safest method, it relieves symptoms the best, and it is best at giving you a better quality of life.
If you’re interested in getting started on using hormone pellet therapy, call and make a consult today at TrueMD. It may be the best action you take for improving your health. Remember, health is a decision you make every day.