EVERYTHING ABOUT
HRT - Hormone Replacement Therapy
Every week I am posting about everything you need to know about hormones. This weeks topic is about HRT – Hormone Replacement Therapy
Did you know …
- Is the replacing or supporting of hormones that for one reason or another are not produced or not produced in adequate amounts.
- Insulin, Thyroid, Cortisol, Estrogen, Progesterone, Testosterone, are the most commonly replaced or supported hormones.
- The first hormone replacement therapy was administered in January 1922 to 14 years old Leonard Thompson, a boy dying from diabetes in a Toronto hospital, became the first person to receive an injection of insulin.
- Insulin from cattle and pigs was used for many years to treat diabetes and saved millions of lives, but it wasn’t perfect, as it caused allergic reactions in many patients.
- The first genetically engineered, synthetic “human” insulin was produced in 1978 using E. coli bacteria to produce the insulin.
- The first Estrogen replacement therapy was given in 1942 which was derived from a the urine of a pregnant mare – called Premarin.
- Divided in 2 groups.
- Essential for life or life threatening if deficient, such as Cortisol, Insulin and Thyroid.
- Nice for life or life ‘quality threatening if deficient, such as Estrogen, Testosterone and Progesterone.
- Essential for life hormones have been studied and used for many years.
- Nice for life hormones have gained more focus because we live longer.
- Today woman will typically live 30 more years after menopause.
- Just 100 years ago life expectancy was 50-55 today its 83-85 years.
- Nice for life hormones are not essential for life, but are essential for the quality of that life.
- Todays women and men are not content with merely existing we want to LIVE life to the fullest in every way.
- Nice for life hormone replacement therapy is poorly studied and therefore NO-ONE has the complete answer and advise from one medical professional to another is often very different maybe even opposing.
Meet Sally and get to know all about HRT
Intro
What does bioidentical mean
Common hormone deficiencies
Common Hormone Deficiencies needing Replacement or Support
Deficiency in the production of the following hormones are the most common in both men and women. Some can be life threatening others life ‘quality’ threatening.
Life Threatening Hormone Deficiencies
- Cortsiol
- Insulin
- T4 & T
Life ’Quality’ Threatening Hormone Deficiencies
- T4 & T3
- Estrogen
- Testosterone
- Progesterone
- DHEA
- Human growth Hormone.
What are Bio-identical or Body-identical Hormones?
- Hormones that are identical to human hormones.
- Are now the conventional and mainstream approach.
- They are synthetically made, ie from a man in a white coat in a lab, but are molecularly identical to the hormones made by the body.
- Insulin from cattle and pigs was used for many years to treat diabetes and saved millions of lives, but it wasn’t perfect, as it caused allergic reactions in many patients.
- The first genetically engineered, synthetic “human” insulin was produced in 1978 using E. coli bacteria to produce the insulin.
- Are not the same as contraceptive drugs or old-style hormone replacement therapy.
Cortisol Replacement Therapy
- Is produced in the adrenal glands
- Is a major catabolic hormone ie. breaks down protein like collagen to release glucose
- Maintains and regulates blood glucose, metabolism,
- Decreases inflammation and supresses the immune system.
- Most commonly referred to as the ‘stress hormone’.
- Production is increased during times of physical, mental and or emotional stress or crisis.
- Temporarily shuts down digestion and reproduction systems.
- Cortisol deficiency is a life threatening disease.
- Can result from
– autoimmune – Addison’s disease
– problems with the Pituitary gland
– prolonged periods of high Cortisol production aka chronic stress.
Symptoms of low cortisol
- Dizziness
- Fatigue
- Mood swings
- Muscle weakness
- Weight loss
- Faintness and dizziness, especially when rising quickly from laying or sitting
- Heart palpitations
- Emotional hypersensitivity
- Inability to cope with stress
- Social anxiety
- Headache
- General body ache
- Lower back pain
- Crave salty foods
- Anxiety and jitters
- Clumsiness and confusion, difficulty maintaining focus
- Low bladder capacity
- Symptoms of IBS – gut inflammation
- Chronic inflammation
- Irregular or non-existent menstrual period
- Often sad even depressed
- Dark circles and/or bags under your eyes
- Low blood sugar levels
- Exhausted but can’t sleep.
Cortisol Deficiency Disease will require Cortisol Replacement Therapy
How
- hydrocortisone injections or pills.
How much
- Hydrocortisone comes as 5mg – 20mg tablets 2 or 3 times a day.
Optimal serum levels
- Normal values depend on the time of day.
- Normal values for a samples taken at 8am – 5 to 25 mcg/dL or 140 to 690 nmol/L.
- Cortisol should be highest in the early am.
- Around 4 pm – 3 to 10 mcg/dL or 83 to 359 nmol/L.
Possible benefits
- you live.
Possible side effects
- feeling dizzy, weak or tired
- headaches
- muscle ache
- indigestion or feeling sick (nausea)
- diarrhoea
- swollen ankles
- increased risk of infection
- depressed
- feeling high
- feeling anxious
- moon face
- weight gain, belly and upper back
- bruise easily
- osteoporosis
- muscle loss – sarcopenia
- eyesight problems.
Insulin Replacement Therapy
- Is produced by the pancreas.
- Considered to be the main anabolic hormone of the body.
- Promotes the absorption of glucose from the blood into liver, fat and skeletal muscle cells.
- Glucose is then stored as glycogen or fats, or, in the case of the liver, into both.
- Type 1 Diabetes is a life threatening disease state where the pancreas does not produce Insulin.
- Can be caused by:
– Genetics
– Autoimmune
– Infection
- BTW – Type 2 Diabetes involves an over production of Insulin.
Symptoms of low insulin
- Very high blood sugar levels
- Dehydration
- Dizziness
- Fatigue
- Frequent urination
- Hunger
- Extreme hunger
- Increased thirst
- Increased need to urinate
- Large unplanned weight loss
- Irritated and mood swings
- Tired and weak
- Blurred vision
- Slow healing
- Frequent infections
- Pins and needles in hands and feet
Type 1 Diabetes will require Insulin replacement therapy as injections. Some health professionals prescribe Insulin for Type 2 Diabetes.
How
- Injections
- Syringe – most common – the syringe is used to draw insulin out of a bottle and then to inject it under the skin.
- Insulin pen – is like a preloaded syringe that can be used multiple times.
- Smart pens – called connected insulin pens (CIPs), can be programmed to calculate insulin doses and send data to your smartphone.
- Insulin jet injector – looks like a large pen which makes high-pressure air to “spray” the insulin through the skin
- External insulin pump – pumps insulin continuously through plastic tubing.
How much
- Work closely with your medical practitioner
- In general start with at 0.6 to 1.0 unit per kg
- 50% of the total daily insulin dose is given as basal
- 50% as bolus, divided up before breakfast, lunch, and dinner
Possible benefits
- You live
- Decreased the effects of symptoms of high blood sugar , such as fatigue and frequent need to urinate.
- Reduce the risk of developing diabetic complications.
- Decreased pressure on the pancreas to produce insulin.
Possible side effects
- Hypoglycemia – low blood sugar
- Headache
- Allergic reactions
- Flu-like symptoms
- Weight gain
- Hypokalemia – low potassium levels
- Lipoatrophy – loss of peripheral fat
- Itching
- Rash.
Hormones T4 & T3 Replacement Therapy
- T4 is produced by the thyroid
- T3 is produced in the liver (and other cells)
- Control metabolism
- T3 increases mitochondrial activity and ATP production ie. the burning of glucose and fats
- Hypothyroid can be life threatening, though more often life ‘quality’ threatening
- Can result from
- Autoimmune – Hashimoto’s
- Low iodine
- Low iron, Vitamin A, seleium, zinc, Vitamin D
- Infection
- Congenital
- Pregnancy
- Radiation
- Heavy metal poisoning
- Pituitary disorders
Symptoms of low T4 & T3
- TATT syndrome – tired all the time
- Weight increase
- Difficulties losing weight
- Cold and freezing all the time
- Cold hands, feet and buttocks
- Constipated
- Thinning hair
- Brittle hair and or nails
- Dry skin
- Myxedema a skin condition where the skin swells starting on the face under the eyes spreading to the jaw and rest of the body
- Muscle weakness
- Muscle and joint aches and pains
- Slow heart rate
- High cholesterol
- If you are a woman – Heavy, irregular menstrual cycles
- If you are a woman – Repeated spontaneous abortions
- Sad and or depressed
- Poor memory
- Poor concentration
T4 Deficiency Disease will require Thyroxine Replacement Therapy as pills.
T3 Deficiency Disease may require replacement therapy if the body doesn’t convert T4 to T3 efficiently.
How
- T4 – Thyroxine – Levothyroxine comes in oral forms.
- T4 comes in intravenous forms used in a hospital setting.
- T3 – Triiodothyronine – Liothyronine – Cytomel is the synthetic form of T3 comes in pill form.
- Some endocrinologists endorse the use of natural desiccated thyroid (NDT), dried pigs or cow thyroid gland that contain T3 and T4 and other thyroid gland proteins such as thyroglobulin.
How much
- L-thyroxine pills 50 – 200mcg taken once each day by mouth, at approximately the same time each day, ideally the first thing in the morning on an empty stomach.
- Avoid taking food within 1 hour and avoid calcium, iron sucralfate, aluminum-containing antacid, and multivitamins within 2 hours before or after the dose.
- If a dose is skipped, two doses may be taken the following day.
- Blood levels of TSH thyroid stimulating hormone and Free T4 should be checked annually and after approx. 4-6 weeks following any adjustment.
- Cytomel pills – 5 – 50mcg, start low.
- Desiccated thyroid – 15 120mg.
Optimal serum TSH, T4 and T3 levels
- TSH – 0.27 – 4.2 mU/L
- Free T4 – 12 – 22 pmol/L
- Free T3 – 1 – 6.8 pmol/L
- NB! – when testing hormones measuring the free hormone levels is important.
Possible benefits
- increase in energy levels
- stable weight
- increased sex drive
- better sleep
- decreased joint and muscle pain
- mood may improve.
Possible side effects
- chest pain
- shortness of breath
- palpitations
- increased heart rate
- anxiety
- increased nervousness
- flushing and sweating
- severe headaches
- vomiting
- diarrhoea
- weight loss
- abnormal menses
- disturbed sleep.
Estrogen Replacement Therapy
- Estrogen is one of the main female sex hormones.
- Responsible for the female physical changes during puberty.
- Regulating the menstrual cycle and enables pregnancy.
- Essential for optimal bone, joint, skin, vaginal, gut, cardiovascular and brain health.
- Men produce estrogen in smaller amounts essential for modulating libido, erectile function, and spermatogenesis.
- Estrogen deficiency is a life ‘quality’ threatening.
- Can be caused by:
– Menopause – surgical or natural
– Problems with the Pituitary gland and or hypothalalmus
– Ovarian cysts
– Eating disorders.
Symptoms of low estrogen
- Menopause, which is official after 1 year without a menstrual bleeding.
- Problems with memory.
- Loss of interest and passion.
- Suddenly sad for no reason.
- Can’t hold focus and concentration as before.
- Emotionally sensitive / fragile / tears come at the drop of a hat for the strangest of things / small breakdowns.
- Poor sleep – wake a lot during the night.
- Lack of reserve, more tired than usual.
- Breast tissue shrinking.
- Increased tummy fat.
- Suddenly high cholesterol.
- Problems with blood sugar regulation and insulin resistance.
- Reduced sensation in your vagina, sex not as pleasurable as before.
- Pain during intercourse.
- Low libido.
- Irregular periods, don’t come every 28 days / or as before.
- Light bleeds.
- Dryness in eyes, nose and mouth.
- Skin is dry.
- Vaginal dryness and thinning of the lining.
- Stiff, painful joints and muscles.
- Increased need to urinate, can’t hold yourself for longer periods at a time.
- Difficulty holding yourself when you sneeze, jump, etc.
- Frequent bladder infections.
- Osteoporosis or osteopenia.
- Hot flushes / flashes.
- Erectile dysfunction in men, even low libido.
Estrogen Deficiency can be supported with Estrogen Replacement Therapy
How
- preferably transdermal through gels, patches or sprays.
- also found as pills.
- NB! – Protecting the uterine wall with Progesterone replacement therapy is necessary.
How much
- Estradiol pills – 0.5 – 2 mg per day.
- Estradiol gels – 0.06 mg 1-2 per day – 0.5 – 1.25 grams of gel.
- Estradiol patches – delivers 0.025 to 0.1 mg per day.
- Estriol cream – 5ml of cream contains 0.5mg 1 per day, can also be used on face and neck wrinkles.
- Estriol pills – 1 mg per day.
Optimal serum levels
- Recent post menopause – 40‐60 pg/mL or 146 – 220 pmol/L or dried‐urine levels of ~ 1.8 ‐ 0ng/mg.
- Older post menopause – 20 to 40 pg/mL or 73 – 146 pmol/L or dried‐urine levels of 0.7 to ~ 1.3 to 1.5ng/mg.
Possible benefits
- Improved symptoms of menopause such as:
– hot flushes
– mood swings
– vaginal dryness
– joint pains
– dry skin
– sleeplessness
– irritable bladder symptoms
– brain fog
- Increased bone strength.
- Less risk of bladder infections.
- Less vaginal dryness.
- Better skin strength and hydration.
- Less belly fat.
- Increased libido.
- More mental and emotional reserve.
- Less risk of heart attack.
- Increases HDL. cholesterol (the good kind).
- Decreases LDL cholesterol (the bad kind).
- Relaxes, smooths and dilates blood vessels so blood flow increases.
- Decreased risk of osteoporosis and fractures.
- Decreased incidence of colon cancer.
- Possible decreased risk of Dementia and Alzheimer’s disease.
- Improves insulin sensitivity and thereby blood glucose levels and less risk of type 2 diabetes.
- Decreased mortality.
Possible side effects
- Bloating
- Breast tenderness or swelling
- Mood swings
- Vaginal bleeding (only if the uterus is not protected)
- Increased risk of endometrial cancer (only if the uterus is not protected)
- 5% increased risk of breast cancer (drinking, smoking, obesity and inactivity increase risk from 5 – 15%)
- Increased risk of blood clots and stroke, connected to non-bioidentical Estrogens.
Testosterone Replacement Therapy
- Testosterone is the main male sex hormone.
- Creates and supports the physical changes during puberty, such as deepening of the voice and growth of the genitals, hair and muscles.
- Helps regulate heart function and cardiovascular health, plays a role in sperm production, bone health, energy levels, concentration, and muscle mass.
- Woman also produce testosterone important for bone health and reproductive tissue.
- Testosterone converts to Estrogen.
- Testosterone deficiency is not life threatening, but will decrease life quality
- Can be caused by:
– aging
– thyroid problems
– injury to testicles
– testicular cancer
– infection
– HIV
– type 2 diabetes
– side effects of medications
– genetic abnormalities that affect the testicles
– pituitary gland problems and or hypothalamus problems.
Symptoms of low testosterone
- Low sex drive / libido.
- Erectile dysfunction.
- Low sperm count.
- Difficulties building muscle mass.
- Loss of muscle mass, poor muscle definition and strength.
- Easily stressed.
- Osteoporosis or low bone mass.
- Increased fat accumulation especially around the middle and or hips.
- Man boobs.
- Loss of body hair.
- More tired and out of sorts.
- Lower self-esteem.
- Low motivation.
- Poor decision-making and procrastination.
- Less of a risk taker, more cautious than before.
- Mood swings.
- More ’grumpy’ than before.
Low Testosterone is not life threatening but can be dangerous and may be necessary for improving quality of life.
How
- skin patches
- gels
- intramuscular injections,
- tablets that dissolve in the mouth
- surgically implanted pellets that release the hormone.
How much
- 50–400 mg injected into your muscle every 2–4 weeks.
- Start dose 50 mg gel/patch applied topically once daily in the morning.
Optimal serum Testosterone levels
- Between 500 – 800 ng/dl or 17 to 27 nmol/L are considered optimal.
Possible benefits
- Increase bone density.
- Rearrange fat distribution.
- Increase insulin sensitivity.
- Increase muscle strength and mass.
- Increase facial and body hair.
- Increase red blood cell production.
- Increase sex drive.
- Increase quality of erections.
- Promote sperm production.
- Increase energy and mood.
Possible side effects (especially with excess)
- increased acne.
- fluid retention.
- increased urination.
- breast enlargement.
- prostate enlargement.
- decreased testicular size.
- decreased sperm count.
- increased aggressive behaviours.
- increased red blood cell production, which could contribute to the increased risk of forming a blood clot.
- may worsen sleep apnea in older people.
- not advised for men with prostate or men and women with breast cancer.
Progesterone Replacement Therapy
- Generally thought of as a female hormone, which is incorrect.
- Produced in the corpus luteum after ovulation in women and in the Adrenal glands in both men and women.
- Crucial in pregnancy – pro-gest-ation.
- Controls the effects of Estrogen in various tissue, such as uterine wall and breast tissue.
- Important for bone health.
- Influences spermiogenesis in men and a process called acrosome reaction which is the penetration of the egg to enable fertilisation.
- Precursor to Aldosterone, Cortisol and Androgen hormones and thereby Testosterone in both men and women.
- Progesterone deficiency is life ‘quality’ threatening.
- Can be caused by:
– abnormal hormonal fluctuations in the menstrual cycle
– menopause
– polycystic ovary syndrome – PCOS
– thyroid problems
– prolactin disorder
– pituitary problems and or hypothalamus.
Symptoms of low progesterone
- Swollen, painful breasts, possibly cystic in the last half of the cycle.
- Problems with cysts, ovarian and breast.
- Over active / excess growth of the endometrium (lining of the uterus).
- Spotting in the last half of the cycle or days up to your menstrual bleed.
- Heavy/prolonged menstruation.
- Short menstrual cycle, 19 – 25 days.
- Fertility problems, such as spontaneous abortion in the first trimester.
- Fluid retention / weight increase especially in the days before your menstrual bleed.
- Oedema / fluid retention especially ankles and tummy.
- Sleeping difficulties especially falling asleep / getting to sleep again if waking in the night.
- More tense, anxious, nervous, worried than usual.
- Osteoporosis / osteopenia / low bone mass.
- Hot flashes.
- Hair loss or thinning.
- Over active immune reactions, allergies, autoimmune diseases, etc.
- Headaches /migraine.
- Poor sperm health.
Low Progesterone is not life threatening but Progesterone replacement therapy may be necessary for improving quality of life.
Maybe be considered essential for fertility complications and Estrogen dominant disease states, such as Endometriosis
How
- Micronized progesterone pills – Prometrium or Utrogestan or Progefik.
- Micronized progesterone creams or gels.
- NB! The Mirena coils does not contain Progesterone, it contains Levonorgestrel a progestin which is not bio-identical with Progesterone.
How much
- 200mg progesterone pills for 12 days in the cycle during the fertile years.
- 100mg progesterone pills if used continuously after menopause.
- Vaginal gel – sustained release Crinone Vaginal Gel in 4% or 8% concentration – 45 mg – daily or 2 x weekly may be enough to prevent activation of the uterine wall.
- Creams of 25 mg/mL per day may be enough to manage hot flashes.
- Creams of 75 mg/mL may lead to the same progesterone levels as taking a 150 mg or 200 mg oral dose.
Optimal serum Testosterone levels
- Difficult to evaluate as serum levels don’t reflect actual uterine tissue concentrations.
- No bleeding is the goal when using progesterone replacement therapy post menopause.
Possible benefits
- Eases anxiety.
- Promotes memory.
- Helps to prevent overgrowth of certain types of cells, which can help protect against some cancers including those of the breast or the uterus.
- Helps to prevent overgrowth of cells of the endometrial lining and prevent endometriosis from forming.
- Helps prevent fibrocystic disease and ovarian cysts.
- Helps with symptoms of PMS..
- Increases ability to handle stress.
- Helps the metabolism by contributing to the use of fat for energy.
- Assists in preventing plaque from forming on arterial walls.
- Helps to lower triglycerides.
- Essential for bone growth.
- Assists in the proper function of the thyroid gland.
- Can help to slow down the aging process.
- Improves insomnia.
- Improves libido.
- Reduces or eliminates migraines.
- Reduces inflammation and joint pain.
- Regulate menstrual cycles.
- Reduce hot flashes.
- Reduce weight gain.
Possible side effects
- Increased sleepiness.
- Increased anxiousness.
- Mood swings.
- Depression.
- Breast tenderness.
- Headaches or migraines.
- Acne.
- Abdominal pain.
- Back pain.
- Vaginal bleeding.
- NB! most progesterone side effects relate to progestins which are non-bioidentical.
DHEA Replacement Therapy
- Is one of the most abundant circulating steroids in humans.
- Is produced in the adrenal glands, the gonads, and the brain.
- It plays an important role in mood, immune function, alertness, is an anti-inflammatory and antioxidant.
- Is the precursor to other Androgen hormones and Estrogen, though in its self is not very bioactive.
- Is a neuro-steroid.
- Converts to DHEA-S, the sulphated version.
- Levels of DHEA-S in circulation are approximately 250 to 300 times those of DHEA.
- DHEA-S is hormonally inert but important as a neuro-steroid.
- Low levels can indicate chronic inflammation.
- In older men, having low levels of DHEA is also associated with an increased mortality.
- DHEA deficiency is life quality threatening associated with aging and a number of diseases, such as anorexia, type 2 diabetes, and HIV.
- Can be caused by
– aging.
– adrenal insufficiency.
– Addison disease.
– problems with the pituitary gland and or hypothalamus.
– use of glucocorticoid medicines.
– prolonged physical, mental and or emotional stress.
Symptoms of low DHEA
- Tiredness
- Decreased immune defence
- Frequent infections and colds
- Heart problems
- High blood sugar
- Low libido
- Depressed
- Anxiousness
- Reduced muscle tone / strength
- Dry skin and eyes
- Reduced hair under the arms and pubic areas
- Increased inflammation
- Joint pain.
Low DHEA is in general not life threatening but life quality threatening.
How
- tablets
- sublingual tablets
- creams
How much
- 25 and 200mg a day
Optimal serum DHEA-S levels
- Women – 275 – 400 ug/dL.
- Men – 350 – 500 ug/dL.
Possible benefits
- improve depression and other psychological conditions.
- improve obesity.
- improve adrenal insufficiency.
- improve skin hydration and firmness (in older people).
- improve osteoporosis.
- improve vaginal atrophy.
- improve erectile function.
Possible side effects
- Oily skin and acne, as well as skin thickening.
- Hair loss.
- Stomach upset.
- High blood pressure.
- Changes in menstrual cycle.
- Facial hair in women.
- Deepening of the voice in women.
- Fatigue.
- Nasal congestion.
- Headache.
- Rapid or irregular heart beat.
- Insomnia.
- Changes in cholesterol levels.
Growth Hormone Replacement Therapy
- Produced in the anterior pituitary gland.
- Stimulates growth.
- Cell reproduction.
- Cell regeneration.
- Essential for growth.
- Stimulates production of IGF-1.
- Increases the concentration of glucose and free fatty acids.
- Increases the conversion of T4 to T3.
- Regulates bone formation.
- Growth hormone deficiency is not considered life threatening in adults, but is essential for growth in children approx. 16 -18 years.
- Can be caused by:
– Pituitary problems
– aging.
Symptoms of low Growth Hormone (in adults)
- Anxiety and/or depression.
- Baldness (in men)
- Decrease in sexual function and interest.
- Decreased muscle mass and strength.
- Difficult to concentration and lack of memory.
- Dry, thin skin.
- Elevated triglyceride levels.
- Fatigue and/or tiredness
- Heart problems
- High levels of LDL (the “bad”) cholesterol.
- Insulin resistance.
- Lower tolerance to exercise.
- Reduced bone density.
- Sensitivity to heat and cold.
- Very low energy levels.
- Weight gain, especially around the waist.
Low growth hormone is in general not life threatening but if untreated increases mortality and may be life quality threatening.
Low or growth hormone deficiency in children can be dangerous.
How
- injections.
How much
- Long acting growth hormone (LAGH) analogues are now available for treating growth hormone deficiency both in children and adults – once weekly injections.
- Conventional growth hormone – daily injections.
Optimal serum growth hormone levels in adults
- Men – above 5 ng/mL or 226 pmol/L.
- Women – above 10 ng/mL or 452 pmol/L.
Possible benefits
- Increase exercise capacity.
- Increase bone density.
- Increase muscle mass.
- Decrease body fat.
Possible side effects
- fluid retention, with peripheral oedema,
- arthralgias – joint stiffness.
- carpal tunnel syndrome.
- paresthesias – burning or prickling sensation.
- impaired glucose tolerance – higher blood sugar levels.
Questions? Please don't hesitate to contact me
