Using Bioidentical Hormone Replacement Therapy for Hormonal Declines

Hormonal declines are inevitable and when it arrives at our doors, the symptoms can be mild to a staggering feeling of exhaustion, depression, and not belonging to one’s own skin any longer. Symptoms include weight gain, mood changes, hot flashes, insomnia, joint pain, no sex drive, brain fog, and low energy. The neurohormonal shifts begin a decline in bone loss (osteopenia/osteoporosis), cholesterol changes atherosclerosis (hardening of the arteries caused by buildup of plaque), cognitive decline (Alzheimer’s), collagen loss (skin elasticity, wrinkles), vaginal atrophy (painful sex), and cortisol/stress hormone fluctuations (weight gain especially around the waist).
 
Bioidentical Hormone Replacement Therapy (BHRT), which is FDA-approved (except when compounded — a custom formulation of medication to fit a unique need of a patient), has been shown in research to reduce rates of heart disease, osteoporosis, Alzheimer’s, and vaginal atrophy. On the other hand, risks may include blood clots, stroke, and Myocardial Infarction (heart attack). However, because there is no long-term data with bioidentical hormones, the risks are not known. The studies for these side effects come from Premarin® and Provera® (conjugated estrogens) which are not bioidentical and taken in oral form.
 
When I prescribe BHRT, I have them compounded and have them in patch, trouche (lozenges that dissolve slowing in the mouth), suppository or liquid form; they do not pass through the liver on its first phase of metabolism and where oral estrogen pass through the liver which is the reason the rate of blood clots increases. The oral birth control pill has the same risk due to the first pass in the liver.
 
When patients initially establish care with me, labs and DUTCH test are necessary to assess their baseline hormonal status. The timing for starting BHRT is paramount to make sure bone density is established as well as warding off other disease processes. Once BHRT are prescribed, I require a yearly DUTCH test and labs. To remain as an established patient, the minimum visits will be two times per year. Most patients on average see me three times per year. Appointments can be conveniently held via telemedicine.

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